Pub Date : 2023-05-24DOI: 10.3329/bjm.v34i20.66178
S. M. Arafat, Hurjahan Banu, Md Shahed Morshed, N. Sultana, A. Saleh, M. Hasanat
Background: Endocrine systems are vulnerable to destruction and dysfunction by coronavirus disease 2019 (COVID-19). Data regarding the follow-up status of hormones following the recovery are scarce in the literature. The aim of the study to evaluate hormone levels and statuses among noncritically ill patients with COVID-19 during and three months after acute infection. Methods: This longitudinal study was done in a tertiary care hospital from September 2021 to February 2022 among 91 noncritical RT-PCR-confirmed COVID-19 patients. After taking relevant history and performing physical examinations, blood was drawn between 07:00 am to 09:00 am in a fasting state to measure serum TSH, FT4, total testosterone (TT), DHEAS, cortisol, and plasma ACTH during hospitalization and after three months. All the hormones were measured by chemiluminescent microparticle immune assay. Results: During admission,19.8% of participants had adrenal insufficiency (<276 nmol/L) and 28.0% had different types of thyroid function abnormalities. Among 37 males, 8.1% had low TT and 29.7% had low DHEAS. Among 54 females, 27.8% had high TT and 7.4% had low and 3.7% had high DHEAS. Among 91, 8 died, 68 were lost to follow-up, and follow-up hormone levels were available for only 15 participants. The number of participants with adrenal insufficiency increased from 1 to 7. During admission, 7 patients had various types of thyroid function abnormalities which reduced to only three cases including two cases of primary hypothyroidism. While TT and DHEAS status deteriorated in males, increased hyperandrogenemia status was observed in females. Conclusion: Adrenal insufficiency is common during shortterm follow-up periods even in noncritical cases of COVID-19 whereas most of the patients with thyroid function abnormalities recovered. A sex-specific opposite response was observed in androgen status. J Medicine 2023; Vol. 34, No. 2(1) Supplement: 218
{"title":"Endocrine Dysfunc-Tion Among Patients with Covid-19: A Experience from Tertiary Hospital in Bangladesh","authors":"S. M. Arafat, Hurjahan Banu, Md Shahed Morshed, N. Sultana, A. Saleh, M. Hasanat","doi":"10.3329/bjm.v34i20.66178","DOIUrl":"https://doi.org/10.3329/bjm.v34i20.66178","url":null,"abstract":"Background: Endocrine systems are vulnerable to destruction and dysfunction by coronavirus disease 2019 (COVID-19). Data regarding the follow-up status of hormones following the recovery are scarce in the literature. The aim of the study to evaluate hormone levels and statuses among noncritically ill patients with COVID-19 during and three months after acute infection.\u0000Methods: This longitudinal study was done in a tertiary care hospital from September 2021 to February 2022 among 91 noncritical RT-PCR-confirmed COVID-19 patients. After taking relevant history and performing physical examinations, blood was drawn between 07:00 am to 09:00 am in a fasting state to measure serum TSH, FT4, total testosterone (TT), DHEAS, cortisol, and plasma ACTH during hospitalization and after three months. All the hormones were measured by chemiluminescent microparticle immune assay.\u0000Results: During admission,19.8% of participants had adrenal insufficiency (<276 nmol/L) and 28.0% had different types of thyroid function abnormalities. Among 37 males, 8.1% had low TT and 29.7% had low DHEAS. Among 54 females, 27.8% had high TT and 7.4% had low and 3.7% had high DHEAS. Among 91, 8 died, 68 were lost to follow-up, and follow-up hormone levels were available for only 15 participants. The number of participants with adrenal insufficiency increased from 1 to 7. During admission, 7 patients had various types of thyroid function abnormalities which reduced to only three cases including two cases of primary hypothyroidism. While TT and DHEAS status deteriorated in males, increased hyperandrogenemia status was observed in females.\u0000Conclusion: Adrenal insufficiency is common during shortterm follow-up periods even in noncritical cases of COVID-19 whereas most of the patients with thyroid function abnormalities recovered. A sex-specific opposite response was observed in androgen status.\u0000J Medicine 2023; Vol. 34, No. 2(1) Supplement: 218","PeriodicalId":8721,"journal":{"name":"Bangladesh Journal of Veterinary Medicine","volume":"47 6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89491807","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.v34i20.66099
M. Mostafi
Despite the fact that fluid and electrolyte preparations are the most commonly prescribed medications in hospitals, a number of studies have shown that the knowledge and practice of fluid and electrolytebalance among young doctors is suboptimal, possibly due to inadequate attention to this most common but less taught chapter. This is responsible for errors in management, which continue to cause avoidable morbidity and even mortality. This presentation is aimed to create interest and further studies amongst the physician to assist them in understanding and solving some of the most common practical issuesof day- to-day clinical practice. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 180
