Background: Prescriber plays a vital role of choosing the drug and its brand for the patient which affects the patient in terms of safety, efficacy as well as the cost. In India, the infectious diseases form the major burden. Fluoroquinolones are one of the most prescribed antibiotics which provide therapeutic cure. The study aimed to see the cost variation of oral fluoroquinolones available in India. Methods: The costs of a particular oral fluouroquinolones were obtained from CIMS and Drug Today for the same strength and dosage. Results: Of 25 drugs used as single drug therapy Levofoxacin (500 mg) showed highest price variation of 14526.87 % and only 6 had less than 100 % variation. Of the 10 types of combinations are available with 12 types of dosage forms. Maximum cost variation (390.63%) was seen with ofloxacin and ornidazole (200+500) combination. Conclusion: There is a wide cost variation among oral fluoroquinolones which adds to the dilemma for the prescribing physician. There is a need to include pharmaco-economics in medical curriculum for sensitizing the doctors about cost of prescriptions and need for regulatory authorities to initiate measures to bring regularities in cost and monitor it.

A previously healthy 12-year-old boy presented with abdominal pain and clinical and laboratory features highly suggestive of diabetic ketoacidosis. When his blood glucose plummeted and his urinary ketones disappeared within the first hour of insulin therapy, while his abdominal pain, acidosis and hemodynamic status failed to improve despite vigorous fluid resuscitation, the diagnosis of diabetic ketoacidosis was questioned. At laparotomy, gangrenous, hugely dilated large bowel was found, requiring a subtotal colectomy from the cecum to the sigmoid colon; leaving the patient with an ileostomy. The child survived a complicated postoperative course and is currently doing well.

Present study was carried out on adult Swiss albino mice of both sex, consisting of six groups with six mice in each group to find out additive analgesic effect of Hydro-alcoholic extract of Ginger with Paracetamol and also to find out additive analgesic effect of Hydro-alcoholic extract of Ginger with Ibuprofen by hot plate and tail flick methods. These six groups were, Groups-A paracetamol, group-B was Ibuprofen, group-C was distilled water, group-D (Hydro-alcoholic extract of Ginger, group-E (Paracetamol + Hydro-alcoholic extract of Ginger), and group-F (Ibuprofen + Hydro-alcoholic extract of Ginger). We find that Paracetamol, ibuprofen has analgesic effect of their own on mice but we did not find any significant analgesic effect of Ginger on mice in singly or additive analgesic effect in combination with ibuprofen or paracetamol. So, we may conclude that Ginger has no additive analgesic effect and no analgesic effect on single use also.

Introduction: Chronic kidney disease (CKD) is one of the most common non communicable diseases throughout the world. According to the data of Bangladesh Renal Registry almost twenty millions of Bangladeshi adults are suffering from various stages of CKD. Many of these CKD patients ultimately developed ESRD when life is not sustainable unless renal replacement therapy is initiated. Objective: The purpose of the present study was to estimate the rates of infections and clinical and microbiological evaluation of bloodstream infections in patients undergoing maintenance hemodialysis. Methods: This cross sectional study was conducted from January 2014 to December 2015 for a period of 2(two) years in the Department of Nephrology at Bangabandhu Sheikh Mujib Medical University, Dhaka. All adult patients underwent hemodialysis of both sexes fulfilling the inclusion and exclusion criteria were included in the study. Then each patient was evaluated during each hemodialysis session for the (1) presence of bloodstream infection (BSI) using CDC (Centre for disease control) case definitions by blood cultures (Two samples were sent for cultures one from peripheral veins and another from vascular access either from fistula or from central venous catheter) and (2) clinical features. Result: The mean age of the patients were 38.26 (15.26) years. In this present study male (71.7%) are predominant than female (28.3%). Maximum (51.7%) patients were under weight. In this study 50 (83.3%) patients had anemia. Mean (SD) WBC, Hb, S. uric acid, FPG, Plasma glucose 2h ABF, HbA1C, S. total protein and S. albumin were 14415 (4000) count/cmm, 9.61 (1.62) g/dl, 417.67 (100.87) µmol/l, 5.37 (1.18) mmol/l, 7.27 (2.18) mmol/l, 6.42 % (0.68), 62.71 (5.82) g/l and 28.97 (4.99) g/l respectively. Out of 46 AV fistula cases, culture was positive in vein 8 (13.3%) cases and in fistula 5 (10.8%) cases. Out of 11 permanent CV catheter cases, culture was positive in vein 6 (54.5%) cases and in catheter

