PhD Thesis

Effects of Vitamin-D 3 Supplement on the Cognitive Status in Patient with Systemic Lupus Erythematosus with Neuropsychiatric Phenomenon

2026-04-19T00:00:00Z

Effects of Vitamin-D 3 Supplement on the Cognitive Status in Patient with Systemic Lupus Erythematosus with Neuropsychiatric Phenomenon Sultana, Nasreen Systemic Lupus Erythematosus (SLE) is a complicated autoimmune illness that affects several organ systems, including the central nervous system. Neuropsychiatric (NP) SLE (NPSLE) is characterized by neurological and psychiatric symptoms such as cognitive dysfunction, mood problems, and seizures, and has been linked to severe impairments in memory, attention, and executive functioning can lead to altered brain perfusion. Vitamin D3 has shown promise in neuro-protection and cognitive improvement, which may benefit NPSLE patients. This study investigates the effects of Vitamin D3 supplementation on cognitive function and brain perfusion in NPSLE patients. Material & Methods This randomized controlled trial (RCT) included NPSLE patients (N=72), divided into an intervention group (n=34) receiving Vitamin D3 supplementation, and a control group (n=38) without supplementation. Baseline and six-month evaluations of serum Vitamin D levels, Mini-Mental State Examination (MMSE) scores, and brain perfusion using Single-photon emission computed tomography (SPECT) imaging (Z-scores) were conducted at National Institute of Nuclear Medicine & Allied Science (NINMAS), Dhaka. The intervention group received 40,000 IU of Vitamin D3/week for six weeks, followed by a maintenance dose of 2000 IU/day for three months, along with standard SLE management. Both verbal and written informed consent was obtained, and adherence was encouraged through weekly reminders via text or calls. After six months, outcomes were analyzed to assess the impact of Vitamin D3 on cognitive function and brain perfusion in NPSLE patients. xv Results Baseline characteristics (age, gender, BMI, and waist-to-hip ratio/WHR) were indifferent (P>0.05) between groups (Control vs. cases). No significant differences (P>0.05) were found between groups in age (28.24±7.18 vs. 26.32±7.94,), gender distribution (predominantly female), BMI (19.0±1.4 vs.19.2±2.0,), and waist-to-hip ratio (0.78±0.11 vs. 0.76±0.10). Moreover, at baseline, vitamin D levels were low and similar across both groups (14.5±5.3 ng/ml vs. 16.2±4.9, p=0.173). After the study period, a significant (p<0.001) increase in vitamin D3 levels (28.3±5.3 ng/ml) was observed in the intervention group as compared to controls (15.1±3.4 ng/ml), indicating effective supplementation. Moreover, at baseline, MMSE scores were similar (24.1±1.7 vs. 24.3±1.5) between groups (P=0.677) while at the end line, the intervention group (26.5±1.4) showed a significant improvement in MMSE scores than control (23.8±2.25; p<0.001). This suggests a positive effect of Vitamin D3 supplementation on cognitive function. Brain perfusion was analyzed using SPECT imaging techniques (Z-scores), and at baseline, abnormal perfusion was prevalent in both groups (81.6% vs. 88.2%, P=.522), primarily in the frontal, parietal lobes, and precuneus regions (z-score: 1.4 vs. 1.46, P=0.549). This baseline homogeneity indicates effective randomization and establishes comparable initial conditions between the study groups. However, at the end line, mean z-scores were insignificantly (P=.457) higher in the control group (n=13, z-scores=1.84) than intervention group (n=21, z- scores=1.66) while 65.8% (n=25) of the Brain SPECT of the controls were not available at end line, as compared to cases (n=13). On top of that, significant between-group differences emerged in performing perfusion test results (Fisher’s exact test= 6.997, p = 0.028) when considered comparison in missing cases between groups, which indicates among available controls (n=13), eleven xvi showed abnormal brain perfusion. Furthermore, the intervention group demonstrated distinct patterns of perfusion compared to controls, suggesting a potential effect of Vitamin D3 supplementation on cerebral perfusion parameters. These findings suggest that despite the study groups (intervention vs. control) exhibited indifferent (all P>0.05) vitamin D3 levels, MMSE scores, and perfusion characteristics at the baseline, significant differences emerged between groups especially in the MMSE-scores (small effect size, Partial eta squared=.460 for MMSE between case and. control) attributable to the effective vitamin D3 supplementation (High effect size, Partial eta squared=.714 for Vitamin D, Case vs. control) following the intervention period (6-months). Conclusion Vitamin D3 supplementation led to substantial improvements in serum vitamin D levels, cognitive function (MMSE scores), and brain perfusion in the intervention group. These findings support the potential role of Vitamin D3 as an adjunctive therapy in NPSLE, enhancing cognitive performance and cerebral perfusion. Further studies are recommended to validate these results and assess the long-term benefits of Vitamin D3 in managing NPSLE-related cognitive impairment This thesis is submitted for the degree of Doctor of Philosophy.

