TPW May-June 2021

ENDORSED BY

DGDA

OBS &

GYNAECOLOGY

If someone wants to be a Motherhood is a time
good gynaecologist, he of expectation and joy
or she should be devoted for a woman, her
to this discipline with the family, and the
thirst to learn more. community.

- PROF TA CHOWDHURY -WHO





CONTENTS

Volume 12 n No. 6 n may-june 2021 NEWS

Chief Advisor NEW ARRIVALS 4
Prof. Dr. Abdul Ghani
Ex-Chairman, Dept of Pharmacy NEWS 17
University of Dhaka
Advisor, International Affairs FIP NEWS 21
Prof. Dr. Moshe Szyf
GlaxoSmithKline & James McGill Professor INTERVIEW 23
Dept. of Pharmacology & Therapeutics PROF. DR T A CHOWDHURY 29
McGill University Medical School PROF. DR. FERDOUSI BEGUM 35
Montreal, Quebec Canada PROF. DR FARHANA DEWAN 41
Pharmaceutical Advisor PROF. DR. ROWSHAN ARA BEGUM 45
Abu Nayeem Saifur Rahman PROF. DR. SALMA ROUF 51
Medical Advisor PROF. DR. SEHEREEN F. SIDDIQUA 55
Dr. R. M. Samiul Hasan PROF. MAJOR (RTD) DR. LAILA ARJUMAND BANU 57
Media Advisor PROF. DR. NAZMA HOQUE 61
Dr. Sajal Ashfaque PROF. TRIPTI RANI DAS 69
Dr. SMG Saklayen Russel DR. NARGIS FATEMA 73
Dr. Saleh Mahmood Tusher DR. JOYSREE SAHA
Editor
Muhammad Masud IN CONVERSATION 38
Executive Editor DR. E.H. AREFIN AHMED
S A Nadeem
managing editor SONOLOGIST SPEAKS 67
Sandip Kumar Saha DR. FARZANA ALAM
Associate Editor
Humayera Kabir Hana ARTICLE 65
Business Editor PROF. SAMSAD JAHAN 79
Md. Shahjahan MD. REZWANUL ISLAM 83
Research Editor DR. SAHAR RAZA
Prof. Dr. Md. Moklesur Rahman Sarker
head of marketing WHO SPEAK 27
Faisal Ahmmed
Marketing INFODEMICS 33
Sanat Saha
Circulation OBS & GYNAE UPDATE 48
Md. Sikander
Md. Bashar WHO RESEARCH 63
Computer Graphics
Md. Aftabul Islam TECHNOLOGY 76
Production
Mati Ar Manush FAQ 78
Editorial/Business Office
51, Kalabagan 1st Lane (Ground floor) RESEARCH UPDATE 80
Dhaka-1205, Bangladesh
E-mail: [email protected] GUEST COLUMN 86
Printing
Image Printing & Packaging, 3 Purana Paltan, Dhaka. IN BRIEF 88
Published by
Muhammad Masud RED ALERT 91
51, Kalabagan 1st Lane (Ground floor)
Dhaka-1205, Bangladesh, Tel/Fax: +88 02 58155677 FDA APPLORALS 92

IMPORTANT FDA UPDATE 93

Every care is taken to ensure the accuracy of the information DRUG SAFETY 95
given in this journal but no responsibility is accepted for any
error and/or omissions. Editor/publisher is not responsible in GLOBAL MARKET 97
any way for views/comments expressed herein.
GLEANINGS FROM THE LOCAL PRESS 98
04 THE PHARMA WORLD
INNOVATION 99

REGISTRATION RULES 101

DOCTOR’S DIARY 103



NEW ARRIVALS

ACME Brand Name: Glucozid MR
Generic Name: Gliclazide BP
Brand Name: Telisa Strength: 30mg & 60mg
Generic Name: Telmisartan USP Dosage Form: Tablet
Strength: 40 mg, 80 mg Indication: For the treatment of
Dosage Form: Tablet T2DM
Indications: Hypertension, Hyper-
tension with CV risk. Brand Name: Nesudil Plus
Generic Name: Netarsudil + Latano-
Brand Name: Telisa-A prost
Generic Name: Telmisartan USP + Strength: 0.02% + 0.005%
Amlodipine BP Dosage Form: Ophthalmic Solution
Strength: 40mg+5mg, 80mg+5mg (3 ml)
Dosage Form: Tablet Indications: Primary open angle
Indications: Uncontrolled Hyperten- glaucoma & ocular hypertension.
sion, Uncontrolled Hypertension
with high CV risk. Beximco

Brand Name: Remicov Brand Name: Zymet® Pro
Generic Name: Remdesivir INN Generic Name: Pancreatin
Strength: 100 mg Strength: 325 mg
Dosage Form: Lyophilized Powder Dosage Form: Capsule
for IV Inj. Indications: Exocrine Pancreatic
Indications: Treatment of COVID-19 Insufficiency.
patients requiring hospitalization.
Brand Name: Carnovas®
Aristopharma Generic Name: Nebivolol
Strength: 2.5mg, 5mg & 10mg
Brand Name: Miracit Dosage Form: Tablet
Generic Name: Butamirate Citrate Indications: Hypertension and
INN Chronic Heart Failure.
Strength: 7.5 mg/5ml
Dosage Form: Syrup Brand Name: Carnovas HZ®
Indication: Acute Dry Cough Generic Name: Nebivolol +
Hydrochlorothiazide
Brand Name: Livcare Dosage Form: Tablet
Generic Name: Obeticholic Acid INN Strength: 2.5mg + 12.5mg
Strength: 5mg & 10mg Indication: Hypertension.
Dosage Form: Tablet
Indications: Primary Biliary Cholan-
gitis (PBC), Cholestatic Liver Disease
& Non-Alcoholic Fatty Liver Disease
(NAFLD) including Non-Alcoholic
Steatohepatitis (NASH)

06 THE PHARMA WORLD

NEW ARRIVALS

Brand Name: D-Rise Brand Name: Amotid CL
Generic Name: Cholecalciferol Generic Name: Amoxicillin + Clavu-
Strength: 200000 IU lanic Acid
Dosage Form: Oral/IM Injection Strength: 625 mg & 100 ml PFS
Indications: Severe Vitamin D defi- Dosage Form: Tablet & PFS
ciency in elderly, Osteoporosis and Indications: Community-acquired
Fracture. pneumonia, Acute bacterial rhinosi-
nusitis, UTI, Acute otitis media & SSTI.
Brand Name: Odycin D®
Generic Name: Moxifloxacin + Dexa Brand Name: Formet-L
Strength: 0.5% + 0.1% Generic Name: Metformin Hydro-
Dosage Form: Eye Drops chloride+ Linagliptin
Indications: Ocular infections as- Strength: 500 mg + 2.5 mg
sociated with inflammation. Dosage Form: Tablet
Indication: Type 2 diabetes.
Brand Name: Symbion® HFA Inhaler
Generic Name: Formoterol Fumarate Brand Name: Formet-V
& Budesonide Generic Name: Metformin Hydro-
Strength: 4.5/80 mcg & 4.5/160 mcg chloride+ Vildagliptin
Dosage Form: Metered Dose Inhaler Strength: 500 mg + 50 mg
Indication: For asthma Dosage Form: Tablet
Indication: Type 2 diabetes.
Biopharma
Brand Name: Olvance-AM
Brand Name: Napgin Plus Generic Name: Olmesartan Me-
Generic Name: Naproxen + Esome- doxomil+ Amlodipine
prazole Strength: 20 mg + 5 mg
Strength: 500 mg + 20 mg Dosage Form: Tablet
Dosage Form: Tablet Indication: Hypertension.
Indications: Osteoarthritic joint
pain, Acute gout & acute musculo- Brand Name: Ortho-D3
skeletal disorder, Low back pain & Generic Name: Cholecalciferol
Rheumatoid arthritis. Strength: 40000 IU
Dosage Form: Capsule
Brand Name: Aceta One Indications: Cholecalciferol (Vitamin
Generic Name: Paracetamol D3) deficiency states & Inadequate
Strength: 1000 mg absorption of calcium.
Dosage Form: Tablet
Indications: Fever, Mild to moderate Brand Name: Lasocon D
pain, Fever and pain after vaccina- Generic Name: Dexlansoprazole
tion, Headache, Migraine & Muscle Strength: 30 mg
ache. Dosage Form: Capsule
Indications: Gastric ulcer, Duodenal
ulcer & Gastro-Esophageal Reflux
Disease (GERD).

THE PHARMA WORLD 07



NEW ARRIVALS

Brand Name: Famoloc Brand Name: Emazid M
Generic Name: Famotidine Generic Name: Empagliflozin +
Strength: 20 mg & 40 mg Metformin
Dosage Form: Tablet Strength: 5mg + 500mg
Indications: Heartburn, Peptic ulcer, Dosage Form: Tablet
Dyspepsia & Urticaria. Indication: Type 2 diabetes.

Brand Name: Vcand Everest
Generic Name: Voriconazole
Strength: 200 mg Brand Name: Olixar 5
Dosage Form: Tablet Generic Name: Olanzapine BP
Indications: Dermatophytosis, Strength: 5mg
Invasive aspergillosis, Deep tissue Dosage Form: Film coated Tablet
Infections & Esophageal candidiasis. Indication: Schizophrenia, Preven-
tion of Bipolar Disorder and Mania
Brand Name: Cloma 1
Generic Name: Clonazepam Brand Name: Olixar 10
Strength: 1 mg Generic Name: Olanzapine BP
Dosage Form: Tablet Strength: 10mg
Indications: Panic disorder, Rapid Dosage Form: Tablet
eye movement, Burning mouth Indication: Schizophrenia, Preven-
syndrome, Tardive dyskinesia & tion of Bipolar Disorder and Mania.
Seizures.
Brand Name: Picoplus
SK+F Generic Name: Sodium Picosulfate
Strength: 5 mg/5 ml
Brand Name: Pazotab Dosage Form: Oral Solution
Generic Name: Pazopanib Hydro- Indication: Constipation of any
chloride etiology, relief from prolonged &
Strength: 200 mg recurrent constipation, bowel clear-
Dosage Form: Tablet ance before surgery, childbirth or
Indications: Advanced Renal Cell radiological investigations.
Carcinoma (RCC), Advanced Soft Tis-
sue Sarcoma (STS) GOODMAN

Brand Name: Amlevo Brand Name: Esohil
Generic Name: S-Amlodipine (Le- Generic Name: Esomeprazole USP
vamlodipine) Strength: 20 mg & 40 mg
Strength: 2.5mg Dosage Form: Capsule
Dosage Form: Tablet Indications: Erosive Esophagitis,
Indication: Hypertension, angina Gastro-esophageal reflux disease
(GERD) Gastric & Duodenal Ulcer,
NSAID-induced peptic ulcer

THE PHARMA WORLD 09



NEW ARRIVALS

Brand Name: Airmont Brand Name: Sentrol
Generic Name: Montelukast USP Generic Name: Cetirizine Dihydro-
Strength: 10 mg chloride BP
Dosage Form: Tablet Strength: 10 mg
Indications: Asthma, Allergic Rhinitis Dosage Form: Tablet
(AR), Exercise induced Bronchocon- Indications: Allergic rhinitis, Urti-
striction (EIB) caria

Brand Name: Azibact Brand Name: Recita
Generic Name: Azithromycin USP Generic Name: Escitalopram USP
Strength: 500 mg, 200 mg/ 5 ml Strength: 5 mg & 10 mg
Dosage Form: Tablet, PFS Dosage Form: Tablet
Indications: RTIs, UTIs, SSTIs, Otitis Indications: Major depressive disor-
media der, Panic disorder, Obsessive com-
pulsive disorder, Anxiety disorder
Brand Name: Contilos
Generic Name: Lactulose USP Brand Name: D-Coral
Strength: 3.35 gm/ 5 ml Generic Name: Coral Calcium BP +
Dosage Form: Oral solution Vitamin D3 USP
Indications: Constipation, Hepatic Strength: Coral Calcium 500 mg +
encephalopathy Vitamin D3 200 IU
Dosage Form: Tablet
Brand Name: Hexidine Indications: Osteopenia, Osteopo-
Generic Name: Chlorhexidine Gluco- rosis, Calcium deficiency, Osteo-
nate+ Isopropyl Alcohol malacia, Calcium deficiencies during
Strength: 0.5% w/v Chlorhexidine pregnancy & lactation
Gluconate in 70% w/w Isopropyl
Alcohol BP Brand Name: Goodmet
Dosage Form: Solution Generic Name: Metformin HCl BP
Indications: Disinfection of clean Strength: 500 mg & 850 mg
and intact skin & Post-operative Dosage Form: Tablet
Surgical hand disinfection Indications: Type 2 diabetes mel-
litus, Polycystic ovarian syndrome
Brand Name: Preneu
Generic Name: Pregabalin BP Brand Name: Dexila
Strength: 50 mg & 75 mg Generic Name: Dexlansoprazole INN
Dosage Form: Capsule Strength: 30 mg
Indications: Peripheral neuropathy Dosage Form: Capsule
(NP), Diabetic peripheral neuropa- Indications: Erosive Esophagitis,
thy, Postherpetic neurophaty, Fibro- Gastro-esophageal reflux disease
myalgia, Spinal cord injury (GERD) Gastric & Duodenal Ulcer,
NSAID-induced peptic ulcer

