Bangladesh Journal of Medicine Published by Association of Physicians of Bangladesh. Association of Physicians of Bangladesh en-US Bangladesh Journal of Medicine 1023-1986 Autism Spectrum Disorder <p>Abstract not available</p> <p>Bangladesh J Medicine Jan 2019; 30(1) : 1-3</p> Iffat Ara Shamsad ##submission.copyrightStatement## 2019-01-22 2019-01-22 30 1 1 3 10.3329/bjmed.v30i1.39915 Endoscopic Retrograde Cholangiopancreatography Findings Differs From Ultrasound Results: A Study On Choledocholitihisis Patients In A Tertiary Care Hospital Of Bangladesh <p><strong>Background</strong>: Endoscopic retrograde cholangio-pancreatography (ERCP) is a universally established modality in evaluation and treatment of pancreatico-biliary disorders. Choledocholothiasis is one of its common indications. In the context of Bangladesh, clinical studies on ERCP, specially, assessment of the role of pre-procedural Ultrasound as a screening tool, is relatively rare. In this work, we have analyzed the ERCP outcome of 95 patients and compared their pre-procedural ultrasound results afterwards.</p> <p><strong>Methods</strong>: This cross-sectional observational study was conducted in the BIRDEM General Hospital during June 2013 to January2015 on 95 ERCP patients. Among 95 patients, maximum (27.7%) were diagnosed as Choledocholithiasis. The important diagnosis among the rest were, Chronic Calcific Pancreatitis (13.8%), Ca head of Pancreas (12.7%), Cholangiocarcinoma (11.7%), and peri- ampullary carcinoma (11.7%). Ultrasound could not detect common bile duct stone in 42% of choledocholithiasis patients. It detected dilated common bile duct in 30% patients and 15% patients had normal ultrasound report while they underwent ERCP due to high clinical suspicion and found to have duct stone afterwards.</p> <p><strong>Conclusion</strong>: The role of ultrasound as a screening test for choledocholithiasis should be progressively assessed by comparing it with MRCP and ERCP results. This study will encourage further research to find correlation between the ERCP and Imaging (both ultrasound and MRCP) in choledocholithiasis patients</p> <p>Bangladesh J Medicine Jan 2019; 30(1) : 5-8</p> Tareq Mahmud Bhiuyan Mousumi Sanyal Sabrina Yesmin S ##submission.copyrightStatement## 2019-01-22 2019-01-22 30 1 5 8 10.3329/bjmed.v30i1.39916 Role of ascitic fluid study in early detection of spontaneous bacterial peritonitis in asymptomatic patients of cirrhosis of liver <p>Spontaneous bacterial peritonitis (SBP)is an acute bacterial infection of ascitic fluid and one of the commonest complication of patients with cirrhosis presented with ascitis. Routine analysis of ascetic fluid particularly for polymorphonuclear leukocyte is an important tool for detecting spontaneous bacterial peritonitis including clinically unsuspected and asymptomatic patients also. Thus it helps in reducing mortality and morbidity by early and effective detection of spontaneous bacterial peritonitis. <strong>Objective</strong>: This study was carried out to evaluate the role of ascitic fluid analysis in early detection of spontaneous bacterial peritonitis and to document the proportion of spontaneous bacterial peritonitis present asymptomatically.</p> <p><strong>Study design</strong>: This was a cross sectional observational study prospective in nature on 50 cases of diagnosed chronic liver disease patients in indoor of department of medicine of Sir Salimullah medical college Hospital, Dhaka from 02/01/13 to 01/07/13, for a period of 6 months.</p> <p><strong>Result</strong>: The study showed that age frequency 5(10%) were from 21-30 years, 15(30%) were from 31- 40 years, 15(30%) were from 40 -50years and 15(30%) were from &gt;50 years of age. Out of 50 patients, 38(76%) were male and 12(24%) were female patients. The etiology of liver cirrhosis was hepatitis B virus in 22(44%), hepatitis C virus in 4(8%), alcohol in 1 (2%) and others in 23(46%) patients. Among 50 patients, 16(32%) were spontaneous bacterial peritonitis and 34(68%) were non spontaneous bacterial peritonitis. The symptoms of spontaneous bacterial peritonitis were upper GI bleeding in 8 patients (50%), fever in 12 patients (75%), abdominal pain in 10 patients (62.5%), abdominal tenderness in 7 patients (43.75%), hepatic encephalopathy in 9 patients (56.25%), jaundice in 10 patients (62.50%), splenomegaly in 16 patients (100%), ascites in 16 patients (100%) and 5 (10%) patients were asymptomatic spontaneous bacterial peritonitis. According to Child Pugh’s, 2(12.5%) patients were at stage-A, 5 (31.25%) patients were at stage-B and 9 (56.25%) patients were at stage- C. Ascitic fluid characteristics (mean +SD) of all patients were, Total cell counts/mm3 (571+499.9), Neutrophil counts/mm<sup>3</sup> (144.8+445.1), Sugar (112+38.19) mg/dl, Protein (1.85+1.09). Among SBP patients, 7 (43.75%) have PMN cell counts 250-750/mm<sup>3</sup>, 6 (37.50%) have 750-1750/mm<sup>3</sup> and 3 (18.75%) have &gt;1750/mm<sup>3</sup>.