Anwer Khan Modern Medical College Journal The Official journal of the Anwer Khan Modern Medical College &amp; Hospital. <br />This is an open access journal which means that all contents are freely available in the website without charge to the user. Users are allowed to read, download, copy, distribute without asking prior permission from the publisher or the author. Anwer Khan Modern Medical College en-US Anwer Khan Modern Medical College Journal 2221-836X Adverse Effects of Tobacco on Pregnancy Outcome <p>Abstract not available</p><p>Anwer Khan Modern Medical College Journal Vol. 9, No. 2: Jul 2018, P 83-84</p> ME Rahman ##submission.copyrightStatement## 2018-12-05 2018-12-05 9 2 83 84 10.3329/akmmcj.v9i2.39199 Association of B-Type Natriureteric Peptide Levels With Estimated Glomerular Filtration Rate in Different Stages of Chronic Kidney Disease And Relevant Echocardiographic Changes <p><strong>Background: </strong>B-type natriuretic peptide (BNP) is a biomarker of cardiovascular disease that is common in patients with chronic kidney disease (CKD). The influence of glomerular filtration rate (GFR) on BNP in CKD may stem from failure to account fully for the effects of coexistent cardiac disease, dysfunction and volume overload.</p><p><strong>Material &amp; Methods: </strong>This is a cross sectional descriptive type of observational study conducted by the Department of Nephrology of Anwer Khan Modern Medical College Hospital during the period of Jan 2016 to Dec 2016.</p><p><strong>Results: </strong>A total number of 71 patients were included in the study. Out of them 42(59.15%) were male and 29(40.85%) were female with a M:F of 1.45:1. The mean age of the patients was 62.54+13.92 years (Range 18- 90 years). Mean e GFR was 21.81+15.01 ml/min/1.73 body surface area, mean Serum Creatinine was 5.04+3.29 mg/dl, mean Hb% was 10.90+1.5 gm/dl and that of BNP was 1335.03+1838.43 Pg/ml and that of Ejection Fraction (EF) was 50.05+12.61%. 21.12%(15) were on Stage 3 CKD(Chronic Kidney Disease) and 33.80% (24) and 45.08%(32) were on Stage-4 and Stage-5 respectively.There was a strong and highly significant inverse association between BNP and e GFR (p&lt;0.001), with higher BNP level observed in those with lower eGFR. BNP is directly proportional to Serum Creatinine which is significant (p&lt;0.001). BNP rises as Serum Creatinine rises. Regarding echocardiographic changes, almost all the patients 69(97.18%) had Left ventricular hypertrophy (LVH). 24(33.80%) had Left ventricular (LV) diastolic dysfunction, 19(26.76%) had LV systolic dysfunction and dilated LV and rest of them 28(39.44%)had good biventricular function. 35 (49.29%) patients had mild pericardial effusion(PE) and 39(54.92%) had hypokinesia in different cardiac wall. Most of the patients 65(91.54%) had mild mitral regurgitation (MR), tricuspid regurgitation (TR), aortic regurgitation (AR).</p><p><strong>Conclusion: </strong>Our goal was to provide compelling evidence of the association of renal function and BNP, with the full expectation that additional prospective studies will be required to validate and better define this relationship. Ideally, clinicians need clear guidelines regarding BNP and heart failure that include consideration of eGFR. Currently most institutions, including our own, continue to use BNP cutoff diagnostic levels that have not been adjusted for eGFR. Our data emphasized that a single BNP measurement must be evaluated in conjunction with the entire clinical presentation, particularly the level of renal failure.</p><p>Anwer Khan Modern Medical College Journal Vol. 9, No. 2: Jul 2018, P 85-90</p> Nazneen Mahmood M Muhibur Rahman KMSH Sirazul Huq Md Mahtabuddin Hassan Md Mahmudur Rahman Siddiqui Rubayat Sheik Giasuddin Farhana Mahmood Shamima Islam Shumi ##submission.copyrightStatement## 2018-12-05 2018-12-05 9 2 85 90 10.3329/akmmcj.v9i2.39200 Serum Visfatin Levels Estimated in Overweight Individuals <p><strong>Background: </strong>Visfatin is a novel adipocytokine predominantly secreted from visceral fat and its blood shows insulin-mimetic effects which correlate with overweight, type 2 diabetes mellitus (T2DM) and inflammation. Overweight is an important component of metabolic syndrome. However, the relationship between visfatin levels and overweight is not yet clear. The aim of this study was to investigate the relationship of serum visfatin levels in overweight and apparently healthy subjects.