TPW

&TROPICAL DISEASES FEVER

Volume 14 n No. 4 n july-august 2023 Published by Muhammad Masud. 51, Kalabagan 1st Lane (Ground floor) Dhaka-1205, Bangladesh, Tel/Fax: +88 02 58155677 n Printing: Image Printing & Packaging 3 Purana Paltan, Dhaka. IMPORTANT: Every care is taken to ensure the accuracy of the information given in this journal but no responsibility is accepted for any error and/or omissions. Editor/ publisher is not responsible in any way for views/comments expressed herein. Global Scan 29 WHO Alert 51 Focus on PV 68 Research Update 70 Pharmacovigilance 79 Pharma Quiz 85 Drug Safety 86 Red Alert 87 Case Study 88 Advisor, International Affairs Prof. Dr. Moshe Szyf GlaxoSmithKline & James McGill Professor Dept. of Pharmacology & Therapeutics McGill University Medical School Montreal, Quebec Canada Pharmaceutical Advisor Abu Nayeem Saifur Rahman Medical Advisor Dr. R. M. Samiul Hasan Media Advisor Dr. Sajal Ashfaque Dr. SMG Saklayen Russel Dr. Saleh Mahmood Tusher Editor Muhammad Masud Executive Editor S A Nadeem managing editor Sandip Kumar Saha Associate Editor Humayera Kabir Hana Business Editor Md. Shahjahan Research Editor Prof. Dr. Md. Moklesur Rahman Sarker graphics editor Munir Hussein head of marketing Faisal Ahmmed Marketing Md. Shohag Hossen Circulation Md. Sikander Md. Bashar Computer Graphics Md. Aftabul Islam Production Mati Ar Manush Editorial/Business Office 51, Kalabagan 1st Lane (Ground floor) Dhaka-1205, Bangladesh E-mail: [email protected] Prof. Dr. ABM Abdullah UGC Professor, BSMMU Personal Physician to Hon’ble Prime Minister Prof. Dr. Mohammod Shahidullah Department of Neonatology BSMMU, Dhaka Prof. M.A. Salam Founder President & CEO Urology & Transplant Foundation of Bangladesh Dhaka board of Advisors National Prof. Brig. (Rtd.) Abdul Malik Founder & President National Heart Foundation, Dhaka National Prof. Dr. A K Azad Khan President Diabetic Association of Bangladesh & Chairman Board of Trustees Bangladesh University of Health Sciences (BUHS), Dhaka Prof. Dr. TA Chowdhury Professor, Dept. of Obstetrics & Gynaecology BIRDEM, Dhaka Prof. Dr. Abdul Ghani Ex-Chairman Dept. of Pharmacy, University of Dhaka Prof. Dr. Harun-Ur-Rashid Founder & Chief Consultant Kidney Fundation Hospital & Research Institute, Dhaka Technology 91 Innovation 93 Digital 94 Did You Know 96 FDA Update 98 FDA Approvals 99 Appointments & Promotions 100 Facts on Fingertips 102 Glossary of Terms 102 Course and Conferences 103 Upcoming Event 107 News New Arrivals 5, BAPI News 16, DGDA News 18, FIP News 23, Industry News 24 Interview Prof. Dr. Khan Abul Kalam Azad 31 Prof Dr. Md. Titu Miah 37 Prof. Dr. Ahmedul Kabir 39 Prof. Dr. Quazi Tarikul Islam 45 Md. Quamrul Hassan 48 Prof. H A M Nazmul Ahasan 53 Prof. Dr. Md. Mujibur Rahman 59 CONTENTS Opinion Emeritus Prof. Dr. ABM Abdullah 48 Alik Krishna Roy 67 Prof. Dr. Shohael Mahmud Arafat 63 Prof. Dr. Md. Abul Kalam Azad 73 Prof. Dr. Ahmed Hossain 77 Prof. Dr. Md. Asadul Kabir 81 Prof. Dr. Syed Ghulam Mogni Mowla 83

NEW ARRIVALS THE PHARMA WORLD 7 Brand Name: Omari Generic Name: Omarigliptin Dosage Form: Tablet Strength: 12.5 mg & 25 mg Indications: Type-2 Diabetes Mellitus Brand Name: Imegli Generic Name: Imeglimin Hydrochloride INN Dosage Form: Tablet Strength: 500 mg Indications: Imegli is indicated to improve glycemic control in adults with type 2 diabetes mellitus. Brand Name: Filofer Generic Name: Ferric Maltol INN Dosage Form: Capsule Strength: 30 mg Indications: Indicated for the treatment of Iron Deficiency or Iron Deficiency Anemia (IDA) in adults. Brand Name: Glifo-M + Glifo-M XR Generic Name: Empagliflozin + Metformin Dosage Form: Tablet Strength: 12.5/500, 10/1000 XR + 25/1000 XR Indications: Glifo-M is indicated to improve glycemic control in Brand Name: Limbix DS Generic Name: Amitriptyline USP + Chlordiazepoxide USP Dosage Form: Tablet Strength: (25 mg + 10 mg) Indications: Moderate to severe depression associated with moderate to severe anxiety & Insomnia Brand Name: Pranlu Generic Name: Pranlukast Hydrate INN Dosage Form: Dry Syrup Strength: 100 mg/ml Indications: Asthma, Allergic Rhinitis Brand Name: Tracid Generic Name: Tranexamic Acid BP Dosage Form: Tablet Strength: 650 mg Indications: Heavy Menstrual Bleeding (HMB) Acme adults with type 2 diabetes mellitus with the risk of cardiovascular disease. Brand Name: Prindol Generic Name: Pridinol mesilate INN Dosage Form: Tablet Strength: 3 mg Indications: Central and peripheral muscle spasms, including, Low back pain (lumbago), Neck spasm (torticollis) & General muscle pain.

Brand Name: Vonix + Vonix Generic Name: Vonoprazan Dosage Form: Tablet Strength: 10 mg + 20 mg Indications: Gastric Ulcer and Duodenal Ulcer, Reflux Esophagitis (GERD), Maintenance therapy to prevent recurrence or relapse of Reflux Esophagitis, Prevention of recurrent Gastric or Duodenal Ulcer associated with Low-Dose Aspirin or NSAID administration. THE PHARMA WORLD 9 Aristopharma Biopharma Brand Name: Vonofix Generic Name: Vonoprazan INN 10 mg & 20 mg Tablet Dosage Form: Tablet Strength: 10 mg & 20 mg Indications: Vonoprazan is usually used to treat gastric/ duodenal ulcer, reflux Brand Name: Norzim Generic Name: Chlordiazepoxide USP 5 mg & Amitriptyline USP 12.5 mg Tablet Dosage Form: Tablet Strength: 5 mg +12.5 mg Indications: Norzim is indicated for the treatment of patients with moderate to severe depression associated with moderate to severe anxiety. Brand Name: Lexapro Generic Name: Escitalopram Dosage Form: Tablet Strength: 5mg & 10mg Indications: Major depressive disorder, Generalized anxiety disorder, Panic disorder & Social phobia. Brand Name: Salbu-L Generic Name: Levosalbutamol Dosage Form: Syrup Strength: 1mg/5ml (100 ml) Indications: Asthma, Wheezing, Troubled breathing & Shortness of breathing. Brand Name: Vasofex XR Generic Name: Prazosin Dosage Form: Tablet Strength: 2.5 mg & 5 mg Indications: High blood pressure, Enlargement prostate (BPH) & Posttraumatic stress disorder associated nightmares. Brand Name: Glucostat MR Generic Name: Gliclazide Dosage Form: Tablet Strength: 60 mg Indications: Non-insulin dependent diabetes mellitus (NIDDM). Brand Name: Lulifun Generic Name: Luliconazole Dosage Form: Cream Strength: 1% (30 gm) Indications: Ring worm, Tinea versicolour, Jock itch & Athlete’s foot. Dosage Form: Ophthalmic Gel Forming Solution Strength: 5 mg/ml Indications: Gold Standard US FDAapproved β-blocker with less systemic absorption in advanced Gel Forming Technology for the treatment of primary open-angle glaucoma or ocular hypertension with a favorable safety profile. Brand Name: Aristomol GFS Generic Name: Timolol Maleate esophagitis and for suppression of recurrence of gastric ulcer & duodenal ulcer associated with low-dose aspirin or nonsteroidal anti-inflammatory drug, medication in combination with clarithromycin and amoxicillin for the eradication of Helicobacter pylori.

DBL Pharma 10 THE PHARMA WORLD Eskayef Brand Name: Presnor Generic Name: Olmesartan Medoxomil Dosage Form: Tablet Strength: 20 mg & 40 mg Indications: Hypertension Brand Name: Dopatic Generic Name: Domperidone Dosage Form: Tablet Strength: 10 mg Indications: For the relief of the symptoms of nausea and vomiting & indicated for stimulation of gut motility in non-ulcer dyspepsia, Esophageal reflux and gastritis, Diabetic gastroparesis, Functional dyspepsia Brand Name: Vini Generic Name: Vonoprazan Dosage Form: Film coated Tablet Strength: 10 mg & 20 mg Indication: Gastric Ulcer, Duodenal Ulcer, Reflux Esophagitis, H. Pylori Infection (Dual or Triple Therapy), Recurrent NSAID induced Gastric or Duodenal Ulcer, Maintenance Therapy (after healing Reflux Esophagitis). Brand Name: Filgram™ Generic Name: Filgrastim 30 MU/0.5ml PFS Dosage Form: Pre-filled syringe Strength: 30 MU/0.5 ml Indications: Patients with severe chronic neutropenia, Patients with cancer receiving myelosuppressive chemotherapy or induction and/or consolidation chemotherapy for AML, Patients with cancer undergoing bone marrow transplantation & Patient with congenital neutropenia. Brand Name: Corazon Generic Name: Vericiguat Dosage Form: Tablet Strength: 2.5 mg & 5mg Indication: Heart Failure Brand Name: Fenidone Generic Name: Pirfenidone Dosage Form: Film Coated Tablet Strength: 267mg and 801mg Indication: Idiopathic Pulmonary Fibrosis (IPF) Brand Name: Tems Plus Generic Name: Telmisartan & Hydrochlorothiazide Dosage Form: Tablet Strength: 40mg/12.5mg, 80mg/12.5mg Indication: Hypertension Brand Name: Mig Generic: Mirogabalin Dosage Form: FilmCoated Tablet Strength: 2.5mg, 5mg, 10 mg Indications: Neuropathic Pain, Diabetic Peripheral Neuropathic Pain (DPNP), Post-herpetic Neuralgia (PHN), Chemotherapy-Induced Peripheral Neuropathy (CIPN), Central Neuropathic Pain after Spinal Cord Injury.

