Pub Date : 2023-05-24DOI: 10.3329/bjm.v34i20.66172
C. Podder, M. Amin, N. Chowdhury
Hereditary persistence of alpha- fetoprotein (HFAFP) is a rare benign autosomal dominant disorder.Here we report a case of 15 years old boy who was found to have elevated alpha-fetoprotein during her routine evaluation for gynaecomastia. All other common possibilities for raised alpha-fetoprotein were excluded.Subsequently, 2 of his family members were found to have raised alpha-fetoprotein.One is his father and another one is his brother.Raised alpha-fetoprotein has a wide differential diagnosis including, pregnancy, germ cell tumors, hepatocellular carcinoma and others.But after exclusion of other possibilities, persisting elevated alphafetoprotein raises the suspicion for HPAFP.Testing other family members for AFP and specific genetic study aid in diagnosis. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 216-217
{"title":"Hereditary Persistence Of Alpha-fetoprotein: A Rare Entity From A Primary Care Center In Bangladesh","authors":"C. Podder, M. Amin, N. Chowdhury","doi":"10.3329/bjm.v34i20.66172","DOIUrl":"https://doi.org/10.3329/bjm.v34i20.66172","url":null,"abstract":"Hereditary persistence of alpha- fetoprotein (HFAFP) is a rare benign autosomal dominant disorder.Here we report a case of 15 years old boy who was found to have elevated alpha-fetoprotein during her routine evaluation for gynaecomastia. All other common possibilities for raised alpha-fetoprotein were excluded.Subsequently, 2 of his family members were found to have raised alpha-fetoprotein.One is his father and another one is his brother.Raised alpha-fetoprotein has a wide differential diagnosis including, pregnancy, germ cell tumors, hepatocellular carcinoma and others.But after exclusion of other possibilities, persisting elevated alphafetoprotein raises the suspicion for HPAFP.Testing other family members for AFP and specific genetic study aid in diagnosis.\u0000Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 216-217","PeriodicalId":8721,"journal":{"name":"Bangladesh Journal of Veterinary Medicine","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72639754","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}
Pub Date : 2023-05-24DOI: 10.3329/bjm.v34i20.66131
Md Golam Kibria
Abdominal pain caused by acute pancreatitis (AP) is not uncommon in day to day medical practice worldwide. AP is the sudden inflammation of the pancreas, and it may be confined to the pancreas, or may be more life-threatening, affecting all organs and systems. It progresses mildly in 80% of patients and resolves with treatment, but in cases of severe AP, with mortality of around 30% has been recorded. AP is most often established by clinical symptoms and at least threefold raised enzymes and by imaging (any two of these three).In the management AP, treatment is mainly related to the severity of the disease and approaches are constantly being updated. With early diagnosis and treatment, most of the patients can be discharged, and the development of complications and mortality can be reduced. Hemodynamic status should be assessed immediately upon presentation and resuscitative measures begun as needed. Early targeted fluid therapy within the first 48 h is critical to improve the outcome of severe AP. Patients with organ failure and or SIRS should be admitted to an ICU /HDU whenever possible. Emergency management decision are early fluid management strategy, utility and timing of antibiotics, the timing and type of nutritional support and in relevant cases endoscopic retrograde cholangiopancreatography (ERCP) and cholecystectomy approachescan change the course of the disease and the length of stay in the hospital. Therefore, emergency management is important.Enteral nutrition is recommended to prevent infectious complications, whereas parenteral nutrition should be avoided.Routine use of prophylactic antibiotics in patients with severe AP and or sterile necrosis is not recommended.In patients with infected necrosis, antibiotics known to penetrate pancreatic necrosis may be useful in delaying intervention, thus decreasing morbidity and mortality. Successful clinical management requires close interdisciplinary cooperation and coordination from experienced gastroenterologists, intensive care physicians, surgeons, and radiologists. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 188-189
{"title":"Acute pancreatitis: Early Management","authors":"Md Golam Kibria","doi":"10.3329/bjm.v34i20.66131","DOIUrl":"https://doi.org/10.3329/bjm.v34i20.66131","url":null,"abstract":"Abdominal pain caused by acute pancreatitis (AP) is not uncommon in day to day medical practice worldwide. AP is the sudden inflammation of the pancreas, and it may be confined to the pancreas, or may be more life-threatening, affecting all organs and systems. It progresses mildly in 80% of patients and resolves with treatment, but in cases of severe AP, with mortality of around 30% has been recorded. AP is most often established by clinical symptoms and at least threefold raised enzymes and by imaging (any two of these three).In the management AP, treatment is mainly related to the severity of the disease and approaches are constantly being updated. With early diagnosis and treatment, most of the patients can be discharged, and the development of complications and mortality can be reduced. Hemodynamic status should be assessed immediately upon presentation and resuscitative measures begun as needed. Early targeted fluid therapy within the first 48 h is critical to improve the outcome of severe AP. Patients with organ failure and or SIRS should be admitted to an ICU /HDU whenever possible. Emergency