Background

Little is known about the prevalence of depression in people with diabetes in Bangladesh. This study examined the prevalence and factors associated with depression in out-patients with Type 2 diabetes in Bangladesh.

Methods

In this cross-sectional study a random sample of 483 diabetes out-patients from three diabetes clinics in Bangladesh was invited to participate. Of them 417 patients took part. Depressive symptoms were measured using previously developed and culturally standardized Bengali and Sylheti versions of the World HealthOrganization-5 Well Being Index (WHO-5) and the Patient Health Questionairre-9 (PHQ-9) with predefined cut-off scores. Data was collected using two different modes; e.g. standard assisted collection and audio questionnaire methods. Associations between depression and patient characteristics were explored using regression analysis.

Results

The prevalence of depressive symptoms was 34% (PHQ-9 score ≥ 5) and 36% (WHO-5 score < 52) with audio questionnaire delivery method. The prevalence rates were similar regardless of the type (PHQ-9 vs. WHO-5) and language (Sylheti vs. Bengali) of the questionnaires, and methods of delivery (standard assisted vs. audio methods). The significant predictors of depressive symptoms using either the PHQ-9 or WHO-5 questionnaires were; age, income, gender, treatment intensity, and co-morbid cardiovascular disease. Further, depression was strongly associated with poor glycaemic control and number of co-morbid conditions.

Conclusions

This study demonstrated that depression prevalence is common in out-patients with type 2 diabetes in Bangladesh. In a setting where recognition, screening and treatment levels remain low, health care providers need to focus their efforts on diagnosing, referring and effectively treating this important disease in order to improve service delivery.

Iron is one among the major metals present in the earth's crust and is essential for sound sustenance of human body. Its deficiency leads to various health ailments. Contemporary medicine advises iron supplements in iron deficiency anemia. Ayurvedic classics also quote significant information about administration of iron. Lauha Kalpas are the unique compound herbo-mineral formulations where iron (Lauha) is used as a major ingredient. Relevant literature (Bhaishajya Ratnavali, Charaka Samhita, Rasendra Sara Samgraha etc.) reviewed to gather information about Lauha Kalpas. Critical analysis of these Lauha Kalpas reveals that ancient seers administered iron in a better acceptable form. Unlike popular understanding these are not only Khalviya preparations; but Churna (powders), Avaleha (confectionaries), Rasakriya (solidified decoctions), and Putapaka (incinerated) form of preparations are also found. Apart from solid dosage forms, semisolid dosage forms mentioned in classics are very much useful. Unfortunately most of the formulations are not found in the market. Hence Pharmaceutical firms may bring these unique dosage forms in to the market to supply the healthcare needs of the community. It is interesting that iron preparations are used in Ayurveda in different medical conditions apart from anemia (Pandu). This leaves a scope for further researches on different dosage forms of iron and their indications.

Shukti is an important component of Sudha Varga, which is considered as the latest class in the field of Rasa Shastra. Two types of Shukti have been mentioned in Rasa Shastra texts i.e. Jala Shukti and Mukta Shukti according to the availability. In present study, an attempt has been made to develop a standard manufacturing procedure (SMP) of Jala Shukti Bhasma and Mukta Shukti Bhasma. Five batches of Jala Shukti Bhasma and Mukta Shukti Bhasma were prepared and standardization was attempted by maintaining batch manufacturing records of individual batches. During pharmaceutical procedures like Shodhana, Bhavana, Marana, etc. due care of temperature, its duration, percentage of weight gain or loss and the cost factor of the end product, etc. were considered. The average weight loss observed was 12.08 g i.e. 2.42% and 14.62 g i.e. 2.92% during Jala Shukti and Mukta Shukiti Shodhana respectively. Average weight loss found was 38.94 g i.e. 7.79% in Jala Shukti Bhasma while in Mukta Shukti Bhasma, it was 35.24 g i.e. 7.05%. At the end of the pharmaceutical procedure, it was found that Mukta Shukti Bhasma is 2.8 times costlier than Jala Shukti Bhasma.

