Journal of Medicine 2021-01-25T09:38:38+00:00 Prof. SM Hafiz Open Journal Systems <p>An official organ of Bangladesh Society of Medicine. Full text articles available. <br>Enlisted on DOAJ, HINARI, AsiaJOL. <br>Indexed in EMBASE, SCOPUS, EBSCO, ProQuest, CAB International, CrossRef, IndexCopernicus, Ulrichsweb, Open J-Gate, Google Scholar.</p> Variable Presentations of Tuberculosis during COVID-19 Pandemic- A Case Series 2021-01-25T09:38:27+00:00 Mahbub Mayukh Rishad Sumaiya Akter Arfa Rahman Homayra Tahseen HAM Nazmul Ahasan Quazi Tarikul Islam <p>Tuberculosis is an ancient infectious disease, which can involve almost any organ of the body and can have broad spectrum of presentations. The objective of this case series presentation is to highlight the importance of considering Tuberculosis as a diagnosis even in this COVID pandemic time. It presents with wide variety of clinical features involving different organs and often potentially fatal. Mortality from tuberculosis is most often due to delay in diagnosis &amp; thus starting treatment. Thus, treatment should be initiated immediately based on strong clinical suspicion. Here we have presented six different cases of TB where each case presented differently in a tertiary care private hospital of Dhaka.</p> <p>J MEDICINE JAN 2021; 22 (1) : 60-66</p> 2021-01-14T00:00:00+00:00 Copyright (c) 2021 Journal of Medicine Normocomplementemic Idiopathic Urticarial Vasculitis 2021-01-25T09:38:29+00:00 Matheo Augusto Morandi Stumpf <p>Abstract not available</p> <p>J MEDICINE JAN 2021; 22 (1) : 67-68</p> 2021-01-14T00:00:00+00:00 Copyright (c) 2021 Journal of Medicine Favipiravir Induced Acute Pancreatitis in a COVID-19 Patient 2021-01-25T09:38:30+00:00 AHM Ejrarul Alam Khan Mohammad Mahfuzul Hoque Md Uzzwal Mallik Kamalesh Chandra Basu Mohammed Masudul Hasan Imran Mahmud Mirza Mohammad Asif Adnan Md Mujibur Rahman <p>There are a number of gastrointestinal symptoms and complications of COVID-19. Asymptomatic increase in pancreatic enzymes and rarely symptomatic pancreatitis are observed in this disease. This article describes a 37-year-old male suffering from mildly symptomatic COVID-19 infection, who received tablet favipiravir for his management. His condition was improving, when he developed acute pancreatitis, diagnosed clinically, biochemically and also with help of abdominal ultrasound. When he developed this, all typical symptoms of COVID-19 were improved. As a result, role of favipiravir in the development of this pancreatitis was suspected.</p> <p>J MEDICINE JAN 2021; 22 (1) : 69-71</p> 2021-01-14T00:00:00+00:00 Copyright (c) 2021 Journal of Medicine Experience of Managing Snake Bite Cases in a Medicine Unit of Tertiary Care Hospital in Bangladesh - A Case Series 2021-01-25T09:38:31+00:00 Md Abu Bakar Siddique Md Mujibur Rahman AKM Humayon Kabir Md Uzzwal Mallik - Md Habibullah Md Mehedi Hassan Mostofa Kamal Chowdhury <p><strong>Background: </strong>Snakebite is a neglected public health problem in many countries of the world. Being a tropical country Bangladesh is also facing this problem. In this case series we have tried to focus the illiteracy, prejudice and mismanagement happen in snake bite cases from primary to tertiary level and how effective management can save life of snake bite victim.</p> <p><strong>Case presentation: </strong>Among the 29 snake bite cases admitted in a medicine ward of tertiary care hospital four were venomous bites- two male and two female. Our patients came from around Dhaka city. Though victim failed to bring the snake, by studying clinical features and syndromic approaches we suspected Kraits as the culprit in three cases and Cobra in one case. Time period between bite and attend to hospital ranged from 4 hr to 16.30 hours. All victims had inappropriate application of tourniquet to their limbs as a first aid management. Most of them first visit OZHA (traditional healer). Two of them developed respiratory failure. All cases were managed in ICU with polyvalent ASV. One developed anaphylaxis which was managed with adrenaline. All patients recovered completely.</p> <p><strong>Conclusion: </strong>Arrival to hospital without delay, facilities for management with trained physicians and proper supply of ASV may reduce death from snake bite and reduce financial burden to the patient. Developing public awareness to remove prejudice about snakes and identifying venomous snake bite is also necessary.