Ham Nazmul Ahasan

Dengue Expanded Syndrome: An unusual presentation

Dengue fever is a mosquito borne viral infection found in tropic & sub-tropic regions. The symptomatic dengue infection follows an uncomplicated course; however, unusual manifestations of this disease are now being increasingly reported as expanded dengue syndrome which incorporates wide spectrum of uncommon presentation of this common disease which does not fall into either dengue shock syndrome or dengue hemorrhagic fever. We report a case of a 30 year old lady who presented with high grade fever, rash, diffuse abdominal pain & vomiting, who ultimately developed shock and features of multi organ failure. We diagnosed her as a case of expanded dengue syndrome with multi organ failure ( hepatitis with very high transaminase levels, pancreatitis, acalculous cholecystitis, coagulation failure & acute kidney injury) with septicaemia. With prompt diagnosis and aggressive management, this potentially fatal patient was cured. Bangladesh J Medicine Jan 2018; 29(1) : 45-47

Methanol Poisoning with Fatality- Case Series in Dhaka Medical College Hospital in Bangladesh

Background: Adulterated methanol is highly toxic and leads to severe metabolic acidosis and blindness and mortality is very high if not treated with specific antidote. The time of ingestion and severity of illness is very short and comprehensive quick assessment and care is crucial for survival of patient. The selective antidote Fomepizole is not available in Bangladesh and pure intravenous ethanol is also out of reach in health care facility. The oral ethanol has its legislative regulation. Occasional clusters of severe methanol poisoning leading to fatality has been observed in recent years in Bangladesh. Here is a case series of 8 cases of adulterated methanol poisoning in a tertiary care hospital with lethality. Results and discussion: From November 2012 to January, 2013, in sphere of 3 months medicine units of Dhaka Medical College Hospital (DMCH) experienced 8 cases of methanol poisoning with fatality. Six patient presented in unconscious states within 3 to 7 h of consuming methanol while two patient presented within 48 h. All of them had gastrointestinal toxicity with variable episodes of vomiting. Three patients presented with visual impairment while only two out of eight had normal ophthalmoscopy. Respiratory distress was uniformly found in all patients before unstable profound shock. Blood ethanol level was not performed in any patient due to lack of available facility. Seven patients received only supportive measures ranging from steroids to sodium bi carbonate while one patient presented in severe toxicity and died quickly before any supportive measures. Antidote was not prescribed in any patient in the form of fomepizole or intravenous or oral ethanol. Conclusion: The judicious use of antidote even in the form of oral ethanol and folinic acid can save the precious life. A national guideline should be uniformly practiced by the physicians to combat the catastrophic methanol poisoning in Bangladesh.

Study of Serum Vitamin D Level in Different Socio-Demographic Population - A Pilot Study

Background: Recently, we see in our clinical practice that many patients who are coming with generalized body aches and pains and diagnosed as fibromyalgia or chronic fatigue, not adequately responding to treatment. When their vitamin D level was done, it was found to be low and correction of their low vitamin D level improved their symptoms dramatically. Despite abundant sunshine in Bangladesh, allowing vitamin D synthesis all the year round, why our people are developing hypovitaminosis D inspired us to do this current study. Our present study is designed to estimate the prevalence of vitamin D deficiency among adult patients presented with aches & pains as well as to study the association of low vitamin D levels with different socio-demographic parameters. Methods: A cross sectional observational study was conducted among 212 adult patients aged 18 years and above presented with generalized body aches and pains, attended both outpatient and inpatient departments of Popular Medical College Hospital during the period of March’16- August’16 ( 6 months). Association between vitamin D status & the individual specific variables was statistically analyzed. Results: The prevalence of vitamin D deficiency among the study population was found to be100% in all age groups. Among 212 study population, 73.6% were female (n=156) & 26.4% were male (n=56). Mean Vitamin D level among male was 14.29 (SD 4.68) & among female was 12.64 (SD 4.74). The factors associated with severely deficient Vitamin D level were female sex, urban population, o 19 (1) : 22-29

Atypical Presentation of Pretibial Myxoedema in Graves’ Disease

a. Quazi Tarikul Islam, Professor of Medicine, Popular Medical College, Dhanmondi, Dhaka b. Abdul Basit Ibne Momen, Assistant Registrar of Medicine, Popular Medical College, Dhanmondi, Dhaka c. Abul Kashem Khondokar, Professor and head of Medicine, Popular Medical College, Dhanmondi, Dhaka d. HAM Nazmul Ahasan, Professor of Medicine, Popular Medical College, Dhanmondi, Dhaka e. Homayra Tahseen, Associate Professor of Medicine, Popular Medical College, Dhanmondi, Dhaka Address of Correspondence: Quazi Tarikul Islam, Professor of Medicine, Popular Medical College, Dhanmondi, Dhaka, E-mail: prof.tarik@gmail.com Fig .-1: His thyroid profile revealed TSH 0.00 mIU/L, F-T4 30.27 pmol/L, F-T3 16.51pmol/L, Anti-Thyroglobulin Ab 1.66 IU/ml

A Patient with Recurrent Hypokalaemia

Address of Correspondence: Dr. Chandra Shekhar Bala, Junior Consultant (Medicine), NINS and Hospital. pain, dryness of mouth or grittiness of eye. She was not on any medication. Her urine analysis revealed plenty of pus cell with few RBC but Urine Culture and sensitivity could not reveal growth of any organism. Neutrophilic leukocytosis was noted in full blood count. Renal function test within normal limit. Her Potassium was 1.9mmol/Liter with raised Chloride (124 mmol/L) level and decreased bicarbonate level(21 mmol/L. Her Venous blood PH was within 7.3. Her Urinary Potassium excretion was high (74.78 mmol/24 hours). Her serum calcium, Phosphate and serum PTH were normal within limit.

Care for the Senior Citizens in Bangladesh: Present and Future

Population demography is on transition in Bangladesh as well. Life expectancy has risenfrom 49 years to 70 yearsalong with the declining fertility and mortality rates. Approximately 8.4 % of the population is aged over 60 years at present.By 2050 median age may rise to 34.8 yearswith 16% of its population over the age of 60 years. Regarding national support & social security for the elderly: In the past health care system of our country engaged much of its resource, time and energy to combat the communicable diseases and to provide nutrition and improve sanitation. But things have been changed. A recent national level survey revealed that 29% of the population has two or more risk factors of Non Communicable Diseases. 3 Medicine wards of medical colleges and other hospitals are dealing with non communicable disease and their complications more than ever. Median age of admission in medicine wards of Dhaka Medical college Hospital was 44.5 years. Based on the facts and figure the Government has taken several measures to ensure health and wellbeing of elderly population. a) Pension is a monthly retirement incentives to government employees.

From the desk of Editor-in-Chief Vol.30(3)

Not available DOI: http://dx.doi.org/10.3329/jbcps.v30i3.12474 J Bangladesh Coll Phys Surg 2012; 30: 185

From the Desk of the Editor in Chief

Not available DOI: http://dx.doi.org/10.3329/jbcps.v29i4.11351 J Bangladesh Coll Phys Surg 2011; 29: 254

From the Desk of Editor in Chief Vol.29(2) 2011

DOI: http://dx.doi.org/10.3329/jbcps.v29i2.7961 (J Bangladesh Coll Phys Surg 2011; 29: 118)