THE PHARMA WORLD 11 Incepta Everest Brand Name: Itokine Generic Name: Itopride Hydrochloride INN Dosage Form: Tablet Strength: 50 mg Indications: Indicated for gastrointestinal symptoms including the feeling of swollen abdomen, early satiety, postprandial fullness, upper abdominal pain or discomfort, nausea and Brand Name: Vonosil vomiting, anorexia, and heartburn; non-ulcer dyspepsia. Generic Name: Vonoprazan INN Dosage Form: Tablet Strength: 10 mg & 20 mg Indications: Gastric ulcer, duodenal ulcer, reflux esophagitis, prevention of recurrence of gastric or duodenal ulcer during lowdose aspirin administration, prevention of recurrence of gastric or duodenal ulcer during NSAID administration, Adjunct to Helicobacter pylori eradication in the following: Gastric ulcer, duodenal ulcer, gastric mucosa-associated lymphatic tissue (MALT) lymphoma, idiopathic thrombocytopenic purpura, the stomach after endoscopic resection of early-stage gastric cancer or Helicobacter pylori gastritis. Brand Name: Cravacin Generic Name: Deucravacitinib INN Dosage Form: Tablet Strength: 6 mg Indications: Cravacin is a tyrosine kinase-2 inhibitor which is used to treat adults with moderate to severe plaque psoriasis who are candidates for systemic or phototherapy. Brand Name: Gefan Generic Name: Gefapixant INN Dosage Form: Tablet Strength: 45mg Indications: Indicated for the treatment of refractory chronic cough & unexplained chronic cough. Brand Name: Daprostat Generic Name: Daprodustat INN Dosage Form: Film-coated Tablet Strength: 2/4/6 mg Indications: Indicated for the treatment of anemia due to chronic kidney disease (CKD) in adults who have been receiving dialysis for at least four months. Brand Name: Sulmetic Generic Name: Amisulpride Dosage Form: IV Injection Strength: 5 mg/ 2 ml Indication: Prevention and treatment of nausea & vomiting of patients in hospitals. Brand Name: Algicid Plus Tablet Generic Name: Sodium Alginate, Sodium Bicarbonate, Calcium Carbonate Dosage Form: Tablet Strength: 250 mg, 133.5mg, 80mg Indication: Hyperacidity.

Brand Name: E-MUPS Generic Name: Esomeprazole Dosage Form: Tablet Strength:: 20 mg Indications: Gastroesophageal Reflux Disease (GERD). Risk reduction in NSAID associated gastric ulcer. H. pylori eradication (Triple therapy). Zollinger-Ellison syndrome and idiopathic hypersecretion. Kumudini Nipro JMI Brand Name: Myguard Generic Name: Zolmitriptan Dosage Form: Nasal Spray Strength: 5 mg Indication: Migraine. Brand Name: Deflazit Generic Name: Deflazacort Dosage Form: Tablet Strength: 18 mg Indication: Inflammatory and autoimmune diseases. Brand Name: Nystaderm Cream Generic Name: Nystatin and Chlorhexidine Dosage Form: Cream Strength: 2% and 1% Indication: Ringworm, Athlete’s foot, infected nappy rash. Brand Name: Teripen Generic Name: Teriparatide Dosage Form: Pre-filled Syringe Strength: 2.4ml/250mcg/ml Indication: Osteoporosis with fracture risk. Brand Name: Luzo Generic Name: Luliconazole 1% Dosage Form: Cream Strength: 10 mg Indications: Indicated for the topical treatment of interdigital tinea pedis, tinea cruris and tinea corporis caused by the organisms Trichophyton rubrum and Epidermophyton floccosum. Brand Name: Ezyout Generic Name: Sodium Picosulfate Dosage Form: Tablet Strength: 10 mg Indications: Constipation of any etiology, Relief from prolonged & recurrent constipation, Bowel clearance before surgery, childbirth or radiological investigations. Brand Name: Emjenta Generic Name: Empagliflozin + Linagliptin Dosage form: Film-coated tablet Strength: 10/5mg & 25/5mg Indication: Type 2 Diabetes Mellitus. Brand Name: Sulafate Generic Name: Sucralfate USP 1 gm/5ml Dosage Form: Oral Suspension Strength: 200ml Indication: Duodenal ulcer, Gastric Ulcer & Chronic Gastritis. Brand Name: Bilbest Generic Name: Bilastine INN Dosage Form: Tablet & Syrup Strength: 20 mg & 12.5mg/5 ml syrup Indication: Allergic RhinoConjunctivitis (seasonal and perennial) and Urticaria One Pharma THE PHARMA WORLD 13

Popular Renata Brand Name: Ezylife Max Generic Name: Sodium Picosulfate Dosage Form: Concentrated oral solution Strength: 7.5 mg/ml Indication: Constipation Brand Name: Urotide Generic Name: Finasteride+Tadalafil Dosage Form: Capsule Strength: 5 mg+5 mg Indication: Benign Prostatic Hyperplasia. Brand: Vonomax Generic: Vonoprazan Fumarate Dosage Form: Tablet Strength: Vonoprazan 10 mg & Vonoprazan 20 mg Indications: Gastroesophageal Reflux Disease (GERD), Gastric Ulcer, Duodenal Ulcer, Maintenance Therapy for Recurrence & Recrudescence of Reflux Esophagitis, Prevention of Recurrence of Gastric or Duodenal Ulcer During Low-dose Aspirin or NSAIDs Administration. Brand Name: Alphapress® XR Generic Name : Prazosin Dosage Form: Tablet Strength : Prazosin 2.5 & 5mg Indications: Hypertension, Left Ventricular Failure, Raynaud’s Phenomenon & Raynaud’s Disease, Benign Prostatic Hyperplasia. Brand Name: Dabiren® Generic Name: Dabigatran Etexilate Mesylate Dosage Form: Capsule Strength: Dabigatran 75 & 150mg Indications: Stroke, Deep venous thrombosis (DVT) & pulmonary embolism (PE). Brand Name: Palorid Generic Name: Prucalopride INN Dosage Form: Tablet Strength: 1 mg & 2 mg Indication: Chronic Idiopathic Constipation (CIC) Pharmasia Brand Name: Novonil Generic Name: Vonoprazan Dosage Form: Tablet Strength: 10 mg & 20 mg Indications: Gastric ulcer, Duodenal ulcer, GERD, Reflux esophagitis, Prevention of recurrence of gastric or duodenal ulcer during NSAIDs administration, Adjunct to H. pylori eradication (Triple therapy) Square Brand Name: Freezy Generic Name: Mentha Piperita (as Menthol)+Cinnamomum Camphora (as Camphor)+Wintergreen oil (as Methyl salicylate) Dosage Form: Nasal Inhaler Stick Strength: (415.40 mg+415.40 mg+122.70 mg) per gm Indication: Indicated for nasal congestion or blocked nose Brand Name: Emoli Generic Name: Benzalkonium Chloride+Chlorhexidine Hydrochloride+Isopropyl Myristate+Light Liquid Paraffin Dosage Form: Lotion Strength: (0.1 gm+0.1 gm+2.5 gm+2.5 gm) per 100 gm Indication: For the management of dry and pruritic (itchy) skin conditions, especially eczema and dermatitis and for use as a soap substitute. THE PHARMA WORLD 15

Brand Name: Emjard M Generic Name: Empagliflozin+Metformin Hydrochloride Dosage Form: Tablet Strength: 12.5 mg+500 mg Indication: Indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes Brand Name: Vonokit Generic Name: Vonoprazan + Amoxicillin + Clarithromycin Dosage Form: Tablet+Capsule+Tablet Strength: 20 mg+500 mg (2 capsules)+500 mg Indication: For the treatment of Helicobacter pylori (H. pylori) infection in adults Brand Name: Fitvit Generic Name: Malus domestica Fruit extract as acid (apple vinegar), Garcinia cambogia Fruit extract, Ginger root powder & Cayenne pepper Fruit powder Dosage Form: Capsule Strength: 300mg+50mg+50mg+50mg Indication: Weight management Brand Name: Voniza Generic Name: Vonoprazan Dosage Form: Tablet Strength: 10 mg, 20 mg Indication: Gastric ulcer (GU), Duodenal ulcer (DU), Reflux esophagitis (RE), Erosive esophagitis EE), Maintenance treatment of reflux esophagitis (erosive esophagitis) in patients with Brand Name: Safyron Generic Name: Dydrogesterone Dosage Form: Tablet Strength: 10 mg Indication: Progesterone deficiencies (Treatment of Threatened miscarriage, Habitual miscarriage, Dysmenorrhoea, Endometriosis, Secondary amenorrhoea, Irregular cycles, Dysfunctional Uterine Bleeding, Infertility due to luteal insufficiency), To counteract the effects of unopposed Oestrogen on the endometrium in Hormone Replacement Therapy for women with disorders due to natural or surgical induced menopause with an intact uterus repeat recurrence and relapse of the condition, Prevention of recurrence of gastric ulcer or duodenal ulcer during NSAIDs Administration, Adjunct to Helicobacter pylori eradication associated with: Gastric ulcer, duodenal ulcer, gastric MALT lymphoma, idiopathic thrombocytopenic purpura, the stomach after endoscopic resection of early stage cancer or Helicobacter pylori gastritis THE PHARMA WORLD 17 51, Kalabagan 1st Lane, Dhaka-1205, Bangladesh Tel: +88-02-58155677, Cell: +8801677395919 E-mail: [email protected] ... and remain updated! suBscriBe to