Evaluation of Nutritional and Developmental Consequences and Renal Function of Children who Recovered from Hypernatremia

2026-04-19T00:00:00Z

Evaluation of Nutritional and Developmental Consequences and Renal Function of Children who Recovered from Hypernatremia Huq, Sayeeda Hypernatremia (HN), defined as high sodium in the blood (≥145 μmol/L), is a serious complication of diarrheal diseases in children. However, clinical manifestations are usually observed in children in developing countries at the level of 150 μmol/L The primary cause of HN is excessive water loss relative to sodium loss. The resulting hyperosmolality can lead to neuronal cell shrinkage, causing brain injury, including widespread cerebral hemorrhage, thrombosis, subdural effusion, and permanent neurological deficits. Retrospective study conducted in icddr,b showed that 2.4-5.1% children with diarrhea had hypernatremia and case fatality ranges from 15-9%(Chisti et al., 2016).Deaths are often attributed to the severe effects of HN on the brain or to rapid rehydration, which can result in cerebral edema. A prospective observational study was conducted at Dhaka Hospital of icddr,b from August 2013 to October 2015. In total, 259 children under five years old were enrolled. After treatment, 224 children were successfully discharged. The death rate was 13.5%, with neurological sequelae in 29.9%, acute kidney injury in 32.4%, and severe malnutrition in 44% of the children. However, post hypernatremia impact in long term on morbidity, nutritional status, cognitive development, and renal function is largely unknown. Therefore, it is imperative to evaluate nutritional status, growth, cognitive development, and renal function in long term among children recovered from hypernatremia. vi Methodology: This Observational longitudinal study was conducted among children under five years of age who had hypernatremia and participated in the prospective observational study conducted from August 2013 to October 2015. The original study aimed to investigate neurologic complications and developmental consequences in children with hypernatremia. The sample size is based on 224 children who successfully recovered from the initial hypernatremia study. Accounting for a 25% attrition rate, the sample size was estimated to be 168. However, due to dropouts during follow-up, 143 children were successfully followed up in the present study. The study lasted from March 2016 to March 2017, and children were examined at the Dhaka Hospital of icddr, b. All children were brought to Dhaka Hospital inpatient ward for a complete physical, nutritional, neurological, and cognitive assessment. A spot urine analysis was also performed to evaluate their kidney function. Upon arrival, each child's weight, height, and mid-upper arm circumference (MUAC) were measured using standard procedures. Data were collected using pre-designed and pre-tested Case Report Forms (CRFs), which included the child’s medical records, exact address, socio-demographic information, family status, living conditions, history of illness, and immunization status. Cognitive, motor and neuropsychological development were assessed by a trained psychologist using standard procedures. Two different tools were used depending on the child's age. The Bayley Scales of Infant Development-III (BSID-III) was used for children under 36 months, while the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-III) was used for children older than 36 months. Motor function was assessed using the Movement Assessment Battery for Children-II (MABC-II). A spot urine sample was collected from each child for vii microscopic examination, and the protein-to-creatinine ratio was calculated to detect potential glomerular damage. Results: Of the 224 recovered hypernatremia children, 143 (64%) parents consented to participate in this study. The mean age of the children was 35 ± 8 months, and 59% were male. Mean± SD of weight and height of the study participants were 12.4 ±3.1 kg and 89.5 ±7.5 cm, respectively. Malnutrition was not significant in this study population. After stratified by two age groups, children aged up to 36 months and those older than 36 months, Median (IQR) of family income, 13000(10000,20000) vs. 11500 (8000,18000); maternal, 7(4,10) vs. 8(5,10); and paternal, 6(4, 9) vs. 8(1,10) education levels were comparable. Around 50% of the study children commonly presented with upper respiratory infections. After 12 months of recovering from hypernatremia, half of the children had an increased protein-to- creatinine ratio. Children with mild hypernatremia were more likely to have raised urinary Pr/Cr ratio, though none presented with any evidence of urinary problems or glomerular damage. Eighty-six percent (86%) of the children from better socioeconomic status were less likely to have a high Pr/Cr ratio in comparison with their poorest counterparts (p=<0.001). Children under 36 months are twice more likely to have raised urinary Pr/Cr compared to those more than 36 months; 2.31(1.06, 5.02); p-0.035. The mean cognitive score improved significantly at 12 months’ post-recovery (86.1± 16.3; p=0.002), as well as the motor and language composite score; 83. ±15.7, and 80.9± 13.8 respectively. These developmental scores were similar between male and female participants. viii However, 10% of the children showed poor cognitive performance (<69) after 12 months. After adjusting for age and weight-for-age Z-scores (WAZ), composite scores of cognitions and socioemotional domain of development showed a significant difference between baseline and end-line assessment (p=0.002 and p=0.013, respectively). On the other hand, after 12 months’ children mostly presented with average IQ. The mean Movement Assessment score indicated that children are at risk of movement difficulties during the post-hypernatremia recovery period. Conclusion: Long-term evaluation of children's nutritional status and renal function recovered from hypernatremia did not reveal any significant clinical abnormalities. However, developmental assessments indicated that most children exhibited average neurocognitive development and IQ. Further studies are required to validate the spot urine method against the gold standard 24-hour urine collection method for assessing proteinuria in post-hypernatremia children. This thesis is submitted for the degree of Doctor of Philosophy.

