Bangladesh Journal of Medicine <p>Published by Association of Physicians of Bangladesh.</p> <p>The Bangladesh Journal of Medicine (BJM),the offcial journal of Association of physicians of Bangladesh is apeer review journal.It is published twice in ayear (Jan and July).It accepts&nbsp; original research, reviews, case reports, clinical images , comments to editor or correspondence on a variety of &nbsp;Medicine related topics.Full text articles are available online. It is indexed in BM&amp;DC, Banglajol, Asiajol, Crossref,Alsofia Science, Infobase index. </p> Association of Physicians of Bangladesh en-US Bangladesh Journal of Medicine 1023-1986 Undergraduate medical education in Bangladesh- Urgency to explore current situation and future direction <p>Abstract not available</p> <p>Bangladesh J Medicine July 2019; 30(2) : 51-52</p> Md Robed Amin Quazi Tarikul Islam ##submission.copyrightStatement## 2019-05-27 2019-05-27 30 2 51 52 10.3329/bjmed.v30i2.41529 Nutritional status of patients with tuberculosis attending at tertiary medical center in Bangladesh <p><strong>Background: </strong>Tuberculosis (TB) is a common communicable disease in Bangladesh. Treatment of TB sometimes depends on nutritional status of the patient. Both in developed and developing countries TB has been found to coexist with malnutrition among patients at the beginning of treatment. So it would be very important to evaluate the nutritional assessment of a patient before starting treatment. If malnutrition exists in a patient of TB than nutrition supplementation can play an important role in improving the disease condition to reduce further morbidity and mortality.</p> <p><strong>Method:</strong>It was a descriptive study, conducted on eighty-seven adult TB participant attending at medicine department, Bangabandhu Sheikh Mujib Medical University (BSMMU), where nutritional status (Body-Mass Index or BMI) was measured by keeping records of patient’s height in meters and weight in kilogram.</p> <p><strong>Result: </strong>A total 87 participants were included in this study where 45 (52 percent) were males and 42 (48 percent) were females. Most of the participants were healthy 56 percent (n=49) participants. However, under-nutrition was present in 36 percent (n=31) participants and over-nutrition were only 8 percent (n=7). Most of the participant takes more than three meals 54 percent (n=47) participants. However, three meals were taken by 45 percent (n=39) participants and two meals were taken only 1 percent (n=1).</p> <p><strong>Conclusion: </strong>In this study almost 36% participants of tuberculosis were in under-nutrition. So Nutrition supplementation could be needed in improving the disease condition to reduce further morbidity and mortality. On the other hand large scale study should be needed for taking proper steps to know the overall situation of the country.</p> <p>Bangladesh J Medicine July 2019; 30(2) : 53-57</p> Mohammad Ferdous Ur Rahaman Jannatara Shefa Manos Kumar Mandal Md Rafiqul Alam ##submission.copyrightStatement## 2019-05-27 2019-05-27 30 2 53 57 10.3329/bjmed.v30i2.41530 Biochemical Scoring System For Diagnosing Nonalcoholic steatohepatitis <p><strong>Background: </strong>Nonalcoholic fatty liver disease (NAFLD) encompasses a spectrum of conditions ranging from simple steatosis to steatohepatitis, advanced fibrosis, and end stage liver disease. Despite the high prevalence and severity of hepatic illness, NAFLD remains underdiagnosed, because of few symptoms, lack of accurate laboratory markers. <strong>Objective: </strong>To evaluate a biochemical score for diagnosing non-alcoholic steatohepatitis.</p> <p><strong>Methods: </strong>An observational, cross sectional study was carried out for a period of two years in the Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. 43 patients of Non-alcoholic fatty liver disease (NAFLD) attending at department of Hepatology were selected and underwent for biochemical investigations and liver biopsy with NAFLD Activity Score (NAS).</p> <p><strong>Results: </strong>A biochemical score (TAAG score) assigned 1 point for each parameter (fasting serum triglyceride &gt;ULN, alanine aminotransferase &gt;ULN, AST/ALT ratio (AAR) ≤1 and gamma-glutamyl transferase &gt;ULN) was evaluated. TAAG score ≥3 was present in 32.5% of study population and 40% of NASH patients. It had a sensitivity of 40%, specificity 26% and AUROC 0.54.</p> <p><strong>Conclusion: </strong>Biochemical scoring system comprising traditional biomarkers did not significantly predict NASH. Biopsy is the only way to estimate steatohepatitis and/or fibrosis.