C. Tabassum, Mohammad Arifuzzaman, M. Sayem, Tanvir Mostafa, Kazi Bodruddoza, A. Kabir
Background: Dengue fever has emerged as one of the most common viral diseases in the world. The clinical manifestation ranges from mild febrile illness to severe disease such as dengue hemorrhagic fever and dengue shock syndrome. Dengue is known to affect various systems. So, different aspects of disease need to be explored. Cardiac involvement in dengue fever is not uncommon and has been reported in literature. ECG is widely used as a screening tool not only because it is easily available but also due to its ability to indicate cardiac involvement. Objective: The aim of the study was to determine the patterns of ECG changes and their frequency in a cohort of patients with dengue fever (DF) and dengue hemorrhagic fever (DHF) along with the association of ECG changes with severity of dengue infection and clinical manifestation of cardiac involvement. Method: We conducted a cross-sectional observational study involving 50 patients with dengue fever and dengue hemorrhagic fever, admitted in Medicine department of Dhaka Medical College Hospital, Dhaka from 1st October, 2017 to 31st March, 2018. Admitted patients with high grade fever and positive Dengue IgM, NS1 AG or RT-PCR were included. Patients with electrolyte abnormalities, preexisting heart disease, drugs interfering with heart rhythm were excluded from study. The Standard 12 lead ECG was carried out in study patients on 3rd day of disease onset and on the day of discharge after disease recovery. Frequency & pattern of ECG changes like heart rate, rhythm, P wave, T wave, ST segments and QRS complex were analyzed and recorded. Statistical analysis was done using SPSS 25 on windows 10. Categorical and numerical data’s were expressed as frequencies and percentage. Cross tabulation was done between DF and DHF with different ECG findings. To establish the significance of various findings and association in between variables chi-square analysis, Pearson correlations were done in all cases. P value < 0.05 considered significant Result: Total 50 patients with dengue fever were enrolled, 39 patients (78%) were diagnosed as dengue fever and 11 patients (22%) were diagnosed as dengue hemorrhagic fever (DHF). Mean age of the patient was 33.08 ± 9.79 years. Male – female ratio of 1.5:1 fever was noted in all 50 patients (100%), myalgia (94%), headache (84%), skin rash (82%), & retro-orbital pain(54%), vomiting (26%), only 3 patients (6%) complained about abdominal pain. Only 4 patients had cardiac symptoms. 3 patients complained about palpitation and only 1 patient had symptom of chest pain and dyspnea. In most of the patients, (34 in number, 68%) ECG was normal. Only 16 patients (32%) had abnormal findings in ECG. 9 patients (18%) had bradycardia, 3 patients (6%) had tachycardia, 2 Patient (4%) had T Inversion and 1 patient (2%) had ST elevation and 1 patient (2%) had ST depression. Among total 16 abnormal ECG, predominant finding was bradycardia (>50% of abnormal ECG). P value is <0.01. Correlation of EC
{"title":"Patterns of ECG Manifestations in Dengue Infection","authors":"C. Tabassum, Mohammad Arifuzzaman, M. Sayem, Tanvir Mostafa, Kazi Bodruddoza, A. Kabir","doi":"10.3329/jom.v24i2.67274","DOIUrl":"https://doi.org/10.3329/jom.v24i2.67274","url":null,"abstract":"Background: Dengue fever has emerged as one of the most common viral diseases in the world. The clinical manifestation ranges from mild febrile illness to severe disease such as dengue hemorrhagic fever and dengue shock syndrome. Dengue is known to affect various systems. So, different aspects of disease need to be explored. Cardiac involvement in dengue fever is not uncommon and has been reported in literature. ECG is widely used as a screening tool not only because it is easily available but also due to its ability to indicate cardiac involvement.\u0000Objective: The aim of the study was to determine the patterns of ECG changes and their frequency in a cohort of patients with dengue fever (DF) and dengue hemorrhagic fever (DHF) along with the association of ECG changes with severity of dengue infection and clinical manifestation of cardiac involvement.