Journal of Medicine <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> Bangladesh Society of Medicine en-US Journal of Medicine 1997-9797 Authors who publish with this journal agree to the following terms:<br /><br /><ol type="a"><ol type="a"><li>Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a <a href="" target="_new">Creative Commons Attribution License</a> that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</li></ol></ol><br /><ol type="a"><ol type="a"><li>Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</li></ol></ol><br /><ol type="a"><li>Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See <a href="" target="_new">The Effect of Open Access</a>).</li></ol> COVID-19: Where we are in Bangladesh <p>Abstract Not Available</p> <p>J MEDICINE JUL 2020; 21 (2) : 67-68</p> Md Mujibur Rahman ##submission.copyrightStatement## 2020-11-09 2020-11-09 21 2 67 68 10.3329/jom.v21i2.50207 An Epidemiological Study of Laboratory Confirmed COVID-19 Cases Admitted in Dhaka Medical College Hospital <p><strong>Background: </strong>The objective of the study was to report the epidemiological characteristics of symptomatic laboratory confirmed COVID-19 patients seeking care from Dhaka Medical College Hospital (DMCH).</p> <p><strong>Methods: </strong>This observational study was conducted in department of Medicine, DMCH for the period of 2 months following ethical approval. Total 100 RT-PCR confirmed COVID-19 patients were included and interviewed. Informed written consent was ensured before participation. Collected data were entered in a predesigned case record form and subsequently analyzed by SPSS-20.</p> <p><strong>Results: </strong>Average age of presentation was 37.20±10.02(SD) years with male predominance (77%). Urban presence was in 90%. Thirty-two percent of the patients had comorbidities, with diabetes (16%) and hypertension (19%) being the most frequently observed.The most commonly observed symptoms was fever (65%), followed by cough (58%), breathlessness (42%), Dysgeusia (40%) and fatigue (33%). Mean duration of illness was 8.74±4.8 (SD) days. Overall mortality was 9%. All patients were managed according to the national guidelines and only 7% required ICU support.</p> <p><strong>Conclusion: </strong>Patients were mostly middle-aged and male. Typical presentations were fever, cough, breathlessness and dysgeusia. Overall mortality was 9% among the admitted patients and requirement of ICU was 7%. Further study with large sample size is recommended to get a more precise picture.</p> <p>J MEDICINE JUL 2020; 21 (2) : 69-75</p> Mohammad Murad Hossain Sayeef Hossain Khan Mark AKM Humayon Kabir Partha Pratim Das Md Khairul Islam Aparna Das ##submission.copyrightStatement## 2020-11-09 2020-11-09 21 2 69 75 10.3329/jom.v21i2.50208 Association of Cardiovascular Disease with Micro Albuminuria in Type 2 Diabetes Mellitus - Study in A Tertiary Care Hospital <p><strong>Introduction: </strong>Microalbuminuria appears to be the earliest sign and predictor of the subsequent diabetic renal disease and is a marker of increased cardiovascular morbidity and mortality. It is also a predictor of morbidity and mortality in patients who do not have evidence of significant renal disease</p> <p><strong>Objective: </strong>To evaluate the association of microalbuminuria in type 2 DM with cardiovascular diseases and to correlate microalbuminuria with age of onset in type 2 diabetes mellitus.</p> <p><strong>Materials and Method: </strong>A hospital based observational study was carried out in the Department of Medicine, Dhaka Medical College &amp; Hospital,Dhaka, from January 2014 to November 2014. A total of 100 patients diagnosed as type 2 diabetes mellitus according to American Diabetic Association guideline were included in this study. Association of microalbuminuria with cardiovascular diseases was determined by statistical analysis and regression analysis.