Ariful Basher

Is serum zinc level associated with prediabetes and diabetes?: A cross-sectional study from Bangladesh

Aims To determine serum zinc level and other relevant biological markers in normal, prediabetic and diabetic individuals and their association with Homeostasis Model Assessment (HOMA) parameters. Methods This cross-sectional study was conducted between March and December 2009. Any patient aged ≥30 years attending the medicine outpatient department of a medical university hospital in Dhaka, Bangladesh and who had a blood glucose level ordered by a physician was eligible to participate. Results A total of 280 participants were analysed. On fasting blood sugar results, 51% were normal, 13% had prediabetes and 36% had diabetes. Mean serum zinc level was lowest in prediabetic compared to normal and diabetic participants (mean differences were approximately 65 ppb/L and 33 ppb/L, respectively). In multiple linear regression, serum zinc level was found to be significantly lower in prediabetes than in those with normoglycemia. Beta cell function was significantly lower in prediabetes than normal participants. Adjusted linear regression for HOMA parameters did not show a statistically significant association between serum zinc level, beta cell function (P = 0.07) and insulin resistance (P = 0.08). Low serum zinc accentuated the increase in insulin resistance seen with increasing BMI. Conclusion Participants with prediabetes have lower zinc levels than controls and zinc is significantly associated with beta cell function and insulin resistance. Further longitudinal population based studies are warranted and controlled trials would be valuable for establishing whether zinc supplementation in prediabetes could be a useful strategy in preventing progression to Type 2 diabetes.

Criminal poisoning of commuters in Bangladesh: Prospective and retrospective study

Travel-related poisoning is an emerging social and public health emergency in Bangladesh but its cause and significance have not been determined. To investigate this syndrome we performed a prospective clinical study and retrospective analysis of hospital records in a general medicine unit of a public tertiary care teaching hospital in Dhaka, Bangladesh, using toxicological analysis by fluorescence polarization immunoassay (FPIA) and liquid chromatography coupled to time-of-flight mass spectrometry (LC-TOF MS). The participants of the prospective study were 130 consecutive patients aged 16-80 years who were admitted with central nervous system depression (Glasgow Coma Score 3-14) after using public transportation, in the absence of other abnormalities, from January through June 2004, and a convenience sample of 15 such patients admitted during 3 days in May 2006. In 2004-2006, travel-related poisoning increased from 6.1 to 9.5% of all admissions (210-309 of 3266-3843 per year), representing 46.6-55.7% of all admitted poisoning cases. Incidents were associated with bus (76%), taxi, train, and air travel, or local markets; 98% of patients remembered buying or accepting food or drinks before losing consciousness. Direct financial damage (missing property) was diverse and frequently existential. Among 94 urine samples analyzed by FPIA, 74% tested positive for benzodiazepines. Among 15 urine samples analyzed by LC-TOF MS, lorazepam was detected in all; five also contained diazepam or metabolites; nitrazepam was present in three. FPIA results obtained for these 15 samples were below the recommended cut-off in eight (53%; lorazepam only). Our findings show that the massive medicosocial emergency of travel-related poisoning in Bangladesh is the result of drug-facilitated organized crime and that benzodiazepine drugs are used to commit these crimes, suggesting modifications to the local emergency management of the victims of this type of poisoning. They also highlight the need for more research in the neglected field of acute poisoning in Bangladesh, and for criminal investigations of the use of benzodiazepine drugs in this country.

Immediate hypersensitivity reaction following liposomal amphotericin-B (AmBisome) infusion.

Liposomal amphotericin-B (AmBisome) is now becoming first choice for the treatment of visceral leishmaniasis (kala-azar) patients due to high efficacy and less toxicity. The reported incidence of hypersensitivity reactions to liposomal amphotericin-B (AmBisome), especially during therapy, is very rare. We report two patients with kala-azar: one developed breathing difficulties and hypotension followed by shock and the other had facial angioedema with chest tightness during treatment. Both patients were managed with immediate action of injection: adrenaline, diphenhydramine and hydrocortisone. In our experience, AmBisome can cause severe hypersensitivity reactions that warrant proper support and close supervision.

Case Report: Treatment of Widespread Nodular Post kala-Azar Dermal Leishmaniasis with Extended-Dose Liposomal Amphotericin B in Bangladesh: A Series of Four Cases.

Post kala-azar dermal leishmaniasis (PKDL) is a skin manifestation which usually appears after visceral leishmaniasis. It is now proved that PKDL patients serve as a reservoir for anthropometric leishmanial transmission. Hence, to achieve the kala-azar elimination target set by the World Health Organization in the Indian Subcontinent, PKDL cases should be given priority. The goal of treatment for PKDL should be early reepithelizlization and rapid cure, but unfortunately this has been difficult to achieve, especially for patients with severe lesions. Therefore, we describe here four cases of PKDL who had widespread nodular and macular lesions and were treated with two cycles of LAmB doses with 20 mg/kg body weight divided into four equal doses (each dose contains 5 mg/kg) administered every alternate day. This treatment schedule achieved 100% treatment success with the minimal safety concern.