The immunomodulatory activity of Shirishavaleha prepared from two different parts of Shirisha (Albizia lebbeck Benth), i.e., Twak (Bark) and Sara (Heartwood) as main ingredients was evaluated for humoral antibody formation and cell-mediated immunity in established experimental models. The study used Wistar rats of either sex weighing 200 ± 40 g, while the test drug was administered orally at a dose of 1.8 g/kg. Hemagglutination titer and body weight were recorded to assess effects on humoral immunity; immunological paw edema was assessed for cell-mediated immunity. Shirishavaleha prepared from heartwood shows significant enhancement in antibody formation, attenuation of body weight changes, and suppression of immunological paw edema, while Shirishavaleha prepared from bark shows weak immunomodulatory activity. The study therefore concludes that Shirishavaleha prepared from heartwood has significant immunomodulatory activity.

Ten batches of Shirishavaleha were prepared by using Twak (Bark) and Sara (Heartwood) of Shirisha [Albizzia lebbeck Benth]. The adopted formulation was based on Shirisharishta of Bhaishajya Ratnavali. Though Shirisharishta has significant therapeutic effect in cases of Tamaka swasa, etc.; it has few difficulties during the pharmaceutical procedure like consuming long time, climatic influences etc. Considering these inconveniencies, the formulation composition has been converted in to Shirishavaleha. Avaleha has been prepared by using Twak and Sara of Shirisha. No significant differences were found in pharmaceutical aspects of both the samples of Shirishavaleha and the current method of preparation can be considered as standard. Attempts were also made to develop analytical profile of avaleha, which were almost similar in both the samples, except showing more Rf values in High Performance Thin Layer Chromatography profile of Sara group.

The Ayurvedic system of medicine has stood the test of time for four millennia or more. The ancient seers found that drugs of different origin (herbal, metal or animal) in addition to codes of conduct and dietary regulations are suitable tools to maintain health in healthy and eradicating diseases in diseased. Use of metallic preparations in healthcare is a unique feature in this system. Processed metals including Mercury, Gold, Silver, Lead, Zinc, Copper etc. were used very frequently by seers of the Indian tradition in different disease conditions with great authority. It is generally claimed, that these metals are detoxified during the highly complex manufacturing processes described in Ayurvedic, especially Rasashastra texts. Charaka Samhita, one of the scheduled books of Ayurveda also holds ample of references regarding the use of metals for different purposes, which are summarized in the current paper.

The purpose of the present study was to evaluate the anti-inflammatory activity of Shirishavaleha prepared from two different parts of Shirisha (Albizia lebbeck Benth.), viz. the bark (Twak) and the heartwood (Sara). The activity was screened in the carrageenan-induced rat paw edema model in albino rats. The raw materials were collected and authenticated in the university and the trial formulations were prepared by following standard classical guidelines. Randomly selected animals were divided into four groups of six animals each. The test drugs were administered orally at a dose of 1.8 g/kg for 5 days. Phenylbutazone was used as the standard anti-inflammatory drug for comparison. Between the two different test samples studied, the formulation made from heartwood showed a weak anti-inflammatory activity in this model while that made from the bark produced a considerable suppression of edema after 6 h. It appears that the bark sample would be preferable for clinical use.

Mycobacterium mucogenicum is rarely associated to human infections. However, in the last year, a few reports of sepsis and fatal cases of central nervous systems have been documented. Here we report a fatal case of granulomatous meningoencephalitis of three weeks of evolution where DNA from a M. mucogenicum-like microorganism was identified post-mortem in samples of brain tissue.

Inflammation has always been a problem of unease to all clinicians and patients since centuries. A total safe and effective drug against inflammation is yet to be emerged in our field which can fulfill the requirements is the need of the hour. Keeping the significance of this in view, clues are being taken from the rich Ayurvedic treasure to find out a safe anti inflammatory drug.