Jamal Uddin Ahmed

Platelet aggregation abnormalities in arterial occlusive diseases (AOD)

Objectives: To assess the prevalence and distribution of rheumatic diseases at rheumatology clinic in a tertiary level hospital. Methods: This retrospective study was done at rheumatology clinic of BIRDEM from July 2009 to December 2012. Diagnoses were reached by using clinical criteria supplemented by necessary investigations. Results: Total number of patients was 772 with female predominance (F:M ratio of 1.3:1). Mean age was 46.9 (range 1383) years. Majority (85.9%) were in 3 to 6 decades. Degenerative diseases (49.9%) were most common, followed by inflammatory conditions (33.5%), soft tissue rheumatism (7%), metabolic bone disease (4.8%) and connective tissue diseases (2.5%). Rheumatoid arthritis (27.7%) was the most prevalent disease, followed by osteoarthritis of knees (26.2%) and lumber spines (23.4). Tendinitis, osteoporosis, fibromyalgia and systemic lupus erythematosus prevailed in 5.6%, 4.8%, 1.4% and 1.3% cases respectively. Common comorbidities were diabetes mellitus (87.9%), hypertension (22.2%), ischaemic heart disease (12.4%), dyslipidaemia (10.1%), fatty liver (7.9%), chronic kidney disease (6.9%) and hypothyroidism (4.5%). Commonly prescribed medications were non-steroidal anti-inflammatory drugs (93%), disease modifying anti-rheumatic drugs (28.9%) and prednisolone (10.6%). Physiotherapy was required in 13.3% cases. In 56.6% cases various combination of treatment was required. In 12% patients receiving methotrexate, adverse effects occurred. Conclusion: Degenerative joint and spine diseases were more common but as an individual disease rheumatoid arthritis was the most prevalent condition.

Bangladesh national guidelines on the management of tuberculosis and diabetes mellitus co-morbidity (summary)

Tuberculosis (TB) and diabetes mellitus (DM) have synergetic relationship. People with diabetes are 2–3 times at higher risk of getting active TB disease. On the other hand, TB or anti-TB treatment may cause glucose intolerance. The dual disease of DM and TB is more likely to be associated with atypical disease presentation, higher probability of treatment failure and complications. In most of the health-care delivery systems of the world, DM and TB are managed separately by two vertical health-care delivery programs in spite of clear interaction between the two diseases. Thus, there should be a uniform management service for TB-DM co-morbidity. Realizing this situation, Bangladesh Diabetic Samity (BADAS), a nonprofit, nongovernment organization for the management of diabetes in Bangladesh, with the patronization of TB CARE II Project funded by U.S. Agency for International Development (USAID), launched a project in 2013 titled BADAS-USAID TB Care II, Bangladesh with the goal of “Integrated approach to increase access to TB services for diabetic patients.” One of the project objective and activity was to develop a national guideline for the management of TB-DM comorbidity. Thus, under the guidance of National Tuberculosis Control Program, of the Directorate General of Health Services, Government of the Peoples Republic of Bangladesh and World Health Organization (WHO), this guideline was developed in 2014. It is based on the existing “National Guidelines and Operational Manual for TB Control” (5th edition) and guidelines for management of DM as per WHO and International Diabetes Federations. Along with that, expert opinions from public health experts and clinicians and “Medline”-searched literature were used to develop the guidelines. These guidelines illustrate the atypical presentation of the TB-DM co-morbidity, recommendations for screening, treatment, and follow-up of these patients and also recommendations in case of management of TB in patients with kidney and liver diseases. Thus, these guidelines will be a comprehensive tool for physicians to manage TB in diabetic patients.

Emerging Viral Diseases

Human life is intricately related to it’s surrounding environment which also harbors other animals and some deadly infectious pathogens. Any threat to the environment can thus increase the threat of new and so-called ‘emerging infectious diseases’ (EIDs) especially novel viral infections called ‘emerging viral diseases’. This occurs partly due to changing climate as well as human interference with nature and animal life. An important event in new disease emergence is genetic changes in the pathogen that make it possible to become established in a new host species, productively infect new individuals in the new hosts (typically humans) and create local, regional or worldwide health threats. The world has witnessed some emerging and deadly viral threats in recent past with huge mortality and morbidity. Among them were severe acute respiratory syndrome (SARS), bird flu, swine flu, Middle East respiratory syndrome (MERS), ebola virus disease. Moreover some disease has caused great concern in certain regions including Bangladesh in terms of morbidity, like Nipah virus, Zika virus, Dengue and Chikungunya fever. Here in this article an attempt was made to briefly describe some of these emerging viral infections. Birdem Med J 2017; 7(3): 224-232

Answer to medical quiz: Images

Review Multiple myeloma is the malignant proliferation of plasma cells producing abnormal monoclonal immunoglobulin or its fragment (M protein). Although a small number of malignant plasma cells are present in the circulation, the majority are present in the bonemarrow. The malignant plasma cells produce cytokines, which stimulate osteoclast causing bone resorption. Diagnostic criteria1 includes any 2 of the following: 1. Increased malignant plasma cells in bone marrow 2. Serum and/or urinary M protein 3. Skeletal lytic lesions Causes of renal damage in multiple myeloma: Renal involvement occurs in 20-40% of newly diagnosed multiple myeloma patients. Causes are: 1. Cast nephropathy most common (60 70%) 2. Light chain deposition disease (20 40%) 3. Amyloidosis 4. Others: urate nephropathy, hypercalcaemia, drugs etc.