SETTING: TBM-KIDS is a phase I/II trial enrolling children with tuberculous meningitis (TBM) in three tertiary referral centers in India and Malawi.OBJECTIVE: To describe the challenges encountered in conducting the first randomized clinical trial of antimicrobial agents in pediatric TBM.DESIGN: The sources of the data were primarily monthly trial reports, non-enrollment case report forms, study diaries and registers maintained for recruitment, experiences shared by key team members during regular study calls and comments from site review visits. We reviewed, broadly categorized, and describe in detail the challenges encountered by study teams in trial implementation.RESULTS: Over 17 months, 3371 children with clinical presentations consistent with meningoencephalitis or undergoing lumbar puncture were assessed for eligibility; 21 (<1%) met enrollment criteria. We encountered challenges related to diagnosis, management of sick children, large catchment areas, adverse event attribution, concomitant medications, infrastructure requirements, expensive pediatric formulations with short expiry, and detection of treatment response in a highly variable disease across the age continuum. Training and adaptation of tools for neurocognitive and neurologic function assessment were necessary. Special care was undertaken to explain study participation to distraught caregivers and manage children longitudinally.CONCLUSION: Interventional trials in pediatric TBM are challenging but are critically important for improving the treatment of a disease that disables children physically, cognitively and emotionally. Sharing these challenges may help to address them more effectively as a TB research community and to advance treatments for this at-risk population.
Introduction: Hs-CRP is a nonspecific marker of the inflammatory response has been associated with development of type 2 diabetes mellitus. Cardiovascular disease is a major consequence of diabetes. DM confers a 2-4 fold rise in cardiovascular risk compared with general population. One of the many modifiable risk factors for both cardiovascular disease and diabetes is diet. Fiber is an important dietary factor that may modify the risk of both diseases. Material & methods: The current study is an attempt to explore the association of dietary fiber on inflammatory marker, hs-CRP in type2 diabetic subjects. Total 80 diabetic subjects were included in this study of which 40 were taking more dietary fiber and 40 were taking relatively low dietary fiber. Serum hs-CRP was measured by chemiluminescent immunometric assay (DPC Biermann Gmbh., Germany). Nutrient information was calculated using a pretested food recall questionnaire prepared by nutritionists for usual Bangladeshi food articles. Results: Hs-CRP was significantly higher in subjects taking low dietary fiber. There was significant negative correlation between CRP of subjects taking high and low intake of dietary fiber. Conclusion: So, low dietary fiber consumption maybe a possible causal factor of raised CRP. Type 2 diabetic patients who took less dietary fiber in their diets had elevated blood CRP levels. DOI: http://dx.doi.org/10.3329/bjms.v11i2.11434 Bangladesh Journal of Medical Science Vol. 11 No. 02 April 2012: 117-120
Background: Stroke is a leading cause of mortality and disability worldwide. To prevent complications and permanent defects, early diagnosis, distinguishing the type and risk factor of stroke is crucial. Methodology: It was a hospital based cross sectional study, purposive sampling method was used, and a total of 469 stroke patients admitted into Department of Medicine, Rangpur medical college hospital, Bangladesh were included in this study. Results: In this study we have studied of 469 acute stroke patients. Among them 81% (380) were ischemic stroke patients and 19% (89) were hemorrhagic stroke. Overall male were more than female 308 (65.7%) vs 161(34.4%). The mean age for the ischemic stroke group was 64.1 ± 10.9 years, which was significantly higher than that of the hemorrhagic group (59.8 ± 9.60years) (P<0.05). Acute hemorrhagic stroke patients presented with acute onset of focal neurological deficit 61.8%, headache 64%, vomiting 59.6%, alteration of consciousness 48.3% and convulsion 27%. On the other hand, acute ischemic stroke patient presented with alteration of consciousness 65.5%, acute onset of focal neurological deficit 39.5%, paralysis 41%, deficit after awakening 32.4% and aphasia 34.7%. Among the risk factors of stroke in acute ischemic stroke patients hypertension was 59.2%, diabetes mellitus 20%, history of previous stroke 16.1%, ischemic heart disease 14.5% and atrial fibrillation 10.3% were present, on the other hand in acute hemorrhagic stroke patients hypertension 76.4%, smoking 70.8% and diabetes mellitus 6.7% were present. 26.97% of the acute hemorrhagic stroke and 13.9% of the acute ischemic stroke patients died in hospital. Conclusion: Common presentation of stroke was acute onset of focal neurological deficit; headache and vomiting were more in hemorrhagic stroke patient; alteration of consciousness, paralysis was predominant in ischemic stroke patient.
Background: Type 2 Diabetes Mellitus (T2DM) and thyroid disorder are common endocrine disorders that affect major population worldwide. Subclinical hypothyroidism is common among T2DM.Objectives: To observe thyroid stimulating hormone (TSH), total thyroxine (TT4), free thyroxine (FT4), total triiodothyronine (TT3), free triiodothyronine (FT3) levels in newly diagnosed T2DM.Methods: This cross sectional study was conducted from July 2014 to June 2015. For this, 50 newly diagnosed T2DM patients aged 30 to 50 years of both sexes were enrolled from the Out Patient Department of Endocrinology, Rangpur Medical College and Diabetic Association, Rangpur. Fifty age matched non-diabetic healthy subjects of both sexes constituted control. Serum TSH, TT4 , FT4, TT3, FT3 levels were estimated to observe thyroid function. All these hormones were estimated by ELISA method. For statistical analysis independent sample “t” test was performed.Results: Serum TSH was significantly higher (p<0.001) and serum TT4, FT4, FT3 levels were significantly lower (p<0.001) in T2DM compared to control. Eight (16%) of T2DM were hypothyroid.Conclusion: From this study it can be concluded that altered thyroid status leading to hypothyroidism may be associated with T2DM.Bangladesh Soc Physiol. 2017, December; 12(2): 61-64
Background and Purpose: Diabetes and ischemic stroke are common diseases that frequently occurring together. Several studies have shown that people with diabetes have approximately twice the risk of ischemic stroke compared with those without diabetes. Although diabetes is a strong risk factor for ischemic stroke, it is still unclear whether risk factors, neuroimaging findings and hospital outcome are different in diabetic and nondiabetic patients. The aim of the present study was to evaluate cerebrovascular risk factor prevalence, neuroimaging findings and hospital outcome in patients between diabetic and non-diabetic of ischaemic stroke.Methods: We conducted a prospective study of 380 consecutive patients with cerebral infarction admitted into Rangpur Medical College Hospital over a 18-month period. With the use of a simple identical data sheet, we recorded the demographics, cardiovascular risk factors, neuroimaging findings and outcome in ischemic stroke patients with and without diabetes.Results: Overall, diabetes was present in 76 patients (20%). Diabetic patients, compared with those without diabetes, were younger (p=.034) and they were more likely to have hypertension (69.7%), hyperlipidemia (28.9%), ischemic heart disease (22.4%), previous cerebral infract (23.7%) and renal impairment (19.7%). Diabetic infract more frequently occurred in thalamus (11.8%), pons (9.2%) and with cerebral posterior involvement (13.2%). Mortality was higher in diabetic group (P = .046).Conclusions: Diabetic patients had higher risk burden for ischemic stroke with poorer short term hospital outcome than non-diabetic subjects. So control of diabetes and other risk factors along with a strict observation of adult individuals healthy life-style should warrant successful ischemic stroke prevention in our country.J MEDICINE July 2017; 18 (2) : 75-79
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