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Introduction: Obstructive jaundice is frequently encountered worldwide including Bangladesh. Therapeutic Endoscopic Retrograde Cholangiopancreatography (ERCP) is one of the procedures to manage obstructive jaundice. Objectives: To ascertain the outcome of obstructive jaundice patients who underwent ERCP. Materials and Methods: It was a hospital based cross sectional observational study, carried out in Gastroenterology Department of Combined Military Hospital (CMH) Dhaka from May 2017 to May 2019. Total 200 patients were included in the study. Verbal consents were taken from patients. Data were collected with a checklist and analyzed by using SPSS 20. Results: Total 200 patients’ mean age±SD was 56.5±14.5 years with range 21 to 92 years and majority were 41 to 60 years 80(40%) followed by 61 to 80 years 78(39%). Etiology of obstructive jaundice were, benign 137(68.5%) and malignant 63(31.5%). Among the benign: 69(34.5%) were choledocholithiasis, 45(22.5%) biliary stricture, 20(10.0%) papillary stenosis and 3(1.5%) biliary warms. Among the malignant: 24(12.0%) were distal cholangiocarcinoma, 21(10.5%) periampullary tumors, 10(5.0%) Klatskin tumor, 4(2.0%) carcinoma head of pancreas, and 4(2.0%) other malignancy. Mean serum bilirubin level 17.6 mg/dl with minimum 0.6mg/dl, maximum 41.3mg/dl; mean alkaline phosphatase (ALP) level 351.4U/L with minimum 111U/L and maximum 1262U/L; mean alanine aminotransferase (ALT) level 118.8 U/L with minimum 28 U/L, maximum 521 U/L; ERCP were successfully done in 188(94.0%) patients with single attempt 171 (85.5%), repeated sessions 17(8.5%) and 12(6.0%) patients unsuccessful ERCP; complications occurred in 17(8.5%)patients, of whom post-ERCP pancreatitis 9(4.5%) and post procedure cholangitis 4(2.0%)patients. Conclusion: Benign etiologies of obstructive jaundice were more common than malignant one. Both benign and malignant etiology of obstructive jaundice can be successfully managed with ERCP with few complications. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 27-30

Introduction: Diverse manifestation of recent dengue outbreak has posed a challenge to pre-existing nature of dengue virus infection and management. This study was designed to observe clinicopathological profile and analyze the diverse presentation and outcome of dengue syndrome in recent outbreak in Bangladesh. Methods: This was a hospital based observational study, carried out in Medicine department of Combined Military Hospital (CMH) Dhaka cantonment in between May and September 2019. Total 300 laboratory-confirmed dengue cases aged more than 11 years presenting within 7 days of symptom onset were studied. Patients who presented 7 days after the onset of symptoms or those who were transferred to other hospitals were excluded from study. Results: Total patients were 300 with male predominance (187, 62.3%) and mean age±SD was 37.6±7.5years with age range 12 to76 years; common presentations were fever (300, 100%),headache (265, 88.3%), skin rash (197, 65.7%), bodyache (186, 62.0%),vomiting (152, 50.7%), diarrhoea (65, 21.7%),abdominal pain (58, 19.3%), and bleeding manifestation (36, 12.0). Eighty four (28%) patient had classical dengue fever (DF), 61 (20.3%) had dengue haemorrhagic fever (DHF), 45(15%) had dengue shock syndrome (DSS) and 110(36.7%) had expanded dengue syndrome(EDS). Relevant investigations showed 157(52.3%) patients had leukopenia,18(6%) had leukocytosis, 254(84.7%) had thrombocytopenia with lowest platelet count 1x109/L,135(45%) had abnormal ALT, 110(36.7%) had abnormal AST, 84(28%) had hyponatraemia,43(14.3%) had AKI,125(41.7%) had pleural effusion with 36(12%) bilateral;102(34%) had ascites, 25(8.3%) developed acalculous cholecystitis;7(2.3%) patient developed cerebrovascular accident. Eighteen (6%) patients required mechanical ventilation and 15 (5%) patients required haemodialysis. Regarding outcome, 5 (1.7%) patients died and 295 (98.3%) patients survived. Conclusion: Dengue fever was presented with common as well as other features and involved a number of organs including liver, kidneys, brain, pleura, peritoneum, and gall bladder and had diverse manifestations and adverse outcome. J Bangladesh Coll Phys Surg 2021; 39: 213-219

