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Background: Dengue fever is endemic in Bangladesh. Its incidence has been increasing and spreadingfrom urban Dhaka to rural areas. In 2019, over 100,000 cases reported with deaths over 250.Clinical profiles varied from classical signs and symptoms to alarming severity and complications,such as, Expanded Dengue Syndrome (EDS), Dengue Shock Syndrome (DSS) along with coinfectionsand comorbidities. No detail study on EDS & DSS carried out yet over 2019 outbreak. This reporthighlights the features, management and the outcome of EDS & DSS cases of 2018-19 admitted in aspecialized tertiary private hospital in Dhaka, Bangladesh. Methods: This cross sectional observational study was performed at Square Hospital, Dhaka,exclusively over 62 adult dengue patients with complications who fulfilled the admission criteria inICU and HDU and managed as per national guidelines and diagnosed by positive NS1 Ag, DengueRT PCR , Anti-dengue IgM, hematological and biochemical tests. Results: Of 343 cases, 62 (18.1%) patients had complications; 17 (27.4%) admitted in ICU and 45(72.6%) patients in HDU. Among 62 patients, 25 patients had EDS (40.3%) and 17 had DSS (27.4%).Of the EDS patients, majority were 40-50 years old with male predominance. Of 62 patients, 42 hadatypical presentations (67.74%), 25 (40.3%) had EDS and 17 (27.4%) had DSS, 16 (25.8%) had coinfection,45 (72.58%) had co-morbidities. Most patients presented with gastrointestinal symptoms(80%). Twenty one cases (84%) of EDS survive; 4 (16%), died after developing rhabdomyolysis, multiorgandysfunction and acute renal failure. Conclusion: Early diagnosis of complicated cases by clinical features, lab predictors and early fluidtherapy are the key to successful management with positive outcome. Death could be averted byrecognizing the stage of plasma leakage indicated by raised CRP, reduced serum Albumin, andultrasonography for detecting ascites, pleural effusion, mucosal thickening and edema of gall bladderand appropriate replacement of fluid loss and maintenance of nutrition. Bangladesh J Medicine July 2020; 31(2) :58-63

Background and aims Dyspnea is one of the most common symptoms associated with the COVID‐19 caused by novel coronavirus SARS‐CoV‐2. This study aimed to assess the prevalence of dyspnea, observe co‐variables, and find predictors of dyspnea after 2 months of recovery from COVID‐19. Methods A total of 377 patients were included in the study based on their responses and clinical findings during initial admission to the hospital with COVID‐19. After excluding five deceased patients, a total of 327 patients were interviewed through telephone using a 12‐point dyspnea scale and using relevant questions to gauge the patient clinically. Interviews were carried out by trained physicians, and responses were recorded and stored. All analyses were carried out using the statistical programming language R. Results Of the total 327 participants in the study, 34% had stated that they were suffering from respiratory symptoms even after 2 months of COVID‐19. The study demonstrated that patient oxygen saturation level SpO2 (P = .03), D‐dimer (P = .001), serum ferritin (P = .006), and the presence and severity of dyspnea are significantly correlated. In addition to that, patient smoking history (P = .012) and comorbidities such as chronic obstructive pulmonary disease (COPD) (P = .021) were found to be statistically significant among groups. Conclusion These findings of this study can be useful for predicting and managing long‐term complications of COVID‐19.

Background: Copy number variations (CNVs) play a critical role into the pathogenesis of neurodevelopmental disorders (NDD) among children. In this study, we aim to identify clinically relevant CNVs, genes and their phenotypic characteristics in an ethnically underrepresented homogenous population of Bangladesh. Methods: We have conducted genome-wide chromosomal microarray analysis (CMA) for 212 NDD patients with male to female ratio of 2.2:1.0 to identify rare chromosomal abnormalities (deletion /duplication/ rearrangements). To identify candidate genes within the rare CNVs, multiple gene constraint metrics (i.e. “Critical-Exon Genes (CEGs)”) were applied to the population data. Autism Diagnostic Observation Schedule-Second Edition (ADOS-2) was followed in a subset of 95 NDD patients to assess the severity of autism and all statistical tests were performed using R package. Results: In our cohort, the head circumference of males are significantly greater than females (p=0.0002). Of all samples assayed, 12.26% (26/212) and 47.17% (100/212) patients carried pathogenic and variant of uncertain significance (VOUS) CNVs, respectively. 2.83% (6/212) pathogenic CNVs are located at the subtelomeric regions. Further burden test identified females are significant carriers of pathogenic CNVs in comparison to males (OR=4.2; p=0.0007). ADOS-2 subset show severe social communication deficit (p=0.014) and overall ASD symptoms severity (p=0.026) among the patients carrying duplication CNV compared to the CNV negative group. Candidate gene analysis identified 153 unique CEGs in pathogenic CNVs and 31 in VOUS. Of the unique genes, 18 genes were found to be in smaller (PSMC3 gene as a potential candidate gene for Autism Spectrum Disorder (ASD). Moreover, we hypothesized that KMT2B gene duplication might be associated with intellectual disability. Conclusion: Our results show the utility of CMA for precise genetic diagnosis and its integration into the diagnosis therapeutics and management of NDD patients.