Neural tube defects (NTDs) are general complex congenital malformations consequential from failure of the neural tube closure during embryogenesis. It is recognized that folic acid supplementation decreases the predominance of NTDs, which has led to national public health policies regarding folic acid. To build your healthful pregnancy the choice diet includes a variety of nutrient-packed foods from the following groups: Fruits, Vegetables, Dairy foods, Protein, Whole grains etc. The present review focus on the some of the folic acid rich supplement food which helps to healthful pregnancy and lower the risk of congenital birth defect (NTDs).

To study the role of the obstetric risk factors for low birth weight and preterm birth. A case-control study was carried out in 2017 at the University Hospital – Pleven; 1212 women in childbirth and 1212 live-born babies after single pregnancies were included in the study. The live-born infants were divided into two groups. The cases included the preterm low-birth-weight (PLBW) newborns weighing less than 2500 grams (g). The controls included full-term newborns with normal birth weight (FTNBW). The role of 8 obstetric risk factors (RFs) on PLBW was studied (maternal age, type of birth, amniotic fluid deficiency and congenital abnormalities, maternal pelvic size abnormalities, placental abnormalities, abnormalities of fetal membranes, umbilical cord abnormalities, and presentation of the fetus). The obstetric RFs were significantly associated with PLBW. Risk of PLBW is significantly higher (p=0.001) in breech presentation (exp (β)=6.622), placental abnormalities (exp (β)=5.556), maternal pelvic size abnormalities (exp (β)=4.426) and amniotic fluid deficiency and congenital abnormalities (exp (β)=2.903). The results of that study can be useful for effecting prevention programing of pregnancy and prematurity.

Sixty six (64) Sprague- dawley rats (average weight 150 - 240 g) of each sex were used for the experiment. The animals were acclimatized, maintained and housed in laboratory for 28 days. At the end of the study animals were anesthetized and were sacrificed by cervical decapitation. Blood was collected via cardiac puncture and studied for White blood cells (WBC), Red blood cells (RBC), Haemoglobin (HGB), Hematocrite (HCT), and Platelets (PLT) by Using Operon hematology analyzer. In the present study, hematological findings among the treated and control groups of rats, we found that the hematological parameters were disturbs on the treatment of anti -TB drugs ETH and PAS. Whereas we observed that after administration of seed extract of Piper nigrum independently or in combination with the anti -TB drugs, the hematological parameters were improved towards normalization.

The objective of present investigation is to prepare and optimize an oral floating alginate gel beads of Diclofenac sodium using sodium alginate and oils was utilized as a dispersed phase to generate a uniform emulsion to create multiple tiny chambers in the alginate matrix for better buoyancy. Diclofenac sodium loaded beads were prepared by emulsion gelatin method. In this method pre gelation liquid of sodium alginate solution (2-4% w/v) was prepared. Oil (Light liquid paraffin, coconut oil, and olive oil) in the concentration (10%, 20% and 30%, was then added to the polymer solution. From the results formulation F3 was chosen as the most optimized formulation as it possessed all the required physicochemical characters and sustained drug release. The in vitro release data fitted with higher values in matrix model and the release was found to be Non- Fickian diffusion (anomalous transport) as the n value is in between 0.5 to 1. Entrapment efficiency and drug release of optimized batch FL3 were found to be 78.22% and 92.63% respectively. Drug absorption from the gastrointestinal tract is highly variable process and prolonging gastric retention of the dosage form is a challenging task. Under such circumstances, floating drug delivery system proves to be promising approach for gastric retention. The optimization of floating, drug entrapment efficiency and drug release behavior of Diclofenac beads was done by applying design expert

Objective: The objective of the study was to formulate a mouth fast dissolving tablets of Aceclofenac and its invitro evaluation. Materials and methods: Aceclofenac mouth dissolving tablets were prepared by direct compression method. Three batches were prepared. The tablets were evaluated by hardness, friability, disintegration test, wetting test and in-vitro dissolution method. Results: The granules were evaluated by determining the angle of repose (24.58±0.602° to 30.29±0.327), bulk density, tapped density, Hausner ratio, and Carr’s index. The prepared Aceclofenac tablets were subjected to measurement of hardness (4.2 ±0.08, 4.5 ±0.06 and 5.5 ±0.05 kg/cm2 respectively), friability (0.88±0.02, 0.67±0.08, and 0.55±0.07 % respectively), disintegration, wetting and invitro release study. All parameters were satisfactory within limit. Conclusion: So, it is concluded that the F3 batch is better than another batch. The release pattern is depending upon the amount of Sodium starch glycolate added. Though long-term stability study is required for future development of these formulations.