\u0000Method: We conducted a cross-sectional observational study involving 50 patients with dengue fever and dengue hemorrhagic fever, admitted in Medicine department of Dhaka Medical College Hospital, Dhaka from 1st October, 2017 to 31st March, 2018. Admitted patients with high grade fever and positive Dengue IgM, NS1 AG or RT-PCR were included. Patients with electrolyte abnormalities, preexisting heart disease, drugs interfering with heart rhythm were excluded from study. The Standard 12 lead ECG was carried out in study patients on 3rd day of disease onset and on the day of discharge after disease recovery. Frequency & pattern of ECG changes like heart rate, rhythm, P wave, T wave, ST segments and QRS complex were analyzed and recorded. Statistical analysis was done using SPSS 25 on windows 10. Categorical and numerical data’s were expressed as frequencies and percentage. Cross tabulation was done between DF and DHF with different ECG findings. To establish the significance of various findings and association in between variables chi-square analysis, Pearson correlations were done in all cases. P value < 0.05 considered significant\u0000Result: Total 50 patients with dengue fever were enrolled, 39 patients (78%) were diagnosed as dengue fever and 11 patients (22%) were diagnosed as dengue hemorrhagic fever (DHF). Mean age of the patient was 33.08 ± 9.79 years. Male – female ratio of 1.5:1 fever was noted in all 50 patients (100%), myalgia (94%), headache (84%), skin rash (82%), & retro-orbital pain(54%), vomiting (26%), only 3 patients (6%) complained about abdominal pain. Only 4 patients had cardiac symptoms. 3 patients complained about palpitation and only 1 patient had symptom of chest pain and dyspnea. In most of the patients, (34 in number, 68%) ECG was normal. Only 16 patients (32%) had abnormal findings in ECG. 9 patients (18%) had bradycardia, 3 patients (6%) had tachycardia, 2 Patient (4%) had T Inversion and 1 patient (2%) had ST elevation and 1 patient (2%) had ST depression. Among total 16 abnormal ECG, predominant finding was bradycardia (>50% of abnormal ECG). P value is <0.01. Correlation of EC","PeriodicalId":76013,"journal":{"name":"Journal of medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49170240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sadia Sabah, Z. Hossain, Md. Sadiqur Rahman, T. B. Hannan, F. Johora, M. Masum, F. Chowdhury
Bangladesh is non endemic for Cutaneous Leishmaniasis (CL). Rarely, we come across such cases in workers returning from Middle east particularly Saudi Arabia. Recently we found and managed a case of cutaneous leishmaniasis in a 37 year old male returning from Saudi Arabia with a lesion behind his left ankle joint. Although Sodium Stibogluconate is the first choice of drug to treat CL, it is not available in Bangladesh. He was managed successfully with Liposomal Amphotericin B. High index of suspicion is needed to diagnose such case without any delay. J MEDICINE 2023; 24(2): 167-168
{"title":"An Expatriate from Saudi Arabia with Papulo-nodular Rash and Blisters for Two Years","authors":"Sadia Sabah, Z. Hossain, Md. Sadiqur Rahman, T. B. Hannan, F. Johora, M. Masum, F. Chowdhury","doi":"10.3329/jom.v24i2.67283","DOIUrl":"https://doi.org/10.3329/jom.v24i2.67283","url":null,"abstract":"Bangladesh is non endemic for Cutaneous Leishmaniasis (CL). Rarely, we come across such cases in workers returning from Middle east particularly Saudi Arabia. Recently we found and managed a case of cutaneous leishmaniasis in a 37 year old male returning from Saudi Arabia with a lesion behind his left ankle joint. Although Sodium Stibogluconate is the first choice of drug to treat CL, it is not available in Bangladesh. He was managed successfully with Liposomal Amphotericin B. High index of suspicion is needed to diagnose such case without any delay.\u0000J MEDICINE 2023; 24(2): 167-168","PeriodicalId":76013,"journal":{"name":"Journal of medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46110547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Postherpetic neuralgia is a well-studied and somewhat common sequala of herpes zoster leading to intense pain episodes. Pain-induced vasovagal episodes can rarely lead to asystole, which is a fatal potential complication. It is crucial to have a high clinical suspicion of asystole when a patient presents with severe herpetic neuralgia leading to syncope. This is a unique cause of a 67-year-old Caucasian female who presented with syncope caused by severe postherpetic neuralgia with the eventual finding of pain-induced asystole episodes. J MEDICINE 2023; 24(2): 162-165