Background: Hepatic malignancy is an important clinical condition which is associated with poor outcome. Clinicalassessment of a patient with hepatic malignancy is crucial to sort out the primary and secondary, and so biochemicaland radiological investigations are needed. Hence fine needle aspiration cytology (FNAC) of the lesion is essentialwhich is a minimal invasive procedure to combat a deadly disease. Objective: The aim of this prospective cross sectional observational study was clinical assessment of primary andsecondary hepatic malignancy and its co-relation with FNAC of hepatic malignancy. Methods: Patients admitted in Medicine Department, Dhaka medical College, with hepatic malignancy from January2013 to June 2014 and then confirmed by FNAC (USG guided) of liver mass were included in the study. A total 100patients were enrolled in the study in a non-random convenient sampling method. Result: In this study 42 patients were found having primary Hepatocellular Carcinoma (HCC) and 58 patients hadsecondary hepatic malignancy. FNAC confirmed secondary hepatic malignancy (n=58) as metastatic adenocarcinoma43(74.1%), metastatic small cell carcinoma 9(15.5%), Gastro Intestinal Stromal Tumour (GIST) 2(3.4%), squamouscell carcinoma 2(3.4%) & Non Hodgkins lymphoma 2(3.4%). Most of the patients of primary hepatic malignancybetween 20-40 years 18(42.9%) and secondary hepatic malignancy between 40-60 years 35(60.3%). Incidence in maleis more in both primary 31(73.8%) and secondary 38(65.5%) hepatic malignancy. Both HCC and secondariespredominantly presents with abdominal pain, 39(92.9%) cases of HCC and 47(81.0%) of secondaries. Incidence ofmultiple lesion in ultrasonogram is more in both primary 30(71.4%) and secondary 47(81.0%) hepatic malignancy.Positive HBsAg, Positive Anti HBc (total), Positive Anti HCV were found in 15(35.7%), 11(26.2%) and 9(21.4%) casesof HCC respectively. Positive Alpha Feto Protein (AFP) was found insignificant in this study. Conclusion: Fine Needle Aspiration (FNA) is a useful diagnostic test for evaluating patients with discrete hepaticmasses. Correlation with clinical, radiological and cytological findings is helpful in arriving at the correct diagnosisand therefore increases overall accuracy and cost-effectiveness of the procedure. Bangladesh Crit Care J September 2019; 7(2): 81-85

Background: The assessment of antibody responses to severe acute respiratory syndrome coronavirus-2 is potentially confounded by exposures to flaviviruses. The aims of the present research were to determine whether anti-dengue antibodies affect the viral load and the detection of anti-coronavirus nucleocapsid (N)-protein antibodies in coronavirus infectious disease 2019 (COVID-19) in Bangladesh. Methods: Viral RNA was evaluated in swab specimens from 115 COVID-19 patients by real-time reverse transcription polymerase chain reaction (rT-PCR). The anti-N-protein antibodies, anti-dengue virus E-protein antibodies and the dengue non-structural protein-1 were determined in serum from 115 COVID-19 patients, 30 acute dengue fever pre-COVID-19 pandemic and nine normal controls by ELISA. Results: The concentrations of viral RNA in the nasopharyngeal, Ct median (95% CI), 22 (21.9–23.3) was significantly higher than viral RNA concentrations in oropharyngeal swabs, and 29 (27–30.5) p &lt, 0.0001. Viral RNA concentrations were not correlated with-dengue IgG levels. The anti-nucleocapsid antibodies were IgA 27% positive and IgG 35% positive at days 1 to 8 post-onset of COVID-19 symptoms versus IgA 0% and IgG 0% in dengue patients, p &lt, 0.0001. The levels of anti- nucleocapsid IgA or IgG versus the levels of anti-dengue IgM or IgG revealed no significant correlations. Conclusions: Viral RNA and anti-nucleocapsid antibodies were detected in COVID-19 patients from dengue-endemic regions of Bangladesh, independently of the dengue IgG levels.