</p> <p>J MEDICINE JAN 2021; 22 (1) : 72-76</p> 2021-01-14T00:00:00+00:00 Copyright (c) 2021 Journal of Medicine Reinfection with SARS-CoV-2 after 152 Days: A Case Report 2021-01-25T09:38:33+00:00 SM Abdullah Al Mamun Quazi Tarikul Islam Sanaullah Sarker Asifur Rahman <p><strong>Background: </strong>In general, reinfection means a person was infected (got sick) once, recovered, and then later became infected again. Based on what we know from similar viruses, some reinfections are expected. We are still learning more about COVID-19. Ongoing COVID-19 studies will help us to understand.The degree of protective immunity conferred by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is currently unknown. As such, the possibility of reinfection with SARS-CoV-2 is not well understood. Here we describe presentation and investigations of two instances of SARS-CoV-2 infection in the same individual.</p> <p><strong>Methodology : </strong>A 38-year-old man who is a resident of Dhaka city , Engineer by profession presented to doctors on two occasions with symptoms of viral infection. First time at a community testing event in June, 2020, and a second time to Evercare hospital at the mid November , 2020. Nasopharyngeal swabs were obtained from the patient at each presentation and twice during follow-up. RT PCR testing was done to confirm SARS-CoV-2 infection. CXR P/A view was performed in 1st time of Covid infection &amp; HRCT of chest was performed during his stay at Evercare hospitals</p> <p><strong>Findings: </strong>The patient had two positive tests for SARS-CoV-2, the first on June 20th, 2020, and the second on November 18th 2020, separated by two negative tests done during follow-up in July, 2020. The second infection was symptomatically more severe than the first with remarkable radiological changes of Chest in high resolution CT scanning .</p> <p><strong>Interpretation: </strong>Two subsequent negative RT PCR after 1st positive with clinically asymptomatic period after 2 weeks of mild symptoms was observed in our patient . About 5 months later he was Covid19 positive again with moderate symptoms. These findings suggest that the patient was infected by SARS-CoV- 2 on two separate occasions probably by genetically distinct virus. Thus, previous exposure to SARS-CoV- 2 might not guarantee total immunity in all cases. All individuals, whether previously diagnosed with COVID- 19 or not, should take identical precautions to avoid infection with SARS-CoV-2. The implications of reinfections could be relevant for vaccine development and application.</p> <p>J MEDICINE JAN 2021; 22 (1) : 77-80</p> 2021-01-14T00:00:00+00:00 Copyright (c) 2021 Journal of Medicine Atypical ‘Granulomatosis with Polyangiitis’ Presenting with Epistaxis 2021-01-25T09:38:35+00:00 Sumaiya Akter HAM Nazmul Ahasan Quazi Tarikul Islam <p>Granulomatosis with polyangiitis (GPA) is a systemic necrotizing vasculitis involving small and mediumsized blood vessels and granulomatous inflammation of upper and lower respiratory systems and/or renal system. In the limited form of GPA, there is no systemic involvement of disease with sparing of kidneys. Herein, we report a case of 37-year-old male who was diagnosed as ethmoidal polyposis clinically. Ethmoidal tissue biopsy granulomatous angiitis. Diagnosis of GPA was made which was substantiated by antineutrophil cytoplasmic antibody (ANCA) positivity. This was a case of GPA involving only upper respiratory system. The early diagnosis and initiation of treatment are critical for improved survival of patients with GPA. Tissue biopsy is necessary for the diagnosis of GPA.</p> <p>J MEDICINE JAN 2021; 22 (1) : 81-83</p> 2021-01-14T00:00:00+00:00 Copyright (c) 2021 Journal of Medicine COVID-19 Vaccine & Bangladesh: New Year’s New Hope!!! 2021-01-25T09:38:07+00:00 Quazi Tarikul Islam Homayra Tahseen Hossain <p>Abstract not available</p> <p>J MEDICINE JAN 2021; 22 (1) : 1-2</p> 2021-01-14T00:00:00+00:00 Copyright (c) 2021 Journal of Medicine Fatal Intra-Abdominal Hemorrhage in a Middle Aged Lady with Severe COVID-19 2021-01-25T09:38:36+00:00 Mohammad Mahfuzul Hoque Ponkaj Kanti Datta <p>Contrast enhance CT scan of Abdomen showing a large encysted collection at the left of the abdomen extending from lumbar region to left iliac region pushing the surrounding viscera forward. Collection was due to retro-peritoneal hemorrhage in a Middle aged Lady with COVID-19 who was on therapeutic dose of anticoagulation with Low Molecular Weight Heparin.