</p><p><strong>Methodology: </strong>This was a cross-sectional comparative study includes 50 overweight subjects who had no disease conditions and 42 controls. Anthropometric measurements included Height (HT), body mass index (BMI), waist circumferences (WC) and hip circumferences (HC) were performed by using standard methods. Serum visfatin levels were analyzed by Enzyme Linked Immunosorbent Assay (ELISA). Biochemical parameters estimated by ELISA and standard methods where fasting serum visfatin, fasting serum insulin and fasting plasma glucose, serum triglycerideg (TG), serum cholesterol (CHOL) levels and lipid profiles were evaluated. All data were presented as Mean (M) and Standard Deviation (±SD) and results were compared with students t-test and correlation coefficient. The values were considered significant at 0.05 level of significance.</p><p><strong>Results: </strong>BMI, WC, HC and %BFM were significantly higher in overweight subjects compaired to controls. Serum visfatin (ng/ml) value in overweight subjects also was observed significantly higher compared to the controls.</p><p><strong>Conclusion: </strong>A significant corelation of plasma visfatin levels was observed with anthropometric parameters whereas no significant relationship observed with any of the biochemical parametres either the study subjects or controls. This study shows correlation between serum visfatin and overweight subjects. Future studies with large population possibly will explore and explain the role and relationship of serum visfatin with overweight, T2DM and others diseases as related to visfatin.</p><p>Anwer Khan Modern Medical College Journal Vol. 9, No. 2: Jul 2018, P 91-95</p> Fahmida Kabir Shiekh Anisul Haque KMG Haque ##submission.copyrightStatement## 2018-12-05 2018-12-05 9 2 91 95 10.3329/akmmcj.v9i2.39201 Comparative Study of Level of Serum Uric Acid in Type 2 Diabetes Mellitus Associated with Hypertension <p><strong>Background: </strong>The role of uric acid in the progression of prediabetes to diabetes has been known. Serum uric acid has been shown to beassociated with cardiovascular disease, hypertension, and chronic kidney disease. However, conflicting data exist asregards the serum uric acid (UA) levels in type 2 diabetes mellitus, which are associated with risk factors andcomplications.</p><p><strong>Material &amp; Methods: </strong>The present study was designed to look for any association of serum uric acid with hypertension in type 2diabetes mellitus, taking into consideration the relevant clinical, biochemical and the anthropometric data. 110 patientswith type 2 male diabetes mellitus as case and 100 healthy malecontrols were included in this study.</p><p><strong>Results: </strong>This study shows that there were significant differences in mean of age, duration of DM, exercise time, waist hip ratio, systolic blood pressure and diastolic blood pressure within case and control but no significant differences of mean BMI was found between and control. The mean age, duration of DM, exercise time, waist hip ratio, systolic blood pressure and diastolic blood pressure and BMI were (51.83±9.911 years, 6.87±5.54 years, 1.94±.831 hours, .92±.03, 140±6.75 mm of Hg,90±2.41 mm of Hg and 25.43±3.19 Kg/m2 respectively), where as in controls these were (44.81±9.66 yrs, 00 years, 1.12±.327 hours, .91±.03, 130±1.28 mm of Hg, 80±6.18 mm of Hg and 24.96±3.02 Kg/m2 respectively). This table also shows that significant differences in mean of FBS, ABF, HbA1C and S. Uric acid between case and control, but there was no significant differences of mean TG, Cholesterol, HDL and LDL. The mean of FBS, ABF, HbA1C and S. Uric acid among the cases were (8.19±2.48 mmol/L, 11.29±3.47 mmol/L, 7.96±6.04 mg%, 189.72±111.36 mg/dl, 179±43 mg/dl, 38.38±13.77 mg/dl, 102.10±35.79 mg/dl and 8.39±2.61 mg/dl respectively, on the other hand among the control these were 5.91±1.13 mmol/L, 9.19±1.95 mmol/L, 5.93±1.01 mg%, 200±104.49 mg/dl, 183±42.25 mg/dl, 38.14±5.52 mg/dl, 110±33.23 mg/dl and 5.14±.84 mg/dl respectively.