Background: Inguinal hernia is the most common surgical disorder occurring in young as well as elder males worldwide. Management wise there are many surgeries available in both tissue-based hernia repair as well as commonly practised prolene mesh inguinal hernia repair. New technique has developed, desarda hernia repair, is the tissue-based hernia repair in which, an un-detached strip of external oblique aponeurosis is used to repair the posterior wall of inguinal canal. This study compares the outcome of both desarda repair and lictenstein mesh hernia repair. Methods: Hospital based interventional study included 100 patients diagnosed with inguinal hernia and were divided into two groups, D (50 patients) for desarda technique and L (50 patients) for lictenstein repair. Outcomes measured were post operative complications as seroma, hematoma, orchitis, early and late postoperative pain, chronic pain and last was the recurrence. Hospital stay was also taken into consideration and follow up was done on day 7, 1 month, 6 months and 1 year after surgery. Results: During follow up, 10 patients suffered from chronic pain in lictenstein group compared to 5 patients in desarda group which was not significant (p = O.262). 1 Recurrence was seen both groups (p = 1). Seroma was seen in 2 patients in desarda and nil in L group whereas hematoma was seen more in L group. Conclusion: Results were comparable in both the groups, desarda being a new technique can be used in young patients to avoid complications most probably seen in mesh hernia repair.

Background: Hypertensive disorders in pregnancy is one of the major causes of maternal and neonatal morbidity, mortality, premature birth, intrauterine growth retardation (IUGR), and low birth weight and solely maternal mortality is account for 10-15% of maternal deaths in developing countries. Each year, an estimated 2.9 million babies die during the neonatal period and 2.6 million babies are stillborn around the world due to presence of PIH in pregnancy. According to WHO 2018, the rate of stillbirth is 21.9 per 1000 births in women with a pregnancy induced hypertension (PIH). The objectives of the study is to estimate the prevalence of pregnancy induced hypertension during pregnancy in a selected rural health center in Bangladesh. Methods & Materials: A descriptive cross sectional study was carried out and a semi-structured questionnaire was used to capture demographic data, obstetric history and on PIH status. The study was conducted from June 2019 to November, 2019. The 80 pregnant women with on or above 20 weeks of gestation admitted in the Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh or who sought outdoor service were enrolled in the study through purposive sampling technique who met the inclusion criteria. Data on PIH was extracted based on hypertension with on or above systolic and diastolic blood pressure140 mmHg and 90 mmHg respectively and presence of anemia, oedema, vertigo, sudden weight gain, insomnia and oliguria throughclinical examination and measuring blood pressure (BP) using predesigned and pretested questionnaire. Results: The mean age of the women was found to have24.72 (±SD). The prevalence of Pregnancy Induced Hypertension (PIH) was found 7/80×100 = 8.75%. More than 57% of PIH was mild, followed by around 29% and 14% of PIH were moderate and severe respectively. History of hypertension, LUCS (The lower uterine segment cesarean section), abortion and stillbirth were found 5 (6.25%), 17 (21.25%), 21 (26.25%) and 13 (16.25%)

Colloid cyst at third ventricle is a common entity noted in the neurosurgical practice. Presentation ranges from an incidental presentation to patient presenting with comatosed state with sudden acute hydrocephalus. Careful planning either to observe or operate is taken. Surgery ranges from keyhole endoscopic excision to microsurgical excision. Outcome is good if treated appropriately.