THE PHARMA WORLD 011



NEW ARRIVALS

Brand Name: Heximax Brand Name: Feelfree Vaginal
Generic Name: Trihexyphenidyl HCl Contraceptive Gel
BP Generic Name: Lactic Acid BP + Citric
Strength: 2 mg & 5 mg Acid BP + Potassium Bitartrate USP
Dosage Form: Tablet Strength: 1.8 %+ 1% + 0.4 %
Indications: Parkinson’s disease, Dosage Form: Gel
Extrapyramidal symptoms (EPS) Indications: Prevention of preg-
nancy in female of reproductive po-
Brand Name: Risponex tential for use as a non-hormonal,
Generic Name: Risperidone USP non-systemic, on-demand method
Strength: 2 mg & 4 mg of contraception.
Dosage Form: Tablet
Indications: Schizophrenia , Bipolar Brand Name: Itracon
disorder , Acute & chronic psy- Generic Name: Itraconazole USP
choses Irritability associated with Strength: 200 mg
autism. Dosage Form: film coated Tablet
Indications: Tinea corporis, Tinea
Brand Name: Corovas cruris, Tinea pedis, Tinea manuum,
Generic Name: Rosuvastatin USP Vulvovaginal candidiasis, Fungal
Strength: 5 mg & 10 mg keratitis, Pityriasis versicolor, Oropha-
Dosage Form: Tablet ryngeal candidiasis, Onychomycosis,
Indications: Hypercholesterolemia, Histoplasmosis, Systemic Infections:
Hyperlipidemia, Mixed dyslipid- (Aspergillosis, Candidiasis and Crypto-
emia, Hypertriglyceridemia, Pre- coccus infection when other drugs are
vention of cardiovascular disease. ineffective) Antifungal prophylaxis: To
prevent systemic fungal infection in
Brand Name: Motiwin severely neutropenic patients.
Generic Name: Domperidone BP
Strength: 10 mg & 5 mg/ 5 ml Brand Name: Zenocin
Dosage Form: Tablet & Suspension Generic Name: Ozenoxacin INN
Indications: Dyspepsia, Nausea Strength: 1%
& Vomiting, Gastro-intestinal Dosage Form: Cream
discomfort. Indications: Topical treatment of
impetigo due to Staphylococcus
Navana aureus or Streptococcus pyogenes
in adult and paediatric patients 2
Brand Name: L-Amlo months of age and older.
Generic Name: Levamlodipine
Maleate INN Brand Name: Curafin
Strength: Levamlodipine Maleate Generic Name: Amorolfine BP
INN equivalent to Levamlodipine Strength: 0.25%
1.25mg, 2.5mg & 5 mg. Dosage Form: Cream
Dosage Form: Tablet Indications: Treatment of Tinea pedis
Indications: Used alone or in (athlete’s foot), Tinea cruris, Tinea
combination with other antihy- inguinalis, Tinea corporis, Tinea
pertensive agents for treatment of manuum & Pityriasis versicolor.
hypertension, reducing the risk of
fatal and nonfatal cardiovascular Brand Name: Duracef -Max
events-primarily strokes and myo- Generic Name: Cefixime BP
cardial infarctions. Strength: 500 mg / 5 ml
Dosage Form: Suspension
Indications: Otitis media, Pharyngi-
tis/Tonsillitis, Uncomplicated Uri-
nary Tract infection, Uncomplicated
Gonorrhoea.

THE PHARMA WORLD 13



NEW ARRIVALS

Brand Name: Olmepin Also used as supplement in case
Generic Name: Olmesartan Me- of inadequate intake of Calcium in
doxomil USP+ Amlodipine childhood diet, rickets, pregnancy
Besilate BP. & lactation, and elderly patients.
Strength: 20mg+5mg, 40 mg+5 mg. Other indications include pancre-
Dosage Form: Tablet atitis, phosphate binder in chronic
Indications: Treatment of hy- renal failure etc.
pertension, alone or with other
antihypertensive agents. Brand Name: Rupaxen
Generic Name: Rupatadine
Brand Name: Droniva Strength: 10 mg
Generic Name: Ibandronic Acid INN Dosage Form: Tablet
150 mg. Indications: Indicated for the
Strength: Ibandronate Monoso- symptomatic treatment of season-
dium Monohydrate INN equivalent al & perennial allergic rhinitis and
to Ibandronic Acid 150 mg. idiopathic urticaria.
Dosage Form: Tablet
Indications: Treatment and preven- Brand Name: Orcenac SR
tion of osteoporosis in postmeno- Generic Name: Aceclofenac
pausal women. Increases bone Strength: 200 mg
mineral density (BMD) and reduces Dosage Form: Tablet
the incidence of vertebral frac- Indications: Indicated for the
tures. treatment of pain and inflamma-
tion in osteoarthritis, rheumatoid
Organic arthritis, ankylosing spondylitis,
low back pain and other acute
Brand Name: Oscoral-D musculoskeletal disorders like
Generic Name: Calcium (Coral sprains, strains, dental and other
Source) + Vitamin D3 minor surgery, post-operative pain,
Strength: 500 mg + 200 IU primary dysmenorrhoea etc.
Dosage Form: Tablet
Indications: Indicated for the treat- POPULAR
ment & prevention of osteoporosis,
osteomalacia, tetany, hypoparathy- Brand Name: Astamax
roidism, disorder of osteogenesis. Generic Name: Astaxanthin
Also used as supplement in case Strength: Astaxanthin 2 mg & 4 mg
of inadequate intake of Calcium in Dosage Form: Capsule
childhood diet, rickets, pregnancy Indication: Antioxidant, Cardio-
& lactation, and elderly patients. vascular Health, Immune System
Other indications include pancre- Enhancer, Skin Improvement,
atitis, phosphate binder in chronic Strength & endurance, Brain &
renal failure etc. Central Nervous System Health, Eye
Health, Arthritis, Silent inflamma-
Brand Name: Oscoral-DX tion (C-reactive protein), Reproduc-
Generic Name: Calcium (Coral tive Health (Infertility).
Source) + Vitamin D3
Strength: 600 mg + 400 IU Brand Name: Hyprogel
Dosage Form: Tablet Generic Name: Hypromellose (En-
Indications: Indicated for the treat- riched with Carbomer 980)
ment & prevention of osteoporosis, Strength: Hypromellose 0.3%
osteomalacia, tetany, hypoparathy- Dosage Form: Eye Drop
roidism, disorder of osteogenesis. Indications: Dry eye

THE PHARMA WORLD 15

NEW ARRIVALS

Brand Name: Jakloc XR Techno Drug
Generic Name: Tofacitinib INN
Strength: 11 mg Brand Name: Prolan
Dosage Form: XR tablet Generic Name: Dexlansoprazole
Indications: Rheumatoid arthritis, Strength: 30 & 60 mg
Psoriatic arthritis, Ulcerative colitis. Dosage Form: Capsule
Indications: Healing of Erosive
Brand Name: Popular Hand Sanitizer Esophagitis, Maintenance of
Spray Healed Erosive Esophagitis, Symp-
Generic Name: Ethanol, Hydrogen tomatic Non-Erosive Gastroesoph-
Peroxide & Glycerol ageal Reflux Disease.
Strength: Ethanol 80%, Hydrogen
peroxide 0.125% & Glycerol 1.45% Brand Name: Avalon
Dosage Form: Spray  Generic Name: Azithromycin
Indication: For the disinfection of Strength: 500 mg, 200 mg/5 ml (35
clean and intact skin. For pre-opera- ml) & 200 mg/5 ml (50 ml)
tive surgical hand disinfection, hand Dosage Form: Tablet, Powder for
disinfection on the ward prior to suspension
aseptic procedures or after handling Indications: Lower respiratory tract
contaminated materials. For disin- infections including bronchitis,
fection of the patients’ skin prior to Pneumonia, upper respiratory tract
surgery or other invasive procedures. infections including sinusitis, Phar-
yngitis/tonsillitis, otitis media, and
Brand Name: Vaptan 15 (1st Time in in skin and soft tissue infections,
Bangladesh) Sexually transmitted diseases in
Generic Name: Tolvaptan men and women.
Strength: Tolvaptan 15 mg
Dosage Form: Tablet Brand Name: Lotem
Indications: Hypervolemic or Generic Name: Montelukast Sodium
Euvolemic Hyponatremia, Autoso- Strength: 4. 5 mg & 10 mg
mal Dominant Polycystic Kidney Dosage Form: Tablet
Disease (ADPKD). Indications: Prophylaxis and chronic
treatment of asthma, Acute preven-
Square tion of Exercise-Induced Broncho-
constriction (EIB), Relief of symptoms
Brand Name: Peranel of Allergic Rhinitis (AR): Seasonal &
Generic Name: Perampanel Perennial Allergic Rhinitis.
Dosage Form: Tablet
Strength: 2 mg & 4 mg Brand Name: Romilac
Indication:  Partial-Onset Seizures, Generic Name: Ketorolac Trometh-
Primary Generalized Tonic-Clonic amine
Seizures Strength: 10 mg
Dosage Form: Tablet
Brand Name: Contour Plus Indications: Acute Pain Manage-
Generic Name: Blood Glucose ment.
Monitoring Device & Test Strips
Dosage Form: Medical Device Brand Name: Exonid
Indication: Blood Glucose Monitoring Generic Name: Fexofenadine
Strength: 60 mg, 120 mg & 180 mg
Brand Name: Contour TS & 30 mg/5 ml (50 ml)
Generic Name: Blood Glucose Dosage Form: Tablet & Suspension
Monitoring Device & Test Strips Indications: Seasonal allergic rhini-
Dosage Form: Medical Device tis in adults and children.
Indication: Blood Glucose Monitoring.

16 THE PHARMA WORLD

NEW ARRIVALS

Brand Name: Motilex We value your opinion
Generic Name: Domperidone and would like you to
Strength: 10 mg, 5 mg/5 ml (60 ml) share it with us.This
Dosage Form: Tablet, PFS
Indications: Epigastric sense of would help us to
fullness, feeling of abdominal deliver a more enriched
distension, Upper abdominal pain,
Eructation, flatulence, early satiety THE PHARMA WORLD
Nausea and vomiting Heartburn to you.
with or without regurgitations of
gastric contents in the mouth Non- +88 016 7739 5919
ulcer dyspepsia.
THE PHARMA WORLD 17
WHITE HORSE

Brand Name: Diastat®
Generic Name: Empagliflozin INN
Strength: 10 mg & 25 mg
Dosage Form: Tablet
Indication: Diabetes Mellitus Type-II.

Brand Name: D-Care®
Generic Name: Cholecalciferol USP
Strength: 2000 IU, 20000 IU & 40000IU
Dosage Form: Tablet & Capsule
Indications: Vitamin D3 deficiency,
osteoporosis.

Brand Name: Nerfid®
Generic Name: Pregabalin USP
Strength: 25 mg, 50 mg & 75 mg
Dosage Form: Capsule
Indications: Neuropathic pain as-
sociated with diabetic peripheral
neuropathy, post-herpetic neural-
gia and fibromyalgia

Brand Name: Nexopan®Plus
Generic Name: Naproxen USP +
Esomeprazole Magnesium Trihy-
drate USP
Strength: 500mg + 20mg
Dosage Form: Tablet
Indications: Osteoarthritis, Rheuma-
toid Arthritis, Ankylosing Spondyli-
tis, NSAID associated Gastric Ulcer

Brand Name: Bio-7®
Generic Name: Biotin BP
Strength: 1000 mcg
Dosage Form: Tablet
Indications: Hair Loss, Brittle Nails
(Onychoschizia), weak splitting or
soft nails, Eczema & dermatitis.



NEWS

BAPI donates medicines to Palestine

The Bangladesh Association of Phar-
maceutical Industries (BAPI) donated
medicines worth Tk4 million to the
Palestinian people.

Foreign Minister Dr AK Abdul Momen
handed over the consignment to Pal-
estinian Ambassador to Bangladesh,
Mr. Yusuf Ramadan at the state guest-
house Padma. BAPI General Secretary
SM Shafiuzzaman Treasurer Md. Hal-
imuzzaman, Advisor Dr. Momenul Haq,
and Executive Committee member Md.
Abdur Razzak were also present.