Effect of egg Protein, Omega-3 fatty acids and Vitamin D on Immunonutritional Status and Quality of Life of Breast Cancer Patients undergoing Chemotherapy: A Randomized Control Trial

2025-02-18T00:00:00Z

Effect of egg Protein, Omega-3 fatty acids and Vitamin D on Immunonutritional Status and Quality of Life of Breast Cancer Patients undergoing Chemotherapy: A Randomized Control Trial Akhtar, Khursheda Background: Breast cancer ranked second over all cancers. With increasing numbers of breast cancer patients, the number of younger survivors is growing. Medical treatments such as chemotherapy can negatively interfere with nutritional status. A major player in adequate nutrition is protein. Protein is responsible for building and repairing muscle, tissues, and every cell in human body. It can also help strengthen immune system, making one less susceptible to sickness and infection. Along with the risk factor of breast cancer, it is necessary to find out how- nutritional status, immunity, micronutrient deficiency and quality of life, can be improved to address better disease prognosis. In this study, gold standard egg-protein, omega-3 fatty acid, and Vitamin D were supplemented to the BC chemotherapy patients aiming to improve nutritional status and immunity, thus upgrading QoL and immune-nutritional status. Here, scientific evidence shows a path to oncologist and dietician through improving diet rich in standard protein and Quality of life for the efficacy of drugs. The aim of this study was to assess the effect of breast cancer chemotherapy patients through supplement protein, omega 3 and vitamin D. Materials and Methods: This study, started in December 2019, was a randomized controlled trial (Three-month or 12-weeks follow up) involved breast cancer patients (N=104) undergoing chemotherapy. Participants selected randomly (using a random number generator from the 'calculator.net' website) for both the control (n=52), and intervention groups (n=52). Ethical approvals were obtained from the Ethical Review Committee, Faculty of Biological Sciences, University of Dhaka (Ref. No. 86/Bio. Scs.), and the National Institute of Cancer Research and Hospital, Dhaka (Ref. No. NICRH/Ethics/2020/240). Data collection was carried out through face-to-face interviews using a structured questionnaire. Data were collected at three time points (Baseline, six-weeks later, after the intervention or 12-weeks later), during three-month (or twelve weeks) interventions. Both verbal and written informed consents were obtained from all participants. The intervention group received supplements of 3 eggs (1 whole+ 2 whites), omega-3 fatty xv acids (1 g), and vitamin D (2000 IU) daily for 3-months. Both groups underwent a series of laboratory tests (Albumin, SGPT, SGOT, Creatinine, CRP, CBC, Neutrophil, Eosinophil, and Basophil etc.), and estimation of IgG and CD4 were used to assess immune function, while BMI (Kg/m2), and the Subjective Global Assessment (SGA) scale were used to evaluate nutritional status. Information on physical activity and 