Bangladesh Journal of Medicine Published by Association of Physicians of Bangladesh. Association of Physicians of Bangladesh en-US Bangladesh Journal of Medicine 1023-1986 Toxicology in Medical Practice- Time for revolutionary change <p>Abstract not available</p><p>Bangladesh J Medicine Jul 2018; 29(2) : 49-50</p> Md Robed Amin Quazi Tarikul Islam ##submission.copyrightStatement## 2018-08-18 2018-08-18 29 2 49 50 10.3329/bjmed.v29i2.37937 Port Site Infections Following Laparoscopic Cholecystectomy <p><strong>Background</strong>: Port site infections (PSIs) following laparoscopic cholecystectomy is an infrequent complication. Among the causes of PSIs Mycobacterium tuberculosis is rare but it has been increasingly recognized in the recent years. Lack of awareness of this complication leads to prolonged morbidity. Early diagnosis and treatment is important for theresolution of the disease.</p><p><strong>Methods</strong>: This was an observational descriptive study carried out on patients who underwent laparoscopic cholecystectomy. In patients of PSIs, Gram and AFB staining with culture &amp; sensitivity of pus and biopsy of abscess wall or sinus tract were obtained as per need to reach the diagnosis. Patients were treated accordingly.</p><p><strong>Results</strong>: The rate of PSIs was 3.92% in this study. Age, sex &amp; body weight have no impact on PSIs. Diabetes mellitus, hypertension, hypothyroidism, acute cholecystitis &amp; spillage of bile or stone during the procedure increases the rate of PSIs. Epigastric port was affected more than that of other ports. Among the causes of port site infections in 55.18% cases it was with Gram +ve bacteria, in 34.49% cases with Gram -ve bacteria, in 1.72% cases atypical mycobacteria, in 5.17% cases Mycobacterium tuberculosis &amp; in 3.44% cases no organisms were found. Most of the PSIs developed early within one month &amp; responded well with antibiotics. Diagnosisof port site tuberculosis was established by histopathological examination of tissue from abscess wall or sinus tract &amp; treated as per WHO guide line. No recurrence noted at 2 years follow up.</p><p><strong>Conclusion</strong>: Port site tuberculosis after laparoscopic cholecystectomy is a rare entity. The present study is an attempt to make surgeons aware of this rare complication. Early diagnosis and proper treatment are prerequisites to the successful outcome. Strict adherence to well established sterilization protocol is a must for the prevention.</p><p>Bangladesh J Medicine Jul 2018; 29(2) : 51-58</p> Sadia Sajmin Siddiqua Md Azizul Islam Khan Md Arif Uddin Khan Shovon Sayeed ##submission.copyrightStatement## 2018-08-18 2018-08-18 29 2 51 58 10.3329/bjmed.v29i2.37938 Profile of Intensive Care Unit admission and Outcomes of Medical and Surgical patients at A Tertiary Government Hospital: A 5 Year Trend Analysis <p><strong>Background: </strong>The intensive care unit (ICU) is that part of the hospital where critically ill patients that require advanced airway, respiratory and haemodynamic supports are usually admitted. Intensive care unit admissions which aim at achieving an outcome better than if the patients were admitted into other parts of the hospital however come at a huge cost to the hospital, the personnel and patients’ relations.</p><p><strong>Objective: </strong>To audit the 5 year bed occupancy rate and outcome of medicine and surgical patients admitted into the ICU of the Chittagong Medical College Hospital, Chittagong, Bangladesh.</p><p><strong>Design: </strong>A 5 years retrospective study (Record review) from January 2012 to December 2016. Method: Data were extracted from the ICU records of the patient and analyzed.</p><p><strong>Results: </strong>During this study period, the frequency of admission into ICU was significantly more (p&lt;0.001) from medical discipline (55.20%) than surgical disciplines (44.80%). The incidence of survival was significantly lower (p&lt;0.001) from medical discipline (37.68%), than from surgical disciplines (49.05%). Occurrence of total ventilatory support provided in all disciplines was 60.32% and it was significantly higher for the surgical patients. Overall mortality rate was 57.23%.