{"title":"Fluid & Electrolytes in Clinical Practice","authors":"M. Mostafi","doi":"10.3329/bjm.v34i20.66099","DOIUrl":"https://doi.org/10.3329/bjm.v34i20.66099","url":null,"abstract":"Despite the fact that fluid and electrolyte preparations are the most commonly prescribed medications in hospitals, a number of studies have shown that the knowledge and practice of fluid and electrolytebalance among young doctors is suboptimal, possibly due to inadequate attention to this most common but less taught chapter. This is responsible for errors in management, which continue to cause avoidable morbidity and even mortality. This presentation is aimed to create interest and further studies amongst the physician to assist them in understanding and solving some of the most common practical issuesof day- to-day clinical practice.\u0000Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 180","PeriodicalId":8721,"journal":{"name":"Bangladesh Journal of Veterinary Medicine","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88282114","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.v34i20.66169
Kishore Kumar Shil, M. Hasan, N. Sultana, Sayad Bin Abdus Salam, M. Hasanat
Background: Youth-onset type 2 Diabetes mellitus (T2DM) often presents with high glycemic values.To see the plasma glucose and hemoglobin A1c (HBA1c) at diagnosis and their relationship with â-cell secretory capacity and insulin resistance in phenotypic T2DM of young. Methods: This cross-sectional study enrolled 72 newlydiagnosed youth-onset phenotypically T2DM [age range 19-29, median 27, inter-quartile range (IQR) 24-29 years; male 32 (44.4%), female 40 (55.6%)] during March-December’2022 in Endocrinology department, BSMMU. The secretory capacity of â-cell was estimated by fasting C-peptide (measured by chemiluminescence immunoassay) and insulin resistance by calculating visceral adiposity index (VAI) and serum triglyceride/highdensity lipoprotein (TH/HDL) ratio. Results: Median HbA1c, fasting plasma glucose (FPG), and 2h plasma glucose (2h-PG) of the participants were 8.7% (IQR 6.7-11.0), 10.8 (IQR 7.1-16.3) mmol/L and 18.0 (IQR 13.1- 24.3) mmol/L respectively. All glycemic values were negatively correlated to fasting C-peptide (HbA1c: r=-0.437, p<0.001; FPG: r=-0.479, p<0.001; 2h-PG: r=-0.456, p<0.001), body mass index (HbA1c: r=-0.546, p<0.001; FPG: r=- 0.550, p<0.001; 2h-PG: r=-0.505, p<0.001) and waist circumference (HbA1c: r=-0.422, p<0.001; FPG: r=-0.399, p=0.001; 2h-PG: r=-0.361, p=0.002). There were no significant correlations of any glycemic values to VAI (HbA1c: r=-0.037, p=0.757; FPG: r=0.075, p=0.532; 2h-PG: r=0.136, p=0.254) or TG/HDL ratio (HbA1c: r=0.036, p=0.764; FPG: r=0.144, p=0.228; 2h-PG: r=0.196, p=0.099). In a linear regression model adjusted for VAI, each nmol reduction of C-peptide was associated with 0.49 (95%CI 0.19-0.79) rise of HbA1c% (p=0.002). Conclusion: Higher glycemic excursion at diagnosis of youth-onset T2DM is related to lower â-cells reserve and lower obesity indices but not to insulin resistance. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 214-215
{"title":"Higher Glycemic Excursion of Newly Diagnosed Youthonset Type-2 Diabetes Mellitus May Be Related to Â-Cell Secretory Capacity and Not to Insulin Resistance","authors":"Kishore Kumar Shil, M. Hasan, N. Sultana, Sayad Bin Abdus Salam, M. Hasanat","doi":"10.3329/bjm.v34i20.66169","DOIUrl":"https://doi.org/10.3329/bjm.v34i20.66169","url":null,"abstract":"Background: Youth-onset type 2 Diabetes mellitus (T2DM) often presents with high glycemic values.To see the plasma glucose and hemoglobin A1c (HBA1c) at diagnosis and their relationship with â-cell secretory capacity and insulin resistance in phenotypic T2DM of young.\u0000Methods: This cross-sectional study enrolled 72 newlydiagnosed youth-onset phenotypically T2DM [age range 19-29, median 27, inter-quartile range (IQR) 24-29 years; male 32 (44.4%), female 40 (55.6%)] during March-December’2022 in Endocrinology department, BSMMU. The secretory capacity of â-cell was estimated by fasting C-peptide (measured by chemiluminescence immunoassay) and insulin resistance by calculating visceral adiposity index (VAI) and serum triglyceride/highdensity lipoprotein (TH/HDL) ratio.\u0000Results: Median HbA1c, fasting plasma glucose (FPG), and 2h plasma glucose (2h-PG) of the participants were 8.7% (IQR 6.7-11.0), 10.8 (IQR 7.1-16.3) mmol/L and 18.0 (IQR 13.1- 24.3) mmol/L respectively. All glycemic values were negatively correlated to fasting C-peptide (HbA1c: r=-0.437, p<0.001; FPG: r=-0.479, p<0.001; 2h-PG: r=-0.456, p<0.001), body mass index (HbA1c: r=-0.546, p<0.001; FPG: r=- 0.550, p<0.001; 2h-PG: r=-0.505, p<0.001) and waist circumference (HbA1c: r=-0.422, p<0.001; FPG: r=-0.399, p=0.001; 2h-PG: r=-0.361, p=0.002). There were no significant correlations of any glycemic values to VAI (HbA1c: r=-0.037, p=0.757; FPG: r=0.075, p=0.532; 2h-PG: r=0.136, p=0.254) or TG/HDL ratio (HbA1c: r=0.036, p=0.764; FPG: r=0.144, p=0.228; 2h-PG: r=0.196, p=0.099). In a linear regression model adjusted for VAI, each nmol reduction of C-peptide was associated with 0.49 (95%CI 0.19-0.79) rise of HbA1c% (p=0.002).\u0000Conclusion: Higher glycemic excursion at diagnosis of youth-onset T2DM is related to lower â-cells reserve and lower obesity indices but not to insulin resistance.\u0000Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 214-215 ","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":"76058495","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.v34i20.66146
R. Chakrabortty