AmBisome Induced Avascular Necrosis of the Alae of the Nose of a very young girl suffering from Kala‐azar – a Case Report

Although liposomal amphotericin B (AmBisome) is considered as the first‐line treatment for New Kala‐azar, there is not enough evidence on the dosage formulation in children and its effect on them. Being considered as the safest drug for treatment of Kala‐azar, this case of AmBisome‐induced avascular necrosis now gives rise to the question; whether it is actually safe enough and if a dosage modification is needed in case of children. This so far, to the best of our knowledge, is the first instance of such severe adverse event due to AmBisome administration.

Corneal complications following Post Kala-azar Dermal Leishmaniasis treatment

Post Kala-azar Dermal Leishmaniasis (PKDL) is a sequel of Visceral Leishmaniasis (VL). The patients act as a reservoir for the causative parasite (i.e. Leishmania donovani) and thus should be diagnosed and treated with the utmost urgency to prevent the transmission of the disease. In this study, we tried to report the first instances of corneal complications supposedly associated with Miltefosine (MF), in PKDL patients and the probable pathophysiology of such events. The recently rejuvenated National Kala-azar Elimination Program in Bangladesh has put great emphasis on monitoring all the leishmaniasis patients to investigate possible adverse drug reactions (ADR). A total of 194 patients have received Miltefosine for the treatment of Post Kala-azar Dermal Leishmaniasis. So far five patients were found to have developed unilateral ophthalmic complications during the periods from May 2016 to October 2017, after being treated with MF for PKDL. Unfortunately, one of whom had to go through complete evisceration of the affected eyeball. Despite the fact that MF is the only oral formulation of choice to treat PKDL, occurrences of such unexpected ADRs after MF administration urges the exploration of the pathogenesis of such incidents and determine measures to avert such occurrences from happening in future.

Atypical presentation of post-kala-azar dermal leishmaniasis

Atypical Presentation of Post-Kala Azar Dermal Leishmaniasis in Bhutan Pradhan A, Tobgay T, Dorjee S, Wangdi T, Zhou G and Karunaweera ND Jigmi Dorji Wangchuck National Referral Hospital, Bhutan Khesar Gyalpo University of Medical Sciences of Bhutan Vector-borne Disease Control Programme, Ministry of Health Program in Public Health, University of California, Irvine, USA. Department of Parasitology, Faculty of Medicine, University of Colombo, Sri Lanka. #Equal contribution as first authors

Training in infectious diseases in India

586 www.thelancet.com/infection Vol 12 August 2012 Several studies have shown that nasopharyngeal carriage of vaccine-type S pneumoniae strains is negatively associated with Staphylococcus aureus carriage in the nasopharynx. Selva and co-workers described an antistaphylococcal mechanism whereby S pneumoniae kills S aureus by producing hydrogen peroxide. van Gils and colleagues report that use of the vaccine increased carriage of S aureus in a cohort of Dutch children. Could use of polyvalent pneumococcal vaccines be driving the increased incidence of community-acquired meticillin-resistant S aureus (MRSA) infection? Although Miller and colleagues did describe S pneumoniae serotype replacement, they did not investigate S aureus carriage. To show a negative association between S pneumoniae and S aureus carriage in a UK cohort of heptavalent pneumococcal conjugate vaccine recipients would be useful. Further studies should explore the link between vaccination and staphylococcal disease, both in vaccine recipients and the people they contact. Meticillin-resistant and meticillin-sensitive strains should be distinguished in investigations of S aureus carriage. The Panton-Valentine leukocidin status of the isolate should also be investigated because it is linked epidemiologically with communityacquired MRSA infection. These data would help to clarify any role that pneumococcal vaccines might have in S aureus infection.

Patterns of Self Poisoning by Household Substances ............................................................................IJMTFM (2011) 1(2):59-64

Background: Poisoning is an important public health problem in developing countries like Bangladesh; self poisoning with organophosphorous compound (OPC) used in agriculture is particularly common. However, tertiary level hospitals in urban settings, self-poisoning with different household substances is also frequent, especially in teenagers. This study aims to identify the common household substances used for self harm and describe their clinical profile. Methods: A prospective study was performed in five adult medicine units of Dhaka Medical College Hospital over a period of six months from January 2008 to June 2008. Data were collected purposefully in a standard case record forms. Results: One hundred and twenty eight patients with a definite history of self poisoning were enrolled. Majority of patients came from urban areas (77.4%); mean age was 20 years and 48.1% were unmarried. Most patients (102, 76.7%) were female. A suicidal intention was mentioned in 88.7% of cases and family disharmony (70.7%) was the main reported reason. Most of the patients (119, 89.4%) were educated with at least Primary school. The most commonly used compounds were Savlon (Chlorhexidine 0.05%, Cetrimide 0.5%) in 50.4% of cases and Harpic(Sodium alkyle benzene sulphonate & sodium alkene sulphonate) in 30.8% of poisoning cases. 92.5% of patients sought treatment in a public hospital. All patients received supportive and symptomatic treatment, commonly with intravenous fluids and omeprazole. Recovery was usually fast; 92.9% improved within two days. All patients survived and no complications were noted. Conclusion: Though poisoning due to household substances is usually mild, prompt recognition and early treatment is important. An effort should be made to define preventive measures that can be implemented in order to reduce this common form of self poisoning.