management decision are early fluid management strategy, utility and timing of antibiotics, the timing and type of nutritional support and in relevant cases endoscopic retrograde cholangiopancreatography (ERCP) and cholecystectomy approachescan change the course of the disease and the length of stay in the hospital. Therefore, emergency management is important.Enteral nutrition is recommended to prevent infectious complications, whereas parenteral nutrition should be avoided.Routine use of prophylactic antibiotics in patients with severe AP and or sterile necrosis is not recommended.In patients with infected necrosis, antibiotics known to penetrate pancreatic necrosis may be useful in delaying intervention, thus decreasing morbidity and mortality. Successful clinical management requires close interdisciplinary cooperation and coordination from experienced gastroenterologists, intensive care physicians, surgeons, and radiologists. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 188-189","PeriodicalId":8721,"journal":{"name":"Bangladesh Journal of Veterinary Medicine","volume":"53 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135139871","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}
Pub Date : 2023-05-24DOI: 10.3329/bjm.v34i20.66136
Suraiya Begum
Childhood obesity is a growing global health hazard extending to adulthood. The prevalence of obesity in children in developed and developing countries has risen dramatically in the past few decades and is currently at epidemic proportions. Obese children and adolescents were around five times more likely to be obese in adulthood than those who were not obese. Adiposity rebound in early childhood is a risk factor for obesity in adolescence and adulthood. Numerous sequelae are associated with children being overweight or obese, even at a very young age. Obesity in childhood and adolescence is significantly associated with an increased risk of insulin resistance, type 2 diabetes mellitus, dyslipidemia, hypertension, metabolic syndrome, non-alcoholic fatty liver disease, and obstructive sleep apnea. Obese children are more likely to experience psychological morbidity, lower self-esteem, and more behavioral problems than non-obese children. These comorbid conditions may progress to adult life and the development of atherosclerosis, cerebrovascular disorders, and cardiovascular morbidity later in life. Obese children are more likely to become obese adults and suffer lifelong physical and mental problems and risk of premature mortality. The use of infant formula, decreased physical activity, excessive calorie intake, and changes in gut microbiota patterns are associated with the increasing prevalence of childhood obesity. Efforts will be focused on trying to treat obesity itself and, therefore, prevent progression to overt sequelae, either in childhood or later in adult life. The most important strategy for preventing obesity and sequelae is lifestyle modification which includes healthy eating behaviors, regular physical activity, and reduced sedentary activity. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 191-192
{"title":"Childhood obesity: Sequelae in adult life","authors":"Suraiya Begum","doi":"10.3329/bjm.v34i20.66136","DOIUrl":"https://doi.org/10.3329/bjm.v34i20.66136","url":null,"abstract":"Childhood obesity is a growing global health hazard extending to adulthood. The prevalence of obesity in children in developed and developing countries has risen dramatically in the past few decades and is currently at epidemic proportions. Obese children and adolescents were around five times more likely to be obese in adulthood than those who were not obese. Adiposity rebound in early childhood is a risk factor for obesity in adolescence and adulthood. Numerous sequelae are associated with children being overweight or obese, even at a very young age. Obesity in childhood and adolescence is significantly associated with an increased risk of insulin resistance, type 2 diabetes mellitus, dyslipidemia, hypertension, metabolic syndrome, non-alcoholic fatty liver disease, and obstructive sleep apnea. Obese children are more likely to experience psychological morbidity, lower self-esteem, and more behavioral problems than non-obese children. These comorbid conditions may progress to adult life and the development of atherosclerosis, cerebrovascular disorders, and cardiovascular morbidity later in life. Obese children are more likely to become obese adults and suffer lifelong physical and mental problems and risk of premature mortality. The use of infant formula, decreased physical activity, excessive calorie intake, and changes in gut microbiota patterns are associated with the increasing prevalence of childhood obesity. Efforts will be focused on trying to treat obesity itself and, therefore, prevent progression to overt sequelae, either in childhood or later in adult life. The most important strategy for preventing obesity and sequelae is lifestyle modification which includes healthy eating behaviors, regular physical activity, and reduced sedentary activity. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 191-192","PeriodicalId":8721,"journal":{"name":"Bangladesh Journal of Veterinary Medicine","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135139873","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}
Pub Date : 2023-05-24DOI: 10.3329/bjm.v34i20.66117
Chaudury Meshkat Ahmed
