TPW

GASTROLIVER

CONTENTS Volume 15 n No. 2 n March-April 2024 Published by Muhammad Masud. Editorial and Business office 51, Kalabagan 1st Lane (Ground floor) Dhaka-1205, Bangladesh, Tel/Fax: +88 02 58155677, E-mail: [email protected] 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. Research Update 31 Worth Knowing About ... 47 Glossary of Terms 51 Did You Know 59, 69 Feature 69 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 EDITORIAL ASSISTANT Siam Hossain 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 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. 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 Prof. Dr. ABM Abdullah UGC Professor, BSMMU Personal Physician to Hon’ble Prime Minister AMR 70 Pharmacovigilance 71 Drug Safety 72 Red Alert 73 Technology 83 Course and Conferences 91 Medical Miracle 99 FDA Approvals 100 FDA Update 101 Appointments & Promotions 102 Upcoming Events 107 Pre-Event 108 Post Event 109 News New Arrivals 5, WHO News 22, DGDA News 23, Industry News 25, Seminar 30, Fip News 65 Interview Prof. Dr. Mobin Khan 33 Prof. Dr. Salimur Rahman 39 Prof. Dr. Faruque Ahmed 41 Prof. Dr. Md. Habibur Rahman 45 Prof. Dr. Md. Ashraful Islam 49 Prof. Dr. A H M Rowshon 53 Prof. Dr. Mamun-Al-Mahtab (Shwapnil) 57 Prof. Dr. Swapan Chandra Dhar 61 Prof. Dr. Md. Anwarul Kabir 63 Prof. Dr. Ayub Al Mamun 67 Prof. Dr. Faroque Ahmed 75 Prof. Dr. Shahinul Alam 79 Prof. Dr. Chanchal Kumar Ghosh 81 Prof. Dr. Tohidul Karim Majumder 85 Prof Dr. Md. Mahmuduzzaman 89 Prof. Dr. Md. Razibul Alam 93 Dr. Md. Saif Uddoula 97

NEW ARRIVALS 7 ACME Brand Name: Airfors Generic Name: Salbutamol Sulfate BP & Budesonide BP Dosage Form: Metered Dose Inhaler (MDI) Strength: 90 mcg & 80 mcg Indications: Rescue treatment for Asthma. Brand Name: Cystnil Generic Name: D-Chiro Inositol & Myo-Inositol Dosage Form: Tablet Strength: D-Chiro Inositol 150mg & Myo-Inositol 550mg Indications: Poly Cystic Ovary Syndrome (PCOS) & PCOS induced infertility. Brand Name: D-gest Generic Name: Dydrogesterone BP Dosage Form: Tablet Strength: 10 mg Indications: Threatened miscarriage, Recurrent miscarriage, Infertility due to luteal insufficiency. Brand Name: Fast 100 ml Generic Name: Paracetamol BP Dosage Form: Suspension Strength: 120 mg/5ml in 100 ml Indications: Fever, Mild to moderate pain. Brand Name: Folikidz Generic Name: Folic Acid BP Dosage Form: Oral Solution Strength: 2.5 mg/5ml Indications: Folate deficiency, Megaloblastic Anemia. Brand Name: Lulikill Generic Name: Luliconazole INN Dosage Form: Cream Strength: 1% (20 g) Indications: Tinea Pedis, Tinea Cruris & Tinea Corporis. Brand Name: Olic Generic Name: Obeticholic Acid Dosage Form: Tablet Strength: 5 mg & 10 mg Indications: Primary biliary cholangitis. Brand Name: SUMA Generic Name: Sumatriptan BP 10mg Dosage Form: Nasal Spray Strength: 10mg (30 Sprays) Indications: Acute migraine. Brand Name: Telisa Plus Generic Name: Telmisartan & Hydrochlorothiazide Dosage Form: Tablet Strength: 40/12.5 & 80/12.5 Indications: Moderate to severe Hypertension. Brand Name: Trugut Generic Name: Lactobacillus acidophilus 2.25 billion, Lactobacillus bulgaricus 75 million, Lactobacillus lactis 2.1 billion, Lactobacillus casei 2.25 billion, Streptococcus thermophilus 300 million, Bifidobacterium bifidum 450 million, Bifidobacterium longum 75 million, Bifidobacterium infantis 1.5 billion, Fructo-Oligosaccharides 50 mg, soyafiber & papaya extract 140 mg. Dosage Form: Capsule Strength: 9 billion probiotics Indications: Indicated for the treatment of IBS, constipation, flatulence & indigestion.

NEW ARRIVALS 9 Ad-Din Brand Name: Co-Clav Generic Name: Amoxicillin Trihydrate BP + Clavulanic Acid BP Dosage Form: Tablet & PFS Strength: 625mg & 125mg/5ml Indications: Upper & Lower Respiratory tract infections, Genital-urinary tract infections, Skin & soft structure infections, Bone & joint infections, Sinusitis, Acute otitis media, Communityacquired pneumonia, Dental Brand Name: Cefixime-A Generic Name: Cefixime USP Dosage Form: Capsule & PFS Strength: 200mg, 400mg & 100mg/5ml Indications: Pneumonia, Typhoid fever, Sinusitis, Tonsillitis, Pharyngitis, Otitis media, Acute Exacerbation of Chronic Bronchitis, Respiratory tract infections, Acute bronchitis, Skin & soft tissue infections, Gonococcal urethritis. Brand Name: Adrox-CV Generic Name: Cefuroxime USP + Clavulanic Acid BP Dosage Form: Tablet & PFS Strength: 250mg, 500mg & 125mg/5ml Indications: Pneumonia, Typhoid fever, Sinusitis, Tonsillitis, Pharyngitis, Otitis media, Lyme disease, Acute Exacerbation of Chronic Bronchitis, Respiratory tract infections, Urinary tract infections, Acute bronchitis, Skin & soft tissue infections, Surgical Prophylaxis. Brand Name: Tium Injection Generic Name: Tiemonium Methylsulphate Dosage Form: Injection Strength: 5 mg /2 ml Indications: Visceral muscle spasm, Mild cystitis, Spasmodic dysmenorrhea, Gastroenteritis, Biliary colic, Cholecystitis, Colonopathies. Brand Name: Feva Rapid Generic Name: Paracetamol BP Dosage Form: Tablet Strength: 500 mg Indications: Fever, Mild to moderate pain, Fever & pain after vaccination, Headache, Migraine, Muscle ache. Brand Name: Dequadin VT Generic Name: Dequalinium Chloride BP Dosage Form: Vaginal tablet Strength: 10 mg Indications: Bacterial Vaginosis (BV), Vulvovaginal Candidiasis (VVC), Trichomoniasis Vaginitis (TV) & Mixed Vaginal Infections. Brand Name: Trifera Generic Name: Trifarotene INN Dosage Form: Cream Strength: 0.005% (15 gm) Indications: Topical treatment of Acne vulgaris. Brand Name: Fast One Generic Name: Paracetamol Dosage Form: Tablet Strength: 1000mg Indications: Fever, Mild to moderate pain. abscess, Intra-abdominal sepsis.

10 NEW ARRIVALS Brand Name: Lacor IV/IM Injection Generic Name: Ketorolac Tromethamine USP Dosage Form: Injection Strength: 30 mg Indications: Moderate to severe pain, Surgical pain, Accidental pain. Brand Name: Newxone Generic Name: Ceftriaxone USP Dosage Form: IV Injection Strength: 1 g & 2 g Indications: Pneumonia, Typhoid fever, Sinusitis, Tonsillitis, Pharyngitis, Otitis media, Acute Exacerbation of Chronic Bronchitis, Respiratory tract infections, Acute bronchitis, Skin & soft tissue infections, Gonococcal urethritis, Surgical infections. Brand Name: Admero Generic Name: Meropenem USP Dosage Form: IV Injection Strength: 500 g & 1 g Indications: Pneumonia, Respiratory tract infections, Urinary tract infections, Intra-abdominal infections, Meningitis, Septicemia, Skin & soft tissue infections, Cystic fibrosis, Diabetic foot infections, Surgical infections. Brand Name: Feva Extend Generic Name: Paracetamol BP Dosage Form: Tablet Strength: 665 mg Indications: Fever, Mild to moderate pain, Fever & pain after vaccination, Headache, Migraine, Muscle ache. Brand Name: Feva One Generic Name: Paracetamol BP Dosage Form: Tablet Strength: 1000 mg Indications: Fever, Mild to moderate pain, Fever & pain after vaccination, Headache, Migraine, Muscle ache. ARISTOPHARMA Brand Name: Zavicef Generic Name: Ceftazidime 2 g + Avibactam 0.5 g Dosage Form: IV Injection for Infusion Strength: 2.5 g Indications: • Complicated intra-abdominal infection (cIAI), • Complicated urinary tract infection (cUTI), including pyelonephritis, • HospitalBrand Name: Lizox Generic Name: Linezolid Dosage Form: Tablet Strength: 400 mg & 600 mg acquired pneumonia (HAP), including ventilator-associated pneumonia (VAP). Indications: Community Acquired Pneumonia (CAP), Urinary Tract Infections (UTI), Intra-Abdominal Infections (IAIs), Diabetic Foot Infections etc. Brand Name: Renvista Generic Name: Roxadustat INN Dosage Form: Tablet Strength: 20mg, 50mg & 100mg Indications: Renvista (Roxadustat) is indicated for the treatment of adult patients with symptomatic anemia associated with Chronic Kidney Disease (CKD). Brand Name: Goodbac-L Generic Name: Bacillus subtilis (HU58) Dosage Form: Syrup Strength: 2 billion CFU/5 ml Indications: Diarrhea, Irritable Bowel Syndrome (IBS), Weak immune system.

NEW ARRIVALS 11 Brand Name: Tocogel Generic Name: d-Alpha tocopherol Dosage Form: Softgel Capsule Strength: 200 IU & 400 IU Indications: As an antioxidant for healthy hair & skin, immune deficiency, male infertility, hemolytic anemia due to vitamin E deficiency, cardiovascular disease. Brand Name: Adronic 4 Generic Name: Zoledronic Acid BP Dosage Form: Concentrated Solution for IV Infusion Strength: 4 mg/5 ml Indications: Hypercalcemia of malignancy, Bone metastases from solid tumors and multiple myelomas. Dosage Form: Eye drops Strength: 0.4% & 0.3% Indications: Systear® SUD is a preservativefree Single Unit Dose (SUD) lubricant for mild to moderate dry eyes & for computer vision syndrome. It is manufactured in a re-closable vial made of high-quality resin from Germany, exclusively for ophthalmic use. It forms a protective gel matrix at the ocular surface which facilitates the regeneration of corneal epithelial cells. Dosage Form: Eye Drops Strength: 0.2% Indications: Daily Fresh SUD is a preservativefree Single Unit Dose (SUD) natural lubricant for dry eyes and other ocular discomforts. It is manufactured in a re-closable vial made of high-quality resin from Germany, exclusively for ophthalmic use. It is also indicated for contact lens induced dry eyes, sensitive eyes, POAG patients, and post-operative patients. Dosage Form: Eye drops Strength: 1% Indications: Drylief SUD is a preservativefree Single Unit Dose (SUD) eye drop which is recommended for moderate to severe dry eyes and provides long-lasting protection against dryness and irritation. It is manufactured in a re-closable vial made of high-quality resin from Germany, exclusively for ophthalmic use. It also helps to increase the stability of precorneal tear film stability and regenerate the corneal epithelial cells of the conjunctiva. Brand Name: Sabicard Generic Name: Sacubitril & Valsartan Dosage Form: Tablet Strength: 50 mg, 100 mg & 200 mg Indications: Chronic heart failure. Brand Name: Systear® SUD Generic Name: Polyethylene Glycol 400 & Propylene Glycol Brand Name: Daily Fresh SUD Generic Name: Sodium Hyaluronate Brand Name: Drylief SUD Generic Name: Carboxymethylcellulose Sodium Brand Name: Wikijet Generic Name: Tirzepatide INN Dosage Form: Pre-filled Syringe Injection Strength: 2.5 mg/0.5 ml & 5 mg/0.5 ml Indications: Type- 2 Diabetes Mellitus & Obesity.

