Md. Shahid Sarwar

Elevated serum MDA and depleted non-enzymatic antioxidants, macro-minerals and trace elements are associated with bipolar disorder

Genetic and neurobiological factors are considered to be the major causes of mood and mental disorders. However, over the past few years, increased levels of serum malondialdehyde and altered levels of various non-enzymatic antioxidants and essential minerals involved in abnormal functional activity have been identified as major contributing factors to the pathogenesis of several neurological disorders. The aim of this study was to determine the levels of the serum lipid peroxidation product malondialdehyde (MDA), antioxidants (vitamin A, E and C), macro-minerals (calcium, potassium and sodium) and trace elements (zinc, iron and selenium) in patients with bipolar disorder and to explore their role in disease progression. This is a prospective case-control study that evaluated 55 patients with bipolar disorder and 55 healthy volunteers matched by age and sex. Serum MDA levels were determined by UV spectrophotometry as a marker of lipid peroxidation. RP-HPLC was employed to investigate the serum vitamin A and E concentrations, whereas UV spectrophotometry was used to quantify levels of vitamin C. Serum macro-minerals and trace elements were analyzed by atomic absorption spectroscopy (AAS). Statistical analysis was performed with independent sample t-tests and Pearsons correlation test. We found significantly higher concentrations of MDA (p<0.05) and significantly lower concentrations of antioxidants (vitamin A, E and C) (p<0.05) in the patient group compared with control group. Regarding trace elements and macro-minerals, lower concentrations of zinc, calcium, iron, selenium, sodium and potassium were found in the patient group compared with control subjects (p<0.05). Our study suggests that high serum MDA concentrations and low serum concentrations of antioxidants, macro-minerals and trace elements are strongly associated with bipolar disorder.

Determination of Serum Antioxidant Vitamins, Glutathione and MDA Levels in Panic Disorder Patients

There are sufficient experimental evidences to establish the relationship between the elevated level of malondealdehyde (MDA)-the lipid peroxidation product and depleted level of antioxidants (Vitamin A, E, C and glutathione) in several psychiatric disorders. But previously no study was carried out to determine these components in panic disorder (PD) patients of Bangladesh. This study was conducted to assess the serum concentration of antioxidant vitamins, MDA and glutathione in 54 panic disorder patients and 52 healthy volunteers. Patients were recruited from Bangabandhu Sheikh Mujib Medical University, Bangladesh by random sampling. Serum level of MDA, glutathione and vitamin C were determined by UV spectrophotometric method whereas Vitamins A and E were detected by RP-HPLC method. Data were analyzed by independent t test and Pearsons correlation analysis. It had been found that the PD patients had low level of antioxidants like vitamin A (p=0.041) and vitamin E (p=0.018) than the healthy controls whereas the change of vitamin C is not significant. It had been found that the MDA content was significantly higher (p<0.05) in PD patients than that of controls. There was no significant difference for the glutathione content between the 2 groups. Pearsons correlation coefficient suggested that there were significant negative correlation between the glutathione level and vitamin C (p=0.013) and a positive correlation between the vitamin E and vitamin A (p=0.020) in patient group. Our study reveals that panic disorder patients have considerably higher level of MDA, lower level of antioxidant vitamins and glutathione than the healthy control subjects.

Resistant Hypertension: Underlying Causes and Treatment

Resistant hypertension (RH) is defined as failure to achieve goal blood pressure while receiving a 3 drug regimen at optimal doses that includes a diuretic. The exact prevalence of resistant hypertension is unknown which may vary from 5% to 50%. Patient or clinician-related factors contributing to resistant hypertension include patients non-adherence to antihypertensive therapy, White-coat effect and pseudo-hypertension and life style factors (Obesity, alcohol, smoking, dietary sodium etc). Several drugs may induce pre-existing hypertension where non-steroidal anti-inflammatory drugs are usually the most common due to their frequent use; whereas oral contraceptives, sympathomimetics (decongestants, anorectics), adrenal steroids and antineoplastic drugs targeting the vascular endothelial growth factor (VEGF) pathway has a good deal of contribution to resistant hypertension. Most common secondary causes of resistant hypertension are obstructive sleep apnea, renal artery stenosis, renal parenchymal disease, and primary aldosteronism while some uncommon causes such as pheochromocytoma, Cushings disease, thyroid and parathyroid dysfunction; and aortic coarctation also contribute to resistant hypertension. Both pharmacological and non-pharmacological treatments are available for the management of resistant hypertension. This article reviews the prevalence, symptoms, causes and treatment of resistant hypertension.