</p><p>Anwer Khan Modern Medical College Journal Vol. 9, No. 2: Jul 2018, P 96-101</p> Roksana Yeasmin MA Muttalib Nazneen Sultana Md Jamil Hasan Karami - Ayatunnessa Fahmida Akhter Maruf ##submission.copyrightStatement## 2018-12-05 2018-12-05 9 2 96 101 10.3329/akmmcj.v9i2.39202 In Hospital outcome of Prediction of Peripheral Arterial disease In Diabetic Tobacco User Patients <p><strong>Background: </strong>Peripheral artery disease (PAD) is a distinct atherosclerotic disorder marked by stenosis of the arteries common in tobacco users. Here we investigate prediction of unknown peripheral arterial disease (PAD) amongst patients with diabetic tobacco user and diabetic without tobacco user.</p><p><strong>Methodology: </strong>This prospective observational study was conducted in the Department of Cardiology, Ibrahim Cardiac Hospital and Research Institute, Dhaka, Bangladesh. A total of 60 patients were enrolled in this study who were presented with chest pain associated with lower limb claudication. They were diabetic population, constituted tobacco user in group-I and without tobacco user in group-II.</p><p><strong>Results: </strong>Hypertension was the leading risk factor in both groups (76.7% vs. 80%). 80% of patients of group I and 46.7% of patients of group II had mild form of ABI value. 3.3% of patient of group II had severe form of ABI value. There was no statistical significant difference between two group of patients (p=0.053). 93.3% patients of group I and 96.7% patients of group II had coronary artery disease. Twenty three patients of tobacco user group (n=30) had peripheral artery disease, whereas ten patients of without tobacco user group (n=30) had peripheral artery disease which was statistically significant (p=0.003). Three quarters (76.7%) of group I developed PVD as compared to 33.3% of group II. The risk of developing PVD in diabetic smokers was observed to be more than 6 fold (95% CI: 2.109-20.479) higher than that in non tobacco user were diabetics. 16.7% patients of group I atherosclerosis in femoral artery and the value is 10% in case of group-II, which is statistically in significant(p=0.433).</p><p><strong>Conclusion: </strong>The awareness and implementation of ABI in general clinical practice is poor. A simple, inexpensive test like ABI can improve the diagnosis of PAD in clinical practice and thus help in preventing CAD and consequent death by a range of medical therapies.</p><p>Anwer Khan Modern Medical College Journal Vol. 9, No. 2: Jul 2018, P 102-109</p> Syed Dawood Md Taimur Sahela Nasrin M Maksumul Haq Hemanta I Gomes Farzana Islam ##submission.copyrightStatement## 2018-12-05 2018-12-05 9 2 102 109 10.3329/akmmcj.v9i2.39203 Estimation of Serum Magnesium in Bangladeshi Gestational Diabetic Mother <p><strong>Background: </strong>Gestational diabetes mellitus (GDM) is characterized by glucose intolerance during pregnancy.GDM is associated with an increased incidence of congenital abnormalities usually aggravated by maternal magnesium deficiency. Magnesium is one of the essential trace elements for normal embryogenesis and foetal growth and its deficiency increase mortality and morbidity rate of mothers, embryos and neonates.</p><p><strong>Objective: </strong>To evaluate the association of serum magnesium with GDM in second and third trimester. Materials &amp; Methods: This case control study was conducted in Mymensingh Medical College Hospital during the period from July 2013 to June 2014 to evaluate the association of magnesium with GDM in Bangladeshi women. A total number of 172 subjects were participated in this study; among them eighty six women diagnosed with GDM were selected as case (Group-I) and eighty six healthy pregnant women were control (Group-II). The case group again subdivided as Group Ia and Ib second and third trimester respectively. Control group also subdivided as Group IIa and IIb second and third trimester respectively. Student's unpaired t test was used to analyse the data between groups. For analytical purpose 95% confidence limit (p&lt;0.05) was taken as level of significance.