18 THE PHARMA WORLD BAPI NEWS The Bangladesh Association of Pharmaceutical Industries said on Wednesday it is hopeful of more collaboration with Gulf countries after signing an agreement with the Arab Union of the Manufacturers of Pharmaceuticals and Medical Appliances in Jordan.  BAPI signed a memorandum of understanding with Amman-based AUPAM on Tuesday, under which the two bodies agreed to further cooperation, including in knowledge-sharing and trade of pharmaceuticals.  “This MoU will help increase collaboration in the pharmaceuticals sector between Bangladesh and Gulf countries. It will help companies in both regions explore opportunities and strengthen collaboration,” BAPI treasurer Mohammed Halimuzzaman told.  “It’s beneficial from both ends,” he said. “AUPAM is very cooperative and cordial in working with us.”  Under the agreement, Bangladesh will assist AUPAM with the technology required to establish manufacturing facilities, while the Arab organization will help the South Asian nation export pharmaceutical goods to the Gulf region.  “When we want to export pharmaceutical goods to that region, we need to have approval from the regulatory authorities of that region. MoU to strengthen Jordanian-Bangladeshi ties in pharmaceutical industry signed Under the agreement, Bangladesh will assist AUPAM with the technology required to establish manufacturing facilities, while the Arab organization will help the South Asian nation export pharmaceutical goods to the Gulf region

THE PHARMA WORLD 19BAPI NEWS We requested that AUPAM leaders help us get this approval more efficiently,” Halimuzzaman said. “They would like to have partners from Bangladesh to build manufacturing facilities in their region. They would like to have technology from us.”  Speaking during the signing ceremony, Abdulnaser Sijari, president of AUPAM, said: “The MoU would create multi-faceted cooperation between both associations and set forth a roadmap to enable improved sector trade.” “The pharmaceutical industry in Bangladesh is booming. It has earned a reputation for its quality and competitive pricing,” Nahida Sobhan, Bangladesh’s ambassador to Jordan, told Arab News.  “The agreement with AUPAM opens up new horizons for collaboration as well as more trade. And it will benefit pharmaceutical industries both in the Arab region and in Bangladesh.”  n “The agreement with AUPAM opens up new horizons for collaboration as well as more trade. And it will benefit pharmaceutical industries both in the Arab region and in Bangladesh.”

DGDA NEWS 20 THE PHARMA WORLD In an effort to address global antibiotic resistance, the Directorate General of Drug Administration (DGDA) held an awareness program in Chittagong recently. They introduced healthcare professionals to the WHO AWaRe (Access, Watch, Reserve) classification, a tool that categorizes antibiotics into three groups based on effectiveness and importance in treating infections. This classification guides prescribers to make informed decisions, promoting rational antibiotic use and preserving these drugs for the future. During the program, Major General Mohammad Yousuf inaugurated the AWaRe poster publication, endorsed by the WHO, outlining key principles of the classification. This poster aids physicians in selecting appropriate antibiotics. It encourages the use of effective and accessible antibiotics (Access group) while discouraging unnecessary use of last-resort antibiotics (Reserve group) to combat resistance. Accurate diagnosis was emphasized to avoid overuse and misuse. The AWaRe classification also supports antibiotic stewardship programs, fostering coordination among healthcare providers. This poster enhances stewardship practices and ensures juAmong the heads of the affiliated directorates of the health services division, Major General Mohammad Yousuf, Director General of the Directorate General of Drug Administration has received the “National Integrity Award 2022-23” according to the policy of National integrity Award (Amended), 2021, National Integrity Award is given to the officers and employees of the government for their outstanding contributions for working with integrity with the basis of the indicators mentioned in the policy. The award is given to the people practicing activities with integrity efficiently from the ministry/ division or any other government institution on the basis of abovementioned policy. Major General Mohammad Yousuf was among the four officers and employees of the Health Services Division of the Ministry of Health and Family Welfare who received the award, according to a circular published recently. He was ornated with the award in accordance with the 10 integrity indicators mentioned in the policy on the category of the heads from different organizations of Health services Division. This is also a great achievement for Major General Mohammad Yousuf as well as the Directorate General of Drug Administration who are relentlessly working to ensure safe, efficacious and effective medicine throughout the country. n Promoting rational antibiotic use: DGDA’s AWaRe initiative for combatting resistance Director General of the Directorate General of Drug Administration receives Integrity Award

THE PHARMA WORLD 21

DGDA NEWS 22 THE PHARMA WORLD Recently the Annual Performance Agreement (APA) for fiscal year 2023-23 was signed between Honorable Secretary of Health Service Division Dr. Md. Anwar Hossain Hawlader and Director General of Directorate General of Drug Administration Major General Mohammad Yousuf at the ministry’s conference room along with the other offices of the Health Services Division and Medical Education and Family Welfare Division of the Ministry of Health and Family Welfare. Honorable Minister for Health and Family Welfare, Government of the People’s Republic of Bangladesh Mr. Zahid Maleque was present as the chief guest. The main purposes of introducing the APA are- increasing transparency and accountability of the government activities, moving the focus of the ministry from process orientation to result orientation, and providing an objective and fair basis to evaluate the overall performance of the ministries and divisions at the end of the year. n Annual Performance Agreement (APA) Signing Ceremony dicious antibiotic use throughout the healthcare system. DGDA’s awareness efforts in Chittagong, distributing the AWaRe poster, empower physicians to combat resistance. This system is a global standard, promoting responsible antibiotic use. With DGDA’s support, Chittagong physicians are equipped to prioritize antibiotics effectively, contribute to responsible drug use, and ensure a healthier future for all. n

THE PHARMA WORLD 23 On July 11 & 12, 2023 the 5th Arab Pharma Manufacturers’ Expo, 2023 under the title: ‘The future of the biosimilar industry in the Arab countries’ was held in Amman, Jordan. Bangladesh pharmaceutical industry is very much vibrant and capable of manufacturing all kind of dosage forms of generic drugs as well as biosimilar products. It is at closed proximity to very large pharma supplier of the world - India and China. The Director General of Directorate General of Drug Administration (DGDA) Major General Mohammad Yousuf in his speech said, “To treat autoimmune disease conventional DMRD takes long time, sometime less effective and noneffective. Biologies and Biosimilar are very effective, but only the price issue. Biosimilar products are produced in Bangladesh is affordable. Bangladesh can provide simaglutide, adalimumab at very reasonable price having high quality. Ritoximab, Trastuzumab, Ranizumab, etc are used for immunotherapy and cancer therapy, has shown very effective. Biosimilars manufactured in Bangladesh is safe, efficacious and high quality similar to its reference biologies, not suboptimal quality. Therefore, we invite you all to procure your biosimilar products from Bangladesh.” n 5th Arab Pharma Manufacturers’ Expo, 2023

NEWS T he 2023 World Congress of Pharmacy and Pharmaceutical Sciences will take place from 24-28 September in Brisbane, Australia. We invite you to attend so that you can keep your readers up to date with developments in pharmacy globally, moving towards 2030 — the target date for the United Nations Sustainable Development Goals, which include “Good health and wellbeing for all” (SDG 3). The overarching theme of the congress is how pharmacy can help ensure a sustainable future for health care. The programme is now available here. Recommended sessions include: l Surveillance of infection outbreaks and identifying high-risk patients l Innovative approaches for remuneration of community pharmacy services l Antimicrobial resistance and pharmaceutical innovation l Humanitarian pharmacy, with examples from Syria, Turkey and Ukraine l Accelerating mRNA therapeutics l The world’s first “metaverse” pharmacy l Machine learning and artificial intelligence in drug discovery and medication optimisation In addition, pre congress, there will be a Digital Pharmacy Summit on 23 September, and your press registration includes access to this event. How to register To register as a member of the press please email [email protected] with: 1. Your full name; 2. Your role/job title; 3. The name of the publication/news agency you represent and, where applicable, its website address; plus 4. Any one (scan, pdf, screenshot, image, etc) of the following: l Your press card/press pass; l Your business card stating your publication/news agency and your position at that publication/agency; l A copy of an article/story you have written in the past year and which shows your name in the byline; or l Your name printed in your publication’s flannel panel or listed under editorial staff on your website. l A page from your publication (print or web) either showing promotion of FIP’s 2023 Brisbane congress (click here for content) or reporting from FIP’s 2022 Seville congress. n 81st FIP World Congress of Pharmacy & Pharmaceutical Sciences THE PHARMA WORLD 25 On World No Tobacco Day, the International Pharmaceutical Federation (FIP) publishes a new handbook for pharmacists to support tobacco cessation and treat tobacco dependence. The handbook has been developed in collaboration with an international group of experts from various organisations, including the World Health Organization. The handbook outlines the latest evidencebased practices, techniques and strategies for pharmacists to help people on the often-challenging journey to a tobacco-free life and remaining abstinent. It includes guidance on how to conduct patient assessments, design treatment plans, support behavioural change, select appropriate medicines to manage withdrawal symptoms and monitor progress, as well as covering other aspects such as health promotion, patient education and referral, and interprofessional collaboration. The new handbook is accompanied by a publication describing the knowledge and skills required for the delivery of pharmacist-led interventions to support tobacco cessation in addition to other modifiable NCD risk factors such as physical inactivity, unhealthy diet and harmful use of alcohol. n Two new resources to help pharmacists tackle non-communicable diseases caused by tobacco are now available from FIP

INDUSTRY NEWS Recently, Bangladesh’s groundbreaking first once-weekly oral Antidiabetic medicationMarzev®, was officially launched amidst a prestigious event at the Dhaka Club in the presence of esteemed doctors from BIRDEM. During the program, Associate Professor Dr. Faria Afsana delivered keynote speech where she highlighted the drug’s potential to significantly enhance patient adherence to diabetes treatment. National Professor Dr. AK Azad Khan, Prof. Dr. Faruque Pathan, Prof. S M Ashrafuzzaman, Prof. Dr. Feroz Amin & other distinguished endocrinologists also shared their insights during the event. According to senior officials from ACI Pharmaceuticals, the medicine’s manufacturer, this drug will revolutionize diabetes management by offering cost-effective and accessible treatment, thereby elevating patients’ quality of life, says a Company press release. n Hepatitis is a silent killer. Every year, around 22,000 people are dying in Bangladesh due to Hepatitis. 9 out of 10 people are unaware that they are infected with the virus. To reduce the burden of Hepatitis B and C infections, World Hepatitis Day is observed every year on 28th July. With the aim of eliminating Hepatitis by 2030, Everest Pharmaceuticals had observed World Hepatitis Day on 28th July 2023 by arranging an awareness music video by the renowned artists Balam and Nancy, followed by a road show for the general people of the city. The road show was inaugurated by Professor Dr. Mamun Al Mahtab (Shwapnil), Head of Interventional Hepatology Division, Bangabandhu Sheikh Mujib Medical University. n ACI launches antidiabetic medication- Marzev® Everest Pharma observes World Hepatitis Day 2023 26 THE PHARMA WORLD

