Search

Background: Anemia during pregnancy is associated with adverse outcomes. Prevalence of anemia is thought to be high in developing countries. This study was aimed at determining the prevalence and socio-demographic and reproductive factors associated with anemia among a group of pregnant mother. Methods: This cross-sectional observational study was conducted on pregnant women who visited the antenatal clinic of Combined Military Hospital (CMH), Savar, Dhaka from January 2017 to December 2019. Hemoglobin level was measured in all these women to assess the presence of anemia and was categorized according to the World Health Organization (WHO) criteria. Demographic data and information on maternal age, gestational age, educational and income level, and socioeconomic status were collected from anemic pregnant women and were analyzed. Results: Out of 1500 pregnant women 525 (35%) were found to be anemic (Hemoglobin

Coronavirus disease 2019 (COVID-19) is a contagious respiratory and vascular disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). First identified in Wuhan, China, it has caused an ongoing pandemic. Some viruses give us lifelong immunity after first infection and initially researchers thought that SARS-CoV-2 infection may give lifelong immunity after first infection but few cases of reinfection are reported both locally and internationally. We report 3 symptomatic cases of reinfection, diagnosed clinically and confirmed by positive reverse transcriptase polymerase chain reaction (RT-PCR) for SARS-CoV-2. So, everybody who survived an infection of SARS-Cov-2, should maintain universal masking and social distancing. Birdem Med J 2020; 10, COVID Supplement: 107-110

Norwegian scabies is characterized by hyperkeratotic, heavily scaling, crusted lesions rarely presents as exfoliative dermatitis (erythroderma). This term applies when 90% or more of the skin surface is involved by scabies. A 75-year-old woman having uncontrolled diabetes mellitus and hypertension was admitted in BIRDEM general hospital with generalized erythroderma for 6 months and high fever along with vomiting for 4 days. Clinical and laboratory findings were suggestive of severe sepsis with septic shock, which were being managed by supportive medications. Microscopic examination of scales and crusts dissolved in 10% KOH revealed fields teeming with scabies mites and eggs. A skin biopsy was planned but could not be done due to critical condition of the patient. Despite of all supportive measures, patient expired due to septic shock before starting definitive treatment of Norwegian scabies. Birdem Med J 2020; 10(3): 215-217

This study proposes a prediction model to evaluate the failure bond strength of the untreated and epoxy-treated reinforcement bars having a wide range of bar diameter (Db), bar length (Lb), coating thickness (Cw) and the compressive strengths of concrete (f′c). In order to achieve the stated objective, a total of 462 records were collected, compiled, and prepared an extensive database from the past experimental studies. Various regression models were performed between the four independent variables Db, Lb, Cw and f′c and the response variable of the failure bond force of reinforcement (Pf). Using the statistical significance and the diagnostics of the validation of all models, the empirical equation that represented the best fit to the data points was proposed. The study revealed that the predicted bond strength showed a very good correlation with R2 of 94.45% and 93.35% with the experimental values for the training (304 data records) and validation (158 data records) datasets, respectively. Further rationalization of the model proposed herein was also investigated using the experimental data of three existing studies, and the results reconfirmed the similar conclusion; the proposed empirical equation was capable of predicting the failure bond force of untreated and epoxy treated reinforcement.

Background: Threatened abortion is the most common complication in the first half of gestation. Spontaneous abortion occurs in less than 30% of the women who experience threatened abortion. In order to prevent pregnancy loss several supportive therapies including hormonal therapy like human chorionic gonadotropin (hCG) or 17-alpha-hydroxyprogesterone (progesterone) have been advocated. The exogenous administration of hCG is aimed at stimulating and therefore optimizing progesterone production. Aim of this study was to compare the efficacy of supportive therapy with hCG and progesterone in women with threatened abortion. Methods: This prospective study was carried out in the department of obstetrics and gynecology of the Combined Military hospital (CMH), Savar, Dhaka, Bangladesh from July 2016 to June 2017. One hundred pregnant patients admitted with the history of per vaginal bleeding before 20 weeks of gestation without having any other co-morbidity were included in this study. Patients were randomized to two treatment groups. The participants in group A (52, 52%) received injection hCG weekly while those in group B (48, 48%) received injection progesterone from recruitment up until 20 weeks of gestation. Further USG were performed one week and four weeks after recruitment to the study and again at 20 weeks and subsequently when indicated. The final outcome of pregnancy were recorded and analyzed. Results: Among 100 patients majority belonged to the 26-30 year age group. Mean age of the patients was 27.2±10.5 years. There was not much significant difference between the groups in terms of parity. More than 75% of patients in both the groups presented before 16 weeks of gestation with threatened abortion. In both the groups more than 75% of the patients had previous history of pregnancy loss. In terms of pregnancy outcome more patients in hCG group had live pregnancy than progesterone group (88.5% vs 66.7%) (p=0.012). Out of 46 live birth in hCG group, 4 (7.7%) were preterm labor between 31-35 weeks of pregnancy and one baby died in neonatal ICU, one died at 31 weeks of gestation which was delivered by vaginally. On the other hand out of 32 live birth in progesterone group, there was 3 (6.3%) preterm labor. Growth retardation was less in hCG group compared to progesterone group (9.6% vs 14.6%). However cesarean section rate was high in both the groups. Conclusion: Treatment with injection hCG has better pregnancy outcome than that of injection17-alphahydroxyprogesterone in early pregnancy with threatened abortion of unexplained cause. Birdem Med J 2019; 9(1): 7-10

