Bangladesh Journal of Veterinary Medicine最新文献

{"title":"Cardiovascular assessment in Noncardiovascular surgery: what evidences say?","authors":"A. Maskey","doi":"10.3329/bjm.v34i20.66097","DOIUrl":"https://doi.org/10.3329/bjm.v34i20.66097","url":null,"abstract":"Annually more than 300 million patients (about 5% of the world population) undergo major surgery worldwide. Nearly 85% of major operations are noncardiac surgical procedures. Proper preoperative evaluation is important to reduce cardiovascular morbidity and mortality in patients undergoing noncardiac surgery. Cardiac risk is determined by two main factors: patient-related risk and surgical risk. Timing of surgery (Immediate, Urgent, time-sensitive, elective), type of surgical approach ( laparoscopy, vascular and endovascular procedure, open surgeries) , risk of surgery ( Low, intermediate, high surgical risk) determine surgical risk. Patient-related risk is assessed by patient’s age, the presence of cardiovascular risk factors (e.g. smoking, hypertension, diabetes, dyslipidaemia,) or established cardiovascular disease, and comorbidities (heart failure, arrhythmia etc.).In emergency surgery preoperative evaluation is limited as saving life is more important. In elective surgery patient related risk factors, comorbidity, associated cardiovascular diseases, timing and risk of surgery , functional capacity determine further preoperative evaluation with necessary investigations like ECG, Echo, laboratory investigations, biomarkers, stress test, coronary angiogram etc.\u0000Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 179","PeriodicalId":8721,"journal":{"name":"Bangladesh Journal of Veterinary Medicine","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87240014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevention of Acute Respiratory Failure Due to Administration of Polymyxins by Intravenous Calcium Gluconate in Critically Ill Patients for Treating Carbapenem Resistant Infections in Acute Medicine Unit: A Quality Improvement Project (Qip)","authors":"Bornali Chowdhury, Ahmed Mursel Anam, S. Huq, Adnan Shareef, Mymuna Binte Mukarrom","doi":"10.3329/bjm.v34i20.66171","DOIUrl":"https://doi.org/10.3329/bjm.v34i20.66171","url":null,"abstract":"Background: Polymyxin B and colistin are most potent antibiotics for treating carbapenem resistant infections due tomultidrugs resistant organisms that are currently rising remarkably and alarm signs for global health. These are last resorts options for bacteremia during crisis time when pathogens are only sensitive to polymyxins. Most common life threatening complication is respiratory muscle paralysis due to neuromuscular blockage that lead to apnea, acute type 2 respiratory failure and death. Main aim of this quality Improvement project (QIP)was to demonstrate therapeutic effectiveness and outcomes of I/V calcium gluconate during administration of polymyxins.\u0000Methods: This QIP was conducted at acute medicine and HDU of a tertiary care hospital for 2 months in Bangladesh. Patients who got I/V calcium gluconate with polymyxins in January and February, 2023 were compared with similar data without calcium gluconate for prior 4 months. Data analysis and interpretation done by unpaired t test.\u0000Results: Primary outcome shows statistically significant decrease dintubation and mechanical ventilation due to sudden respiratory failure and ICU transfer after getting I/V calcium gluconate during polymyxins(30.8%,n=13 and 88.9% ,n=9 and p= <0.005).\u0000Conclusion: This study showsstrongly visible positive outcome in prevention of acute respiratory failure by polymyxins in critically ill patients. We feel that all physicians may practice this study in acute medicine and critical care setup.\u0000Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 216 ","PeriodicalId":8721,"journal":{"name":"Bangladesh Journal of Veterinary Medicine","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91036425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Naphthalene Poisoning in a Young Glucose 6 Phosphate Dehydrogenase Deficient Patient","authors":"A. Begum","doi":"10.3329/bjm.v34i20.66179","DOIUrl":"https://doi.org/10.3329/bjm.v34i20.66179","url":null,"abstract":"Naphthalene poisoning is a rare form of toxicity that may occur after ingestion, inhalation, or dermal exposure to naphthalene-containing compounds. It is a volatile polycyclic hydrocarbon used as a household deodorizer and moth repellent.Ingestional naphthalene poisoning can leadto methaemo-globulinaemia and intravascular haemolysis with diagnostic and therapeutic challenge. Associated G6PD deficiency may make it more complicated. A 20-year-old man presented with low-grade fever, lethargy and dark urine for 4 days.His vitals showed normal temperature, tachycardia with normal blood pressure and low oxygen saturation(76%) despite having high flow oxygen (15L/min).On repeated queries, he gave a history of ingesting a few naphthalene balls after a heated conversation with his friends. Laboratory workup showed features of haemolysis, methaemoglobinaemia, haemoglobinuria and low glucose 6 phosphate dehydrogenase level. The patient was treated conservatively with intravenous fluid, packed red blood cells transfusion, N acetylcysteine andascorbic acid with full recovery.