Bangladesh Journal of Medicine

Evolution of Management of Diabetes Mellitus

Khwaja Nazim Uddin — 2024-01-04

Abstract not available

Bangladesh J Medicine 2024; 35(1): 3-8

Breaking Down the Walls of Osteoporosis: A Call to Action

Rubina Yasmin — 2024-01-04

Abstract not available

Bangladesh J Medicine 2024; 35(1): 1-2

A Personal Journey in Patient Care

HAM Nazmul Ahasan — 2024-01-04

Abstract not available

Bangladesh J Medicine 2024; 35(1): 47

Medical Quiz-1 Vol. 35(1) 2024

AKM Monwarul Islam — 2024-01-04

Abstract not available

Bangladesh J Medicine 2024; 35(1): 48

Medical Quiz-2 Vol. 35(1) 2024

Quazi Tarikul Islam — 2024-01-04

Abstract not available

Bangladesh J Medicine 2024; 35(1): 49

Answer to Medical Quiz - 1 Vol. 35(1) 2024

AKM Monwarul Islam — 2024-01-04

Abstract not available

Bangladesh J Medicine 2024; 35(1): 50

Answer to Medical Quiz - 2 Vol. 35(1) 2024

Quazi Tarikul Islam — 2024-01-04

Abstract not available

Bangladesh J Medicine 2024; 35(1): 51

Risk factors, Clinical presentation and In-hospital Outcome of Acute Myocardial Infarction in Elderly Patients

Nawsabah Noor — 2024-01-04

Background: Coronary artery disease (CAD) is the leading cause of mortality, morbidity in the developed and developing country. Ageing is important risk factor for coronary artery disease. The role of conventional cardiovascular risk factors in older persons is incompletely understood because only fragmentary and inadequate data are available in most instance and manifestations of acute myocardial infarction are generally believed to be atypical in the elderly. The aim of the study was to find out the clinical presentation, common risk factors and In-hospital Outcome of Acute Myocardial Infarction in Elderly Patients.

Methods: An observational study in tertiary level hospital. Study protocol was approved by ethical review committee of Sir Salimullah Medical College & Mitford Hospital, Dhaka. Sample was selected from the population by purposive sampling technique. Detail demographic data were collected from the subject and recorded in structured case report form. Researcher makes contact with patient and patients caregiver, and describe them about study aim-objective, and then informed consent was taken. All collected questionnaire checked very carefully to identify the error in the data. Data processing work were consisting of registration of schedules, editing, coding and computerization, preparation of dummy tables, analysis and matching data.

Result: In this series, the maximum number of patients (57.0%) was between 60-69 years age group, with mean value 67.21 ± 9.05 years. Out of 100 cases (62%) cases were male and (38%) were female (Figure 1). Male – female ratio was 1.63:1. Large numbers of respondents came from urban area (58%). Among the patients the poor class (44%) comprising the major percentage of the myocardial infarction patients. In this study majority (58%) of the patients had sedentary lifestyle before the onset of myocardial infarction. Among all the risk factors hypertension was the most common risk factor, present in 62% cases; next common risk factors were Diabetes mellitus 56%, dyslipidemia 32%, obesity 22%, smoking 40%. In this study majority of patients (56%) presented with shortness of breath as predominant symptoms. Besides typical chest pain others important atypical symptoms were atypical chest pain (31%), upper abdominal pain (18%), giddiness (4%) and confusional state (3%). In this study many of the patients had developed acute LVF (34%), arrhythmia (17%), cardiogenic shock (8%).

Conclusion: We concluded that the manifestations of AMI are more subtle in the elderly, with different risk factors. The elderly subjects are under thrombolysed and have higher complication rate.

