Arm Luthful Kabir

Evaluation of the Safety and Adverse Effects of Goreisan/Wulingsan, a Traditional Japanese-Chinese Herbal Formulation (Kampo), in a Rat Model: a Toxicological Evaluation

Diarrhea is the second leading cause of death among children less than 5 years of age. Most of these deaths occur in developing countries in the tropical areas of Africa and South Asia. Goreisan/Wulingsan, a formula of Japanese-Chinese medicinal herbs (Kampo), has been used for the treatment of diarrhea and vomiting from ancient times in East Asia. Therefore, we planned a randomized controlled clinical trial of Goreisan/Wulingsan in Bangladeshi children. Although it is believed to be safe in East Asia, information regarding its toxicity on animals is scarce. Since Goreisan/Wulingsan has never been used in Bangladesh, it was necessary to ensure the safety of the formula in an animal experiment. Rats were assigned to a control group (normal saline, n = 4) or various Goreisan/Wulingsan groups (n = 26) receiving doses of 1 to 8 mg/g/day (7.7 to 61.5 times the recommended pediatric dose) over a period of 25 days. Their activities and health conditions were observed until they were sacrificed, after which blood samples were collected for biochemical liver function tests. The kidneys, liver and heart tissue were collected for histopathological study. No lethality was observed during the experiment. All of the rats consumed the doses completely and no constipation was observed, suggesting the absence of any inhibitory effect on intestinal motion. Also, no abnormal neurological activity was detected, nor any significant elevation of AST, ALT or ALP levels, except for AST and ALT at the highest dose of 8 mg/g/day. Histopathological studies of the kidneys, liver and heart tissues revealed no abnormalities. In conclusion, our results showed that Goreisan/Wulingsan is safe for rats, thereby justifying the use of the drug in a human trial.

Changing Trends in the Respiratory Disorders of Children in three Decades in Bangladesh

We used to see cases of common cold, CSOM, pneumonia and tonsillitis in 1990s in our pediatric OPD experience.1 The most important cases that we came across in the community were ARI/pneumonia2 and the topmost inpatient case out of top ten inpatients in a pediatric ward of a medical college hospital was pneumonia.3 Pneumonia was the most important cause of high mortality in pediatric inpatients as well followed by PEM, ‘encephalitis like disease’ diarrhea and meningitis.WHO and UNICEF have emphasized on the case detection and management of pneumonia through Integrated Management of Childhood Illness (IMCI) training.4 This effort had great impact on the reduction of under five and infant mortality. Presently, more than two third (67.5%) of children below five years who attend different hospitals of Bangladesh are suffering from respiratory disorders and out of them 85% attend OPD and 15% are hospitalized.5

Pulmonary Manifestations of Primary Immunodeficiencies in Children - A Review

Primary immunodeficiency diseases (PIDs) are inherited defects of the innate or adaptive arms of the immune system that differs from secondary immunodeficiencies. Respiratory disorders are significant causes of morbidity and the leading causes of death (30% -65%) in both children and adults with PIDs. The spectrum of respiratory manifestations is extremely wide due to PIDs. PIDs are broadly classified according to the components of the immune system that is primarily disrupted. Predominant antibody deficiency disorders are the most frequent and comprise approximately 70-75% of all PIDs. The most common clinical manifestations are infections involving the respiratory tract e.g. rhinosinusitis, otitis media, bronchitis, bronchiectasis and recurrent pneumonia (30% -65%). Recurrent respiratory infections are often the first warning sign. Timely diagnosis and appropriate therapy can improve or at least decelerate the progression of these complications. Infectious and non-infectious respiratory complications determinate the patient’s prognosis. These complications are associated with significant morbidity and mortality in PID patients. Appropriate awareness of these manifestations is essential, especially for the pulmonologist to reduce morbidity and mortality in PID patients.

Congenital Pulmonary Airway Malformation Type 4: A Case Report

Congenital pulmonary airway malformation (CPAM) is a very rare pulmonary disease in children. It is often misdiagnosed as a persistent and localized pneumothorax without any further pathological diagnosis. Malignancy and frequent airway infections are major concerns in these patients. Surgical excision is recommended to make a definite diagnosis and exclude hidden malignancies, and is also the treatment of choice. Herein, we report a 1-year-old girl presenting with an acute airway infection. Localized radiolucency was incidentally noted in the left upper lung field on a chest radiograph. No change in the radiolucent lesion was noted after three months of observation, so she received surgical excision. Histological examination disclosed type 4 CPAM without a malignant component thereby avoiding the possibility of repeated airway infection. After surgery her general condition was good, and no new respiratory symptoms were noted after follow-up for one year.