</p> <p><strong>Results: </strong>The majority (40.0%) of patients were in 5<sup>th</sup> decade and the mean (±SD) age was 57.17±11.2 years. According to BMI it is observed that majority of patients were obese in both groups, where male 66.0% and female 75.5%.The occurrence of cardiovascular diseases in type 2 diabetes mellitus patients is increasing with duration of DM, where 61.9% found in newly diagnosed DM. It was observed that 38(38.0%) patients had normoalbuminuria (&lt;30 mg/gm), their mean ACR was 17.6±8.1 mg/gm and 62(62.0%) patients had microalbuminuria (30-300 mg/gm), their mean ACR was 158.7±88.3 mg/gm. Microalbuminuria was found 53(67.1%) and 9(42.9%) patients with cardiovascular diseases and without cardiovascular diseases respectively. Occurrence of microalbuminuia was found significantly higher (p&lt;0.05) in type 2 DM patients with cardiovascular diseases.</p> <p><strong>Conclusion:</strong>Microalbuminuria is found strongly associated with cardiovascular diseases in type 2 diabetes mellitus patients and there is 2.72 times more chance of developing cardiovascular diseases.</p> <p>J MEDICINE JUL 2020; 21 (2) : 76-81</p> Md Jahirul Haque Md Nazrul Islam Md Zakaria Al Aziz Shah Mohammad Ashrafuzzaman Gobindo Chandra Banik AKM Sajedur Rahman Sarmistha Biswas HAM Nazmul Ahasan ##submission.copyrightStatement## 2020-11-09 2020-11-09 21 2 76 81 10.3329/jom.v21i2.50209 Demographic and Clinical profile of 190 COVID-19 Patients in a Tertiary Care Private Hospital of Dhaka, Bangladesh: An Observational Study <p>From late December’19 till the end of August 2020, in this nine months period, world has lost more than eight hundred thousands people due to COVID-19 pandemic. Clinical data on COVID-19 in Bangladesh is less. The objective of our study was to evaluate demographic and clinical profile with in a defined period among COVID-19 Bangladeshi Patients in a Tertiary Care Private Medical College Hospital of Dhaka. We conducted a retrospective descriptive study on epidemiological &amp; clinical profile along with short term treatment outcomes of 190 COVID-19 patients from COVID dedicated unit of Popular Medical College Hospital (PMCH) during the period of 18th June to 22nd August 2020 (2 months) with a pre-determined case record form (CRF).Among this 190 patients, mean age was found to be 53 years. Highest percentage of patients (44%) belonged to 41-60 years of age. Regarding gender distribution, two-third patients were male (65%) &amp; one-third patients were female (35%). The predominant symptoms of our enrolled patients were fever (88%),cough (81%) , dyspnoea (58%) &amp; fatigue( 50%). Around half of the patients had been suffering from Hypertension (54%) and Diabetes (47%). Almost half of our patients belonged to moderate severity (48%).The duration of Hospital stay was from 1-36 days, mean was 7 days. There was significant difference for severe and non-severe cases (p value 0.01).</p> <p>J MEDICINE JUL 2020; 21 (2) : 82-88</p> Homayara Tahseen Hossain Tasmina Chowdhury Maksudul Islam Majumder Arfa Rahman Ava Quazi Audry Arafat Rahman - Md Zahiruddin HAM Nazmul Ahasan Quazi Tarikul Islam ##submission.copyrightStatement## 2020-11-09 2020-11-09 21 2 82 88 10.3329/jom.v21i2.50210 Patterns of Organ Involvement and Outcomes of SLE: A Real-Life Experience in Lupus Clinic <p>SLE is one of the most common autoimmune disorders of women of childbearing age.It often manifests with various constitutional symptoms as well as combination of major organ involvement and outcome varies in different studies with current treatment. The present study is to see the patterns of organ involvement and outcomes at least after 6 months with standard treatment. This retrospective study was conducted in lupus clinic of two largest