Bangladesh J Medicine 2024; 35(1): 9-14

Association of Hypertension with Body Mass Index in northern districts of Bangladesh

Mahfuzer Rahman — 2024-01-04

Background: Body Mass Index is one of the significant determinant associated with many disease process particularly hypertension. There is positive association between Body Mass Index (BMI) and blood pressure (BP). Lowering BMI with weight reduction significantly reduces blood pressure (BP). The main purpose of this study was to find out the association of BMI with hypertension. The aim of the study is to find out any association between BMI and hypertension in a particular area of Bangladesh.

Methods: This is a retrospective study which involves review of written medical records for adults diagnosed with hypertension aged 18 years and above. This study was conducted at hypertension and research centre, Rangpur. A total of 14137 hypertensive patients were included in this study. Hypertension was defined by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). BMI was calculated by a person’s weight in kilograms divided by his height in meters squared.

Results: Majority (42.1%) of hypertensive patients were within 41 to 50 years of age. Among 14137 participants 4.6% were underweight, 46.5% were healthy weight, 38.7% were overweight and 10.2& were obese. The mean values of systolic and diastolic blood pressure were144.9, 145.2, 148.3, 152.7 and 89.8, 90.4, 91.2, 92.8 respectively with increasing BMI.

Conclusion: Increasing BMI increases the risk of HTN.

Bangladesh J Medicine 2024; 35(1): 15-19

Delirium on Admission: Patterns in a Medicine Unit of a Tertiary Care Hospital in Bangladesh

Sanghita Banik Proma — 2024-01-04

Background: Delirium, a complex neuropsychiatric syndrome, poses challenges in clinical settings due to its varied aetiology and under diagnosis. This study aimed to explore the prevalence, demographic characteristics, and contributing factors of delirium as a presenting feature in the population admitted to a tertiary care hospital in Bangladesh. Limited studies on delirium in low- and middle-income countries necessitate a comprehensive investigation to inform healthcare practices in diverse settings.

Methods: A prospective observational study was conducted on 102 patients diagnosed with delirium among a total of 2599 patients admitted to the medicine unit over six months. Delirium was assessed using the Confusion Assessment Method (CAM) score, with demographic variables and comorbidities analyzed.

Results: The study identified a delirium prevalence of 3.8%, with stroke and poisoning as major contributors. Females (56.8%), individuals above 50 years (69.8%), and those with comorbidities (67.6%) exhibited higher susceptibility to delirium. The multifactorial aetiology included stroke (49.3%), poisoning (1.42%), electrolyte imbalance (0.76%), and others. Sedative poisoning predominated (45.9%) among poisoning cases.

Conclusion: This study highlights the demographic and etiological dimensions of delirium. The significant impact of stroke, the underexplored realm of poisoning-related delirium, and the influence of age and comorbidities underscore the need for targeted interventions and increased awareness.

Bangladesh J Medicine 2024; 35(1): 20-25

Baseline Haematological Evaluation in Individuals Prior to Initiating Antiretroviral Therapy for HIV

Khaled Mahbub Murshed — 2024-01-04

Introduction: Human immunodeficiency virus (HIV) was discovered in 1983, while acquired immunodeficiency syndrome (AIDS) was first detected in 1981. Since then, it continues to be a public health problem. The phenomenon of HIV/AIDS is best viewed as a pandemic affecting almost all countries of the world. The first case of HIV/AIDS in Bangladesh was documented in 1989.This study was conducted to evaluate the baseline haematologicalcharacteristic in individuals prior to initiating antiretroviral therapy for HIV.

Methods: This study was a cross sectional analytical study conducted among one hundred and fifty-four HIV positive patients attending at ART center, Bangabandhu Sheikh Mujib Medical University. Patients were included as per inclusion and exclusion criteria. Co-morbid conditions were excluded mostly by self-reporting and clinically relevant investigations.

Result:The study revealed that HIV infected patients were predominantly middle-aged and young comprising > 70% of the patients with the mean age of the patients being 35.5 ± 9.5 years (range: 20-60 years). A male preponderance was observed in the study with a male-to-female ratio being 3:1. The majority (92.2%) of patients received first-line ART. The red cell indices like Hct, MCV, MCH, and MCHC were also low at the initiation of therapy but changed to normality after treatment.