One of the most common cause for “unexplained shortness of breath” is heart failure with preserved ejection fraction (HFpEF), that is frequently missed by the physician. Untill the wide use of BNP/NT ProBNP the term even remained unfamaliar to many of them. More over the concepts that, to make a diagnosis of HFpEF, a diastolic dysfunction is mandatory accounts for another cause of missing the diagnosis of HFpEF.The reality is Half of the all forms of heart failure is attributed to HFpEF. The diagnosis based on : the symptom of heart failure, the raised BNP/NT Pro BNP and any of the two of the either left venticular hypertrophy (LVH)/ left atrial enlargement (LAE) or features of diastolic dysfunction( as assessed by an echocadiography).The first criteria that is the symptom of heart failure is often non specific and frequently difficult to distinguish from other clinical conditions. The levels of BNP/NT ProBNP also needed to be defined according to various clinical conditions where there may be raised level of this biomarkers in the absence of heart failure.On the other hand the echocardiographic detection of LVH, LAE or left ventricular diastolic dysfunction is either time consuming or inconclusive in many patients. The various clinical phenotypes of HFpEF in the clinical back ground also make it diffcult to “fit one size for all”. Our presentation will focus on the various facets of missed diagnosed HFpEF. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 181-182
“不明原因的呼吸短促”最常见的原因之一是心力衰竭并保留射血分数(HFpEF)，这经常被医生忽略。直到BNP/NT ProBNP的广泛使用，这个术语对他们中的许多人来说仍然是陌生的。更重要的是，要诊断HFpEF，舒张功能障碍是强制性的，这是遗漏HFpEF诊断的另一个原因。事实上，所有形式的心力衰竭中有一半是由HFpEF引起的。诊断依据:心衰症状、BNP/NT Pro BNP升高、左心室肥厚(LVH)/左心房扩大(LAE)或舒张功能障碍(超声心动图评估)中的任意两种。作为心衰症状的第一个标准通常是非特异性的，并且常常难以与其他临床情况区分开来。BNP/NT ProBNP的水平也需要根据不同的临床情况来确定，在没有心力衰竭的情况下，这些生物标志物的水平可能会升高。另一方面，超声心动图检测LVH、LAE或左室舒张功能不全在许多患者中要么耗时，要么不确定。临床背景下HFpEF的各种临床表型也使其难以“一刀切”。我们的演讲将集中在漏诊HFpEF的各个方面。孟加拉国J医学2023;第34卷，第2号(1)补编:181-182
{"title":"Heart failure with preserved ejection fraction (HFpEF): A missed diagnosis","authors":"Chaudury Meshkat Ahmed","doi":"10.3329/bjm.v34i20.66117","DOIUrl":"https://doi.org/10.3329/bjm.v34i20.66117","url":null,"abstract":"One of the most common cause for “unexplained shortness of breath” is heart failure with preserved ejection fraction (HFpEF), that is frequently missed by the physician. Untill the wide use of BNP/NT ProBNP the term even remained unfamaliar to many of them. More over the concepts that, to make a diagnosis of HFpEF, a diastolic dysfunction is mandatory accounts for another cause of missing the diagnosis of HFpEF.The reality is Half of the all forms of heart failure is attributed to HFpEF. The diagnosis based on : the symptom of heart failure, the raised BNP/NT Pro BNP and any of the two of the either left venticular hypertrophy (LVH)/ left atrial enlargement (LAE) or features of diastolic dysfunction( as assessed by an echocadiography).The first criteria that is the symptom of heart failure is often non specific and frequently difficult to distinguish from other clinical conditions. The levels of BNP/NT ProBNP also needed to be defined according to various clinical conditions where there may be raised level of this biomarkers in the absence of heart failure.On the other hand the echocardiographic detection of LVH, LAE or left ventricular diastolic dysfunction is either time consuming or inconclusive in many patients. The various clinical phenotypes of HFpEF in the clinical back ground also make it diffcult to “fit one size for all”. Our presentation will focus on the various facets of missed diagnosed HFpEF. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 181-182","PeriodicalId":8721,"journal":{"name":"Bangladesh Journal of Veterinary Medicine","volume":"145 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135139874","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}
Pub Date : 2023-05-24DOI: 10.3329/bjm.v34i20.66170
Salman Bashar Al Ayub, M. H. Rahman, Muhammad Rafiqul Islam, N. Khatun
Background: Cancer is one of the most common causes of mortality & morbidity globally, accounting for an estimated 10 million deaths in 2020. The diagnosis of cancer is a stressful event causing significant psychological distresses, most commonly depression and anxiety, directly interfering with disease outcome and quality of life. The aim of the study is to assess the level of depression and anxiety among adult patients with solid tumours as well as the association of various socio-demographic and clinical factors with them. Methods: This cross-sectional type of descriptive study was conducted at the National Institute of Cancer Research & Hospital (NICRH), Dhaka for a period of 12 months. A total of 405 histologically confirmed adult solid tumour patients were enrolled in the study using purposive sampling after fulfilling inclusion and exclusion criteria. Data were collected from the patients by face-to-face interviews using a semi-structured questionnaire and Bangla version of the DASS-21 scale. Results: In this study, the mean age of the respondents was 47.4 ± 16.5 years, the respondents were predominantly male with the male-tofemale ratio being 3:2 roughly. Gastrointestinal cancers (27.4%) were most prevalent, followed by lung (19.5%), gynaecological (11.4%), breast cancers and sarcomas (both 9.4%). The majority of the patients were undergoing chemotherapy (71.9%) and harbouring stage IV disease (64.4%) with duration of illness for less than twelve months (62% of respondents). The prevalence of depressive and anxious symptomatology among all patients was 38.02% and 42.96%, respectively. More than half (53.3%) of the adult patients with solid tumours were suffering from either of depression and/or anxiety. 