</p> <p>J MEDICINE JAN 2021; 22 (1) : 84-85</p> 2021-01-14T00:00:00+00:00 Copyright (c) 2021 Journal of Medicine Clinicopathological Correlation with Outcome of Diffuse Large B Cell Lymphoma: Experience in a Specialized Cancer Care Centre in Bangladesh 2021-01-25T09:38:09+00:00 Tamanna Bahar Zulfia Zinat Chowdhury Shaila Rahman Salina Haque AKM Mynul Islam Mohammad Ali Md Mahbubur Rahman <p><strong>Background</strong>: Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL) in the world, and accounts for 30%–40% of all adult NHLs. It is clinically, morphologically and genetically a heterogeneous group of tumors composed of large B cells. This study aimed to determine the clinical features, treatment options, the response rate in a specialized cancer care centre.</p> <p><strong>Methods</strong>: This retrospective study included all DLBCL patients registered in the department of Haematology of National Institute of Cancer Research and Hospital (NICR&amp;H), Bangladesh between July 2016 to June 2019.</p> <p><strong>Results</strong>: A total of 151cases were included in this study. The mean age was 47 years with a standard deviation (SD) of 15 years. Males (66.2%) were more in the occurrence of DLBCL. We divided the cases into three different entities of DLBCL and non-germinal centre B (non-GCB) variety was the prevalent (46.4%) one. Several types of first-line chemotherapy were used in management and the overall response rate (ORR) was 76.6% and 9.2% of death. The response was found to be significant with B symptoms, stage, and international prognostic index (IPI) score. But no significant difference was observed in outcome among different types of DLBCL after treatment.</p> <p><strong>Conclusion: </strong>This retrospective study will help to ascertain the co relation of DLBCL outcome with clinicopathological profile. (edited)</p> <p>J MEDICINE JAN 2021; 22 (1) : 3-6</p> 2021-01-14T00:00:00+00:00 Copyright (c) 2021 Journal of Medicine Periodontal Disease as a Risk Factor for Cardiovascular Disease - A Questionnaire Survey among Physicians 2021-01-25T09:38:11+00:00 Varun Arya Ramya Shenoy Kudpi Nikita Rungta <p><strong>Introduction: </strong>Periodontal infections have been documented to influence coronary heart diseases such as angina, myocardial infarction, atherosclerosis and other systemic conditions like stroke, diabetes mellitus and preterm low birth weight babies. Over the last two decades, several studies have reported associations between periodontitis and cardiovascular disease (CVD). The association is now a part of the dental school curriculum and periodontology. However, in contrast, this important aspect is missing in the medical school curriculum and not many physicians are aware of the role periodontal disease plays in CVD.</p> <p><strong>Aim: </strong>To assess the knowledge and practices of physicians of Mangalore City, South India, on periodontal disease as a risk factor in Cardiovascular Diseases (CVD).</p> <p><strong>Methodology: </strong>A questionnaire survey was carried out to assess physicians’ knowledge and practices in the city of Mangalore, South India. The physicians were divided into four groups as follows: Group I - Physicians associated with medical colleges; Group II – Sole private practitioners; Group III - Physicians associated with medical colleges and having their private practice; Group IV - Post-graduate students. A Chi-square test was applied to test the difference between knowledge and practices among the groups.</p> <p><strong>Results: </strong>Out of a total of 106 physicians, 56 (52.3%) participated in the survey. Periodontal disease was considered to be a risk factor in CVD by 87.5% (n=47) respondents and 96.4% (n=54) respondents stated that bleeding/enlargement of the gingivae was a sign of periodontal infection. Only 40% (n=23) of the respondents asked about oral problems during general check-up.</p> <p><strong>Conclusions: </strong>The knowledge regarding the periodontal disease as a risk factor in CVD was high, however, the application of the knowledge in routine medical check-ups was observed to be less.