{"title":"Postherpetic Neuralgia Induced Asystole - A Deadly Consequence of a Common Disease","authors":"Ayesha Mohan, F. Hoque","doi":"10.3329/jom.v24i2.67282","DOIUrl":"https://doi.org/10.3329/jom.v24i2.67282","url":null,"abstract":"Postherpetic neuralgia is a well-studied and somewhat common sequala of herpes zoster leading to intense pain episodes. Pain-induced vasovagal episodes can rarely lead to asystole, which is a fatal potential complication. It is crucial to have a high clinical suspicion of asystole when a patient presents with severe herpetic neuralgia leading to syncope. This is a unique cause of a 67-year-old Caucasian female who presented with syncope caused by severe postherpetic neuralgia with the eventual finding of pain-induced asystole episodes.\u0000J MEDICINE 2023; 24(2): 162-165","PeriodicalId":76013,"journal":{"name":"Journal of medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44546735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Impaired insulin secretion and resistance remain the core defects in T2DM, but at least six other pathophysiological abnormalities contribute to the dysregulation of glucose metabolism. Diabetic nephropathy is one of the most common microvascular complications and a major cause of end-stage renal disease. Despite many treatment options available, diabetic kidney disease continues to affect a large population with diabetes. The kidneys have the highest DPP-4 expression level in mammalians. DPP- 4 is expressed in several segments of the nephron and the tubule interstitium, placing it at the nexus of inflammation, immune system activation, glomerular and proximal tubular function, salt regulation, and kidney fibrosis. Moreover, DPP-4 expression and urinary activity are up-regulated in diabetic nephropathy, highlighting its role as a potential target to manage diabetic nephropathy. DPP-4 inhibition is associated with mitigation of diabetic and hypertensive renal injury and protection of renal function. Renal glucose reabsorption by SGLT proteins is a critical component of glycemic regulation. SGLT2 protein expression is increased in human diabetic nephropathy even with advanced kidney disease indicating that SGLT2 can be an effective target in treatment of diabetic nephropathy. This review article discusses roles played by DPP-4 inhibitors and SGLT-2 inhibitors alone and in combination in diabetic nephropathy supported by clinical evidences. MEDLINE and EMBASE were searched through September 2022. Randomized controlled trials published in English that evaluated SGLT2 inhibitors and/or DPP4 inhibitors in patients with T2DM were selected. J MEDICINE 2023; 24: 43-49
{"title":"Can DPP-4 Enhibitors and SGLT-2 Inhibitors Pleotropic Effects be Extended to Treat Diabetic Nephropathy?","authors":"A. Faruqui","doi":"10.3329/jom.v24i1.64903","DOIUrl":"https://doi.org/10.3329/jom.v24i1.64903","url":null,"abstract":"Impaired insulin secretion and resistance remain the core defects in T2DM, but at least six other pathophysiological abnormalities contribute to the dysregulation of glucose metabolism. Diabetic nephropathy is one of the most common microvascular complications and a major cause of end-stage renal disease. Despite many treatment options available, diabetic kidney disease continues to affect a large population with diabetes. The kidneys have the highest DPP-4 expression level in mammalians. DPP- 4 is expressed in several segments of the nephron and the tubule interstitium, placing it at the nexus of inflammation, immune system activation, glomerular and proximal tubular function, salt regulation, and kidney fibrosis. Moreover, DPP-4 expression and urinary activity are up-regulated in diabetic nephropathy, highlighting its role as a potential target to manage diabetic nephropathy. DPP-4 inhibition is associated with mitigation of diabetic and hypertensive renal injury and protection of renal function. Renal glucose reabsorption by SGLT proteins is a critical component of glycemic regulation. SGLT2 protein expression is increased in human diabetic nephropathy even with advanced kidney disease indicating that SGLT2 can be an effective target in treatment of diabetic nephropathy. This review article discusses roles played by DPP-4 inhibitors and SGLT-2 inhibitors alone and in combination in diabetic nephropathy supported by clinical evidences. MEDLINE and EMBASE were searched through September 2022. Randomized controlled trials published in English that evaluated SGLT2 inhibitors and/or DPP4 inhibitors in patients with T2DM were selected.\u0000J MEDICINE 2023; 24: 43-49","PeriodicalId":76013,"journal":{"name":"Journal of medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42776438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ummay Fatema Khatun, S. Dey, S. Paul, S. Kabir, Aparna S. Dev