The foreign minister reiterated
Bangladesh’s position on Palestine
and said Prime Minister Sheikh Hasi-
na had donated $50,000 as humani-
tarian assistance to Palestine. l

ACME gives emergency Beacon donates
medicines to Palestine pharmaceutical products
to war-hit Palestinians
Palestine is facing a dangerous escalation in violence
where more than 100 Palestinians have been hurt and Beacon Pharmaceuticals Ltd. donated pharmaceutical
hospitalized in clashes every day. products worth around Tk 40 lakh to the war-hit people
of Palestine to accelerate their treatment.
The ACME Laboratories Ltd. is standing beside them
to contribute a little in this devastating war situation Beacon, a leading drug maker in Bangladesh, handed
by handing over emergency medicines to Palestinian over the pharmaceutical products for the people of Pal-
Ambassador to Bangladesh, Mr. Yousef SY Ramadan, at estine to its Ambassador to Bangladesh Yousef SY Rama-
the Embassy of the State of Palestine, Dhaka, in order dan at state guesthouse Padma in Dhaka.
to help the wounded people. l
Foreign Minister  Dr AK Abdul Momen, Foreign Secre-
tary Masud Bin Momen, Mohammad Ebadul Karim, man-
aging director of  Beacon Pharmaceuticals Ltd, among
others, were also present at the programme. l

THE PHARMA WORLD 19

NEWS

Bangladeshi scientists discover
new antibiotic

Ateam of Bangladeshi scientists The discovery of the antibiotics gene that produces antibiotics, which
and researchers made history from the bacteria called ‘Staphylococ- had not before been reported. It can
by discovering a new antibiotic cus hominis’ has already been rec- be utilized to treat a variety of bac-
from rare bacteria found on jute seed ognized in a peer-reviewed journal terium-borne diseases. At least five
that can fight bacterial infections and Nature Research, titled “A plant endo- antibiotics can be produced from the
drug-resistant bacterial diseases. phyte staphylococcus hominis strain bacteria, providing a means to com-
MBL_AB63 produces a novel lantibiotic, bat various kinds of bacterial infec-
The team comprises several pro- homicorcin and a position one variant.” tions, according to genome sequenc-
fessors of Dhaka University (DU), ing by the research team. The study
some students, and a member of the “After genome sequencing of this ran for three years at the molecular
Bangladesh Council of Scientific and bacteria, we found that it has a gene biology laboratory of DU.
Industrial Research (BCSIR). They are that produces antibiotics which were
Professor Dr Haseena Khan of DU not previously reported. It was a dif- Prof. Mohammad Reazul Islam said,
Dept of Biochemistry and Molecular ficult task to separate the pure anti- “It’s a peptide antibiotic that works
Biology, Professor Dr M Aftab Uddin of biotics from many other things pro- against drug registrant. We can get
DU Dept of Genetic Engineering and duced by the bacteria, and our team good antibiotics if we can make them
Biotechnology, Shammi Akter, Mah- member Prof Aftab Uddin did that available on the market for commer-
buba Ferdous, Badrul Haidar, Al Amin, part smoothly” said Prof. Haseena. cial production. We need research
AHM Shofiul Islam Molla, and Dr Mo- funds and the government patroniza-
hammad Reazul Islam. The genome sequencing of this tion to make this happen.” l
bacteria revealed that it contains a

SUCCESS STORY First-ever successful
valve surgery at NICVD

A double valve replacement surgery of heart with mini- ment with a hole of only 2-3 inches is very rare all over
mally invasive cardiac surgery (MICS) method, the first of the world.” “This operation is done in a modern way and
its kind in the country, has successfully been conduct- now we have also been able to step on that milestone and
ed at the National Institute of Cardiovascular Disease make the name of the country brighter and foreigners may
(NICVD) in the city recently. come to our country for heart treatment,” said Dr Siam.

Under the leadership of Dr Ashraful Hoque Siam, the “Generally in traditional procedure, by cutting sternum,
youngest cardiac surgeon in the history of Bangladesh the surgery takes four to six months to heal the bones, pa-
and South Asia, a total of 10 doctors participated in this tients have to endure severe pain and bleeding and there
operation on 30-year old Hasina Begum and completed are more possibilities to get infected,” he added.
it in about five hours.
President of the Society of Cardiac Surgeons of Bang-
“For the first time in the country, we conducted the ladesh Professor Farooq Ahmed congratulated Dr Siam
double valve surgery with MICS method on May 25. The and his team, saying, “Congratulations to Dr Siam for the
patient is stable now and ready to go home,” said Dr Siam. 1st operation of this type in Bangladesh.”

“Under the constant supervision and cooperation of “It is a matter of great pride for us that we have been
Prime Minister Sheikh Hasina, for the first time in the able to start this type of surgery in our country,” said
country, we have been able to perform a complex op- Director of the National Heart Institute, Mir Jamaluddin.
eration like double valve with only 2-3 inch hole in MICS
method,” he said. Among the other members of his operation team
were Prof Dr Shahnaz, Dr Salam, Dr Romena Rahman, Dr
“This double valve operation is a very complex opera- Asif Ahsan Chowdhury, Dr Imran, Dr Manzoor, Dr Wahida,
tion of the heart and in this MICS method, valve replace- Dr Sayem, Dr Rubaiyat and Dr Sourav. l

20 THE PHARMA WORLD

NEWS

CONGRATS! DGDA issues emergency
use authorization to
National Professor 6 vaccines in Bangladesh
Abdul Malik
receives World The Directorate General of Drug release signed by Maj Gen Md Mahbubur
Hypertension Administration (DGDA) has issued Rahman, Director General of DGDA.
League Excellence emergency use authorisation (EUA)
Award to Johnson & Johnson’s Covid-19 vac- Earlier, the DGDA approved five dou-
cine “Janssen” in the country. The Line ble-dose Covid-19 vaccines for emer-
National Professor Brig (Retd) Director (MNC&H) of the Directorate gency use in Bangladesh. The other
Abdul Malik was honoured with General of Health Services (DGHS) ap- approved vaccines are: Covishield pro-
the ‘Excellence Award in Diplo- plied for the approval as the local dis- duced by Serum Institute of India, Sput-
macy and Advocacy for Popula- tributor of the vaccine. nik V produced by Generium Joint Stock
tion Hypertension Risk Reduc- Company of Russia, Sinopharm pro-
tion’ by the World Hypertension The EUA was issued as per the rec- duced by Beijing Institute of Biological
League. ommendation of the committee for the Products Co. Ltd of China, Pfizer vaccine
evaluation of drug, investigational drug, manufactured by Pfizer Manufacturing
This award is the recognition vaccine, and medical device in case of Belgium NV, and Coronavac produced
of his role in creating aware- public health emergency, said a press by Sinovac Life Sciences Ltd of China. l
ness among the people about
controlling Hypertension, said a Professor AK Azad Khan Professor Mahmud Hasan
press release. The award is an-
nounced on May 17 every year Prof AK Azad Khan and Prof Mahmud
on World Hypertension Day, Hasan appointed as National Professors
which is celebrated annually to
spread awareness about hyper- Professor AK Azad Khan and pro- Prof AK Azad is President of
tension disease, its prevention, fessor Mahmud Hasan were made Bangladesh Diabetic Association.
detection, and control. national professors for the next five Prof. Khan is an eminent academi-
years. They were appointed with the cian. He has promoted the creation
Professor Malik, the pioneer approval of President Md Abdul Ha- of a country-wide diabetes and
cardiologist of the country, is mid, said a Secondary and Higher NCD network of Affiliated Associa-
the founder and president of Education Division gazette notifi- tions (AAs).
the National Heart Foundation cation. The eminent educationists
of Bangladesh. He has been will perform the duties of national Professor Mahmud Hasan, the
working for a long to prevent professors and get honorarium and President of Bangladesh Gastro-
and control HTN and other risk other benefits as per the Bangladesh enterology Society, is an eminent
factors of cardiovascular diseas- National Professor Resolution (ap- educationist and gastro, liver and
es in Bangladesh. l pointment, conditions and facilities) pancreatic specialist. He is the past
1981, it said. president of BCPS (College of Physi-
cians and Surgeons, Bangladesh). l

THE PHARMA WORLD 21



FIP NEWS

Trust to be the focus of World
Pharmacists Day 2021

“Pharmacy: Always FIP develops tool to support regulators
trusted for your in implementing pharmacy-based vaccina-
health” will be the tion programmes to combat pandemic
theme of World Phar-
macists Day on 25 Ministries of health and regu- management.
September, the Inter- lators can make use of a tool “FIP’s pharmacy-based vac-
national Pharmaceutical Federation produced by the International
(FIP) announced recently. Pharmaceutical Federation (FIP) cination self-assessment tool
Trust barometers have found that to enhance strategies and create places a priority on patient care
distrust of societal leaders has in- the necessary regulatory frame- and public protection during a
creased and distrust of information works to combat the COVID-19 pandemic through the passing of
sources is at a record high, (1) fuelled pandemic through pharmacist- enabling legislation with regula-
by the COVID-19 pandemic and the led vaccination programmes. tory oversight and quality assur-
infodemic around it. At a time of un- The resource has been devel- ance. It may also be useful as a
certainty and when vaccines hesitan- oped based on the experiences review tool in countries where
cy remains a major hurdle, (1) public of regulators in countries where pharmacists already play test-
trust in pharmacy is more important pharmacy-based vaccination and ing- or vaccine-related roles but
than ever. testing have been successfully could further expand or consoli-
For many years, pharmacists have introduced and regulated. date such roles,” Guse said.
consistently been named among the
top five most trusted professionals in However, successful strategies He added: “Drafting or enact-
national surveys.(2,3,4) Educators are that involve pharmacists need ing new or amended laws can be
also consistently in the top five (2,3) to be grounded in public protec- slow, and it may be simpler and
and, according to a recent survey, sci- tion, quality of care and an in- faster to develop regulations un-
entists are the most trusted people depth understanding of needs der an enabling law instead. In
in the world.(5) “Pharmacists, educa- at country level with regard to particular, FIP and its member
tors and scientists — that’s our phar- vaccination and testing services. organisations can be a resource
macy profession,” said FIP president, Resource requirements, such for the appropriate drafting and
Dominique Jordan. as workforce qualifications and development of supportive regu-
This year’s World Pharmacists Day training, infrastructure and fund- lations, policies, and standards
campaign is an opportunity for phar- ing, also need to be considered,” of care and training programmes.
macy to show appreciation for the trust said Ronald Guse, chair of FIP’s If a permanent change in the leg-
placed in the profession and increase Forum of Professional Regulators. islation is not possible, health
awareness of this trust and pharma- ministers and regulators ought
cists’ vital role in improving health.  In the face of current and fu- to consider developing new leg-
Evidence indicates a significant as- ture waves of COVID-19, FIP’s tool islation that allows for expanded
sociation between trust in healthcare aims to help policymakers to as- functions of the pharmacist on
professionals and health outcomes sess pandemic preparedness and an emergency basis to address
for patients. Pharmacy has built up the state of legislation within patient care needs in a pandemic
a reserve of trust over many years of their country in order to facilitate or other declared emergencies.
caring, positive relationships, exper- mass vaccination through phar- Improving vaccination access
tise and excellent practice, all deliv- macists. It consists of a checklist and coverage is a global impera-
ered with consistency. We can put this that helps to identify priority ac- tive and policymakers must en-
trust to good use in countering the tions related to vaccination, test- able pharmacists to contribute
anti-vaxxers as well as in continuing ing, prescribing and supply chain to this goal.” l
to improve the health of our commu-
nities in general. l

THE PHARMA WORLD 23



INTERVIEW

If someone wants to be a good gynaecologist,
he or she should be devoted to this
discipline with the thirst to learn more