</p> <p><strong>Conclusion:</strong> Spontaneous bacterial peritonitis is a common complication of decompensated cirrhotic patients. The classical signs of SBP (e.g. abdominal tenderness or fever) may not be present. We observed the trend towards more frequent occurrence of the infection in patients suffered from severe liver disease (e.g. Child Pugh’s –C) and the role of ascitic fluid analysis is statically significant.</p> <p>Bangladesh J Medicine Jan 2019; 30(1) : 9-18</p> Md Asadul Kabir Md Maniruzzaman Sarkar Kazi Bodruddoza Anwarul Bari Jewel Chowdhury ##submission.copyrightStatement## 2019-01-22 2019-01-22 30 1 9 18 10.3329/bjmed.v30i1.39917 Perceptions of Physicians and Allied Health Care Workers of Pharmacists’ Role In Care Optimization for Schizophrenic Patients At Federal Neuro-Psychiatric Hospital Maiduguri, North-Eastern Nigeria <p><strong>Introduction</strong>: In clinical practice, it is required that a profession not only clearly describe their own roles and responsibilities to other professionals but should also be aware of other professions’ roles in relation to their own. The objective of this study was to assess the perceptions of physicians and allied health care workers (Other health care professionals) of the roles of pharmacists in optimizing care for schizophrenic patients.</p> <p><strong>Methods</strong>: A self-administered 17-item validated questionnaire was distributed to 120 health care professionals working at Federal Neuro-Psychiatric Hospital Maiduguri from September to October 2016. Results obtained were analysed using Chi-square test.</p> <p><strong>Results</strong>: Health care professionals mostly had positive perceptions with a statistically significant difference (P&lt; 0.05) across all assessed items. However, competent and knowledge of the pharmacists accounting for 93 (83.8%), involvement of the pharmacist in patient care accounting for 91(82%) and reassuring patients to improve quality of life accounting for 98(88.3%) had the highest number of health care professionals with positive perceptions while documenting patient care, monitoring and reemphasizing physicians instructions had the lowest accounting for 69 (62.2%), 74(66.7%) and 74 (66.7%) respectively in the different sections.</p> <p><strong>Conclusions:</strong> The health care professionals surveyed mostly had positive perceptions. Thus, pharmacists can leverage on this to meet their roles in optimizing care for schizophrenic patients.</p> <p>Bangladesh J Medicine Jan 2019; 30(1) : 19-23</p> H Yusuf A Giwa S Mohammed SN Aguye Abdu FM Dungus A Sani F Ashemi ##submission.copyrightStatement## 2019-01-22 2019-01-22 30 1 19 23 10.3329/bjmed.v30i1.39918 Detection of Clinically Relevant Copy Number Variation of SEZ6L2 Gene in a Bangladeshi Autism Spectrum Disorder Cohort <p><strong>Introduction</strong>: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder. Due to long term impairment, high genetic component (heritability&gt; 90%), lack of effective prevention and treatment, ASD has been prioritized for genetic studies. Studies on Copy Number Variations (CNV) at chromosome 16p11.2 locus have mostly been conducted in population of pure or predominant European ancestry. It is not known whether this is also prevalent among the ASD affected individuals in population of other ancestries such as Bangladeshi population. The aim of this research work is to detect CNV of SEZ6L2 gene at 16p11.2 locus and to describe the associated clinical characteristics in Bangladeshi cohort with clinically diagnosed ASD.</p> <p><strong>Methods</strong>: The known SEZ6L2 gene was interrogated for copy number variation (CNV) in twenty five autistic patients with SYBR Green I assay using the real time qPCR. Probands were interrogated using relative standard curve (efficiency correction) method. Epilepsy with speech disorder and postnatal infection might be more common among autistic patients with CNV at this SEZ6L2 gene.