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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

Human life is intricately related to it’s surrounding environment which also harbors other animals and some deadly infectious pathogens. Any threat to the environment can thus increase the threat of new and so-called ‘emerging infectious diseases’ (EIDs) especially novel viral infections called ‘emerging viral diseases’. This occurs partly due to changing climate as well as human interference with nature and animal life. An important event in new disease emergence is genetic changes in the pathogen that make it possible to become established in a new host species, productively infect new individuals in the new hosts (typically humans) and create local, regional or worldwide health threats. The world has witnessed some emerging and deadly viral threats in recent past with huge mortality and morbidity. Among them were severe acute respiratory syndrome (SARS), bird flu, swine flu, Middle East respiratory syndrome (MERS), ebola virus disease. Moreover some disease has caused great concern in certain regions including Bangladesh in terms of morbidity, like Nipah virus, Zika virus, Dengue and Chikungunya fever. Here in this article an attempt was made to briefly describe some of these emerging viral infections.Birdem Med J 2017; 7(3): 224-232

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

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

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

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

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.