</p> <p>Bangladesh J Medicine July 2019; 30(2) : 58-62</p> Sheikh Mohammad Noor E Alam Shahinul Alam Dulal Chandra Das Mamun Al Mahtab ##submission.copyrightStatement## 2019-05-27 2019-05-27 30 2 58 62 10.3329/bjmed.v30i2.41531 Comparison of Effectiveness between DPP4 inhibitors combined with Versus Other Oral Hypoglycaemic Agent(s) in Diabetic patients <p><strong>Background: </strong>Diabetes is global health burden of disease that requires life-long pharmacological and non-pharmacological management to prevent complications such as cardiovascular disease, retinopathy, nephropathy, and neuropathy. Treatment of type 2 diabetes is based on an interplay of patient characteristics, severity of hyperglycemia and available therapeutic options. Metformin, sulfonylureas (SU) and DPP IV inhibitor are the most studied of the oral medications used worldwide. They play a prominent initial role in the type 2 diabetes treatment algorithm recommended by the several guideline. The growing evidence on new technologies and therapeutic interventions is rapidly expanding our knowledge and ability to manage diabetes and its complications; at the same time, however, it is challenge for physicians to select appropriate medication in appropriate dose for optimal patients care.</p> <p><strong>Objectives: </strong>To compare the safety and efficacy of the dipeptidylpeptidase-4 (DPP-4) inhibitors combination with other oral hypoglycaemic agent(s) in patients with type 2 diabetes and inadequate glycemic control.</p> <p><strong>Materials &amp; method: </strong>Study was conducted among 600 patients over a period of 24 months. All the patients were adult male and female type 2 diabetic patients who received regular oral anti-diabetic drug(s) and duration of T2DM for one year or more were enrolled for study. Total 150 cases were selected. Patients with Type 1 DM, pregnant women with DM and who was receiving injectable antidiabetic medications were excluded from this study. Detail demographic data were collected from the informant and recorded in structured case report form. Clinical examination and relevant investigations were done. Main outcome variable was Glycemic status (HbA1C, FBG, 2HABF). Effectiveness of drugs was evaluated by glycaemic status of the patients.</p> <p><strong>Result: </strong>Maximum number of patients (38.5%) was between 31-40 years age group with mean age 37.8±9.5 years. Present study shows that, for good glycemic control, all three results (FBS, 2H ABF and HbA1c) were within targeted level in majority patients of DPP4 Inhibitor combination group. Although FBS was best result in metformin group. About 51.9% of SUs group achieved the glycemic control targets level. In case of metformin group it was in 59.8% of patients, and in combined therapy 67.1% patients shows good glycemic target. So DPP4 Inhibitor combination is better medication than other to maintain good glycemic status in type 2 DM patient, due to maximum number of patients reached all three components of result within target range.</p> <p><strong>Conclusion: </strong>Diabetes is chronic illness. Good glycemic control with choosing appropriate anti-diabetic medication is pivotal for DM management. In this study it is observed that DPP4 Inhibitor combination group of drug is better than other anti-diabetic medication to maintain good glycemic status in type 2 DM patients.</p> <p>Bangladesh J Medicine July 2019; 30(2) : 63-70</p> Md Shameem Haidar ##submission.copyrightStatement## 2019-05-27 2019-05-27 30 2 63 70 10.3329/bjmed.v30i2.41532 A Meta-Analysis of the Prevalence of Clinical Manifestations of Chikungunya Virus Disease in Bangladesh <p><strong>Background: </strong>Chikungunya is known as a mosquito-borne viral disease. It is transmitted to the human body by infected mosquitoes and caused different symptoms. The main aim of this study was to investigate the percentage of Chikungunya virus disease (CHIKV) patients who would had different clinical features at the acute or sub-acute stage of this disease in Bangladesh.</p> <p><strong>Methodology: </strong>In this meta-analysis, PubMed Central and BanglaJOL had been searched. Total 8 eligible studies had been selected for quantitative analysis. The pooled prevalence (PP) was used as effect measure to find the number of patients who would had different symptoms at acute or subacute stage of CHIKV disease. The pooled prevalence and 95% confidence interval (CI) had been calculated using random effects model. To measure the presence of heterogeneity Cochran chi-square test was used and I<sup>2</sup> was used to quantify the heterogeneity.