</p><p><strong>Conclusion: </strong>During prioritizing the patients for ICU admission surgical cases should get preference. It is primarily necessary to optimize patient to doctor ratio and patient to nurse ratio and providing the service by critical care physicians (“intensivists”) to reduce the mortality rate of ICU.</p><p>Bangladesh J Medicine Jul 2018; 29(2) : 59-62</p> Shakera Ahmed Omar Faruque Yusuf AKM Shamsul Alam Anisul Awal ##submission.copyrightStatement## 2018-08-18 2018-08-18 29 2 59 62 10.3329/bjmed.v29i2.37939 Right Ventricular Functional Status in Chronic Obstructive Pulmonary Disease Patient <p><strong>Aim: </strong>To detect the right ventricular status by echocardiography of COPD patients.</p><p><strong>Background: </strong>Chronic obstructive pulmonary disease is an increasing cause of chronic morbidity and mortality worldwide. Smoking is the major cause and the patients consult with physicians very much late when become complicated. Echocardiography is the main determinant of outcome of COPD patient. We can assess the level of pulmonary hypertension which leads to right heart failure.</p><p><strong>Methods : </strong>This is a cross sectional study. Study place was Department of Medicine, Rangpur Medical College from 1<sup>st</sup> July to 30 September 2014.Clinically and post bronchodilator Spiro metrically diagnosed cases were taken. Patients were graded into Mild, Moderate, severe and very severe categories according to GOLD criteria. Statistical analysis was done with echo findings of RV dilatation and hypertrophy by using Chi-square test and statistical significance was taken as p &lt; 0.05</p><p><strong>Results : </strong>Mean age was 61.50 (sd±9.76) years with male predominance. Mean duration of disease was 6.80 ( sd ± 4.71) years. Patients had a mean duration of smoking of 23.2 ±3.6 pack years. ECG and Echo findings such as RV dilatation, RV hypertrophy and pulmonary hypertension were showed significant correlation with severity and duration of disease. Diagnosis of cor-pulmonale was clinically 20%, ECG 50% and echocardiographically 92%.</p><p><strong>Conclusion </strong>: COPD is more common in males in 5<sup>th</sup> to 7<sup>th</sup> decade with the smoking history of more than 20 pack years. Most patients have moderate to severe disease at presentation. Echocardiography can detect the RV dysfunction in COPD patient earlier. ECG and Echo findings increase as the severity and duration of the disease increases and echocardiography is better than ECG or clinical methods in detecting RV dysfunction.</p><p>Bangladesh J Medicine Jul 2018; 29(2) : 63-68</p> MA Ohab Devendra Nath Sarkar Bidhu Bhusan Das Haripada Sarker M Zakir Hossain Samprity Islam Rowshan Alam Devavrata Sarkar ##submission.copyrightStatement## 2018-08-18 2018-08-18 29 2 63 68 10.3329/bjmed.v29i2.37940 Experience with Serum Magnesium Estimations in Critically Ill Patients Admitted in High Dependency Unit of A Tertiary Care Hospital <p><strong>Background: </strong>Magnesium deficiency has been a common, but easily ignored, electrolyte abnormality. Studies on magnesium in our country are lacking. Here, we have estimated and correlated serum magnesium levels with outcomes and other electrolyte imbalance in critically ill patients with respect to the mortality, in hospital outcome and length of high dependency unit (HDU) stay.</p><p><strong>Methods: </strong>A prospective, observational study was conducted in patients who had been admitted to the HDU. Patient’s demographic profile, medical history, serum magnesium, calcium and electrolytes were enrolled on admission. Patients were divided into normomagnesemic, hypomagnesemic hypermagnesemic groups and compared for various parameters.