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ObjectiveTo determine predictors of change in neuropsychiatric (NP) event status in a large, prospective, international inception cohort of patients with systemic lupus erythematosus (SLE).MethodsUpon enrollment and annually thereafter, NP events attributed to SLE and non-SLE causes and physician-determined resolution were documented. Factors potentially associated with the onset and resolution of NP events were determined by time-to-event analysis using a multistate modeling structure.ResultsNP events occurred in 955 (52.3%) of 1,827 patients, and 593 (31.0%) of 1,910 unique events were attributed to SLE. For SLE-associated NP (SLE NP) events, multivariate analysis revealed a positive association with male sex (P=0.028), concurrent non-SLE NP events excluding headache (P < 0.001), active SLE (P = 0.012), and glucocorticoid use (P = 0.008). There was a negative association with Asian race (P = 0.002), postsecondary education (P = 0.001), and treatment with immunosuppressive drugs (P = 0.019) or antimalarial drugs (P = 0.056). For non-SLE NP events excluding headache, there was a positive association with concurrent SLE NP events (P < 0.001) and a negative association with African race (P = 0.012) and Asian race (P < 0.001). NP events attributed to SLE had a higher resolution rate than non-SLE NP events, with the exception of headache, which had comparable resolution rates. For SLE NP events, multivariate analysis revealed that resolution was more common in patients of Asian race (P = 0.006) and for central/focal NP events (P < 0.001). For non-SLE NP events, resolution was more common in patients of African race (P = 0.017) and less common in patients who were older at SLE diagnosis (P < 0.001).ConclusionIn a large and long-term study of the occurrence and resolution of NP events in SLE, we identified subgroups with better and worse prognosis. The course of NP events differs greatly depending on their nature and attribution.

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

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

To assess the impact on intraocular pressure (IOP) after Phacoemulsification (PE) with Posterior Chamber Intraocular Lens (PCIOL) implantation and its relation with ocular biometric parameters. The study was a prospective observational study included 524 eyes with normal IOP (11-21 mmHg) who underwent uneventful Phacoemulsification with PCIOL Implantation surgery for age-related cataract. IOP, Central Corneal Thickness (CCT), Anterior Chamber Depth (ACD), Axial Length (AL) were measured pre-operatively and one month post-operatively by Goldman Applanation Tonometer, Corneal Pachymeter and Optical Coherence Biometer, respectively. The post-operative IOP change and its relation with preoperative biometric parameters were determined.: The mean pre-operative and post-operative IOP was 13.44±1.98 & 11.54±1.66mmHg, respectively, with an average IOP reduction after one month of 1.90±0.61mmHg. The mean pre-operative and post-operative ACD was 3.27±0.24 and 3.66±0.27 mm, respectively, with an average increase of 0.39 ±0.3 mm. Paired t-test showed post-operative IOP reduction was significantly associated with preoperative IOP (p: IOP is significantly reduced, and ACD increased after PE with PCIOL implantation surgery and is associated with post-operative IOP reduction. The post-operative IOP reduction is proportional to pre-operative IOP, and more the preoperative IOP, more the post-operative IOP reduction.

SARS-CoV-2 corona virus infection (COVID-19) is a public health emergency of international concern causing many deaths. The aim of this study was to assess demography, clinical presentation, blood group, disease severity and outcome of COVID-19 infected patients in Bangladesh. This is a cross sectional, observational study of 436 COVID- 19 infected patients, confirmed by RT-PCR assay's on nasopharyngeal swab specimens, presented at Faridpur Medical College Hospital and Kurmitola General Hospital during the month of May to September, 2020. Data were collected in a preformed data sheet and analyzed for variables included demography, source of infection, spreading within family, clinical features, blood group, disease severity and outcome. Study showed mean age 41.27±16.65 years with slight male predominance (1.87:1), most were service holder (47%), source of infection was unknown (40%), from infected family members (35%) and working place (23%). In 44% cases, family members of infected index cases were unaffected. Common co-morbidities were Diabetes Mellitus (19.7%) and Hypertension (19%). Blood group of most (41.29%) was B positive. Disease spectrum ranged from asymptomatic (15%), mild (53%), moderate (19%) and severe (13%) disease. Common presenting symptoms were fever (72.2%), cough (42.9%) dyspnoea (29.6%), myalgia (22.9%), anorexia (17.9%), fatigue (17.4%), diarrhea (13.5%), headache (12.4%) and anosmia (12.4%). Majority (75.2%) had nonspecific (fever, mayalgia, fatigue) symptoms and in 16.28% cases it was the only presentation. Respiratory (61.9%) and GI (28.4%) symptoms presented either concomitantly or with nonspecific symptoms (55%). Majority (95%) of patients recovered and only 5% died. Faridpur Med. Coll. J. Jan 2020;15(2): 53-57

Objective: To determine subjective outcomes after cholesteatoma surgery. Design: Cross sectional observational study Methods: Study place: Shaheed Ziaur Rahman Medical college Hospital (SZMCH), Bogura, Bangladesh Study population: Chronic otitis media (COM) with extensive cholesteatoma. Interventions: Canal wall down mastoidectomy for cholesteatoma. Main Outcome Measures: In this study, the Chronic Ear Survey (CES) was provided to all patients preoperatively and one year after surgery. The preoperative and postoperative score differences were analyzed. We also assessed correlations between chronic ear survey scores and air conduction threshold. Results: Seventy six patients were enrolled in our study & marked improvements were found in total CES score & all subscale scores postoperatively (P value: 0.00). The total CES score and symptom subscale scores were observed greater improvement (P value: 0.00).Significant negative linear correlations were observed among total CES scores, symptom subscale scores and air conduction thresholds (P

Whilst suicide is well established as a critical global public health burden causing around 800,000 deaths annually along with many more attempts, there is a concern that the impact of the coronavirus (COVID‐19) pandemic might intensify suicidality. The purpose of this study is to draw attention to the budding correlation between the COVID‐19 pandemic and suicidality from the theoretical perspective of Emile Durkheim's sociology of suicide. A review of online newspaper databases (1 January to 30 April 2020) that reported suicide cases and attempts triggered as a result of the disruptions caused by the COVID‐19 pandemic were included and analysed. Out of the 28 identified cases, there were three suicide attempts, one homicide‐suicide/pact‐suicide, and 24 suicides spanning 10 countries. Durkheim explained the social causation of suicide and provided a four‐fold suicide typology. The cases were analysed according to their appropriate typology, and classified as egoistic (9), altruistic (3), anomic (8), and fatalistic (8). Durkheim suggests that the rise and fall of suicide rates will depend on the nature of social change. As society is undergoing massive social disruption resulting from the COVID‐19 pandemic, suicide rates may increase unless suicide prevention measures align with the current social reconstruction process.