tertiary care hospitals in Dhaka city of Bangladesh over 2010 to 2019. It included 277 patients of SLE, diagnosed on the basis of ACR lupus diagnostic criteria and ACR lupus nephritis guideline and had received standard treatment. Outcomes were assessed by SLEDAI. The most common clinical manifestations were fever (71.8%), joint pain (71.4%), oral ulceration (54.8%), alopecia (36.4%), butterfly rash (28.5%), photosensitivity (32.1%) and Raynaud’s phenomenon (16.6%). Commonly involved major organ-systems were renal (41.5%), CNS (16.6%), pulmonary (7.2%), cardiac (3.2%) and hematological (12.2%). Renal biopsy was done in 91cases and the histology showed majority (37.3%) in class-IV. With standard treatment, a significant reduction of mean serum creatinine, proteinuria and SLEDAI was observed at least after 6 months. A total 35(12.63%) flares and 6 (2.17%) deaths occurred during the course of treatment. Renal and CNS are the most commonly involved major organ systems next to skin and joints. The overall outcome is favorable with standard treatment.</p> <p>J MEDICINE JUL 2020; 21 (2) : 89-92</p> Md Mujibur Rahman - Md Moniruzzaman SK Jakaria Been Sayeed Rashedul Hassan Md Uzzwal Mallik Satyajit Barua Md Abdur Rahim Saima Azad Md Rockyb Hasan Nazim Uddin Arman Hossain Bikash Chandra Mandal ##submission.copyrightStatement## 2020-11-09 2020-11-09 21 2 89 92 10.3329/jom.v21i2.50211 Antimicrobial Sensitivity Pattern of the Common Uropathogens among Patients Admitted in A Tertiary Care Hospital in Bangladesh <p>Urinary tract infection is one of the most common bacterial infections seen in clinical practice both in developed and developing countries. The causative agents of Urinary tract infection vary from place to place and they also vary in their susceptibility and resistance patterns. This descriptive study aimed to evaluate the antibiotic susceptibility patterns of pathogens isolated from routine laboratory specimens at Dhaka Medical College Hospital. A descriptive cross- sectional study was done from January 2018 to June 2018. A total of 100 mid-stream urine samples from the suspected UTI patients were tested microbiologically and antimicrobial susceptibility test were performed for the isolated pathogens using Kirby-Bauer disk diffusion method with positivity rate of UTI was 90% (90/100). Escherichia coli (39%) was the most UTI causing bacteria followed by Klebsiella 18(18%), Acinetobacter 12(12%), Staphylococci, 9 (9%), Pseudomonas 6 (6%), Enterococcus species 3 (3%) and Proteus 3 (3%). Female 83 (83%) were more affected in comparison with male. Adult female especially age range 18-30 years were found in high risk. Nitrofurantoin, Amikacin and Meropenem were recorded as most sensitive antibiogram for most of the bacteria’s whereas cephalosporin showed increased resistance. However, for uncomplicated community acquired UTI, Nitrofurantoin (oral) and Amikacin (Injectable) can be chosen as first line medication.</p> <p>J MEDICINE JUL 2020; 21 (2) : 93-97</p> AKM Humayon Kabir SK Jakaria Been Sayeed Prodip Kumar Biswas SM Hafiz Md Uzzwal Mallik Md Nazim Uddin ##submission.copyrightStatement## 2020-11-09 2020-11-09 21 2 93 97 10.3329/jom.v21i2.50212 E-Prescribing: Benefit, Barrier, and Adopting Challenge in Electronic Prescribing <p>E-Prescribing system provides prescribing drugs electronically that can be a stand-alone system or be integrated with Electronic Health Records (EHRs) system. When implementing an E-Prescribing system, we need to consider it’s benefits and barriers, also adopting factors that can affect the success of the implementation. The main advantage of using an E-Prescribing system is to increase patient safety, meanwhile, the biggest barriers and challenges are it’s cost-related and adaptation by health facilities and related health workers. This article review provides information about E-prescribing and it’s elements to help for a better understanding of the system and to give some insights before adopting the e-prescribing system.