</p><p><strong>Results: </strong>Serum Magnesium levels were significantly decreased in cases compared to control group. Highly significant difference (p&lt;0.001) was found between Gr-Ia and Gr-IIa. The result was also highly significant (p&lt;0.001) when compared between Gr-Ib and Gr-IIb .</p><p><strong>Conclusion: </strong>Estimation of serum magnesium level should be incorporated in every GDM cases for prevention of complications.</p><p>Anwer Khan Modern Medical College Journal Vol. 9, No. 2: Jul 2018, P 110-113</p> Farzana Akonjee Mishu Syed Md Tanjilul Haque ##submission.copyrightStatement## 2018-12-05 2018-12-05 9 2 110 113 10.3329/akmmcj.v9i2.39205 Ejection Fraction <35% - Anaesthetic Experience of 236 Cases: A Retrospective Study <p><strong>Background: </strong>EF is an important measurement in determining how well the heart is pumping out blood and in diagnosing as well as tracking the heart failure (HF). Normal EF varies at 55% to 70%, while EF 40% to 55% may indicate damage perhaps from previous heart attack, but may not indicate HF. However, measurement under 40% may show evidence of HF or cardiomyopathy and patient with EF&lt; 35% may be at the risk of life threatening irregular heartbeats. Such patients are considered to be at high risk for anaesthesia as life threatening irregular heartbeats lead to sudden cardiac arrest and sudden death.</p><p><strong>Objectives: </strong>The aim of this study was to find out the characteristics of patients, identifying of the risk factors, better understanding of pathophysiology, pre-operative optimization of the patients, uses of stable drugs &amp; anesthetic techniques, reduces intraoperative or early postoperative complications &amp; perioperative morbidity, mortality.</p><p><strong>Methods: </strong>In this retrospective study we described our experiences of 236 cases of very low ejection fraction (20% - 35%) from 1st July 2014 - 30th June 2017. We reviewed their medical history and noted age, sex, type of operation &amp; anesthesia, pattern of operation either elective or emergency, preoperative investigation and preparation, as well as details of anaesthetic management, were also recorded.</p><p><strong>Results: </strong>General anaesthesia was performed in 176 (74.58%) cases and rest of 60(25.42%) cases were regional where spinal 42(17.80%) cases &amp; epidural 18(7.62%) cases. The age of the patients were in the range of 20 to 70 years, with majority of the patients were in 60 to 69 years age group. The majority of the patients about 46.19% were in LVEF 26 - 30% group, 36.01% patients were in 31 - 35% group and rest of 17.80% patients were in 20 - 25% group. Average duration of operation incase of general anesthesia 66.5(±2.28SD) min and incase of regional 44.2(±3.25SD) min. The mortality rate only 1.27%.</p><p><strong>Conclusions: </strong>Preoperative patient optimization, intraoperative haemodynamic stability and postoperative care have contributed to the success of very low ejection fraction patients in our hospital.</p><p>Anwer Khan Modern Medical College Journal Vol. 9, No. 2: Jul 2018, P 114-120</p> Md Shafiul Alam Shaheen Kawsar Sardar AKM Nurnobi Chowdhury Md Mushfiqur Rahman Md Noor A Alam Raju Ahmed Md Jashim Uddin ##submission.copyrightStatement## 2018-12-05 2018-12-05 9 2 114 120 10.3329/akmmcj.v9i2.39206 Outcome of External Dacryocysto-Rhinostomy (DCR) Operation Without Silicone Tube Intubation <p><strong>Background: </strong>Dacryocysto-rhinostomy (DCR) is a bypass surgery in which an anastomosis is made between the medial wall of the lacrimal sac &amp; the lateral wall of the nasal mucosa by cutting the intervening bone at the level of middle meatus to restore the flow of tears when the obstruction is beyond the common canaliculus. The aim of this study was to evaluate the surgical intervention of conventional external DCR without silicon tube intubation.