</p> <p><strong>Results</strong>: The two cases with characteristics CNV was detected who had clinically manifestation of convulsion at different ages, partial developmental delay in multiple domains including delay in walking, speech delay and mental age not corresponding with the chronological age. This work describes the frequency of CNV is 8.3 %. This rate is skewed due to small sample size and do not reflect the true frequency of 16p11.2 duplication impacting SEZ6L2 gene.</p> <p><strong>Conclusion</strong>: Epilepsy with speech disorder and postnatal infection might be more common among autistic patients with CNV at this SEZ6L2 gene.</p> <p>Bangladesh J Medicine Jan 2019; 30(1) : 24-29</p> KM Furkan Uddin Md Robed Amin Nasima Sultana Md Abdul Aleem Suprovath Kumar Sarker Laila Anjuman Banu Mohammad Shaheb Ali Wahida Khanam Narsis Rahman Md Abdul Baqui Hosneara Akter Nushrat Jahan Dity Md AB Ziauddin Hossain ##submission.copyrightStatement## 2019-01-22 2019-01-22 30 1 24 29 10.3329/bjmed.v30i1.39919 Precipitating Factors Contributing Severe Hypoglycemia among Type-2 Diabetic Patients Admitted in a Tertiary Care Hospital of Bangladesh <p><strong>Background</strong>: Hypoglycemia is the commonest acute emergency in the diabetic population. This study intends to find out the factors precipitating severe hypoglycemia in type-2 diabetes patients admitted in a tertiary care hospital in Bangladesh.</p> <p><strong>Methods</strong>: This cross-sectional study was conducted among 311 diabetic patients admitted in BIRDEM general hospital with hypoglycemia (plasma glucose concentration of &lt;70mg/dl or 3.9mmol/l) with or without altered level of consciousness or neurological recovery of the patient occur after normalization of blood sugar , from a period of March 2014 to April 2015. After obtaining informed written consent a questionnaire focusing on the probable factors of severe hypoglycemia was supplied to the subjects or attendants at bedside. Relevant reports were collected from record book.</p> <p><strong>Results</strong>: Mean age of the study respondents was 49.02(±15.99) years which ranged from 18 to 90 years with male predominance (59%). Mean duration of diabetes was 8.5(±5.4) years with range from 3 to 15 years. Majority (85.5%) had more than 6.5% of HbA1c. Severe hypoglycemia was revealed mostly (61.41%) in insulin users. Among them 74(33.5%) and 79(35.7%) patients were using premixed and self mixed regimes respectively. Factors causing severe hypoglycemia were assessed by multivariate analysis. Significant association was found in meal related factors (p&lt;0.001)(missed meal, delayed or inadequate meal), insulin related factors (p&lt;0.001) (Newer dose, miscalculation, faulty technique, defective absorption). Other factors were renal impairment (p&lt;0.001), gastroparesis (p&lt;0.01) and aging (p =0.04).</p> <p><strong>Conclusion</strong>: Lifestyle factors are the most important precipitating causes of hypoglycemia. Therefore, appropriate diabetic education including self adjustment and periodic re-evaluation of patient’s knowledge, attitude and practice towards hypoglycemia is of utmost importance to prevent this common but life-threatening complication.</p> <p>Bangladesh J Medicine Jan 2019; 30(1) : 30-34</p> Rushda Sarmin Binte Rouf Md Faruque Pathan ##submission.copyrightStatement## 2019-01-22 2019-01-22 30 1 30 34 10.3329/bjmed.v30i1.39920 Arteriovenous Fistula After Cerebral Venous Sinus Thrombosis <p>Thrombosis of the deep cerebral vein is a rare entity. Thrombosis of cerebral veins or dural sinus obstructs blood drainage from brain tissue, leading to cerebral parenchymal dysfunction and increased venous and capillary pressure with disruption of the blood-brain barrier. Many conditions are associated with cerebral venous sinus thrombosis. Prothrombotic conditions, malignancy, infection and head injury has been reported as risk factors for cerebral venous sinus thrombosis (CVST). Neuroimaging features of CVST include focal areas of oedema or venous infarction, hemorrhagic venous infarction, diffuse brain edema or rarely subarachnoid haemorrhage. Magnetic resonance imaging of the brain in combination with magnetic resonance venography is the most informative technique in demonstrating the presence of dural thrombus and cortical vein thrombosis.