</p> <p>J MEDICINE JUL 2020; 21 (2) : 98-101</p> Rasmi Zakiah Oktarlina ##submission.copyrightStatement## 2020-11-09 2020-11-09 21 2 98 101 10.3329/jom.v21i2.50213 Cognitive Dysfunctions in Inflammatory Bowel Disease and Irritable Bowel Syndrome <p>The aim of this paper is to summarize the current evidence on cognitive dysfunctions in adults with inflammatory bowel disease and inflammatory bowel syndrome.The online databases PubMed and PsycINFO were searched. All quantitative studies published in English found in the mentioned databases until December 2019 were included. Quantitative studies which did not include a control group, qualitative studies and case studies were excluded. We found seven papers about cognitive dysfunctions in IBD and IBS. Four of seven papers compare cognitive functions of patients with IBD and IBS. Three of seven studies assess cognitive functions in IBD. Three papers assessed memory, three papers studied selective attention and inhibition response, two papers assessed cognitive flexibility, one paper measured information processing speed, and one paper assessed verbal fluency.</p> <p>J MEDICINE JUL 2020; 21 (2) : 102-104</p> Mariana Suárez Bagnasco ##submission.copyrightStatement## 2020-11-09 2020-11-09 21 2 102 104 10.3329/jom.v21i2.50214 A Rare Case of Hypokalemia Induced Rhabdomyolysis Secondary to Gitelman Syndrome: An Easily Overlooked Inherited Tubulopathy <p>Hypokalemia is a common clinical problem in endocrinologists’ and nephrologists’ practice. There are many obvious causes of hypokalemia such as diarrhea, vomiting or diuretics abuse. Other causes such as tubulopathies are rarely observed and their diagnosis is more challenging. There are many inherited and acquired tubulopathies causing hypokalemia, sometimes severe and life-threatening. We report a case of a middle aged female patient who presented with weakness of upper and lower limbs, muscle pain and oliguria. On evaluation, she had hypokalemia, hypomagnesemia, metabolic alkalosis and hypocalciuria and diagnosis of Gitelman syndrome was established. In addition, she had acute kidney injury (AKI ) due to rhabdomyolysis secondary to hypokalemia. A short review on the etiology, pathogenesis and management of Gitelman syndrome is presented.</p> <p>J MEDICINE JUL 2020; 21 (2) : 105-108</p> Richmond Ronald Gomes Diapankar Kumar Basak Akmat Ali ##submission.copyrightStatement## 2020-11-09 2020-11-09 21 2 105 108 10.3329/jom.v21i2.50215 T-cell Lymphoblastic Leukaemia/Lymphoma Presenting as Bilateral Renal Enlargement and Arthritis: A Rare Case Report <p>Lymphoma usually presents as painless enlargement of lymph nodes with or without systemic symptoms like fever, weight loss, night sweats, itching and hepatosplenomegaly. But renal enlargement and arthritis as initial manifestations of lymphoma are very uncommon and poses a potential diagnostic challenge. Renal manifestations of lymphoma are usually nonspecific hematuria, fever, flank pain and oliguria. Pathological data are scanty in this regard; few reports indicate that it has a very poor prognosis. Here we described a case of lymphoma presented with bilateral palpable kidneys, pyrexia and arthritis. Initially diagnosis was confused as renal dysfunction was absent and also the condition is rare. However, strong clinical suspicion along with radiological and histopathological evidence as well as immunophenotyping tests helped to diagnose the case as T-cell lymphoblastic leukaemia/lymphoma.