Introduction: Vitamin D deficiency or insufficiency is a worldwide problem including Bangladesh. It is common in Rheumatological diseases. Objectives: To find outthe clinical correlation of serum Vitamin D level with Rheumatological diseases. Materials and Methods: This was a hospital based case control study. It was conducted in Rheumatology department of Combined Military Hospital Dhaka. Total 100 patients having Rheumatological diseases and 100 age and sex matched healthy control were included in the study. Data were collected from face to face interview, clinical examination and relevant investigation reports and processed with SPSS version 20 and obtained in tables and charts. Results: Among 100 study patients’Osteoarthritis (OA) were 24(24.0%), Rheumatoid arthritis (RA) 20(20.0%), SLE 16(16.0%), Osteoporosis 16(16.0%), Ankylosing spondylitis (AS) 10(10.0%), Chikungunya arthritis (CS) 4(4.0%)and other arthritis 10(10.0%). Among patients group 84(84.0%) had vitamin D deficiency/ insufficiency, of whom OA were 20(23.80%), RA 16(19.04%), SLE 16(19.04%), osteoporosis 14 (16.66%),AS 8(9.52%), CS 2(2.38%) and other arthritis 8(9.52%).Abnormal vitamin D level were in SLE 16(100.0%), osteoporosis 14(87.50%), OA20(83.33%), RA(80.0%), AS 8(80.0%), CS 2(50.0%), and other arthritis 8(80.0%).In study patients, 60 had adequate sun exposure of whom 48(72.07%) had low serum vitamin D level and 40 had inadequate sun exposure of whom 36 (90.0%) had low vitamin D level that reflects sunlight exposure affects vitamin D status.Abnormal serum vitamin D level was more common in Rheumatological diseased patients than healthy group (p

Background: Acute pancreatitis is an important cause of morbidity and mortality among gastrointestinal disorders. But little is known about etiology and clinical profile in Indian population. Objective: To know clinicopathological profile, etiology and outcome of acute pancreatitis in study patients. Material and methods: This observational cross-sectional study was conducted in a tertiary care and research hospital in New Delhi India from May 2018 to November 2018. Total 30 established cases of acute pancreatitis were included in the study. Data were collected and processed by using SPSS version20 and result was obtained in tables and diagrams. Results: Among 30 patients, 21(70%) were male and 9(30%) female; 18 to 89 yrs of aged patients were included in the study with mean age 41.6±17.5 years, of 18-30 years of aged patients were more affected (10, 33.3%); patients of different occupation were studied;26(86.7%)patients were non-smoker and 4(13.3%) smoker; 16(53.3%) were non-alcoholic and 14(46.7%) patients had a habit of alcoholism of whom, all were male; patients who used to take e”5 units of alcohol per day were frequently affected (10, 71.4%) by acute pancreatitis, though it did not spared occasional drinkers (2, 14.3%);22(73.3%) patients had interstitial pancreatitis and 8(26.7%) had acute necrotizing pancreatitis;14(46.7%) patients had acute pancreatitis due to alcohol, 10 (33.3%) patients had gall stone, 2(6.7%) patients developed pancreatitis after ERCP;29(96.7%) patients presented with abdominal pain, 28 (93.3%) had vomiting, 21 (70%) patients had jaundice, 10 (33.3%) had fever, 18 (60%) patients had anemia, 17 (56.7%) patients develop ascites, 19 (63.3%) patients develop pleural effusion, 7(23.3%) patients developed ileus, and 3(10.0%) patients developed circulatory shock; 25(83.3%) patients developed organ dysfunction during in hospital care, of whom 11(36.7%) patients had transient and 14(46.7%) had persistent organ dysfunction; 5(16.7%) patients were complicated with pseudocyst, 6(20%) had walled of necrosis (WON), 7(23.3%) developed sepsis, 14(46.7%) developed renal dysfunction, 23(76.7%) developed hepatic dysfunction, 8(26.7%) developed respiratory dysfunction, 6(20%) developed pneumonia; 8(26.7%) patients had been suffering from different comorbidity; ultrasound of abdomen were abnormal in all 30(100%) patients; As per CTSI score, severe pancreatitis 14(46.7%), moderate pancreatitis 14(46.7%) and mild pancreatitis 2(6.7%); 24(80%) patients received only medical treatment and 6(20%) patients needed surgical or radiological intervention; 19(63.3%) patients were improved symptomatically, 8(26.7%) patients were cured and 3(10%) patients died during in hospital care. Conclusion: Alcohol was the predominant etiology of acute pancreatitis, mostly affecting young and middle aged male, but mortality was more in gall stone related pancreatitis. Hepatic dysfunction was observed frequently that may attribute to effect of chronic alcohol abuse. J Bangladesh Coll Phys Surg 2020; 38(2): 86-92

Pernicious anaemia often poses diagnostic and therapeutic challenges to the clinician. Herein, we representing a 55 years old lady who presented with anaemia along with its classical symptoms and features of peripheral neuropathy due to Pernicious anaemia associated with Psoriasis and Arthropathy without any association of other autoimmune disorder. She had all objective evidences of autoimmune atrophic gastritis in gastric fundic biopsy and positive anti-intrinsic factor antibody. Treatment with injection vitamin B12 improved the condition rapidly. JAFMC Bangladesh. Vol 15, No 2 (December) 2019: 243-245

Dandy–Walker malformation (DWM) is a group of congenital human brain malformation with specific characteristics. It may be associated with a number of other organ malformation including heart, eye, and thyroid glands. In our case, DWM was associated with heart malformation in the form of patent ductus arteriosus (PDA) and was complicated by atrial fibrillation. The case was established by computed tomography of brain, echocardiography and electrocardiography. The patient was asymptomatic until 7 years of age.J Bangladesh Coll Phys Surg 2018; 36(3): 128-131