19.7% had mild, 13.6% had moderate, 3.7% had severe and 1% had extremely severe levels of depression, while the percentages were 17.3%, 11.6%, 9.4% and 4.7% respectively, for severity of anxiety. In inpatient setting, depressive disorders were significantly higher in females than males (p<0.01) and among the lung cancer patients; in contrast, gastrointestinal cancer and the presence of co-morbidities predisposed more to anxiety (p<0.05). Although mode of treatment and severity of disease showed no significant relationship with the prevalence of depression or anxiety, ECOG performance status was found to have a significant impact on both of the disorders. On analysis of the socio-demographic variables, illiterate and low-income people were seen to suffer more with a severe and extremely severe level of depression, on the other hand, homemakers and lower socio-economic class had higher levels of anxiety. Conclusion: The study findings demonstrated a higher prevalence of depressive and anxious symptomatology in the inpatient setting; therefore, counselling, screening, and timely evaluation of mental health should be a part of the standard protocol of oncology care. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 215-216
{"title":"Assessment of Depression and Anxiety Among Adult Patients With Solid Tumours Admitted in National Institute of Cancer Research & Hospital","authors":"Salman Bashar Al Ayub, M. H. Rahman, Muhammad Rafiqul Islam, N. Khatun","doi":"10.3329/bjm.v34i20.66170","DOIUrl":"https://doi.org/10.3329/bjm.v34i20.66170","url":null,"abstract":"Background: Cancer is one of the most common causes of mortality & morbidity globally, accounting for an estimated 10 million deaths in 2020. The diagnosis of cancer is a stressful event causing significant psychological distresses, most commonly depression and anxiety, directly interfering with disease outcome and quality of life. The aim of the study is to assess the level of depression and anxiety among adult patients with solid tumours as well as the association of various socio-demographic and clinical factors with them.\u0000Methods: This cross-sectional type of descriptive study was conducted at the National Institute of Cancer Research & Hospital (NICRH), Dhaka for a period of 12 months. A total of 405 histologically confirmed adult solid tumour patients were enrolled in the study using purposive sampling after fulfilling inclusion and exclusion criteria. Data were collected from the patients by face-to-face interviews using a semi-structured questionnaire and Bangla version of the DASS-21 scale.\u0000Results: In this study, the mean age of the respondents was 47.4 ± 16.5 years, the respondents were predominantly male with the male-tofemale ratio being 3:2 roughly. Gastrointestinal cancers (27.4%) were most prevalent, followed by lung (19.5%), gynaecological (11.4%), breast cancers and sarcomas (both 9.4%). The majority of the patients were undergoing chemotherapy (71.9%) and harbouring stage IV disease (64.4%) with duration of illness for less than twelve months (62% of respondents). The prevalence of depressive and anxious symptomatology among all patients was 38.02% and 42.96%, respectively. More than half (53.3%) of the adult patients with solid tumours were suffering from either of depression and/or anxiety. 19.7% had mild, 13.6% had moderate, 3.7% had severe and 1% had extremely severe levels of depression, while the percentages were 17.3%, 11.6%, 9.4% and 4.7% respectively, for severity of anxiety. In inpatient setting, depressive disorders were significantly higher in females than males (p<0.01) and among the lung cancer patients; in contrast, gastrointestinal cancer and the presence of co-morbidities predisposed more to anxiety (p<0.05). Although mode of treatment and severity of disease showed no significant relationship with the prevalence of depression or anxiety, ECOG performance status was found to have a significant impact on both of the disorders. On analysis of the socio-demographic variables, illiterate and low-income people were seen to suffer more with a severe and extremely severe level of depression, on the other hand, homemakers and lower socio-economic class had higher levels of anxiety.\u0000Conclusion: The study findings demonstrated a higher prevalence of depressive and anxious symptomatology in the inpatient setting; therefore, counselling, screening, and timely evaluation of mental health should be a part of the standard protocol of oncology care.\u0000Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 215-216","PeriodicalId":8721,"journal":{"name":"Bangladesh Journal of Veterinary Medicine","volume":"96 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84726142","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}
Pub Date : 2023-05-24DOI: 10.3329/bjm.v34i20.66129
S. Rahman
Background: Hepatitis C virus (HCV) has been a major public health threatboth worldwide and in Bangladesh due to itsconsiderable disease burden, morbidities, and death. An individualized, cost-effective, standard treatment regimen can help combat and eliminate HCV once and for all. Methods: This is an executive summary of the latest EASL (European Association for the Study of the Liver) recommendationsbased on existing literature, and clinical expertise from a panel of specialists chosen by the EASL Governing Board. Additionally, author’s clinical experience is undertaken for considering country level context. Results: HCV infection requires personalized treatment, based on factors such as genotype, liver fibrosis stage, and comorbidities. Direct-acting antiviral (DAA) regimens have replaced interferon, and are recommended as the first-line treatment for all patients with chronic HCV infection, irrespective of genotype. It is recommended to initiate treatment as soon as possible to prevent the progression of liver disease, and associated complications. For patients with decompensated cirrhosis, liver transplantation should be considered as a treatment option after weighing risk-benefit. Additionally, the management of special populations such as children, pregnant women, lactating mother, HCVpatients co-infected with HIV, HBV or SARS-CoV-2, patients with renal impairment, haemoglobin-opathies or bleeding disorders require special attention. Monitoring patients during and after treatment is recommended to ensure sustained virologic response (SVR), to detect any potential complication, and to check potential HCV reinfection. Conclusion: The EASL recommendations provide a comprehensive overview on personalized treatment of HCV, and monitoring for optimal patient outcomes, ushering high hopes for HCV elimination in the future. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 188
{"title":"HCV Management: Recent Updates","authors":"S. Rahman","doi":"10.3329/bjm.v34i20.66129","DOIUrl":"https://doi.org/10.3329/bjm.v34i20.66129","url":null,"abstract":"Background: Hepatitis C virus (HCV) has been a major public health threatboth worldwide and in Bangladesh due to itsconsiderable disease burden, morbidities, and death. An individualized, cost-effective, standard treatment regimen can help combat and eliminate HCV once and for all.\u0000Methods: This is an executive summary of the latest EASL (European Association for the Study of the Liver) recommendationsbased on existing literature, and clinical expertise from a panel of specialists chosen by the EASL Governing Board. Additionally, author’s clinical experience is undertaken for considering country level context. Results: HCV infection requires personalized treatment, based on factors such as genotype, liver fibrosis stage, and comorbidities. Direct-acting antiviral (DAA) regimens have replaced interferon, and are recommended as the first-line treatment for all patients with chronic HCV infection, irrespective of genotype. It is recommended to initiate treatment as soon as possible to prevent the progression of liver disease, and associated complications. For patients with decompensated cirrhosis, liver transplantation should be considered as a treatment option after weighing risk-benefit. Additionally, the management of special populations such as children, pregnant women, lactating mother, HCVpatients co-infected with HIV, HBV or SARS-CoV-2, patients with renal impairment, haemoglobin-opathies or bleeding disorders require special attention. Monitoring patients during and after treatment is recommended to ensure sustained virologic response (SVR), to detect any potential complication, and to check potential HCV reinfection.\u0000Conclusion: The EASL recommendations provide a comprehensive overview on personalized treatment of HCV, and monitoring for optimal patient outcomes, ushering high hopes for HCV elimination in the future.\u0000Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 188","PeriodicalId":8721,"journal":{"name":"Bangladesh Journal of Veterinary Medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89698650","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}
Pub Date : 2023-05-24DOI: 10.3329/bjm.v34i20.66119
Aminur Rahman
Parkinson’s disease (PD) is the second most common neurodegenerative disorder worldwide, projected to affect at least 12 million people worldwide by 2040. The Hoehn and Yahr Scale stages 4 or 5 are referred to as advanced Parkinson’s disease (PD), which is characterized by significant motor deficits, a high risk of falling, extremely limited independence in terms of mobility, and cognitive and psychotic disorders. Motor fluctuations and dyskinesias frequently affect persons living with advanced PD, in which dyskinesia develops within 5.81 years from diagnosis, and motor fluctuations within 10 years. Continuous monitoring is necessary when motor fluctuations first appear to decide when to start an advanced treatment. Consequently, there is a vast need for improved treatments to address these motor symptoms. Deep brain stimulation, apomorphine subcutaneous infusion, levodopa-carbidopa intestinal gel infusion, and magnetic resonance-guided high-intensity focused ultrasound (FUS) are four device-aided therapies that provide new hope for treating PD in its advanced stages. The selection of device-assisted therapies is now mostly driven by the motor profile of the patient, with non-motor symptoms having a minimal impact on the decision-making process for the delivery and maintenance of successful therapy. In preliminary human trials, passive and active antiprotein á—synuclein vaccinations are being investigated. Monoclonal antibodies (mAbs) like prasinezumab that target the aggregates of á— synuclein can reduce the levels of free á—synuclein in serum by 97% by passive vaccination. The use of á—synuclein fragments or equivalent epitopes in active vaccination to stimulate an immune response is also being investigated. Although cell-based regeneration therapies utilizing fetal brain cells are successful in a small number of cases, this treatment is not practical due to the lack of fetal tissue. A sustainable source of dopamine-producing cells, such as stem cells, dopaminergic progenitors obtained from induced pluripotent stem cells (iPSCs), or cells derived from embryonic stem cells (ESCs), is currently being researched. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 182-183