Background: Polypharmacy has been associated with adverse drug reactions, medication errors and non- adherence to prescribe drugs and geriatric population is more prone to this condition. On the other hand, dementia is a major concern among growing chronic diseases in the ageing society and its assessment has not been adequately done in our setting. Method: One hundred subjects aged more≥60 years were included in this analytical cross-sectional from the Medicine Department of Chattogram Medical College Hospital from November 2018 to April 2019. A structured case record form collected data, and drug adherence were measured by Morisky Medication Adherence Scale-8 (MMAS-8). PP was defined as intake of e”5 drugs. Cognitive impairment was classified as presence or absence of dementia by Mini-cog tool. Results: The average age of individuals was 65.56±6.9 years and 62 were men. The prevalence of polypharmacy, dementia, and drug non-adherence was respectively, 56%, 47%, and 49%. Patients with polypharmacy were more likely to be non-adherent (odds ratio: 2.4; 95% CI: 1.1-5.4; p=0.039) and demented (odds ratio: 3.38; 95% CI: 1.1-11.8; p=0.019) than the elderly patients without polypharmacy. Conclusion: As there is significant association between polypharmacy with dementia and drug nonadherence, judicious use of drugs is mandatory to reduce these risk. J MEDICINE 2023; 24: 3-9
{"title":"Assessment of Frequency of Polypharmacy along with its Relation to Dementia and Drug Adherence among Admitted Geriatric Patients in Medicine Wards of a Tertiary Care Hospital","authors":"Ummay Fatema Khatun, S. Dey, S. Paul, S. Kabir, Aparna S. Dev","doi":"10.3329/jom.v24i1.64897","DOIUrl":"https://doi.org/10.3329/jom.v24i1.64897","url":null,"abstract":"Background: Polypharmacy has been associated with adverse drug reactions, medication errors and non- adherence to prescribe drugs and geriatric population is more prone to this condition. On the other hand, dementia is a major concern among growing chronic diseases in the ageing society and its assessment has not been adequately done in our setting.\u0000Method: One hundred subjects aged more≥60 years were included in this analytical cross-sectional from the Medicine Department of Chattogram Medical College Hospital from November 2018 to April 2019. A structured case record form collected data, and drug adherence were measured by Morisky Medication Adherence Scale-8 (MMAS-8). PP was defined as intake of e”5 drugs. Cognitive impairment was classified as presence or absence of dementia by Mini-cog tool.\u0000Results: The average age of individuals was 65.56±6.9 years and 62 were men. The prevalence of polypharmacy, dementia, and drug non-adherence was respectively, 56%, 47%, and 49%. Patients with polypharmacy were more likely to be non-adherent (odds ratio: 2.4; 95% CI: 1.1-5.4; p=0.039) and demented (odds ratio: 3.38; 95% CI: 1.1-11.8; p=0.019) than the elderly patients without polypharmacy.\u0000Conclusion: As there is significant association between polypharmacy with dementia and drug nonadherence, judicious use of drugs is mandatory to reduce these risk.\u0000J MEDICINE 2023; 24: 3-9","PeriodicalId":76013,"journal":{"name":"Journal of medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48613587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Md Sohidul Islam, M. R. Habib, Elmay Taswafe Asha, Mahbuba Sharmin, Mehnaj Ashraf, A. Mahmud, A. L. Kabir, M. R. Alam, F. Chowdhury