NEW ARRIVALS 13 Beximco Brand Name: Amdocal® Generic Name: Amlodipine 2.5 mg Dosage Form: Tablets Strength: Each tablet contains 2.5 mg of Amlodipine BP Indications: Indicated for the treatment of hypertension in patients with compromised end organs. Brand Name: Cibrate® Generic Name: Ciprofibrate 100 mg Dosage Form: Tablets Strength: Each tablet contains 100 mg of Ciprofibrate BP Indications: Indicated for the treatment of severe hypertriBrand Name: Cardoprin® Generic Name: Aspirin 75mg Dosage Form: Tablets Brand Name: Azmasol® Plus Generic Name: Salbutamol & Budesonide Dosage Form: Metered Dose Inhaler Strength: Each actuation delivers Salbutamol 90 mcg & Budesonide 80 mcg Indications: Indicated for immediate relief from bronchoconstriction & airway inflammation. Brand Name: D-Rise® Generic Name: Cholecalciferol Dosage Form: Vegetable Shell Capsule (VegeCap) Strength: Each capsule contains Cholecalciferol USP 50,000 IU Indications: Indicated for the treatment of severe Vitamin D deficiency in adults. Brand Name: Xadu® Generic Name: Roxadustat Dosage Form: Tablet Strength: 20 mg, 50mg, and 100 mg Indications: Indicated for treatment of adult patients with symptomatic anaemia associated with chronic kidney disease (CKD). Brand Name: Lopera® Generic Name: Loperamide Hydrochloride Dosage Form: Oral Solution Strength: Loperamide Hydrochloride USP 1 mg/5ml Indications: Indicated for acute and chronic non-infectious diarrhoea in patients over 4 years of age. glyceridemia with or without low HDL cholesterol. Strength: Each tablet contains 75mg of Aspirin Indications: Indicated for the secondary prevention of Heart Attack or Stroke in high-risk ASCVD patients. Brand Name: Gastalfet® Generic Name: Sucralfate Dosage Form: Oral Suspension Strength: Sucralfate USP 1 gm/5ml Indications: Indicated for the treatment of duodenal ulcer & gastric ulcer.

14 NEW ARRIVALS Brand Name: Trilexa® Bexicap® Generic Name: Fluticasone furoate + Umeclidinium + Vilanterol Dosage Form: Dry Powder Inhaler Strength: Fluticasone furoate INN 100 mcg + Umeclidinium 62.5 mcg (as Umeclidinium bromide INN) + Vilanterol 25 mcg (as Vilanterol trifenatate INN) & Fluticasone furoate INN 200 mcg + Umeclidinium 62.5 mcg (as Umeclidinium bromide INN) + Vilanterol 25 mcg (as Vilanterol trifenatate INN) Indications: Indicated for ● Maintenance treatment of patients with chronic obstructive pulmonary disease (COPD), ● Maintenance treatment of asthma in patients aged 18 years and older. Brand Name: Jardimet XR® Generic Name: Empagliflozin + Metformin HCL Dosage Form: Extended-Release Tablet Strength: Each Extended-Release tablet contains Empagliflozin 5mg + Metformin HCL 1000 mg, Empagliflozin 10 mg + Metformin HCL 1000 mg, Empagliflozin 25mg + Metformin HCL 1000 mg Indications: Type 2 Diabetic Mellitus. Brand Name: Jointec® Pro Generic Name: Glucosamine Sulfate 750mg & Chondroitin Sulfate 600mg Dosage Form: Film Coated Tablet Strength: Each film coated tablet contains Glucosamine Sulfate 750mg & Chondroitin Sulfate 600mg. Indications: Jointec® Pro is indicated for the treatment of osteoarthritis of knee, hip, spine, and other locations as a dietary supplement. It is also beneficial for rheumatoid arthritis and joint injuries. Brand Name: Midita® Generic Name: Lasmiditan Hemisuccinate Dosage Form: Tablet Strength: Each tablet of Midita 50 mg contains 50 mg of Lasmiditan Hemisuccinate and each tablet of Midita 100 mg contains 100 mg of Lasmiditan Hemisuccinate. Indications: Indicated for the acute treatment of migraine with or without aura in adult. Brand Name: Emijoy DS® Generic Name: Chlordiazepoxide and Amitriptyline Dosage Form: Tablet Strength: Each tablet contains Chlordiazepoxide 10 mg and Amitriptyline 25 mg Indications: Indicated for the treatment of patients with severe depression associated with severe anxiety. Brand Name: Bactrobex® Generic Name: Mupirocin 2% Dosage Form: 10gm Ointment in Laminated Tube Dosage Form: Capsule Strength: Finasteride USP 5 mg and Tadalafil USP 5 mg Indications: Indicated for the treatment of Benign Prostatic Hyperplasia (BPH). Brand Name: Simrin® Generic Name: Brinzolamide & Brimonidine Tartrate Dosage Form: Ophthalmic Suspension Strength: Brinzolamide USP 1% + Brimonidine Tartrate BP 0.2% Indications: Reduction of elevated intraocular pressure (IOP) in patients with openangle glaucoma. Strength: Each gram of ointment contains Mupirocin USP 20 mg w/w. Indications: Indicated for the topical treatment of impetigo (skin diseases) due to Staphylococcus aureus and Streptococcus pyogenes. It is also indicated in folliculitis, furunculosis and secondary skin infections. Brand Name: Urofi® Generic Name: Finasteride + Tadalafil Brand Name: Neopem® Generic Name: Faropenem Dosage Form: Tablet Strength: 150 mg and 200 mg Indications: URTI, LRTI, GUTI, Gynecological Infections, ENT infections, SSTI.

NEW ARRIVALS 15 Biopharma Brand Name: Vintelix® Generic Name: Vortioxetine Dosage Form: 10 mg & 5 mg tablets Strength: Each 10mg tablet contain 10 mg of Vortioxetine & 5 mg tablet contain 5 mg of Vortioxetine Indications: Indicated for Major Depressive Disorder. Brand Name: Melato® Generic Name: Melatonin Dosage Form: 3mg tablet Strength: Each tablet contain 3 mg of Melatonin Indications: Indicated for Circadian rhythm sleep disorders, Delayed sleep phase, Insomnia, Jet lag & Shift work disorder. Brand Name: Vulcan® Generic Name: Oteseconazole Dosage Form: Capsule Strength: 150 mg Indications: Vulcan is indicated for Recurrent Vulvovaginal Candidiasis (RVVC) in females who are NOT of reproductive potential. Vulcan® should only be taken by post-menopausal women, females who are not pregnant and who are not able to become pregnant. Brand Name: Delaxin® Generic Name: Delafloxacin Dosage Form: IV infusion Strength: Delafloxacin 300 mg IV infusion Indications: Acute Bacterial Skin and Skin Structure Infection (ABSSSI). Brand Name: Vonocab® 10/ Vonocab® 20 Generic Name: Vonoprazan Dosage Form: Film Coated Tablet Strength: Vonoprazan Fumarate INN (Equivalent to Vonoprazan 10/20 mg) Indications: Indicated for the treatment of heartburn & GERD. Brand Name: Vonocab® Trio Kit Generic Name: Vonoprazan + Amoxicillin + Clarithromycin Dosage Form: Tablet & Capsule Strength: Vonoprazan INN 20 mg Tablet + Amoxicillin BP (500 + 500) mg Capsule + Clarithromycin USP 500 mg Tablet Indications: Indicated for the treatment of duodenal ulcer & peptic ulcer. Brand Name: Voligel® MAX Generic Name: Diclofenac Sodium 2% Dosage Form: Topical Gel 50g Strength: Each gm Gel contains Diclofenac Diethylamine BP eq. to Diclofenac Sodium 20 mg. Indications: For the quick relief from pain, swelling and inflammation due to Musculoskeletal disorders such as sprains, Strains, tendinitis, bursitis, hands, neck & shoulder pain. Brand Name: Gemzen® Generic Name: Gemcitabine Dosage Form: 1 gm & 200 mg lyophilized powder for IV Infusion Strength: Each vial contains 1 g & 200 mg of Gemcitabine. Indications: Indicated for the treatment of Metastatic Breast Cancer, Non- small cell Lung Cancer (NSCLC), Ovarian Cancer, Pancreatic Cancer & Bladder Cancer. Brand Name: Rifexa Generic Name: Rifaximin Dosage Form: Tablet Strength: 200 mg & 550 mg Indications: Irritable Bowel Syndrome (IBS), Travelers’ Diarrhea, Infectious Diarrhea, Hepatic Encephalopathy, Microbial overgrowth in small intestine. Brand Name: Formet XR Generic Name: Metformin Hydrochloride Dosage Form: Tablet Strength: 1 gm Indications: Non-Insulin Dependent Diabetes Mellitus (NIDDM), Insulin Dependent Diabetes Mellitus (IDDM) as adjuvant therapy in combination with insulin, Obese patients with NIDDM & Polycystic Ovarian Syndrome (PCOS).

NEW ARRIVALS 17 Everest Goodman Hamdard Brand Name: RenoAlfa Generic Name: Amino Acid Keto Analogues Dosage Form: Tablet Strength: 600 mg Indications: RenoAlfa is indicated for prevention & treatment of damages due to faulty or deficient protein metabolism in chronic kidney disease in connection with a limited dietary protein intake 40 gm/day or less (adult). Usually this applies to patients whose glomerular filtration rate is less than 25 ml/min. Brand Name: GabaFix Generic Name: Mirogabalin Besylate INN Dosage Form: Tablet Strength: 2.5 & 5 mg Indications: GabaFix is indicated for Peripheral neuropathic pain, Diabetic peripheral neuropathic pain, Post-herpetic neuralgia and Central neuropathic pain after spinal cord injury. Brand Name: Clonabest Generic Name: Clonazepam USP Strength: 0.5 mg, 1mg & 2 mg Dosage Form: Tablet Indications: Panic disorder, Epilepsy Bipolar affective disorder. Brand Name: Onibest Generic Name: Tiemonium Methylsulphate INN Strength: 50 mg Dosage Form: Tablet Indications: Spasmodic dysmenorrhea biliary tract pain, Diarrhea, Pain in uterus smooth muscle spasm in GIT. Brand Name: Ezytake Generic Name: Sodium Picosulfate BP Strength: 10 mg & 100 ml Dosage Form: Tablet & Oral solution. Indications: Constipation of any etiology, Prolonged and recurrent constipation, Bowel clearance before surgery, Childbirth or radiological investigations. Brand Name: H-Moringa Generic Name: Moringa oleifera Strength: 500 mg Dosage From: Capsule Composition: Moringa (Moringa oleifera) leaf extracts 500 mg. Indications: Malnutrition, Anemia, Obesity, General weakness, High serum glucose, Immunodeficiency. Brand Name: Femista Generic Name: Dasamularista Dosage From: Syrup Composition: Each 5 ml syrup contains as extract- Aegle marmelos 28.58 mg, Oroxylum indicum 28.58 mg, Gmelina arborea 28.58 mg, Stereospermum suaveolens 28.58 mg, Premna integrifolia 28.58 mg, Desmodium gangeticum 28.58 mg, Uraria picta 28.58 mg, Solanum indicum 28.58 mg, Solanum xanthocarpum 28.58 mg, Tribulus terrestris 28.58 mg, Hemidesmus indicus 11.43 mg, Hibiscus abelmoschus 11.43 mg and other ingredients with excipients as required. Brand Name: Hazmitab Generic Name: Vaskar Lavan Dosage From: ChewableTablet Composition: Each tablet contains- Piper longum 24.00 mg, Nigella sativa 24.00 mg, Piper nigrum 12.00 mg, Zingiber officinale 6.00 mg, Sodium chloride 24.00 mg & Other ingredients Q.S. Indications: Anorexia, Digestive, Carminative & Indigestion. Indications: Postpartum complications, Lactation insufficiency & Nutritional deficiency in women. Brand Name: Ovacyst Generic Name: D-chiro-inositol Strength: 500 mg Dosage From: Capsule Composition: D-chiro-inositol 500 mg standardized extract. Indications: Polycystic ovary syndrome (PCOS), anovulation, ovarian hyperthecosis, amenorrhea, hirsutism, alopecia, acanthosis nigricans and acne.