Low serum selenium concentration is associated with preeclampsia in pregnant women from Bangladesh

OBJECTIVES Preeclampsia is a hypertensive disorder of pregnancy which is one of the leading causes of maternal and perinatal mortality and pre-term delivery, especially in low and middle income countries. Selenium is an important constituent of selenoproteins that act as antioxidant and have several metabolic functions. The present study was conducted to determine serum selenium concentration in preeclampsia patients in order to find out the role of selenium in preeclampsia. METHODS This study was conducted as case-control study with 74 preeclampsia patients as cases whose gestation were ≥20 weeks (52 mild and 22 severe patients) and 118 normotensive pregnant women as controls from same gestational period. Detailed patient history was recorded during routine hospital visits. Serum selenium concentration was determined by using atomic absorption spectroscopy. Independent sample t-test and Pearsons correlation test were done for the statistical analysis using the statistical software package SPSS, version 16. RESULTS Our study found that mean serum concentration of selenium in preeclampsia patients was significantly lower than that of healthy pregnant women (p<0.05). Further analysis for selenium concentration with disease severity explored that selenium concentration was significantly lower in severe preeclampsia in comparison to mild preeclampsia (p<0.05). We found no significant difference for selenium concentration between rural and urban preeclampsia patients (p>0.05). Pearsons correlation analysis reveals significant negative correlation of selenium with systolic blood pressure (r=-0.419, p=0.001), diastolic blood pressure (r=-0.392, p=0.001), and gestational period (r=-0.218, p=0.001). CONCLUSION Our study found that preeclampsia patients have decreased serum selenium concentration than the healthy pregnant women.

Effect of socio-economic status and estimation of lipid peroxidation and antioxidant in preeclamptic pregnant women: a case-control study

Objective: Increased extent of lipid peroxidation and decreased antioxidant defense has been postulated as a major contributor to the development of preeclampsia. The present study was conducted to determine the serum level of malondialdehyde (MDA) and vitamin C in these patients. Methods: This research was conducted as a case–control study to assess the extent of lipid peroxidation and antioxidant status in 150 preeclampsia patients and 174 healthy pregnant women. Lipid peroxidation was assessed by measuring serum MDA level, and antioxidant defense was evaluated for serum vitamin C by UV spectrophotometric method. Independent sample t test and Pearson’s correlation test were used for the statistical analysis with statistical software package SPSS, version 16.0 (SPSS, Inc., Chicago, IL). Results: Our study found significantly higher level of MDA (p < 0.05) and significantly lower level of vitamin C (p < 0.05) in preeclampsia patients in comparison to the control subjects. Pearson’s correlation analysis revealed that there was negative correlation between the serum level of MDA and vitamin C for both patient (r = −0.057, p = 0.669) and control groups (r = −0.128, p = 0.487). Analysis of socio-economic data revealed that preeclampsia was more prevalent among the rural pregnant than the urban pregnant women (OR 1.44, 95% CI 0.665–3.14, p = 0.352). It was also observed that primigravida pregnant were at higher risk for the development of preeclampsia than the multigravida pregnant women (OR 1.87, 95% CI 0.868–4.04, p = 0.108). Conclusions: Elevated serum MDA and depleted serum vitamin C may be associated with the development of preeclampsia.

Spectrum of Disease and Prescription Pattern for Outpatients with Neurological Disorders: An Empirical Pilot Study in Bangladesh