\u0000J Medicine 2023; Vol. 34, No. 2(1) Supplement: 218","PeriodicalId":8721,"journal":{"name":"Bangladesh Journal of Veterinary Medicine","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91245288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Precision Medicine: An Emerging Approach for Patient Care","authors":"M Amir Hossain","doi":"10.3329/bjm.v34i20.66150","DOIUrl":"https://doi.org/10.3329/bjm.v34i20.66150","url":null,"abstract":"The philosophy behind contemporary healthcare is that one size fits all. Unfortunately, the outcomes of a standardized treatment regimen are not always uniform. That’s where the concept of precision medicine comes in. According to the Precision Medicine Initiative, precision medicine is “an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person.” This approach allow doctors and researchers to predict more accurately which treatment and prevention strategies for a particular disease will work in which groups of people and is in contrast to a one-size-fits-all approach, in which disease treatment and prevention strategies are developed for the average person, with less consideration for the differences between individuals. Although the term “precision medicine” is relatively new, the concept has been a part of healthcare for many years. For example, a person who needs a blood transfusion is not given blood from a randomly selected donor; instead, the donor’s blood type is matched to the recipient to reduce the risk of complications. The adoption of precision medicine will grow because its benefits to healthcare providers and patients are numerous. The highlighting ones are to shift the emphasis in medicine from reaction to prevention, predict susceptibility to disease, improve disease detection, preempt disease progression, customize disease-prevention strategies, prescribe more effective drugs, avoid prescribing drugs with predictable side effects and so on.The goal of precision medicine is to target the right treatments to the right patients at the right time. The short-term goals involve expanding precision medicine in the area of cancer research. Researchers at the National Cancer Institute (NCI) hope to use an increased knowledge of the genetics and biology of cancer to find new, more effective treatments for various forms of this disease. The long-term goals of the Precision Medicine Initiative focus on bringing precision medicine to all areas of health and healthcare on a large scale. Insufficient technologies, limited knowledge, and gaps in research are major obstacles to adding precision medicine to routine clinical care. Advances in precision medicine have already led to powerful new discoveries and FDA-approved treatments that are tailored to specific characteristics of individuals. Patients with a variety of cancers routinely undergo molecular testing as part of patient care, enabling physicians to select treatments that improve chances of survival and reduce exposure to adverse effects. Precision medicine will timely enable clinicians to integrate healthcare data with targeted assays and tests to identify and assess disease biomarkers and risks, determine actionable genetic variants in patients, obtain the entire picture of the metabolome, and map metabolites to disease pathways. Implementof precision medicine as a holistic approach, req","PeriodicalId":8721,"journal":{"name":"Bangladesh Journal of Veterinary Medicine","volume":"24 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":"135140816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Approach to multidrug resistant bacterial infections","authors":"A. Basher","doi":"10.3329/bjm.v34i20.66143","DOIUrl":"https://doi.org/10.3329/bjm.v34i20.66143","url":null,"abstract":"Several bacterial pathogens have evolved into multidrug resistant (MDR) forms both in developed and developing countries at an expanding rate. The World Health Organization has identified antimicrobial resistance as one of the three most important problems facing human health. It was estimated that 4·95 million deaths were associated with bacterial AMR globally in 2019.1 Three infectious syndromes dominated the global burdens attributable to AMR: lower respiratory and thorax infections, bloodstream infections, and intra-abdominal infections. Some of the most important MDR pathogens that currently cause infection in hospital and in the community are the so-called “ESKAPE” pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumanii, Pseudomonas aeruginosa, and Enterobacter species), emphasizing their capacity to “escape” the effects of routine antibiotics. Most of the MDR studies were heterogeneous in terms of study design, patient population, site of infection, choice of antibiotic treatment, duration