Bangladesh is one of the world’s top ten burdened countries for viral hepatitis. We investigated an adult fever cohort (n=201) recruited in Dhaka, to determine the prevalence of hepatitis B virus (HBV) infection and to identify cases of occult hepatitis B infection (OBI). HBV exposure (anti-HBc) was documented in 72/201 (36%), and active HBV infection in 16/201 (8%), among whom 3 were defined as OBI (defined as detectable HBV DNA but negative HBsAg). Applying a target-enrichment sequencing pipeline to samples with HBV DNA >3.0log10 IU/ml, we obtained deep whole genome sequences for four cases, identifying genotypes A, C and D. Polymorphisms in the surface gene of the OBI case may account for the negative HBsAg status. We identified mutations associated with nucleos(t)ide analogue resistance, although the clinical significance in this cohort is not known. The high prevalence of HBV in this setting highlights the benefits of offering screening in hospital patients and the importance of HBV DNA testing of transfusion products to reduce the risk of transmission. In order to work towards international Sustainable Development Goal targets for HBV elimination, increased investment is required for diagnosis, treatment and prevention in Bangladesh.

Melioidosis is known to occur in Bangladesh, but there are few reports about the condition in the published international literature. We set out to review all known cases of melioidosis in the country to date, using both retrospective and prospective data. A web-based literature search was conducted to identify all published case reports, original articles and conference abstracts. Cases were also included from a prospective study conducted in 2017. Fifty-one cases were identified between 1961 and 2017. Cases have been reported from sixteen out of the 64 districts of Bangladesh. The median age of the patients at presentation was 45 years (IQR 37–52), with a significant male (77%) predominance. Many patients (14/39; 36%) were farmers and 83% had diabetes mellitus. A skin/soft tissue abscess was the most common primary clinical presentation (13/49; 27%), followed by septic arthritis (10/49; 20%), pneumonia, and a deep-seated abscess/organ abscess (7/49; 14%). The major challenges to the diagnosis and treatment of melioidosis in Bangladesh are the lack of resources and the lack of awareness of melioidosis. Capacity development programs are urgently required to define the burden of disease and to tackle the mortality rates.

No abstract availableDOI: http://dx.doi.org/10.3329/jom.v14i2.19693 J Medicine 2013, 14(2): 213-217

Background: Non-alcoholic fatty liver disease (NAFLD) is becoming a public health problem with increasing incidence and it has been shown to be associated with diabetes, dyslipidemia, obesity and metabolic syndrome and ultimately puts more than half the world’s population at risk of developing NAFLD/NASH/cirrhosis in the coming decades. The importance of detection of patients with NAFLD is to intervene the associated factors and avoid transformation to more severe forms of the disease.Methods: An observational case control study was carried out at Medicine Department, Dhaka Medical College Hospital (DMCH), Dhaka, during the period of August, 2011 to June, 2012. A total number of 100 consecutive patients and 100 healthy controls was approaches DMCH were enrolled in this study. Out of 100 NAFLD patients only 20 patients gave consent for liver biopsy to see the extent of liver damage.Result: Less physical activity, Obesity, mean blood pressure, Diabetes, TG, TC were significantly (P5) was found in 9(45%) of the NAFLD group.Conclusion: Significant proportion of NAFLD patient suffers from NASH which is alarming and they have potential for the development of advanced liver disease. So recognition of these risk factors in patients of NAFLD can help in early implementation of strategies that halt the progression of this disease. DOI: http://dx.doi.org/10.3329/jom.v14i2.19665 J Medicine 2013, 14(2): 143-148

Bangladesh Journal of Medicine, Vol 24 No 1, 2013, Page 31-34 DOI: http://dx.doi.org/10.3329/bjmed.v24i1.15034

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

Bangladesh Journal of Medicine, Vol 23 No 2, 2012, Page 76-79 DOI: http://dx.doi.org/10.3329/bjmed.v23i2.14990