Prof. Dr T A Chowdhury As a pioneer Gynaecologist diseases, hypertensive disorders dur-
Professor of the country, what, in your ing pregnancy as well as premature
Dept. of Obstetrics and Gynaecology opinion, are the most common labour among other things. Usually if
BIRDEM, Dhaka Gynaecological disorders taken proper precautions and timely
prevalent among our women? treatment is done, then this disease
is not likely progress into serious
Actually, it is difficult to say in short conditions. However, if neglected or
because there are many gynaecologi- left untreated, these conditions can
cal conditions which are prevalent progress into serious maternal and
all over the world and they are also fetal complications. Maternal compli-
present here. But there are some oth- cations include hey eclampsia, heart
ers which are more common here due failure and even death during preg-
to the poor economic conditions of nancy or immediately after delivery.
the people, poor hygiene, and lack Our advice is all pregnant patients
of care during delivery. For example, is that they should have regular an-
genital prolapse, which generally re- tenatal checkup, so that such com-
sult from mismanagement during plications can be detected early, and
labour is quite common. Another is appropriate actions can be taken to
vesicovaginal fistula (where a woman prevent the complications becoming
goes on leaking urine continuously) is a threat to the mother and the baby.
also common due to negligence dur-
ing labour. Pelvic infections are also Is an IVF pregnancy considered
more common in this country due to high risk? What are the risks and
poor hygiene, poor living conditions success rate of the procedure?
and low nutritional status. Gynaeco-
logical conditions which are not very IVF or In-vitro fertilisation means that
dangerous in western countries can the embryo (by the ovum and sperm
sometimes become dangerous for from the wife and the husband) is
our patients. Anaemia is also very fertilised outside the body and they
common. I think, many of the gynae- are subsequently transferred to the
cological conditions in our country uterus. This is done when both the
arise due to mismanagement during fallopian tubes are damaged or in
labour. If efficient care during labour cases where all the other means of
can be made accessible to all women, pregnancy is unsuccessful. It requires
many of these conditions will gradu- expert gynecologists to pick up the
ally disappear. ovum and a competent embryologist
so that the fetus can be grown out-
What are the elements that side the body. The process requires
constitute high risk pregnancy? very expensive equipment and have
What measures can be taken to be imported from abroad. On top of
to manage and prevent that, there is the cost of drugs which
such complications? is approximately 1 lakh taka per cycle.
So, naturally the cost of the procedure
There are many cases where a preg- becomes very high. As such, in many
nancy carries more risk than usual. cases the procedure cannot be done
These cases include diabetes, heart

THE PHARMA WORLD 25



INTERVIEW

below 200,000 taka. Once the woman through a small hole, through which Unnecessary C-Sections has become
becomes pregnant, it may or may not the telescope and other instruments a major public health issue in
become high risk. Usually, the pa- are introduced inside the body. But Bangladesh. Why is this so and
tients who come for IVF are of more the problem here is that the mass what can be done to prevent this?
advanced aged and we know that with has to be removed and this cannot
advanced age pregnancy, comes addi- be done through the small opening. It is true that the C-section incidents in
tional complications which may lead So, it is either done by a small ab- Bangladesh have increased but there
to high-risk pregnancy. So, IVF itself is dominal incision or by opening the are some reasons for that. The doctors
not high risk, but since it is done in vagina or by a surgical tool called the are not doing it for their own benefit.
elderly patients, high risk complica- morcellator. Previously women used to give birth
tions may occur. to many children. There was high in-
Morcellators are used to cut tissue cidence of stillbirth also. Nowadays,
Endometriosis can often lead into smaller pieces so that it can be women are opting to have one or two
to infertility and is itself a removed through the small incision children, that too in an advanced age.
very serious condition. What site. In many cases, the results are sat-
are the causes, complications, isfactory. In malignancy, we remove As pregnancy has become risky, it is
and treatment thereof? the regional lymph node through becoming more and more the patient’s
laparoscopy as studies found that it is choice these days to have a c-section
Endometrios is a widespread problem much better than open operations. In with the belief that the baby would
among women. It causes severe pain, gynaecological malignancy laparos- come through the process safely. So,
irregular ministration, and infertility. copy is very promising, particularly in many times we find the patients in-
The exact cause of this condition is cancer of the cervix. sisting that they do not want normal
unknown. Endometriosis  is a condi- delivery. Another factor is a social
tion where tissue similar to the lining Due to challenges posed by problem-in this country, is patients
of the uterus grow outside the uterus, COVID-19, please tell us, in do not want to understand what the
mainly in Ovaries, fallopian tubes or brief, how the pandemic has problem is with them. In critical con-
other places in the pelvic cavity. Un- changed the norm in pregnancy, ditions, even when doctors tried their
der the influence of hormones, they childbirth and postpartum care. best while providing vaginal delivery, if
also start to menstruate. This blood something goes wrong, the patients al-
is trapped and leads to formation of During COVID-19 there has been long ways blame the doctors. So, many doc-
cysts. Ultimately it results in infertil- time lockdown in many places. So tors do not want to take any chances.
ity. Unfortunately, treatment of en- many patients could not avail of the
dometriosis does not improve fertil- medical care during pregnancy, dur- I am not talking about our country
ity. For treatment of infertility along ing labour and after labour. There has only; the scenario is same in most de-
with endometriosis, we often have been increase in incidences where the veloped countries also. For example,
to go for surgery. Nowadays, options women were delivering at home. In Brazil and many other countries in
like laparoscopic surgeries can im- some cases, even during severe com- South America, the caesarean section
prove the situation but cannot cure. plications, they could not go to the rate is even higher than Bangladesh.
Laparoscopic surgery can remove the hospital and had to take treatment at Only the developed countries have
endometriotic deposit, separate the home. lower caesarian section rate as the
adhesion and increase the chances of patients understand their problem,
pregnancy. So, we found out that both mater- and they can be counseled properly
nal morbidity and mortality have in- about the risks and benefits, doctors
Could you please tell us, in brief creased drastically during the period can try to prolong their delivery.
out the role of laparoscopic COVID pandemic. On the other hand,
surgery in infertility and initially, most facilities and physi- Another thing is lack of manpower-
gynaecological oncology? cians were diverted towards treating as most of the deliveries occur at night,
the COVID-19 patients. So, there was there are not enough doctors and
Laparoscopic surgery has now be- a lack of doctors and nurses for pro- midwives to conduct all the deliveries.
come relatively common and pre- viding routine services. But, since the When the patient is having prolonged
ferred for some gynaecological pro- lockdown has been relaxed, the situa- labour, the attendants may decide to
cedures but not all. In principle, it tion is slowly getting better. go for c-section for timely delivery. So,
means that if removal of uterus, ovar- the reasons for rate of C-section going
ian cysts or myoma is done, it is not The patients now have better ac- up in our country is multi-factorial. We
done by open operations but rather cess to healthcare and go to hospital can bring the rate down by councel-
whenever needed to get appropriate ling the patients about their complica-
treatment. tions, and there is better understand-

THE PHARMA WORLD 27

INTERVIEW

ing in the community and when we very prolonged and expensive. The pening abroad. He must be able to
have sufficient number of midwives to patients must have the mental resil- work in an environment where all the
deliver the babies safely. ience to endure the treatment. Many latest technologies and equipment
patients do not stick to the treatment are available with knowledge of most
Where does Bangladesh stand as and stop it halfway. In ART, the success sophisticated techniques. Unfortu-
far as prevention, diagnosis and rate in most countries is 30%, which nately, in our country the number of
treatment of infertility is concerned, means that only one in three patients gynecologists are too many. Most of
compared to the advanced will successfully conceive through our female doctors desire to become
countries? What can be done to ART. Our success rate is also similar, a gynecologist. To become a good ob-
increase the affordability and 20-30%. As you know, technology is stetrician and a good gynecologist it
equitability of assisted reproduction advancing very rapidly- there are so takes hard work. In advanced coun-
technologies (ART) in our country? many new equipment and techniques tries not many women are becoming
coming up that it is very hard for us to obstetricians, as they need to look
There is not much difference actu- keep up because the price is so high. after their families as well. It is mostly
ally. Most of the procedures which Otherwise, we have top-notch exper- male dominated discipline there. But,
are done abroad, can be done here. tise and facilities with good outcome in our country it is the tradition that
But the problem is that the number in treatments. Whichever treatment is gynaecologists must be women. But
of facilities is limited. In govt. hos- done abroad, it can be done here. the criteria should be like this- if
pitals, it is not done because it is so someone wants to be a gynecologist,
expensive. Also, importing equipment What is your take-home message he or she should be wholehearted,
is time consuming. For example, if for the aspiring gynaecologists? he or she should be well-trained and
we order an instrument, it may take updated on the advancements of this
months to reach us. So, most of the Like any other branch in medicine, discipline, should have the knowl-
infertility treatments are done in the obstetrics and gynecology is also ex- edge and go to other countries for ex-
private sector. The treatments provid- panding rapidly. Newer and newer change of views and expertise, gain
ed by the private sector is at par with techniques are coming, and newer experience and he or she should have
the advanced world; in many cases and better equipment is being avail- thirst to learn more. This is how we
it is even better. All the medications, able also. If a doctor wants to be a can apply the expertise to treat our
technology and facilities are available good gynecologist, he must have a women with world class standard. l
in Bangladesh, but the treatment is knowledge about the advances hap-

Stillbirths, other pregnancy complications up during pandemic

The ripple effect of the  COVID-19  scourge has led to ers dying during pregnancy or childbirth increased by
more complications among pregnant women world- about one-third. Also, there was a nearly sixfold in-
wide, including an increase in stillbirths, a new study crease in surgery for ectopic pregnancies (when the
says. The research review also found higher rates of fertilized egg is growing outside the uterus) during the
maternal deaths and depression in the first year of the pandemic. If discovered early, ectopic pregnancies are
pandemic. typically treated with medication. The increase in ec-
topic pregnancy surgery suggests that more women de-
“The COVID-19 pandemic has had a profound impact layed seeking care, according to the researchers.
on health care systems around the world. Disruption to
services, nationwide lockdowns, and fear of attending They also found increases in mothers’ postpartum
health care facilities mean that the adverse effects of depression and anxiety. Pregnancy outcomes were
COVID-19 are expected to have health consequences worse in low- and middle-income countries than in
that extend beyond the deaths and disease caused by high-income countries, according to the study. The re-
the virus itself,” said study lead author Dr. Asma Khalil, a searchers also found a 10% decline in preterm births
professor at St. George’s University of London. in wealthy nations, but no change in low- and middle-
income countries.
Khalil’s team reviewed 40 studies that included data
on 6 million pregnancies in 17 countries. Overall, there The findings show the need for immediate action to
was a 28% increase in the odds of stillbirth, which is the maintain safe pregnancy care worldwide, especially dur-
loss of the fetus after 20 weeks, and the risk of moth- ing the pandemic, the researchers said.

28 THE PHARMA WORLD

WHO SPEAKS

WHO’s Chief Scientist, Dr. Soumya
Swaminathan talks to Vismita Gupta
Smith about Vaccines, pregnancy,
menstruation, lactation, and fertility.
THE PHARMA WORLD has reproduced the
interview from WHO media resources.

Here is excerpt ...

Vismita Gupta-Smith: Soumya, my first question to vated viruses or the viral vectored platforms or subunit pro-
you is women who are breast feeding infants, what is teins. None of them have a live virus that can multiply within
the advice for them? Should they get vaccinated? the body and that could potentially create a problem. So, I
think it’s important that pregnant women in every country
Dr Soumya Swaminathan: Yes, the answer is yes. So, women be explained the benefits versus the risks and be offered
who have given birth and who are breastfeeding their ba- the vaccine if they would like to take it. And it’s probably
bies can take the vaccine, should take the vaccine when it the right thing to do in many situations, as I said, where the
becomes available to them. There is no risk at all because pregnant woman is at higher risk of getting the infection and
all the vaccines that are being used presently, none of them where the vaccines would bring more benefits.
have the live virus in it. And so there’s no risk of transmis-
sion through the breast milk. In fact, the antibodies that the VGS: Soumya, should women get vaccinated
mother has can go through the breast milk to the baby and when they’re menstruating?
may only serve maybe to protect the baby a little bit. But
there’s absolutely no harm. It’s very safe. And so women who Dr. SS: So, there is nothing scientifically to really come in the
are breastfeeding can definitely take the vaccines that are way of a menstruating woman taking the vaccine, apart from
currently available. the fact that, you know, she may feel a bit tired, but if that’s
the date on which you have a vaccine appointment and you
VGS: Soumya, what about women who are happen to have your periods, there’s absolutely no problem
pregnant or are planning to get pregnant? in going ahead and getting the vaccine.