Chronic Obstructive Pulmonary Disease (COPD) is one of the leading causes of death and disability globally as well as in Bangladesh. Continuing research is essential to combat the threat posed by rising prevalence of COPD. Here we present recent updates in the field of COPD research. The revised definition of COPD emphasizes COPD as a heterogeneous disease affecting the bronchi, bronchioles, alveoli and pulmonary vasculature. The traditional view of COPD as a smoker’s disease with a late onset has been replaced by the new concept of COPD etiotypes, which recognizes the contribution of developmental, genetic, environmental, infective and idiopathic contributions to COPD. Vaping has also been proposed as a risk factor for COPD. Two precursors to COPD – pre-COPD and PRISm – have also been proposed to highlight the opportunity of early detection and management. Clinical classification of COPD has been updated to the simplified ABE approach. New recommendations for treatment prioritize the initial use of a fixed dose LABA+LAMA combination. A more judicious use of ICS in COPD patients is recommended, in those with specific indications (exacerbation-prone, high eosinophil counts, or concomitant asthma). In this population, single-inhaler triple-therapy of LABALAMA- ICS has replaced previous recommendations of LABA-ICS. A strong emphasis has been placed on appropriate, individualized choice of inhaler device and training on technique for each patient. Interventional pulmonology and minimally invasive surgery also have a growing role in management of selected patients. Small airways disease is a key cause of morbidity in COPD. Newer diagnostic techniques, such as impulse oscillometry, and novel drug formulations (extra-fine particles, cosuspension forms, soft mist inhalers) are under study. The monoclonal antibody dupilumab has also shown promise in reducing COPD exacerbation. Finally, COPD is a multisystem disease and any management plan must include steps to identify and treat associated co-morbidities. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 197
{"title":"Chronic Obstructive Pulmonary Disease – Recent Updates","authors":"R. Chakrabortty","doi":"10.3329/bjm.v34i20.66146","DOIUrl":"https://doi.org/10.3329/bjm.v34i20.66146","url":null,"abstract":"Chronic Obstructive Pulmonary Disease (COPD) is one of the leading causes of death and disability globally as well as in Bangladesh. Continuing research is essential to combat the threat posed by rising prevalence of COPD. Here we present recent updates in the field of COPD research. The revised definition of COPD emphasizes COPD as a heterogeneous disease affecting the bronchi, bronchioles, alveoli and pulmonary vasculature. The traditional view of COPD as a smoker’s disease with a late onset has been replaced by the new concept of COPD etiotypes, which recognizes the contribution of developmental, genetic, environmental, infective and idiopathic contributions to COPD. Vaping has also been proposed as a risk factor for COPD. Two precursors to COPD – pre-COPD and PRISm – have also been proposed to highlight the opportunity of early detection and management. Clinical classification of COPD has been updated to the simplified ABE approach. New recommendations for treatment prioritize the initial use of a fixed dose LABA+LAMA combination. A more judicious use of ICS in COPD patients is recommended, in those with specific indications (exacerbation-prone, high eosinophil counts, or concomitant asthma). In this population, single-inhaler triple-therapy of LABALAMA- ICS has replaced previous recommendations of LABA-ICS. A strong emphasis has been placed on appropriate, individualized choice of inhaler device and training on technique for each patient. Interventional pulmonology and minimally invasive surgery also have a growing role in management of selected patients. Small airways disease is a key cause of morbidity in COPD. Newer diagnostic techniques, such as impulse oscillometry, and novel drug formulations (extra-fine particles, cosuspension forms, soft mist inhalers) are under study. The monoclonal antibody dupilumab has also shown promise in reducing COPD exacerbation. Finally, COPD is a multisystem disease and any management plan must include steps to identify and treat associated co-morbidities.\u0000Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 197","PeriodicalId":8721,"journal":{"name":"Bangladesh Journal of Veterinary Medicine","volume":"76 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73996005","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.v34i20.66120
M. E. Hussain
Epilepsy is a chronic neurological disorder characterized by recurrent seizures. It affects millions of people worldwide and can have a significant impact on a person’s quality of life. Evidence-based management is gaining popularity in all fields of Medicine. In the treatment of epilepsy it involves the use of proven strategies and interventions based on the best available research like systematic reviews and meta analysis. The goal of evidence-based management is to achieve seizure control while minimizing adverse effects and improving quality of life. Close collaboration between healthcare professionals, patients and caregivers is essential to developing and implementing effective management plans. Ongoing research and evaluation of management strategies are crucial to continuously improving the quality of care for the people with epilepsy. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 183