{"title":"New Hope in Parkinson’s Disease Management","authors":"Aminur Rahman","doi":"10.3329/bjm.v34i20.66119","DOIUrl":"https://doi.org/10.3329/bjm.v34i20.66119","url":null,"abstract":"Parkinson’s disease (PD) is the second most common neurodegenerative disorder worldwide, projected to affect at least 12 million people worldwide by 2040. The Hoehn and Yahr Scale stages 4 or 5 are referred to as advanced Parkinson’s disease (PD), which is characterized by significant motor deficits, a high risk of falling, extremely limited independence in terms of mobility, and cognitive and psychotic disorders. Motor fluctuations and dyskinesias frequently affect persons living with advanced PD, in which dyskinesia develops within 5.81 years from diagnosis, and motor fluctuations within 10 years. Continuous monitoring is necessary when motor fluctuations first appear to decide when to start an advanced treatment. Consequently, there is a vast need for improved treatments to address these motor symptoms. Deep brain stimulation, apomorphine subcutaneous infusion, levodopa-carbidopa intestinal gel infusion, and magnetic resonance-guided high-intensity focused ultrasound (FUS) are four device-aided therapies that provide new hope for treating PD in its advanced stages. The selection of device-assisted therapies is now mostly driven by the motor profile of the patient, with non-motor symptoms having a minimal impact on the decision-making process for the delivery and maintenance of successful therapy. In preliminary human trials, passive and active antiprotein á—synuclein vaccinations are being investigated. Monoclonal antibodies (mAbs) like prasinezumab that target the aggregates of á— synuclein can reduce the levels of free á—synuclein in serum by 97% by passive vaccination. The use of á—synuclein fragments or equivalent epitopes in active vaccination to stimulate an immune response is also being investigated. Although cell-based regeneration therapies utilizing fetal brain cells are successful in a small number of cases, this treatment is not practical due to the lack of fetal tissue. A sustainable source of dopamine-producing cells, such as stem cells, dopaminergic progenitors obtained from induced pluripotent stem cells (iPSCs), or cells derived from embryonic stem cells (ESCs), is currently being researched.\u0000Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 182-183","PeriodicalId":8721,"journal":{"name":"Bangladesh Journal of Veterinary Medicine","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85246122","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}
Pub Date : 2023-05-24DOI: 10.3329/bjm.v34i20.66162
Mushfiq Newaz Ahmed, Nihar Ranjan Saha, Md. Sayedul Islam
Background: Exacerbation of chronic obstructive pulmonary disease (COPD) leads to multiple hospital admissions, longer hospital stays, increased treatment costs as well as increased morbidity and mortality. Currently, no optimal scoring system exists that can predict need for NIV in patients with acute exacerbation of COPD. Accurate prognostic tool can help physicians to select the appropriate level of care and preparedness.To compare DECAF [(D) dyspnoea, (E) eosinopenia, (C) consolidation, (A) acidemia, (F) atrial fibrillation] and modified DECAF score [(D) dyspnoea, (E) eosinopenia, (C) consolidation, (A) acidemia, (F) frequency of hospital admission] in predicting the need for NIV in patients with acute exacerbation of chronic obstructive pulmonary disease. Methods: This cross-sectional study was conducted in the Department of Respiratory Medicine, NIDCH, Mohakhali, Dhaka from June 2021 to August 2022. A total of 91 patients with acute exacerbation of COPD were enrolled in this study. All patients were subjected to complete medical history taking, chest examination, dyspnoea assessment by extended modified Medical Research Council Dyspnoea (eMRCD), complete blood count, chest radiograph, ECG, and arterial blood gas analysis. Both DECAF and modified DECAF score were calculated and the need for NIV was documented. All collected data were analysed using appropriate statistical formula and SPSS programme. Results: Out of 91 patients, 20 patients (21.97%) required non-invasive ventilation. The area under the ROC curve of DECAF and modified DECAF score was 0.973 and 0.974 respectively in predicting the need for NIV. The sensitivity, specificity, PPV and NPV of DECAF score were 84.21%, 94.44%, 80.00% and 95.77% respectively at a cut off value of 3. The sensitivity, specificity, PPV and NPV of modified DECAF score were 84.52%, 100%, 100% and 96.51% respectively at a cut off value of 4 Conclusion: Both DECAF score and the modified DECAF score are practical and can be calculated easily using simple questions and routine investigations available during the initial admission. Both were good predictors, but modified DECAF was superior in predicting need for NIV in patients with acute exacerbation of COPD Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 208-209
{"title":"Prediction of the Need for Niv in Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Comparative Study Between Decaf And Modified Decaf Score","authors":"Mushfiq Newaz Ahmed, Nihar Ranjan Saha, Md. Sayedul Islam","doi":"10.3329/bjm.v34i20.66162","DOIUrl":"https://doi.org/10.3329/bjm.v34i20.66162","url":null,"abstract":"Background: Exacerbation of chronic obstructive pulmonary disease (COPD) leads to multiple hospital admissions, longer hospital stays, increased treatment costs as well as increased morbidity and mortality. Currently, no optimal scoring system exists that can predict need for NIV in patients with acute exacerbation of COPD. Accurate prognostic tool can help physicians to select the appropriate level of care and preparedness.To compare DECAF [(D) dyspnoea, (E) eosinopenia, (C) consolidation, (A) acidemia, (F) atrial fibrillation] and modified DECAF score [(D) dyspnoea, (E) eosinopenia, (C) consolidation, (A) acidemia, (F) frequency of hospital admission] in predicting the need for NIV in patients with acute exacerbation of chronic obstructive pulmonary disease.