</p> <p>J MEDICINE JAN 2021; 22 (1) : 7-11</p> 2021-01-14T00:00:00+00:00 Copyright (c) 2021 Journal of Medicine Relation between Glycemic Control among the Patients with Type 2 DM and Level of Blood Pressure 2021-01-25T09:38:12+00:00 Md Al Amin Tahira Zannat Md Nazim Uddin - Md Moniruzzaman - Md Habibullah AKM Humayon Kabir Md Enamul Karim <p><strong>Introduction</strong>: Inadequate glycemic control among patients with type 2 diabetes constitutes a major public health problem and risk factor for the development of diabetes related complications. Hypertension is a common co-morbid condition of diabetes. Hypertension as a factor for poor glycemic control in diabetes patients has not been properly evaluated in Bangladesh. The aim of the study was to assess status of glycemic control among patients with Type 2 DM depending on the level of blood pressure in a tertiary care hospital.</p> <p><strong>Method: </strong>This cross sectional study was carried out among 200 adult patients of either gender with type 2 diabetes mellitus, in the Department of Medicine and endocrinology, Dhaka Medical College Hospital from January to June 2015.</p> <p><strong>Results: </strong>The mean age of the respondents were 56.85(±10.84) years, ranging from 35 to 77 years. Among 200 patients, 129 (64.5%) were hypertensive and 71 (35.5%) were normotensive with a mean duration of hypertension was 10.03 (±3.39) years. The mean HbA1c for all diabetic, hypertensive and normotensive patients were 7.41% (±1.35), 7.63% (±1.30) and 7.02% (±1.37) respectively. The mean HbA1c was significantly higher in hypertensive than normotensive group (p=0.002). The mean HbA1c was also significantly higher in patients with duration of hypertension (p=0.03) for more than 10 years and in patients who used beta blocker (p=0.005) and diuretics (p=0.02) as hypertensive medication. Among the patients with normal BMI and on dietary modification, those who were hypertensive had significantly higher (p=0.00008) mean HbA1c (7.12(±0.99)) than those were normotensive (5.01(±0.01)).</p> <p><strong>Conclusion: </strong>The glycemic control in type 2 DM is found to be poor among the hypertensive patients. There is a complex association of multiple factors like age, gender, duration of hypertension and medications strongly influence the glycemic control of type 2 diabetics with hypertension.</p> <p>J MEDICINE JAN 2021; 22 (1) : 12-17</p> 2021-01-14T00:00:00+00:00 Copyright (c) 2021 Journal of Medicine Knowledge Attitude and Practice of Dengue Syndrome Management on the Basis of National Guideline by the Physicians of Dhaka City 2021-01-25T09:38:14+00:00 Mohammad Rafiqul Islam Sarmistha Biswas Mohammad Robed Amin Md Ridwanur Rahman <p><strong>Objectives: </strong>Dengue is the fastest emerging arboviral infection. It was expected that the National Control Program will promote the use of the revised and updated version of the guideline for uniform clinical management of Dengue/DHF in the country with a view to reduce case fatality due to dengue. We tried to assess the knowledge attitude and practice of different tier of physicians on the basis of this guideline.</p> <p><strong>Method: </strong>Total 317 physicians from academic hospital, 57 physicians from non-academic hospital and 21 private practitioners took part in the survey.</p> <p><strong>Results: </strong>knowledge and attitude regarding management protocol of Dengue syndrome were significantly (p&lt;0.05) associated with different academic tier but practice was not significantly (p&lt;0.05) associated with different academics. The mean of accurate knowledge regarding management protocol of Dengue syndrome was significantly (p&lt;0.05) associated with training status but attitude and practice were not significantly (p&lt;0.05) associated with training status.</p> <p><strong>Conclusion: </strong>This study reveals that physicians possibly didn’t went through the dengue guideline properly as their knowledge, attitude and practice were poor in each tier of professional practice. But dengue training improved knowledge regarding management of patients.</p> <p>J MEDICINE JAN 2021; 22 (1) : 18-21</p> 2021-01-14T00:00:00+00:00 Copyright (c) 2021 Journal of Medicine Glycaemic Status in Acute Stroke in Nondiabetic Patient 2021-01-25T09:38:15+00:00 Mohammad Shamsul Arefin Patwary HAM Nazmul Ahasan Md Titu Miah Quazi Tarikul Islam Farzana Rahman Munmun Joybaer Anam Chowdhury Ahmed Ferdous Jahangir <p><strong>Background: </strong>Elevated blood glucose is common in the early stage of stroke. Besides, blood glucose level increases during acute stroke in nondiabetic patients.