of followup period, and the outcome definitions, making it difficult to compare the different treatments and combinations of antibiotics used. Current recommendations in Europe and USA are based on systematic reviews that suggest different methods to prevent and control MDR infections, but provide little data on new and alternative antibiotic treatment options and therefore provide little firm guidance on specific treatment choices and algorithms. Attempts are ongoing to overcome antibacterial resistance by using new agents and combinations of new plus old agents. For example, both old (clavulanic acid, tazobactam) and new (avibactam, vaborbactam, relebactam) BLIs are being used in treatment algorithm for critically ill patients in the ICU according to MDR pathogen. There were still controversies regarding microbiological success for single agent compared with combinations of multiple agents. Many bacteria have the ability to produce biofilms, comprising organized congregations of bacteria adhering to each other making complex condition where antibiotic failed to wipe out bacteria despite of retaining in vitro susceptibility. It is also not always possible to conduct randomized controlled studies involving the required number of patients in a timely manner. So a requirement with the increasing choice of highly effective antimicrobial drugs, with dosages based on pharmacokinetic analysis of drug disposition, selection of the appropriate drug based on clinical microbiological data and pharmacodynamic indices. Rational antimicrobial therapy is more applicable today than in the history of antimicrobial therapy. Exploring newer modalities such as phage therapy and lytic antibiotics as well as obtaining a deeper understanding of the pathways involved in MDR mechanisms in order to engineer targeted drugs. Besides, rapid and comprehensive diagnostics are the key factor for the future management of antimicrobial resis","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":"77576971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the Efficacy and Tolerability of a Fixed Dose Combination of Amlodipine And Indapamide in Patients Older Than 55 Years","authors":"Q. Islam, K. Haque, Kaniz Moula, H. Ahasan, Md. Ismail Patwary, K. A. Azad, Mujibur Rahman, Md Zakir Hossain, M. Miah, A. Azad","doi":"10.3329/bjm.v34i20.66148","DOIUrl":"https://doi.org/10.3329/bjm.v34i20.66148","url":null,"abstract":"Background: There is very limited real-life data on hypertension management in Bangladeshi population. Considering this fact, this study evaluated the effectiveness of treatment with an indapamide/amlodipine single-pill combination (SPC) in Bangladeshi patients over the age of 55 years, in an OPD setting with uncontrolledsystolic hypertension in real-life clinical practice.\u0000Methods: This was a 3-month, multicenter, observational, open-label study conducted in 3 divisional cities of Bangladesh among patients with grade I or II hypertensions who were either uncontrolled on previous antihypertensive treatment or treatment-naïve. The effectiveness of indapamide/amlodipine SPC was assessed by the change in office systolic blood pressure (SBP) and the rate of target SBP (< 140 mmHg)achievement at 2 weeks, 1 month and 3 months, in four age groups: 55–59 years, 60–69 years, 70–79 years, and80 years or older.\u0000Results: The COMBINE study recruited 213 patients, of whom 185 took indapamide/amlodipine 1.5/5 mg SPC forafull three-month course of therapy.Mean age was 62.4±7.4 years, 76 men [41.1%] and 109 women [58.9%]. The absolute decrease of SBP during 3 months of taking indapamide/amlodipine single-pill combination (SPC) was 27.7 mm Hg, DBP - 10.2 mm Hg.After 3 months of treatment significant SBPdecreases from baseline were observed in each age group:”29.9 mmHg (from 156.7 to 126.8),”25.1 mmHg (from 152.7 to 127.6),”26.1 mmHg (from 152.8 to 126.7),and “ 24.5 mmHg (from 151.8 to 127.3)in the 55–59, 60–69, 70–79, and 80 years and older age groups, respectively.\u0000Conclusion: This COMBINE study results showed that indapamide/amlodipine SPC was associated with significant and rapid reductions in BP even in a different age range of Bangladeshi patients in routine clinical practice. This study result is consistent with already achieved data of this SPC globally.