Background: Haematological malignancy and its treatment produce multiple symptoms that significantly distress patients and impair function. Symptoms caused by treatment may delay treatment or lead to premature treatment termination and residual treatment-related symptoms often complicate post treatment rehabilitation. When treatment is no longer possible, symptom control becomes the focus of cancer care. Objectives: The study was aimed to determine the symptom burden of the haematological malignancy patients. Methods: A cross sectional study was conducted from July 2015 to June 2016 among the haematological malignancy patients. A total of 316 haematological malignancy adult (age ≥18 years) patients were purposively selected from haematology department of two tertiary level of hospitals in Dhaka city. Face to face interviews were taken from the diagnosed haematological malignancy patients admitted in the hospital and attending outdoor using questionnaire based on symptom distress scale (SDS). Results: Mean age was 39 years and most of the patients suffering from Acute Leukemia 162(51.3%). Mean monthly family income was around 22235 taka and 120(37.9%) patients were unemployed. Patients with haematological malignancy had a considerable physical and psychological symptom burden which ranged from 94.3% for fatigue to 8.5% for difficulty in concentration. Physical symptoms such as fatigue 127 (40.2%), change in appetite 86 (27.2%), pain1 81 (25.6%), insomnia44 (13.9%) caused severedistress and psychological symptoms include change in appearance 37 (11.7%) and outlook 33 (10.4%) were sever distressing. Significant association (p

Introduction: This retrospective study was done to see colonoscopic yields in patients presenting with lower gastrointestinal bleeding. Materials & Methods: Reports of patients undergoing colonoscopy due to bleeding per rectum were retrieved from endoscopy records. Patients’ particulars and colonoscopic findings were recorded in a data sheet. Analysis was done using SPSS 20 version. Results: A total of 309 patients (male 211 (68.3%) and female 98 (31.7) with mean age 40.3 years %)) were included in this study. According to colonoscopic yield, causes of LGIB were haemorrhoids 137 (44.33% ), rectal and colonic growth 58(18.77% ) rectal and colonic polyps 54 (17.47% ), anal fissure 38 (12.29% ), proctitis 18 (5.82%), colitis 18(5.82%), ileal ulcer and ileitis 34(11.0%). Colorectal growth was more common among patients age 26 to 60years. Among male rectal growth was slightly higher than female. Conclusion: Lower gastrointestinal bleeding is more common among males. Commonest cause of LGIB are internal haemorrhoids, rectal growth, rectal and colonic polyps and anal fissure. Colorectal neoplasm, proctitis, colitis and ileal inflammation and ulcers constitute small part. Medicine Today 2021 Vol.33(2): 120-122

Objectives Patients with SLE have an increased risk of developing cardiovascular disease (CVD). Multiple studies have shown that these patients have increased numbers of carotid plaques and greater intima-media thickness (IMT) than healthy controls. Measures such as total plaque area (TPA) and plaque echogenicity may be more sensitive and more relevant to cardiovascular risk than presence of plaque and IMT alone. Our objective was to produce the first report of TPA and echogenicity in a population of patients with SLE. Methods One hundred patients with SLE and no history of clinical CVD were recruited. Clinical, serological and treatment variables were recorded and serum was tested for antibodies to apolipoprotein A-1 and high-density lipoprotein. Both carotid and both femoral artery bifurcations of each patient were scanned to determine IMT, TPA and echogenicity of plaques. Univariable and multivariable statistical analyses were carried out to define factors associated with each of these outcomes. Results Thirty-six patients had carotid and/or femoral plaque. Increasing age was associated with presence of plaque and increased IMT. Triglyceride levels were associated with presence of plaque. Mean (s.d.) TPA was 60.8 (41.6) mm2. Patients taking prednisolone had higher TPA. Most plaques were echolucent, but increased echogenicity was associated with prednisolone therapy and persistent disease activity. Conclusion TPA and plaque echogenicity in patients with SLE are associated with different factors than those associated with presence of plaque and IMT. Longitudinal studies may show whether these outcome measures add value in the management of cardiovascular risk in SLE.

Purpose of Review: The management of eye injuries is both difficult and argumentative. This study attempts to highlight the management of ocular trauma using currently available information in the literature and author experience. This review presents a workable framework from the first presentation, epidemiology, classification, investigations, management principles, complications, prognostic factors, final visual outcome and management debates. Review Findings: Mechanical ocular trauma is a leading cause of monocular blindness and possible handicap worldwide. Among several classification systems, the most widely accepted is Birmingham Eye Trauma Terminology (BETT). Mechanical ocular trauma is a topic of unsolved controversy. Patching for corneal abrasion, paracentesis for hyphema, the timing of cataract surgery and intraocular lens implantation are all issues in anterior segment injuries. Regarding posterior segment controversies, the timing of vitrectomy, use of prophylactic cryotherapy, the necessity of intravitreal antibiotics in the absence of infection, the use of vitrectomy vs vitreous tap in traumatic endophthalmitis is the issues. The pediatric age group needs to be approached by a different protocol due to the risk of amblyopia, intraocular inflammation, and significant vitreoretinal adhesions. The various prognostic factors have a role in the final visual outcome. B scan is used to exclude R.D, Intraocular foreign body (IOFB), and vitreous haemorrhage in hazy media. Individual surgical strategies are used for every patient according to the classification and extent of the injuries. Conclusion: This article examines relevant evidence on the management challenges and controversies of mechanical trauma of the eye and offers treatment recommendations based on published research and the authors’ own experience.

Background: Dry eye is characterized by tear film instability, decreased tear volume and a high Ocular Surface Disease Index (OSDI) score. Face masks have been linked to dry eye complaints in recent studies. Purpose: To evaluate the changes in tear-film status and Ocular Surface Disease Index (OSDI) score following prolonged use of face mask. Design: Cross-sectional study. Method: Patients between 18 to 70 years using masks regularly for at least 2 hours/day for at least 5 days/week from different eye-care centres in Dhaka were included. All subjects were divided into 4 groups. Mask use lasted approximately 2 hours/day in Group 1, 4 hours/day in Group 2, 6 hours/day in Group 3 and 8 hours or more/day in Group 4. Evaluation of symptoms, tear- film stability and tear volume was done by Ocular Surface Disease Index (OSDI) scores, Tear-film Break-Up Time (TBUT) and Schirmer-1 test. Average of right & left eye’s Tear-film Break Up time (TBUT) and Schirmer-1 value were noted. Results: Total 100 patients were enrolled (n = 100). The TBUT (p < 0.001) and Schirmer-1 measurement (p = 0.01) were significantly lesser and Ocular Surface Disease Index (OSDI) score were significantly higher in patients using face-masks for longer time (p < 0.001). Conclusion: Patients who wore masks for prolonged time had tear film instability, reduced tear volume and higher Ocular Surface Disease Index (OSDI) score.