</p> <p>J MEDICINE JUL 2020; 21 (2) : 109-112</p> Md Minhaj Uddin Bhuiyan Rajib Bhowmic Md Shahriar Siddiki Md Kamrul Hasan Patwari Sarmistha Biswas ##submission.copyrightStatement## 2020-11-09 2020-11-09 21 2 109 112 10.3329/jom.v21i2.50216 Aeromonas Hydrophilia as a Rare Cause of Septic Arthritis in a Hemodialysis Patient <p>Septic arthritis usually represents a direct invasion of joint space by various microorganisms, most commonly caused by bacteria. Most of the time, it is caused by Staphylococci spp. or Streptococci spp. This is a case of a 70-year-old Chinese man with underlying end stage renal failure on regular hemodialysis who presented with recurrent right shoulder pain and swelling. He was diagnosed with right shoulder septic arthritis whereby arthrotomy was performed. Intra-operative tissue specimen from his right shoulder grew Aeromonas hydrophilia which was susceptible to ceftriaxone, cefepime, ciprofloxacin, gentamicin and sulfamethoxazole-trimethoprim. He was given intravenous cefepime for 21 days and discharged after treatment completed.</p> <p>J MEDICINE JUL 2020; 21 (2) : 113-116</p> Saarah Huurieyah Wan Rosli Chuan Hun Ding Asrul Abdul Wahab ##submission.copyrightStatement## 2020-11-09 2020-11-09 21 2 113 116 10.3329/jom.v21i2.50217 A Case Report of Vascular Ectasias of GI Tract Presenting as Occult Gastro-Intestinal Bleed Diagnosed on Capsule Endoscopy <p>Abstract Not Available</p> <p>J MEDICINE JUL 2020; 21 (2) : 117-118</p> Santosh Hajare Suhas M ##submission.copyrightStatement## 2020-11-09 2020-11-09 21 2 117 118 10.3329/jom.v21i2.50218 42-Year-Old Patient With Severe COVID-19 Pneumonia and Cytokine Storm: Hurdles During Management <p>A middle aged man presented with fever for 14 days, dry cough for 10 days and shortness of breath for 6 days. He tested positive for RT-PCR for COVID-19 on 5<sup>th</sup> day of illness. Patient was maintaining home isolation until he developed shortness of breath. After hospitalization patient was treated with standard dose of Remdesivir, dexamethasone and antibiotics. But his oxygen demand was increasing day by day. Inflammatory markers including serum ferritin, CRP level was also increasing. Patient was having a cytokine storm. At this point of treatment anti IL6 Tocilizumab was being considered. But patient’s wellbeing was improved and tocilizumab was not given. Our patient gradually recovered from severe COVID-19 pneumonia and cytokine storm without tocilizumab.</p> <p>J MEDICINE JUL 2020; 21 (2) : 119-122</p> Maksudul Islam Mazumder Sumaiya Akter Halima Sadia Ishrat Binte Reza M Zahir Uddin HAM Nazmul Ahasan ##submission.copyrightStatement## 2020-11-09 2020-11-09 21 2 119 122 10.3329/jom.v21i2.50219 Haemophagocytic Lymphohistiocytosis Associated with Dengue Fever - A case series <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. Dengue induced hemophagocytic lymphohistiocytosis (HLH) is a serious condition and may prove fatal if not detected early and treated appropriately. Diagnosis of HLH is challenging and usually missed as clinical and laboratory findings are nonspecific. It should be suspected with prolonged fever beyond seven days associated with splenomegaly, hyperferritinemia, worsening cytopenias and development of multiorgan dysfunction. A proportion of patients recovered with supportive therapy, however most required interventions with corticosteroids, intravenous immunoglobulin or chemotherapy. We report 3 cases of dengue associated HLH . Among them 2 patients were treated with steroid with good outcome, and one died from MODS.</p> <p>J MEDICINE JUL 2020; 21 (2) : 123-126</p> Quazi Tarikul Islam Hirinmoy Barman Sagor Tasmina Chowdhury Tuli ##submission.copyrightStatement## 2020-11-09 2020-11-09 21 2 123 126 10.3329/jom.v21i2.50220 Dysphagia Even for Barium Swallow, What’s Next? <p>Abstract Not Available</p> <p>J MEDICINE JUL 2020; 21 (2) : 127-128</p> Muhammad Nuaim Ishak Irfan Mohamad Nik Fariza Husna Nik Hassan ##submission.copyrightStatement## 2020-11-09 2020-11-09 21 2 127 128 10.3329/jom.v21i2.50221