\u0000Methods: This cross-sectional study was conducted in the Department of Respiratory Medicine, NIDCH, Mohakhali, Dhaka from June 2021 to August 2022. A total of 91 patients with acute exacerbation of COPD were enrolled in this study. All patients were subjected to complete medical history taking, chest examination, dyspnoea assessment by extended modified Medical Research Council Dyspnoea (eMRCD), complete blood count, chest radiograph, ECG, and arterial blood gas analysis. Both DECAF and modified DECAF score were calculated and the need for NIV was documented. All collected data were analysed using appropriate statistical formula and SPSS programme.\u0000Results: Out of 91 patients, 20 patients (21.97%) required non-invasive ventilation. The area under the ROC curve of DECAF and modified DECAF score was 0.973 and 0.974 respectively in predicting the need for NIV. The sensitivity, specificity, PPV and NPV of DECAF score were 84.21%, 94.44%, 80.00% and 95.77% respectively at a cut off value of 3. The sensitivity, specificity, PPV and NPV of modified DECAF score were 84.52%, 100%, 100% and 96.51% respectively at a cut off value of 4\u0000Conclusion: Both DECAF score and the modified DECAF score are practical and can be calculated easily using simple questions and routine investigations available during the initial admission. Both were good predictors, but modified DECAF was superior in predicting need for NIV in patients with acute exacerbation of COPD Bangladesh\u0000J Medicine 2023; Vol. 34, No. 2(1) Supplement: 208-209 ","PeriodicalId":8721,"journal":{"name":"Bangladesh Journal of Veterinary Medicine","volume":"56 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77258864","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}
Pub Date : 2023-05-24DOI: 10.3329/bjm.v34i20.66128
Mostofa Kamal Chowdhury
Cancers are among the leading causes of morbidity and mortality worldwide. Cancer itself or cancer treatment often causes pain which can affectthe quality of life. Cancer pain management is an essential part of cancer treatment and palliative care. Cancer patients may require pain management at any stage of their disease, not only at the end. Expert opinion and statistics from country experiences from numerous low-income countries, where treatment coverage is typically inadequate or non-existent, indicate that around 80% of cancer patients feel moderate or severe pain that lasts on average 90 days. As a result, cancer pain is a major source of avoidable unnecessary suffering. Cancer pain management plans often involve pharmacological and nonpharmacological therapies and psycho-social and spiritual support. Palliative care and pain management are critical components of Universal Health Care. The medical use of narcotic drugs is essential for the treatment of pain and suffering. Therefore appropriate provisions must be made to assure their availability for such purposes. Some obstacles exist that limit the appropriate management of cancer-related discomfort. Communication difficulties, lack of pain management training and education, ethnic/cultural/ religious disparities, opiophobia among health professionals and the general public, and restricted availability to opioids are the primary barriers to successful cancer pain treatment. To combat cancer pain and reduce the suffering of these incurable people, education and training of health professionals on cancer pain management, provision of suitable holistic supports, opioids should be made accessible and available, and general awareness development are some examples. All government and nongovernment players must come forward and work together to win this battle. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 187
{"title":"Cancer pain: way to overcome","authors":"Mostofa Kamal Chowdhury","doi":"10.3329/bjm.v34i20.66128","DOIUrl":"https://doi.org/10.3329/bjm.v34i20.66128","url":null,"abstract":"Cancers are among the leading causes of morbidity and mortality worldwide. Cancer itself or cancer treatment often causes pain which can affectthe quality of life. Cancer pain management is an essential part of cancer treatment and palliative care. Cancer patients may require pain management at any stage of their disease, not only at the end. Expert opinion and statistics from country experiences from numerous low-income countries, where treatment coverage is typically inadequate or non-existent, indicate that around 80% of cancer patients feel moderate or severe pain that lasts on average 90 days. As a result, cancer pain is a major source of avoidable unnecessary suffering. Cancer pain management plans often involve pharmacological and nonpharmacological therapies and psycho-social and spiritual support. Palliative care and pain management are critical components of Universal Health Care. The medical use of narcotic drugs is essential for the treatment of pain and suffering. Therefore appropriate provisions must be made to assure their availability for such purposes. Some obstacles exist that limit the appropriate management of cancer-related discomfort. Communication difficulties, lack of pain management training and education, ethnic/cultural/ religious disparities, opiophobia among health professionals and the general public, and restricted availability to opioids are the primary barriers to successful cancer pain treatment. To combat cancer pain and reduce the suffering of these incurable people, education and training of health professionals on cancer pain management, provision of suitable holistic supports, opioids should be made accessible and available, and general awareness development are some examples. All government and nongovernment players must come forward and work together to win this battle. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 187","PeriodicalId":8721,"journal":{"name":"Bangladesh Journal of Veterinary Medicine","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135139870","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}