Background: Antenatal ultrasound assessment of placental morphology plays an important role in evaluating fetal health, revealing abnormalities, such as infract & calcification. Abnormal placental maturity is associated with poor pregnancy outcome. In some high risk pregnancy placental maturity is accelerated as in pregancy –induced hypertension (PIH), intrauterine growth retardation (IUGR), whether in other high risk cases like diabetes and Rh-isoimmunization there is delayed placental maturation. Objectives: This was a cross sectional type of descriptive study. The study was carried out to assess placental grading by USG in high risk and normal pregnancy for predicting neonatal outcome. Material and method: The study was carried out in the Department of Obstetrics & Gynaecology in collaboration with the Department of Radiology & Imaging of Rajshahi Medical College Hospital from January 2012 to December 2013. : A total 200 pregnant mother, attending the inpatient department constituted study population who delivered their babies at Rajshahi Medical College Hospital were selected in antenatal period for USG examination to detect placental grade. Result: Ultrasonography showed, 35% had Grade-II placental maturity, 33.5%- Grade-III, 25% Grade - I and 6.5% had Grade-0 maturity. Majority of the mother (75%) were normal and had healthy baby. The relationship of placental maturity with gestational age of mother in normal pregnancy and in high risk pregnancy was found to be statistically significant. Placental maturity and fetal outcome in normal pregnancy was found significantly associated (p0.5). Early maturation of placenta in hypertensive women and delayed maturation in diabetic women were observed. Conclusion: Sonographic diagnosis of grade-III placenta has been reported to be as excellent predictor of fetal lung maturity than difficult and hazardous invasive procedure like amniocentesis. TAJ 2020; 33(2): 94-99

ObjectiveThe Systemic Lupus International Collaborating Clinics (SLICC) frailty index (FI) predicts mortality and damage accrual in systemic lupus erythematosus (SLE), but its association with hospitalizations has not been described. Our objective was to estimate the association of baseline SLICC-FI values with future hospitalizations in the SLICC inception cohort.MethodsBaseline SLICC-FI scores were calculated. The number and duration of inpatient hospitalizations during follow-up were recorded. Negative binomial regression was used to estimate the association between baseline SLICC-FI values and the rate of hospitalizations per patient-year of follow-up. Linear regression was used to estimate the association of baseline SLICC-FI scores with the proportion of follow-up time spent in the hospital. Multivariable models were adjusted for relevant baseline characteristics.ResultsThe 1,549 patients with SLE eligible for this analysis were mostly female (88.7%), with a mean ± SD age of 35.7 ± 13.3 years and a median disease duration of 1.2 years (interquartile range 0.9-1.5) at baseline. Mean ± SD baseline SLICC-FI was 0.17 ± 0.08. During mean ± SD follow-up of 7.2 ± 3.7 years, 614 patients (39.6%) experienced 1,570 hospitalizations. Higher baseline SLICC-FI values (per 0.05 increment) were associated with more frequent hospitalizations during follow-up, with an incidence rate ratio of 1.21 (95% confidence interval [95% CI] 1.13-1.30) after adjustment for baseline age, sex, glucocorticoid use, immunosuppressive use, ethnicity/location, SLE Disease Activity Index 2000 score, SLICC/American College of Rheumatology Damage Index score, and disease duration. Among patients with ≥1 hospitalization, higher baseline SLICC-FI values predicted a greater proportion of follow-up time spent hospitalized (relative rate 1.09 [95% CI 1.02-1.16]).ConclusionThe SLICC-FI predicts future hospitalizations among incident SLE patients, further supporting the SLICC-FI as a valid health measure in SLE.

Antiphospholipid syndrome (APS), an acquired autoimmune thrombophilia, is characterised by thrombosis and/or pregnancy morbidity in association with persistent antiphospholipid antibodies. The 16th International Congress on Antiphospholipid Antibodies Task Force on APS Treatment Trends reviewed the current status with regard to existing and novel treatment trends for APS, which is the focus of this Task Force report. The report addresses current treatments and developments since the last report, on the use of direct oral anticoagulants in patients with APS, antiplatelet agents, adjunctive therapies (hydroxychloroquine, statins and vitamin D), targeted treatment including rituximab, belimumab, and anti-TNF agents, complement inhibition and drugs based on peptides of beta-2-glycoprotein I. In addition, the report summarises potential new players, including coenzyme Q10, adenosine receptor agonists and adenosine potentiation. In each case, the report provides recommendations for clinicians, based on the current state of the art, and suggests a clinical research agenda. The initiation and development of appropriate clinical studies requires a focus on devising suitable outcome measures, including a disease activity index, an optimal damage index, and a specific quality of life index.

Chronic Obstructive Pulmonary Disease (COPD) is a progressive disease and there is not yet a cure. Not only in Bangladesh but also worldwide the incidence of COPD is increasing. The disease is associated with some metabolic derangement such as electrolytes imbalance. Those factors further worsen the disease course. As a result COPD related morbidity, mortality and cost to health systems are also increasing. This cross-sectional observational study was conducted in Faridpur Medical College Hospital (FMCH) over 6 months among 100 patients who were admitted with acute exacerbation of COPD. The mean age was (58.13 ± 9.96) years. In this study serum electrolytes were found below the normal range in 68 (68%) cases and within normal range in 32(32%) cases. Isolated hyponatremia was observed in 36(53%) and 15(22%) had isolated hypokalaemia. Both hyponatremia and hypokalaemia was found in 17(25%) cases. The mean serum sodium level was (133.82±2.52) mmol/l. Among patients with isolated hyponatremia, 24(67%) had mild hyponatremia and 12(33%) got moderate hyponatremia. Again the mean serum potassium was (3.45±0.23) mmol/l. Among patients with isolated hypokalaemia, 10(67%) had mild hypokalaemia and 5(33%) had moderate hypokalaemia. Both hyponatremia and hypokalaemia was observed in one fourth of total electrolytes depleted cases and all were within the mild range. No patient had severe hyponatremia or hypokalaemia. Faridpur Med. Coll. J. Jan 2020;15(1): 24-27

Brucellosis is a neglected endemic zoonosis in Bangladesh and has a significant impact on public health and animal welfare of dairy farming as well as dairy farm economics. A cross‐sectional study was conducted to evaluate the seroprevalence of and risk factors for brucellosis in dairy cattle in the Chittagong metropolitan area (CMA) of Chittagong, Bangladesh. We collected serum samples (n = 158) from six randomly selected dairy farms in the CMA between February and November, 2015. The Rose Bengal Plate Test (RBPT) and a competitive ELISA (cELISA) were used as the screening and confirmatory tests respectively. Farm level and animal level demographic and risk factor data were collected using a questionnaire. The risk factors were analysed using a multivariable logistic regression with random effects. The overall seroprevalences of antibodies against brucellosis in cattle were 21.5% (34/158) and 7.6% (12/158) based on parallel and serial interpretation of the two tests respectively. Our results revealed that 20.3% (32/158) samples were positive using the RBPT and 8.9% (14/158) were positive using the cELISA. The within‐herd seroprevalence ranged from 10% to 26.3% and 5 to 20.7% using the RBPT and cELISA tests respectively. The odds of seropositivity were significantly higher in lactating cows (OR: 2.59; 95% CI: 1.02–6.55), cows producing less than 2 litres of milk (OR: 29.6; 95% CI: 4.3–353.8), cow producing 2–12 litres of milk (OR: 4.8; 95% CI: 1.1–33.4) and cows with reproductive disorders (OR: 3.2; 95% CI: 1.2–10.1). About 7.6% (12/158) and 1.3% (2/158) of cattle were found to be infected with acute and chronic brucellosis respectively. Based on these results, we suggest that cows that have reproductive disorders and are producing little milk should be prioritized for brucellosis screening in CMA. The screening tests should be used to control brucellosis in cattle in order to protect animal welfare, human health and to minimize the economic losses., A cross‐sectional study was conducted to evaluate the seroprevalence of and risk factors for brucellosis in dairy cattle in the Chittagong metropolitan area (CMA) of Chittagong, Bangladesh. The overall seroprevalences of antibodies against brucellosis in cattle were 21.5% (34/158) and 7.6% (12/158) based on parallel and serial interpretation of the two tests, respectively. Based on these results, we suggest that cows that have reproductive disorders and are producing little milk should be prioritized for brucellosis screening in CMA.