</p> <p><strong>Objective: </strong>Objective of the study was to assess the glycemic status during acute stroke in nondiabetic patients, find the rate of newly developed diabetes during acute stroke and rate of newly developed Impaired Fasting Glucose, Impaired Glucose Tolerance during acute stroke.</p> <p><strong>Methods: </strong>The purposive sampling method was used to identify the patients and by proper history taking, documentary papers and laboratorial support evidenced by HbA1c level less than 6.5% (This means patient to be non diabetic). Data were collected from 100 patients. It was conducted from August, 2018 to February, 2019 in the Department of Medicine of Dhaka Medical College Hospital. The data were collected through questionnaire ,pre-tested earlier and data collection sheet illustrating the glycemic status during acute stroke among the nondiabetic patients.</p> <p><strong>Results: </strong>While analyzing the lab investigations among the respondents, mean HbA1c level was found 5.69± 0.65 mmol/L level which was found normal among the entire patient group. Patients Fasting Blood Sugar(FBS) was tested and mean FBS level was 5.94±0.86. In 62% of the patients, IFG was found, and in 12% of patients, FBS value was found to be diabetic while 26% showed normal glycemic status. Average OGTT(2 hours after 75 gm glucose) impression was 8.53± 2.02 mmol/L. OGTT level was normal among 30%, 54% patients had IGT and 16% of the respondents were found diabetic.</p> <p><strong>Conclusion</strong>: The study finds that, in patients with no history of diabetes who have acute stroke, may develop moderately elevated glucose levels which may affect short term and long term stroke related morbidity and mortality.</p> <p>J MEDICINE JAN 2021; 22 (1) : 22-26</p> 2021-01-14T00:00:00+00:00 Copyright (c) 2021 Journal of Medicine Association of Anthropometric Measurement With Ultrasound- Diagnosed Non Alcoholic Fatty Liver Disease In Dhaka Medical College Hospital 2021-01-25T09:38:17+00:00 Farhana Sultana Mohammad Shamsuddoha Sarker Shanchay Faruque Ahmed <p><strong>Introduction: </strong>Nonalcoholic fatty liver disease (NAFLD) is an increasingly recognized cause of liver disease worldwide. The present study was conducted with the aim to determine the association between anthropometric measurement and incidence of NAFLD among the adult population.</p> <p><strong>Material and Methods: </strong>A hospital based cross sectional study was performed among 240 patients attending outpatient department of Hepatology, Gastroenterology and admitted in patient of Medicine, Hepatology, Gastroenterology department of Dhaka Medical College Hospital, who are Ultrasound diagnosed NAFLD, fulfilled the inclusion criteria. The Study was done from August, 2013 to February, 2014 in Dhaka Medical College Hospital, Dhaka, Bangladesh. Then a pro-forma was made and filled it by direct interview, reading the remarks of the consultant about the patient written on the file, using the hospital lab results and by discussing the patient’s file remarks with the medical officer on duty. NAFLD was confirmed by Ultrasonography. Relevant Laboratory investigations were done to assess severity and prognosis. All subjects underwent anthropometric measurement which included height, weight, waist circumference, waist hip ratio (WHR), waist height ratio (WHtR). Body mass index (BMI) and were calculated using the standard formula.</p> <p><strong>Results: </strong>Out of 240 patients, 51(21.25%) were found to be diagnosed with NAFLD (95%CI=22.8-27.8) subjects. The cases of NAFLD were significantly higher in males (55.0%) as compared to females (45%) (RR=1.17, 95%CI=1.14-2.58, p=0.008). The BMI, waist circumference, WHR and WHtR were significantly (p&lt;0.0001) associated with NAFLD. Likewise, NAFLD was found significantly (p&lt;0.0001) higher among obese and overweight subjects. However, in multivariate logistic regression analysis, sex (adjusted OR=11.30, 95%CI=3.44-37.11, p&lt;0.0001), waist circumference (adjusted OR=1.27, 95%CI=1.56-1.39, p&lt;0.0001), hip circumference (adjusted OR=0.90, 95%CI=0.82-0.99, p=0.04) and BMI (adjusted OR=1.83, 95%CI=1.10- 2.20, p=0.001) were significantly associated with NAFLD.</p> <p><strong>Conclusion: </strong>It can be concluded that higher anthropometric measurements were significantly associated with NAFLD.