24-hour dietary intake were also collected. Quality of life (QoL) was measured for both groups using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaires (EORTC QLQ-30 version 3 and EORTC QLQ-BR23). Statistical analysis was conducted using SPSS (version 27) and a significance level of .05. Descriptive statistics, including mean, standard deviation (SD), and percentages were used. At first, normality tests were performed for the data, and for non-normal data, a log10 transformation was applied to normalize the distribution before performing statistical treatment. Homoscedasticity (constant variance), multicoolinearity (tolerance tests) were applied for multivariate tests. Non-parametric ‘Friedman rank test’ was used to compare the case and control groups especially for the laboratory data, and a general linear model (GLM) was used to assess the differences between the two groups across three timelines. Results: The mean age was 44±8.9 years in the intervention group and 44.7±9.3 years in the control group. Baseline BMI was 25.8±4.0 kg/m² in the intervention group (range 19.4-38.2 kg/m²) and 26.4±4.2 kg/m² in the control group (range 18.5-35.5 kg/m²). Patients with advanced-stage, recurrent, or metastatic breast cancer were excluded. Immunohistochemistry revealed that in the intervention and control groups, respectively, the prevalence of breast cancer subtypes was as follows: Luminal A (9.6% vs. 28.8%), Luminal B (7.7% vs. 15.4%), Triple Negative (57.7% vs. 32.7%), and Her2 (25% vs. 23.1%). Subjective Global Assessment (SGA) scores showed significant improvement in the intervention group compared to the control group across three timelines, with a grand mean of 5.24±0.7 for the intervention group and 4.66±0.66 for the control group (p < 0.05). QOL scores were also significantly higher in the intervention group (4.8±0.66) compared to the control group (4.0±0.80) (p < 0.05). xvi BMI showed significant changes over time within both groups, but no significant differences were found between the groups. For albumin, a significance differences within-group effect was observed (F (1,102) =14.67, p < 0.001), though the interaction effect between groups approached significance (F (1,102) =2.9, p = 0.057). Significant within-group and interaction effects were found for SGA scores (F(2,204)=29.36, p < 0.001; F(2,204)=27.39, p < 0.001), Vitamin D (F(1,102)=54.9, p < 0.001; F(1,102)=82.9, p < 0.001), and CD4 levels (F(1,102)=24.9, p < 0.001; F(1,102)=6.57, p = 0.012). IgG showed no significant differences between the groups. Health and QOL both showed significant interaction effects between the intervention and control groups (F (2,204) =101.05, p < 0.001; F (2,204) =91.91, p < 0.001, respectively). In conclusion, the intervention with egg protein, omega-3 fatty acids, and vitamin D supplementation significantly improved nutritional status (BMI Kg/m2, SGA), immune parameters (IgG, CD4), and quality of life (QoL) in breast cancer patients undergoing chemotherapy. This thesis is submitted for the degree of Doctor of Philosophy.