</p><p><strong>Methods: </strong>This study was conducted at Jahurul Islam Medical College Hospital, Kishoregonj, from July 2016 to January 2018. Fifty cases with chronic dacryocystitis were selected for the study. The operation was done under local anaesthesia. The patients were followed up for 3 months.</p><p><strong>Result: </strong>The mean age of the patient at the time of surgery was 40.9±13.1 years ranged from 16 to 65 years. Male to female ratio was 1:2.1. There were three patients with reactionary haemorrhage, one wound infection, two with wound gap, one epicanthal fold and one granuloma formation. There were no failed DCR in this series.</p><p><strong>Conclusion: </strong>Conventional DCR is the most common oculoplastic surgery performed for managing epiphora due to nasolacrimal duct obstruction.</p><p>Anwer Khan Modern Medical College Journal Vol. 9, No. 2: Jul 2018, P 121-123</p> Md Anwar Hossain Khan AHM Zahirul Islam Biswas Md Mosharraf Hossain ##submission.copyrightStatement## 2018-12-05 2018-12-05 9 2 121 123 10.3329/akmmcj.v9i2.39207 Clinico-Pathological Profile and Management Outcome of Fournier’s Gangrene in a Tertiary Care Hospital <p><strong>Background: </strong>Fournier’s gangrene is a vascular disaster of infective origin occurring about male external genitalia. Diabetes Mellitus is an important predisposing factor. A good number of patients of this rare clinical entity are admitted frequently in our centre. Till now the disease has the potential for significant morbidity and also mortality.</p><p><strong>Objective: </strong>The study was designed to be conducted among patients suffering from Fournier’s gangrene to identify the possible source of sepsis, to denote pattern and extent of area involvement and microorganisms isolated and to observe the treatment course and outcome.</p><p><strong>Methods: </strong>This prospective observational study was carried out in BIRDEM General Hospital, Dhaka among 60 patients of Fournier’s gangrene admitted under surgery department during the period of October 2016 to January 2018 using purposive sampling method.</p><p><strong>Result: </strong>The results of this study suggest that majority of the study population were in 51 to 60 years (Mean 52±4.9) age group. All the patients were diabetic with grossly elevated blood glucose level (Mean RBS=17.3 mmol/dl). In addition to scrotum, perineum, penis, buttock and lower abdomen were also affected to variable extent (73.3%). All patients required major debridement which had to be repeated in 68.3% cases. Steptococcus pyogens was the most common organism isolated (43.3%) followed by Eschericia coli (35%) and majority were of polymicrobial type (61.6%). Mortality rate was 8.3%.</p><p><strong>Conclusion: </strong>The diagnosis and treatment of Fournier’s gangrene is enigmatic and challenging to the physician. Urgent surgical debridement along with other appropriate supportive measures can reduce morbidity and mortality.</p><p>Anwer Khan Modern Medical College Journal Vol. 9, No. 2: Jul 2018, P 124-130</p> Mahmud Ekram Ullah Amreen Faruk Rajibul Haque Talukder - Farukuzzaman Noor A Alam ##submission.copyrightStatement## 2018-12-05 2018-12-05 9 2 124 130 10.3329/akmmcj.v9i2.39208 Comparative Study of Oral Clonidine Versus Gabapentin as Premedication for Anxiolysis, Sedation and Attenuation of Pressor Response to Laryngoscopy and Tracheal Intubation <p><strong>Background and Aims: </strong>We conducted a prospective, randomized, double-blind and controlled trial to compare the effects of oral clonidine and gabapentin as premedication in obtunding hemodynamic response to laryngoscopy and intubation in normotensive patients undergoing elective surgery. We also compared the preoperative anxiety and sedation status between these two drugs.