Purpose: Keratoconus is an ectatic disorder of cornea and mostly involve teen aged group, still the pathogenesis and aetiology is not clearly defined. We try to establish the progression of the diseases is inversely proportional to the age of onset of the patient. Design: It was an observational study, carried out at a private eye hospital where patient was referred for RGP contact lenses. Methods: This observational study was carried out from Jan’ 2017 to Dec’ 2019 total three year period and 304 patients with Keratoconus were in the initial study and we divided them into two groups. Group: A, ≤25 years old and Group: B, >25 years old but among these 304 patient we included 200 patients in our study those who completed minimum 3 years follow-up and meet the inclusion criteria. Results: After three years ‘K’ value in group: A

Antiphospholipid syndrome (APS) is an autoimmune disease characterised by vascular thrombosis and/or pregnancy morbidity in the presence of persistently positive serum tests for antiphospholipid antibodies. Management of APS centres on preventing these clinical events and in preventing chronic damage caused by these events. In patients with thrombotic APS, long-term anticoagulation is recommended in the majority of cases. Although there were hopes that direct-acting oral anticoagulants could replace warfarin for prevention of thrombosis in patients with APS, this now seems less likely due to recent trial results. There is no evidence for use of anticoagulation in people who are aPL-positive but have never had a thrombosis but low-dose aspirin may be beneficial in those who have a higher-risk aPL profile. Management of obstetric APS is with daily subcutaneous heparin and low-dose aspirin. This gives a live birth rate of 70% or more. Catastrophic APS is rare, occurring in 1% of patients with APS. It is characterised by thrombosis in multiple organs simultaneously, with a high mortality rate. The management is with corticosteroids, anticoagulation, and immunoglobulins or plasma exchange.

Background: Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of developing cardiovascular disease. Echocardiography (ECHO) carries information about cardiac diseases and prognosis in COPD patients. Objective: To find out the Echocardiography changes in COPD patients and to assess Right ventricular (RV) dysfunction by echocardiography and correlate with the disease severity. Methods: A prospective study was conducted on 70 patients admitted with symptoms and signs suggestive of COPD in the Department of Medicine, Gazi Medical College and Hospital (GMCH), Khulna from January 2017 to December 2018. Patients were diagnosed clinically as having COPD with confirmation by spirometry. The patients with asthma, bronchiectasis, tuberculosis, pneumoconiosis, restrictive lung disease like kyphoscoliosis, rheumatic, congenital, ischemic heart disease and hypertension were excluded from the present study. Results: Regarding symptoms, majority 65 (92.9%) patients had breathlessness, 58 (82.9%) had cough with sputum, 25 (35.7%) had swelling of feet. Regarding signs, 68 (97.1%) patients had tachypnea, 24 (34.3%) had raised JVP, 23 (32.9%) had loud P2 suggestive of pulmonary arterial hypertension. Regarding echocardiographic findings, 42 (60.0%) patients had Cor pulmonale, 32 (45.7%) had LVDD, 31 (44.3%) had RVH, 30 (42.9%) had PAH, 29 (41.4%) patients had RA/RV dilation, 11 (15.7%) had RVSD and 9 (12.9%) had LVH. Table 08 shows RA/RV dilatation, RVH, Cor pulmonale, PAH and LVDD were statistically significant (p

Background: Neonatal sepsis is one of the leading causes of neonatal mortality and morbidity globally, more in developing countries. Frequent monitoring of changing pattern of pathogens causing neonatal sepsis is mandatory for effective treatment. Objectives: This study was done to isolate and identify different organisms of sepsis and to compare different types of organisms between early-onset neonatal sepsis (EONS) and late-onset neonatal sepsis (LONS). Materials and Methods: This cross sectional descriptive study was conducted in Department of Microbiology in collaboration with Department of Neonatology, (DMCH) Dhaka. Blood sample was collected from 106 clinically suspected septicemic neonates and isolation and identification of organism was done by automated blood culture and standard microbiological protocol. Data was collected from attendants by filling a predesigned questionnaire. Results: Among 106 samples, 76 (71.69%) were bloodculture positive. Prevalence of (LONS) was higher 42 (55.26%) in comparison to (EONS) 34 (44.74%). Male neonates were affected more 42 (55.26%) than female 34 (44.74%). Among the isolated organisms, Enterobacter spp. was the predominant organism 20 (26.31%) followed by Klebsiella pneumoniae 18 (23.68%) and Candida spp. 12 (15.79%). Conclusion: Gram-negative organisms play the leading role for causing neonatal sepsis and Enterobacter outbreak should be concerned. Therefore, regular surveillance of organism profile causing neonatal sepsis is of utmost necessity. KYAMC Journal Vol. 11, No.-1, April 2020, Page 14-20

Objectives To compare membranous lupus nephritis (MLN) and proliferative lupus nephritis (PLN) with respect to survival, demographic, clinical and laboratory characteristics; and to investigate predictors of renal and patient survival. Methods Single-centre retrospective observational study. Patients with biopsy-proven PLN, MLN and mixed lupus nephritis were included. Groups were compared using appropriate statistical tests and survival was analysed through the Kaplan-Meier method. Cox regression analysis was performed to investigate predictors of renal and patient survival. Results A total of 187 patients with biopsy-proven lupus nephritis (135 with PLN, 38 with MLN and 14 with mixed LN) were followed for up to 42 years (median 12 years). There was a higher proportion of MLN amongst Afro-Caribbeans than amongst Caucasians (31% vs 15%, P = 0.010). Patients with MLN had significantly lower anti-dsDNA antibodies (P = 0.001) and higher C3 levels (P = 0.018) at diagnosis. Cumulative renal survival rates at 5, 10, 15 and 20 years were 91, 81, 75 and 66% for PLN and 100, 97, 92 and 84% for MLN, respectively (P = 0.028). Cumulative patient survival at 5, 10, 15 and 20 years was 94, 86, 80 and 76%, with no difference between PLN and MLN. Urinary protein-creatinine ratio above 42 mg/mmol and eGFR below 76 ml/min/1.73 m2, one year after the diagnosis of LN, were the strongest predictors of progression to end-stage renal disease. eGFR below 77 ml/min/1.73 m2, at one year, development of end-stage renal disease and Afro-Caribbean ethnicity were associated with higher mortality. Conclusion Patients with MLN and PLN differ significantly regarding serological profiles and renal survival, suggesting different pathogenesis. Renal function at year one predicts renal and patient survival.