Background: Neurological disorders represent one of the most prominent causes of morbidity and mortality that adversely affect the lifestyle of patients and a major percentage of these diseases exists in developing countries. Purpose: The objective of this study was to examine the prevalence and prescription pattern for outpatients with neurological disorders in Bangladesh. Methods: The study was conducted on 1,684 patients in 6 hospitals (National Institute of Neurosciences and Hospital, Dhaka Medical College and Hospital, Bangabandhu Sheikh Mujib Medical University, Shaheed Suhrawardy Medical College, Sir Salimullah Medical College, and Apollo Hospitals Dhaka) of the Dhaka City from March 2014 to June 2015. Data were collected through a predesigned questionnaire from the patients that contain information about gender, age, marital status, occupation, residential status, affected disease, self-medicated medicines, and prescribed medicines. Results: Out of 1,684 patients, 28.38% patients were aged 51–60 years and male, 57.19% predominance. The study exposed headache and migraine for 29.75% patients, followed by stroke for 23.93% patients and seizure for 7.07% patients. Genetic reason for the neurological disorders was seen only among 12.35% patients. In this study, 16.98% patients had been affected by neurological disorders for more than 2 years and 19% of patients for less than 6 months. Most extensively prescribed medicines were multivitamins and multiminerals used by 17.89% of patients followed by nonsteroidal anti-inflammatory drugs and other analgesic by 14.84%; afterwards antiulcerants were used by 12.62%, subsequently anticoagulants were used by 11.61% followed by antihyperlipidemic medicines by 10.26% and antiepileptic drugs by 8.08% of patients. The crucial reasons for the selection of prescribed medicines were the confidence that patients had with the physician’s prescribed medicines, which was shown for 40.97% patients and knowledge of the medicines was reported for 35.04% patients. The period of prescribed medicine usage was 1–3 months for 39.73% patients and 3–6 months for 29.16% patients. The patient’s compliance for prescribed medicines was satisfactory for 34.56% patients, good for 28.15% patients, and side effects were reported for 23.22% patients. Conclusion: In Bangladesh, it is not surprising to note that neurological diseases are more prevalent than other different diseases among different age groups and genders. Headache and migraine, stroke and seizure are most frequently encountered neurological disorders here. Treatment procedure of these disorders is not quite suitable due to the anomalies of health care management systems. Appropriate management of the health care system, especially the placement of hospital and community pharmacy can overcome the existing inconsistencies as well as increase the knowledge, awareness, and perception of the patients about health and neurological disorders.

Analyzing the chance of developing dementia among geriatric people: a cross-sectional pilot study in Bangladesh: Analyzing the chance of dementia

Alzheimers disease is the most common form of dementia, representing 60–80% of cases, and ageing is the primary risk factor for the development of Alzheimers disease. The objective of this study was to examine the chance of developing dementia (i.e. mild cognitive impairment (MCI), Alzheimers disease) among geriatric people in Bangladesh.

Exploration of Analgesic Activity of the Ethanolic Extract of Erythrina variegate Bark

The aim of this study was to evaluate analgesic activity of the ethanolic extract of the bark of Erythrina variegata . The analgesic potential of the extract was evaluated using acetic acid-induced writhing test for peripheral analgesic activity and tail immersion, hot plate, formalin and glutamate test at 50, 100, and 200 mg/kg body weight doses. In analgesic activity tests, the extract at the doses of 50, 100, and 200 mg/kg b.w. produced a remarkable increase in pain threshold in a dose dependent manner. In acetic acid induced writhing test, the inhibitory effect was to be parallel to the reference drug diclofenac sodium. The extract showed 18.89% writhing inhibitory effect at the dose 200 mg/kg b.w., whereas diclofenac sodium showed 79.42% inhibition of writhing at a dose of 10 mg/kg b.w. The results of tail immersion and hot plate test also showed potential analgesic activity of the extract which is also comparable to the standard drug morphine (5 mg/kg b.w.). In formalin test, the bark extract at doses 200 mg/kg b.w. were found to exhibit the highest 47.80% inhibitory effect in late phase, whereas the reference drug morphine showed 63.64% inhibitory effect on licking of the hind paw. In glutamate test, the bark extract at doses 200 mg/kg b.w. were found to exhibit the highest 68.07% inhibitory effect in late phase, whereas the reference drug diclofenac sodium showed 61.53% inhibitory effect on licking of the hind paw. In conclusion, it can be said that the plant part have potential analgesic activity and may be used to relief pain.