{"title":"Epilepsy: Evidence-based management","authors":"M. E. Hussain","doi":"10.3329/bjm.v34i20.66120","DOIUrl":"https://doi.org/10.3329/bjm.v34i20.66120","url":null,"abstract":"Epilepsy is a chronic neurological disorder characterized by recurrent seizures. It affects millions of people worldwide and can have a significant impact on a person’s quality of life. Evidence-based management is gaining popularity in all fields of Medicine. In the treatment of epilepsy it involves the use of proven strategies and interventions based on the best available research like systematic reviews and meta analysis. The goal of evidence-based management is to achieve seizure control while minimizing adverse effects and improving quality of life. Close collaboration between healthcare professionals, patients and caregivers is essential to developing and implementing effective management plans. Ongoing research and evaluation of management strategies are crucial to continuously improving the quality of care for the people with epilepsy.\u0000Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 183","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":"74021267","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.v34i20.66123
H. Ahasan
Atypical mycobacteria or nontuberculous mycobacteria are organisms that cause various diseases such as skin and soft tissue infection, lymphadenitis, pulmonary infection, disseminated infection, and a wide range of more rarely encountered infections. The mycobacteria that most commonly cause this condition are most commonly found in the soil, indoor and outdoor water sources, and are recognized to colonize poorly sanitized medical equipment. Atypical mycobacteria most commonly infect young children, immunocompromised individuals, individuals with indwelling medical equipment, and those who have recently undergone surgical or non-surgical procedures. These bacteria can be further categorized into slow and rapidly growing organisms and grouped by the organ systems they commonly affect. Due to their morphology and growth patterns, atypical mycobacteria are difficult to identify on diagnostic testing. Treatment often requires extended courses of combination antibiotic therapy, frequently with surgical intervention. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 184
{"title":"Atypical Mycobacterial Infection: An Achilles heel for Clinician","authors":"H. Ahasan","doi":"10.3329/bjm.v34i20.66123","DOIUrl":"https://doi.org/10.3329/bjm.v34i20.66123","url":null,"abstract":"Atypical mycobacteria or nontuberculous mycobacteria are organisms that cause various diseases such as skin and soft tissue infection, lymphadenitis, pulmonary infection, disseminated infection, and a wide range of more rarely encountered infections. The mycobacteria that most commonly cause this condition are most commonly found in the soil, indoor and outdoor water sources, and are recognized to colonize poorly sanitized medical equipment. Atypical mycobacteria most commonly infect young children, immunocompromised individuals, individuals with indwelling medical equipment, and those who have recently undergone surgical or non-surgical procedures. These bacteria can be further categorized into slow and rapidly growing organisms and grouped by the organ systems they commonly affect. Due to their morphology and growth patterns, atypical mycobacteria are difficult to identify on diagnostic testing. Treatment often requires extended courses of combination antibiotic therapy, frequently with surgical intervention.\u0000Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 184","PeriodicalId":8721,"journal":{"name":"Bangladesh Journal of Veterinary Medicine","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78702083","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.v34i20.66187
Chowdhury Md Navim Kabir
Background: Compare efficacy and safety level different Proton pump inhibitors and H2 receptor blockers by livelihood score category. Methods: 52 participants (30 male and 22 female) participated in this cross sectional studies. They were asked about their drug history specially pattern of drug, starting time, change history (if applicable) dosage schedule, relevant adverse effects etc. Results: Out of 52 participants, 27 patients (52%) regularly took proton pump inhibitors for avoiding gastro intestinal irritations more than 7-8 months.10 patients having heart burn and rest of taking different medication for improvement. Out of 27 patients 10 were male and 17 were female. Dependency upon proton pump inhibitors was more in female due to spicy food intake and lack of punctuality of meal. Important clue that 17 patients switch to lansoprazole/rabeprazole from omeprazole/esomeprazole due to insufficient duration of anti-heart burn activity. Condition improved after starting lansoprazole/dexlansoprazole/rabeprazole. Livelihood score of Rabeprazole is D and for lansoprazole/dexlansoprazole it is C. That means hepatic injury is unlikely such as enzyme elevation. Rest of 20 patients who had history of occasional proton pump inhibitor use.Remaining 5 participants didn’t give adequate information about their drug history. After switching, 10 patients found fatty liver grade 1 which previously diagnosed as grade 2. Conclusion: Carbohydrate and protein dominancy in daily food is prime reason for GIT irritation. In advance stage fate may be ulceration as well as non- alcoholic fatty liver disease. Avoiding unnecessary Non-steroidal anti-inflammatory drugs and selection of proton pump inhibitors according to livelihood score, decrease patient’s gastric irritation as well as establishing healthy drug usage. J Medicine 2023; Vol. 34, No. 2(1) Supplement: 224