Purpose: Exudative pleural effusion usually indicates an underlying pulmonary pathology. Sometimes etiological diagnosis of exudative pleural effusion is difficult despite cytological, biochemical and microbiological tests. Aim of present study was to make an etiological diagnosis of exudative pleural effusion by pleural biopsy.Methods: This cross-sectional observational study was performed from January 2012 to December 2014 in the Department of Internal Medicine & Pulmonology of BIRDEM General Hospital, Dhaka, Bangladesh. A total of 51 patients with exudative pleural effusion in whom the diagnosis was uncertain after routine biochemical, cytological and microbiological evaluation of pleural fluid were included in the study. These patients underwent pleural biopsy by Abram’s needle and histopathology was done to determine the etiology of pleural effusion.Results: Majority (74.5%) of the patients were male. Mean age of the patients was 52.7±16.0 years. Most (52.9%) patients had right sided pleural effusion. Histopathology report of the pleural biopsy showed granulomatous inflammation compatible with tuberculosis (TB) in 15 (29.4%), metastatic malignancy in 10 (19.6%) and chronic inflammation in 9 (17.6%) cases. In 17 (33.3%) cases the histopathology did not reveal any abnormality. Among 10 cases of metastatic malignancy, most (7, 70%) were adenocarcinoma. Compared to malignancy cases, TB cases were younger in age (Mean age: TB - 45.0±17.9 vs malignancy - 61.8±13.0 years). Pleural fluid was straw color in all (100%) cases of TB and hemorrhagic in almost all (90%) cases of metastatic malignancy (p 0.000). Mean value of pleural fluid protein (59.1±4.8 vs 47.3±4.2 gm/L; p 0.003), lactate dehydrogenase (LDH) (917.3±219.3 vs 464.3±112.3 U/L; p 0.101), adenosine deaminase (ADA) (39.0±3.7 vs 15.615.6±2.3 U/L; p 0.016), total leukocyte count (1039.3±776.8 vs 439.2±138.2 cells/cmm; p 0.328) and lymphocyte percentage (94.4±4.3 vs 68.3±9.3; p 0.003) were all raised in TB compared to metastatic malignancyConclusions: Pleural biopsy was definitive diagnostic in almost half the patients with exudative pleural effusion. Tuberculosis was more common than malignancy particularly in young persons. Pleural fluid protein, LDH and ADA are significantly raised in TB compared to malignancy.Bangladesh Crit Care J March 2017; 5(1): 33-36

Rifampicin is one of the most effective antitubercular agents. Among its rare adverse effects, acute interstitial nephritis is noteworthy. Furthermore, exfoliative dermatitis caused by rifampicin is quite uncommon. Simultaneous occurrence of the both complications in the same patient has not been reported so far. Here we describe a case history of a 76-year-old male who developed rifampicin induced acute interstitial nephritis and exfoliative dermatitis at the same time.Birdem Med J 2017; 7(2): 168-171

Background: Diabetes mellitus (DM) is an immunosuppressive condition and uncontrolled diabetes is associated with increased susceptibility to various infections like pneumonia. Community acquired pneumonia (CAP) in diabetic patients is often caused by more virulent or atypical organisms and associated with increased resistance to conventional antibiotics. The aims of this study were to identify the bacterial etiology of CAP in patients with DM and to see their antibiotic sensitivity pattern.Methods: This was a cross-sectional, observational study conducted in the Department of Internal Medicine & Pulmonology of BIRDEM General Hospital, Dhaka, Bangladesh, from January 2013 to December 2015. A total of 120 hospitalized diabetic patients diagnosed with CAP and with a positive sputum culture growth of any bacteria were included in the study.Results: Majority (67%) of the patients were male. Mean age of the patients was - 55.69 ±10.5 years. Mean duration of diabetes was - 7.35 ±1.3 years. Mean HbA1c was - 8.6 ±1.89%. Sputum for culture showed that out of 120 (100%) patients, Klebsiella pneumoniae was detected in 53 (44.2%) patients, Staphylococcus aureus in 18 (15.0%), Pseudomonas species in 16 (13.3%) patients, Acinetobacter in 10 (8.3%), Escherichia coli in 9 (7.5%) patients and 14 (11.7%) patients had growth of other organisms. Sensitivity pattern of different bacterial growth in sputum to commonly used antibiotics like ceftriaxone, ciprofloxacin, amikacin and imipenem were as follows – Klebsiella (19%, 47%, 74%, 96% respectively), Staph aureus (11%, 33%, 78%, 67% respectively), Pseudomonas (19%, 75%, 81%, 88% respectively), Acinetobacter (0%, 0%, 20%, 50% respectively), E. coli (22%, 22%, 100%, 100% respectively). All (100%) of the Pseudomonas and Acinetobacter were sensitive to colistin. Most of the growth of all the bacteria (Klebsiella 94%, Staphylococcus 78%, Pseudomonas 81%, Acinetobacter 100%, E. coli 100%) occurred in patients with poor glycemic control (HbA1c ? 7.0%).Conclusion: This study results suggest that CAP in diabetic patients are more frequently due to Klebsiella pneumoniae, Staphylococcus aureus and Pseudomonas species and mostly they are less sensitive to commonly used antibiotics like ceftriaxone and ciprofloxacin. So, whenever possible, treatment of CAP should be guided by sputum culture and sensitivity test and for empirical treatment of CAP in diabetic patients, alternative antibiotics like imipenem and amikacin should be considered.Birdem Med J 2017; 7(2): 101-105