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

Introduction: Dengue is a major public health concern in our country. The alarming thing is that the seasonal trend of dengue infection is changing with time in Bangladesh due to climate change and unplanned urbanization. Our study was conducted to determine the frequency of dengue virus infection among the febrile patients in 2018 at Dhaka Medical College Hospital (DMCH) and to observe the seasonal trend. Materials and Methods: The study was carried out on 899 febrile patients attended in DMCH from January to December, 2018. Whole blood samples were collected and sera were tested for dengue NS1 antigen and anti-dengue IgM antibodies using commercial test kits (NS1 by OMC Healthcare (Pvt.) Ltd & IgM antibody by Omega Diagnostics Ltd.), respectively. All negative dengue cases were tested for anti Chikungunya antibody to exclude chikungunya. Results: Of the total 899 febrile patients, 350(38.93%) were positive for Dengue infection. Out of them 264(75.43%) were positive for NS1, 82 (23.43%) were positive for IgM and 4 (1.14%) were positive for dengue NS1antigen + anti dengue IgM antibody. More than 50% patients belonged to age group 15-29 years. Males were predominant. More than 60% cases were detected in the post monsoon season. Conclusion: Highest dengue cases were detected in this year in comparison to the previous year’s probably due to re-emergence of DEN-3 serotype. Due to pattern of climate change, seasonal trend of dengue infection was not maintained. Moreover, unplanned urbanization and poor solid waste management have worsened the situation more. J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 105-111

Helicobacter Pylori a very common worldwide infection is responsible for number of upper GIT lesions like gastritis, peptic ulcer disease, gastric carcinoma and mucosa associated lymphoid tissue lymphoma. On the other hand, dyspepsia is a wide spectrum of nonspecific upper GIT symptoms for which patients very frequently visit gastroenterology clinics. The objective of the study was to find prevalence of Helicobacter Pylori among the patients with dyspeptic symptoms who had gastro-duodenal mucosal lesions on upper GIT endoscopy and also if there is any association between these two variables. 164 cases of dyspepsia were done index upper GIT endoscopy as per inclusion and exclusion criteria from April 2018 to December 2018 in Seikh Sayera Khatun Medical College Hospital, Gopalganj. Two gastric biopsies (from antrum and body) were taken and immediately placed in a commercial RUT (rapid urease test) kit. Positive test (rapid urease test) was indicated by change in the color of the kit from yellow to pink or red within 24 hours. Out of 164 patients, 62 (37.8%) patients had gastro-duodenal mucosal lesions and rest(62.2%) showed normal upper GIT at endoscopy. Among the 62 patients highest (38) number of the patients endoscopy showed gastritis and least (3) showed gastric ulcer. Among 62 patients with endoscopic gastro-duodenal mucosal lesions, 36 patients were infected with Helicobacter Pylori. On the contrary 27 patients out of 102 subjects who had normal upper GIT at endoscopy recorded infected with Helicobacter Pylori. Statistically analysis was done using chi-square test with the help of SPSS software windows version 25. The level of statistical significance was set at 0.05. In our study it was observed that statistically there was significant relation of Helicobacter Pylori with gastro-duodenal mucosal lesions as P value was less than 0.05. In this study, we found that Helicobacter Pylori was significantly associated with gastro-duodenal mucosal lesions among the patients with dyspeptic symptoms. So, our suggestion will be to confirm H. pylori infection if anybody has gastro-duodenal mucosal lesions if a subject does upper GIT endoscopy for dyspeptic symptoms. J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 100-104

Background: Community-acquired pneumonia (CAP) is the most frequent infectious disease, responsible for significant morbidity and mortality world wide. Poor outcome in CAP patients is directly related to pneumonia also to comorbidities both during hospitalization and long term after discharge. Objective: To determine the incidence of major cardiac complications in CAP patients. Materials and Methods: This observational study was conducted in Medicine Department, Gazi Medical College and Hospital (GMCAH) Khulna from January 2016 to March 2019. We studied patients with association of CAP and ACE on admission or Patients with CAP on admission, developing ACE after 48 to 72 hours of hospital stay. Patients who were admitted with ACE but developed a CAP after 48 to 72 hours of admission and Patients with severe sepsis with a concomitant elevated troponin were excluded from the study. Results: Out of 1406 patients with CAP, 12.4% presented with cardiovascular events and 87.6% without cardiovascular events. In cardiovascular events, 79.3% patient had heart failure, 17.8% had cardiac arrhythmia and 2.9% had myocardial infarction. Subjects with hyperlipidemia had 2.10 fold more cardiac events than subjects without hyperlipidemia. A Subject with (PSI) 80 had 3.16 (95% CI 1.18 to 8.47) times increase in odds having cardiovascular events. Hyperlipidemia and PSI were significantly associated with cardiovascular events. Conclusion: Major cardiac complications occur in a substantial proportion of patients with CAP. Physicians and patients need to appreciate the significance of this association for timely recognition and management of these events. Strategies aimed at preventing pneumonia in high-risk population need to be optimized. KYAMC Journal Vol. 10, No.-4, January 2020, Page 191-195

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

Background: Helicobacter pylori (H. pylori) remains one of the most common worldwide human infections and is associated with a number of important upper gastrointestinal (GI) conditions including chronic gastritis, peptic ulcer disease, gastric carcinoma and special type of lymphoma. Anaemia is a common disorder in developing countries and the commonest cause is iron deficiency. There are many causes for high prevalence of this disorder in our society, many are well-known and investigated while some are new and not well established. Although H. pylori associates peptic ulcers and gastric malignancy can cause bleeding, resulting in iron deficiency, but majority of patients infected with H. pylori does not have ulcer or malignancy. They usually have chronic gastritis that is not associated with GI bleeding. About 35% of iron deficiency anaemia cases remain unexplained after a gastrointestinal evaluation. Recently investigation focused on the role of H. pylori, in the development of extra-gastrointestinal diseases including Iron deficiency anaemia. Methodology: This observational, cross sectional study was carried out at BSMMU, Dhaka from July 2010 to October 2011 to find out the association between H. pylori infection and iron deficiency anemia in Bangladeshi adults. Patients with dyspepsia and indication of upper GI endoscopy were initially enrolled in the study and finally a total of 168 subjects were included based on inclusion and exclusion criteria. Result: Among 168 patients, 105 (62.5%) were male and 63(37.5%) were female with the mean age of 33.25 years. On endoscopy, 147(87.5%) of the patients had normal findings and 21(12.5 %) had erosive gastritis. None of them had hemorrhagic erosive gastritis. Among 168 patients, 115(68.45%) were positive and 53(31.55%) were negative for H. pylori by rapid urease test. In our study, we have found a significant low mean serum ferritin level (P0.05) different in hemoglobin level according to H. pylori status. Conclusion: Though there was no significant low hemoglobin level in our study, mean hemoglobin level was low in H. pylori positive patient. In our study H. pylori was not significantly associated with iron deficiency anemia but it was significantly associated with iron deficiency. J Bangladesh Coll Phys Surg 2020; 38(2): 68-78