Elevated Serum Lipid Peroxidation and Reduced Vitamin C and Trace Element Concentrations Are Correlated With Epilepsy

Background. Epilepsy is one of the chronic and heterogeneous epidemic neurological disorders leading to substantial mortality. The aim of the present study was to investigate the serum levels of malondialdehyde (MDA), vitamin C, and trace elements namely zinc (Zn), copper (Cu), and manganese (Mn) in epileptic patients of Bangladesh and to establish if there are any pathophysiological correlations. Methods. This was a case-control study with 40 generalized epileptic patients and 40 healthy subjects as controls. Epilepsy was determined by the presence of seizure events with an abnormal electroencephalography and magnetic resonance imaging report of brain. Results. Anthropometric parameters highlighted that age is a major risk factor of epilepsy and men are more prone to epilepsy than women. Blood serum analysis demonstrated significantly (P < .001) higher values of MDA and lower level of vitamin C in the patient group (4.41 ± 0.76 μmol/mL and 18.31 ± 0.84 μmol/L, respectively) compared with control (1.81 ± 0.70 μmol/mL and 29.72 ± 1.06 μmol/L, respectively). Pearson’s correlation analysis revealed a negative correlation between the serum level of MDA and vitamin C for both patient (r = −0.023, P = .887) and control group (r = −0.142, P = .383). This study also revealed that the trace elements (Zn, Cu) were significantly (P < .05) lower in epileptics (68.32 ± 4.59 and 50.81 ± 2.54 μg/dL, respectively) where the level of Mn in patients (187.71 ± 9.04 μg/dL) was almost similar to that of the control group (P > .05). The univariate analysis demonstrated that zinc <70 μg/dL (odds ratio = 3.56, P < .05) and copper <50 μg/dL were associated (odds ratio = 14.73, P < .001) with an increased risk of epilepsy. Establishment of interelement relationship strongly supported that there was a disturbance in the element homeostasis of epileptic patients. Conclusions. The study results strengthen the role of lipid peroxidation, antioxidants and trace elements in the pathogenesis and warrant larger studies to investigate the association of these biochemical parameters with epilepsy.

Effects of five Bangladeshi plant extracts on In vitro thrombolysis and cytotoxicity

Background: Piper Betle, Pterospermum acerifolium, Saraca indica, Argyreia speciosa, and Rhaphidophora glauca are medicinal plants commonly used as traditional medicine for the treatment of various diseases. To examine, whether organic extracts of these plants possess thrombolytic properties with minimal or no toxicity is our main aim of the study. Materials and Methods: In vitro thrombolytic model was used to check the clot lysis effects using streptokinase (SK) as a positive control and water as a negative control. Cytotoxicity was screened by brine shrimp lethality bioassay using vincristine sulfate (VS) as positive control. Results: Among herbal drugs, different organic extracts of P. betle, P. acerifolium, S. indica, A. speciosa, and R. glauca showed significant (P < 0.05 and P < 0.0001) clot lysis activity viz., 31.58% ±0.76%, 40.50% ±0.94%, 49.70% ±1.69%, 35.81% ±0.86%, and 43.80% ±0.91%, respectively, compared to reference drug SK (79.32% ±1.629%). In brine shrimp cytotoxic assay, mortality achieved by the extracts showed lethal concentration 50 (LC50) values 274.64 ± 3.46, 215.60 ± 4.59, 478.40 ± 6.98, 233.37 ± 2.56, and 209.32 ± 1.98 μg/ml, respectively, with reference to VS (LC50,0.05 ± 0.34). Conclusion: In this study, S. indica, R. glauca, and P. acerifolium possessed effective thrombolytic activity. Further studies can be undertaken to identify certain structure of the ingredients in the extracts and to elucidate the precise mechanism of action. SUMMARY Five Bangladesh medicinal plants, named Piper betle, Pterospermum acerifolium, Saraca indica, Argyreia speciosa, and Rhaphidophora glauca were subjected to comparative antithrombotic and toxicity based analysis. In comparative study, Saraca indica showed highest clot lysis (49.70 ± 1.69%) activity among the other plant with lowest toxicity (LC50: 478.40 ± 6.98) Abbreviations Used: h: Hour; min: Minutes; sec: Second; kg: Kilogram; g: Gram; μg: Microgram; L: Liter; mL: Millilitre; μL: Micro liter; μg/mL: Microgram per Milliliter; mg/kg: Milligram per kilogram; %: Percent; °C: Degree Celsius; et al.: et alliori (and others); w/w: Weight by Weight; v/v: Volume by Volume; SEM: Standard Error Mean; LC50: lethal concentration at 50%