{"title":"Management of Gastrointestinal Tract Diseases by Liver Friendly Drugs: Evaluation of Livelihood Score Efficacy","authors":"Chowdhury Md Navim Kabir","doi":"10.3329/bjm.v34i20.66187","DOIUrl":"https://doi.org/10.3329/bjm.v34i20.66187","url":null,"abstract":"Background: Compare efficacy and safety level different Proton pump inhibitors and H2 receptor blockers by livelihood score category.\u0000Methods: 52 participants (30 male and 22 female) participated in this cross sectional studies. They were asked about their drug history specially pattern of drug, starting time, change history (if applicable) dosage schedule, relevant adverse effects etc.\u0000Results: Out of 52 participants, 27 patients (52%) regularly took proton pump inhibitors for avoiding gastro intestinal irritations more than 7-8 months.10 patients having heart burn and rest of taking different medication for improvement. Out of 27 patients 10 were male and 17 were female. Dependency upon proton pump inhibitors was more in female due to spicy food intake and lack of punctuality of meal. Important clue that 17 patients switch to lansoprazole/rabeprazole from omeprazole/esomeprazole due to insufficient duration of anti-heart burn activity. Condition improved after starting lansoprazole/dexlansoprazole/rabeprazole. Livelihood score of Rabeprazole is D and for lansoprazole/dexlansoprazole it is C. That means hepatic injury is unlikely such as enzyme elevation. Rest of 20 patients who had history of occasional proton pump inhibitor use.Remaining 5 participants didn’t give adequate information about their drug history. After switching, 10 patients found fatty liver grade 1 which previously diagnosed as grade 2.\u0000Conclusion: Carbohydrate and protein dominancy in daily food is prime reason for GIT irritation. In advance stage fate may be ulceration as well as non- alcoholic fatty liver disease. Avoiding unnecessary Non-steroidal anti-inflammatory drugs and selection of proton pump inhibitors according to livelihood score, decrease patient’s gastric irritation as well as establishing healthy drug usage.\u0000J Medicine 2023; Vol. 34, No. 2(1) Supplement: 224","PeriodicalId":8721,"journal":{"name":"Bangladesh Journal of Veterinary Medicine","volume":"70 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80397762","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.v34i20.66158
Aminur Rahman, Muhammad Jamil Ahmed, A. H. Russel, M. N. Huq, Z. Ali
Background: Cerebral venous sinus thrombosis (CVST) are an uncommon cause of stroke and is often more difficult to diagnose than usual causes of stroke.A number of studies have confirmed the usefulness of Ddimer level in CVST. The aim of the current study to evaluate the correlation of plasma D-dimer levels in diagnosis of CVST. Methods: This case-control study was conducted on 50 stroke patients and 50 healthy individuals as the control group who will attend in the Department of Neurology of Sir Salimullah Medical College & Mitford Hospital, Dhaka Bangladesh during one year (2021-2022) with new onset headache and presentations suggestive of CSVT will be included in the study. Every medical or surgical condition which causes an increase in D-dimer level was considered as exclusion criteria. Results: Among patient group, 28(56%) patients were females, while 22(44%) patients were males, and the mean of age was 37.7±11.8 years. Headache was the most frequent presentation that observed in 90% of the patients. The patient with focal neurological signs, papilloedema and seizures came next in 52%, 44% and 30% respectively. The average duration of the symptoms was 6.9 ±3.2 days. Overall, the mean plasma level of D-dimer in CVST patients and controls were 526.7± 97.34 ng/mL and 332.3± 53.71 ng/mL respectively (Table: 3). Independent t-test revealed a significant difference (t= 2.167, p= 0.029). According to cut-off value of the assay (400 ng/mL) there were 44 CVST patients (88%) who were positive for the test compared with 7 (14%) among controls (p< 0.001). Stratification of the study population according to male revealed a wide gap between patient and control males (541.7± 114.9 ng/mL and 320.2±71.13 ng/mL respectively) with a significant difference (p= 0.017) (Table: 4). However, in females, this gap was narrower (530.4± 100.9 ng/mL in females with CVST and 349.7±92.5 ng/ mL in healthy females) but still significant (p= 0.032). The test revealed that the area under the curve (AUC) was 0.879, 95%CI=0.807-0.95, p<0.001. The sensitivity and specificity of the test at cut off value of 400ng/ mL were 0.88 and 0.86 respectively, indicating a very good discrimination value. The positive and negative predictive values of D-dimer in diagnosis of CVST were 86.27 % and 87.76% respectively. Conclusion: Our study suggests that measurement of D-dimer can be a reliable tool for diagnosis of CVST, especially in patients with acute and subacute disease. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 202-203