Venous thrombosis (VT) of deep vein is a life-threatening condition which may lead to sudden death as an immediate complication due to formation of thrombo-embolism. VT is associated with various risk factors such as prolonged immobilization, inflammation, and/or coagulation disorders including muscular or venous injury. Deep venous thrombosis (DVT) frequently occurs in the lower limb. Successful treatment of DVT exclusively with homeopathic remedies has rarely been recorded in peer-reviewed journals. The present case report intends to record yet another case of DVT in an old patient totally cured exclusively by the non-invasive method of treatment with micro doses of potentized homeopathic drugs selected on the basis of the totality of symptoms and individualization of the case. Since this report is based on a single case of recovery, results of more such cases are warranted to strengthen the outcome of the present study.

Crohn’s disease (CD) is a disorder of uncertain etiology that is characterized by transmural inflammation of the gastrointestinal tract. CD may involve the entire gastrointestinal tract from mouth to the perianal area. Isolated jejunal involvement of CD is a rare entity. We describe a case of CD involving only jejunum with successful treatment in a 74-years-man who presented with melaena, abdominal pain and significant weight loss. Endoscopy of upper gastro-intestinal tract revealed gastritis and colonoscopy showed small sessile polyp at rectum and sigmoid colon, polypectomy was done accordingly. After few days of polypectomy, he again noticed melaena along with abdominal discomfort and weakness with loss of 4 kg weight within this periods. Diagnosis was confirmed by capsule endoscopy and serology. Treatment was thereafter started with oral steroid and mesalamine sachet. The patient is now on remission and is on regular follow up. CD has propensity to involve the distal small intestine and proximal large bowel. Affected persons usually experience diarrhea and abdominal pain, frequently accompanied by weight loss. Proximal small bowel involvement is less common than distal small bowel or colonic involvement in CD. CD involving proximal small intestine should be suspected in Asian patients with middle gastro-intestinal bleeding. It is associated with a high risk of clinical relapse and morbidity, including the need for abdominal surgery. Different modalities of baseline evaluation and more sophisticated diagnostic modalities may be required for patients with CD involving proximal small bowel. Capsule endoscopy (CE) currently plays an important role in CD. Birdem Med J 2020; 10(1): 68-72

Background: Ischemic Heart Disease (IHD) is preventable and reversible if early screening and elimination of the risk factors like life style modification and dietary intervention can be done. Exercise Tolerant Test (ETT) has become an important diagnostic tool to evaluate patient with suspected or known case of ischemic heart disease. Objective: To determine the frequency of IHD among subjects who presented with chest pain and to identify the common indications for ETT. Methodology: It was a cross-sectional study; the data was collected from ETT Unit of Mugda Medical College Hospital, Dhaka, Bangladesh using standard Bruce protocol. Result: Out of 200 patients, there were 124(61%) male and 78(39%) female who presented in the cardiology department for ETT. Common indications for ETT were evaluation of chest pain 180(90%), followed by general check-up 14(7%), post-PCI evaluations 4(2%) and post- CABG evaluation 2(1%).Presenting complaints were typical angina 12(6%), shortness of breath 56(28%), nonspecific chest pain 82(41%), chest compression 46(23%) and others 4(2%). Exercise ECG showed no ST changes in 138(69%) patients. The most common risk factors were hypertension, diabetes, smoking and obesity. Majority of the subjects 136(68%) were test negative whereas 42 (21%) were test positive and 22(11%) were test equivocal. Conclusions: It is concluded that most of the subjects presenting with the suspected symptoms of myocardial ischemia were negative for IHD, and so why we advocate the use of ETT as a screening tool in patients who presents with features simulating angina. This will prevent unnecessary hospital admission. Bangladesh Heart Journal 2019; 34(2) : 122-126

Objective: To assess cancer risk factors in incident systemic lupus erythematosus (SLE). Methods: Clinical variables and cancer outcomes were assessed annually among incident SLE patients. Multivariate hazard regression models (overall risk and most common cancers) included demographic characteristics and time-dependent medications (corticosteroids, antimalarial drugs, immunosuppressants), smoking, and the adjusted mean Systemic Lupus Erythematosus Disease Activity Index 2000 score. Results: Among 1,668 patients (average 9 years follow-up), 65 cancers occurred: 15 breast, 10 nonmelanoma skin, 7 lung, 6 hematologic, 6 prostate, 5 melanoma, 3 cervical, 3 renal, 2 each gastric, head and neck, and thyroid, and 1 each rectal, sarcoma, thymoma, and uterine cancers. Half of the cancers (including all lung cancers) occurred in past/current smokers, versus one-third of patients without cancer. Multivariate analyses indicated that overall cancer risk was related primarily to male sex and older age at SLE diagnosis. In addition, smoking was associated with lung cancer. For breast cancer risk, age was positively associated and antimalarial drugs were negatively associated. Antimalarial drugs and higher disease activity were also negatively associated with nonmelanoma skin cancer risk, whereas age and cyclophosphamide were positively associated. Disease activity was associated positively with hematologic and negatively with nonmelanoma skin cancer risk. Conclusion: Smoking is a key modifiable risk factor, especially for lung cancer, in SLE. Immunosuppressive medications were not clearly associated with higher risk except for cyclophosphamide and nonmelanoma skin cancer. Antimalarials were negatively associated with breast cancer and nonmelanoma skin cancer risk. SLE activity was associated positively with hematologic cancer and negatively with nonmelanoma skin cancer. Since the absolute number of cancers was small, additional follow-up will help consolidate these findings.

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease with a prevalence of approximately 1 in 1000.1 It occurs 9 times more commonly in women than men and is more common in some ethnic groups, notably in people of African/Caribbean ethnicity.

ObjectiveTo achieve consensus on a definition of remission in SLE (DORIS).BackgroundRemission is the stated goal for both patient and caregiver, but consensus on a definition of remission has been lacking. Previously, an international task force consisting of patient representatives and medical specialists published a framework for such a definition, without reaching a final recommendation.MethodsSeveral systematic literature reviews were performed and specific research questions examined in suitably chosen data sets. The findings were discussed, reformulated as recommendations and voted on.ResultsBased on data from the literature and several SLE-specific data sets, a set of recommendations was endorsed. Ultimately, the DORIS Task Force recommended a single definition of remission in SLE, based on clinical systemic lupus erythematosus disease activitiy index (SLEDAI)=0, Evaluator’s Global Assessment ConclusionThe 2021 DORIS definition of remission in SLE is recommended for use in clinical care, education, and research including clinical trials and observational studies.