Background: Tuberculosis (TB) is a major public health problem in Bangladesh. This study aimed to evaluate the current status of the knowledge, attitude, and health-seeking practice regarding TB amongst diabetic patients.Methods: This cross-sectional study was done in the Pulmonology OPD of Department of Internal Medicine, BIRDEM, 750 bedded Specialized Diabetic Tertiary Care hospital, Dhaka, Bangladesh from January to December 2015.Results: Out of 420 subjects (mean ±SD, age 51±12 years), 51% were male. Regarding educational status, 42% had primary and 34% had secondary education, while 12% graduated and 12% never attended school. More than half of the subjects belonged to the lower-middle income group. The proportion of poor, average and good score for knowledge were 19%, 66% and 15%, attitude 6%, 42% and 52% and for practice 11%, 82% and 7% respectively.Conclusion: Co-ordinated educational campaign with prioritized focus for poorer and less educated people needs to be considered for reducing tuberculosis transmission and better outcome with special attention to diabetic population.Birdem Med J 2017; 7(2): 127-131

Background: Urinary tract infections (UTIs) are common during pregnancy. Untreated asymptomatic bacteriuria (ASB) during pregnancy may cause serious complications including pyelonephritis and delivery of premature or low-birth-weight infants. This study aimed to assess the risk factors for asymptomatic bacteriuria, bacterial agents and their antibiotic susceptibility pattern in pregnant women attending in Combined Military Hospital (CMH), Dhaka.Methods: This cross-sectional study was conducted in a total of 1540 pregnant women with no signs and symptoms of UTI from October 2013 to March 2015. Clean catch mid-stream urine samples were collected from all study participants using sterile containers. Urine samples were cultured using standard bacteriological methods. Identification of suspected colonies and antibiotic sensitivity testing were done. Patients having ASB were further evaluated to find out associated risk factors.Results: Out of 1540 pregnant women, 254 (16.5%) had asymptomatic bacteriuria (Colony forming unit >105/mL).The most frequently isolated bacteria were Escherichia coli (E. coli) (50.4%), followed by Klebsiella (24.0%). The antibiotic sensitivity rate of bacterial isolates were highest for imipenem and amikacin. Among different associated conditions, anemia (16.5%), gestational diabetes mellitus (GDM) (10%) and past history of UTI (5.1%) were found to be the most frequent factors associated with increased prevalence of ASB.Conclusion: In this study, the prevalence of ASB was high among pregnant women with anemia, GDM and past history of UTI. E. coli was the most common organism causing ASB, which is less susceptible to conventional oral antibiotics but more susceptible to imipenem and amikacin. So, careful drug selection is required for successful outcome in ASB.Birdem Med J 2016; 6(2): 79-83

Background: Fiber-optic bronchoscopy (FOB) is an invasive procedure performed to identify possible endobronchial lesions. Diabetic patients often present with non-resolving pneumonia and collapse, many of whom are elderly and smoker; thus always giving rise to the suspicion of malignancy.Methods: This observational study was performed from March 2009 to August 2013 in the Department of Internal Medicine and Pulmonology of BIRDEM General Hospital, Dhaka, Bangladesh; a 500 bedded tertiary care hospital dealing mostly with diabetic patients.Results: Out of 160 diabetic patients 126 (78.7%) were male, 34 (21.3%) were female. Mean age of the patients was – 57.2 ±10.8 years. The indications of bronchoscopy were collapse (38, 23.8%), non-resolving consolidation (55, 34.4%), mass lesion (38, 23.8%), hemoptysis (10, 6.2%) and others (19, 11.8%). Findings in the bronchoscopy were mitotic lesion (56, 35.0%), inflammatory lesion (50, 31.3%) and normal finding (54, 33.8%). Among 56 cases of mitotic lesion, bronchial biopsy was taken in 48 (85.7%) cases. Histopathology reports of bronchial biopsy were squamous cell carcinoma (18, 37.5%), large cell carcinoma (11, 22.9%), adenocarcinoma (7, 14.6%), small cell carcinoma (5, 10.4%), inflammatory lesion (4, 8.3%) and normal finding (3, 6.3%). Among 38 cases of collapse, mitotic lesion was found in 24 (63.2%) cases. Among 55 (100%) cases of non-resolving consolidation, mitotic lesion was found in 18 (32.5%), inflammation in 23 (41.8%) and normal findings in 14 (25.5%) cases.Conclusion: Bronchoscopy is an useful method to detect any endobronchial lesion in suspected cases of collapse or non-resolving pneumonia in diabetic patients and it can be the choice of investigation in non-resolving pneumonia.Birdem Med J 2016; 6(1): 18-21

Background and Aims: Urinary tract infection (UTI) is a common illness. The spectrum of bacteria causing UTI and their antibiotic sensitivity is not uniform. This study was designed to describe the bacteriological spectrum causing UTI and their antibiotic sensitivity.Methods: This cross-sectional study was done in the Department of Internal Medicine, BIRDEM General Hospital from January to June, 2013.Results: Total number of patients was 103 with females predominance (F:M ratio 2:1). Mean age was 57.5 years. Most (91.3%) of the study population were diabetic with poor glycaemic control (mean HbA1c 9.9%). Common symptoms were fever, dysuria, increased urinary frequency, suprapubic pain, vomiting and loin pain. Neutrophilic leukocytosis was common (94.2%). E. coli (79.6%) was the commonest aetiological agent followed by Klebsiella (9.7%), Citrobacter (3.9%), Acinetobacter (1.9%), Enterobacter (1.9%), Enterococcus (1.9%) and Pseudomonas (0.9%). Imipenem (100%), aminoglycosides e.g. amikacin and gentamycin and nitrofurantoin were among the most sensitive antibiotics.Conclusion: E. coli is the commonest organism causing UTI and imipenem, amikacin and nitrofurantoin are the most sensitive antibiotics.Birdem Med J 2015; 5(1): 20-23