18 NEW ARRIVALS Incepta Brand Name: Arjunarista-H Generic Name: Arjunarista Dosage From: Syrup Composition: Each 5 ml syrup contains (as extract) Terminalia arjuna 2.08 g, Vitis vinifera 1.04 g, Bassia latifolia 0.42 g & Woodfordia fruticosa 0.42 g. Indications: Hyperlipidemia, Hypercholesterolemia, Ischemic heart disease and General weakness. Brand Name: Ihram Generic Name: Glycerin soap Dosage From: Solid Composition: Vitamin E, Glycerin base. Specially made for Hajj & Umrah. Brand Name: Ihram Generic Name: Glycerin neem soap Dosage From: Solid Composition: Neem oil, Vitamin E, Glycerin & Tea tree oil. Indications: Dry skin, Acne, Pimple, Eczema and Psoriasis. Brand Name: Vitigo Generic Name: Ruxolitinib 1.5% Strength: 1.50% Dosage From: Cream Indication: Vitiligo. Brand Name: Tynifer Generic Name: Ferric Maltol Strength: 30 mg Dosage From: Capsule Indication: Anemia. Brand Name: Spusoft Generic Name: Erdosteine Strength: 175mg/5ml Dosage From: Powder for Suspension Indication: Cough Preparation. Brand Name: Sinoline Generic Name: Guaifenesin, Levomenthol and Diphenhydramine Strength: 100 ml Dosage From: Syrup Indication: Cough Preparation. Brand Name: Ornopain Generic Name: Lornoxicam Strength: 4 mg & 8 mg Dosage From: Tablet Indication: Pain Killer. Brand Name: Nocandia Generic Name: Itraconazole Strength: 100mg Dosage From: Capsule Indication: Fungal Infection. Brand Name: Osteo-D Max Generic Name: Colecalciferol Strength: 2000 IU/ml Dosage From: Oral Solution Indications: Vitamin D deficiency, preventing rickets, osteomalacia and osteoporosis. Brand Name: Ambolyt 75 SR Generic Name: Ambroxol Hydrochloride Strength: 75 mg Dosage From: Sustained Release Capsule Indications: Productive cough, Acute and chronic inflammatory disorders of upper and lower respiratory tracts associated with viscid mucus including acute and chronic bronchitis, Inflammatory disease of rhinopharyngeal tract (laryngitis, pharyngitis, sinusitis and rhinitis) associated with viscid mucus, Asthmatic bronchitis bronchial asthma with thick expectoration, Bronchiectasis, Chronic pneumonia etc. Brand Name: NYTENSO 5 Generic Name: Vortioxetine Hydrobromide Strength: 5 mg Dosage From: Tablet Indications: For the treatment of major depressive disorder (MDD) in adults.

NEW ARRIVALS 19 Nipro JMI Brand Name: Calgi-DX Generic Name: Calcium (Algae source) & Vitamin D3 Strength: Calcium 600 mg & Vitamin D3 400 IU Dosage Form: Film Coated Tablet Indications: Osteoporosis, Osteomalacia, Tetany, Hypoparathyroidism. Brand Name: Diazid MR Generic Name: Gliclazide Strength: 30 mg & 60 mg Dosage Form: Film-coated tablet Indication: Type 2 Diabetes Mellitus. Brand Name: Unigerd Generic Name: Vonoprazan Strength: 20 mg & 10 mg Dosage Form: Tablet Indications: Gastric ulcer, Duodenal ulcer, Reflux Esophagitis, H. Pylori Eradication. Novatek One Pharma Opsonin Brand Name: Colut Generic Name: Colchicine USP Dosage Form: Tablet Strength: 10 mg Indications: Healing & Maintenance of Erosive Esophagitis, Gastric Ulcer, Duodenal Ulcer & Prevention of recurrence of Gastric Ulcer or Duodenal Ulcer during NSAIDs administration. Strength: 0.6 mg Dosage Form: Tablet Indications: Prophylaxis and treatment of Acute Gout Flares in adults, Familial Mediterranean Fever (FMF), Pain, and Inflammation in adults and children over 4 years. Brand Name: Vonobest Generic Name: Vonoprazan INN 20 mg Brand Name: Cifirate Generic Name: Ciprofibrate BP Dosage Form: Tablet Strength: 100 mg Indications: Severe Hypertriglyceridemia & Mixed Hyperlipidemia. Brand Name: Opatin Generic Name: Olopatadine Hydrochloride USP Dosage Form: Nasal Spray Strength: 665 mcg/Spray Indications: Allergic Rhinitis. Brand Name: Beltas & Beltas Kids Generic Name: Bilastine Dosage Form: Tablet & Oral Solution Strength: 10 mg Orodispersible Tablet, 20 mg Tablet & 2.5 mg/ml Oral Solution Indications: Allergic Rhino conjunctivitis (Allergic Rhinitis & Conjunctivitis), Urticarial. Brand Name: Lulinox Generic Name: Luliconazole INN Dosage Form: Cream Strength: 1% Indications: Tinea Cruris, Tinea Corporis, Tinea Pedis etc.

NEW ARRIVALS 21 Brand Name: Dequa VT Generic Name: Dequalinium Chloride Dosage Form: Vaginal Tablet Strength: 10 mg Indications: Bacterial vaginosis. Brand Name: Emolia Generic Name: Light Liquid Paraffin BP & White Soft Paraffin BP Dosage Form: Cream Strength: 6% + 10% Indications: Different dry skin conditions. Brand Name: Candiflox Generic Name: Ofloxacin + Clotrimazole + Beclomethasone Dipropionate + Lidocaine HCl Dosage Form: Ear Drops Strength: 0.3% + 1% + 0.025% + 2% Indications: Superficial bacterial and fungal infections of the external auditory canal and middle ear. Brand Name: Brirel Generic Name: Ticagrelor BP Dosage Form: Tablet Strength: 60 mg Indications: Acute Coronary Syndrome, Stent Thrombosis, Post MI and Stroke. Brand Name: Luxen Generic Name: Lutein + Zeaxanthin Dosage Form: Capsule Strength: 20 mg + 5 mg Indications: Age Related Macular Degeneration (AMD), Cataract, Diabetic Retinopathy, Uveitis, Oxidative Stress in Eye, Skin and Brain. Brand Name: Megron Generic Name: Mirabegron Dosage Form: Extended Release Tablet Strength: 25 mg and 50 mg Indications: Overactive Bladder. Brand Name: Lurasid Generic Name: Lurasidone Dosage Form: Tablet Strength: 25 mg and 40 mg Indications: Schizophrenia, Bipolar disorder and Major Depressive Disorder etc. Brand Name: Relanab Generic Name: Nabumetone USP Dosage Form: Tablet Strength: 1000 mg Indications: For the relief of pain and inflammation of Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis & Soft Tissue Injury. Brand Name: Zovia, Zovia N & Zovia D Generic Name: Vitamin A, Vitamin D, Vitamin E, Vitamin B complex & Vitamin C Dosage Form: Lyophilized Powder for IV Injection/Infusion. Indications: It is indicated for adults & children aged 11 years & above, where administration by the IV route is required. Such as surgery, burn, fracture, trauma, infectious disease, generalized weakness, malnutrition, NPO & comatose state. Brand Name: Algisum DX Generic Name: Sodium Alginate, Sodium Bicarbonate & Calcium Carbonate Dosage Form: Oral Suspension Strength: 500 mg + 213 mg + 325 mg/10 ml Indications: GERD, Heartburn, Indigestion, Acid Reflux, Hyperacidity. Brand Name: Betagest Generic Name: Labetalol Hydrochloride Dosage Form: Injection Strength: 5 mg/ml Indications: Severe Gestational Hypertension. Brand Name: Sanbur Generic Name: Dexlansoprazole Dosage Form: MUPS Tablet Strength: 30 mg Indications: GERD, Heartburn, Hyperacidity, Erosive & Non erosive esophagitis.

22 NEW ARRIVALS Orion Pharmasia Sharif Popular Square Brand Name: Omariglip Generic Name: Omarigliptin Dosage Form: Tablet Strength: 12.5 mg & 25 mg Indications: Indicated for the treatment of type 2 diabetes. PHARMASIA Brand Name: Neurolife Generic Name: Mirogabalin Dosage Form: Tablet Strength: 5 mg & 10 mg Indications: Peripheral Neuropathic Pain. Brand: Itolux Generic: Itopride Hydrochloride Dosage Form: Tablet Strength: Itopride Hydrochloride 50 mg Indications: Dyspepsia, Nausea, Vomiting, Heartburn, Loss of appetite, Stomach discomfort, Bloating. Brand: Colacap Generic: Undenatured Type II Collagen Dosage Form: Capsule Strength: 40 mg Indications: Osteoarthritis, Rheumatoid arthritis, Joint pain & inflammation, Difficulties in flexibility & mobility, Joint discomfort & stiffness (knee extension), Impaired joint function, Strenuous exercise & sports. Brand Name: Bilabil Generic Name: Bilastine Dosage Form: 20 mg Tablet & 50 ml Syrup Strength: 20 mg Tablet & 12.5 mg/5 ml Syrup. Indications: Bilastine is indicated for the symptomatic relief of symptoms of allergic rhinitis, rhinoconjunctivitis and urticaria (pruritus and hives). Brand Name: Isotrin 20 Generic Name: Isotretinoin Dosage Form: Capsule Strength: 20 mg Indications: For the treatment of severe recalcitrant nodular acne (resistant to adequate courses of standard therapy with systemic antibacterial and topical therapy) in patients 12 years of age and older. Brand Name: Dumeg 500 Generic Name: Imeglimin Hydrochloride Dosage Form: Tablet Strength: 500 mg Indications: Management of Type-2 diabetes. Brand Name: Urobery Generic Name: Cranberry Fruit Extract Dosage Form: Capsule Strength: 400 mg Indications: Treatment and prevention of Urinary Tract Infections (UTI), Helps to remove kidney stones Brand Name: De-rash Plus Generic Name: Miconazole Nitrate+Zinc Oxide+White Soft Paraffin Dosage Form: Ointment Strength: 0.25%+15%+81.35% Indications: For the treatment of Diaper Dermatitis associated with fungal infections. Brand Name: Newbain 2 Generic Name: Nalbuphine Hydrochloride Dosage Form: Injection Strength: 20 mg/2 ml Indications: Indicated to treat moderate to severe pain, pre & post-operative analgesia, as a supplement to balanced anesthesia, for obstetrical analgesia during labor and delivery. Brand Name: Revocit Generic Name: Ferric Iron (as Ferric Citrate) Dosage Form: Tablet Strength: 210 mg Indications: For the treatment of Iron Deficiency Anemia (IDA) and Hyperphosphatemia. Brand Name: Itra Generic Name: Itraconazole Dosage Form: Oral Solution Strength: 10 mg/ml Indications: For the treatment of different types of fungal infections.