</p><p><strong>Materials and Methods: </strong>A total of 60 patients of American Society of Anesthesiologists (ASA) physical status I, aged 20 -50 years of either sex enrolled in the study were randomly divided into two groups of 30 each. Group A patients received oral clonidine 200 mcg and Group B patients received oral gabapentin 900 mg, 90 minutes prior to induction of anesthesia. The heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were observed and recorded pre and post endotracheal intubation. Anxiety and sedation score were noted after 60 minutes of oral administration of drug as well as before induction of anesthesia.</p><p><strong>Results: </strong>Both groups were matched for age, sex, weight and intubation time. Anxiety score and sedation score before induction were significantly better in clonidine group as compared with gabapentin group. Also oral clonidine attenuated the increase in heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure better than oral gabapentin (p&lt;0.05).</p><p><strong>Conclusion: </strong>Oral clonidine provided good attenuation of hemodynamic response to laryngoscopy and intubation as compared with oral gabapentin. Also clonidine is better agent as anxiolytic and sedative than gabapentin.</p><p>Anwer Khan Modern Medical College Journal Vol. 9, No. 2: Jul 2018, P 131-136</p> Muhammad Sazzad Hossain Mohammad Mamunur Rashid Syed Ariful Islam Md Anisur Rahman Babu Devashis Saha Nadia Islam Md Sirajul Islam M Alamgir Chowdhury ##submission.copyrightStatement## 2018-12-05 2018-12-05 9 2 131 136 10.3329/akmmcj.v9i2.39209 Red Cell Distribution Width (RDW) and Hb% in the Detection of Iron Deficiency Anemia in Pregnant Women <p><strong>Background: </strong>Detection of iron deficiency early during pregnancy is essential for correct management. Red cell distribution width (RDW) is a new routine parameter in fully automated hematology analyzer that can give the idea of early iron deficiency before Hb%. This study was aimed to see the role of red cell distribution width and Hb% in determining early iron deficiency in pregnant women.</p><p><strong>Methods: </strong>In this study 190 pregnant women were included. CBC including Hb% and RDW and iron profile were done. RDW were compared with Hb% in various stages of iron deficiency.</p><p><strong>Results: </strong>RDW was more significant than Hb level in latent iron deficiency when Hb level was normal (p&lt;0.05). In mild and moderate iron deficiency anemia, RDW was increased progressively though Hb level was reduced. In this study RDW had sensitivity 82.3% and specificity 97.4%. Whereas Hb level had sensitivity 56.6% and specificity 90.9% for iron deficiency.</p><p><strong>Conclusion: </strong>Latent iron deficiency without other complicating disease could be screened out early by increased RDW when Hb% was normal.</p><p>Anwer Khan Modern Medical College Journal Vol. 9, No. 2: Jul 2018, P 137-141</p> Gazi Sharmin Sultana Syed Aminul Haque - Ayatunnesa Md MA Muttalib Md Quddusur Rahman ##submission.copyrightStatement## 2018-12-05 2018-12-05 9 2 137 141 10.3329/akmmcj.v9i2.39210 Blood Component Therapy <p>Transfusion medicine has undergone advancements since its initiation in the early 20th century. One of these was the discovery that blood can be divided into individual components and delivered separately. Today, blood transfusions nearly always consist of the ad-ministration of 1 or more components of blood. Whole blood transfusion is now limited to situations involving massive resuscitation (trauma ) The most familiar cellular components include packed red blood cells (PRBC), washed PRBC, leukoreduced PRBC and pooled or aphaeresis platelets. Plasma products such as FFP or cryoprecipitate, ant hemophilic factor (CRYO). The transfusion of red blood cells (RBCs), platelets, fresh-frozen plasma (FFP), and cryoprecipitate has the potential of improving clinical outcomes in perioperative and peripartum settings. These benefits include improved tissue oxygenation and decreased bleeding. However, transfusions are not without risks or costs. With the advent of blood component therapy, each unit of whole blood collected serves the specific needs of several, rather than a single patient.