</p> <p>J MEDICINE JAN 2021; 22 (1) : 27-32</p> 2021-01-14T00:00:00+00:00 Copyright (c) 2021 Journal of Medicine Clinical Profile, Haematological Changes and Outcomes of Dengue Patients in Dengue Outbreak-2019 in Jashore, Bangladesh- An Observational Study 2021-01-25T09:38:19+00:00 Mohammad Ali Goutam Kumar Acherjya AKM Mynul Islam ABM Saiful Alam SM Shafiqur Rahman Ranajit Sen Chowdhury - Md Shamsuzzaman Rajashish Chakrabortty Gobinda Chandra Roy <p><strong>Background: </strong>Bangladesh is an endemic zone for re-emerging dengue viral infection since 2000. For the last few years, dengue viral outbreak occurs in the rainy season mostly in Dhaka city and seldom sporadic case finds beyond the Dhaka city of Bangladesh. But this outbreak expands also outside the Dhaka city of Bangladesh in 2019. Therefore, with scarcity of data regarding this field in the peripheral part of Bangladesh, we have designed this study among dengue infected patients in Jashore, Bangladesh.</p> <p><strong>Objectives: </strong>This observational study aims to assess the clinical presentations, laboratory findings especially hematological changes and outcomes of patients with dengue viral infection at Jashore district in dengue outbreak-2019 in Bangladesh.</p> <p><strong>Methodology: </strong>This was an observational study, carried out from 25thApril 2019 to 5thSeptember 2019 during dengue outbreak season in Jashore, Bangladesh. Patients were selected from outpatient department and indoor of a local private hospital in Jashore, Bangladesh who had given informed written consent to participate in our study.</p> <p><strong>Result: </strong>Total eligible 77 patients were included in this study. Out of which 70 patients (90.9%) were dengue NS1 antigen Positive on Immunochromatography (ICT) and the rest were anti-dengue IgM antibody positive on ICT method. Around 74 (96.1%) patients had fever as the most common feature in dengue infection. Eighty-seven percentages (87%) of patients had history of headache. Other striking complaints were body ache (66.2%), back pain (51.9%), nausea (55.8%), vomiting (31.2%), anorexia (27.3%), arthralgia (29.9%) and retro-orbital pain (26.0%). Sore throat being a common feature in flu-like illness also found in 18.2% cases. Mean total count of whole blood count (WBC) falls on day 5 (5.76 X 109/L) and then gradually increased. Mean platelet count of study patient was normal throughout the course of the disease process. But, in some cases minimum platelets was found 21 X 109/L at the time of presentation and on day 5 and day 6 which was dropped down to 17 X 109/L. Mean Haematocrit (%) was more or less in a steady state throughout the acute phage of the disease. But, in some cases throughout the hospital stay minimum haematocrit was less than 30% and initially in some cases maximum haematocrit was more than 50% among some dengue infected patients. Total 67 (87%) subjects with dengue viral infection required hospital admission and mean hospital stay was 4 days with a standard deviation (SD) was ±2 days. Blood transfusion was required in only one patient. Around 95% patient was recovered and only 4 cases were referred to the higher centre further better management. Regarding complications, we had found diarrhoea in 9(11.7%) and bleeding disorder in 14.3% patients.</p> <p><strong>Conclusion: </strong>In our study, the most common clinical presentations were fever, headache, body-ache, back pain, and gastrointestinal upset. The mean hematological started dropping down from 4th day and gradually improved after 7th day. Some patients developed diarrhea, bleeding disorders and hepatitis as complications during their disease process. We observed a good clinical outcome evident by without having severity and death toll among our study participants. There was very seldom requirement of blood and blood product transfusion in our study.</p> <p>J MEDICINE JAN 2021; 22 (1) : 33-40</p> 2021-01-14T00:00:00+00:00 Copyright (c) 2021 Journal of Medicine Etiological Evaluation of Acute Confusional State in Elderly (≥60 Years) Patients 2021-01-25T09:38:21+00:00 Md Motlabur Rahman Rakesh Panday Kamal Uddin Sohel Zuhayer Ahmed Shahana Khanam MA Sattar Sarker Pratyay Hasan Md Khairul Islam <p><strong>Background: </strong>Acute confusional state or delirium is a frequent cause of hospital admission in the elderly. It is characterized by an acute fluctuating impairment of cognitive functions and inattention. Recognition and prompt treatment is crucial to decrease the morbidity and mortality of hospitalized elderly patients. Aim of this study was to evaluate the distribution of common medical conditions related to acute confusional state among elderly hospitalized Patients.