Pregnancy in women with chronic liver disease (CLD) or cirrhosis is rare as CLD usually causes infertility. With improved management of CLD, pregnancy in patients with CLD is likely to become more common. Pregnancy in a CLD patient is likely to be associated with increased fetal and maternal mortality & morbidity. Pregnancy outcome may be influenced by the underlying etiology and extent of liver disease. Here we describe the case of a pregnancy in a young woman with CLD first time detected during pregnancy that ultimately resulted in fetal death, but the mother survived after delivery.Birdem Med J 2015; 5(2): 107-110

Background: Fever of unknown origin (FUO) is not an uncommon problem in general medical practice. Sometimes extensive investigations fail to reach an aetiological diagnosis; on the other hand, in few cases, fever resolves spontaneously. This study was aimed to evaluate the aetiology of FUO in a tertiary care setting.Methods: This cross-sectional study was done in the Department of Internal Medicine of BIRDEM General Hospital, Dhaka, Bangladesh from July 2012 to June 2013.Results: Among the 33 patients studied (1.23% of total admissions), 22 (66.7%) were male. Mean age of the study population was 40.2±7.9 years. Most patients (84.8%) were diabetic. Infection (20, 60.6%) was the commonest cause, followed by malignancy (9, 27.3%). Among the infective causes (20), extra-pulmonary tuberculosis (5, 25%) was the commonest, followed by liver abscess (4, 20%). Other less common causes were Kala-azar (1), malaria (2), histoplasmosis (2), melioidosis (1), cholecystitis (1), renal abscess (1), rickettsial fever (1), apical dental abscess (1) and infective endocarditis (1). Non-Hodgkin’s lymphoma (6), renal cell carcinoma (2) and hepatocellular carcinoma (1) constituted the malignant causes of FUO in this series. Systemic lupus erythematosus was the aetiology of FUO in 1 case. One case remained undiagnosed and 2 patients left hospital before a definite diagnosis could be made.Conclusion: Extra-pulmonary tuberculosis and non-Hodgkin’s lymphoma were the two most common causes of FUO in this study. Repeated history taking, clinical examinations and careful stepwise investigations can diagnose the aetiolgy in most cases of FUO.Birdem Med J 2016; 6(1): 7-11

Background: Elevated level of serum alanine aminotransferase (ALT) is not uncommon in routine laboratory test. This study was aimed to find out the aetiology of asymptomatic raised ALT in hospitalized type 2 diabetes mellitus (T2DM) patients Methods: This cross-sectional study was done in BIRDEM over a period of six month. T2DM patients having asymptomatic raised serum ALT were evaluated clinically and by laboratory tests.Results: Total number of patients was 53. Among them male were 39 and female were 14. Male and female ratio was 2.8:1. Mean age was 49.2±7.9 years. Mean body mass index (BMI) was 25.5±5 kg/m2. Among the study subjects, 25 (47.2%) were overweight and 16 (30.2%) were obese. Hypertension, hepatomegaly and dyslipidaemia were present in 29 (54.7%), 11 (20.8%) and 36 (67.96%) cases respectively. Non-alcoholic fatty liver disease (NFALD) was the commonest (37, 69.8%) aetiology for raised ALT in this study. Seropositivity for hepatitis B virus (HBV) surface antigen (HBsAg) and antibody against hepatitis C virus (anti-HCV) were present in 7 and 5 cases respectively. In 4 cases cause could not be identified. Most of the cases with >5 times raised ALT had hepatitis B or C infection.Conclusion: Elevation of serum ALT is common in T2DM patients. NAFLD is the commonest cause followed by hepatitis B and C virus infection.Birdem Med J 2016; 6(1): 32-35

Background and Objective: Biochemical evidence of hepatic enzyme rise is very common in dengue fever. This study was designed to see the levels of elevated hepatic enzymes and their correlation with severity of dengue fever (DF).\Materials and Methods: It was an observational study conducted in the Department of Internal Medicine of BIRDEM Hospital, Dhaka, over a period of six months (July to December, 2010). Fifty serologically confirmed (IgM/IgM and IgG) dengue fever patients were included in the study.Results: Of the 50 patients, 32 (64%) were male and 18 (36%) were female. The mean age was 44.2 (21-54) years. Out of 50 cases, 23 (46%) cases had classical dengue fever, 20 (40%) had dengue haemorrhagic fever (DHF) Grade I, 6 (12%) had DHF Grade II and 1 (2%) had DHF Grade III. Hepatic enzymes were raised in 47 (94%) cases. Mean aspartate aminotransferase (AST) was 98.77 U/L, mean alanine aminotransferase (ALT) was 88.09 U/L. In 46 (92%) cases AST was more than ALT. Enzyme rise was more in DHF (Grade III- mean AST 298 U/L, mean ALT 232 U/L, Grade II- mean AST 212.6 U/L, mean ALT 198.7 U/L, Grade I- mean AST 97.3 U/ L, mean ALT 86.2 U/L) than classical dengue fever (mean AST 61.7 U/L, mean ALT 54.9 U/L). Mean bilirubin was 1.82 mg/dl. No difference was observed between classical dengue fever and DHF regarding serum bilirubin level.Conclusion: The above results suggest that hepatic involvement in dengue fever is common and the amplitude of transaminase rise indicates the severity of the disease.Birdem Med J 2015; 5(2): 74-77