NEW ARRIVALS 23 Brand Name: Corasis-DX ® Generic Name: Calcium (From Coral Source) Dosage Form: Tablet Strength: 600 mg & Vitamin D3 400 IU Indications: Osteoporosis, Osteomalacia, Tetany, Hypoparathyroidism, Disorders of osteogenesis. Brand Name: Picorif ® 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: Stinba ® Generic Name: Ebastine Dosage Form: Tablet Strength: 10 mg Indications: Seasonal & Perennial Allergic Rhinitis, Chronic Idiopathic Urticaria. Brand Name: Preba ® Generic Name: Pregabalin Dosage Form: Tablet Strength: 50mg Indications: Diabetic Peripheral Neuropathy, Postherpetic Neuralgia (PHN), Fibromyalgia, Neuropathic pain of spinal cord injury. Brand Name: Sitafit ® Generic Name: Sitagliptin + Metformin Hydrochloride Dosage Form: Tablet Strength: 50 mg & 500 mg Indications: Improve Glycemic Control in adults with Type 2 Diabetes Mellitus. Brand Name: Tamsulin ® Generic Name: Tamsulosin Hydrochloride Dosage Form: Tablet Strength: 0.4 mg Indications: Moderate to severe symptoms of Benign Prostatic Hyperplasia (BPH). Brand Name: Vgofil ® Generic Name: Tadalafil Dosage Form: Tablet Strength: 10 mg Indications: Erectile dysfunction (ED), Symptomatic relief of Benign Prostatic Hyperplasia (BPH). Brand Name: Picorif ® Generic Name: Sodium Picosulfate Dosage Form: Oral Solution Strength: 100 ml Indications: Constipation of any etiology, relief from prolonged & recurrent constipation, bowel clearance before surgery, childbirth or radiological investigations. Brand Name: Stinba ® Generic Name: Ebastine Dosage Form: Syrup Strength: 60 ml Indications: Seasonal & Perennial Allergic Rhinitis, Chronic Idiopathic Urticaria. Brand Name: Preba ® Generic Name: Pregabalin Dosage Form: Tablet Strength: 75mg Indications: Diabetic Peripheral Neuropathy, Postherpetic Neuralgia (PHN), Fibromyalgia, Neuropathic pain of spinal cord injury. Brand Name: Vilip Plus ® Generic Name: Vildagliptin & Metformin Hydrochloride Dosage Form: Tablet Strength: 50 mg & 850 mg Indications: Improve Glycemic Control in adults with Type 2 Diabetes Mellitus. Brand Name: Tamsulin Plus® Generic Name: Tamsulosin Hydrochloride & Dutasteride Dosage Form: Capsule Strength: 0.4 mg & 0.5 mg Indications: Moderate to severe symptoms of Benign Prostatic Hyperplasia (BPH). Reduction in the risk of acute urinary retention and surgery in patients with moderate to severe symptoms of BPH. Team Pharma

24 WHO NEWS A WHO report states that more than 6,000 people become infected with viral hepatitis each day worldwide, and greater progress is needed to combat the disease. Report authors found that viral hepatitis deaths rose from 1.1 million in 2019 to 1.3 million in 2022, and while new cases saw a decline during that period, the organization’s goals of reducing new infections by 90% and deaths by 65% in the next six years still may not be met. Hepatitis is the second leading cause of death by communicable disease, excluding SARS-CoV-2. l WHO: More work needed to reduce viral hepatitis deaths Critical priority: l Acinetobacter baumannii, carbapenem-resistant; l Enterobacterales, third-generation cephalosporin-resistant; and l Enterobacterales, carbapenem-resistant; l Mycobacterium tuberculosis, rifampicin-resistant (included after an independent analysis with parallel tailored criteria, and subsequent application of an adapted multi-criteria decision analysis matrix). High priority: l Salmonella Typhi, fluoroquinolone-resistant l Shigella spp., fluoroquinolone-resistant l Enterococcus faecium, vancomycin-resistant l Pseudomonas aeruginosa, carbapenem-resistant l Non-typhoidal Salmonella, fluoroquinolone-resistant l Neisseria gonorrhoeae, third-generation cephalosporin- and/or fluoroquinolone-resistant l Staphylococcus aureus, methicillin-resistant Medium priority: l Group A streptococci, macrolide-resistant l Streptococcus pneumoniae, macrolide-resistant l Haemophilus influenzae, ampicillin-resistant l Group B streptococci, penicillin-resistant Changes since 2017 reflect the dynamic nature of AMR, necessitating tailored interventions. Building on the value of the BPPL as a global tool, tailoring the list to country and regional contexts can account for regional variations in pathogen distribution and the AMR burden. For example, antibiotic-resistant Mycoplasma genitalium,which is not included in the list, is an increasing concern in some parts of the world. l An estimated 35 million new cancer cases to occur in 2050, WHO warns l While experts have made significant advances in treating cancer, cancer continues to remain a global health concern. l The latest report from the World Health Organization predicts that there will be over 35 million new cases of cancer in 2050, a significant rise from the approximate 20 million cancer cases that occurred in 2022. l Reports from the International Agency for Research on Cancer found that lung, breast, and colorectal cancers are the most common types worldwide. l The data point to several factors contributing to cancer cases and allows for exploring mitigation and prevention strategies. l WHO updates list of drug-resistant bacteria most threatening to human health The World Health Organization (WHO) released its updated Bacterial Priority Pathogens List (BPPL) 2024, featuring 15 families of antibiotic-resistant bacteria grouped into critical, high and medium categories for prioritization. The list provides guidance on the development of new and necessary treatments to stop the spread of antimicrobial resistance (AMR). The WHO BPPL 2024 includes the following bacteria:

DGDA NEWS 25 Major General Mohammad Yousuf, Director General of the Directorate General of Drug Administration (DGDA), participated in a four-day workshop titled “Dashboard Development and Diethyl Glycol/Ethylene Glycol screening Technologies workshop” at Oxford University, UK, from April 9th to 12th, 2024 with the technical support of the Medicine Quality Support program of the WHO and the Bill & Melinda Gates Foundation. Eighty participants from 27 countries across Africa, Asia, South-East Asia, Europe and America had joined in this program. Diethylene glycol (DEG) and ethylene glycol (EG) are used in the manufacture of products such as antifreeze and glues, but should never be incorporated in human pharmaceuticals as they are toxic. However, there have been multiple reports of their presence in pediatric cough and paracetamol syrups. New requirements for screening technologies are also evolving. Following incidents of pediatric medicine syrups containing diethylene glycol and ethylene glycol (DEG/EG) that have killed hundreds of children worldwide, interest in devices that can detect these contaminants has increased. A further challenge for medicine quality regulatory authorities and other organizations is how to translate this research into policy to offer better guidance on the most suitable devices. During the workshop interactive sessions and demonstrations and displays took place; these included: l Developing a freely available digital guide on screening technologies to help with decision making l Medicine Quality Research Group (MQRG)’s work with chemists and physicists to detect diethylene glycol and ethylene glycol in pharmaceuticals l Using screening technologies l Developing a ‘target product profile’ to enable development of specific devices to detect DEG/EG l A roadmap for collaborative research Attendees were also given a tour of the Museum of History of Science Museum ‘April Fakes Day’ exhibition about falsified medicines, which MQRG supported. The event brought together decisionmakers from medicines regulatory authorities worldwide, along with experts and developers of screening technologies, and other key stakeholders like the World Health Organization. Director General Yousuf presented on the current state of medicine screening technologies in Bangladesh. The program also explored ways to expedite the medicine screening process through the use of various cheap devices especially Diethylene glycol (DEG) in various liquid preparations. These devices have the potential to enable faster detection of suspicious medicines, allowing for quicker referral to the National Drug Control Laboratory (NDCL), thus increasing the surveillance of pharmacy and reducing the load on NDCL. l Diethylene Glycol/Ethylene Glycol Screening Technologies workshop at Oxford University, UK

INDUSTRY NEWS 27 We are proud to announce that Beximco Pharma has been recognized for its environmental commitment by the Ministry of Labor and Employment of Bangladesh. Beximco Pharma is the sole recipient of the prestigious Green Factory Award in the Pharmaceutical Category. Mr. Rabbur Reza, COO, Beximco Pharma, accepted the award, recently. This recognition serves as a testament to our ongoing dedication to sustainability and our unwavering efforts to maintain environmentally conscious practices throughout our operations, says a company press release. l Beximco Pharma receive the prestigious Green Factory Award The contraceptive pill named Levonorgestrel 1.5 mg is known by its brand name of Novella-1. Renata has shipped the initial consignment of Levonorgestrel 1.5 mg, which is the first registered product of the leading Bangladeshi pharma company in Australia. The distribution and commercialisation of Levonorgestrel, known by its brand name of Novella-1, will be done in Australia through Renata’s partner Nova Pharmaceuticals Australasia Pty Ltd, according to a statement of Renata PLC. Levonorgestrel is approved by the World Health Organisation, amongst other regulatory authority bodies such as the US FDA and Therapeutic Goods Administration (TGA), as a first line oral emergency contraceptive pill. Being a potent product, it is manufactured and supplied from Renata’s TGA approved potent product facility, the statement read. The commercial launch of Levonorgestrel, with two other products in queue for registration in Australia, would further bolster Renata’s growing market access worldwide, Renata said. “This event hallmarks Renata’s expansion into yet another stringent regulated market, attributing to the quality assured global standards of its products.” Nova Pharmaceuticals has been a leader in market supply of pharmaceutical products to all pharmacies and supermarkets in Australia for the last 18 years. l Renata ships first drug registered in Australia Acme’s collaboration meeting on Omarigliptin with Birdem The Acme Laboratories Ltd., a reputed pharmaceutical company of the country, organized a collaboration meeting on Omarigliptin with Birdem General Hospital. Diabetes is a silent killer that gradually causes various complications in the human body which sometimes becomes the cause of death. Among them are heart diseases, neurological diseases and kidney problems. According to the American Heart Association, diabetes is one of the seven major risks to heart disease. In addition, about 40% of diabetic patients suffer from kidney problems. The insightful session was led by Prof. Dr. Feroz Amin, with the presence of Associate Prof. Dr. Faria Afsana and other renowned Key Opinion Leaders in the field of Endocrinology. l