\u0000Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 200","PeriodicalId":8721,"journal":{"name":"Bangladesh Journal of Veterinary Medicine","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86735706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Tuberculosis in special situations","authors":"M. D. Hossain, A. Mahmud, Md Ali Hossain, Mohammad Abdus Shakur Khan, K. Bennoor, Md Ferdous Wahid","doi":"10.3329/bjm.v34i20.66145","DOIUrl":"https://doi.org/10.3329/bjm.v34i20.66145","url":null,"abstract":"Treatment of Tuberculosis in special situations implies overcoming special challenges in patients with diabetes, pregnant women, people aged over 65 years, and those with chronic kidney or liver disease.Rifampicin is a potent hepatic enzyme inducer, may lower plasma levels of sulphonyl urea and can increase the hypoglycemic effect of metformin. Since insulin is not metabolized, no pharmacokinetic interactions with anti-TB drugs occur. Gastrointestinal upset and hepatitis are reported as the most frequent adverse events in older people. In patients >80 years,pyrazinamide may be omitted. In TB patients with chronic kidney disease (CKD), an inappropriate dosage of anti-TB drugs can result in unsuccessful treatment or side effects. Current guidelines for first-line anti-TB drugs therefore recommend that dosages of ethambutol (EMB) and pyrazinamide (PZA) be adjusted according to patient renal function and body weight, although no change in dosage is necessary for patients with mild renal insufficiency . However, it remains unknown how the renal function-based dosage adjustments recommended by the guidelines affect efficacy outcomes for TB patients with CKD. In chronic liver disease (CLD) patients, The Child–Turcotte–Pugh (CTP) score can be used as a guide for designing appropriate regimens. In stable CLD (CTP d”7), a treatment regimen including isoniazid, rifampicin, and ethambutol is recommended, a 2-month intensive phase with the three drugs, followed by isoniazid and rifampicin continuation phase for 7 months partially liver-sparing regimen consisting of Ethambutol, Rifampicin, and a quinolone for 9 months is advisable in case of more severe CLD (CTP 8–10).If CLD is very advanced (CTP £11), a total liver-sparing regimen consisting of Ethambutol and a quinolone (Levofloxacin or Moxifloxacin) for 12 months.\u0000Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 196-197","PeriodicalId":8721,"journal":{"name":"Bangladesh Journal of Veterinary Medicine","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90971410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kidney Disease – Bangladesh Perspective","authors":"M. R. Alam","doi":"10.3329/bjm.v34i20.66098","DOIUrl":"https://doi.org/10.3329/bjm.v34i20.66098","url":null,"abstract":"In Bangladesh, most patients with Chronic Kidney Disease (CKD) are diagnosed in the advanced stages of the disease, which leads to a high demand for kidney transplantation and dialysis services.Several studies suggest prevalence rate of CKD 6–18%; of them 11% were in stage III–V.Every year 35,000-40,000 new cases of kidney failure.Every year >20,000 chronic kidney failure patients die as they cannot afford dialysis or kidney transplant.73% treatment cost is out of pocket in Bangladesh.The cost of hemodialysis per session varies from 400- 4500 BDT (USD 4-45) depending on institute.Even the ultra-poor patients who take dialysis at the rate of BDT 500 (USD 5) per session have to spend a minimum of BDT 20,000 (USD 200) per month only for the treatment cost. 40% patients discontinue dialysis after 3-4 months due to financial constraint. The existing facilities can hardly accommodate 9000–10,000 new patients, which means RRT isnot available for 70–75% of ESRD patients.Annually dialysis is done on >18,000 kidney patients across the country.80% of the total kidney-related deaths are caused due to insolvency to continue treatment.Currently >90% of dialysis patients are receiving Hemodialysis.Initiatives are taken to make CAPD more accessible, but high cost of PD fluid & lack of trained personnel remains as major barriers. Challenges are there in providing Nephrocare.There is insufficient number and uneven distribution of trained medical & allied health professionals, lack of proper referral system & follow-up & lack of laboratory facility in many areas, particularly in rural setup.Absence of insurance coverage for kidney dialysis & transplant treatment.Absence of patient support group & their participation in policy making process. To overcome the challenges we have to ensure affordable & equitable access to kidney care for people living with CKD through Public & Public Private Partnerships. Protection from out-of-pocket healthcare expenditure through universal health coverage to provide insurance coverage for CKD patients and Subsidized treatment for dialysis & kidney transplant.Expansion of Fellowship program to develop more Nephrologists & training facility/ centers to develop more allied health professionals.Facilitating research for kidney disease with technical and financial support.Improve screening to ensure timely diagnosis and prevent CKD related complications.