Background: For patients with acute cholecystitis the timing of operative intervention has two broad approaches- early cholecystectomy and elective or delayed cholecystectomy. The main advantage of early cholecystectomy is that, it offers a definitive treatment during the same admission and avoids the problem of failed conservative treatment. The present study is an endeavour to discuss and to compare the outcome of management of acute cholecystitis with early and delayed cholecystectomy.Methods: 100 patients with clinical diagnosis of acute cholecystitis, admitted in the surgical wards of Gauhati Medical College and Hospital during the period of 1st July 2017 to 30th June 2018 were selected for the study. 40 patients underwent early cholecystectomy (within 7 days of onset of symptoms) and 60 patients underwent elective or late cholecystectomy (after a gap of 6-8 weeks from the acute attack).Results: In the present series the average duration of surgery was 90.37±11.96 minutes in the early group and 65.3±7.83 minutes for the elective group which is found to be statistically significant (p value

IntroductionPreterm birth is the major cause of under-five mortality. Population-based data on determinants and proportions of children born preterm are limited, especially from low-income countries. This study aimed at assessing time trends and social, reproductive and environmental determinants of preterm births based on a population-based pregnancy cohort over 25 years in rural Bangladesh.MethodsIn this cohort study in Matlab, a rural area in Bangladesh, we used data from the Health and Demographic Surveillance System from 1990 to 2014. Gestational age at birth was based on the reported last menstrual period and verified by ultrasound assessments. Preterm birth proportions were assessed within strata of social and reproductive characteristics, and time series analysis was performed with decomposition for trend and seasonality. We also determined the prevented fractions of preterm birth reduction associated with social and demographic changes during the follow-up period.ResultsAnalyses were based on 63 063 live births. Preterm birth decreased from 29% (95% CI 28.6 to 30.1) in 1990–1994 to 11% (95% CI 10.5 to 11.6) in 2010–2014. Low education, older age and multi-parity were associated with higher proportions of preterm births across the study period. Preterm births had a marked seasonal variation. A rapid increase in women’s educational level and decrease in parity were associated with the decline in preterm births, and 27% of the reduction observed from 1990 to 2014 could be attributed to these educational and reproductive changes.ConclusionThe reduction in preterm birth was to a large extent associated with the sociodemographic transition, especially changes in maternal education and parity. The persistent seasonal variation in the proportion of preterm birth may reflect the environmental stressors for pregnant women across the study period. Continued investments in girls’ education and family planning programmes may contribute to further reduction of preterm births in Bangladesh.

Tuberculosis (TB) and diabetes mellitus (DM) have synergetic relationship. People with diabetes are 2–3 times at higher risk of getting active TB disease. On the other hand, TB or anti-TB treatment may cause glucose intolerance. The dual disease of DM and TB is more likely to be associated with atypical disease presentation, higher probability of treatment failure and complications. In most of the health-care delivery systems of the world, DM and TB are managed separately by two vertical health-care delivery programs in spite of clear interaction between the two diseases. Thus, there should be a uniform management service for TB-DM co-morbidity. Realizing this situation, Bangladesh Diabetic Samity (BADAS), a nonprofit, nongovernment organization for the management of diabetes in Bangladesh, with the patronization of TB CARE II Project funded by U.S. Agency for International Development (USAID), launched a project in 2013 titled BADAS-USAID TB Care II, Bangladesh with the goal of “Integrated approach to increase access to TB services for diabetic patients.” One of the project objective and activity was to develop a national guideline for the management of TB-DM comorbidity. Thus, under the guidance of National Tuberculosis Control Program, of the Directorate General of Health Services, Government of the People's Republic of Bangladesh and World Health Organization (WHO), this guideline was developed in 2014. It is based on the existing “National Guidelines and Operational Manual for TB Control” (5th edition) and guidelines for management of DM as per WHO and International Diabetes Federations. Along with that, expert opinions from public health experts and clinicians and “Medline”-searched literature were used to develop the guidelines. These guidelines illustrate the atypical presentation of the TB-DM co-morbidity, recommendations for screening, treatment, and follow-up of these patients and also recommendations in case of management of TB in patients with kidney and liver diseases. Thus, these guidelines will be a comprehensive tool for physicians to manage TB in diabetic patients.

A middle aged woman presenting with fatigue, pruritus, xanthelesma and hepatomegaly remains the typical presentation of primary biliary cirrhosis. Here, we present a case of primary biliary cirrhosis occurring in a male patient, who presented with fatigue and pruritus, had hepato-splenomegaly, raised serum alkaline phosphatase, positive anti-mitrochondrial antibody and negative antinuclear antibody.J MEDICINE July 2015; 16 (2) : 128-131

Histoplasmosis is a mild self-limiting respiratory illness in immune-competent individuals. It disseminates in immune-suppressed states like patients with human immunodeficiency virus (HIV) infection, haematological malignancies, post transplant states and patients receiving immunesuppressive therapy. Here we report a case of disseminated histoplasmosis in a 45 year old diabetic, returning worker who presented with fever, cough, rash, oro-genital ulcer and weight loss. He was anaemic, there was crepitation on lung auscultation and hepatomegaly. Diagnostic workup revealed HIV infection with disseminated histoplasmosis. Intravenous amphotericin B was started along with other supportive therapy and for anti-retroviral therapy he was sent to a referral center. Being an uncommon condition in our perspective, we are reporting the case. DOI: http://dx.doi.org/10.3329/bjmed.v24i2.20221 Bangladesh J Medicine 2013; 24 : 78-81