Dr. SS: Yeah, that’s really important because pregnancy, of VGS: Soumya, we hear a lot of misinformation
course, is a very special situation because we are concerned about vaccines and fertility and infertility. Could
about the health of the mother, but also about the health you please explain the science behind this?
of the foetus, the unborn child. And so any drug or vaccine
that is administered during pregnancy, we always take spe- Dr. SS: Yes, it’s a common myth. And I should start by saying
cial care to make sure that, you know, there is no potential that there is absolutely no scientific evidence or truth behind
safety concern or any adverse event. In the case of COVID, this concern that vaccines somehow interfere with fertility,
we know that pregnant women are at higher risk of getting either in men or in women, because what vaccines do is
severe COVID and also at higher risk of delivering a baby they stimulate an immune response against that particular
prematurely. So, in situations where there is a lot of COVID protein or antigen of that virus or bacteria. So in this case,
transmission in the country and a woman is exposed to it, or the COVID vaccine stimulates both antibody response and a
if she’s in a profession like a health care worker or a front- cell mediated immune response against the spike protein of
line worker where she’s at especially high risk of acquiring the SARS-CoV-2 virus. So, there is no way in which they could
the infection, the benefits of getting the vaccine definitely interfere with the functioning of the reproductive organs in
outweigh the risks, particularly since the platforms that we either men or women. So, I think people can rest assured that
used currently for vaccines are the mRNA platform, inacti- these vaccines in no way interfere with fertility. l

THE PHARMA WORLD 29



INTERVIEW

OGSB has kept our OBGYN specialists
updated in knowledge, skill and
attitude throughout the year

Prof. Dr. Ferdousi Begum As the president of OGSB, please Commonest gyanecological prob-
Professor tell us about the role of OGSB in lems are menstrual disturbances, in-
Dept. of Obstetrics & Gynaecology, overall maternal and neonatal fertility, different types of infectious
Ibrahim Medical College and BIRDEM health system of our country. diseases and tumours of reproductive
Hospital, Dhaka. organs including cancers.
As-salamualikum.
President, South Asian Federation of Obstetrical & Gynaecologcial Society The times during labour and delivery
Obstetrics & Gynaecology (SAFOG). of Bangladesh (OGSB) has been es- is very daunting already and
tablished in 1972. It started working COVID-19 poses extra challenges.
President, Obstetrical & Gynaecologi- with management of ladies who were What is being done to protect the
cal Society of Bangladesh (OGSB). survivor of liberation war. patients from COVID -19 and what
is the protocol when the mother is
President, Gestosis Society, Bangla- It has about 2200 members of 16 tested COVID positive, in terms of
desh Chapter. branches. OGSB is working relentlessly childbirth and postpartum care?
covering all aspect of women’s, mater-
Member, SEAR-TAG, Women’s and nal, adolescent, girl child and newborn Yes, our already burdened health care
Children’s Health, WHO. health including reproductive health system are challanged by Covid-19.
of the country. We work covering all First: The priority of the health care
aspect their lives including health system has been shifted totally to
and rights. We work closely with Gov- the care of Covid-19 patients. So in
ernment, development partners, In- many places the services for mater-
ternational & National NGOs, private nal & newborn health like many other
organizations and other professional branches of medicine has suffered
bodies. We cover clinical care (preven- during the first stage of the disease.
tive & curative), advocacy, awareness
raising, policy making, interventions, OGSB, together with Government,
empowerment of women & girl child, clinicians and development partners,
public health, data information gen- developed message including draft
eration and many others. We work in leaflet & posters of general people
unison with all relevant health care and service providers. For patients we
providers and allied forces. developed message on how to pre-
vent Covid-19 and what to do when
As an eminent Gynaecologist one is infected with Covid-19.
of the country, what in your
opinion, are the most common A person whether infected with
Gynaecological disorders Covid-19 or not should always main-
prevalent among our women? tain the general rules. If a pregnant
patient is infected : not to panic, most
Common obstetrics problem are com- of the patients has only mild symp-
plications of pregnancy, labour and de- toms, remains in good health. So one
livery such as pre-eclampsia, eclamp- has to consult doctor, stay home in a
sia, Diabetes in pregnancy, Excessive separate room, take good food and
bleeding during pregnancy, delivery maintain healthy life. If your visits to
and after delivery and different kind of hospital are due now, wait for 2 weeks
infection. In addition there are compli- till you are well. You can avail telemed-
cations of abortion related issues and icine. But in case of emergency, visit
complications of early pregnancy. to a hospital where care for Covid-19

THE PHARMA WORLD 31



INTERVIEW

patients are available. We will deliver When a woman is rarely IVF. Elderly PCOS patient needs
you carefully with all pre caution. good contraception with oral pill for
pregnant, she has the right birth control and regulating regular
After childbirth you should remain cycles. PCOS patients at higher risk
isolated in a separate room, wear to be looked after during of diabetes, cardiovascular diseases,
mask, can breastfeed and nurse and obesity related diseases and cancer
take care of the child, unless she is and after the pregnancy of lining of uterus (endometrial can-
severely ill, when the baby is suffering cer). So they should take proper treat-
you can keep the baby at a distance and during the delivery. It ment, always lead healthy life style
of at least 6 feet and can remove the and keep in touch with doctors.
mask. For any emergency, you should means that the husband,
contact your doctors/service provid- Prevention of PCOS
ers or go immediately to hospital. family and the society If we analyze, we will see that girls are
Doctor may advice you to take tel- suffering more of PCOS in recent time.
emedicine services as required. have the responsibility, so The apparent cause is unhealthy life
style: lack of physical movement &
We, OGSB has kept our OBGYN spe- that she can avail all the junk food including sweetened car-
cialists updated in knowledge skill and bonated drinks.
attitude throughout the year through facilities and safely deliver
web based and in-person training, The playground in the school
dissemination of information, confer- the baby and lives happily. premises and in residential areas is
ence, video, guideline development a rarity. Especially for the girls. Their
and boosting up psychologically and special measure before and during lives are confined from school bench-
providing encouragement and various pregnancy. The success rate varies es to computer or television. Young
forms of support. depending on different factors av- stars used to take too much fast food
erage success rate is around 30%. & sweets/ice cream/cakes.
What are the elements that Chance of multiple pregnancy such
constitute high risk pregnancy? as twins and triplets are more in IVF To Prevent PCOS We have to change
What measures can be taken pregnancy. Other risks are similar to a our mind-set and make ourselves
to manage and prevent normal pregnancy. But as these group move and eat natural foods and
such complications? of women have higher age, so age re- maintain optimal weight according to
lated complications are high. the height. Though normal weight and
High risk pregnancy is a pregnancy lean woman/girls can have PCOS but
where the mother and the baby is at a Disorders like polycystic ovary obesity increases the chance.
higher risk than those who are not at syndrome (PCOS) and anovulation
that much risk. Examples are Diabe- due to hormonal imbalances are the Bangladesh has recently
tes, hypertension, or any other severe leading cause of infertility in women. celebrated International Day to
disease or pregnancy complications. How are they treated? Is there any End Obstetric Fistula. It is one
way to prevent such disorders? of the most serious and tragic
For prevention, the best way is to injuries that can occur during
maintain a healthy life style with good Yes, PCOS is a common cause of in- childbirth. How can it be prevented
nutrition and exercise to keep your- fertility in women. Patients of PCOS and treated? What can be done
self fit. We should avail pre pregnancy may present with different problems nationally to rehabilitate women
counseling to detect and treat any dis- at different ages. Adolescents/Young suffering from obstetric Fistula?
ease if present and treat those before girls suffer from irregular menstrua-
becoming pregnant. Similarly all preg- tion, acne, excessive hair grown, obe- Yes, Fistula are extremely tragic con-
nant women should come for regu- sity, blacking of skin. They are treated sequence of ill managed delivery.
lar antenatal checkup from the very with advice for life style modification It causes immense suffering of the
beginning so that we can advise for including healthy diet and regular ex- women and the families.
many preventive measures to avoid ercise different medication including
many of these high risk of pregnancies. metformin, cosmetic surgery, laser May 23, was the ‘end fistula day’. In
application and weight reduction. order to prevent fistula we need to be
Is an IVF pregnancy considered extremely careful. Obstetric fistula is
high risk? What are the risks and In adults, infertility is an additional an example of violations of human
success rate of the procedure? problem-which need special treat- rights of women.
ment such as ovulation induction;
IVF pregnancies is considered as a When a woman is pregnant, she
very special situation and needs has the right to be looked after dur-

THE PHARMA WORLD 33

INTERVIEW

ing and after the pregnancy and dur- All women should get proper nutri- cording to World Health Organisation,
ing the delivery. It means that the tion, education and power for deci- to keep mother and baby safe, at least
husband, family and the society have sion making and opportunity for good 5 – 15 % deliveries have been done by
the responsibility, so that she can work. So that, all get proper antenatal Caesarean section. It is less than that;
avail all the facilities and safely de- care and hospital delivery or delivery there are increased death and dis-
liver the baby and lives happily. For by skilled health attendants. abilities of mother & babies.
many reasons if the women is short
stature (may be due to malnutrition Unnecessary C-Sections has In case where the mothers & ba-
or family reason) or young age (her become a major public health bies’ lives are threatened, especially
baby has not rotated properly) there issue in Bangladesh. Why is this in high-risk pregnancy many more
may be mismatch and baby’s head happening and what can be women may need caesarean section
cannot come down. Grown enough) or done to prevent such crisis? to keep both safe. Once the women
the baby is big or not rotated properly have caesarean section, in next deliv-
during childbirth; these may result This trend has overshoot now for ery she is usually undergone caesar-
into non progress of labour or ob- several reasons: women and fam- ean section again.
structed and prolonged labour. Due to ily sometimes wants to avoid labour
prolonged pressure of the hard bones pain, which is the most severe form of In Bangladesh, in 1980’s maternal
of baby’s head and women’s pelvic pain in the world and it may take 8-12 mortality was as high as 580 per lac live
bones, soft tissue of urinary bladder hours to tolerate this severe pain. So, births: Caesarean section was very low.
and rectum is so much pressurized many women and their family want So, there was a movement for increas-
that blood supply stops. to avoid labour and thinks caesarean ing hospital delivery and awareness
section is less hazardous. raising so that women and family are
As a result, the tissues get rotten not afraid of this life saving measure
and that develops hole in the passage Labour is complicated procedure; of Caesarean section. Somehow now a
of urine & stool. There is no way to condition of the mother and especial- day’s caesarean section becomes un-
control urine as it is produced continu- ly baby may become worse and the necessarily high. Caesarean section is
ously. The acidic nature of urine burns baby may die inside the uterus – so a major operation and carries all the
the legs of women, they remain con- many a times family does not want to risk of danger to mother and baby. To
tinuously wet and smelly with smell of take risk. and due to increased blames keep mother and baby safe we should
urine. Many a times she cannot hold. of health services providers and liti- strike a balance and optimize.
gation for death and disability of the
So, they have to remain in home; baby, doctors, nurses & midwives do Equal access to fertility care remains
they cannot come out; they cannot do not want to take much chance or re- a challenge for low and middle-
their household work; cannot main- sponsibility. Lack of adequate number income countries. What can be done
tain conjugal life or child bearing. So, of competent health workers in this to increase the affordability and
there are totally outcast and cannot field and lack of adequate machiner- equitability of assisted reproduction
earn money and become dependent ies & supplies to look after the baby technologies (ART) in our country?
on father or brother. They even have during labour are important factors.
to be living with arrivals. But this is These reasons result in increased rate Fertility care is expensive in all coun-
totally preventable. of casearean section worldwide. So, tries of the world. It is technology de-
this has to be taken care of by aware- pendent, needs higher training and
If fistula occurs, it is curable by ness, resulting in respectful mater- expensive equipment, highly trained
surgery by the fistula surgeons. Gov- nity care, adequate manpower, their specialized manpower and expensive
ernment voluntary workers has devel- proper training and refresher training. medication. In high income country
oped awareness raising program for Supporting them with proper equip- it is not a problem. But in low- and
prevention and treatment of obstetric ment and supplies. Proper supportive middle-income countries it will al-
fistula and trained expert fistula sur- supervision is important. Mother & ways remain a challenge because pri-
geon, fistula care centres and reha- family has to be understating of the ority remains elsewhere (malnutrition
bilitation centres for this unfortunate situation and cooperation with the infection diseases, deaths, disabili-
group of women. These centres are health service providers. Natural child ties). Due to competitive priority, Govt
established in Dhaka Medical College birth under close supervision in a hos- cannot provide adequate support to
and other big medical college hospi- pital by competent birth attendant is these services. In our country it has
tals. All the babies of these women always safe and better. developed in Private sector with Per-
are born dead. The treatment of this sonal Interest. It is developing slowly
condition is to deliver these women Caesarean section is a life saving in public sector parallel to our eco-
by caesarean section. So that the measure for mother & the baby. Ac- nomic development. l
mother & baby remain safe.