Background: Tibial shaft fractures were common occurrence due to road traffic accident, most casualty affecting the active working people, male were more affected than female. Treatment of diaphyseal fractures were treated by close reduction and internal fixation with interlocking intramedullary nail showed in many study with excellent results. Objective: To evaluate and analyze the results and outcome of tibial shaft fractures by interlocking intramedullary nail. Methods: This prospective observational study (case series) was conducted in the department of orthopaedic and traumatology department, Dhaka Medical College and Hospital and NITOR from January 2011 to December 2012. This study included both sexes and age between 18 years to 55 years and 30 patients were included in this study. As per inclusion and exclusion criteria all stable or non-displaced unstable or displaced and Gustilo type-1 fractures of proximal, middle and distal third fractures were included in this study .Diagnosis of the tibial diaphyseal fracture was made by history, clinical examination & radiological evidence. Results: A total number of 30 patients were treated and followed up in this study. Among 30 patients 21 (70%) were male and 9 (30%) were female, mean age was 31.8 years with a range of 18 years to 55 years median was 32.5 years mode was 34 years and SD was 2.1. in the study mode of injury distribution was 21 (70%) RTA, 6 (20%) fall from height and 3 (10%) assault. In this study severity injury 46.7% are stable 33% are unstable and 23.3% was Gustilo-1 , distribution of level of fracture was middle third 57% distill third 29% and proximal third 17% , injury surgery interval average 11.5 days (60%) in 18 cases and 5 days (40%) in 12 cases. Partial weight bearing given at 2 weeks & full weight bearing at 6 weeks and union occurred in average 18.5 weeks. In rating of final outcome 24 cases (80%) were excellent, 3 cases (9%) were good, 2 cases (7%) were fair and 1 case.......

Background: Hypothyroidism is one of the major endocrine diseases involving various organs including musculoskeletal systems. Musculoskeletal involvement has led to varying degree of morbidity. The mechanism of musculoskeletal involvement is probably auto-immune related. Methods: This was a prospective study of the patients with diagnosis of hypothyroidism referred from the endocrine clinic with various musculoskeletal complaints. The duration of the study was one year (July 2018-June 2019). All the patients with hypothyroidism with musculoskeletal complaints were included. Excluded were patients with other endocrine and infectious diseases. Results: Eight hundred and fourty rheumatology patients were seen over the study period. Females constituted 72.6%. One hundred and twenty-six hypothyroid patients were seen during the period comprising 112 (88.9% females and 14 (11.1%) males. The mean age of patients was 44 ± 8 years. Most patients (90.3%) presented at the rheumatology clinic after the third year of diagnosis of hypothyroidism. Generalized body pain was the leading non-articular disease, while myopathy ranked first among muscle and articular disorders. Normocytic normochromic anaemia, abnormal lipid profile and elevated creatine phosphokinase (CPK) enzyme were the predominant laboratory abnormalities. Conclusion: Due to overlapping of symptoms of hypothyroidism over those of systemic auto-immune diseases, it is therefore important to perform thyroid function test in patients presenting with musculoskeletal complaints.

Background: Caffeine is an alkaloid occurring naturally in plants. It is a widely consumed food/drug constituent and has well-documented benefits like improvement in mental alertness, concentration, fatigue and athletic performance. The primary objective of this study explores the behavior and attitude of Saudi people in Northern Border Area regarding caffeine intake. The secondary objectives of the study are to determine the mostly used caffeinated products, the frequency of caffeine use and the study group background about drug interaction with caffeine. Methods: Descriptive cross-sectional design was used to carry out this study from December 2015 to March 2016. The study was conducted in different areas in Northern Border region. The sample comprised of 454 Saudi persons aged between 15 and 60 years. Data was collected through a structured paper questionnaire, mentioning the purpose of the study after taking oral consent. Statistical analysis was done by utilizing MS EXCEL program functions. Results: The males represented more than half (57%) of the study group. Participants with university education represented 48.5% and secondary education represented 42% of study population. Only 11% of this study participants informed about having chronic diseases. Coffee is the most preferred drink containing caffeine (51%), followed by carbonated soft drink (22.5%). 26% began consumption at age group of 8 to 16 years and 28% began at age group of 16 to 18 years. 39% of participants have no certain cause for caffeine consumption. 31% of study group drink one cup/bottle per day, while 25% of study group drink two cups/bottles per day. 28% participants experience some symptoms when quitting or delaying caffeine drink mainly headaches (18.1%). 56% participants use more than one type of caffeine. The cost is not a significant factor in caffeine product choice (77%). 69% of participants reported that their friends have no effect on the choice for caffeine type. .................