This descriptive study was done in the Deponment of Physiology. Dhaka Medical College, Dhaka. during the period of January 2008 to December 2008. The objective of the study was to measure pulse and blood pressure in smokers and nonsmoker adult male stroke patients and to find out changes in pulse and blood pressure among the smoker and non-smoker stroke patients. To accomplish this purpose 105 patient of over 20 years of age were selected. They were divided into two groups: Group A consisting of thirty n on-smoker and group B consisting of seven,' five smoker stroke patients. The finding showed that smoking caused no statistical significant difference 1p>0.05) in pulse and systolic blood pressure among she groups. Diastolic blood pressure was significantly higher (p

In the present study. Forced Vital Capacity (PVC) suit estimated in 100 women in Dingo city. For this purpose a total 100 women subjects with age ranged from 25 years to 35 years withow any recent history of respiratory diseases were selected. 75 normal pregnant women as experimental group and 25 healthy non-pregnant women as control. Eiperintemed group included 25 first trimester. 25 second trimester and 25 third trimester of pregnat women. The FVC was estimated by using a automatic spironteter during the first. second and third trimester of pregnant women and also in non-pregnant control. The mean of the measured values of PVC were analysed statistically. The PVC was significantly lower in third trimester of pregnant women than that of non-pregnant women. Again the FVC was significantly haver he third trimester than that of first trimester of pregnant women. There were no statistically significant difference of PVC bentren the nonpregnant and first trimester: ',email the non-pregnant and second trimester; henveen the first trimester and second trimester: and between the second ',integer and third trimester of pregnant women. h may be concluded dun the causes of progressively decreased FVC throughout the pregnancy were most likely to he mechanical effects of progressively increasing uterus that progressively decrease the hum rolume capacity.

The present study was designed to observe ABC and haemoglobin concentration in female table/es. For this purpose, a total member of 60 /oaks. age ranged from 17-38 years. were selected Thirty of them were athletes 101IperillK011eli group) and 30 non-athletes (comrolh Athletes were selected form Dhanonadi Mohan Krira Comptes ad controls fiat students of Dhaka University. ROC man and haemoglobin concentration were measured by electronk reO water method. RBC moot was land significantly lower in athletes than that of controls but Mere was no change in haemoglobin concentration. The reat of the study 'weals that lowered RBC coma was due to mechanical damage of ersahrocytic membrane leading to shortening of mean life span of ROC.

Bangladesh Journal of Medicine, Vol 24 No 1, 2013, Page 35-37 DOI: http://dx.doi.org/10.3329/bjmed.v24i1.15035

 In the present study the partial pressure of carbon dioxide (PaCO 2 ) and bicarbonate ion (HCO 3 - ) in arterial blood was estimated in 32 women in Dhaka city. For this purpose a total 32 women subjects with age ranged from 25 years to 35 years without any recent history of respiratory diseases were selected and divided into 8 healthy non-pregnant women as control and 24 normal pregnant women as experimental group. Experimental group was further divided into 8 first trimester, 8 second trimester & 8 third trimester of pregnant women. The PaCO 2 and HCO 3 - were estimated by using "Easy Blood Gas Auto Analyzer". The PaCO 2 and HCO 3 - were estimated during the 1st, 2nd, 3rd trimesters of pregnant women and non-pregnant women. The mean of measured values of PaCO 2 and HCO 3 - were analyzed statistically in relation to 1st, 2nd, 3rd trimesters of pregnant women & non-pregnant women. The PaCO 2 and HCO 3 - were significantly lower in 1st trimester, 2nd trimester & 3rd trimester of pregnant women than that of non-pregnant women. There were no statistically significant difference of PaCO 2 and HCO 3 - between the 1st trimester and 2nd trimester; between the 1st trimester and 3rd trimester; and between the 2nd trimester and 3rd trimester of pregnant women. It may be concluded that the causes of progressively decreased PaCO 2 and HCO 3 - throughout the pregnancy were most likely to be due to effect of progesterone causing hyperventilation. Hyperventilation in pregnancy is due to hypersensitivity of respiratory centre. Due to hyperventilation, there is expelling out CO 2 and HCO 3 - causing decreases PaCO 2 and HCO 3 - during pregnancy. doi: 10.3329/jbsp.v3i0.1788 J Bangladesh Soc Physiol.2008 Dec;(3):13-16.