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Background: Sepsis is a complex, life-threatening, heterogeneous infectious disease associated with increased rates of morbidity and mortality. Early assessment of the prognosis of sepsis is key to achieving a favorable outcome for the disease. This study aimed to identify the prognostic value of PCT for sepsis patients. Materials and Methods: We conducted a prospective analytical study involving 100 adult patients with sepsis who were admitted to the Medicine dept and intensive care unit from 2019 to 2020. At least one blood test for PCT level was performed for all patients within the first 24 hours of suspecting an infection. Results: Our study found that a maximum number of patients (43.0%) were between 51-60 years age group, mean age of the patient was 49.35 ± 11.7 years. Out of 100 cases, 65% were male and 35% were female. The male and female ratio was 1.85:1. In this study serum, procalcitonin levels 0.5-2.0 ng/were detected in 15.0% of patients with mean±SD 1.3±0.8. Serum procalcitonin levels 2.1-10.0 ng/mL were detected in 29.0% of patients with mean±SD 5.9±2.5 and >10.0 ng/mL was detected in 56 patients. Based on the receiver-operator characteristic (ROC) curves, procalcitonin had the area under curve 0.923, with 89.4% sensitivity and 87.5% specificity. In our study, procalcitonin showed the best predictive value for the short-term outcome of sepsis with a cut-off value of 14.8 ng/mL (AUC 0.923). Study shows that 76.0% of the patients recovered completely, but 24.0% of patients expired during the hospital stay. Conclusion: There was a statistically significant correlation in serum procalcitonin with the outcome of sepsis (p < 0.001). So the effectiveness of serum procalcitonin has proven significant in the prediction of mortality in sepsis patients. J MEDICINE 2023; 24: 18-22

Solitary plasmacytoma of bone (SPB, also called osseous plasmacytoma) is a localized tumor in the bone comprised of a single clone of plasma cells in the absence of other features of MM (Multiple Myeloma). Most patients present with skeletal pain or a pathologic fracture of the affected bone. Patients with vertebral involvement may have severe back pain or neurologic compromise (e.g. cord compression). J MEDICINE 2022; 23: 173-175

Background: Health conditions like Diabetes mellitus sometimes affects serious to health due to unavailability of accurate check. But with advancements of diagnostics test like glycated hemoglobin (HbA1c) can save many lives to detect Diabetes Mellitus. Objective: In this study our main goal is to evaluate the accuracy of glycated hemoglobin (HbA1c.) in the diagnosis of Diabetes Mellitus. Methods: The Tertiary Medical College, Bangladesh, outpatient department (OPD) conducted this cross-sectional study. Where information was gathered between January 2019 and January 2020. During the research, a total of 100 individuals were enrolled with contemporaneous FPG, OGTT and A1c findings and diabetes mellitus suspicion. Purposive sampling was used to acquire the samples according to the inclusion criteria. Results: Most of the patients in the research were aged 47 to 57. 30.8% of the population and the majority (60%) were male. 71% of diabetes patients were identified alone by A1c, followed by 66% by 2h OGTT, and 43% of diabetic patients were diagnosed solely by fasting plasma glucose (FPG). IFG was found in 58% of the patients, whereas OGTT found IGT in 20% of the patients, and A1c found IGT in 24% of the patients. The difference between A1c and OGTT in diagnosing glucose intolerance was statistically significant (P 0.0001). Conclusion: This study's findings support the use of HbA1c as a screening tool for type 2 diabetes. Increasing access to diabetes care in Bangladesh may be made easier by using the HbA1c test, which is less onerous for patients than either FPG or oral glucose tolerance testing.

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

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

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

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

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.