</p> <p><strong>Result: </strong>This meta-analysis indicated significant association between CHIKV disease patients and fever was [PP: 0.99; p-value = 0.00], joint pain [PP: 0.95, p-value = 0.00], rash [PP: 0.55, p-value = 0.00], joint swelling [PP: 0.38, p-value = 0.001], headache [PP: 0.48, p-value = 0.007], pruritus [PP: 0.37, p-value = 0.001], myalgia [PP: 0.62, p-value = 0.00], co-morbidity [PP: 0.56, p-value = 0.001] at the acute stage of the disease and joint pain persists &gt; 1 month [PP: 0.50, p-value = 0.001] at the subacute stage of this disease.</p> <p><strong>Conclusion: </strong>In this meta-analysis ever, joint pain were found as most frequently occurred symptoms at the acute stage of CHIKV disease.</p> <p>Bangladesh J Medicine July 2019; 30(2) : 71-77</p> Farha Musharrat Noor Md Belal Hossain Quazi Tarikul Islam ##submission.copyrightStatement## 2019-05-27 2019-05-27 30 2 71 77 10.3329/bjmed.v30i2.41533 Risk of Hepatitis B and Hepatitis C Among Whole Blood Transfused Chronic Hemodialysed Chronic Kidney Disease (CKD) Patients <p><strong>Background: </strong>Patients with chronic renal failure on maintenance hemodialysis (MHD) have high risks of viral infections and the prevalence of transfusion transmissible viral infection is common among them. The aim of our study was to detect hepatitis B and hepatitis C virus in hemodialysis patients and healthy donors and to explore if there was a relationship between duration of hemodialysis and hepatitis B and hepatitis C in our patients.</p> <p><strong>Methodology</strong>: A cross sectional study was conducted in a private hemodialysis clinic in Dhaka city with end stage renal disease on maintenance hemodialysis and an age matched healthy donors as comparable group from July 2015 to June 2016. Serum alanine aminotransferase (ALT), serum aspartate aminotransferase (AST), HBsAg and anti HCV were determined along with duration and units of blood transfusion needed by them.</p> <p><strong>Results: </strong>Our study showed the mean age of 126 MHD patients were 42.2±11.7 years along with 132 healthy donors as control group had mean age 39.2±9.7 years. Among the hemodialysis patients 34 (26.98%) showed transfusion transmitted infection positivity and in control group 11 (8.33%) showed transfusion transmitted infection positivity with the difference between two study group showed statistical significance (p&lt;o.oo1). History of blood transfusion showed the significant predictor of occurrence of TTV infection in hemodialysis patients (p&lt;0.01). Duration of hemodialysis and seropositivity of TTI was not significant (p&gt;0.05). The number of units of blood transfusion and the TTI positivity also showed no significant difference (p&gt;0.05) with HBsAg (17.46%) and anti HCV (9.52%).</p> <p><strong>Conclusions: </strong>The prevalence of TTI in hemodialysis patients is significantly higher than that in healthy individuals. So, the regular screening of HBV and HCV among patients and healthy donors are strictly provided to monitor the communicable disease.</p> <p>Bangladesh J Medicine July 2019; 30(2) : 78-82</p> Md Abdul Quader Khan Anisul Islam Tashmim Farhana Dipta Md Ashadul Islam ##submission.copyrightStatement## 2019-05-27 2019-05-27 30 2 78 82 10.3329/bjmed.v30i2.41534 Dilemma in laboratory diagnosis of Dengue, Chikungunya and Zika viruses <p>Dengue, Chikungunya and Zika are the vector-borne diseases that constitute a potential epidemiological risk due to the recent increase in cases, complications, and severity. The co-circulation of the three diseases is a matter of public health interest due to their transmission by the same vector as well as the increase in the number of cases of severe dengue hemorrhagic fever, post-chikungunya chronic joint disease and microcephaly related to Zika virus. Therefore, it is important to be familiar with the various clinical presentations and laboratory methods to make the differential diagnosis, start appropriate treatment, and prevent the associated complications.