</p> <p>Bangladesh J Medicine Jan 2019; 30(1) : 35-37</p> Low Qin Jian Cheo Seng Wee ##submission.copyrightStatement## 2019-01-22 2019-01-22 30 1 35 37 10.3329/bjmed.v30i1.39921 Dengue Fever with pulmonary alveolar hemorrhage - Common infection with uncommon association - rare case report <p>Dengue fever (DF) is major health hazard around the world in recent decades especially in India. Flu like illness to polyserositis among common presentation of DF. Dengue fever presenting as pulmonary hemorrhage is rare. Here we present a case of 16 -year young male patient presented with fever and shortness of breath, initially diagnosed as dengue fever by serological examination. CT chest findings mimiking as pneumonia ,however further fall in hemoglobin and progressive dysnoea, bronchoscopy and bronchial wash cytology done which reveal association of pulmonary hemorrhage. This case report alerted clinicians about rare presentation and high index of suspicion of pulmonary hemorrhage in DF with dysnoea for early diagnosis and to avoid its fatal outcome.</p> <p>Bangladesh J Medicine Jan 2019; 30(1) : 38-40</p> B Saroj Kumar Prusty Majed Abdul Basit Momin ##submission.copyrightStatement## 2019-01-22 2019-01-22 30 1 38 40 10.3329/bjmed.v30i1.39922 A Patient with Intermediate Syndrome with Toxic Encephalopathy Following Organophosphate Poisoning <p>OP poisoning is the common cause of mortality and morbidity in Bangladesh. Although acute cholinergic crisis is the common form of presentation of such cases, the intermediate syndrome and delayed encephalopathy can be also presented in op compound. A 14 year old adolescent presented with acute onset of intermediate syndrome and simultaneous early encephalopathy after ingestion of combination of Chlorpyrifos with Cypermithrin known popularly as market name of ‘Mortar’. The patient was provided supportive care and few days of ICU care with complete recovery. The interesting feature of the case was absence of cholinergic crisis and hence patient was not treated with atropine or pralidoxime.The simultaneous combination of presenting features, prolonged coma and even on absence of specific antidote complete recovery was the highlighting points of this unique case.</p> <p>Bangladesh J Medicine Jan 2019; 30(1) : 41-43</p> Mohiuddin Sharif Muktadir Bhuiyan Rajib Roy Mahfuzul Haque Md Robed Amin ##submission.copyrightStatement## 2019-01-22 2019-01-22 30 1 41 43 10.3329/bjmed.v30i1.39923 Affordable and high-quality outpatient adult medical care <p>In low- and middle-income countries (LMIC) like Bangladesh, hospitalization-requiring care for all is usually adequately provided by public institutions for poorer, and private hospitals for wealthier citizens. In contrast, outpatient medical care and pharmaceuticals require out-of-pocket payments by patients. How to provide such services which are affordable and of effectively high-quality, has been difficult to define. With increasing non-communicable disease (NCD) case-burdens in cancer and cardiovascular diseases in LMIC/Bangladesh, addressing these service challenges is becoming more urgent. We have been working to provide medical care for women with breast problems and have identified in this setting the following components as critical to meeting this affordability/quality challenge: 1. Maximal use of information technology tools; 2. Increased paraprofessional staffing; 3. Diagnostic pathways and care guidelines which are evidence-based.; 4. Increased point-of-care diagnostic services; and 5. Implementational research. While broad societal issues of poverty, human rights, governance, and education strongly influence the quality of medical care, local systemic solutions are needed if the 2030 WHO Sustainable Development Goal of lowering morbidity and mortality from NCDs by one third, is to be met.</p> <p>Bangladesh J Medicine Jan 2019; 30(1) : 44-49</p> Richard R Love Reza Salim ##submission.copyrightStatement## 2019-01-22 2019-01-22 30 1 44 49 10.3329/bjmed.v30i1.39924 A middle age lady with Fever and Productive cough <p>Abstract not available</p> <p>Bangladesh J Medicine Jan 2019; 30(1) : 50</p> AHM Thafikul Mazid Md Robed Amin ##submission.copyrightStatement## 2019-01-22 2019-01-22 30 1 50 50 10.3329/bjmed.v30i1.39925