{"title":"The Role of Plasma D-dimer As An Initial Diagnostic Biomarker of Cerebral Venous Sinus Thrombosis In A Tertiary Level Hospital, Bangladesh – Case Control Study","authors":"Aminur Rahman, Muhammad Jamil Ahmed, A. H. Russel, M. N. Huq, Z. Ali","doi":"10.3329/bjm.v34i20.66158","DOIUrl":"https://doi.org/10.3329/bjm.v34i20.66158","url":null,"abstract":"Background: Cerebral venous sinus thrombosis (CVST) are an uncommon cause of stroke and is often more difficult to diagnose than usual causes of stroke.A number of studies have confirmed the usefulness of Ddimer level in CVST. The aim of the current study to evaluate the correlation of plasma D-dimer levels in diagnosis of CVST.\u0000Methods: This case-control study was conducted on 50 stroke patients and 50 healthy individuals as the control group who will attend in the Department of Neurology of Sir Salimullah Medical College & Mitford Hospital, Dhaka Bangladesh during one year (2021-2022) with new onset headache and presentations suggestive of CSVT will be included in the study. Every medical or surgical condition which causes an increase in D-dimer level was considered as exclusion criteria.\u0000Results: Among patient group, 28(56%) patients were females, while 22(44%) patients were males, and the mean of age was 37.7±11.8 years. Headache was the most frequent presentation that observed in 90% of the patients. The patient with focal neurological signs, papilloedema and seizures came next in 52%, 44% and 30% respectively. The average duration of the symptoms was 6.9 ±3.2 days. Overall, the mean plasma level of D-dimer in CVST patients and controls were 526.7± 97.34 ng/mL and 332.3± 53.71 ng/mL respectively (Table: 3). Independent t-test revealed a significant difference (t= 2.167, p= 0.029). According to cut-off value of the assay (400 ng/mL) there were 44 CVST patients (88%) who were positive for the test compared with 7 (14%) among controls (p< 0.001). Stratification of the study population according to male revealed a wide gap between patient and control males (541.7± 114.9 ng/mL and 320.2±71.13 ng/mL respectively) with a significant difference (p= 0.017) (Table: 4). However, in females, this gap was narrower (530.4± 100.9 ng/mL in females with CVST and 349.7±92.5 ng/ mL in healthy females) but still significant (p= 0.032). The test revealed that the area under the curve (AUC) was 0.879, 95%CI=0.807-0.95, p<0.001. The sensitivity and specificity of the test at cut off value of 400ng/ mL were 0.88 and 0.86 respectively, indicating a very good discrimination value. The positive and negative predictive values of D-dimer in diagnosis of CVST were 86.27 % and 87.76% respectively.\u0000Conclusion: Our study suggests that measurement of D-dimer can be a reliable tool for diagnosis of CVST, especially in patients with acute and subacute disease.\u0000Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 202-203","PeriodicalId":8721,"journal":{"name":"Bangladesh Journal of Veterinary Medicine","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83686866","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.v34i20.66159
Nawsabah Noor, Md Khairul Islam, F. Chowdhury, M. Sharif, R. H. Ratul, Sohana Jahan, Md. Kawsar Ahmed, Kaisar Ahmed, Meemnur Rashid, Farhan Muhib, R. Amin, Md. Titu Miah, T. Hasan
Background: During the COVID-19 pandemic, general wards generally were capable of providing up to 15L/ min of oxygen. Shortage of Intensive Care Unit (ICU) beds, High-Flow Nasal Oxygen (HFNO), and other intermediary devices have caused many premature deaths during the pandemic. During this period, we have developed OxyJet CPAP, a locally-made 3D printed continuous positive airway pressure (CPAP) device that can provide up to 60 liters/min of oxygen without electric power. This study assessed whether the OxyJet CPAP could be a non-inferior alternative to an HFNO device in COVID-19 wards. Methods: We performed an open-label, parallel-assignment, randomized controlled trial in 45 patients admitted to the general COVID- 19/suspected wards of Dhaka Medical College Hospital (DMCH), Bangladesh, between April 17, 2021, and July 9, 2021. Eligible patients were confirmed/suspected COVID-19 aged between 18—65 with oxygen saturation (SpO2) between 85—90% while being treated with a non-rebreather mask at 15L/min of 100% oxygen. We used a computerized pseudorandom sequence generator for randomization. The sample size was calculated based on a non-inferiority margin of 1.5 days. Analysis was intention-to-treat. Results: The primary outcome of the trial was ventilator-free days (VFDs) within a 10-day period assessed after study completion. A total of 180 patients were screened, and 45 eligible patients were enrolled. We randomly assigned 23 (51.11%) patients to receive CPAP and 22 (48.89%) patients to receive HFNO. For the CPAP and HFNO arms, the mean value of the primary outcome was found to be 7.41 (STD 3.68) and 6.6 (STD 3.69) days, respectively. The mean difference in the primary outcome was 0.81 (95% CI -1.41—3.03), with the lower bound above the non-inferiority margin, thus, establishing the non-inferiority hypothesis (p = 0.021). Adverse events (AE) were recorded according to the Common Terminology Criteria for Adverse Events (CTCAE) scale (1—5). In the CPAP and HFNO arms, the mean CTCAE scale was found to be 1.39 (STD 0.499) and 1.59 (STD 0.503), respectively, showing no significant difference (p = 0.189). In Post Hoc analysis, we found that, on average, the OxyJet CPAP requires significantly less oxygen per patient compared to HFNO with a median difference of -16.11 L/min (95% CI -24.63—-6.67, p=0.001). Conclusion: The results show that the OxyJet CPAP treatment was non-inferior compared to the HFNO treatment. In the context of many hospitals in Bangladesh, especially in rural areas, using the locally made OxyJet CPAP could provide significant benefits due to its lower cost and usability. This device can be used as an effective bridging therapy reducing ICU admissions in the general ward settings or preserving life while awaiting resource availability. In addition, the device can also be used in emergencies and ambulances. The Directorate General of Drug Administration (DGDA) has provided limited approval of the device for hospital use. Currently, we ar