</p> <p><strong>Methods: </strong>This was a cross sectional study. We enrolled 380 patients from different medicine wards in Dhaka Medical College Hospital. We included patients with acute confusional state/delirium of less than 7 days duration. The enrolled patients fulfilled the diagnostic criteria of an acute confusional state. A predesigned checklist was used for data collection. Head injury was excluded by history and CT scan of brain. Patients with preexisting illnesses, such as dementia, psychiatric illnesses and recurrent seizures, and any case of poisoning was excluded. All findings were noted and recorded. A written informed consent was taken from the attendant and relatives.</p> <p><strong>Result: </strong>Among 380 patients, most of confusional state developed after the age of 65 years and the mean age was 69 +/-7.6 years. Associated medical conditions were uncontrolled hypertension (63.2%), fever &amp; infection (41.6%), uncontrolled DM (36.6%), CVD (28.4%), CKD &amp; electrolytes abnormalities (10.5%), joint diseases &amp; pain (13.7%). Most of the patients used plyphormacy (76.6%) out of which antihypertensive (60%) were common. The mean duration of presentation was 6.1+/-0.6 days, and among all patients about 63.7% were improved, 29.50% was in persistant symptom of confusion and 6.8% of them died.</p> <p><strong>Conclusion: </strong>Acute confusional state was common after 65 years. Uncontrolled hypertension, fever &amp; infection, uncontrolled diabetes, CVD, CKD &amp; electrolytes abnormalities and polypharmacy were found commonly in patients with acute confusional state.</p> <p>J MEDICINE JAN 2021; 22 (1) : 41-45</p> 2021-01-14T00:00:00+00:00 Copyright (c) 2021 Journal of Medicine Should Schools Reopen during the COVID-19 Pandemic? 2021-01-25T09:38:26+00:00 Qais Gasibat Aburwais Aymen Musab Gasibat <p>Abstract not available</p> <p>J MEDICINE JAN 2021; 22 (1) : 57-59</p> 2021-01-14T00:00:00+00:00 Copyright (c) 2021 Journal of Medicine Rationale of Using Common Antifibrotic Therapy in Post COVID Fibrosis 2021-01-25T09:38:23+00:00 SM Abdullah Al Mamun Rowshne Jahan Quazi Tarikul Islam Tahera Nazrin Kahn Shajalal <p>Different mechanisms of lung injury in COVID-19 have been described, like viral to immune-mediated mechanisms. Lung injury can be either subsequent to chronic inflammation or an idiopathic and genetically influenced process. Pulmonary fibrosis can occur with acute lung injury &amp; a known sequela to ARDS. However, persistent radiological abnormalities after ARDS are of little clinical significance and have dwindled with protective lung ventilation. Pulmonary fibrosis is associated with permanent pulmonary architectural distortion and irreversible lung dysfunction. Available clinical, radiographic, and autopsy data has indicated that pulmonary fibrosis is central to severe acute respiratory distress syndrome (SARS) and MERS pathology, and current evidence suggests that pulmonary fibrosis could also complicate infection by SARS-CoV-2 The aim of this review is to explore the current literature on the pathogenesis of lung injury in COVID-19 infection, its risk factors &amp; to find out the possible effective therapy within the existing medication. After literature review, we conclude that, currently there are no approved therapies for SARS COV2. Trials are based on drugs that are already approved for other diseases, have acceptable safety profiles or have been effective in animal studies against the other two highly pathogenic coronaviruses. Apart from the potent use of antivirals to reduce the viral effects, the use of antifibrotic therapies could also be under consideration based on the pulmonary fibrotic disease observed after COVID-19 recovery. Pirfenidone and Nintedanib are the two approved anti fibrotic drugs for Idiopathic Pulmonary Fibrosis (IPF). Despite having different modes of action, both are effective in attenuating the rate of lung function decline and are widely considered to improve life expectancy.</p> <p>J MEDICINE JAN 2021; 22 (1) : 46-50</p> 2021-01-14T00:00:00+00:00 Copyright (c) 2021 Journal of Medicine Referral Norms for the New Normal 2021-01-25T09:38:25+00:00 HAM Nazmul Ahasan Musavvir Samin Ruslan Ahasan <p>Abstract not available</p> <p>J MEDICINE JAN 2021; 22 (1) : 51-56</p> 2021-01-14T00:00:00+00:00 Copyright (c) 2021 Journal of Medicine