INDUSTRY NEWS 29 Renata’s Cabergoline 0.5mg is now approved in the UK Another win for Renata’s development expertise in potent products. Renata’s Cabergoline 0.5 mg is now approved in the UK, developed against the reference product Dostinex. Renata’s Cabergoline 0.5 mg is one of the first generic to be successfully approved in the UK. This product is indicated for the treatment of hyperprolactinemic disorders and for the inhibition of physiological lactation in cases of pregnancy loss. l Healthcare Pharmaceuticals act as Scientific Partner to celebrate World Voice Day A rally and seminar was held recently on the occasion of World Voice Day 2024, at BSMMU campus with Healthcare Pharmaceuticals Limited as scientific partner of the event. Honorable Vice Chancellor of BSMMU, Prof. Deen Mohd. Noorul Haq and President of Laryngology and Voice Association of Bangladesh, Prof. Dr. Kamrul Hasan Tarafdar were present at the event. “All treatments for vocal problems are now available in the country, no need to go abroad” said Hon’ble Vice-Chancellor, Prof. Deen Mohd. Noorul Haq, while celebrating World Voice Day at BSMMU. The University’s Pro Vice-Chancellor (Administration) Prof. Saif Uddin Ahmed, Pro Vice-Chancellor (Research and Development) Professor Dr. Md. Moniruzzaman Khan, Dean- Faculty of Surgery, Prof. Dr. Mohammad Hossain , Dean- Faculty of Nursing, Professor Dr. Debabrata Banik, BSMMU Registrar, Prof. Dr. ABM Abdul Hannan, Proctor, Prof. Dr. Md. Habibur Rahman (Dulal), Head of Otology division of BSMMU and Director of Cochlear Implant Project, Prof. Dr. Zahurul Huq and others were also present at the event. l Orion Pharma Ltd. has proudly partnered with Sheikh Russel National Gastroliver Institute & Hospital to host a knowledgebased scientific seminar on ‘Women’s Issues in Gastroenterology’. The seminar was held recently. Director of Sheikh Russel National Gastroliver Institute & Hospital, Professor Dr. Md. Golam Kibria, was present in the seminar as Chairperson and National Professor & President of Bangladesh Gastroenterology Society, Professor Dr. Mahmud Hasan and visiting Professor Dr. Mohammad Sirajul Islam were also present as special guests in the seminar. AVP Marketing of Orion Pharma, Muhammad Monzur-E-Khoda presented the benefits of newly launched gastroprokinetic drug, Etopride over conventional Domperidone and doctors appreciated it and thanked Orion for sponsoring the program. Executive Director, Sales & Marketing of Orion Pharma, Mr. S. M. Noor Hossain committed doctors to be beside them in all knowledge development programs in future days too. The program ended with a raffle draw and lunch. l Orion Pharma partners Scientific Seminar with Sheikh Russel National Gastroliver Institute & Hospital

30 INDUSTRY NEWS Renata starts directly exporting medicines to US Renata PLC has begun exporting medicines to the US market, becoming the sixth pharmaceutical manufacturer from Bangladesh to directly ship products to the world’s largest market. In its first shipment, Renata dispatched 12.8 million Metoprolol Tartrate tablets for the US market, according to a press release of the company. The drugs were produced at its Rajendrapur facility. Metoprolol Tartrate is used for treating hypertension, angina, heart failure, and other cardiovascular conditions. Before this, five Bangladeshi pharmaceutical manufacturers - Eskayef Pharmaceuticals Ltd, Square Pharmaceuticals Ltd, Beximco Pharmaceuticals Ltd, Incepta Pharmaceuticals Ltd, and ACI Limited - began exporting medicines to the US market. Renata has also shipped Frovatriptan and Metolazone to the US under a contract manufacturing agreement. According to Renata, the US market for Metoprolol Tartrate is substantial and expanding, with over 65.5 million prescriptions recorded in 2021. The company operates 14 factories in Mirpur, Rajendrapur, and Bhaluka. The Rajendrapur facility received the approval from the US Food and Drug Administration in November 2022. Renata exports its products in 40 countries, says the company press release. l Urology Day was celebrated for the first time in Bangladesh. The day was celebrated in a joint initiative of Bangladesh Association of Urological Surgeons (BAUS) and Department of Urology of Dhaka Medical College. On this occasion, a colorful public awareness procession started from Dhaka Medical College’s Milon Square, went to Central Shaheed Minar and ended at Milon Square. The theme of this year’s day was, ‘urinary problems rely on urologists’. The president of BAUS Professor Dr. Khurshid Alam, Professor Ishtiaq Ahmed Shamim, Dhaka Medical College Principal Professor Dr. Shafiqul Alam Chowdhury and many others were present at the event. The event was co-sponsored by Unimed Unihealth Pharmaceuticals, says a company press release. l Unimed & Unihealth co-sponsor Urology Day Celebration for the first time in Bangladesh Kick-off meeting by ACME on Imeglimin Evolution study in Bangladesh The DIACare team of The ACME Laboratories Ltd. had an insightful discussion with esteemed endocrinologists of Bangladesh on the novel anti-diabetic medication, Imeglimin (Imegli). The hybrid session was led by Associate Prof. Dr. Shahjada Selim, with the presence of Prof. Hafizur Rahman, President of Bangladesh Endocrine Society, and other renowned leaders in the field of Endocrinology. l

INDUSTRY NEWS 31 Everest Pharmaceuticals in association with Bangladesh Gastroenterology Society organized a scientific seminar titled ‘Problems in Diagnosis and Treatment of Chronic Pancreatitis in South Asia’ at Intercontinental Dhaka. Renowned Pancreatologist Dr. Rupjyoti Talukder, Director, Department of Pancreatology, Asian Institute of Gastroenterology (AIG), Hyderabad, India, was present as the keynote speaker in the seminar. National Professor Mahmud Hasan (President, Bangladesh Gastroenterology Society), National Professor A. K. Azad Khan (Honorary President, Bangladesh Gastroenterology Society), Prof. Prajesh Kumar Roy (Senior Vice President, Bangladesh Gastroenterology Society), Prof. Chanchal Kumar Ghosh (Secretary General, Bangladesh Gastroenterology Society) and other renowned gastroenterologists of the country were present in the seminar as chief guest. At the end of this seminar, Everest Pharmaceuticals Ltd. launched new molecule, “PANZEST 25000” manufactured from vegetable source, First time in Bangladesh which is used in the treatment of exocrine pancreatic insufficiency, says a company press release. l Everest Introduces New Medication for Exocrine Pancreatic Insufficiency (EPI) – PANZEST 25000 Hamdard Laboratories (Waqf) Bangladesh hosted its Annual Marketing Conference in Cox’s Bazar, creating an extraordinary gathering of industry professionals. The event held recently, was a day filled with knowledge-sharing and inspiration. Chief Mutawalli and Managing Director, Hakim Md. Yusuf Harun Bhuiyan, graced the event as the chief guest, accompanied by esteemed guests including Professor Hakim Kamrun Nahar Harun, wife of the Managing Director and Principal of Rowshan Jahan Eastern Medical College & Hospital, Lakshmipur, and former IGP AT Ahmedul Haque Chowdhury, a member of Hamdard’s Trustee Board, accompanied by his wife, Minara Begum. Under the expert guidance of Director of Marketing, Mohammad Shariful Islam, and oversight by Director of Information and Mass Communication, Amirul Momenin Manik, the event unfolded seamlessly. Approximately two thousand officials and employees from Hamdard’s marketing department actively participated, making it a truly engaging affair. The unveiling of new products, H-Moringa and Hazmitab Blister Strip Pack, added excitement to the conference. Director of Marketing, Mohammad Shariful Islam, delivered a compelling presentation on marketing strategies, energizing the audience. The Senior Director of Finance and Accounts- Anisul Haque was also present as a special guest, along with Director of Production- Bashir Ahmed, Deputy Director of Administration, and Director (Additional Duties) of Legal and Protocol- Mizanur Rahman, Company Secretary and Director of Administration (Additional Duties)- Abdul Majid, Director (Additional Duties) of Hamdard Foundation Bangladesh- Hakim Abu Yusuf Abdul Haque, Deputy Director of MarketingDr. Abul Taimur Chowdhury, and Deputy Director of Sales- Mokhleshur Rahman Maruf. Acknowledging excellence, performance awards were bestowed upon top marketing personnel, further highlighting Hamdard’s commitment to recognizing talent and dedication, says a company press release. l Hamdard’s Annual Marketing Conference 2023

32 SEMINAR Glaucoma is the leading cause of permanent blindness. Patients do not understand the problem because there are no symptoms of this disease. At least 13 out of 100 people aged over 35 in Bangladesh suffer from glaucoma, an eye disease that causes permanent blindness, according to a survey conducted in 2022 by the Bangladesh Glaucoma Society, an organization of ophthalmologists. Of these, 3 people are severely affected by glaucoma and 10 have been identified as suspected patients. At present, the total number of glaucoma patients in the country is 20 lakh and the number of suspected patients is 50 lakh. The survey results were released at an event titled “Bangladesh Glaucoma Disease Outbreak and Social Impact” held at the Bangabandhu International Conference Center (BICC) in the capital recently. The survey report was presented by Bangladesh Glaucoma Society Advisor Professor Dr Sheikh MA Mannaf. The survey data involved 12,000 people, of whom 5,953 were men and 6,047 were women. Of these, 3,790 were from urban areas and 9,210 were from rural areas. A total of 386 people were found to have glaucoma in the survey, which is about 3.2%. The chief guest at the event was Health and Family Welfare Minister Dr Samanta Lal Sen. Special guests were Bangladesh Medical Research Council Chairman Professor Dr Syed Modasser Ali, Asia Pacific Ophthalmology President Professor Dr Abha Hossain, Bangabandhu Sheikh Mujib Medical University Vice-Chancellor Professor Dr Md Deen Nurul Hauqe, Glaucoma Society President Professor Dr Zakia Sultana Shahid and Secretary General Professor Dr. Siddiqur Rahman. The number of glaucoma patients in the country has increased by about 20% in the last 20 years. At present the number of glaucoma patients in the country is 19,46,730. Of these, the number of male patients is 12,33,390 and the number of women is 7,13,340. Women are more affected by this disease than men. The rate of glaucoma patients in Dhaka is much higher than in other divisions, the survey found. l Bangladesh Glaucoma Society present survey report on Glaucoma Iqbal Ahmed appointed new MD of Beximco Pharma Beximco Pharmaceuticals has appointed its existing director Iqbal Ahmed as the new managing director of the drug maker for five years. He has been on the board of Beximco Pharma since 1985. The appointment is subject to shareholders’ approval at the next annual general meeting, said the company in its disclosure. The company’s former managing director Nazmul Hasan resigned from the position after he became a minister of the government. l Prof Deen Md Nurul Haque appointed BSMMU VC and signed by Mohammad Kamal Hossain, deputy secretary of Ministry of Health and Family Welfare. The circular said, with the approval of the president and chancellor and according to section 12 of Bangabandhu Sheikh Mujib Medical University Act, 1998, Prof Deen Md Nurul Haque has been appointed as the vice-chancellor of BSMMU. He will serve as the VC for the next four years. Nurul is the former Director General of Directorate General of Health Services (DGHS). He also served as the Director of the National Institute of Ophthalmology and Hospital (NIOH). l Renowned ophthalmologist Prof. Deen Md Nurul Haque has been appointed as the new vice-chancellor of Bangabandhu Sheikh Mujib Medical University (BSMMU). Prof Nurul took charge from March 29, according to a notification issued CONGRATS

RESEARCH UPDATE 33 Swapping table salt for salt substitutes may lower the risk of dying early A new study Australia finds that the use of salt substitutes can result in a lower incidence of cardiovascular disease and a reduced risk of death from any cause for up to 10 years. Salt substitutes are typically a mixture containing lower amounts of sodium and increased levels of potassium. The study analyzes the results of 16 randomized controlled trials (RCTs), of these, eight reported incidences of major cardiovascular events, and all-cause mortality for six months or greater. Seven of the eight RCTs were conducted in China and Taiwan. The remaining RCTs tracked hypertension, cause-specific mortality, and effective urinary excretion after six months. Researchers identify key factors associated with brain aging, dementia risk A comprehensive new study examined the effects of a wide range of modifiable factors and dementia onset. The study authors had previously identified a “weak spot” in the brain that develops slowly in adolescence, deteriorates early during aging, and has been linked to dementia. While the focus of the study is primarily on modifiable factors, the authors felt that the inclusion of potential genetic influences provided a clear overall picture of the health of individuals in the study. A new urine test may be able to detect ovarian cancer early Scientists are working on a potential urine-based test to help detect ovarian cancer in its early stages. The researchers’ goal is for medical professionals to use this information, combined with CA-125 blood tests, transvaginal ultrasound, and family history, to provide early-stage detection, diagnosis, and treatment for ovarian cancer. Currently, the techniques commonly used are not always straightforward or cost-effective to detect the molecules connected to ovarian cancer. The researchers worked on a new approach they say could more efficiently and accurately detect these peptides by using nanopore sensing, which has the potential to detect multiple peptides. Nanopore sensing involves passing molecules through a tiny pore (nanopore) and measuring the changes in electrical current or other properties as the molecules move through. Good Blood Pressure Control Could Prevent Fibroids Keeping blood pressure under control could be crucial for women in preventing uterine fibroids, new research shows. Middle-aged women tracked for up to 17 years in a new study were 37% less likely to develop these painful growths if they treated their high blood pressure with medication. On the other hand, “patients with new-onset hypertension had a 45% increased risk of newly reported fibroids,» said the researchers. The findings were published in JAMA Network Open. As outlined in the study, uterine fibroids are benign but painful tumors that arise in the uterus and affect up to 80% of women by the age of 50. Fibroids can trigger pain and bleeding, but right now there are no known means of preventing them.