</p><p><strong>Results: </strong>Out of 60 critically ill-patients, 32 patients (53.33%) were hypomagnesemic, 20 patients (33.33%) were normomagnesemic and 8 patients (13.33%) were hypermagnesemic. The duration of stay of the patients in HDU, in hospital outcome and mortality showed significant variation between these groups. Associated electrolyte abnormalities in hypomagnesemic patients were hypokalemia (56.25%) and hypocalcemia (62.50%). Most of the hypomagnesemic patients were hypertensive (62.50% vs 40%) and was presented in drowsy state (50% vs 40%) compared to normomagnesemic group. Mortality of hypomagnesemic group was 37.50% while that of hypermagnesemic group was 25%. In hospital, arrythmia (18.75%) and convulsion (12.50%) developed in hypomagnesemic groups. Mean duration of length of stay in HDU was 7.45 days in hypomagnesemic, 6.83 days normomagnesemic, and 8.67 days in hypermagnesemic group.</p><p><strong>Conclusion: </strong>Development of magnesium imbalance in critically ill patients is associated with bad prognosis. Monitoring of serum magnesium levels may have prognostic, perhaps therapeutic implication.</p><p>Bangladesh J Medicine Jul 2018; 29(2) : 69-74</p> Tasnuva Saiful Mamun Mostafi Md Abdul Ali Mia Md Robed Amin Syeda Marzana Emran Hossain ##submission.copyrightStatement## 2018-08-18 2018-08-18 29 2 69 74 10.3329/bjmed.v29i2.37941 Obesity – A global Burden, Crucial Problem for the Society <p><strong>Objectives</strong>: To aware doctors, patients, food producers and consumers.</p><p><strong>Data source</strong>: Online search via Google, 70 articles were down loaded, 52 valid papers were selected. Only 12 full text articles were eligible for review. Obesity rates have increased sharply over the past 30 years, creating a global public health crisis. The impact of obesity on morbidity, mortality, and health care costs is profound. Obesity and weight related complications exert a huge burden on patient suffering and social costs. In recent years, exciting advances have occurred in all 3 modalities used to treat obesity: lifestyle intervention, pharmacotherapy, and weight-loss procedures including bariatric surgery. Obese individuals lose approximately 6 to 8 kg (approximately 6% to 8% of initial weight) with 6 months of participation in a high-intensity lifestyle intervention ($ 14 treatment visits) consisting of diet, physical activity, and behavior therapy. Such losses reduce progression to type 2 diabetes in at-risk people and decrease blood pressure and triglyceride levels. All diets, regardless of macronutrient composition, can produce clinically meaningful weight loss (.5%) if they induce a deficit of 500 kcal/d. Physical activity of 150 to 180 min/week yields modest short-term weight loss compared with diet but contributes to improvements in obesity-related conditions. Gradual weight regain is common after lifestyle intervention but can be prevented by continued participation in monthly weight loss maintenance sessions, as well as by high levels of physical activity (ie, 200 to 300min/wk). Patients unable to reduce satisfactorily with lifestyle intervention may be candidates for pharmacotherapy, recommended as an adjunct. Five medications have been approved by the US Food and Drug Administration for chronic weight management, and each has its own risk/benefit profile. The addition of these medications to lifestyle intervention increases mean weight loss by 2.5 to 8.9 kg compared with placebo. Patients with severe obesity who are unable to reduce successfully with lifestyle intervention and pharmacotherapy are eligible for bariatric surgery, including Roux-en-Y gastric bypass, sleeve gastrectomy, or adjustable gastric banding.</p><p>Bangladesh J Medicine Jul 2018; 29(2) : 75-83</p> Quazi Tarikul Islam Ishrat Binte Reza ##submission.copyrightStatement## 2018-08-18 2018-08-18 29 2 75 83 10.3329/bjmed.v29i2.37942 Rickets Due to Distal Renal Tubular Acidosis– an Uncommon Presentation of Wilson’s Disease <p>Rickets is a disease of bone mineralization of growth plate. Refractory rickets can be caused by distal (type 1) renal tubular acidosis (RTA). A number of conditions can result in distal RTA and Wilson’s disease is an uncommon entity. Wilson’s disease is a rare autosomal recessive disorder of copper metabolism with diverse presentations. We describe a case of refractory rickets due to distal RTA, caused by Wilson’s disease. Diagnosis of Wilson’s disease was confirmed with presence of Kayser–Fleischer (K–F) rings and high urinary copper. Further investigations revealed urinary acidification defect with hypercalciuria pointing towards distal RTA. He was treated with penicillamine &amp; oral Zinc and significant clinical improvement was observed.