</p><p>Anwer Khan Modern Medical College Journal Vol. 9, No. 2: Jul 2018, P 142-147</p> Shanaz Karim Ehteshamul Hoque Md Mazharul Hoque Syeda Masooma Rahman Kashfia Islam ##submission.copyrightStatement## 2018-12-05 2018-12-05 9 2 142 147 10.3329/akmmcj.v9i2.39211 Fordyce's Disease Treated with Pimacrolimus: A Rare Case Report <p>Fordyce's disease, a rarely found disease of lips has been reported recently in department of Skin and VD, Gonosashthaya Somaj Vittic Medical College Hospital, Savar, Dhaka. Occasionally it may not be possible to identify the cause. The patient presented with identical features of Fordyce's disease and lip biopsy for histopathology showed the features of Fordyce's disease. Then patient was treated with Pimecrolimus cream and improved. Fordyce's disease is an extremely rare disorder. So its cutaneous findings, histopathology and treatments are highlighted here.</p><p>Anwer Khan Modern Medical College Journal Vol. 9, No. 2: Jul 2018, P 148-151</p> Tania Hoque AZM Maidul Islam ##submission.copyrightStatement## 2018-12-05 2018-12-05 9 2 148 151 10.3329/akmmcj.v9i2.39212 Primary Splenic Lymphoma (PSL): A Rare Presentation of Lymphoma <p>Primary Splenic Lymphoma (PSL) is a rare neoplasm of the spleen. PSL is generally presented as B cell non-Hodgkin lymphoma. Primary involvement of the spleen by lymphoma is much less common than secondary involvement. It usually presents with nonspecific symptoms like left upper abdominal pain or discomfort due to splenomegaly, pyrexia, weight loss, night sweats and weakness. In this article, we are reporting a case of PSL in a 23 years old boy who presented with splenomegaly and non-specifc symptoms.</p><p>Anwer Khan Modern Medical College Journal Vol. 9, No. 2: Jul 2018, P 152-153</p> Md Mahmudur Rahman Siddiqui Md Mostafizur Rahman Md Hasan Ali Masum Abdul Wohab Khan Md Ehteshamul Haque Atia Saeed ##submission.copyrightStatement## 2018-12-05 2018-12-05 9 2 152 153 10.3329/akmmcj.v9i2.39213 Crohn's Disease and Diagnostic Difficulty: A Case Report <p>Crohn's disease is an uncommon disease in Bangladesh. Recently its prevalence is increasing. In the era of tuberculosis, it is sometimes difficult to diagnose in this subcontinent. Mrs. Bilkis Begum 50 years old housewife presented with loose motion with abdominal pain. She had significant weight loss. She was ill looking and anemic. Colonoscopy reveals multiple longitudinal ulcers in the descending colon. Biopsy finding revealed large number of granuloma with aggregates of epithelioid cells, histocytes and few giant cells. No caseation was found. In this scenario anti TB was started and condition of the patient was improved. She has gained her weight. After 6 month of anti Tb therapy repeat colonoscopy was done and revealed multiple healed longitudinal scar marks in the colon. In 15th February 2018 she presented with previous complain. During this time her stool for calprotectin is high. Colonoscopy shows multiple longitudinal ulcers in the sigmoid colon and biopsy shows epithelioid cells and granulation. Now she was diagnosed as a case of crohn's colitis. Induction of therapy was started with prednisolone along with mesalamine. Condition of the patient improved.</p><p>Anwer Khan Modern Medical College Journal Vol. 9, No. 2: Jul 2018, P 154-157</p> Atia Saeed Abu Shahin Swapan Chandra Dhar Md Mahmudur Rahman Siddiqui Anisur Rahman ##submission.copyrightStatement## 2018-12-05 2018-12-05 9 2 154 157 10.3329/akmmcj.v9i2.39215 From the Desk of Editor in Chief Vol.9(2) <p>Abstract not available</p><p>Anwer Khan Modern Medical College Journal Vol. 9, No. 2: Jul 2018, P 158</p> Md Tahminur Rahman ##submission.copyrightStatement## 2018-12-05 2018-12-05 9 2 158 158 10.3329/akmmcj.v9i2.39216 CME Vol.9(2) <p>Abstract not available</p><p>Anwer Khan Modern Medical College Journal Vol. 9, No. 2: Jul 2018, P 159</p> Md Tahminur Rahman ##submission.copyrightStatement## 2018-12-05 2018-12-05 9 2 159 159 10.3329/akmmcj.v9i2.39217