34 THE PHARMA WORLD

INFODEMIC

INTO THE INFODEMIC

Countering COVID’s medicine myths

THE WORD “VIRAL” entered com- that included chloroquine phosphate, ply disseminating correct informa-
mon language in recent years among other ingredients listed on tion. In general, the success of fake
to indicate a piece of communi- the label. Another, broader conse- news seems to be based on commu-
cation that, regardless of its format quence was the depletion of stocks, nication that uses simple language,
(written, graphical, verbal, musical, resulting in a shortage of drugs for often with strong graphic or photo-
or video), quickly spread to a large patients who relied on it for conven- graphic elements, which influences
number of people, generally by so- tional indications, such as lupus and people by leveraging frustration and
cial media sharing. The 2020 COVID-19 rheumatoid arthritis. In South Amer- stimulating resentment. This strategy
pandemic has not only made us re- ica and (even in Bangladesh), one aims to develop negative empathy
discover the original meaning of viral, of the protagonists of the infodemic towards pro-vaccine antagonists. But
but also elevated the concept of viral was ivermectin, a medication used for empathy can also be a powerful tool
communication to what we could call parasitic infections, easily available to counter misinformation and help
an “infodemic”. The infodemic bears in pharmacies and commonly used communicate corrective information
the pandemic’s characteristics of for veterinary treatments. A poten- to the public. Testimonials from those
speed and a huge number of people tial efficacy for ivermectin had been harmed by bad information and dan-
reached, but adds an amount of infor- postulated, but at concentrations that gerous behaviours can be used to
mation of unprecedented magnitude. could only be reached in humans at help spread responsible information.
Indeed, a good percentage of the viral the cost of severe neurological and
information has concerned the drugs liver toxicity. On the other side of the WHILE COUNTERING MISINFORMA-
and other potential treatments for the coin, the infodemic has also jeopard- TION, pharmacovigilance must also
new disease, finding fertile ground in ised the required use of drugs where continue its primary role. In a pan-
a frightened population, possibly in- concerns have been raised about a demic situation where extraordinary
fluencing their behaviour. possible increased COVID-19-related speed is required, we still must en-
risk. For example, in the case of cer- sure, with our usual scientific rigour,
SOME OF THE MOST SERIOUS con- tain antihypertensive drugs, some the safety of drugs used in COVID-19
sequences were observed in the regulatory agencies felt the need to treatment and prevention. This in-
first phase of the disease during the specifically inform and reassure pa- cludes monitoring patients receiv-
second quarter of 2020, when uncer- tients and urge them not to suspend ing existing medicines usually used
tainty and panic reached their peak. life-saving treatments without medi- in other indications as well as those
People had begun to look with hope cal supervision. receiving completely novel and some-
at every treatment highlighted on the times complex treatments, such as
web, without necessarily understand- THE MOST RECENT WAVE of the in- antivirals, monoclonal antibodies,
ing the scientific evidence support- fodemic is focused on new vaccines. convalescent plasma and, last but not
ing its use and without distinguishing The speed with which these vaccines least, vaccines. The simple promotion
between preventive use in healthy were developed can easily be per- of adverse reaction reporting systems
subjects and treatment in sick ones. ceived by many people to be synony- could be an effective approach to raise
The most emblematic case was that mous with superficiality in controls awareness of the safe use of drugs in
of chloroquine/ hydroxychloroquine. compared to a standard situation. the population, and any clear, correct
A much-criticised study with many This misunderstanding is fuelled by information we produce can be lev-
methodological limitations, con- some anti-vaccination and other ge- eraged by other health professionals
ducted in France on a small popula- neric disinformation sources in all in their communications. Whatever
tion, had reported some benefit of media and must be fought not only the scenario, it is certain that phar-
these drugs for COVID-19 patients. In with correct information, but also macovigilance will continue to have
the United States, the products were with transparent monitoring strate- an essential role in public pandemic-
promoted by social communicators gies of immunised subjects. Unfortu- related communications. l
and opinion leaders to such an extent nately, experience teaches us that it
that a healthy man, trying to protect is very difficult to change dangerous Written by Marco Tuccori. He is the Phar-
himself from infection, died after in- behaviours based on deeply rooted macovigilance Manager of Unit of Adverse
gesting a fish tank-cleaning product beliefs or political affiliations by sim-
Drug Reactions Monitoring at University
Hospital of Pisa. Source: Uppsala Reports

THE PHARMA WORLD 35



INTERVIEW

quality care and optimum safety is ensured
By adhering to ogsb guidelines & protocols

Prof. Dr Farhana Dewan As the new president of OGSB, opinion, are the most common
President (Elect), OGSB, Dhaka please tell us about the role of Gynaecological disorders
OGSB in overall maternal and prevalent among our women?
Infertility Specialist & Laparoscopic neonatal health system of our
Surgeon. country. Could you please enlighten Among the gynaecological problems,
us about your future projects? different types of infections, tumours
Professor & Head, Dept of Gynae & and malignancies are common in our
Obs, Ibn Sina Medical College Hospital At present, I am the president elect of country. Among the tumours, uterine
OGSB, which means by the end of next and ovarian fibroids are very com-
two years, I will be the next president mon. Among the infections, there are
and takeover the operations of OGSB infections of the uterus, infections of
Insha’Allah. I am working as part of the cervix, infections of the vagina
the Executive committee with other etc. Common malignancies include
members also. As OGSB has got an ovarian carcinoma, uterine (endome-
extensive array of work which are be- trial) carcinoma, cervical cancer etc.
ing done by itself and in partnership
with the government and other devel- The times during labour and
opment partners of the country. Our delivery is very daunting already
main focus is the development of the and COVID-19 poses extra
women’s health in our country. For this challenges. What precaution
reason, we have chalked out different and measures do you suggest
programmes to help us accomplish our in handling such vulnerable
activities in development of maternal patients during the pandemic?
health as well as newborn health.
COVID-19 is a new virus, a new dis-
OGSB has several sub committees. ease. When the pandemic broke out,
These subcommittees perform their we, the obstetricians became very
activities individually. Besides these, worried thinking about the women in
there are some task forces by which our country especially the pregnant
OGSB performs their work. When women. So, we immediately sat to-
OGSB works with the Government or gether in the society and developed
the developing partners, we focus on protocols and guidelines. This is the
very important issues like reduction national COVID-19 guideline that we
of maternal mortality by addressing have prepared for pregnant women
different conditions and complica- and the second edition has already
tions of the mother. Besides that, come out in June 2020. The guideline
we work on different other issues of prioritises the safety for both the pa-
women health such as maternal mor- tients and the service providers. As
bidities like fistula and other obstet- you know initially, we have lost many
ric abnormalities, we manage the pa- doctors who were serving the pa-
tients according to our protocols and tients in the frontline during the first
guidelines. Our guidelines and proto- wave of COVID-19, as there was a lack
cols are followed all over the country of guidelines on how we can protect
by our members. By adhering to these ourselves as well as the patients. Now
guidelines, quality care and optimum we have the protocols which is known
safety is ensured for the mothers. as the IPC (Infection Prevention and
Control) which is being practiced in
As an eminent Gynaecologist all places and by all the personnel the
of the country, what in your

THE PHARMA WORLD 37

INTERVIEW

patient and service providers alike. large extent compared to 15 years ago, strual periods as well as excessive
PPEs, masks etc are provided and when there was only a handful and IVF heavy bleeding. They develop cysts or
proper hand and respiratory hygiene facilities. Now there are many centres chocolate cysts along the uterine lin-
is maintained. The delivery rooms are in Bangladesh for treating this condi- ing and the cysts break and bleed with
disinfected and kept at negative pres- tion. There are many fertility special- each menstrual cycle. If a  chocolate
sure to contain infections. ists now. Also, the non-specialist ob- cyst ruptures, it can cause severe, sud-
stetricians or gynaecologists are also den abdominal pain. Fertility prob-
Infants born to mothers with sus- expertly providing such treatments. lems also may develop in women of
pected, probable, or confirmed COV- The fertility facilities are available in reproductive age. That’s why we need
ID-19 infection, are fed according to both private and public hospitals. to go for early diagnosis and manage-
standard infant feeding guidelines, ment. Very recently, we have formed
while applying necessary precau- Regarding prevention, there is an Endometriosis Society which deals
tions for IPC such as respiratory hy- nothing much special. We must be with development of protocol for
giene (for example, use of a medical very careful during delivery and dur- management of endometriosis and at
mask), perform hand hygiene before ing the post-abortion care. We have to the same time conducting seminars to
and after contact with the child, and make sure that there is no chance of raise awareness about the issue.
routinely clean and disinfect surfaces. infection. Regarding ovulation induc-
Thus, the mother, the newborn and all tion, it is a fertility treatment that uses Regarding PCOS, it occurs due to
healthcare providers are well protect- medications. As far as advanced treat- hormonal imbalance, insulin resist-
ed and safety is ensured. ment is concerned, The first step is to ance and as a result, anovulation
counsel the couple regarding men- occurs. This is also a major problem
What are the elements that strual cycle and time of intercourse. If which results in infertility or subfer-
constitute high risk pregnancy? even six months or a year, the patient tility. We are addressing this issue
What measures can be taken does not conceive, we opt for ovula- aggressively as well. We have formed
to manage and prevent tion induction. After that even for di- the PCOS Club in the country very re-
such complications? agnostic purposes or to correct any cently. We are developing protocols
anatomical abnormalities, we per- for management of PCOS customized
We mainly focus on two issues in form laparoscopy. After that we opt to adolescent girls and women of our
high-risk pregnancy. When the preg- for the advanced procedures like IVF, country. We are promoting activities
nant woman has hypertension, obe- which is In-vitro fertilization. We have in many schools, involving the teach-
sity and/or diabetes, it is considered many specialized centers in our coun- ers and students and educating them
high risk. Early (teenage) pregnancy try, mostly in private sectors. Because about the gynecological issues.
and late age pregnancy are also only a few public hospitals have the
considered high risk. Other risks are facility as the procedure is very ex- Unnecessary C-Sections has
bleeding complications like antepar- pensive. In our country, cryopreserva- become a major public health
tum and postpartum hemorrhage. tion is also done- such as freezing the issue in Bangladesh. Why is this
embryo or the ovum. For example, if happening and what can be
The high-risk patients should be a woman has cancer, we can pick her done to prevent such crisis?
taken care of more vigilantly. Foetal ovum and freeze it before she starts
movement/position should be moni- chemotherapy. After her treatment is I would like to rephrase the term “un-
tored regularly. If bleeding problem complete, we can start the treatment necessary”. We can say optimizing the
persists, it should be managed ag- for infertility. So, all these facilities high rate of the caesarean section.
gressively. The patient should fol- are available in our country. Further Women who need caesarean, should
low-up regularly. Blood pressure and advanced techniques like GIFT, ZIFT have caesarean. We have taken a step
blood sugar level should be regularly (Intra-Fallopian Transfer of Gamete or in this respect, as per Robson Clas-
monitored, controlled, and main- Zygote), Ovary reconstruction etc., are sification, to classify women who are
tained to avoid progression to preec- available in advanced countries. undergoing caesarean, why are they
lampsia, eclampsia or diabetes. going through caesarean. It is global
Would you enlighten us about some standard for assessing, monitor-
Where does Bangladesh stand common disorders that women face ing and comparing caesarean sec-
as far as prevention, diagnosis like endometriosis and PCOS? tion rates. Robson classifies them in
and treatment of infertility 10 groups based on their obstetric
is concerned, compared to Endometriosis  is a disorder where characteristics (parity, previous CS,
the advanced countries? young adolescent girls and women gestational age, onset of labour, foe-
of reproductive age  experience  very tal presentation, and the number of
Thanks to continued advances in re- painful cramping  during their men- foetuses). For example, if the woman
productive medicine, fertility treat-
ment in Bangladesh is available in a

38 THE PHARMA WORLD

INTERVIEW

had previous c-section, she should In our society, we are promoting country. If we can standardize the prac-
have a c-section. If it is a primigravida evidence-based care for the women, tice of these protocols and guidelines
(first-time pregnant), we have other by following the labour room proto- in all the centres meticulously, this
options than caesarean- we promote col, WHO guidelines, NICE guidelines will be the first step for evidence-best
vaginal birth in this case. We should and other international guidelines. practice. Also, as we are having routine
promote healthy vaginal birth by pro- exchange of views and ideas with the
moting respectful maternal care and What does the future speakers from advanced countries and
judicial use of Oxytocin for induction hold for evidence-based applying what we’ve learnt to our pa-
of labour. We should train our fellow obstetrics in Bangladesh? tients for better outcome. We are regu-
obstetricians about the best practices larly conducting research with BMRC,
of not going for urgent caesarean and I am very optimistic. We are trying WHO and icddr’b. These researches
to rather try to wait for vaginal deliv- our best. Evidence based means that are contributing to development of
ery. I would also like to add that we the management for gynaecological management protocols of the patients.
have developed a cater of midwives. problems like eclampsia, postpartum For example, advancement in manage-
It was the dream of our Prime Minister hemorrhage, antenatal care etc. are ment of infertility, pelvic infections,
and it was also our dream as obstetri- done by combining clinical evidence better management of diabetes and
cians, that we would have assistance from research and experience which other pregnancy related complications.
of skilled birth attendants in the de- are best for the individual patient. We
livery room. The skilled mid-wives are on our way to advancement. As you Thus, we are continuously improving
would take over the delivery process know, we have protocols and guide- our obstetric care. I am hopeful that
and ensure safe vaginal delivery. lines which are followed by our ob- within five to six years, we will improve
stetricians and gynaecologists of our greatly in evidence-based care. l