One of the leading pharmaceutical companies in country, ACME Laboratories Ltd launched three new drugs for harnessing diabetes which are to be ingested in six separate doses. The announcement was made for marketing the drugs named Omari, Imegli and Glifo during a spectacular programme titled “Diabetes Unbound: Unveiling Tomorrow’s Triumph Over Diabetes” held at the Samson H Chowdhury Centre in the capital, says a company press release. The Chairman of the National Diabetic Association Professor A K Azad Khan presided over the event as the chief guest. Besides a whole host of coveted physicians were also present on the occasion. “The drug called Omari will be affordable for all and the introduction of Imegli has paved the leeway for research in treating Type 2 diabetes,” A K Azad said. Most patients suffering from Type 2 diabetes fail to subdue the ailment. That is where the three drugs namely Omari, Imegli and Glifo come in, to regulate glucose levels in the bloodstream, develop insulin and improve the beta cell and mitochondrial function. The drugs revolutionised the treatment of an ailment as complicated as diabetes. The drug Omari is the first of its kind that is to be ingested once every week. n Aristopharma and Euro Pharma to produce medicines for Square Square Pharmaceuticals PLC has struck a contract manufacturing agreement with Aristropharma and Euro Pharma Ltd. Aristopharma inked a contract manufacturing deal with Square Pharmaceuticals to produce injectable items, tablets and dry syrups for Square Pharmaceuticals, says a company press release. n ACME introduces 3 new drugs for curbing diabetes THE PHARMA WORLD 27 In 2005, the milk and milk product consumption was recorded at 32.4 gm, which increased to 33.7 gm in 2010. Vegetable consumption has also increased by 28.6 per cent to 201.9 grams per day in 2022. The vegetable intake was only 157 grams per capita per day in 2005, the HIES 2005 report showed. Just 17 years ago, each Bangladeshi consumed only 57.7 FAST FACTS grams of meat and fish per day, which almost doubled in 2022. Each Bangladeshi person once in 2005 consumed 12gm of wheat which has now increased to 22.9 gm per day, as per the BBS survey. There is a higher likelihood for individuals who have undergone childhood adversity to develop type 2 diabetes (T2D) at a young age. Some seven lakh Bangladeshis go abroad for medical treatment every year.  In 2017, OOPS accounted for 73.9 percent of health expenditure, the highest among South Asian countries.

OPINION With the onset of Monsoon, we find an outbreak of Dengue in Bangladesh every year. In 2000, however, it drew public attention as it created a panic among our people due to massive publicity in media and fear of death among the people. Curiously enough, we notice a rush for collection of blood & platelet as soon as there is an outbreak of Dengue. However, with our physicians becoming more and more experienced and enlightened in management of dengue with passage of time and with more awareness among our patients, unnecessary transfusion of blood and platelet is showing a downward curve. In dengue life threatening? The answer is both yes and no. The answer is no, because 100% dengue patients recover and cured if they are given timely and proper treatment. Although it is said that in hemorrhagic Dengue fever, 5 to 10% patients die, but in my personal experience I can say that rate is less than 1%. So, there is no reason to get panicked unnecessarily. Only those patients die who fail to go to doctor or hospital on time due to negligence or ignore doctor’s advices. Well, some people have got a wrong idea that the danger period or risk is over as soon as the dengue fever is gone after 5/6 days. Here lies the catch. In fact, real critical period starts with the remission of fever, when platelet comes down and bleeding may occur. During this period, both patients and physicians should be very alert by monitoring CBC and Platelet of blood regularly. It should be mentioned here that there is no virus in breast milk, so dengue infected mothers can feed their babies without any hesitation. In dengue a infectious disease? The answer is no – plain and simple. Anybody can share bed, food and plates, glass etc. with a dengue patient without any fear. It does not spread through air even. Only the Ades mosquitoes which bite a person can infect another person if it bites simultaneously. No other mosquito bite can spread dengue. People also ask, is it possible to go for surgery with dengue fever? If it is not emergency, it is better to avoid or delay the surgery. Because, it may trigger new complications, like uncontrolled bleeding which may result in death even. Some patients with appendicitis may need surgery. It is better not to operate a Dengue patient with appendicitis. What tests a dengue patient should undertake? Normally, huge tests are not required. CBC and Platelet count are enough. With 1 and 2 days fever, patient should DENGUE – What you need to know Emeritus Prof. Dr. ABM Abdullah Personal Physician to Hon’ble Prime Minister Real critical period starts with the remission of fever, when platelet comes down and bleeding may occur. During this period, both patients and physicians should be very alert by monitoring CBC and Platelet of blood regularly. THE PHARMA WORLD 29

30 THE PHARMA WORLD go for NSI Antigen and after 4 to 6 days, anti-dengue antibody tests should be done. Platelet starts going down after 4/5 days, so tests should be done at that time. It is observed that many people do the tests frequently and unnecessarily and also from different diagnostic centres which is nothing but sheer wastage of money. Morever, reports from various diagnostic centres may vary which make the things complicated for a physician. For all dengue patients, blood sugar test is a must as sometimes blood sugar rise temporarily during dengue fever. But, to be on the safe side, one may go for some liver test like, SGPT, SGOT, Alkaline, Phosphorustes etc. to check any liver inflammation. If USG of whole abdomen is done, we may find fluid (water) or any xray of chest may reveal fluid in lungs. Normally, these go away with the remission of dengue fever. However, if there are breathing difficulties, X-ray of Chest should be done to detect any problem. Physicians can go for other blood test or culture like PT, D-Dimer, FDP if any there is any complications. There is no need for CT scan of head, even if there is acute headache. As Dengue is a virus fever, treatment should be given as per symptom. In case of fever, paracetamol with plenty of fluid/water is enough. If the patient cannot take food by mouth, IV Saline may be used. However, in case of acute vomiting or inability to take anything by mouth, patients should be hospitalized. For Dengue fever, paracetamol is enough. No painkiller like Aspirin or other pain killers should be given as these may trigger bleeding. As Dengue is a virus fever, there is no need for antibiotics. But, in case, there is another Bactria like Typhoid fever, physicians may decide to go for antibiotic as per diagnosis. But, we should bear in mind that in case of hemorrhagic dengue, no injection in muscle should be given. It may cause Hematoma. Regarding blood transfusion or platelet count, there is a lot of confusions. People insist on blood transfusion in case of low platelet count. We have to remember that if there is no bleeding and HB of patient is normal, there is no need of blood transfusion. It may create new complications like heart failure also. There appears to be panic among some patients and doctors as well. In fact, there is no reason to be panicky if there is a fall of platelet count. Because, it starts increasing within 4/5 days. We should bear in mind that transfusion of unnecessary platelet may trigger Hepataties B and C or even infection with HIV. The use of platelets in treatment seems to have increased due to fear. Doctors may be afraid of worsening the patient’s condition, so they give it earlier. Unnecessary use has increased due to fear. In 80-90% of cases, platelets are being used unnecessarily. Platelets will decrease in a dengue patient - this is very normal. Due to dengue, the normal production process of platelets in our body decreases. Again, even if the production is good, sometimes the breakdown is more than the production. If there is an infection or fever in our body, even if it is not dengue, platelets decrease. In cases where the platelets are very low and bleeding, that is when the patient really needs platelets. There is a myth that Dengue infects only once in life. It is not true. There are 4 different serotype of dengue virus. So, a person may get infected with dengue fever even 4 times in life. Regarding dengue in pregnancy, the patient must get admitted in hospital as soon as possible for constant monitoring for the safety of both mother and child. Can we use steroid during Dengue? It is debatable, many are against use of steroid. In some cases, it works good when there is a fall of platelet or dengue shock syndromes. According to requirements, Dexamethasone may be injected IV eight hourly in some cases. In management of Dengue, we should remember: l Dengue is not a fatal disease. No one should be panicky. Instead, they should be alert. l Dengue goes automatically after 5/6 days if the patients obey the advice of physcians. l Does and don’t’s of Dengue fever should be known to be physicians and patients. No one should overdo anything. l There is no reason to believe that transfusion of blood or platelet is mandatory. l Dengue existed in the past. It is still present and will continue to be there in future also. For this, we must take care of environment and survive by fighting with dengue, without being scared. n

THE PHARMA WORLD 31GLOBESCAN Top 20 Global Pharma Cos 2023 # Companies Name 2022 RX SALES* 2022 R&D S[EMD* 01. Pzifer New York $91.303 $12.381 02. Abbvie North Chicago, Illinois $56.179 $6.435 03. Johnson & Johnson New Brunswick, New Jersey $50.179 $14.140 04. Novartis Basel, Switzerland $50.079 $9.088 05. Merck & Co. Kenilworth, New Jersey $49.627 $11.842 06. Roche Basel, Switzerland $47.909 $14.781 07. Bristol Meyer Squibb New York, New York $45.417 #10.016 08. Astra Zeneca Paris, France $42.998 $9.500 09 Sanofi Brentford, England $40.353 $7.156 10. GSK Brentford, England $38.245 $6.337 11. Takeda Osaka, Japan $29.690 $4.697 12. Gilead Sciences Foster City, California $26.615 $4.968 13. Eli Lilly Bagsvaerd, Indiana $25.463 $7.191 14. Novo Nordisk Bagsvaered, Denmark $25.384 $3.450 15. Amgen London, England $22.536 $4.341 16. Boehringer Ingelheim Ingelheim, Germany $19.473 $5.386 17. Bayer Leverkusen, Germany $18.898 $7.013 18. Modern Cambridge, Massachusetts $18.435 $2.993 19 Viatris Canonsburg, Pennsylvania $15.999 $698 20. CSL Melbourne, Australia $13.123 $1.347 Source: Swiss Biotech Report 2023 Global News India bars doctors from meets sponsored by pharmaceutical companies The National Medical Commission (NMC) of India has barred doctors from meets sponsored by pharma companies. NMC has said doctors should not attend events or seminars or meets “which involves direct or indirect sponsorships from pharmaceutical companies or the allied health sector”. It has said the maximum punishment for violation of these regulations is suspension of licence for three months, reported Times of India. The report mentioned Section 35 of the new professional conduct regulations which also bars doctors and their families from taking consultancy fee or honorariums from pharmaceutical companies or representatives. n Source: Times of India