{"title":"Safety And Efficacy Evaluation Of The Oxyjet Cpap Device Compared To High-flow Nasal Oxygen For Treating Hypoxemic Covid-19 Patients In General Hospital Wards: A Randomized Controlled Trial","authors":"Nawsabah Noor, Md Khairul Islam, F. Chowdhury, M. Sharif, R. H. Ratul, Sohana Jahan, Md. Kawsar Ahmed, Kaisar Ahmed, Meemnur Rashid, Farhan Muhib, R. Amin, Md. Titu Miah, T. Hasan","doi":"10.3329/bjm.v34i20.66159","DOIUrl":"https://doi.org/10.3329/bjm.v34i20.66159","url":null,"abstract":"Background: During the COVID-19 pandemic, general wards generally were capable of providing up to 15L/ min of oxygen. Shortage of Intensive Care Unit (ICU) beds, High-Flow Nasal Oxygen (HFNO), and other intermediary devices have caused many premature deaths during the pandemic. During this period, we have developed OxyJet CPAP, a locally-made 3D printed continuous positive airway pressure (CPAP) device that can provide up to 60 liters/min of oxygen without electric power. This study assessed whether the OxyJet CPAP could be a non-inferior alternative to an HFNO device in COVID-19 wards.\u0000Methods: We performed an open-label, parallel-assignment, randomized controlled trial in 45 patients admitted to the general COVID- 19/suspected wards of Dhaka Medical College Hospital (DMCH), Bangladesh, between April 17, 2021, and July 9, 2021. Eligible patients were confirmed/suspected COVID-19 aged between 18—65 with oxygen saturation (SpO2) between 85—90% while being treated with a non-rebreather mask at 15L/min of 100% oxygen. We used a computerized pseudorandom sequence generator for randomization. The sample size was calculated based on a non-inferiority margin of 1.5 days. Analysis was intention-to-treat.\u0000Results: The primary outcome of the trial was ventilator-free days (VFDs) within a 10-day period assessed after study completion. A total of 180 patients were screened, and 45 eligible patients were enrolled. We randomly assigned 23 (51.11%) patients to receive CPAP and 22 (48.89%) patients to receive HFNO. For the CPAP and HFNO arms, the mean value of the primary outcome was found to be 7.41 (STD 3.68) and 6.6 (STD 3.69) days, respectively. The mean difference in the primary outcome was 0.81 (95% CI -1.41—3.03), with the lower bound above the non-inferiority margin, thus, establishing the non-inferiority hypothesis (p = 0.021). Adverse events (AE) were recorded according to the Common Terminology Criteria for Adverse Events (CTCAE) scale (1—5). In the CPAP and HFNO arms, the mean CTCAE scale was found to be 1.39 (STD 0.499) and 1.59 (STD 0.503), respectively, showing no significant difference (p = 0.189). In Post Hoc analysis, we found that, on average, the OxyJet CPAP requires significantly less oxygen per patient compared to HFNO with a median difference of -16.11 L/min (95% CI -24.63—-6.67, p=0.001).\u0000Conclusion: The results show that the OxyJet CPAP treatment was non-inferior compared to the HFNO treatment. In the context of many hospitals in Bangladesh, especially in rural areas, using the locally made OxyJet CPAP could provide significant benefits due to its lower cost and usability. This device can be used as an effective bridging therapy reducing ICU admissions in the general ward settings or preserving life while awaiting resource availability. In addition, the device can also be used in emergencies and ambulances. The Directorate General of Drug Administration (DGDA) has provided limited approval of the device for hospital use. Currently, we ar","PeriodicalId":8721,"journal":{"name":"Bangladesh Journal of Veterinary Medicine","volume":"67 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74605839","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.v34i20.66127
M. Islam
Oncological emergencies are defined as an acute lifethreatening event in a patient with a tumor occurring as part of their complex treatment regimen or secondarily to their underlying malignancy. These events can occur at any time from the initial diagnosis of their cancer to endstage disease; and can be encountered in any clinical setting, ranging from primary care physician and emergency department visits to a variety of subspecialty environments. Oncologic emergencies are clinical situations that can lead to death in a short time (24-48 hours) if not quickly faced. In the clinical practice of the medical oncologist, such situations do not infrequently occur. The onset of oncologic emergencies may depend on the presence of cancer itself, the therapies carried out to counteract cancer, or the patient’s predisposition to develop such events. It is essential to recognize the aforementioned situations early in order to treat them promptly, thus avoiding serious consequences. BJM