Worth Knowing About

Iodine during Iodine-containing food supple- seaweed, a poorly balanced diet,
pregnancy: ments have no proven benefits for and certain drugs. Iodine is present
Supplementation pregnant women, and  can  be  dan- in iodinated table salt, seafood, in-
should not be gerous for the unborn child. cluding seaweed and fish, and eggs
systematic and dairy products, especially when
Iodine plays a major role in thy- produced through conventional
roid function. Dietary intake of io- rather than organic farming.
dine is sometimes considered in-
adequate in Europe, but there are Most of the multivitamin food
no high-quality data demonstrating supplements marketed for pregnant
the value of systematically recom- women and sold in community phar-
mending iodine supplementation macies deliver high iodine doses,
for pregnant women who are eating sometimes higher than the recom-
a balanced diet. mended allowance. Some iodine food
supplements sold without a prescrip-
Excessive iodine intake during tion, especially over the internet, con-
pregnancy, before the fetus’s thyroid tain up to 50 times more iodine than
has fully matured, can cause  hypo- the recommended daily allowance.
thyroidism in the unborn child. The
clinical consequences in affected It is helpful to inform women of
children are hypothyroidism, goitre, childbearing potential and women
impaired intellectual developmental who are already pregnant that ex-
and hearing loss. cessive doses of iodine-containing
food supplements are dangerous
The recommended iodine allow- for their unborn child. Systematic
ance is not very different from a supplementation should be avoid-
dangerous level of intake. ed, because sufficient daily iodine
is provided by a balanced diet. l
It is advisable to check a preg-
nant woman’s iodine intake, includ- Source: Prescrire
ing that from food supplements,

THE PHARMA WORLD 39

IN CONVERSATION

knowledge of accounting, finance, economics,
and psychology is a must for a marketeer

Dr. E.H. Arefin Ahmed Please let us have the overall All these reduced the demand for
General Manager, Marketing scenario of the pharma medicine specially the acute care
Incepta Pharmaceuticals Ltd. market in Bangladesh. medicines. Chronic care sector has
been stable but we are not experienc-
Medicine is a very important com- ing expected growth. However, there
ponent of healthcare system and has been increase in demand for
Bangladesh has been very successful medicines associated with COVID-19.
in producing all kinds of medicines. Medicines like Remdisivir, Favipiravir,
In terms of technological excellence Dexamethasone, Ivermectin, Doxy-
since 1950s the pharmaceutical sec- cycline, hand sanitizers, antihista-
tor has grown into one of the most mines, paracetamol etc. increased
promising and successful manufac- in demand. Thus, we are not looking
turing industry in the country. What at the growth. We are confident that
is more, our companies are the most once the situation improves, we will
technologically advanced producers be able to bounce back.
of pharmaceuticals among all other
least developed countries (LDCs). The What changes did you make
industry has to its credit a convincing in the marketing strategies to
record of accomplishment in terms of suit the pandemic norms?
both quality and quantity. As per 1st
quarter 2021 report from IMS health, COVID-19 is unusual situation. In a
local market size is over $3 billion crisis subjected to rapid change, mar-
annually and local companies meet keting team need a proactive plan
more than 97% of this local demand. to adjust and adapt how they lead,
According to Export Promotion Bureau speak to their customers and manage
(EPB), Bangladesh’s medicine exports their brands.
registered a 4.49% rise to $135 million
in FY20, which was $129 million in the First, we had to take care of our peo-
previous year. ple. Our management instructed us not
to take undue risk with our people. Be-
How do you evaluate performance sides, Incepta took care of its employ-
of the pharma industries ees affected by COVID-19. From testing
during the pandemic? for COVID to hospital admission, we are
with our people all the way through.
Like any industry, pharmaceutical
sector has been affected by COVID-19. Product detailing is an integral part
The growth target that we set for our- of pharmaceutical brand promotion.
selves were hard to meet. During the Our marketing and sales could not
early days of COVID, we faced some visit the doctors as frequently as be-
issues related to smooth production fore the pandemic. Thus, we shifted
and distribution of medicine. Due to our promotion to web based plat-
lock down, movement was restricted forms using emails, WhatsApp, Viber,
at that time. On the other hand, num- facebook page, you tube channels
ber of non-COVID patients in various etc. Medical education is a continu-
hospitals and clinics had significantly ous process. Due to pandemic, there
reduced for fear of infection. Minor were restrictions in arranging live
medical procedures, surgeries and seminars. Thus, we shifted our focus
other interventions that require hos- to webinars so that CMEs can be ar-
pitalization has been put on hold. ranged unhindered. We are constantly
communicating with our doctors to
fulfill their needs of various safety

40 THE PHARMA WORLD

IN CONVERSATION

equipment like masks, gloves, gowns, of marketing team. A marketer needs in pharmaceutical industry. Various
face shields, hand sanitizers etc. to be skilled in forecasting, negotia- people define that boundary in their
tion, prompt decision making in any own ways, which is up for debate.
What is the secret of your situation, creativity and so on.
success in becoming the major Do you get adequate support
player in the market? From the marketing point of from Bangladesh missions
view, do you stress on quality abroad for exporting medicine?
Since its inception in 1999, Incepta or selling technique for more
Pharmaceuticals established itself as prescription generation? They are doing but we believe Bangla-
one of the leading pharmaceutical desh missions could do more abroad
company in Bangladesh. The business Incepta has developed expertise in for exporting medicines. They could
strategy of Incepta Pharmaceutical is finding gaps in various therapeu- lobby for our industry to health reg-
to offer high technological products tic areas. We are meeting the unmet ulatory agency of the host country.
with an aggressive marketing and demand of the market by launching The high commission of Bangladesh
sales approach. Over the years, In- various generics for the first time in organized a Bangladesh Trade Invest-
cepta Pharmaceutical has established Bangladesh. This first mover advan- ment Expo in Thailand in 2016. Local
its technological superiority and ex- tage has been giving us edge over product including pharmaceuticals
pertise by reverse engineering drug our competitors. Maintaining qual- was highlighted to Thai people in-
products better than its competitors’. ity is our highest priority. Quality is cluding policy makers, investors etc.
Moreover, it is the only pharmaceuti- built into our products and we do not This type of trade expos could open
cal in Bangladesh that has separate compromise with it. Our strong qual- doors to new possibilities for local
Biotech, Vaccines, Hormonal products, ity standards as well as our innovative pharmaceutical industries.
Hospital Items, Diapers etc. in addition and diversified products range has
to its generic manufacturing facility. made us one of the market leaders. Personally, what are the secrets
of your success in your career
After consolidating the positions Which of your brands are market in reaching the very high
in domestic market, Incepta pharma- leaders? Do you think that position where you are now?
ceutical is trying to explore markets sometimes brand craze stands in the
in the global landscape. It exports way of choosing the best quality? Thought of being successful vary from
generic finished formulations in dos- person to person. Success in one’s eye
age and bulk form as well as small Many of our brands are market lead- may not be success of my very own.
amount of API. ers like Pantonix (Pantoprazole), Os- From my point of view, I am not fully
artil (Losartan Potassium), Cefaclav successful but so far I am happy with
What essential skills you nurture (Cefuroxime + Clavulanic Acid), Fixo- what I am today. Honestly speaking,
in your marketing team that card (Amlodipine/Atenolol), Omidon there is no big secret of my successful
contributes to your uniqueness? (Domperidone), Maxsulin (Human journey till today other than honesty,
Insulin) etc. Although brand craze sincerity, hard work, dedication and
Many people think that marketing is do exist but it never comes in way absolute passion towards my respon-
all about making ads or conducting of choosing best quality. All leading sibilities that was/were assigned to
just promotional activities. However, pharmaceutical companies main- me. From the very beginning till to-
making ads is only 5-6% parts of all tain the highest quality parameters day, I just tried to follow one motto to
activities of a marketeer. Other than for their product. Doctors choose repay the trust by all means with full
Knowledge about marketing, a mar- the brand that is most aggressive in hearted efforts.
keteer must have the knowledge of the market, but they usually do not
accounting, finance, economics, and prescribe low quality product. Brand How do you evaluate The
psychology at the same time. Because, competition is always there among Pharma World as an effective
he or she needs to understand the the top pharmaceutical companies. marketing tool?
customer insight and their personal
preference to build a marketing con- Can we say the competition in the The Pharma World Magazine is an
cept. Moreover, to make the concept local market is healthy and ethical? effective marketing tool for product
into reality, he or she needs to analyze advertisement. The best part of the
the feasibility, forecasting, profit anal- We always do business in a clear and magazine is information on all the
ysis, pricing strategy and the more im- transparent way. Negative promotion newly launched drugs in the market.
portantly, is communication. Ability to is not appreciated inside or outside We can get updated information on
synchronize all the activities of each of the company. You need to define pharma industry as well as health
department is also an important skill the boundary of ethical promotion care sector from the magazine. l

THE PHARMA WORLD 41



INTERVIEW

no mother should be refused from any
hospital & all hospitals should provide
care for covid positive mothers

Prof. Dr. Rowshan Ara Begum As an eminent Gynaecologist cians, proposed to the Govt. that no
Former Head of the Dept. , Obs. & of the country, what in your mother should be refused from any
Gynae, Holy Family Red Crescent opinion, are the most common hospital and all hospitals should pro-
Medical College & Hospital Gynaecological disorders vide care for the positive mothers.
Past President, OGSB prevalent among our women? Healthcare providers took it seriously
Councillor, BCPS & BMDC and ensured the care for the delivery
Country Representative, AOFOG,SAFOG In case of reproductive age group, so and post-Partum care.
Focal Point, Mentorship many studies show pregnancy related
Program,UNFPA complications- unsafe abortion, now Maternal Death were not signifi-
Member, National Advisory Technical in 1 out of 6 patients have infections, cant but those who were with other
Committee, COVID-19 yeast infection, other utero vaginal co-morbidities and aged, suffered
prolapse, Abnormal uterine bleeding, with complications.
Pelvic Inflammatory Disease, Fibroid
Uterus, Sexually Transmitted diseas- What are the elements that
es, Ovarian Tumor & Endometrioses. constitute high risk pregnancy?
What measures can be taken
In case of malignant condition- to manage and prevent
cervix cancer. such complications?

In case of adolescent girls-Abnor- Pregnancy under 17 and over 35, are
mal Uterine Bleeding, PCO, Menstrual considered high risk.
Disorder- Dysmenorrhea.
Being Pregnant with multiple ba-
The times during labour and delivery bies, history of complicated pregnan-
is very daunting already and cies such as- Preterm Labor, History
COVID-19 poses extra challenges. of C/S, BOH, Heart Disease, Epilepsy,
Please tell us, in brief, how the Kidney Disease-sensitization, Obesity,
pandemic has changed the norm PE, Gestational Diabetes & Family his-
in delivery and postpartum care. tory of genetic complications.

Pandemic all of a sudden posed on us, To prevent such cases, avoid ear-
an extra challenge. But we faced and ly marriage and pregnancy & avoid
overcame the challenges. Initially, due pregnancy after 35. Lifestyle is to be
to fear and panic situations- home changed; folic acid, calcium, iron &
delivery was encouraged among other micronutrients should be taken.
common people and the number in- Stay away from risky substances such
creased. But immediately after two as- Tobacco, Alcohol and illegal drugs.
months, facilities were reorganized
with human resources and logistics. Disorders like polycystic ovary
Medical facilities have safety meas- syndrome (PCOS) and anovulation
ures in place to protect to patients due to hormonal imbalances
and stuffs from infection. Triage sys- are the leading cause
tem was started to screen the patients of infertility in women. How are
and identify positive cases and ensure they treated? Is there any way
that appropriate PPE is available. to prevent such disorders?