THE PHARMA WORLD 33 INTERVIEW Prof. Dr. Khan Abul Kalam Azad Medicine Specialist Principal Popular Medical College, Dhaka Ex-Principal Dhaka Medical College and Hospital “As a part of CSR everybody of our society should make endevours to raise peoples awarness” As an eminent physician of the country, would you please tell our readers about the major tropical diseases commonly prevalent in Bangladesh? Thank you very much. There are many diseases found in the tropical and subtropical regions of Asia, Africa and the Americas. Many of these diverse diseases often remain neglected. These diseases could be mediated by virus, bacteria, fungi, protozoa or parasites. For example, Kala-azar in Bangladesh is protozoa mediated. Leprosy cases are still found in some instances. Worm infestation is another problem many Bangladeshis face all year-round. Among these, hook worm and round worm are the most common. Hydatid cyst is also a cause of concern, which is spread by dog feces containing a type of tapeworm. Filariasis still remains a major cause of concern in North Bengal. Dengue, Chikungunya, and in some instances, Rabies, are the major tropical neglected diseases (TND) we are fighting all year-round. There are also three major killers which are endemic in this tropical or sub-tropical climate, two of which Bangladesh suffers greatly. First one is Tuberculosis (TB), although not exclusively a tropical disease as it is a problem worldwide, their high incidence in the tropics justifies their inclusion. Another one is HIV AIDS, which is increasing day by day. Malaria is another issue, which is more prevalent in particular parts of Bangladesh. On the other hand, there are many tropical diseases which are not endemic to Bangladesh but found in the Americas and Africa i.e., Chagas’ disease, a disease caused by a trypanosome parasite, yellow fever, schistosomiasis, mucormycosis etc. Of late, Dengue has turned serious and creating a havoc with its new symptoms. What is the treatment protocol for such cases? There are several factors behind the severity of the Dengue infection or outbreak. You’ll see that Dengue is a little different than other virus mediated diseases. Previously, dengue was a seasonal disease that peaked during the monsoon season as a result of larvae growing in the still water. However, these days, people are being affected by Dengue nearly all year-round and the severity is spreading towards outside of Dhaka as well. Secondly, we previously lacked comprehensive understanding regarding the four serotypes of dengue, known as DEN-1, DEN-2, DEN-3, and DEN-4. So, little emphasis were given on identifying the serotypes. But, as these serotypes has different interactions with the antibodies in human blood serum, it became crucial to emphasize on them. DEN-3 was more prevalent last year, while this year, it is DEN-2. DEN-2 is the most virulent of the serotypes, leading to higher hospitali-

zation rate and death rate among all age groups. The major reason for this increased death rate is higher plasma leakage, a process where the proteinrich fluid component of the blood leaks from the blood vessels into the surrounding tissue, thickening the blood and often putting patients into shock. Second reason is expanded Dengue syndrome, where the  vital organs systems such as the cardiovascular system, neurological system, kidneys, Lungs, digestive system, and haematological system are affected. Thirdly, if there is presence of co-morbidity or co-infection who already has a weakened immune system. For example, one person with dengue fever may also develop pneumonia, whether viral or bacterial. Again, co-infection with typhoid fever, hepatitis or urinary tract infection has also been observed in dengue patients. Patients with comorbidities like chronic kidney disease, or patients who’ve had heart failure, stroke or cancer are particularly vulnerable to Dengue infection. Other vulnerable groups are elderly patients, children, pregnant mothers or lactating mothers. Another important thing to note is that infection with one serotype does not give protection against other Serotypes, yet  sequential infections increase the severity of the immunological reaction, i.e., the risk of developing dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). Due to the already disrupted immune system in dengue infection, there is a cascade of antibody mediated injuries, T-cell mediated injuries, complement mediated injuries and plenty of cytokines. These four mechanisms was seen in COVID also. As we have seen in COVID-19, there was micro circulation, microthrombi problems due to the microcirculatory changes and immune coagulopathy caused by SARS-CoV2. So, people have become more vulnerable than before due to the pandemic. So, Dengue has brought on a severe phase for us in this post-COVID era. We don’t have any cure for Dengue, no vaccines, no medications or antivirals. So, prevention remains as the best strategy. We can provide symptomatic management. For example, providing fluid therapy is the mainstay of the management of plasma leakage. Dengue patients who are being treated at home and are not vomiting, can be given various types of oral fluid such as water, juice, milk, or drinks with added electrolytes. Patients experiencing vomiting, plasma leakage leading to pleural effusions, or ascites, on the other hand, should be given IV fluid as soon as possible. Two main types of volume expander are used to replace lost fluid in the management of dengue fever:  crystalloids  and colloids. Crystalloid solutions, such as normal 0·9% saline (4.5% in case of children), Hartmann’s solution or Ringer’s lactate are the ones most commonly used. Colloidal solutions, such as albumin, gelatinbased solutions, and dextran, are provided. Plasma or whole blood is also given. Meticulous administration of fluids is the cornerstone of the management. However, the amount of IV fluids given must be carefully monitored and adjusted through escalation and de-escalation to avoid risk of fluid overload. The doctors and attending nurses adhere to the fluid treatment protocols we developed for Dengue patients. Antivirals, antibiotics, platelet enhancers or platelet transfusion have no role in the treatment of dengue. Contrarily, doing so will worsen the patient’s condition. Would you please describe the epidemiology of typhoid fever in Bangladesh, including the high-risk areas and susceptible population groups? Thank you for bringing attention to typhoid. In our country, Typhoid fever affects people of all ages and  in  all  seasons,  including  summer,  winter,  and  monsoon. Typhoid and paratyphoid fever are bacterial diseases caused by Salmonella typhi and Salmonella paratyphi respectively. Typhoid fever can be fatal if left untreated for longer than two weeks. Symptoms continue to get worse over days and risk of serious complications i.e., intestinal perforation, internal bleeding and encephalitis. Typhoid is a waterborne disease, spread through the excreta of the infected person. Drinking this contaminated water or eating food washed in that contaminated water can contract typhoid fever. Street food is one of the main factor that causes typhoid to spread in our country. Many vendors sell unsanitary food like fuchka, chotpoti, on the side of the road. The vendors don’t maintain good hygiene either. They’re preparing food without washing their hands, and preparing the foods with unclean water. The history of consuming a roadside burger or chotpoti is a feature whenever I try to identify the source by interviewing the typhoid patients. If enough bacteria enter the body, not just immunocompromised persons but also seemingly healthy people can get affected. So, the best way of prevention is avoiding eating open street food at all times. Consuming unpasteurised milk and raw eggs should be avoided at all costs. Food should be healthy, hygienic and boiled. Is there any preventive measure, like vaccination to control typhoid fever in Bangladesh? Yes, we do have a vaccine for typhoid available in our country. This vaccine can protect against 50 serotypes. Can you please tell us about any ongoing research or initiatives in Bangladesh related to fever and tropical diseases? Among tropical diseases, there has been extensive research and studies going on Kala-Azar here in our country. I also have done research on Kala-Azar in Rajshahi. The medical students, even from the first year have become to identify Kala-azar from the symptoms. The sandfly vectors are responsible for transmitting the disease. Implementation of community-based initiatives can reduce the sandfly population and prevent new infections. We have evaluated the efficacy of existing treatment regimens, optimized drug 34 THE PHARMA WORLD

combinations and developed new therapeutic protocol for Kala-azar. We conducted study on Miltefosine, an oral anti-infective in the management of Kala-Azar. Our research also focused on efficacy of amphotericinB, an antifungal drug. There is an on-going research on Malaria in Chittagong Medical College. There has also been focus on snake antivenom in Bangladesh as well. Many individual research projects have also been carried out in various institutions around the country. What are the primary challenges in raising awareness about tropical diseases among the general population in Bangladesh? This is a timeless dynamic. Humans will always be reckless, no matter how much wisdom they acquire, and nature will seek vengeance. When it came to wealthier countries like America, where were the COVID preparations? America brags about everything; my fighter jets, my tanks, my weaponry, my ICUs in hospitals. But America also went through the highest death toll due to COVID. So, where’s the challenge? Nature will retaliate. Whatever you do, the most essential thing is to raise public awareness. For example, right now, I am a conscious activist for Dengue awareness. I will defend myself wherever I am and wherever I reside. I work here, from my mosquito net to my workplace. I will protect all my staff. I will protect where I live, where I work. Therefore, awareness is necessary. People need to be aware of the sources from which they get their food from. Will the dishonest merchants who sell tainted or adulterated food ever sell safe, sanitary food? Every tea cup at the roadside tea shops is cleaned in the same water. Therefore, people should stay away from these foods and bring their own water from home. They should be aware of their environment and surroundings at all times. There is no substitute for this awareness. If you are unwell, you shouldn’t try to treat yourself. You ought to visit the hospital, get medical advice, and then proceed as necessary. Rather than creating panic, authorities should make an effort to communicate with people and educate people about various diseases. This is called social responsibility, a sense of civic duty. It’s about uplifting people through a sense of societal responsibility. Educators, teachers and Imams should come forward and spread awareness. Human welfare is the noblest intention. Every word our prophet (PBUH) uttered was focused on human welfare. Another thing is, we have to preserve nature. Wild creatures should never be brought into the home. Zoonotical diseases are nature’s way of seeking retribution, as I mentioned earlier. Let nature remain as it is. Preserve its beauty. Finally, as a part of Corporate Social Responsibility (CSR) everybody including the Teachers, Imams, NGOs, government officials and even businessmen should make endeavors to make the people aware of about the danger of street food, drowning in ponds/rivers and even animal pets which can trigger various diseases. n THE PHARMA WORLD 35 Alert on toxins and its effects The syrup was manufactured by Fourrts (India) Laboratories for Dabilife Pharma and it contained contaminants higher than the acceptable level, said the WHO. However, Bala Surendran, the vice president of the company, told Bloomberg news last month that the production of the medicine had been subcontracted to another company and that his company had not found any toxins in a sample they had reviewed. The Ministry of Health in India announced that after the medicine failed separate tests conducted in Iraq, products were now being confiscated from the market, reported Bloomberg. This year India mandated testing of cough syrups before exports to prevent such instances, reported the  Indian Express. n WHO ALERT Fresh WHO alert on ‘contaminated’ Indian cough syrup The UN’s health body warned that the contaminated mixture could result in “serious injury or death.” This is the fifth such warning against medicine produced by an Indian manufacturer. The World Health Organization (WHO)  on Monday issued a global alert regarding an Indian-made cough syrup called «Cold Out,» which is being sold in Iraq. The medication was found to be contaminated with toxins. “The substandard batch of the product is unsafe and its use, especially in children, may result in serious injury or death,” the alert warned. This is the fifth such warning being issued against an Indian pharmaceutical manufacturer in the past 10 months.