INTERVIEW 35 I can confidently state that our country has made significant strides in the prevention, diagnosis, and treatment of liver diseases over the past two decades Prof. Dr. Mobin Khan Dept. of Hepatology Liver Disease, Medicine Specialist The Liver Centre, Dhaka vaccine into the national Expanded Program on Immunization (EPI) since 2003, which has led to a significant reduction in new cases of hepatitis B, particularly among the younger population. The scenario for hepatitis C virus (HCV) infection is even more encouraging, with a remarkably low prevalence of only 0.2% reported in Bangladesh. However, it is crucial to note that, unlike HBV, there is currently no vaccine available for the prevention of HCV infection. Therefore, efforts must be directed towards controlling the primary routes of transmission, such as unsafe blood transfusions, high-risk sexual practices, and intravenous drug abuse, to curb the spread of this virus further. In light of these shifting dynamics, it is imperative that we prioritize addressing the escalating burden of NAFLD in Bangladesh. Concerted efforts are needed to raise awareness, promote lifestyle modifications, and develop comprehensive strategies for the prevention, early detection, and effective management of this increasingly prevalent liver disease. Please tell us, in brief, about the prevalence of Viral Hepatitis in Bangladesh. What can be done to eliminate viral Hepatitis from the country? Viral hepatitis remains a significant public health concern in Bangladesh, with four major hepatitis viruses contributing to the burden of disease: hepatitis A, B, C, and E. Collectively, these viruses cause a spectrum of acute and chronic liver diseases, posing substantial health risks and economic implications. The prevalence of hepatitis A virus (HAV) and hepatitis E virus (HEV) infections, which are primarily transmitted through the fecaloral route, continues to occur sporadically. While these viral infections typically manifest as acute, self-limiting illnesses, they can still lead to substantial morbidity, particularly in vulnerable populations such as children (HAV) and pregnant women (HEV). Maintaining adequate hygiene, access to safe drinking water, and proper sanitation remain crucial interventions to prevent the transmission of these waterborne pathogens. On the other hand, hepatitis B virus (HBV) and hepatitis C virus (HCV) are responsible for the majority of chronic hepatitis cases in Bangladesh. The current prevalence of chronic HBV infection is estimated to be around 4%, while the prevalence of HCV is comparatively lower at approximately 0.2%. However, these figures highlight the substantial disease burden imposed by these viruses, as chronic viral hepatitis can lead to severe complications such as cirrhosis and hepatocellular carcinoma (HCC) if left untreated. To effectively combat viral hepatitis in Bangladesh, a multipronged approach is necessary. For hepatitis B, the widespread implementation of the hepatitis B vaccine through the Expanded Program on Immunization (EPI) has been a significant stride forward. Ensuring universal coverage and adherence to the vaccination schedule is crucial for preventing new HBV infections, particularly in children. Additionally, catchup vaccination campaigns targeting adults born before the introduction of the EPI program could further reduce the reservoir of chronic HBV carriers in the population. In the case of hepatitis C, as there is no vaccine currently available, the focus must be on preventing transmission through the implementation of rigorous infection control practices in healthcare settings, promoting harm reduction strategies for intravenous drug users, and ensuring the screening of blood and blood products. Furthermore, increasing access to highly effective directacting antiviral (DAA) therapies, which can cure HCV infection in most cases, should be a priority. Concerted efforts from healthcare providers, policymakers, and the general public are required to raise awareness, strengthen surveillance systems, and implement evidence-based interventions to eliminate viral hepatitis as a public health threat in Bangladesh. As an eminent Hepatologist of the country, would you please let us know about the liver diseases in our country? The scenario of liver diseases in Bangladesh is undergoing a significant epidemiological shift. While viral hepatitis, particularly hepatitis B and C, were once the predominant concerns, we are now witnessing a marked rise in the prevalence of non-alcoholic fatty liver disease (NAFLD). This transition mirrors the trend observed in developed nations, where the burden of NAFLD has been increasing rapidly in tandem with rising rates of obesity, metabolic syndrome, and type 2 diabetes mellitus. A cross-sectional study conducted on a large sample size in Bangladesh revealed that the overall prevalence of NAFLD in our country is estimated to be alarmingly high, ranging between 32.12% to 35.64%. Conversely, the prevalence of hepatitis B virus (HBV) infection has shown a declining trend, currently approximated to be around 4% or even lower. This can be attributed to the successful integration of the hepatitis B

INTERVIEW 37 As a pioneer Hepatologist of our country, would you please tell us, where does Bangladesh stand as far as prevention, diagnosis and treatment of liver diseases are concerned, compared to the advanced countries? As a pioneer in the field of hepatology in Bangladesh, I can confidently state that our country has made significant strides in the prevention, diagnosis, and treatment of liver diseases over the past two decades. However, a direct quantitative comparison with advanced countries remains challenging due to the vast disparities in healthcare resources and infrastructure. Nonetheless, our subjective assessment indicates substantial improvements in various aspects of liver disease management. One of the most notable achievements has been the incorporation of the hepatitis B vaccine into the national Expanded Program on Immunization (EPI) since 2003. This strategic move has led to a remarkable reduction in the prevalence of hepatitis B virus (HBV) infection, particularly among the younger generations. In terms of diagnostic capabilities, Bangladesh has made commendable progress in acquiring advanced tools and techniques. We now have access to non-invasive imaging modalities such as FibroScan, computed tomography (CT) scans, and magnetic resonance imaging (MRI) for the evaluation of liver diseases. Endoscopic procedures like endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance cholangiopancreatography (MRCP) are routinely performed for both diagnostic and therapeutic purposes. Moreover, molecular diagnostic techniques like real-time polymerase chain reaction (RT-PCR) for the amplification and quantification of viral loads for hepatitis B and C are available in many healthcare facilities across the country. Additionally, we now have the capability to detect auto-antibodies associated with auto-immune liver diseases, further enhancing our diagnostic precision. In the realm of treatment, Bangladesh has witnessed a significant improvement in the availability and accessibility of various therapeutic options. Almost all essential medications for the management of liver diseases are now produced locally or imported, making them more affordable for patients. Endoscopic and percutaneous interventions are routinely performed, and we are also making strides in the field of liver transplantation, although this area still requires further development. While we may not yet be on par with the most advanced nations in terms of healthcare infrastructure and resources, the progress made in the prevention, diagnosis, and treatment of liver diseases in Bangladesh is undeniably commendable. With continued efforts, collaborations, and investments in capacity building, we are well-positioned to further enhance our capabilities and provide comprehensive care to patients with liver diseases. What are the chances of someone with HCV infection developing cirrhosis or liver cancer? What are the risk factors? Hepatitis C virus (HCV) infection poses a significant risk for the development of severe liver complications, including cirrhosis and hepatocellular carcinoma (HCC), which is the most common form of primary liver cancer. Globally, an estimated 58 million individuals are living with chronic HCV infection. Alarmingly, approximately 1.5 million new cases are added to this staggering figure each year. The consequences of untreated HCV infection are dire, with nearly 300,000 people losing their lives to HCV-related complications in 2019 alone. While approximately 30% of individuals with acute HCV infection can spontaneously clear the virus within the first six months without treatment, the remaining 70% develop chronic HCV infection. Of those with chronic infection, 15% to 30% are at risk of progressing to liver cirrhosis within two decades if left untreated. Furthermore, the overall annual risk of developing HCC in patients with chronic HCV infection ranges from 1% to 5%. This means that, for every 100 individuals with chronic HCV, one to five may develop liver cancer each year. It is important to note that this risk is further compounded by the presence of certain cofactors and comorbidities. Co-infection with hepatitis B virus (HBV), excessive alcohol consumption, hereditary conditions such as hemochromatosis (iron overload disorder), and the presence of biliary cirrhosis (cirrhosis caused by bile duct diseases) can substantially increase the risk of developing HCC in individuals with chronic HCV infection. Other risk factors that have been identified include older age (typically over 55 years), male gender, low platelet count (thrombocytopenia), and elevated levels of alpha-fetoprotein (AFP), a protein commonly used as a tumor marker for HCC. In the current era, with the advent of highly effective direct-acting antiviral (DAA) therapies that can achieve sustained virologic response (SVR) rates of up to 95% in HCV-infected individuals, the most significant risk factor for the development of HCVrelated complications, including cirrhosis and HCC, is the failure to receive appropriate treatment. Therefore, it is imperative that individuals with chronic HCV infection are promptly identified, evaluated, and offered timely treatment with DAAs to mitigate the risk of disease progression and associated complications. As the Founder & President of “Hepatology Society of Bangladesh”, would you please tell us about the role of your organization regarding hepatic disorders in Bangladesh? As the Founder and President of the Hepatology Society of Bangladesh, I take immense pride in the pivotal role our organization plays in addressing hepatic disorders within our nation. With a mission to enhance awareness, prevention, and management of liver diseases, we have undertaken numerous initiatives to combat this growing public health challenge. At the forefront of our efforts lies a strong emphasis on raising awareness among the general population. We recognize that knowledge empowers individuals to make informed decisions and adopt preventive measures. To this end, we actively engage in organizing press conferences, publishing comprehensive articles in both Bengali and English newspapers, and leveraging the reach of social media platforms to disseminate vital information. Two significant occasions marked on our calendar are the International NASH Day on June 12th and World Hepatitis Day on July 28th. These events serve as platforms for us to intensify our awareness campaigns, highlighting the rising burden of non-alcoholic steatohepatitis (NASH) and viral hepatitis, respectively. Through these initiatives, we aim to equip the public with up-to-date knowledge, dispel misconceptions, and foster a deeper understanding of these conditions. Our team has produced guidelines for general physicians for treating NAFLD. We have been also arranging skill improvement workshops for physicians from diverse disciplines. Furthermore, we have undertaken the commendable task of publishing books tailored to the general public, providing accessible and comprehensible information on liver diseases. These resources serve as valuable tools for self-education and promoting preventive practices within communities. Recognizing the importance of continuous medical education, the Hepatology Society of Bangladesh organizes biennial international hepatology conferences. These events bring