Childhood type 2 Diabetes Mellitus (DM) has increasingly been reported worldwide. It is commonly associated with childhood obesity.It may be presented with classical manifestation of DM such as polyuria, polydipsia, weight lossor acute complications like Diabetic ketoacidosis (DKA), Hyperglycemic Hyperosmolar State (HHS) or features of insulin resistance syndrome. Many a cases it may remain asymptomatic and hence undiagnosed.So,overweight children and adolescents who met screening criteria such as family history of type 2 DM, signs of insulin resistance, and high risk ethnics should undergo screening. Emphasis should be given on early diagnosis and optimum management plan to avoid grave consequences of it in early part of life. Diagnosis of type 2 Diabetes Mellitus in children should be done on the basis of standard diagnostic criteria such as American Diabetic Association (ADA) criteria. Both non-pharmacological and drug management are important equally. Multidisciplinary team approach including self-management plan is mandatory for obtaining optimal therapeutic goals of type 2 DM in children and adolescents. Lifestyle modification, dietary intervention, weight reduction, patient education, psychological support, and oral anti diabetic drugs and insulin therapy should be included in comprehensive diabetic management plan. Complications of type 2 DM should be minimized by all means with strict glycemic control and management of co-morbidity if any. Emphasis should also be given on prevention of type 2 DM by adopting a healthy lifestyle characterized by healthy eating behavior, regular physical activity and subsequent modest weight loss that can prevent the progression of impaired glucose tolerance to clinical diabetes mellitus.J Bangladesh Coll Phys Surg 2017; 35(1): 24-30

Background: Breastfeeding reduces incidence of common childhood illnesses such as diarrhea and thus reduces infant mortality and morbidity.Objective: To find out the incidence of diarrhea in breastfed versus formula fed baby. Methodology: An observational cross sectional study was carried out in the Pediatric department of Northern private medical college hospital, Rangpur from March 2013 to June 2014. Total 150 children aged 1 to 24 months having diarrhea were enrolled in the study.Result: Mean age of children was 11.6 with SD ±5.29 months, ranges from 1 month to 23 months in which exclusively breast fed 51.3%, breast fed plus formula fed 39.3%, exclusively formula fed 9.4%; single attack of diarrhea occurred in 72.7%, 40.7%, and 28.6% children in exclusively breast fed, breast fed plus formula fed and exclusively formula fed children respectively. Frequent attack of diarrhea occurred in 27.3%, 59.3% and 71.4% children in exclusively breast fed, breast fed plus formula fed and exclusively formula fed children respectively; among 59 patients who developed first attack of diarrhea by 6 months of age, 10.2%, 69.5 % and 20.3% were from exclusively breast fed, breast fed plus formula fed and exclusively formula fed children respectively. Patients who developed first attack of diarrhea by 7-12 months of age, 69.8% were from exclusively breast fed, 27.0% from breast fed plus formula fed and 3.2% from exclusively formula fed children. But 28 children whose first diarrhea occurred by 13-24 months of age, 96.4% and 3.6% were from exclusively breast fed, and breast fed plus formula fed group respectively.Conclusion: Breast feeding reduces incidence of diarrhea, prevents frequent attack and early occurrence of diarrhea in under two children.J Bangladesh Coll Phys Surg 2016; 34(1): 21-25

Marshall Syndrome PFAPA (Periodic Fever, Aphthous Stomatitis, Pharyngitis, Adenitis) Syndrome is a chronic condition, typically starting 2-5 years old, in which fever occurs periodically (lasts for 3-7 days), accompanied by aphthous-like ulcers, pharyngitis and/or cervical adenitis. The patients have no clinical symptoms between episodes and it is required to exclude all other diseases before confirming the diagnosis. The dramatic response to treatment with steroid helps diagnosing PFAPA. We are presenting the case of an 8 years male patient, with the history of recurrent episodes of fever (onset at the age of two), oral ulcer and difficulty in deglutition who constantly received antibiotic therapy and or antifungal prescribed by different doctors. Clinically the patient was febrile, mildly pale, cervical lymphadenopathy, aphthous ulcers in the tongue with inflamed tonsils, covered with thick exudates and pharyngeal wall was inflamed and folliculated. There was just palpable liver. Laboratory investigations performed but it was without serological confirmation. Throat swab culture was negative. The child received steroid (Prednisolone) with favorable outcome. Subsequently, the patient presented with similar episodes of fever which disappeared within 24 hours of single dose of prednisolone. After Ranitidine (H2 blocker) prophylaxis the patient remains asymptomatic for about one and half years. With our best knowledge this is the first case report of Marshall Syndrome or PFAPA Syndrome in Bangladesh.J Bangladesh Coll Phys Surg 2016; 34(4): 222-224

not availableJ Bangladesh Coll Phys Surg 2014; 32: 112-113