Role of Natural Antioxidants on the Oxidation Stability of Fats and Oils

2025-11-05T00:00:00Z

Role of Natural Antioxidants on the Oxidation Stability of Fats and Oils MOHAMMAD ABDULLAH, ABU TAREQ Background: The enhancement of oxidation stability in fats and oils through natural antioxidants has garnered significant research interest. Given the susceptibility of fats and oils to oxidation, the incorporation of antioxidants is essential to preserving their quality, nutritional integrity, and safety. This study aims to identify reliable antioxidant sources through a comprehensive analysis of their antioxidant activity, total phenolic and flavonoid content, and polyphenolic composition. Additionally, it assesses the impact of natural extracts on the oxidative stability of fats and oils using induction time monitoring technology and evaluates their effects on unsaturated fatty acids to demonstrate their efficacy in inhibiting oxidation. Methods: A total of 33 plants, sourced from local and ethnic origins, were collected, and their ethanolic extracts were prepared to evaluate their potential as rich sources of natural antioxidants and to analyze their polyphenolic composition. This study utilized a UV spectrophotometer to evaluate total flavonoid, tannin, and phenolic content, as well as antioxidant activity and the 2,2-diphenyl-1-picrylhydrazyl (DPPH) free radical scavenging activity (IC50 value) in 33 ethanol extracts from local and ethnic plant sources. High-performance liquid chromatography with diode array detector (HPLC-DAD) was employed to identify bioactive polyphenolic compounds. Fourteen extracts were selected for further investigation based on their IC50 value, economic significance, and availability. The oxidative stability index (OSI) of soybean oil and hydrogenated fat (dalda) was measured using the Rancimat 743 instrument under varying temperatures (120ºC, 140ºC, and 180ºC) and airflow conditions (15L/h and 20L/h). Additionally, plant ethanolic extracts from betel leaves, tea leaves, spirulina, shime alu leaves, baruna leaves, radish leaves, and shati were viii tested for their OSI performance (induction time >7.0 hours at 120ºC and 20L/h airflow). To assess oxidation stability in baked products, biscuits were prepared using dalda enriched with these extracts, followed by peroxide value, acid value, and thiobarbituric acid reactive substances (TBARS) analysis, along with sensory evaluation. The effect of three extracts on fatty acid stability in soybean oil was further examined using gas chromatography-flame ionization detection (GC-FID) after heating at 180ºC for six hours over seven days. Results: The IC50 values of all tested spices ranged from 60 to 105 µg/mL, while spirulina, betel, tea, and amila leaves exhibited values between 80 and 150 µg/mL. Other extracts, including zinger, turmeric flower, radish, sabarang, uzon, shime alu, boruna, dinge, moringa leaves, and shati, showed IC50 values of 150–200 µg/mL. The ethanolic extracts demonstrated significant flavonoid, tannin, and phenolic content, along with bioactive polyphenolic compounds such as hydroxybenzoic acid, flavonoids, and hydroxycinnamic acids, highlighting their potential as nutraceuticals. Oxidation stability index values for spirulina (8.29 hours), betel leaves (11.39 hours), tea leaves (10.7 hours), and other extracts were comparable to or exceeded that of 0.02% BHT (7.2 hours). Spirulina extract exhibited the highest stability in unsaturated fatty acids, followed by betel and tea leaves. Biscuits prepared with extract-enriched dalda exhibited superior oxidation stability, with betel leaves demonstrating the most favorable effects, followed by spirulina and tea leaves. Sensory evaluation indicated that biscuits with betel and tea leaf extracts were preferred. Conclusion: Among the selected plant extracts, ethanolic extracts of betel leaves, spirulina, and tea leaves exhibited strong natural antioxidant properties, enhancing ix oxidative stability in processed foods by reducing rancidity and extending shelf life. Their rich bioactive polyphenolic composition further suggests potential nutraceutical applications, offering both health benefits and preservative advantages. These findings support the incorporation of natural antioxidants in food processing and underscore the need for further research to explore their broader applications and potential benefits. This thesis is submitted for the degree of Doctor of Philosophy.