Pub Date : 2023-05-24DOI: 10.3329/bjm.v34i20.66100
D. K. Roy
Kidney replacement therapy (KRT) is a term used to encompass life-supporting treatments for kidney failure. Kidney replacement therapy except kidney transplantation replaces nonendocrine kidney functions in patients with kidney failure. Researchers have noted that dialysis, which is one of the most common KRT used, cannot compensate for all the tasks performed by a kidney, and thus the term ‘Kidney support therapy’ has been suggested to be a better name. Support of kidney function in modern times encompasses a wide array of methods and clinical scenarios, from the ambulatory patient to the critically ill. The ability to safely and routinely deliver ongoing organ support in the outpatient setting has, until recently, separated kidney replacement therapy from other organ support. Kidney replacement therapy (KRT) can be applied intermittently or continuously using extracorporeal (hemodialysis) or Para corporeal (peritoneal dialysis) methods. All modalities exchange solute and remove fluid from the blood, using dialysis and filtration across permeable membranes. Nearly 4 million people in the world are living on kidney replacement therapy(KRT),and haemodialysis (HD) remains the commonest form of KRT, accounting forapproximately 69% of all KRT and 89% of all dialysis. Continuous therapy although costly is used mainly for hemodynamically unstable patients; benefits over intermittent therapy are improved tolerability as a result of slower removal of solute and water. Kidney transplantation is the ultimate step for end stage kidney failure management, as it replaces native kidney function completely. The main disadvantages of KRT relate to: Catheter related complications – blood loss, disconnection, infection or failure of access, mechanical complications of the extracorporeal circuit, fluctuations in the salt-water balance, activation of the coagulation cascade. Specific complications of peritoneal dialysis include: peritonitis, catheter- associated infections, hyperglycemia, protein loss etc. Current trends in artificial kidney research are ongoing with the lofty goal of a small device, preferably implanted with little or no maintenance required by the wearer that would deliver safe and highly effective renal replacement therapy including metabolic and endocrine functions. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 181
{"title":"Kidney replacement therapy: Pros and Cons","authors":"D. K. Roy","doi":"10.3329/bjm.v34i20.66100","DOIUrl":"https://doi.org/10.3329/bjm.v34i20.66100","url":null,"abstract":"Kidney replacement therapy (KRT) is a term used to encompass life-supporting treatments for kidney failure. Kidney replacement therapy except kidney transplantation replaces nonendocrine kidney functions in patients with kidney failure. Researchers have noted that dialysis, which is one of the most common KRT used, cannot compensate for all the tasks performed by a kidney, and thus the term ‘Kidney support therapy’ has been suggested to be a better name. Support of kidney function in modern times encompasses a wide array of methods and clinical scenarios, from the ambulatory patient to the critically ill. The ability to safely and routinely deliver ongoing organ support in the outpatient setting has, until recently, separated kidney replacement therapy from other organ support. Kidney replacement therapy (KRT) can be applied intermittently or continuously using extracorporeal (hemodialysis) or Para corporeal (peritoneal dialysis) methods. All modalities exchange solute and remove fluid from the blood, using dialysis and filtration across permeable membranes. Nearly 4 million people in the world are living on kidney replacement therapy(KRT),and haemodialysis (HD) remains the commonest form of KRT, accounting forapproximately 69% of all KRT and 89% of all dialysis. Continuous therapy although costly is used mainly for hemodynamically unstable patients; benefits over intermittent therapy are improved tolerability as a result of slower removal of solute and water. Kidney transplantation is the ultimate step for end stage kidney failure management, as it replaces native kidney function completely. The main disadvantages of KRT relate to: Catheter related complications – blood loss, disconnection, infection or failure of access, mechanical complications of the extracorporeal circuit, fluctuations in the salt-water balance, activation of the coagulation cascade. Specific complications of peritoneal dialysis include: peritonitis, catheter- associated infections, hyperglycemia, protein loss etc. Current trends in artificial kidney research are ongoing with the lofty goal of a small device, preferably implanted with little or no maintenance required by the wearer that would deliver safe and highly effective renal replacement therapy including metabolic and endocrine functions.\u0000Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 181","PeriodicalId":8721,"journal":{"name":"Bangladesh Journal of Veterinary Medicine","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90143056","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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