Objectives: To assess the prevalence and distribution of rheumatic diseases at rheumatology clinic in a tertiary level hospital. Methods: This retrospective study was done at rheumatology clinic of BIRDEM from July 2009 to December 2012. Diagnoses were reached by using clinical criteria supplemented by necessary investigations. Results: Total number of patients was 772 with female predominance (F:M ratio of 1.3:1). Mean age was 46.9 (range 13-83) years. Majority (85.9%) were in 3rd to 6th decades. Degenerative diseases (49.9%) were most common, followed by inflammatory conditions (33.5%), soft tissue rheumatism (7%), metabolic bone disease (4.8%) and connective tissue diseases (2.5%). Rheumatoid arthritis (27.7%) was the most prevalent disease, followed by osteoarthritis of knees (26.2%) and lumber spines (23.4). Tendinitis, osteoporosis, fibromyalgia and systemic lupus erythematosus prevailed in 5.6%, 4.8%, 1.4% and 1.3% cases respectively. Common comorbidities were diabetes mellitus (87.9%), hypertension (22.2%), ischaemic heart disease (12.4%), dyslipidaemia (10.1%), fatty liver (7.9%), chronic kidney disease (6.9%) and hypothyroidism (4.5%). Commonly prescribed medications were non-steroidal anti-inflammatory drugs (93%), disease modifying anti-rheumatic drugs (28.9%) and prednisolone (10.6%). Physiotherapy was required in 13.3% cases. In 56.6% cases various combination of treatment was required. In 12% patients receiving methotrexate, adverse effects occurred. Conclusion: Degenerative joint and spine diseases were more common but as an individual disease rheumatoid arthritis was the most prevalent condition. DOI: http://dx.doi.org/10.3329/jom.v15i1.19855 J Medicine 2014; 15: 23-27

Infertility has been classified with respect to a number of parameters; prominent amongst which are time, causes, treatment cost and socio-cultural implications. The most widely accepted practical classification distinguishes between primary and secondary infertilities with a further sub classification into 3 clearly defined groups that include ovulatory dysfunction, fallopian tube compromise and male factor alongside an ambiguous and controversial group labeled as “unexplained infertility”. In infertility work-up various procedures can be carried out in isolation or in different combination, depending on the indication. Other complimentary procedures can be done when specifically required. So, with infertility in general the diagnosis of tubal infertility should be tailored to the individual patient. Here is a review on an evidence based approach to diagnose the tubal factors for infertility. Purpose of review: The investigation for potential tubal disease is an essential step in the work-up of infertility. This review article will provide an overview of evidence based diagnosis of tubal factor infertility. The different diagnostic tools will be described together with discussion of different minimal access surgical approaches. We intend to highlight the capital and central role of minimal access procedures playing in the diagnosis of tubal infertility as well as to demonstrate the positive impact it has in the fight against infertility; thus redefining the classification and pathology. DOI: http://dx.doi.org/10.3329/birdem.v4i1.18551 Birdem Med J 2014; 4(1): 33-37

Fever of unknown origin (FUO) is a diagnostic challenge for clinicians. Disorders presenting as fever of unknown origin are varied and extensive. Clinicians often find themselves hopeless with a patient with FUO and try to catch a straw by doing every conceivable test and run therapeutic trials in order to diagnose all of the myriad causes of FUO that are in fact part of the differential diagnosis of FUO in general. The main difficulty with diagnostic testing in patients with FUO is that it is unfocused. All disorders have a specific pattern of organ involvement. In a patient with FUO, there are almost always one or more clues from the history, physical examination, or nonspecific laboratory tests that suggest a particular diagnosis or at least limit diagnostic possibilities. It is worthy to remember that fever of unknown origin is more often caused by an atypical presentation of a common entity than by a rare disorder. Thus a focused diagnostic approach can minimize the miseries of both the clinician & the patient. Birdem Med J 2013; 3(1): 27-34 DOI: http://dx.doi.org/10.3329/birdem.v3i1.17124

Behcet’s disease (BD) is an inflammatory disease characterized by recurrent oral aphthous ulcers and numerous systemic manifestations. The underlying cause of Behcet’s disease is unknown. As with other autoimmune diseases, the disorder may represent aberrant immune activity triggered by exposure to an antigen, perhaps infectious, in patient with a genetic predisposition to develop the disease. Here we are reporting a case of Behcet’s disease in a 50 year old gentleman who presented with fever, recurrent oral ulcers and genital ulcer. Diagnostic workup excluded other possible diseases. Pathergy test was positive. Prednisolone was started along with other supportive therapy and patient subsequently improved. Birdem Med J 2013; 3(1): 50-53 DOI: http://dx.doi.org/10.3329/birdem.v3i1.17128

Bangladesh Journal of Medicine, Vol 24 No 1, 2013, Page 10-13 DOI: http://dx.doi.org/10.3329/bjmed.v24i1.15029

Extensively drug-resistant (XDR) tuberculosis is defined as disease caused by Mycobacterium tuberculosis with resistance to at least isoniazid and rifampicin, any fluoroquinolone, and at least one of three injectable secondline drugs (amikacin, capreomycin, or kanamycin). This definition in immensely valuable for more uniform surveillance in varied international settings. The prevalence of tuberculosis drug resistance has risen to the highest rate ever recorded. Although the gold standard for drugsusceptibility testing has been the agar proportion method; due to it’s time consumption, more sensitive, specific and rapid diagnostic tests are required. It is difficult to differentiate XDR tuberculosis from non-XDR tuberculosis clinically, although the former is associated with greater morbidity and mortality. The treatment of XDR tuberculosis should include agents to which the organism is susceptible, and should continue for a minimum of 18-24 months. However, treatment continues to be limited in tuberculosisendemic countries largely because of weaknesses in national tuberculosis health-care models. The ultimate strategy to control drug-resistant tuberculosis is one that implements a comprehensive approach incorporating innovation from the political, social, economic, and scientific realms. DOI: http://dx.doi.org/10.3329/birdem.v1i1.12386 Birdem Med J 2011; 1(1): 30-36