Histoplasmosis is underreported although in Southeast Asia including Bangladesh is thought to be endemic considering the favorable geo-climatic conditions for the organism. Non-recognition of histoplasmosis is particularly attributed to possible misdiagnosis as tuberculosis (which is endemic here and common in Bangladesh) because histoplasmosis mimics tuberculosis in clinical presentation, imaging and histopathology. Disseminated histoplasmosis mainly occur in immunocompromised patients and rare in immunocompetent subjects. Here we are reporting two cases of disseminated histoplasmosis where both were immunocompetent and presented with FUO. Both patients visited several health centers before coming to us with no definite diagnosis and we got them in a progressive stage. Both were confirmed through bone marrow study. Unfortunately, one of them died from disease progression, sepsis and other complications and another patient gradually improved with treatment (amphotericin B and itraconazole). We are reporting these cases to highlight the fact that disseminated histoplasmosis does occur in immunocompetent patient and may occur with or without pulmonary symptoms. A high index of suspicion is required for diagnosis and delay can often be fatal. J MEDICINE 2023; 24: 59-64
{"title":"Disseminated Histoplasmosis in Immunocompetent Patients Presented with Fever of Unknown Origin (FUO)","authors":"Md Sohidul Islam, M. R. Habib, Elmay Taswafe Asha, Mahbuba Sharmin, Mehnaj Ashraf, A. Mahmud, A. L. Kabir, M. R. Alam, F. Chowdhury","doi":"10.3329/jom.v24i1.64906","DOIUrl":"https://doi.org/10.3329/jom.v24i1.64906","url":null,"abstract":"Histoplasmosis is underreported although in Southeast Asia including Bangladesh is thought to be endemic considering the favorable geo-climatic conditions for the organism. Non-recognition of histoplasmosis is particularly attributed to possible misdiagnosis as tuberculosis (which is endemic here and common in Bangladesh) because histoplasmosis mimics tuberculosis in clinical presentation, imaging and histopathology. Disseminated histoplasmosis mainly occur in immunocompromised patients and rare in immunocompetent subjects. Here we are reporting two cases of disseminated histoplasmosis where both were immunocompetent and presented with FUO. Both patients visited several health centers before coming to us with no definite diagnosis and we got them in a progressive stage. Both were confirmed through bone marrow study. Unfortunately, one of them died from disease progression, sepsis and other complications and another patient gradually improved with treatment (amphotericin B and itraconazole). We are reporting these cases to highlight the fact that disseminated histoplasmosis does occur in immunocompetent patient and may occur with or without pulmonary symptoms. A high index of suspicion is required for diagnosis and delay can often be fatal.\u0000J MEDICINE 2023; 24: 59-64","PeriodicalId":76013,"journal":{"name":"Journal of medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47270395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aflatun Akter Jahan, Md. Raziur Rahman, J. Ahmed, Sameena Khan
Background: Sepsis is a complex, life-threatening, heterogeneous infectious disease associated with increased rates of morbidity and mortality. Early assessment of the prognosis of sepsis is key to achieving a favorable outcome for the disease. This study aimed to identify the prognostic value of PCT for sepsis patients. Materials and Methods: We conducted a prospective analytical study involving 100 adult patients with sepsis who were admitted to the Medicine dept and intensive care unit from 2019 to 2020. At least one blood test for PCT level was performed for all patients within the first 24 hours of suspecting an infection. Results: Our study found that a maximum number of patients (43.0%) were between 51-60 years age group, mean age of the patient was 49.35 ± 11.7 years. Out of 100 cases, 65% were male and 35% were female. The male and female ratio was 1.85:1. In this study serum, procalcitonin levels 0.5-2.0 ng/were detected in 15.0% of patients with mean±SD 1.3±0.8. Serum procalcitonin levels 2.1-10.0 ng/mL were detected in 29.0% of patients with mean±SD 5.9±2.5 and >10.0 ng/mL was detected in 56 patients. Based on the receiver-operator characteristic (ROC) curves, procalcitonin had the area under curve 0.923, with 89.4% sensitivity and 87.5% specificity. In our study, procalcitonin showed the best predictive value for the short-term outcome of sepsis with a cut-off value of 14.8 ng/mL (AUC 0.923). Study shows that 76.0% of the patients recovered completely, but 24.0% of patients expired during the hospital stay. Conclusion: There was a statistically significant correlation in serum procalcitonin with the outcome of sepsis (p < 0.001). So the effectiveness of serum procalcitonin has proven significant in the prediction of mortality in sepsis patients. J MEDICINE 2023; 24: 18-22