Conclusion: From the findings of the study, it can be concluded that HIV infected individuals are predominantly male, middle-aged, and young. The most common haematological abnormality is anaemia which is significantly reduced in percentage after a mean treatment period of nine and a half months with ART.

Bangladesh J Medicine 2024; 35(1): 26-32

In the deep sea of Hyponatremia: A case series

Mahbub Mayukh Rishad — 2024-01-04

Hyponatremia is a matter of concern in clinical practice. Hyponatremia can be associated both low or high tonicity and even with normal tonicity. Although severity and morbidity varies widely but sometimes serious hazard can occur from misdiagnosis or late diagnosis. In these 3 case we will discuss different pattern of presentations of hyponatremia. Megestrol acetate is a synthetic progestin used to treat the symptoms of loss of appetite and wasting syndrome in people with AIDS-related cachexia, breast cancer or endometrial cancer. Herein, we report a case of 32 years’ female presented with clinical and biochemical features of central adrenal insufficiency who was taking megestrol acetate chronically. Pituitary function was otherwise essentially normal. Another case about a 46 year old male who was getting treatment for schizophrenia and later found to have hypopituitarism. Our last case about a male of 35 years old who was also diagnosed to have pituitary insufficiency.

Bangladesh J Medicine 2024; 35(1): 33-37

Dengue and Malaria Co-infection in a Young Adult with Atypical Feature

Sayeef Hossain Khan Mark — 2024-01-04

As an endemic zone, malaria and dengue coinfection can be expected in Bangladesh, although there have not been enough case reports of such coinfection. We describe a previously healthy 22-year-old male from Dhaka, with a history of travelling to Coxs-Bazar 3 weeks ago, presented with fever with chills and rigors, generalized weakness and cough for 2 weeks. Clinical examination showed tachycardia, hypotension, subconjunctival haemorrhage and positive tourniquet test. Lab reports showed NS1-Ag positive, thrombocytopenia, progressive anaemia, mild hyperbilirubinemia. He was treated initially for dengue haemorrhagic fever. His laboratory parameters started improving; however, he had persistent fever with chills and rigors daily and persistent coughing. Peripheral smear for Malaria showed schizonts and trophozoites of Plasmodium falciparum and ICT for malaria was positive. He recovered following treatment with IV fluids and oral artesunate. The presence of fever even in a critical phase of dengue, the typical rise of temperature daily, progressive anaemia, mild jaundice and specific travelling history gave a clue of coinfection with Malaria. On follow-up, after 2 weeks, he had no symptoms, and all the laboratory parameters were normal. challenge was the atypical features like dry cough and exertional dyspnoea. The timely diagnosis and appropriate treatment were crucial for prognosis of this patient.

Bangladesh J Medicine 2024; 35(1): 38-41

Primary Hyperaldosteronism is An Unusual Cause of Periodic Paralysis: A Case Report

Aminur Rahman — 2024-01-04

Primary hyperaldosteronism a synonym for Conn's syndrome is characterized by hypernatremia, arterial hypertension, and, in certain situations, potentially fatal hypokalemia. A rare class of neuromuscular disorders known as periodic paralysis (PP) is brought on by an affection of the skeletal muscle's ion channels. In patients with hypokalaemic PP, potassium levels are normal in between attacks, but they remain low in those with secondary hypokalaemic PP. Although secondary causes of PP have been documented in the literature, the majority of cases are hereditary. We report the case of a 46-year-old man who had a history of hypertension and was admitted to the neurology ward after experiencing sudden-onset weakness in all four limbs, primarily affecting the lower limbs, two days earlier. This present case demonstrates a peculiar and severe primary hyperaldosteronism manifested by PP.

Bangladesh J Medicine 2024; 35(1): 42-46