THE PHARMA WORLD 37 INTERVIEW Prof Dr. Md. Titu Miah Director General Medical education, Ministry of health and Family welfare President Bangladesh Society of Medicine Senior vice president Executive Committee of Bangladesh Physicians and Surgeons Medicine and Rheumatologist specialist “Adequate policies should be framed to address the tropical diseases and ensure its proper implementation” As an eminent physician of the country, would you please tell our readers about the major tropical diseases commonly prevalent in Bangladesh? Of many major health issues tropical diseases are always being prioritized due to significant social and economic impact on the affected communities. Dengue, Chikungunya, Tuberculosis, Malaria. Enteric fever are the major tropical diseases in Bangladesh and also kala azar and Filariasis -these two were deadly issues but now almost eliminated from our country. Not only the infectious diseases, I must say snake bite is also a matter of our concern in this subcontinent. Of late, Dengue has turned serious and creating a havoc with its new symptoms ,what is the treatment protocol for such cases?  Yes, this year we are witnessing the worst dengue situation and it is presenting with newer sign and symptoms, but the treatment protocol is as it was before .Alongside high grade fever and musculoskeletal pain this year it is also presenting with diarrhea, respiratory symptoms. People are being panicked with high grade fever but we should keep in mind that the critical phase is while patient may be in afebrile state but plasma leakage can happen. Decreasing platelet counts is not the only problem in dengue patients and it should not be focused and not always need blood transfusion. But decreasing body plasma and reduced blood pressure may complicate the whole situation, so main treatment protocol is fluid replacement and symptomatic management. Of course physicians judgments can decide whether any need of blood transfusion is necessary or not. Community’s risks to dengue also depend on people’s knowledge, attitude and practice towards dengue as well the implementation of routinely vector control activities in the community. Knowledge should be spread as to when to admit the patient in hospital and the warning signs like severe abdominal pain, persistent vomiting or any sign of active bleeding etc. What are the typical clinical features and symptoms of typhoid fever? How the diagnosis is done and what are it’s management? Typhoid fever or enteric fever is also a life threatening infection and a major public health problem. Symptoms include prolonged high fever, fatigue, headache, nausea, diarrhea. Severe cases may lead to serious complications or even death. Because the clinical presentations of typhoid fever is often indistinguishable from other endemic acute febrile illness  (e.g., malaria, dengue), diagnosis is dependent upon labo-

ratory confirmation, typically blood culture .Blood culture sensitivity is decreasing due to widespread use of antibiotics which must be prohibited. Patient must take only the prescribed antibiotic accordingly. What are the key clinical features of Rheumatic fever? What treatment protocol is recommended for rheumatic fever? Are there any need of long term management strategies for patients with rheumatic fever? Rheumatic fever is the consequence of an immunological reaction .Young patient within age 5 to 15 with a history of sore throat, pharyngitis with joint pain, fever, we must suspect rheumatic fever.  We should also exclude juvenile idiopathic arthritis and other autoimmune diseases. As Diagnosis of Rheumatic fever is made upon some major and minor criteria, we should start treatment with antibiotics, NSAIDs. Sometimes steroid may be needed if serious complications like carditis is present according to clinicians choice. If ASO titre (anti streptolysin O titre) is high, without any sign and symptoms diagnosis should not be made as rheumatic fever as it is one of the criterias but not the major criteria. Also we should keep in mind that ASO titre may be positive in recent strep infection (e.g.sore throat). In the long run, if it is untreated, heart valves are damaged. They will need to be replaced with artificial valves, with lifelong blood thinner medication is required in that case. What are the common symptoms of malaria? How is it diagnosed? What are the key strategies for the prevention and control of malaria in high risk areas of Bangladesh? Bangladesh has a serious public health issue with malaria, also with presence throughout the world. It’s a disease caused by parasite transmitted to human by anopheles mosquitoes. Patients coming from malaria endemic zone like hill tracks, border areas with high grade fever from the day one we should be suspected as Malaria with the other causes and search for other clinical features. The approach to diagnosis of malaria consists of clinical diagnosis and parasite diagnosis. Blood film preparation is made (Thick film and thin film) for diagnosis of parasite with light microscopy which is the standard method. Rapid diagnostic test for detection of malaria parasite antigen or antibody, PCR or molecular tests for malaria is the gold standard method of diagnosis. Sufficient medical care and awareness is required not to miss the diagnosis of malaria or other complicated cases of malaria like cerebral malaria where patient presents with severe headache and high fever. people should take precautions to prevent mosquito bites, including applying an approved insect repellent, and making sure there is no accumulated water available for the insects to breed, Travelers should be aware of malaria before going to any malaria endemic zone and take preventive medicine before trip. What are the challenges in providing health care services for fever and tropical diseases in rural areas of Bangladesh? Main challenge is diagnostic facilities. It will be much easier to diagnose the case if diagnostic facilities are available. Though Bangladesh has strong primary health care system like community clinics through which helpless people seek medical treatment from health care providers. Once you have made the diagnosis, providing health care service will bring desired result. To improve the present situation stress should be given to diagnostic facilities. Public should be motivated to seek medical advice. In that case, we also need to address the limitations of manpower. Actually tropical diseases will be our matter of concern every year, in every season. Disease risks may change only and shifts with climate change. These diseases are preventable and controllable. Therefore, adequate policies should be framed to address the tropical diseases and ensure its proper implementation in coordination with health care provides, District Administration, DG Health and other concerned government agencies. n THE PHARMA WORLD 39 As of 2019, an estimated 9 million people get sick from typhoid and 110 000 people die from it every year. Symptoms include prolonged fever, fatigue, headache, nausea, abdominal pain, and constipation or diarrhoea. Some patients may have a rash. Severe cases may lead to serious complications or even death. Typhoid fever can be treated with antibiotics although increasing resistance to different types of antibiotics is making treatment more complicated. The typhoid conjugate vaccine is recommended for use in children from 6 months of age and in adults up to 45 years or 65 years (depending on the vaccine). Two typhoid conjugate vaccines have been prequalified by WHO since December 2017 and are being introduced into childhood immunization programmes in typhoid endemic countries. n Source: WHO Key facts about Typhoid

INTERVIEW “The government has infused healthcare coverage to the deep root of the country through its robust healthcare system” Prof. Dr. Ahmedul Kabir Additional Director General Planning & Development, DGHS Secretary General Bangladesh Society of Medicine Medicine Specialist As an eminent physician of the country, would you please tell our readers about the major tropical diseases commonly prevalent in Bangladesh? Bangladesh is known to be affected by several major tropical diseases due to its climate and geographical location. Some of the common tropical diseases prevalent in Bangladesh include: l Malaria: Malaria is a mosquito-borne disease caused by Plasmodium parasites. In Bangladesh, it is primarily prevalent in the southeastern hilly regions and coastal areas. The risk is higher during the monsoon and postmonsoon seasons. l Dengue Fever: Dengue is a viral infection transmitted by Aedes mosquitoes. Bangladesh experiences periodic outbreaks of dengue, particularly during the rainy season when mosquito breeding is most active. l Chikungunya: Chikungunya is also transmitted by Aedes mosquitoes and shares symptoms with dengue, including high fever and joint pain. It can lead to outbreaks in Bangladesh. l Typhoid Fever: Typhoid is a bacterial infection spread through contaminated food and water. It can be a concern in overcrowded urban areas and regions with poor sanitation. l Tuberculosis (TB): TB is a bacterial infection affecting the lungs and can spread through the air. It remains a significant public health challenge in Bangladesh. l Hepatitis: Hepatitis A and E, which are waterborne infections, are common in Bangladesh. They spread through contaminated food and water sources. l Leishmaniasis: This is a parasitic disease transmitted through sandfly bites and can cause visceral or cutaneous leishmaniasis. l Filariasis: Lymphatic filariasis is a parasitic infection transmitted through mosquito bites and can cause severe swelling of limbs and other body parts. l Japanese Encephalitis: This is a mosquito-borne viral infection that can cause severe inflammation of the brain. It is more prevalent in rural areas and during the monsoon season. l Diarrheal Diseases: Diarrheal illnesses e.g., cholera, waterborne diseases are prevalent in Bangladesh due to issues related to water and sanitation. It’s essential to note that the prevalence and distribution of these diseases may vary over time and can be influenced by various factors, including climate, weather, public health measures, and socio-economic conditions. THE PHARMA WORLD 41