{"title":"Prognostic Value of Serum Procalcitonin in Patients with Sepsis in a Tertiary Level Hospital","authors":"Aflatun Akter Jahan, Md. Raziur Rahman, J. Ahmed, Sameena Khan","doi":"10.3329/jom.v24i1.64899","DOIUrl":"https://doi.org/10.3329/jom.v24i1.64899","url":null,"abstract":"Background: Sepsis is a complex, life-threatening, heterogeneous infectious disease associated with increased rates of morbidity and mortality. Early assessment of the prognosis of sepsis is key to achieving a favorable outcome for the disease. This study aimed to identify the prognostic value of PCT for sepsis patients.\u0000Materials and Methods: We conducted a prospective analytical study involving 100 adult patients with sepsis who were admitted to the Medicine dept and intensive care unit from 2019 to 2020. At least one blood test for PCT level was performed for all patients within the first 24 hours of suspecting an infection.\u0000Results: Our study found that a maximum number of patients (43.0%) were between 51-60 years age group, mean age of the patient was 49.35 ± 11.7 years. Out of 100 cases, 65% were male and 35% were female. The male and female ratio was 1.85:1. In this study serum, procalcitonin levels 0.5-2.0 ng/were detected in 15.0% of patients with mean±SD 1.3±0.8. Serum procalcitonin levels 2.1-10.0 ng/mL were detected in 29.0% of patients with mean±SD 5.9±2.5 and >10.0 ng/mL was detected in 56 patients. Based on the receiver-operator characteristic (ROC) curves, procalcitonin had the area under curve 0.923, with 89.4% sensitivity and 87.5% specificity. In our study, procalcitonin showed the best predictive value for the short-term outcome of sepsis with a cut-off value of 14.8 ng/mL (AUC 0.923). Study shows that 76.0% of the patients recovered completely, but 24.0% of patients expired during the hospital stay.\u0000Conclusion: There was a statistically significant correlation in serum procalcitonin with the outcome of sepsis (p < 0.001). So the effectiveness of serum procalcitonin has proven significant in the prediction of mortality in sepsis patients.\u0000J MEDICINE 2023; 24: 18-22","PeriodicalId":76013,"journal":{"name":"Journal of medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47770995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Junayed Abdul Qayyum, S. J. B. Sayeed, F. Ahmed, Poritash Kumar Sarker, Reaz Mahmud
Background: Vitamin B12 deficiency can impair the metabolism of homocysteine, leading to hyperhomocysteinemia that can cause thrombosis in the intracranial blood vessels resulting in a stroke. Case Presentation: A 15-year-old Muslim young boy initially presented with pallor, slurred speech, right facial weakness, and right-sided hemiplegia. On examination, he was found moderately anemic, nonicteric, and with right-sided stroke evidenced by hypertonia, reduced muscle power jerk exaggerated with extensor plantar response. There was no lymphadenopathy, bony tenderness, intellectual impairment, or organomegaly, and normal vital parameters with the unremarkable cardiovascular examination. Laboratory investigations revealed pancytopenia, with reduced Vit B12, folic acid, and moderately increased homocysteine level. Bone marrow study suggestive of megaloblastic anemia. Immunological, infectious screens; and prothrombotic markers were found negative. CT scan of the head revealed a hypodense lesion in the left parieto-occipital region, DWI sequence on MRI Brain revealed diffusion restriction in the same area while an MR angiogram of the Brain revealed occlusion of the left middle cerebral artery due to thrombus sparing a small segment after its origin. In addition, he had MTHFR c677 C>T (Methyl tetrahydrofolate reductase) gene mutation and responded both clinically and biochemically after vitamin B12, folic supplementation along with aspirin in 5 months. Conclusion: Vitamin B12 deficiency along with MTHFR c677 C>T gene mutation has increased the chance of thrombotic stroke. Vitamin B12 supplementation might be beneficial for patients with an MTHFR gene mutation positive. J MEDICINE 2023; 24: 51-55