\u0000Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 179-180","PeriodicalId":8721,"journal":{"name":"Bangladesh Journal of Veterinary Medicine","volume":"52 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90940145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modern Insulin, Device, and Technology: Tips For Clinicians","authors":"Abm Kamrul Hasan","doi":"10.3329/bjm.v34i20.66135","DOIUrl":"https://doi.org/10.3329/bjm.v34i20.66135","url":null,"abstract":"Insulin has been a lifesaving treatment for people with diabetes since its discovery in 1921. However, the way insulin is delivered evolved over time. Modern insulin, devices, and technology have transformed the management of diabetes and improved the quality of life for millions of people worldwide.Modern insulins are designed to match the needs of people with diabetes better. Traditional insulins, such as regular and NPH insulin, have a delayed onset and peak, making it difficult to manage blood sugar levels. Newer insulins, such as rapid-acting insulin analogs like aspart, glulisine, and lispro, have a faster onset and shorter duration of action, allowing for greater dosing and timing flexibility. Long-acting insulin analogs, like glargine and detemir, provide more consistent blood sugar control and less hypoglycemia risk.Insulin delivery devices have also advanced significantly. The most common device is the insulin pen, which looks like a large pen and uses disposable insulin cartridges. The pen has replaced traditional syringes and vials for many people with diabetes, offering greater convenience and ease of use. Insulin pumps are also becoming more popular, especially among people with type 1 diabetes. A pump delivers insulin through a catheter inserted under the skin, which can be programmed to provide a continuous infusion of insulin or a bolus dose before meals.Technological advancements have also revolutionized diabetes management. Continuous glucose monitoring (CGM) systems use a small sensor inserted under the skin to measure glucose levels every few minutes, providing real-time data to help people make more informed decisions about insulin dosing and food choices. Some CGM systems also offer alerts for high and low blood sugar levels, making it easier to avoid dangerous fluctuations. Automated insulin delivery systems, also known as closed-loop systems or artificial pancreas systems, use CGM data to automatically adjust insulin delivery, reducing the burden of constant monitoring and decision-making for people with diabetes.In summary, modern insulin, devices, and technology have greatly improved the management of diabetes, allowing for better blood sugar control and a better quality of life for people with diabetes. As technology continues to advance, the future of diabetes management looks promising.\u0000Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 191","PeriodicalId":8721,"journal":{"name":"Bangladesh Journal of Veterinary Medicine","volume":"55 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75780747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenging Thyroid Cases in Clinical Practice","authors":"M. Saifuddin","doi":"10.3329/bjm.v34i20.66132","DOIUrl":"https://doi.org/10.3329/bjm.v34i20.66132","url":null,"abstract":"Thyroid disorders are prevalent, and their manifestations are divergent and sometimes it is very challenging to diagnose and deal with some Thyroid cases in clinical practice. Here seven different challenging cases will be discussed that will help clinicians to diagnose and treat such cases in dayto- day clinical practice. First case enlightened us that Thyroid function should not be assessed in seriously ill patients unless there is a strong suspicion of thyroid dysfunction, since there are many other factors in acutely or chronically ill euthyroid patients that influence thyroid function tests. The second case taught us that there is assay interference with Biotin ingestion and patients taking Biotin should hold the supplement for two days prior to assessing thyroid function. Subacute thyroiditis is a self-limiting inflammatory condition of the thyroid gland and COVID-19 virus infection may be associated with subacute thyroiditis as a complication that may occur in patients without any previous thyroid disorder that is revealed in third case. In Secondary hypothyroidism/Hypopituitarism, TSH may be low, normal, or even slightly elevated due to inactive TSH isoform in blood. The fourth case shows us that only TSH testing in clinical practice leads to missing Secondary hypothyroidism/Hypopituitarism. Learning from fifth case is that during monitoring of thyrotoxic patients taking ATDs, serum TSH may remain suppressed for several months after starting therapy and it is therefore not a good parameter for monitoring therapy early during treatment, rather we should rely on FT4 and FT3. The sixth case enlightened us that in case of low TSH in early pregnancy, Gestational transient Thyrotoxicosis should be excluded which is commonly associated with hyperemesis gravidarum with no prior history of thyroid disease, no stigmata of Graves’ disease (Goiter, ophthalmopathy) and a self-limited mild disorder. In poorly compliant patients, there may be a combination of high FT4 and high TSH that is revealed in the seventh case.\u0000Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 189","PeriodicalId":8721,"journal":{"name":"Bangladesh Journal of Veterinary Medicine","volume":"48 37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79553057","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}