Systemic delivery of drugs through nasal route requires extended residence time in nasal cavity. The aim of the present work is to fabricate an In-Situ nasal gel using thermoreversible polymer, PF-127 and mucoadhesive polymers HPMC E15 and PEG 6000 to improve the residence time and easy application of accurate dosage. Optimization of formulations was carried out in terms of their content uniformity, clarity, pH, gelation temperature, viscosity, mucoadhesive strength and spreadability. Drug-excipient compatibility was ascertained by FT-IR Spectroscopy. Optimization of PF-127 concentration (20 and 25%) was done to get gelation temperature of formulations in the nasal physiological temperature range (25-34℃). The regression value of ex vivo permeation kinetic study show highest linearity for F1 and F2 to the Higuchi Model whereas F3, F4, F5, F6 to the first order model & the ‘n’ value of each formulation shown that F1, F2 follow Non- Fickian release and F3, F4, F5, F6 follow Super Case II release mechanism. The value of exponent ‘n’ of Korsmeyer-Peppas model suggests the permeation from F1 & F2 is diffusion & erosion controlled, and F3, F4, F5 & F6 is due to the erosion of the polymeric chain. It can be concluded that as viscosity of the formulation is increased the release mechanism will transform from Non – Fickian to Super Case II release mechanism. Hence a clear In-Situ gel may be formulated using PF 127 which is a stable under accelerated conditions and releases the drug under controlled manner for sustained systemic delivery through nasal route.

Asthma is one of the chronic respiratory conditions. A large Number of patients still experience a high level of morbidity .Much of the morbidity from Asthma is believed to be due to factors such as a chronic condition, poor knowledge of the disease process and medication understanding on the use of and poor self-management. Patient education is becoming an essential area of service provision. In this study30 Patients who were diagnosed as asthma with PFT and attending Pulmonology OPD at SRMC were included and were given a mini AQLQ questionnaire containing 15 questions regarding the level of asthma and limitations of activities, to test their knowledge about Asthma and quality of life, with particular reference to the knowledge about the disease and answers were analyzed to test the knowledge of the Patients about Asthma. It was done twice, first visit and after 3 weeks. These patients were prescribed with bronchodilators (SABA or LABA), Breathing exercises were explained and Inhaler technique was checked and proper technique is taught to the patient. Results showed Educating the patient about disease and teaching inhaler technique, breathing exercise resulted in more improvement in both PFT and quality of life of asthma patients with significant improvement in lung function.

The Syndrome X or metabolic syndrome, a cluster of metabolic and cardiovascular disorders, is typically characterized by abdominal obesity, insulin resistance, hyperglycemia, atherogenic dyslipidemia and hypertension. As the Syndrome X and diabetes mellitus has increased in the recent decades, the importance of early detection of insulin resistance is crucial. Therefore, the aim of this study was to elucidate the association of HbA1c with Syndrome X with insulin resistance using HbA1c as marker. This was a prospective, case control study and including 100 subjects. Out of which, 50 subjects were the patients of Syndrome X and 50 were normal control subjects. Venous whole blood specimen of case group was collected. Samples were also taken from healthy age and sex matched controls. All samples were analyzed for Glycated Haemoglobin (HbA1c) on HbA1c Analyzer. HbA1c level was significant (p<0.0026) in Syndrome X patients. Our results suggest that HbA1c may be a marker for metabolic syndrome and may identify in a certain degree insulin resistance in subjects.

One of the medicinal species used as raw material for the tisanes preparation is the boldo leaf (Peumus boldus). This plant is commonly used as treatment for a variety of conditions, such as digestive and hepatobiliary disorders. It is traditionally known for its choleretic, cholagogue, diuretic, and digestive properties, among others. The objectives of this work were to evaluate the quality of four batches of boldo tisanes of a brand commercialized in Costa Rica through various physicochemical and microbiological tests established in the Central American Technical Regulation (RTCA) 11.03.56.09, and to identify the reproducibility of the quality parameters for the four batches employed. For this reason, the following tests were done: labeling, organoleptic characteristics, foreign matter determination, minimum fill, lead limit, arsenic limit, loss on drying, total ash, microbial enumeration, and specific microorganisms (E. coli and Salmonella sp). The four analyzed batches were in compliance for all assays, except the labeling test, since in all cases only 2 of the 4 items established for the primary packaging (batch number and expiration date) and 3 of the 19 items indicated for the secondary packaging (qualitative-quantitative composition, interactions, and adverse effects) were not found. In addition, the batch 2 had a browner color compared to the others, not complying with the organoleptic test specifications, specifically the color. This is reaffirmed by obtaining a greater percentage of branches in its composition during the foreign matter test. For these reasons, greater controls must be made on the raw material used for the product preparation to achieve reproducibility between the quality characteristics required for the different batches.