INTERVIEW 39 together specialists, physicians, surgeons, and researchers from across the globe, fostering the exchange of knowledge and facilitating the dissemination of the latest advancements in the field of hepatology. By keeping our healthcare professionals abreast of cutting-edge developments, we ensure that our nation remains at the forefront of providing high-quality care to patients with liver diseases. Our efforts extend beyond awareness and education; we actively collaborate with various stakeholders, including policymakers, healthcare providers, and community organizations, to advocate for improved prevention strategies, early detection programs, and accessible treatment options. By fostering these partnerships, we strive to create a comprehensive and coordinated approach to tackle the multifaceted challenges posed by hepatic disorders in Bangladesh. As we continue to navigate the evolving landscape of liver diseases, the Hepatology Society of Bangladesh remains steadfast in its commitment to enhancing the well-being of our nation by promoting awareness, prevention, and high-quality care for all those affected by hepatic disorders. Treatment of Liver diseases is quite expensive. How can we make it affordable for the common people? The treatment of liver diseases, especially chronic conditions like hepatitis B, hepatitis C, and advanced stages of nonalcoholic fatty liver disease (NAFLD), can be financially burdensome for many individuals, posing a significant barrier to access timely and appropriate care. However, concerted efforts from various stakeholders can help alleviate this challenge and make these life-saving treatments more affordable and accessible to the common people of Bangladesh. One of the key factors contributing to the affordability of liver disease treatment in our country is the local production of essential medications. Over the years, Bangladesh has developed a robust pharmaceutical industry capable of manufacturing a wide range of drugs, including those used in the management of liver diseases. This local production has significantly reduced the treatment costs, as the prices of domestically manufactured drugs are typically much lower than their imported counterparts. Furthermore, many of these locally produced drugs have proven to be equally effective as their international originator brands, ensuring that patients receive high-quality treatment without compromising on therapeutic outcomes. This development has been a game-changer, making advanced therapies accessible to a broader segment of the population, including those from underprivileged backgrounds. To further enhance affordability, the government can play a crucial role by implementing targeted subsidies and comprehensive health insurance coverage for liver disease management. By subsidizing essential medications and diagnostic procedures, the financial burden on patients can be significantly reduced, enabling them to initiate and adhere to treatment regimens without compromising their economic stability. Additionally, the integration of liver disease management into existing national health insurance schemes or the development of specialized health insurance programs tailored to cover these conditions can significantly alleviate the financial strain on individuals and families affected by liver diseases. Collaboration with non-governmental organizations (NGOs) and patient support groups can also contribute to improving affordability. These organizations can provide financial assistance, facilitate access to subsidized or donated medications, and offer counseling and support services to help patients navigate the complexities of treatment and financial planning. Moreover, efforts should be made to raise awareness among the general public about the importance of early detection and timely intervention for liver diseases. By promoting preventive measures and encouraging regular screening, many cases can be identified and treated at earlier stages, when the treatment costs are generally lower and the chances of successful outcomes are higher. Ultimately, a multi-faceted approach involving stakeholders from the government, pharmaceutical industry, healthcare providers, NGOs, and patient advocacy groups is crucial to ensuring that life-saving treatments for liver diseases remain accessible and affordable for the common people of Bangladesh. By addressing this challenge, we can improve health outcomes, reduce the economic burden on families, and contribute to the overall well-being of our nation. l FAST FACTS According to Stop Pneumonia about 2.5 million people including about 0.67 million children died of pneumonia across the world in 2019. While 41.4 percent of all births in 2022 were through C-sections, the rate increased to 50.7 percent in 2023, as per the data from Bangladesh Bureau of Statistics (BBS). As per Bangladesh Bureau of Statistics 20 out of every 1,000 newborns under one month died in 2023, up from 16 in 2022. Moreover, 27 out of every 1,000 children under one year of age died in 2023, an increase from 24 in 2022. As per Bangladesh Bureau of Statistics, caesarean section (C-section) delivery rate has increased by 9% in a year. In 2023, the C-section delivery rate was 50.7%, compared to 41.4% a year ago. As per Bangladesh Bureau of Statistics, in 2023, the natural childbirth rate was 49.3%, compared to 58.6% a year earlier. In urban areas, 59.1% of births occurred through caesarean delivery in 2023, compared to 53% the previous year. As per Bangladesh Bureau of Statistics, in 2023, the maternal mortality rate was 136 per lakh, compared to 153 in the previous year. Despite the World Health Organization’s recommendation for countries to allocate at least 15 per cent of their total budget for the health section, Bangladesh allocated only 5 per cent of its total budget to healthcare in the 2023-24 fiscal years. According to Globocan, 1.67 lakh patients are developing cancer and 1.16 lakh cancer patients are dying each year.

41 As an eminent Hepatologist of the country, would you please let us know about the liver diseases in our country? Liver disease is an important entity in our country. In general hospital wards about 10-12% admitted patients are suffering from some form of liver diseases. Most common is viral hepatitis, among them hepatitis B virus is most prevalent. We also find other form of liver diseases like fatty liver, auto immune liver disease, metabolic liver disease and liver cancer. There is also prevalence of hepatitis A and E presented as acute hepatitis. Hepatitis A is most prevalent in children and Hepatitis E in adults. Please tell us, in brief, about the prevalence of Viral Hepatitis in Bangladesh. What can be done to eliminate Hepatitis B from the country? As I have already mentioned hepatitis B and C are most prevalent in our country. Prevalence of hepatitis B in Bangladesh is about 5-6% and after inclusion of hepatitis B vaccine in EPI program the prevalence is rapidly coming down. The prevalence of hepatitis C is approximately 1%. Mass vaccination in neonates is the most important step to eliminate hepatitis B which we have already started for more than 18 years. We can also introduce birth dose vaccination, screening of pregnant woman, vaccination of vulnerable populations, safe blood transfusion, use of disposable syringe and needles and proper sterilization of surgical and dental instruments. What are the risk factors of developing Non-alcoholic fatty liver disease (NAFLD)? How often can NAFLD progress to Nonalcoholic steatohepatitis (NASH)? What can be done to prevent it? Nonalcoholic fatty liver disease (NAFLD) is gradually increasing in our society. Obesity, diabetes, hypertension, hypercholesterolemia are important predisposing factors. Sedentary lifestyle, excess fatty food intake especially fast food and drugs are also contributing factors. Not all fatty liver progresses to NASH, about 18-20% fatty liver progresses to NASH. NASH is associated with inflammation of liver cells, which may ultimately progress to liver cirrhosis and liver cancer. We can prevent fatty liver by lifestyle modification which includes increasing physical activity, avoid fatty food and avoid being overweight. What are the chances of someone with Hepatitis C infection developing cirrhosis or liver cancer? What are the risk factors? Chronic hepatitis C is a silent killer. About 85% of the patients with acute hepatitis C developed chronic liver disease which ultimately may lead to liver cirrhosis and liver cancer. Risk factors for hepatitis C infection are: use of unsterilized syringe and needle, unsafe blood transfusion, unsafe sexual exposure, repeated dialysis and use of unsterile surgical and dental instruments. How effective is stem cell therapy for end stage liver disease? Is it compatible with the socio-economic condition of our country? Now-a-days people are using stem cell therapy in different diseases. We are also using stem cell therapy in chronic liver disease. It shows some promise in some cases but not a replacement of liver transplantation. We can use stem cell therapy in Bangladesh as a new modality of treatment with close collaboration with other centers who are doing it. l About 85% of the patients with acute hepatitis C developed chronic liver disease which ultimately may lead to liver cirrhosis and liver cancer Prof. Dr. Salimur Rahman Consultant, Hepatology & Internal Medicine Lab Aid Specialized Hospital Former Professor Dept. of Hepatology BSMMU INTERVIEW

INTERVIEW 43 There is a global alert against the long term use of PPIs. So, under any circumstances, long term use of PPIs is strongly discouraged Prof. Dr. Faruque Ahmed Former Director Sheikh Russell Gastro Liver Institute & Hospital, Dhaka As an eminent Gastroenterologist of the country, would you please let us know about the common pancreatobiliary and oncologic disorders of the gastrointestinal (GI) tract in our country? Common disorders in the biliary system are gallstones, gall-bladder carcinoma, different bile-duct injuries etc. If we talk about pancreas, there are acute pancreatitis, chronic pancreatitis and different types of pancreatic tumors like solid tumors, cystic tumors and pancreatic cancers, which are very common. Pancreatic divisum is one of the most common congenital pancreatic anomalies we see in our hospital. Among the cancers, GI cancers are the 4th most-common type of cancer and the 2nd highest cause of cancer death globally. Other malignancies such as liver cancer, carcinoma stomach, carcinoma colon, carcinoma esophagus, carcinoma gallbladder, carcinoma pancreas etc. are also common in our country. What are the trigger factors and symptoms for Irritable Bowel Syndrome (IBS)? Is it preventable? What changes in diet can help the patients? There are many factors which may trigger IBS like diet, stress, various drugs or medications etc. Fried foods, junk foods, excessively fatty food can trigger IBS. Milk and milk products also trigger IBS symptoms. Dairy products contain lactose and many people develop lactose intolerance. So, we advise people with IBS to avoid milk and milk products as these will exacerbate the symptoms. Leafy vegetables should also be avoided. Mental stress also plays a huge role in IBS. Mental illnesses like anxiety, depression, tension, or even euphoria may trigger symptoms in IBS. GI infections also exacerbate IBS symptoms. Recommended diet for IBS patients is FODMAPs diet. Studies have shown that a low FODMAP diet improves IBS symptoms. IBS is not preventable; there are no such measures that can be taken to prevent IBS. We have to keep in mind that IBS is a chronic illness. Once an IBS, always remains an IBS. So, the patients should be very aware and mindful of their diet and avoid all the trigger factors mentioned above. Please tell us in brief about peptic ulcer disease (PUD)? How do we treat and prevent recurrence of PUD? Peptic ulcer disease is very common worldwide. It is also a very common disease in our country. Once upon a time Bangladesh had the highest prevalence of PUD in the world. Back in the 80’s, the prevalence was found to be 15%. Today, the prevalence dropped down to 3% to 4%. The scenario of PUD has improved in our country. Peptic ulcer disease is the ulcerous opening or sores developed in the lining of the stomach, oesophagus or intestine, especially the duodenum. Duodenum is the most common site for peptic ulcer to occur as it is the beginning of the small intestine. Peptic ulcer is an acid– peptic disorder. It develops due to an imbalance in the acid-pepsin cycle, both of which are secreted in the stomach. On top of that, there’s infection by Helicobacter Pylori. Most patients experience symptoms like upper abdominal pain, abdominal discomfort, abdominal distension, early satiety, burning in upper abdomen during empty stomach etc. The treatment of PUD is not at all complex. All the medications are excellent in our country and available at an affordable price. We usually recommend treatment for 4-8 weeks. If the patient is found to be infected with H. pylori, we give anti- H. pylori treatment which is very effective in treating PUD and to eradicate the bacteria. Once fully eradicated, we can prevent the recurrence of peptic ulcer disease. Being available over-the counter, patients now-a-days are self-prescribing and overusing anti-ulcerant drugs i.e. PPIs. What are the consequences of such irrational use in long term? PPIs are excellent drugs in general for management of acid related disorders. These are very affordable as well. But there are some limitations in long term use of the PPIs. There is a global alert against the long term use of PPIs. So, under any circumstances, long term use of PPIs is strongly discouraged. And of course, using this drug as OTC, without indication is never advocated. The drug should only be purchased when prescribed by the