</p><p>Bangladesh J Medicine Jul 2018; 29(2) : 84-86</p> Md Abul Kalam Azad Afroja Alam Shaheen Lipika Quayum AFM Azim Anwar Monjila Anjum ##submission.copyrightStatement## 2018-08-18 2018-08-18 29 2 84 86 10.3329/bjmed.v29i2.37943 A 17-Year-Old Male with Prostatic Rhabdomyosarcoma <p>Prostatic rhabdomyosarcoma is a common tumour in infancy and childhood but rare in young adults and older people. A 17-year-old boy presented with features of bladder outlet obstruction. On digital rectal examination, a growth was found in the prostate. After performing trans-rectal ultrasound guided biopsy it revealed rhabdomyosarcoma of prostate which was locally advanced, involving bladder pelvic nodes. Neoadjuvant chemotherapy with ifosfomide and doxorubicin was given for 6 cycles. However, it was still inoperable and therefore, pelvic radiotherapy was started improving the local control.</p><p>Bangladesh J Medicine Jul 2018; 29(2) : 87-90</p> Rukhshana Rabbani Mst Rokaya Sultana Kazi Iftekhar Uddin Ahmed Mahmudul Hasan Abul Hasanat Muhammad Afzalul Haque Shamima Akhter Nahid Yeasmin ##submission.copyrightStatement## 2018-08-18 2018-08-18 29 2 87 90 10.3329/bjmed.v29i2.37944 DRESS Syndrome- A Rare Condition <p>DRESS syndrome <strong>(</strong>Drug reaction with Eosinophilia and Systemic Symptoms) is a rare but potentially life-threatening drug hypersensitivity reaction characterized by fever, exfoliative dermatitis and maculopapular rash, lymphadenopathy, eosinophilia, leucocytosis, and involvement of internal organs as liver, lung, heart, and kidney. The disorder starts within 2–8 weeks after taking an offending drug. Long latency between drug treatment and onset of symptoms along with variability of presentation make the diagnosis quite difficult. Here, we are presenting a case report of 58 year old male presented with short history of high grade fever with extensive skin rash. Investigations revealed leucocytosis with gross eosinophilia. He gave history of taking carbamazepine for more than last 3 months prescribed by his neurologist. According to the RegiSCAR scoring system, our case could be classified as definite DRESS syndrome. After withdrawal of the offending drug carbamazepine and starting high dose of systemic corticosteroid, he improved dramatically. As this syndrome is quite uncommon, so we are reporting this case.</p><p>Bangladesh J Medicine Jul 2018; 29(2) : 91-93</p> Homayra Tahseen Hossain Quazi Tarikul Islam Ishrat Binte Reza Tasmina Chowdhury Md Maksudul Mazumder HAM Nazmul Ahasan ##submission.copyrightStatement## 2018-08-18 2018-08-18 29 2 91 93 10.3329/bjmed.v29i2.37945 Septicaemic Melioidosis Complicated by Septic Arthritis in A Bangladeshi male: A Case Report <p>Melioidosis is an uncommon disease in Bangladesh but in recent years increasing numbers of cases are being diagnosed. A case of septicaemic melioidosis occurring in a young Bangladeshi returning worker is reported here. The patient presented with fever and features of septic arthritis. Diagnostic work-up revealed the growth of Burkholderia pseudomallei from blood and synovial fluid cultures. This case highlights the importance of high index of clinical suspicion for melioidosis in appropriate clinical scenario.</p><p>Bangladesh J Medicine Jul 2018; 29(2) : 94-96</p> Hasna Fahmima Haque Suchismita Debnath Samira Rahat Afroze Farhana Afroz Muhammad Abdur Rahim AKM Musa ##submission.copyrightStatement## 2018-08-18 2018-08-18 29 2 94 96 10.3329/bjmed.v29i2.37946 Forensic Medicine Plays a Vital Role in Our Justice System <p>Abstract not available</p><p>Bangladesh J Medicine Jul 2018; 29(2) : 97</p> Ahmad Sadek ##submission.copyrightStatement## 2018-08-18 2018-08-18 29 2 97 97 10.3329/bjmed.v29i2.37947 A Case of Skin Laxity <p>Abstract not available</p><p>Bangladesh J Medicine Jul 2018; 29(2) : 98</p> Mohammad Rafiqul Islam Mohammad Robed Amin ##submission.copyrightStatement## 2018-08-18 2018-08-18 29 2 98 98 10.3329/bjmed.v29i2.37948