Introduction: Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) is the largest specialized hospital in Bangladesh for care of diabetic patients. Here, most of the hospitalized patients are diabetic, having many complications of diabetes mellitus and other co-morbidities. They often require multiple drugs for treatment. Diabetes mellitus itself, its complications and various medicationsall are related to development of electrolyte imbalance, which are often under-estimated or remain un-diagnosed. Objectives: The Objectives of this study were to see the pattern of electrolyte imbalance in hospitalized diabetic patients and to find out the precipitating causes behind them. Methods: This cross-sectional study was done in the Department of Internal Medicine, BIRDEM in 2008. Data were collected by random sampling from the first 100 adult diabetic patients with electrolyte imbalance, irrespective of their cause of admission. Results: Total number of patients were 100, male were 74 and female were 26 (M:F ratio 2.85: 1). Mean age was 60.18 years with standard deviation of ± 12.15 years (Range 38- 90 years). Among the patients, the mean duration of the diabetes mellitus was 10.96 years with standard deviation ± 8.05 years. Majority (83%) of the patients were on insulin, 22% were on oral anti-diabetic agents and 6% were on medical nutrition therapy. Among the co-morbidities, hypertention was the most prevalent (61%), followed by ischaemic heart disease (24%), chronic kidney disease (21%), dyslipidaemia (8%) and fatty liver (4%). Diabetic peripheral neuropathy was present in 41% cases, nephropathy in 13% cases and retinopathy in 12% cases. Over all 78% (100 patients had electrolyte imbalance out of 128 patients) of patients had some sort of electrolyte imbalance, irrespective of cause of admission. Hyponatraemia was the most common electrolyte imbalance in this study (80%), followed by hypomagnaesemia (38%), hypokalaemia (36%) and hyperkalaemia (14%). In 11% cases there were hyponatraemia, hypokalaemia and hypomagnaesemia. Regarding the precipitating factors, vomiting was most common (51%). In 28% cases electrolyte imbalance was precipitated by various drugs. Diarrhea and renal failure were responsible in a minority of cases. In 4% cases no cause could be identified. No death occurred. Conclusion: From this cross-sectional study it can be concluded that, electrolyte imbalance is common in hospitalized diabetic patients. Serum electrolytes should be checked routinely in hospitalized diabetic patients irrespective of their purpose of admission. DOI: http://dx.doi.org/10.3329/birdem.v2i1.12355 Birdem Med J 2012; 2(1) 14-18

Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disease where low platelet counts predisposeto various bleeding tendencies; intracranial haemorrhageis one of them. It is a rare and devastating complication of ITP, mostly presenting as intracerebral (ICH) or subarachnoid haemorrhage (SAH). Here, we report a 32-year-old splenectomized chronic ITP patient on corticosteroid and azathioprine, in whom spontaneous SAH developed. In this case, conservative management resulted in clinicoradiological improvement and showed eventual favourable out-come.Birdem Med J 2014; 4(2): 105-107

Objectives: To describe the antibiotic sensitivity pattern ofSalmonella typhi and Salmonella paratyphi from blood culture specimens. Methods: This cross-sectional study was done in the Department of Medicine, BIRDEM from July 2009 to June 2012. Standard laboratory and microbiological procedures were followed for blood culture and antibiotic sensitivity tests. Results: Among the 97 blood culture positive samples, S. typhi was 71 (73.2%) and S. paratyphi was 26 (26.8%). Multi-drug resistant strains of S. typhi and S. paratyphi were 23 (32.4%) and 3 (11.5%) cases respectively. Azithromycin, nalidixic acid, ciprofloxacin, levofloxacin and amoxicillin resistance was also found in a good number of cases (S. typhi and S. paratyphi: 71.8% and 57.7%, 42.3% and 30.8%, 38% and 34.6%, 38% and 26.9% and 38% and 26.9% cases respectively). Nineteen (31.1%) of the 61ciprofloxacin sensitive organisms were resistant to nalidixic acid. Ceftriaxone was sensitive in 100% of S. typhi and S. paratyphi. Cefixim, ciprofloxacin, levofloxacin, imipenem were among the most common sensitive antibiotics (S. typhi and S. paratyphi: 83.1% and 73.1%, 62% and 65.4%, 53.5% and 65.4%, 76.1% and 65.4% cases respectively). Conclusion: Ceftriaxone was the most sensitive antibiotic for treating enteric fever followed by cefixim, imipenem and ciprofloxacin. However, in suspected cases of enteric fever, blood culture should be requested before prescribing antibiotic. DOI: http://dx.doi.org/10.3329/jom.v15i2.20684 J MEDICINE 2014; 15 : 122-124