Vol. 34 No. 2(1) Suppliment 2023 Scientific Presentation 186 Therefore, it is critically important that all physicians have a working knowledge of the potential oncological emergencies that may present in their practice and how to provide the most effective care without delay. Nervous system emergencies include spinal cord compression, raised ICP, leptomeningeal disease, seizures and altered mental status whereas superior venacaval syndrome, hyperviscocity syndrome, hyperleukocytosis, venous thromboembolism, Hemorrhage and DIC are the vascular and haematologic emergencies. Several classic metabolic oncologic emergencies include syndrome of inappropriate antidiuretic hormone secretion, tumor lysis syndrome and hypercalcemia of malignancy. Among the pulmonary problems airway obstruction, massive haemoptysis, toxic lung injuries, pneumonitis and pulmonary fibrosis can be caused by cancer and cancer treatment. Urologic emergencies such as hemorrhagic cystitis and obstructive uropathy are also seen. Gastrointestinal bleeding in patients with cancer and typlitis in patients with neutropenic fever are potentially serius complications also. Immune check point inhibitors may cause irAEs in practically any organ system ranging from SJS, TEN, thyroiditis, hypophysitis, adrenilitis, diabetic ketoacidosis to life threatening pneumonitis and myocarditis which may be associated with poor overall survival. Oncologic emergencies can threaten the well-being of almost any patient with a malignancy. Although some of these conditions are related to cancer therapy, they are by no means confined to the period of initial diagnosis and active treatment. In the setting of recurrent malignancy, these events can occur years after the surveillance of a cancer patient has been appropriately transferred from a medical oncologist to a primary care provider. As such, awareness of a patient’s cancer history and its possible complications forms an important part of any clinician’s knowledge base. Prompt iden
{"title":"Emergencies in Oncological Practice","authors":"M. Islam","doi":"10.3329/bjm.v34i20.66127","DOIUrl":"https://doi.org/10.3329/bjm.v34i20.66127","url":null,"abstract":"Oncological emergencies are defined as an acute lifethreatening event in a patient with a tumor occurring as part of their complex treatment regimen or secondarily to their underlying malignancy. These events can occur at any time from the initial diagnosis of their cancer to endstage disease; and can be encountered in any clinical setting, ranging from primary care physician and emergency department visits to a variety of subspecialty environments. Oncologic emergencies are clinical situations that can lead to death in a short time (24-48 hours) if not quickly faced. In the clinical practice of the medical oncologist, such situations do not infrequently occur. The onset of oncologic emergencies may depend on the presence of cancer itself, the therapies carried out to counteract cancer, or the patient’s predisposition to develop such events. It is essential to recognize the aforementioned situations early in order to treat them promptly, thus avoiding serious consequences. BJM Vol. 34 No. 2(1) Suppliment 2023 Scientific Presentation 186 Therefore, it is critically important that all physicians have a working knowledge of the potential oncological emergencies that may present in their practice and how to provide the most effective care without delay. Nervous system emergencies include spinal cord compression, raised ICP, leptomeningeal disease, seizures and altered mental status whereas superior venacaval syndrome, hyperviscocity syndrome, hyperleukocytosis, venous thromboembolism, Hemorrhage and DIC are the vascular and haematologic emergencies. Several classic metabolic oncologic emergencies include syndrome of inappropriate antidiuretic hormone secretion, tumor lysis syndrome and hypercalcemia of malignancy. Among the pulmonary problems airway obstruction, massive haemoptysis, toxic lung injuries, pneumonitis and pulmonary fibrosis can be caused by cancer and cancer treatment. Urologic emergencies such as hemorrhagic cystitis and obstructive uropathy are also seen. Gastrointestinal bleeding in patients with cancer and typlitis in patients with neutropenic fever are potentially serius complications also. Immune check point inhibitors may cause irAEs in practically any organ system ranging from SJS, TEN, thyroiditis, hypophysitis, adrenilitis, diabetic ketoacidosis to life threatening pneumonitis and myocarditis which may be associated with poor overall survival. Oncologic emergencies can threaten the well-being of almost any patient with a malignancy. Although some of these conditions are related to cancer therapy, they are by no means confined to the period of initial diagnosis and active treatment. In the setting of recurrent malignancy, these events can occur years after the surveillance of a cancer patient has been appropriately transferred from a medical oncologist to a primary care provider. As such, awareness of a patient’s cancer history and its possible complications forms an important part of any clinician’s knowledge base. Prompt iden","PeriodicalId":8721,"journal":{"name":"Bangladesh Journal of Veterinary Medicine","volume":"65 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78593701","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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