In our country, some hospitals PCOS itself causes hormonal imbal-
were designated for COVID positive ance, produce higher than normal
patients for delivery and C/S. But af- amounts of male hormone, this skips
ter the second wave, we, the obstetri- menstrual period and makes it hard-
er for them to get pregnant. It causes

THE PHARMA WORLD 43



INTERVIEW

hair growth on the face and body and many complications in pregnancy Management: Obstetricians aimed
baldness too. It leads to diabetes, including Still birth, prematurity, to identify early FGR so delivery can
obesity and Endometrial cancer. perinatal morbidity & cerebral Palsy, be planned according to gestational
Neonatal death conditions in later life age & severity of the condition. Bal-
Treatment: If you’re overweight, diabetics, coronary heart disease and ance of risk and the need for avail-
lose extra weight. Improve cholesterol obesity. ability of services mean that in-
level and blood sugar. volvement of neonatologist in FGR
Causes: Advanced Diabetes, High management is vital post-delivery.
May response in normal menstrual BP, Heart Disease, Infection- Rubel-
cycle, pregnancy and corrects infertil- la, cytomegalovirus, Toxoplasmosis, Unnecessary C-Sections has
ity. If you are diabetic or pre-diabetic, Syphilis Malnutrition & Anaemia, Au- become a major public health
Metformin may help improve Insulin toimmune disease, Smoking, drinking issue in Bangladesh. Why is this
Resistance. Birth control pills help to and abusing drugs. happening and what can be
balance hormone and regulate nor- done to prevent such crisis?
mal menstrual cycle. OCP also helps FGR can be diagnosed by routine
excess hair growth, improve acne and Antenatal examination in the half of C/S is one of the major operations in
decrease cancer. pregnancy- Obstetrics practice which can save the
women’s life, but it should be ration-
For infertility: Induction of ovulation. Fundal height is shorter than ex- alized or optimized.
Prevention: Not entirely possible. pected, USG to see the baby’s size,
Many cases are genetically acquired & blood flow of the umbilical artery If Globally, the rate increase in
tend to run in families. either measure is abnormal, it could developed countries but in most
Role of genes are exactly not clear. mean the baby’s not receiving enough of the developing country, the
Most cases are treated by adapting blood or nutrients of placenta. number is still low and those who
healthy lifestyle including healthy diet, needs it is not getting the opportunity
exercise and maintain ideal weight. Prevention: Preconceptionally en- for this.
couraged a healthy diet, folic acid, op-
What are the complications of timal BMI to achieve best fetal growth. For this, we need respectful qual-
(Fetal growth restriction) FGR? Smoking Cessation at any gestational ity ANC, follow the guidelines of La-
What measures can be taken in age Aspirin modestly reduces the risk bor Room Protocol & evidence-based
terms of prevention, diagnosis of FGR & starts from 16 weeks of the practice & also keep an eye on Rob-
and management of FGR? gestation is recommended. LMWH (Low son’s classification. l
molecular Heparin) can prevent FGR.
Complications of FGR, associated with

THE PHARMA WORLD 45



INTERVIEW

after substantial reduction of maternal mortality

in the last decade to achieve MDG, we

are now targeting to reach SDG

Prof. Dr. Salma Rouf As an eminent Gynaecologist over telephone by availing tel-
Ex. Head of Obs & Gynae of the country, what in your emedicine services where ap-
Dhaka Medical College Hospital opinion, are the most common plicable but need to take at
Professor Obs & Gynae Gynaecological disorders least four in person visits to
Green Life Medical College prevalent among our women? nearby health facilities.
Treasurer, OGSB – Those who are planning for
The most common gynaecological pregnancy, could defer until
disorders prevalent in our women the pandemic situation is un-
are: der control.
– Every healthcare facility should
– Excessive and abnormal vagi- develop infrastructure to deal
nal discharge. with COVID-19 positive as well
as non-infected patients.
– Chronic pelvic pain and other – Triage is to be maintained in
sorts of pain during menstrua- every facility to categorize
tion. emergency patients and to en-
sure optimal management.
– Abnormal uterine bleeding in- – If possible the designated are-
cluding irregularities in men- as to take ANC, pregnancy care
struation in respect of cycle, and child birth and delivery
duration and amount of bleed- areas are to be separated for
ing. COVID-19 positive and non-
COVID patients.
– Genital organ prolapse i.e de- – When dealing with COVID posi-
scent of uterus and other parts. tive patients, the healthcare
providers, patients and accom-
– Failure to conceive. panying persons should take
– Lump in the abdomen etc. proper infection prevention
practices.
COVID-19 poses extra challenges – Management protocols and
during pregnancy and delivery. guidelines are already devel-
What can be done to protect the oped. So, all COVID-19 pregnant
patients from COVID -19 and what patients should be managed
is the protocol when the mother is by maintaining those proto-
tested COVID positive, in terms of cols and guidelines developed
childbirth and postpartum care? by national technical group of
Govt. and OGSB.
Yes, COVID-19 Poses extra challenges
during pregnancy and delivery. We The pandemic has changed
have already faced these challenges. the norm in follow-up of
Remedies are: patients and perinatal care
in general. How effective is
– Raising awareness among the telemedicine in this situation?
health care providers and also
the pregnant patients and their Yes, telemedicine is very effective at
family members for mode of
transmission, personal pro-
tection by wearing masks and
keeping social distance, avoid-
ing travel to crowded places etc.

– Pregnant patients have to take
regular antenatal care mostly

THE PHARMA WORLD 47



INTERVIEW

least for low risk patients by using ble due to multifactorial inheritance vices to these unfortunate pa-
the IT technology. It helps to avoid and pathogenesis. By life style mod- tients which include adequate
journey, exposure and risk of preg- ification specially reducing weight, training to develop fistula sur-
nant patients from being contami- avoiding fatty foods and extra carb, geons and auxiliary stuffs, de-
nated. Telemedicine is also helpful free hand exercise and walking, con- livery of proper services
to formulate when and how the in- trol of impaired glucose tolerance – Rehabilitation and research
person health visits are applicable tolerance and lipid profiles are im- in short capacity building na-
to individual patients. portant. tional interventions like raising
public awareness in mass me-
What are the elements that Bangladesh has recently dia about prevention, financing
constitute high risk pregnancy? celebrated International Day to fistula centre, adequate reha-
Would you describe the End Obstetric Fistula. It is one bilitation in family and creating
most challenging case you of the most serious and tragic job opportunities
have handled so far? injuries that can occur during
childbirth. How can it be prevented Where does Bangladesh stand
There are so many high risk patients and treated? What can be done as far as prevention, diagnosis
and elements are also diverse and nationally to rehabilitate women and treatment of infertility is
multi factorial. Teen age pregnancy, suffering from obstetric Fistula? concerned, compared to the
elderly pregnancy, pregnancy at advanced countries? What steps
too frequent intervals, pregnancies Prevention obstetric fistula includes: do you suggest to improve overall
with previous history of caesarean – Ensuring antenatal care for women healthcare in Bangladesh
delivery, hypertensive disorders of screening of high risk pregnan- and ensure safe motherhood?
pregnancy most dangerous preec- cies susceptible to developing
lampsia, eclampsia, pregnancy with prolonged and obstructed la- Infertility is now becoming a burning
antepartum hemorrhage due lower bour problem in our country. This is the
position of placenta we call it pla- – Meticulous monitoring of la- basic human reproductive right to
centa previa, anemia, diabetics and bour by killed providers to get adequate treatment and oppor-
so many. avoid prolonged labour and its tunities for all options of treatment.
consequences like obstructed
So, there are so many such chal- labour Unfortunately, there are few well
lenging cases I have handled. Preg- – Proper training of midwives equipped centres in our country
nancy with H/O previous cesarean for monitoring labour and SBA so far located in private sectors.
delivery with placenta previa and who are conducting delivery at We need to develop well equipped
PAS (placenta accreta spectrum) home, for timely referral centres with all options for treat-
disorder, abnormal adhesion of pla- – Popularizing institutional de- ment in public sectors also. So far
centa etc. are always challenging for livery I know BSMMU and Dhaka Medical
all obstetricians and dreadful for pa- – Adequate training SBA, mid- College are the only public institutes
tients. wives, nurses and doctors for till now offering composite treat-
conduction of safe vaginal de- ment in separate infertility clinics.
Disorders like polycystic ovary liveries, avoiding harmful pro- We hope that government will take
syndrome (PCOS) and anovulation cedures and practices during appropriate initiative to expand the
due to hormonal imbalances labour scope. We did substantial reduction
are the leading cause – Proper training of doctors for of material mortality in the last dec-
of infertility in women. How are instrumental and operative de- ade to achieve MDG and we are now
they treated? Is there any way liveries in order to avoid iatro- targeting to reach SDG by reducing
to prevent such disorders? genic fistula MMR to 70.
– If patients develop obstructed
Yes, PCOS is the most important, labour, then ensuring quick This is really a challenging target
quite common cause of anovula- hospitalization, proper delivery for us. Our government has already
tion and infertility among the young and prophylactic use of cathe- taken a number of interventions.
women. Treatment options comprise ter for prevention of fistula Together, with our great effort, we
of lifestyle modification, ensur- – Development of fistula centres must ensure safe motherhood and
ing optimal ovulation induction by in local districts and medical reach the target of SDG. It is not safe
drugs according to OI protocols and colleges to provide holistic ser- motherhood only, we have to ensure
less preferable surgical options. Ac- quality women’s health in our Bang-
tually, total prevention is not possi- ladesh. l

THE PHARMA WORLD 49

OBSTETRICS & GYNECOLOGY UPDATE

Neonatal outcome of maternal COVID-19 Immunogenicity of COVID-19 vaccination
in pregnant and lactating people
Emerging data continue to support initial observations
that maternal SARS-CoV-2 infection is not associated The first data on the immune response of pregnant
with a high risk for neonatal morbidity. In a study that and lactating women to COVID-19 vaccination are now
included 92 percent of births in Sweden during the first available. In this prospective study of 84 pregnant, 31
10 months of the pandemic, infants of SARS-CoV-2-posi- lactating, and 16 nonpregnant women who received an
tive mothers had a small increase in the rate of any res- mRNA COVID-19 vaccine, the three cohorts had equiva-
piratory disorder compared with infants of uninfected lent vaccine-induced immune responses, antibody titers
mothers (2.8 versus 2.0 percent). Preterm delivery, which were higher than those induced by SARS-CoV-2 infection
occurred in 8.8 percent of infected and 5.5 percent of during pregnancy, and vaccine-generated antibodies
uninfected mothers, could explain approximately 89 were present in umbilical cord blood and breast milk
percent of the association. A limitation of these data is samples. Although a small study, these data are reas-
lack of information on severity of maternal illness. suring and support our recommendation for COVID-19
vaccination of pregnant and lactating women.
Safety of penicillin skin testing
and challenge in pregnancy Cardiovascular risk profiles in pregnant
people and adolescent offspring
Penicillin skin testing and challenge has typically been
avoided during pregnancy unless penicillin treatment In a multinational cohort study including over 2300
is critical (eg, patients with syphilis), but now there is mother-child pairs, poorer maternal cardiovascular
growing interest in the routine “de-labeling” of patients metrics (as defined by body mass index, blood pressure,
with a history of possible penicillin allergy. In the largest total cholesterol level, glucose level, and smoking) at
study to date of testing during pregnancy, 222 patients approximately 28 weeks of gestation were associated
were referred by obstetricians for outpatient allergy with poorer cardiovascular metrics in offspring exam-
evaluation if they had penicillin reactions that occurred ined at 10 to 14 years of age. Optimizing cardiovascular
>5 years ago; either with features of IgE-mediated al- health in pregnant people may benefit cardiovascular
lergy or uncharacterized reactions. Overall, no serious health in offspring, possibly in part by avoiding adverse
reactions occurred during testing and challenge, and epigenetic modifications in utero.
94 percent of those tested had the label of penicillin
allergy removed. The American College of Obstetrics Fetal effects of maternal
and Gynecology 2020 guidelines for prevention of Group anesthesia during pregnancy
B streptococcal early-onset disease in newborns also
support referral and penicillin skin testing as an option Whether anesthetics administered to the mother
for management of pregnant patients with reported increase the fetus’ risk for adverse neurodevelopment
penicillin allergy. is uncertain, and clinical data are lacking. An obser-
vational study including over 2000 mother/child pairs
Progesterone supplementation of pregnancies reported an association between in utero exposure to
at high risk for spontaneous preterm birth general anesthesia during maternal antenatal surgical
procedures and behavioral problems at age 10 years
The efficacy of progesterone supplementation (PS) for [10]. However, these results must be interpreted with
reducing spontaneous preterm birth (PTB) in high risk caution due to the small number of exposed children (n
pregnancies is controversial because of discordant data = 22), and the possible effects of factors other than gen-
from randomized trials. Now, in a meta-analysis of in- eral anesthesia. This and other evidence is inadequate
dividual participant data from 30 trials (>11,600 partici- to guide anesthetic practice, and necessary surgery
pants), compared with no PS, PS reduced PTB <34 weeks should not be avoided or delayed during pregnancy.
by approximately 20 percent in singleton gestations
with a short midtrimester cervical length or a previous Effect of antenatal corticosteroids on
history of PTB, but not in unselected multiple gesta- neonatal mortality in low-resource countries
tions. There were no clear differences in effect between
vaginal progesterone and intramuscular hydroxypro- Administration of antenatal corticosteroids (ACS) to
gesterone caproate (17-OHPC) and no significant safety patients at risk for preterm birth reduces neonatal mor-
concerns. We continue to suggest 17-OHPC for patients tality when delivery occurs within seven days. In con-
with a previous PTB and vaginal progesterone for those trast to trials in high-income countries, the Antenatal
with a short cervix. Corticosteroids Trial (ACT) reported increased neonatal

50 THE PHARMA WORLD