FinFET has been contemplated as a seemly substitute for the conventional CMOS at the nano-scale regime owing to the projection for application in the integrated circuits fabrication due to its extraordinary properties like improved channel controllability, high ON/OFF current ratio and reduced short-channel effect. In this paper, circuit simulations of 7-nm FinFET and planer CMOS are comprehensively investigated showing a 34.92% and 28.79% increased drain current in 7-nm Fin-FET compared to the existing 22-nm and equivalent 7-nm planer CMOS respectively. A detailed simulation study evaluating the performance of the proposed design is presented exhibiting a 2X increase in drive strength with the increment of fins. Fin thickness of 2.725 nm along with a height of 10.9 nm has been used resulting in an 8X reduction in gate area which is the smallest 7-nm Fin-FET structure yet developed. The indiscriminate variations of the characteristics obtained in various simulations lead to a culmination of shifting to Fin-FET from planer CMOS which is imperative from the prospect of design and manufacture. Keywords—FinFET, multi-gate FETs, 7-nm, nanoscale, HSpice

A refractive system is designed to convert a high-power annular beam into a circular Bessel beam. The input and output surface of the proposed system is derived. We provide cubic polynomial approximation of the surface profiles. A ray tracing through the complete system is provided to verify the design. The design parameters can be selected to choose the desired beam power in the central lobe and length of the refractive system.

A memory-efficient dual cell and a multioutput parallel arithmetic logic unit are designed by using a polarization-encoded optical shadow-casting scheme. The design algorithms for identifying the source patterns, input encoding, and output mask are also presented.

A memory-efficient arithmetic logic unit (ALU) consisting only of two cells has been designed using a polarization-encoded optical shadow truth table partitioning scheme. The design algorithm for identifying the source patterns, input encoding, and output decoder with possible parallel implementation are also presented.

An efficient multiprocessor has been designed using a polarization-encoded optical shadow casting truth table partitioning scheme. As an example, the design algorithm for identifying the source patterns, input patterns, and output mask for the design of an adder-subtracter is presented.

An efficient multiplier has been designed using a polarization-encoded optical shadow casting scheme. The design algorithm for identifying the source patterns, input patterns, and ouput mask is also presented.

A research work was undertaken at The Department of Civil Engineering of University of Asia Pacific (UAP), Dhaka, Bangladesh during April to November 2015. Biaxial bending means the column is carrying bending by one or both axis with axial load and with calculations it is possible to put those unique values into a pattern to make an interaction diagram with balanced failure zone, tension failure zone and finally compression failure zone of a short or slender column. By using programming it is possible to make the calculations in seconds. The method is to make functions and calling them to solve certain specific values to generate the diagram pattern. The outcome was diagram data generating application having the ability to combine programming and “Civil Logic”. This is made for students and Civil Engineers who want to make interaction diagrams for designing a short, square and even slender columns with ease.

ContextIn May 2002, the World Health Organization and the United Nations Children's Fund recommended that the formulation of oral rehydration solution (ORS) for treatment of patients with diarrhea be changed to one with a reduced osmolarity and that safety of the new formulation, particularly development of symptomatic hyponatremia, be monitored.ObjectiveTo measure the rates of symptomatic hyponatremia during treatment of patients with diarrhea with reduced osmolarity ORS.Design, Settings, and PatientsA phase 4 trial conducted at the Dhaka hospital (December 1, 2002-November 30, 2003) and Matlab hospital (February 2, 2003-January 31, 2004) of the International Centre for Diarrhoeal Disease Research Bangladesh: Centre for Health and Population Research, Dhaka, Bangladesh. All patients admitted with uncomplicated watery diarrhea were treated with the newly recommended ORS and monitored. Patients developing neurological symptoms (seizure or altered consciousness) were transferred to the special care ward for treatment and investigated to identify the cause of the symptoms. Patient records of the Dhaka hospital were reviewed during the previous year when the old ORS formulation was used.InterventionReduced osmolarity ORS.Main Outcome MeasureIncidence rate of symptomatic hyponatremia in a 1-year period.ResultsA total of 53 280 patients, including 22 536 children younger than 60 months, were monitored at the Dhaka and Matlab hospitals. Twenty-four patients, none older than 36 months, developed seizures or altered consciousness associated with hyponatremia, with an overall incidence rate of 0.05% (95% confidence interval [CI], 0.03%-0.07%) at the Dhaka hospital and 0.03% (95% CI, 0.01%-0.09%) at the Matlab hospital. During the previous year, 47 patients at the Dhaka hospital had symptoms associated with hyponatremia, for an estimated incidence rate of 0.10% (95% CI, 0.07%-0.13%). The reduction in the rates was statistically significant (odds ratio, 0.50; 95% CI, 0.29-0.85; P = .009).ConclusionThe risk of symptoms associated with hyponatremia in patients treated with the reduced osmolarity ORS is minimal and did not increase with the change in formulation.

A memory-efficient multioutput arithmetic logic unit has been designed using a polarization-encoded optical shadow casting scheme. The authors expand the scope of special-purpose optical digital computing to more general-purpose computing. Consequently, a novel design of an arithmetic logic unit (ALU) is proposed which is capable of performing both arithmetic and logical operations. A conventional ALU architecture is followed, where the output of the ALU are generated separately. Normally, all the outputs of an ALU are not required at the same time. Thus sequential output generation is not a bottleneck. The design algorithms for identifying the source patterns, input encoding, and output mask are presented. >

A high speed parallel full adder is designed which can perform carry-free addition of two modified signed digit quaternary numbers. For digital implementation, the sign digit quaternary numbers are represented using 3-bit 2's complement notation. The adder truth table with possible schemes of the electronic and optical implementation are provided. >

An efficient carry-free addition and borrow-free subtraction of modified signed-digit trinary number scheme is presented which may be used for parallel computing application. A digital 2 bit prototype adder was designed and implemented using electrically programmable logic device (EPLD). >

Birdem Med J 2013; 3(2): 133 DOI: http://dx.doi.org/10.3329/birdem.v3i2.17227