{"title":"Hyperhomocysteinemia due to Vitamin B12 Deficiency with MTHFR Gene Mutation, an Atypical Metabolic Cause of Young Ischemic Stroke: A Case Report","authors":"Junayed Abdul Qayyum, S. J. B. Sayeed, F. Ahmed, Poritash Kumar Sarker, Reaz Mahmud","doi":"10.3329/jom.v24i1.64904","DOIUrl":"https://doi.org/10.3329/jom.v24i1.64904","url":null,"abstract":"Background: Vitamin B12 deficiency can impair the metabolism of homocysteine, leading to hyperhomocysteinemia that can cause thrombosis in the intracranial blood vessels resulting in a stroke.\u0000Case Presentation: A 15-year-old Muslim young boy initially presented with pallor, slurred speech, right facial weakness, and right-sided hemiplegia. On examination, he was found moderately anemic, nonicteric, and with right-sided stroke evidenced by hypertonia, reduced muscle power jerk exaggerated with extensor plantar response. There was no lymphadenopathy, bony tenderness, intellectual impairment, or organomegaly, and normal vital parameters with the unremarkable cardiovascular examination. Laboratory investigations revealed pancytopenia, with reduced Vit B12, folic acid, and moderately increased homocysteine level. Bone marrow study suggestive of megaloblastic anemia. Immunological, infectious screens; and prothrombotic markers were found negative. CT scan of the head revealed a hypodense lesion in the left parieto-occipital region, DWI sequence on MRI Brain revealed diffusion restriction in the same area while an MR angiogram of the Brain revealed occlusion of the left middle cerebral artery due to thrombus sparing a small segment after its origin. In addition, he had MTHFR c677 C>T (Methyl tetrahydrofolate reductase) gene mutation and responded both clinically and biochemically after vitamin B12, folic supplementation along with aspirin in 5 months.\u0000Conclusion: Vitamin B12 deficiency along with MTHFR c677 C>T gene mutation has increased the chance of thrombotic stroke. Vitamin B12 supplementation might be beneficial for patients with an MTHFR gene mutation positive.\u0000J MEDICINE 2023; 24: 51-55","PeriodicalId":76013,"journal":{"name":"Journal of medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49143019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Sepsis and Septic shock: A Global Challenge for the Physicians","authors":"Md. Titu Miah","doi":"10.3329/jom.v24i1.64896","DOIUrl":"https://doi.org/10.3329/jom.v24i1.64896","url":null,"abstract":"Abstract not available\u0000J MEDICINE 2023; 24: 1-2","PeriodicalId":76013,"journal":{"name":"Journal of medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46389350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Leukaemia cutis is a rare but important extra-medullary manifestation of Leukaemia. It develops due to the infiltration of neoplastic leukocytes or their precursors into the epidermis, dermis or subcutaneous tissue. Cutaneous presentation of Leukaemia cutis can precede, follow, present simultaneously with or may present in the absence of systemic Leukaemia. Here we present a pictorial of a 30-year-old male patient known to have Chronic Myeloid Leukaemia with blastic transformation to Acute myeloid Leukaemia with multiple cutaneous lesions, diagnosed as Leukaemia cutis. J MEDICINE 2023; 24: 65-66
{"title":"Leukaemia Cutis in a Patient with Chronic Myeloid Leukaemia with Blast Crisis","authors":"S. Naher, M. Hoque","doi":"10.3329/jom.v24i1.64907","DOIUrl":"https://doi.org/10.3329/jom.v24i1.64907","url":null,"abstract":"Leukaemia cutis is a rare but important extra-medullary manifestation of Leukaemia. It develops due to the infiltration of neoplastic leukocytes or their precursors into the epidermis, dermis or subcutaneous tissue. Cutaneous presentation of Leukaemia cutis can precede, follow, present simultaneously with or may present in the absence of systemic Leukaemia. Here we present a pictorial of a 30-year-old male patient known to have Chronic Myeloid Leukaemia with blastic transformation to Acute myeloid Leukaemia with multiple cutaneous lesions, diagnosed as Leukaemia cutis.\u0000J MEDICINE 2023; 24: 65-66","PeriodicalId":76013,"journal":{"name":"Journal of medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48202703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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