Of late, Dengue has turned serious and creating havoc with its new symptoms. What is the treatment protocol for such cases? Dengue is a viral infection, and supportive care is the primary approach for managing the disease. The main goal of treatment is to alleviate symptoms, prevent complications, and maintain hydration. As a general treatment protocol following measures should be followed: l Rest: Get plenty of rest to help your body fight the infection. l Hydration: Drink plenty of fluids, such as water, oral rehydration solutions (ORS), and electrolyterich beverages to stay hydrated. Severe dengue can cause dehydration, so it is essential to maintain fluid balance. l Fever management: Overthe-counter acetaminophen (paracetamol) is usually recommended to reduce fever and alleviate pain. Avoid non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, as they can increase the risk of bleeding. l Avoid Aspirin and NSAIDs: Aspirin and NSAIDs should be avoided, as they can increase the risk of bleeding, especially in severe dengue cases. l Monitor platelet count: Dengue can cause a decrease in platelet count, which may lead to bleeding. Regular monitoring of platelet levels is necessary, especially in severe cases. l Medical supervision: If you suspect you have dengue or experience severe symptoms, seek medical attention promptly. Early diagnosis and medical supervision are crucial for managing dengue effectively. l Hospitalization: Severe cases of dengue may require hospitalization for close monitoring and intravenous fluids to manage dehydration. It is important to note that the management of dengue can vary depending on the severity of the disease and individual patient factors. In clinical setting, Dengue cases are being treated according to classification of severity. WHO Dengue case classification by severity is as follows: A) Dengue without warning signs: Group A (Send home). B) Dengue with warning signs: Group B (Referred for in-hospital care). C) Severe dengue: Group C (Require emergency management). What are the typical clinical features and symptoms of typhoid fever? How the diagnosis is done and what are its management? Typhoid fever is transmitted by the faecal–oral route, are important causes of fever in South Asia, sub-Saharan Africa and Latin America. This enteric fever is caused by infection with Salmonella enterica serotypes Typhi. It is usually spread through contaminated food or water. Once Salmonella Typhi bacteria are ingested, they multiply and spread into the bloodstream. Urbanization and climate change have the potential to increase the global burden of typhoid. In addition, increasing resistance to antibiotic treatment is making it easier for typhoid to spread in communities that lack access to safe drinking water or adequate sanitation and children are at highest risk. Clinical features: l First week Fever, Headache, Myalgia, Relative bradycardia, Constipation, Diarrhoea and vomiting in children l End of first week Rose spots on trunk, Splenomegaly, Cough, Abdominal distension, Diarrhoea l End of second week Delirium, complications, then coma and death (if untreated) Diagnosis: In the first week, diagnosis may be difficult because, in this invasive stage with bacteraemia, the symptoms are those of a generalized infection without localizing features. Typically, there is a leucopenia. Blood culture establishes the diagnosis and multiple cultures increase the yield. Stool cultures are often positive in the second and third weeks. The Widal test is done to detects antibodies. Management: l Antibiotic therapy, guided by sensitivity testing, as per instructions from the physician. l Surgical: Cholecystectomy may be necessary. People who do not get appropriate antibiotic treatment may have fever for weeks or months and may develop other health problems. Figure: Pocket Guideline for Dengue Clinical Case Management 2022 (Revised), DGHS 42 THE PHARMA WORLD

What are the key clinical features of rheumatic fever? What treatment protocol is recommended for rheumatic fever? Are there any need of longterm management strategies for patients with rheumatic fever? Key clinical features: l Acute rheumatic fever is a multisystem disorder that usually presents with fever, anorexia, lethargy and joint pain, 2–3 weeks after an episode of streptococcal pharyngitis although there may be no history of sore throat. l Arthritis occurs in approximately 75% of patients. l Other features include rashes, subcutaneous nodules, carditis and neurological changes. l Generally Rheumatic fever is diagnosed by using the revised Jones criteria. Major manifestations – Carditis, Polyarthritis, Chorea, Erythema marginatum, Subcutaneous nodules Minor manifestations – Fever, Arthralgia, Raised erythrocyte sedimentation rate or C-reactive protein, Previous rheumatic fever, Leucocytosis, First-degree atrioventricular block. l Supporting evidence of preceding streptococcal infection: recent scarlet fever, raised antistreptolysin O or other streptococcal antibody titer and positive throat culture. l The diagnosis is based on two or more major manifestations, or one major and two or more minor manifestations, along with evidence of preceding streptococcal infection. Long-term management strategies for patients with rheumatic fever To ensure the best possible outcomes for patients with rheumatic fever, long-term management strategies should focus on preventing recurrences of the disease, managing symptoms, and minimizing the risk of complications. Here are some key aspects of long-term management for patients with rheumatic fever: l Regular medical follow-up: The frequency of these visits will depend on the severity of the disease and the individual patient’s needs. During these visits, the healthcare provider will assess the patient’s overall health, check for signs of disease recurrence, and adjust treatment as needed. l Penicillin prophylaxis: Long-term antibiotic prophylaxis with penicillin or other suitable antibiotics is crucial to prevent recurrences of rheumatic fever. l Management of symptoms and complications: Patients with rheumatic fever may experience various symptoms, such as joint pain, fever, and skin rash. Nonsteroidal antiinflammatory drugs (NSAIDs) may be used to relieve joint pain and inflammation. In more severe cases, corticosteroids may be prescribed. Heart complications, such as valve damage, may require specialized management by a cardiologist. l Healthy lifestyle: Encourage patients to adopt a healthy lifestyle that includes regular physical activity, a balanced diet, and avoidance of tobacco and excessive alcohol consumption. l Education and self-management: Educate patients and their families about rheumatic fever, its complications, and the importance of adhering to treatment and follow-up plans. l Dental care: Regular dental checkups are essential for patients with rheumatic fever, as untreated dental infections can potentially trigger a recurrence of the disease. l Prevention of Group A Streptococcus infections: Reinforce the importance of preventing streptococcal infections by maintaining good hygiene practices, avoiding close contact with individuals who have strep throat, and seeking prompt medical attention if any symptoms of a sore throat or streptococcal infection occur. The management of rheumatic fever may vary depending on the severity of the condition and the individual patient’s medical history. Therefore, it is essential for patients to work closely with their healthcare providers to develop a personalized long-term management plan that addresses their specific needs and concerns. What are the common symptoms of malaria? How is it diagnosed? What are the key strategies for the prevention & control of malaria in high-risk areas of Bangladesh? Malaria in humans is caused by Plasmodium falciparum, P. vivax, P. ovale, P. malariae and the zoonotic simian parasite P. knowlesi. It is transmitted by the bite of female Anopheles mosquitoes and occurs throughout the tropics and subtropics. Common symptoms: The clinical features of malaria are non-specifc and the diagnosis must be suspected in anyone returning from an endemic area who has features of infection. In case of Plasmodium falciparum infection: - The onset is often insidious, with malaise, headache and vomiting. - Cough and mild diarrhoea. - The fever has no particular pattern, and the classic periodicity is rarely observed. - Jaundice is common due to haemolysis and hepatic dysfunction. - The liver and spleen enlarge and may become tender. - Anaemia develops rapidly, as does thrombocytopenia. - Patients with falciparum malaria, apparently not seriously ill, may rapidly develop dangerous complications. For example: Cerebral malaria is manifested by delirium, seizures or coma, usually without localizing signs. - Immunity is impaired in pregnancy and the parasite can cause abortion and intrauterine growth retardation. In case of Plasmodium vivax and Plasmodium ovale infection: - Illness usually starts with several days of continued fever before the development of classical bouts of fever on alternate days. - Fever starts with a rigor. - The patient feels cold and the temTHE PHARMA WORLD 43

perature rises to about 40°C. After half an hour to an hour, the hot or flush phase begins. It lasts several hours and gives way to profuse perspiration and a gradual fall in temperature. The cycle is repeated 48 hours later. - Gradually, the spleen and liver enlarge and may become tender. - Anaemia develops slowly. - Relapses are frequent in the first 2 years after leaving the malarious area and infection may be acquired from blood transfusion. Diagnosis: l WHO recommends prompt parasite-based diagnosis by microscopy or malaria rapid diagnostic test (RDT) in all patients suspected of malaria before antimalarial treatment is administered. Light microscopy entails visualization of the malaria parasites in Giemsa-stained blood smear of the patient. l Nucleic acid detection (PCR) is used mainly in research and is useful for determining whether a patient has a recrudescence of the same malaria parasite or a reinfection with a new parasite. Key strategies for the prevention & control of malaria: l Universal coverage by qualityassured prompt diagnosis and treatment for all at-risk populations including the key and vulnerable populations (mobile & migrant populations, ethnic minority groups, disadvantaged/ underserved communities, communities in border and conflict areas, and refugees). l Universal coverage by appropriate prevention interventions for all atrisk populations including the key and vulnerable populations. l Strengthen epidemiological and entomological surveillance appropriate for different settings. l Review and refine malaria stratification periodically based on data related to transmission risk, receptivity and vulnerability for targeted interventions. l Strengthen M&E and reinforce regular supportive supervision and feedback; initiate and strengthen DHIS2 based MIS; and emphasize data quality and its use especially at subnational levels. l Build resilient and sustainable health systems, including improvement of health workforce capacity with requisite skillsets at all levels, and uninterrupted access to quality-assured comorbidities. l Foster strengthening of community systems; and enhance participation and ownership through intensified community engagement endeavors. l Address human rights genderrelated barriers and inequities related to service access, uptake especially meeting the needs of key and vulnerable population groups. l Strengthen quality service delivery through public health facilities as well as community health workers & volunteers (including those with partner NGOs). l Scale up private sector engagement to expand coverage of case detection, streamline case management protocol, ensure timely reporting. l Foster multi-sector strategic coordination and collaboration (with health & non-health sectors, local governments as well as partner agencies). l Gather evidence continually on efficacy of first-line antimalarial drugs for early detection of possible emergence of drug resistant P. falciparum. l Initiate cross-border collaboration between Bangladesh & India, Myanmar to tackle malaria transmission potentials through population movement along international borders; and maximize service delivery, surveillance within national boundaries. l Promote research for addressing programmatic challenges, needs and gaps. l Advocate for malaria elimination and prevention of re-introduction at all levels and sufficient and sustained resources. What are the challenges in providing healthcare services for fever & tropical diseases in rural areas of Bangladesh? Bangladesh is a country located in South Asia, currently encountering a phase of socioeconomic transition with rapid urbanization. Once called rural population are now more connected to the urban community leading a more developed life with a transformation of their demographic condition, daily needs and lifestyle factors. The government has infused healthcare coverage to the deep root of the country through its robust healthcare system. Community clinics, considered as a global role model are providing healthcare at the doorstep, with awareness development and preventive measures including fever and tropical diseases related issues. Transportation network of the country went through a massive development during the past decade so that communication is not at all an issue except some of the hardto-reach areas of chars & coastal regions. Inclusive solutions has been brought like floating hospitals, water ambulance has been arranged by the government, development partners and some NGO’s for accessibility of health services for these vulnerable & marginalized community. To combat against fever & tropical diseases and other health issues, Upazila Health Complex are now equipped with medicine consultants, diagnostic facilities (e.g., radiological, blood & urine tests, GeneXpert machines) and in almost 90% cases the tests are free of cost or with a basic minimum payment. The government is providing free medicines for the patients from pharmacy. In case of further management, the patients are being referred to the district sadar hospitals or tertiary of specialized hospital in case of need. The government has established Bangladesh Institute of Tropical and Infectious Diseases (BITID), dedicated for tropical disease management and prevention. However, changing pattern of diseases and previously mentioned factors are generating newer challenges 44 THE PHARMA WORLD