Case report - Introduction ANCA-associated vasculitis (AAV) encompasses the clinical entities of GPA, MPA, renal-limited vasculitis and eGPA. Even though well recognised and described in the medical literature, ocular manifestations in AAV are relatively uncommon (

Objectives Vitamin D (25(OH)D) deficiency and metabolic syndrome (MetS) may both contribute to increased cardiovascular risk in SLE. We aimed to examine the association of demographic factors, SLE phenotype, therapy and vitamin D levels with MetS and insulin resistance. Methods The Systemic Lupus International Collaborating Clinics (SLICC) enrolled patients recently diagnosed with SLE ( Results Of the 1847 patients, 1163 (63%) had vitamin D measured and 398 (34.2%) subjects were in the lowest 25(OH)D tertile. MetS was present in 286 of 860 (33%) patients whose status could be determined. Patients with lower 25(OH)D were more likely to have MetS and higher HOMA-IR. The MetS components, hypertension, hypertriglyceridemia and decreased high-density lipoprotein (HDL) were all significantly associated with lower 25(OH)D. Increased average glucocorticoid exposure was associated with higher insulin resistance. Conclusions MetS and insulin resistance are associated with lower vitamin D in patients with SLE. Further studies could determine whether vitamin D repletion confers better control of these cardiovascular risk factors and improve long-term outcomes in SLE.

Objective: The Systemic Lupus International Collaborating Clinics (SLICC) 2012 systemic lupus erythematosus (SLE) classification criteria and the revised American College of Rheumatology (ACR) 1997 criteria are list based, counting each SLE manifestation equally. We derived a classification rule based on giving variable weights to the SLICC criteria and compared its performance to the revised ACR 1997, the unweighted SLICC 2012, and the newly reported European Alliance of Associations for Rheumatology (EULAR)/ACR 2019 criteria sets. Methods: The physician-rated patient scenarios used to develop the SLICC 2012 classification criteria were reemployed to devise a new weighted classification rule using multiple linear regression. The performance of the rule was evaluated on an independent set of expert-diagnosed patient scenarios and compared to the performance of the previously reported classification rules. Results: The weighted SLICC criteria and the EULAR/ACR 2019 criteria had less sensitivity but better specificity compared to the list-based revised ACR 1997 and SLICC 2012 classification criteria. There were no statistically significant differences between any pair of rules with respect to overall agreement with the physician diagnosis. Conclusion: The 2 new weighted classification rules did not perform better than the existing list-based rules in terms of overall agreement on a data set originally generated to assess the SLICC criteria. Given the added complexity of summing weights, researchers may prefer the unweighted SLICC criteria. However, the performance of a classification rule will always depend on the populations from which the cases and non-cases are derived and whether the goal is to prioritize sensitivity or specificity.

Background Timely utilization of antenatal care and delivery services supports the health of mothers and babies. Few studies exist on the utilization and determinants of timely ANC and use of different types of health facilities at the community level in Bangladesh. This study aims to assess the utilization, timeliness of, and socio-demographic determinants of antenatal and delivery care services in two sub-districts in Bangladesh. Methods This cross-sectional study used data collected through a structured questionnaire in the eRegMat cluster-randomized controlled trial, which enrolled pregnant women between October 2018-June 2020. We undertook univariate and multivariate logistic regression analysis to determine the associations of socio-demographic variables with timely first ANC, four timely ANC visits, and facility delivery. We considered the associations in the multivariate logistic regression as statistically significant if the p-value was found to be Results Data were available on 3293 pregnant women. Attendance at a timely first antenatal care visit was 59%. Uptake of four timely antenatal care visits was 4.2%. About three-fourths of the women delivered in a health facility. Women from all socio-economic groups gradually shifted from using public health facilities to private hospitals as the pregnancy advanced. Timely first antenatal care visit was associated with: women over 30 years of age (AOR: 1.52, 95% CI: 1.05–2.19); nulliparity (AOR: 1.30, 95% CI: 1.04–1.62); husbands with >10 years of education (AOR: 1.40, 95% CI: 1.09–1.81) and being in the highest wealth quintile (AOR: 1.49, 95% CI: 1.18–1.89). Facility deliveries were associated with woman’s age; parity; education; the husband’s education, and wealth index. None of the available socio-demographic factors were associated with four timely antenatal care visits. Conclusions The study observed socio-demographic inequalities associated with increased utilization of timely first antenatal care visit and facility delivery. The pregnant women, irrespective of wealth shifted from public to private facilities for their antenatal care visits and delivery. To increase the health service utilization and promote good health, maternal health care programs should pay particular attention to young, multiparous women, of low socio-economic status, or with poorly educated husbands. Clinical trial registration ISRCTN69491836; https://www.isrctn.com/. Registered on December 06, 2018. Retrospectively registered.

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

Background: Helicobacter pylori (HP) infection is an important cause of peptic ulcer disease (PUD) in the world. This study was aimed to know the trend of H.P. infection among the symptomatic subjects Method: This was a retrospective observational study conducted from January 2015 to July 2018 in three different hospitals in Dhaka city. Patient who presented with dyspepsia underwent 13C urea breath test. Positive cases were analyzed. Results: A total 1343 patients were taken for UBT where 308 (23%) patients were found positive. The mean age group was 41.21+13.6. Male were more infected (61%) than female (39%). Conclusion: Improving sanitary and hygienic condition of this region along with significantly increasing HP eradication therapy and PPI use by the symptomatic individuals might have contributed to the decreasing trend of infection Anwer Khan Modern Medical College Journal Vol. 10, No. 2: July 2019, P 121-124

Menopause is an inevitable stage of every woman’s life. This cross sectional study was conducted to assess the relationship between physical activity and menopausal symptoms from January to December 2017. By convenient sampling total 213 post menopausal women were interviewed from Mirpur, situated at the northern part of Dhaka. Five most prevalent menopausal symptoms were joint and muscular pain (90.1%), anxiety and sleep disturbance (80.3%), chest discomfort as well as physical and mental exhaustion (78.9%). Most of the respondents were physically active (63.4%), few were inactive (1.9%) and 34.7% respondents were Health Enhancing Physical Activity (HEPA) active. The mean of total Metabolic Equivalent of Task (MET)-minute per week was 2713.46 ± 1152.24 minutes. Menopausal symptoms retrieved from Menopause Rating Scale were assessed according to physical activity level. Physical and mental exhaustion was found statistically significant (p=0.04) with the higher proportion reported in divorced and widowed (90.5%). Significant relationship between psychological subscale and educational status was seen (p=.03). There was significant association between dryness of vagina and educational status (p.05). Anxiety was found statistically significant (p=.04) with highest proportion found in HEPA active women (89.2%). Proportion of sleep problems (100%), physical and mental exhaustion (100%), bladder problems (urinary incontinence) (75%), joint and muscular discomfort (100%) were more in inactive than minimally active and HEPA active women but the relationships were not statistically significant (p>.05). The result indicates that physical activity may have some role in reducing menopausal symptoms. Bangladesh Med J. 2018 Jan; 47 (1): 11-17