Introduction: Magnesium (Mg) is the second most common intracellular cation after potassium (K). Mg is a cofactor in many enzyme systems in human cells and it has a predominant role in normal myocardial physiology. The role of magnesium in cardiovascular disease has received widespread attention. Magnesium has been implicated in the complications like arrhythmias in acute myocardial infarction. Objective: To know the serum magnesium level in patients with acute myocardial infarction and its relation with arrhythmia. Study design: Descriptive cross sectional study. Study place & period: Department of Cardiology, Rajshahi Medical College Hospital, Rajshahi from July, 2013 to November, 2013. Subjects: 50 patients with acute myocardial infarction admitted to the Department of Cardiology, Rajshahi Medical College Hospital. Methods: Data was collected from patients of any age and both sexes with acute myocardial infarction as determined by clinical features, ECG evidence and biochemical report. Blood sample for estimation of serum magnesium level was collected as early as possible within 24 hours of admission and 5th day of admission. After admission to CCU every patient was under continuous cardiac monitoring to see and record any arrhythmia within 5 days onset of symptoms. Results: A total of 50 patients of acute myocardial infarction were included during the study period. The male to female ratio in the study group was 3.17:1 and the maximum incidence of acute myocardial infarction was seen in 5th and 6th decade. The most common presenting symptom was chest pain which was present in all patients and was associated with sweat in 60% of patients and breathlessness in 64% of patients and palpitation in 50%. In the study, the most common risk factor found was smoking (70%) followed by diabetes (36%) and hypertension (30%). Anterior wall MI was found to be the most common type of MI (42%). Arrhythmia developed in (52%) patients and in majority (57.7%) of with anterior wall MI. In the study group mean serum magnesium level in 50 patients on day-1 is 1.86±0.39 and on Day-5 is 2.26±0.5. Mean serum magnesium level in 26 patients with arrhythmia was 1.65±0.26 on day-1 and 1.98±0.25 on day-5. In the study group, mean serum magnesium level in 24 patients without arrhythmia was 2.05±0.41 on day-1 and 2.48±0.52 on day-5. The difference between the magnesium level in patients with arrhythmia and without arrhythmia is statically significant on both day- 1 and day-5 (p<0.001). PVC was the most common type (42.5%) of arrhythmia. Conclusion: serum magnesium levels are significantly low in patients who develop arrhythmia in acute myocardial infarction.

Purpose: the current study was to compare between the effect of polarized light therapy (PLT) and betamethasone phonophoresis in the Treatment of psoriasis. Subject: fifteen patients were included in this study. Their ages ranged from 25 to 60 years. Each patient was divided into two sides Procedures: Group (I) received polarized light therapy (PLT) with a specific energy den¬sity of 40 mW cm. The light is brought and applied to the required area at constant intensity and very low energy but it is constant at 2.4 joule cm2 per min. In addition to topical corticosteroids for 4 weeks, 3 days/week. Group (II) received 4 weeks of treatment with betamethasone diprobionate phonophoresis (BDP) using continuous mode for 5 min, with 1 MHz and 1.5 W/cm2, 3 days/ week while. Group (I) received 4 weeks of treatment with topical corticosteroids only while. The measurements were done before the study and after one month of treatment for all groups by using Ultrasonography. Results: of this study showed reduction in the thickness of skin after the treatment for Group (A), (B) and (c) with a percentage of 41.66%, 29.16%, and 8.69% respectively for the thickness of skin. There was a highly significant difference between groups after the treatment. It was observed that PLT was more effective than betamethasone diprobionate phonophoresis. Conclusion: It could be concluded that. Biptron light therapy (BLT) is more effective than betamethasone phonophoresis in treatment of psoriasis.