</p> <p>Bangladesh J Medicine July 2019; 30(2) : 83-92</p> Mushtaque Ahmed Nabeela Mahboob Kazi Taib Mamun Hasina Iqbal ##submission.copyrightStatement## 2019-05-27 2019-05-27 30 2 83 92 10.3329/bjmed.v30i2.41535 A Rare and Fatal Complication of a Self-Limiting Infection: A Case Report on Dengue Associated Hemophagocytic Lymphohistiocytosis <p>Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening medical condition characterized by hyperphagocytosis secondary to an inappropriate over-activation of macrophages and lymphocytes that driven by excessive cytokines production which resulted in cellular destructions. It can arise de novo as a result of an autosomal recessive genetic disorder, or in the background of an infection, malignancy or autoimmune disease. Dengue fever is one of the uncommon causes of infection related secondary HLH. Here, we present a case of a Dengue associated HLH which was successfully treated with intravenous methylprednisolone and immunoglobulin G. In conclusion, the purpose of this case report is to illustrate the importance of early recognition and prompt initiation of the appropriate treatment for HLH suspected patient whom otherwise has high mortality rate.</p> <p>Bangladesh J Medicine July 2019; 30(2) : 93-95</p> Alvin Oliver Payus Cheong Lei Wah Syahrul Sazliyana Shaharir ##submission.copyrightStatement## 2019-05-27 2019-05-27 30 2 93 95 10.3329/bjmed.v30i2.41536 Two Siblings with Different Presentation of Melas <p>Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) is a rare disease. It is a maternally inherited multisystem disorder caused by mutations of the mitochondrial DNA. MELAS usually occur during childhood period after a normal early development. Commonly, the patients will have a relapsing and remitting course of illness with stroke like episodes and seizures. It will subsequently lead to progressive neurological dysfunction and memory problems. We would like to present two siblings who presented to us with different age of onset and presentation of their illness.</p> <p>Bangladesh J Medicine July 2019; 30(2) : 96-99</p> Qin Jian Low Siti Baizura Binti Abdul Kadzir Seng Wee Cheo ##submission.copyrightStatement## 2019-05-27 2019-05-27 30 2 96 99 10.3329/bjmed.v30i2.41537 Systemic Lupus Erythematosus (SLE) in a male patient previously diagnosed as Adult Onset Still’s Disease: A Case Report <p>Adult-onset Still’s disease (AOSD) is a rare clinical entity with unknown etiology, characterized by evanescent rash, arthritis, fever, and other systemic presentation. In this case report, we describe a male patient of 50 years, previously diagnosed as a case of Adult onset still’s disease based on Yamaguchi criteria after the exclusion of other potential diagnoses. Later he was admitted into the Medicine department of Chittagong Medical College Hospital where he was found to have serological features of Systemic lupus erythematosus, another very much uncommon autoimmune disorder in male. On several occasion of his past admissions, SLE and RA were excluded meticulously. He initially responded to oral steroids only, recurrence of symptoms led us to work on the underlying etiology further. Coexistence of SLE in a patient with AOSD is not so commonly found. In our case, we notice this interesting phenomenon which was crucial for his management.</p> <p>Bangladesh J Medicine July 2019; 30(2) : 100-103</p> Md Anwar Sayed Suman Chowdhury ##submission.copyrightStatement## 2019-05-27 2019-05-27 30 2 100 103 10.3329/bjmed.v30i2.41538 PRES Associated with Eclampsia: A Case Report <p>The occurrence of posterior reversible encephalopathy syndrome (PRES) in patients with eclampsia is a rare condition. PRES is a reversible syndrome characterized by headache, seizure, altered mentation and loss of vision associated with white matter changes on imaging. The lesions in PRES are thought to be due to vasogenic oedema, predominantly in the posterior cerebral hemispheres. This study reports a 32-year-old pregnant woman who presented with headache, dimness of vision, right sided weakness and seizure. The MRI of her brain showed abnormal signal intensity in the white matter of the occipital and parietal lobes. She was treated successfully with pregnancy termination, anti-hypertensives, anticonvulsants, and supportive care. It is concluded that early diagnosis is important to prevent permanent neurologic damage and mortality.</p> <p>Bangladesh J Medicine July 2019; 30(2) : 104-107</p> Tasmina Choudhury Hironmoy Barman Joysree Saha Quazi Tarikul Islam ##submission.copyrightStatement## 2019-05-27 2019-05-27 30 2 104 107 10.3329/bjmed.v30i2.41539 Diabetic patient presented with tingling and burning limbs- is this always peripheral neuropathy? <p>Abstract not available</p> <p>Bangladesh J Medicine July 2019; 30(2) : 108</p> Md Mahmudur Rahman Siddiqui Dewan Shamsul Asif ##submission.copyrightStatement## 2019-05-27 2019-05-27 30 2 108 108 10.3329/bjmed.v30i2.41540