in providing healthcare services. When it comes to fever and tropical diseases, the challenges become more pronounced due to the unique nature of these illnesses. Some of the key challenges include: l There needs more allocation of specialist doctors for the marginalized and vulnerable communities and strengthen the related human resources. l Proper understanding of Public Health perspective of disease epidemiology is important for utilization of existing resources as well as health system’s efficacy. l Motivation to serve in the least developed areas, needs to be strengthened for the frontline health service providers, so that it can aspire them to work closely to the community more dedicatedly. l Health seeking behavior and health literacy: Government is struggling to improve health literacy for in some marginalized communities which may lack of awareness about tropical diseases and preventive measures. Also, improvement in health seeking behavior is a lengthy & continuous process, absence pf which may lead to delayed seeking of medical care and improper use of home remedies, exacerbating the situation. l Disease burden and outbreaks: The effects of climate change, which is one of the major challenges for the country. Tropical diseases, such as dengue fever, malaria, diarrheal diseases, chikungunya, are endemic in some regions of Bangladesh and happen throughout the year in various episodes. Outbreaks of these diseases can overwhelm local healthcare facilities and resources, further straining the healthcare system. l Cultural and social beliefs: Traditional beliefs and some religious practices may influence healthcare-seeking behavior and hinder the adoption of modern medical interventions for fever and tropical diseases. Addressing these challenges requires a comprehensive approach, including improving healthcare infrastructure, increasing the number of healthcare professionals in specific areas, implementing health education and awareness programs, providing subsidized healthcare services, and strengthening disease surveillance and reporting systems. Also, long term strategic action is needed to minimize the effect of climate change. Additionally, partnerships with local communities, NGOs, and international organizations can play a crucial role in improving healthcare access and reducing the burden of fever and tropical diseases in Bangladesh. n THE PHARMA WORLD 45 A group of researchers from the Department of Pharmacy, State University of Bangladesh (SUB), led by Prof. Dr Md. Moklesur Rahman Sarker, Head of Academic & Research Affairs of the Department, has developed a novel immunobooster “SuperBoost” targeting to use for the prevention of any kind of infections including COVID-19 and cancers. This potential nutraceutical has been developed after the last three years extensive research on pharmacological, toxicological, phytochemical, and computational approaches of drug development for the evaluation of its efficacy and safety of “Super-Boost” on different strains of laboratory mice and rats. This project was funded by the Ministry of Education under the GARE (Grant for Advanced Research on Education) project. n SUB’s Pharmacy deptt develops a potential immunobooster for prevention of infectious diseases and cancers Congrats

THE PHARMA WORLD 47 INTERVIEW Prof. Dr. Quazi Tarikul Islam Former Professor of Medicine Dhaka Medical College, Dhaka Editor in Chief National Guideline for management of Clinical Dengue Syndrome “There are 3 groups of patients who present to doctor with Dengue for management” As an eminent physician of the country, would you please tell our readers about the major tropical diseases commonly prevalent in Bangladesh? In the tropic and sub -tropical region Bangladesh is a country where the following diseases are prevalent. Tropical diseases are now levelled as Neglected Tropical diseases (NTD). The major NTDs are: Lymphatic Filariasis, Visceral Lieshmaniasis, Soil Transmitted Helminth infection including (hookworm, ascariasis and trichuriasis), Dengue Fever, Leprosy, Chikungunya, Rabies, Rickettsial fever, Leptospirosis. Of late, Dengue has turned serious and creating a havoc with its new symptoms. What is the updated treatment protocol for such cases? There are 3 groups of patients who present to doctor with Dengue for management. They are: Group A – Classic dengue who does not require admission in hospital and improves within 4-5 days without any physical problem. Symptomatic treatment only. Group B - These group of patients are having comorbidities or warning signs. They should be admitted in hospital for further management. Group C - Dengue shock syndrome. Must be hospitalised preferably in ICU. Death of Dengue cases depends on this group of patients. Critical care management is required to save the life of the patient. What are the typical clinical features and symptoms of Typhoid Fever? How the diagnosis is done and what are its management? Fever which gradually increases from every previous day and goes up to 105 F. It is in other word called step ladder pattern of fever typical for Typhoid fever. Mostly patients have a history of taking food outside home mostly street food. After one week of the onset of fever, spleen and liver may be palpable. Patient might have diarrhoea, abdominal pain. In some cases, there may be perforation of the small intestine which may be fatal and mortality is high. Diagnosis is absolutely by blood culture. Management is mostly by either oral or parental antibiotics. Inj. Ceftriaxone 2gm IV 12 hourly for 10 -14 days is the gold standard of management. Azithromycin, Cefixime, Ofloxacin are the drugs that can be used. What are the common symptoms of Malaria? How it is diagnosed? What are key strategies for prevention and control of Malaria in high risk areas of Bangladesh? Fever with chills. Temperature can go up to 104 F. There may be a positive history of visit to hill track region few weeks before.

The IPDI Foundation has joyfully bestowed upon  National Professor Brigadier (Rtd.) Abdul Malik the esteemed  “Lifetime Achievement Award”. This distinguished accolade is a well-deserved recognition of his unparalleled leadership and pioneering efforts that have left an indelible mark on the advancement and growth of cardiology in the country. Professor Brigadier (Rtd.) Abdul Malik’s exceptional journey as a visionary leader in the realm of cardiology has been nothing short of awe-inspiring. Under his astute guidance, the realm of cardiology in Bangladesh has witnessed a profound transformation. His invaluable expertise and unwavering dedication have played a pivotal role in fostering groundbreaking research, driving technological advancements, and nurturing a new generation of healthcare professionals, all of which have contributed to the remarkable development of cardiology in Bangladesh. n Liver and Spleen may be palpable. In Falciparum malaria, patient may have dark urine (black water Fever). Diagnosis is based on history, clinical examination and investigations. CBC, S.bilirubin, Microscopy of thick and thin film for malarial parasites. ICT for malaria. Sometimes MP from buffy coat. Rapid diagnostic test for malaria. Insecticide-treated mosquito nets and house screening prevent adult mosquito biting in the house IRS – Indoor Residual Spraying to kill adult mosquito in the house Presumptive treatment for killing the malarial parasites in the blood before they can cause malaria. Mosquito repellents- Mosquito coil, aerosol spray, cream to apply on exposed surface of the body Health education What are the key clinical features of Rheumatic fever? What treatment protocol is recommended? Are there any need of long term management for RF? Age between 5 to 15 Sore throat Fever Migratory poly arthralgia or arthritis Erythema marginatum Sydenham Chorea Carditis Subcutaneous nodule Raised ESR First degree AV block Throat swab positive for streptococcal infection Bed rest Treatment of Cardiac failure Aspirin Oral phenoxymethyl penicillin or Benzathine penicillin IM Steroid in special siyuation Yes. Duration of treatment is minimum 5 years or 21 year of age What are the common symptoms and clinical features of Influenza? How does it differ from other respiratory infections? Influenza is commonly acute systemic viral infection of the respiratory tract. Influenza A and B are two organisms responsible. It is usually seasonal. Fever, Malaise and cough are main symptoms. Pneumonia may occur associated with super infection by streptococcus pneumonia or Staph. Aureus. There are so many other viral infection and bacterial infections of the respiratory tract. For example COVID-19 is a viral one but differ from onset and clinical course from influenza where COVID-19 affect primarily lung parenchyma. Bacterial pneumonia involves the lung mainly without upper respiratory involvement. n THE PHARMA WORLD 49 IPDI Foundation Awarded “Lifetime Achievement Award” to “National Professor Brig (Rt) Abdul Malik” Congrats

INTERVIEW Md. Quamrul Hassan Senior Director, Marketing & Sales Popular Pharmaceuticals Ltd. “‘Quality practice’ in every aspect of business operations and ‘compliance’ are essential for long-term success in the pharmaceutical industry” As an integral part of Popular Pharmaceuticals Ltd., would you please introduce your company to our readers? Popular Pharmaceuticals Ltd. (PPL), unique of its kind, is a concern of Popular Group, the leading corporate house in the Private Sector Healthcare Management in Bangladesh. Popular Pharma is a WHO cGMP certified manufacturer & marketer of Pharmaceutical finished formulations holding a number of regional GMP Compliance Certifications in Asia & Africa. This company is also having ISO 9001:2015 certification for its quality management system. Established in 2002, Popular Pharmaceuticals Limited launched its products on August 05, 2005 with a vision to lead the branded generics market in Bangladesh. At present, having a portfolio of more than 500 formulations of diversified molecules catering to the needs of almost all therapeutic areas, PPL at the same time is relentlessly progressing for the future waves of novel formulations. PPL is the only company in Bangladesh having eight separate and dedicated manufacturing facilities on over 12 acres of land for manufacturing of wide variety of formulations as under: l General Product Manufacturing Unit (Solids, Liquid, Cream & Ointment) l Cephalosporin Unit (Solid, injectable) l Sterile Product Unit (Ophthalmics & Injectables) l Facility for Large Volume Parenterals(LVPs) l Hormone Unit l Dialysis Product Unit l Vaccine Unit l Animal Health Product unit PPL manufactures a wide variety of pharmaceutical formulations like Oral solids (all types of Tablets, Capsules, Sachets), Liquids (Syrup, Suspension, PFS), Creams & Ointments, Emulsions, Small Volume Parenterals (SVPs), Sterile Drops, Large Volume Parenterals (LVPs), Hemodialysis Solutions, Pre-filled Syringes etc. The wide range of formulations covers almost all therapeutic areas including biotech products like Human Insulin & Vaccines, Antiulcerants (injectables and solids), Antiallergics, Vitamin Supplements, Parenteral Nutrients (Amino Acids, Fat Emulsions etc), Complete range of Anesthesia products, Penicillins and non beta-lactum antibiotics, Cephalosporins, 50 THE PHARMA WORLD