Vitamin D Deficiency is a world-wide problem and it is defined as 25(OH)D3 level below 20 ng/ml. It contributes skeletal and non-skeletal health effects. Musculo-skeletal abnormalities along with non-skeletal health effects such as microbial infection, cardiovascular disorders, cancers, autoimmune diseases, asthma and allergy, endocrine and metabolic diseases, mental health etc are seen in Vitamin D deficiency. Vitamin D deficiency or insufficiency is mostly under diagnosed or under attention topics or unaware matter to general population. It is mostly preventable and treatable condition that needs due attention to life-style modification, medication, self-awareness and campaign and further research. Journal of Armed Forces Medical College Bangladesh Vol.14(1) 2018: 78-83

Objectives aPL are present in between 20 and 30% of patients with SLE. They can cause vascular events (VE) or pregnancy morbidity. aCL and anti-beta-2-glycoprotein I (anti-β2GPI) are measured in clinical practice. Domain I (DI) of β2GPI is the main site for aPL binding. We investigated the prevalence of IgG anti-DI, aCL and anti-β2GPI antibodies in early SLE and their association with mortality and development of VE. Methods Samples from 501 patients with SLE that had been obtained and stored early during their disease were tested for IgG anti-DI, aCL and anti-β2GPI antibodies by ELISA. LA status and history of VE were obtained by reviewing medical records. Kaplan–Meier analysis was used to investigate mortality and occurrence of VE, comparing groups with and without aPL in early disease. Results Of 501 patients, 190 (38%) had at least one of these aPL, of whom 112 had anti-DI alone. Of 276 patients with complete vascular history, 83 had experienced VE. The 39 patients who were double or triple-ELISA-positive for any combination of the three aPL were more likely to have or develop lupus anticoagulant (P Conclusion IgG anti-DI antibodies were present in early serum samples from 29% of patients and were more common than IgG aCL or anti-β2GPI. There was some evidence suggesting that double or triple-ELISA-positivity for these antibodies identified a group with worse outcomes.

Introduction:Common presentation of thyroid disorders is solitary nodule. A discrete swelling in an otherwise impalpable gland is termed as solitary nodule of thyroid. The majority of solitary thyroid nodules are benign. The incidence of malignancy is 10-20%, being more common in females with a mean age of 35 years.The object of the study was to identify the incidence of malignancy in solitary nodule thyroid which emphasizes on the early diagnosis and adequate treatment. Materials and Methods: The study was carried out in the department of ENT and Head-Neck Surgery of Rangpur Medical College Hospital, Rangpur and Shaheed Ziaur Rahman Medical College Hospital, Boruga in 50 patients with solitary thyroid nodule from July 2013 to June 2015. Results: The solitary thyroid nodules were seen in 1.76% of surgical admissions. The mean age of the incidence of solitary thyroid nodule is 35 years. The incidence of malignancy in solitary thyroid nodule is 18.51%. The solitary thyroid nodules were frequent in females than males in the ratio of 6.71:1. Conclusion: It is concluded from the present study that a remarkable proportion 10% of solitary thyroid nodules was malignant with females preponderance which emphasizes on the early diagnosis and adequate treatment. Medicine Today 2019 Vol.31(2): 85-88

Objective: The spectrum of antinuclear antibodies (ANAs) is changing to include both nuclear staining as well as cytoplasmic and mitotic cell patterns (CMPs) and accordingly a change is occurring in terminology to anticellular antibodies. This study examined the prevalence of indirect immunofluorescence (IIF) anticellular antibody staining using the Systemic Lupus International Collaborating Clinics inception cohort.Methods: Anticellular antibodies were detected by IIF on HEp-2000 substrate using the baseline serum. Three serologic subsets were examined: ANA positive (presence of either nuclear or mixed nuclear/CMP staining), anticellular antibody negative (absence of any intracellular staining), and isolated CMP staining. The odds of being anticellular antibody negative versus ANA or isolated CMP positive was assessed by multivariable analysis.Results: A total of 1,137 patients were included; 1,049 (92.3%) were ANA positive, 71 (6.2%) were anticellular antibody negative, and 17 (1.5%) had an isolated CMP. The isolated CMP–positive group did not differ from the ANA-positive or anticellular antibody–negative groups in clinical, demographic, or serologic features. Patients who were older (odds ratio [OR] 1.02 [95% confidence interval (95% CI) 1.00, 1.04]), of white race/ethnicity (OR 3.53 [95% CI 1.77, 7.03]), or receiving high-dose glucocorticoids at or prior to enrollment (OR 2.39 [95% CI 1.39, 4.12]) were more likely to be anticellular antibody negative. Patients on immunosuppressants (OR 0.35 [95% CI 0.19, 0.64]) or with anti-SSA/Ro 60 (OR 0.41 [95% CI 0.23, 0.74]) or anti–U1 RNP (OR 0.43 [95% CI 0.20, 0.93]) were less likely to be anticellular antibody negative. Conclusion: In newly diagnosed systemic lupus erythematosus, 6.2% of patients were anticellular antibody negative, and 1.5% had an isolated CMP. The prevalence of anticellular antibody–negative systemic lupus erythematosus will likely decrease as emerging nomenclature guidelines recommend that non-nuclear patterns should also be reported as a positive ANA.

Colorectal carcinoma is the second most common malignancy and the second leading cause of cancer deaths in Western countries. The condition becomes increasingly common over the age of 50 years. The total number of colorectal cancer patients available for the study within the stipulated time was 56. Among them 64.29% patients were male and 35.71% patients were female. 01.79% patient belonged to age group ≤ 20, 12.5% belonged to age group 21-30, 19.64% belonged to age group 31-40, 25.0% belonged to age group 41-50, 26.79% belonged to age group 51-60, 08.93% belonged to age group 61-70 and 05.35% patients were >70 years of age. Mean age was 48.05 years ± 13.97 SD. In our study, 27.2% survived ≤3 months, 36.4% 4-6 months, 09.1% 7-9 months, 18.2% 10-12 months, 09.1% 13-24 months and 0% >24 months. Among 11 expired patients, 03 got curative treatment and rest of 08 got palliative treatment. Those who got curative treatment, 66.7% survived 10-12 months and 33.3% 13-24 months. Those who got palliative treatment 37.5% survived ≤3 months, 50.0% 4-6 months and 12.5% 7-9 months. Overall median survival was 07 months, for curative treatment 15 months and for palliative treatment 05 months. TAJ 2018; 31(2): 12-16