physicians and should not be continued for more than 4-8 weeks. Long term use of PPIs may lead to some serious consequences like development of tumors or polyps in the stomach, GI infections, kidney complications and bone-mineral complications. How common is GERD in our country? Can it lead to malignancy? How can we prevent such complications? GERD is also a common GI problem. We have field level studies reveal that the prevalence of GERD in our society is around 20%. Among the GI diseases, GERD is one of the costliest diseases, because to manage GERD you have to take medications for a long time. If GERD is left untreated for a long time, especially for over 5 years, it proceeds to develop oesophageal cancer. So, we can consider GERD as a precancerous condition. GERD is preventable. GERD is related to extra body weight. If we can maintain the standard body-weight, we can prevent the problem. We must avoid foods which may trigger GERD like junk foods, fried foods, and in some cases, full-fat milk or milk products. There are some etiquettes we also need to follow i.e. avoid eating full stomach meals, avoid over-eating, keeping one-third of our stomach empty, avoid eating junk foods, avoid taking water immediately after meal, avoid going to bed right after eating and wait at least two hours after meal to go to sleep. Some drugs like anti-hypertensive agents or anti-anxiety drugs may also precipitate this illness. Therefore, with proper treatment we can cure GERD and if we can control this illness, we can definitely prevent further complications. What is IBD? What is the current status of IBD in our country? This is a group of chronic illnesses of unknown cause characterized by inflammation of the gut. IBD comprises of two diseases namely ULCERATIVE COLITIS & CROHN’S DISEASE. As already mentioned these diseases are chronic and debilitating, affecting mostly the young people of both sex having a course of relapse and spontaneous remission. In these illnesses, patients will have common GI symptoms like abdominal pain, alteration of bowel habit, rectal bleeding or bloody diarrhea. In contrast to common GI illnesses the symptoms will be unremitting leading to weight loss and ill health accompanied with profound personal, familial, social and economic impacts. In the recent past these were limited to industrialized countries but recently these are going to be an emerging problem even in our country. Over the last few years, the burden of these diseases are rising with impressive frequency. Western lifestyle and change of food habit are the major factors are responsible for this. l INTERVIEW 45 Myth: Successful treatment for IBS (irritable bowel syndrome) does not exist. Reality: IBS (irritable bowel syndrome) can be managed and treated with the right combination of diet and medication, under the care of an experienced gastroenterologist. Myth: Acid Reflux Occurs Only in Adults. Reality: Acid reflux can affect people of all ages, including infants and children. Pediatric acid reflux is a real concern and requires proper diagnosis and management. Myth: All IBS (irritable bowel syndrome) cases are the same. Reality: All IBS cases are not the same and shouldn’t be treated similarly. Depending on the severity of the case, there are many treatment options that can be combined in a way that works best for the patient. Eliminating gluten from the diet of an IBS patient may work for them, but not for everyone. Working with an gastroenterologist to test the efficacy of various treatment options will help find the right treatment plan for patients. Myth: If I Have Gas, It Means I Have a Digestive Disorder. Reality: Gas is a normal byproduct of digestion and is usually not a sign of a serious digestive disorder. Excessive gas can be managed through dietary adjustments and lifestyle changes. Myth: Eating seeds and nuts can cause diverticulitis. Reality: Not true! This most persistent myth actually contradicts advice we give for preventing the condition in the first place. A healthy, highfiber diet is actually the best medicine against diverticulitis, and seeds and nuts certainly fit the bill. Myth: IBS is an uncommon condition. Reality: IBS is a very common condition that affects a lot people around the world. It affects all ages, but mostly those under the age of 50. Myth: Crohn’s disease and irritable bowel syndrome (IBS) are the same thing. Reality: Crohn’s disease and IBS are completely different conditions. Crohn’s disease causes inflammation in the GI tract, but IBS doesn’t cause inflammation at all. (IBS affects muscle contractions in the colon.) Both have completely different treatments as well. Myth: Celiac disease affects only the gastrointestinal tract. Reality: What happens in the gut doesn’t stay in the gut – celiac is a systemic disease. Once gluten comes through, the immune cells can be programmed to leave the gastrointestinal tract and can start to fight against the body. Myth: Digestive problems are just a normal part of aging. Reality: While some changes in digestion may occur with age, chronic digestive problems are not an inevitable part of aging. Many digestive issues can be managed and treated with proper care, lifestyle modifications, and medical guidance. M MYTH VS R REALITY VS

INTERVIEW 47 Longstanding GERD may cause Barrett’s oesophagus, a condition that triggers precancerous changes which may lead to cancer in oesophagus Prof. Dr. Md. Habibur Rahman Ex-Professor and Head Department of Gastroenterology Sir Salimullah Medical College and Mitford Hospital As an eminent Gastroenterologist of the country, would you please let us know about the gastrointestinal, pancreaticobiliary and liver diseases in our country? Bangladesh is one of the densely populated developing country of about 180 million people. Gastro-intestinal, pancreaticobiliary and liver diseases are very common in Bangladesh. Although we have no recent data about the prevalence of the diseases, one study done previously on admitted patients in medical ward of a tertiary hospital shows that about one third of the patients are suffering from gastrointestinal and liver diseases. Diarrhea, acute and chronic hepatitis, peptic ulcers and biliary disease, irritable bowel syndrome, GI and hepatic malignancy are common disorders. What are the trigger factors and symptoms for Irritable Bowel Syndrome (IBS)? Is it preventable? What changes in diet can help the patients? Trigger factors of IBS arel Foods containing high fat dairy, gluten such as wheat, food rich in insoluble fibre, lactose containing food like milk, fried food, carbonated beverages, beans and legumes, caffeinated drinks, chocolate, alcohol, broccoli and cabbages. l Stress and anxiety. l Drugs. l GI infection and alteration of gut microbiota. Irritable Bowel Syndrome (IBS) can cause a variety of symptoms. These includel Abdominal pain related to defecation, associated with a change in frequency and/or change in the form of stool. l Bloating. l Feeling of incomplete bowel evacuation. l Mucus in stool. A variety of other GI (i.e. dyspepsia) and non GI symptoms (i.e. migraine, headaches, fibromyalgia, cystitis, dyspareunia) are frequently present in the IBS patient. Symptoms may vary according to the subtype of IBSl IBS with predominant diarrhea, IBS-D. l IBS with predominant constipation, IBS-C. l IBS with mixed bowel habit, IBS-M. IBS is a multi-factorial condition and there is no known cause. We cannot prevent IBS, however symptoms can be controlled by avoiding trigger factors and giving symptomatic treatment. We can help IBS patients by changing their diet which includes avoidance of food that triggers the symptoms and adding some food which are low in FODMAP such as red meat, eggs, fish, leafy greens, seeds, probiotic rich food for example: unsweetened yoghurt. Please tell us in brief about Peptic Ulcer Disease (PUD). How do we treat and prevent recurrence of PUD? Peptic ulcers disease is very well known to general population but sometimes patients may misinterpret other diseases like non-ulcer dyspepsia, irritable bowel syndrome, gallstone disease, gastroesophageal reflux disease as peptic ulcer disease. About four million people annually are affected worldwide and estimated life-time prevalence of 5 to 10% in the general population. Duodenal ulcer and benign gastric ulcer were found in 7.4% and 3.28% patients in Bangladesh, respectively. However, disease incidence is gradually declining after the introduction of PPI and antiHP therapy. Peptic ulcer disease can be treated by using various drugs which include antacid, famotidine, proton pump inhibitor, bismuth citrate and antibiotics for helicobacter pylori. In our country, as a gastroenterologist, we commonly prescribe anti-HP therapy which include PPI 20 mg BD, Amoxicillin 1gm BD. clarithromycin 500mg BD or levofloxacin 500mg BD for 14 days followed by PPI 20 BD for further 6 weeks. Follow up endoscopy is usually done after 6-8 weeks to see the remission of ulcer.

To prevent recurrence of PUD, the following measures should be takenl Avoidance of smoking and nonsteroidal anti-inflammatory drugs. l Exclude unusual cause of peptic ulcer disease. l Ensure patient compliance in treatment of peptic ulcer disease. l Use of drugs which are sensitive to Helicobacter pylori. How common is GERD in our country? Can it lead to malignancy? How can we prevent such complications? Gastroesophageal reflux disease (GERD) is arguably the most common disease encountered by gastroenterologists. Prevalence of GERD is reported to be higher in western countries compared to eastern countries. Prevalence is 18.1-27.8% in North America, 8.8-25.9% in Europe and 2.5-7.8% in East Asia. In our country, population-based survey reported a prevalence of heartburn and acid regurgitation was about 6%. Longstanding GERD may cause Barrett’s oesophagus, a condition that triggers precancerous changes which may lead to cancer in oesophagus. Management of GERD and prevention of its complications arel Lifestyle modifications such as: Weight loss for those who are overweight, head end of bed elevation, dinner 2-3 hours before bedtime , avoid food which includes chocolate, caffeine, alcohol, acidic, spicy and fatty food, and avoidance of some drugs which relax lower oesophagus sphincter. l Drugs: Proton Pump Inhibitor (PPI), sodium alginate, sodium bicarbonate and calcium carbonate in combined formulation can be used for 8 weeks. Duration of treatment may vary from patient to patient. l Endoscopy/Surgery: In some patients, endoscopic intervention or surgery may be needed for management and to prevent complications. Why Hepatitis B vaccine is not being prescribed to all patients, considering its availability and high risk of chronic infection leading to cirrhosis and liver cancer posed by Hepatitis B virus infection? Hepatitis B virus (HBV) infection is one of the most important global health problem. Worldwide, an estimated 296 million people are chronic carrier of HBsAg. Active immunization is the single most important and effective preventive measure against HBV infection. Several studies show that HBV carrier rate is between 2%-7% in Bangladesh. Hepatitis B vaccine is not prescribed to all patients because WHO only recommended mass vaccination in children and adolescents aged less than 19 years who were not previously vaccinated. Bangladesh introduced Hepatitis B vaccine in all children, starting from age six after birth, through EPI from 2005. Hepatitis B vaccination is also indicated for certain risk group includingl Health care workers. l Partners and household contacts of HBsAg positive person. l Injecting drug abusers. l Person who frequently require blood or blood products. l Recipients of solid organ transplantation. l Person with high-risk sexual behavior. l International travellers to HBV endemic countries. Policies for passive immunization against hepatitis B are: l New born infants of HBsAg positive mothers. l Post exposure to HBsAg positive blood and body fluids. l Sexual exposure to HBsAg positive person. l Following liver transplant patients. l 49 Liver disease progresses through several stages, and understanding these stages is crucial for diagnosis, treatment, and management. The stages of liver disease typically include: Liver Health (Stage 0): In this initial stage, the liver is healthy, and there is no significant damage. Regular check-ups and a healthy lifestyle can help maintain liver health. Fatty Liver Disease (Stage 1): This stage often begins with the accumulation of fat in the liver, known as fatty liver disease or hepatic steatosis. It can be reversible with lifestyle changes like weight loss and dietary modifications. Fibrosis (Stages 2–3): As liver disease progresses, fibrosis occurs, where scar tissue gradually replaces healthy liver tissue. Stages 2 and 3 represent increasing levels of fibrosis, indicating more severe liver damage. Cirrhosis (Stage 4): Cirrhosis is the most advanced stage of liver disease. At this point, extensive scarring has occurred, and the liver’s ability to function is significantly impaired. Cirrhosis is irreversible, but management and lifestyle changes can slow its progression. Liver Failure (Stage 5-7): In some cases, liver disease can progress to complete liver failure (end-stage liver disease). This stage may necessitate a liver transplant to sustain life. WORTH KNOWING ABOUT Source: Medium.com INTERVIEW