Khwaja Nazim Uddin

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.

Chikungunya: an emerging viral infection with varied clinical presentations in Bangladesh: Reports of seven cases

BackgroundChikungunya is an emerging and rapidly spreading viral infection in many parts of the world including Bangladesh. It shares many epidemiological and clinical characteristics with dengue. So, a sound knowledge is required for its detection and differentiation from dengue, specially in endemic regions.Case presentationWe present seven confirmed cases of chikungunya having different clinical presentations occurring among middle aged males and females from different socio-economic background in Dhaka city, the capital of Bangladesh. All patients had fever and aches and pains. Less common features were rash, diarrhea, vomiting and altered liver biochemistry. Dengue was excluded in six patients. Paracetamol remained the mainstay of treatment during febrile periods, but over 50% of the patients had prolonged joint symptoms requiring non-steroidal anti-inflammatory drugs.ConclusionsIn spite of being a self-limiting disease, chikungunya may have different presentations and a protracted clinical course. During the febrile episode, exclusion of dengue is equally important. Physicians should be aware of the condition and public health initiatives are necessary to break the disease transmission.

Chikungunya–dengue co-infection during pregnancy requiring preterm Caesarean section: first case report from Bangladesh

We report the first case of chikungunya-dengue co-infection during pregnancy requiring emergency Caesarean section (CS) because of fetal distress in a Bangladeshi primigravida. Though previously unreported, this situation may become increasingly common.

Chikungunya virus and dengue virus coinfection: a case report from Bangladesh

A case of concurrent chikungunya virus and dengue virus infection is reported here. The patient presented with fever and generalized body ache. Diagnostic work-up revealed chikungunya-dengue co-infection. Dengue is endemic in Bangladesh while chikungunya is a recently emerging infection. As both the viruses are transmitted by a common vector, Aedes spp., such co-infections are likely to increase in coming years.IMC J Med Sci 2018; 12(1): 42-43

Successful medical management of a case of Austrian syndrome—an uncommon entity in the modern antibiotic era: a case report

BackgroundAustrian syndrome—the combination of meningitis, pneumonia and infective endocarditis due to Streptococcus pneumoniae infection, is a rare entity. In literature only a few hundreds of cases are reported but surprisingly we did not find any report on Austrian syndrome in or from Bangladesh.Case presentationWe report the case history of a middle aged Bangladeshi diabetic man, who had fever, cough, shortness of breath and altered mentation. He had tachycardia, bi-basal lung crepitations, new cardiac murmurs and meningism. Diagnostic work-up revealed Austrian syndrome. Because of the rarity of the condition, this case is reported.ConclusionA case of pneumococcal pneumonia or meningitis should raise suspicion of concomitant endocarditis and Austrian syndrome, specially if there is heart failure, as early recognition and treatment may appear life-saving.

Letter to the Editor Vol.7(3)

We are happy to see that like many other, you are following BIEDEM Medical Journal keenly. Yes you are correct, last issue was an excellent compilation of research works of doctors of BIRDEM. Because of enthusiastic responses, we have increased the number of issues of BIRDEM Medical Journal from twice yearly to thrice yearly. This issue was specially dedicated for authors of BIRDEM and specially those papers which were presented in different national and international conferences. You could find it declaration section at the end of each article. BIRDEM Medical Journal welcomes all sorts of articles in every discipline. So, depending on the availability of suitable articles, it will be able to meet your aspirations!

Primary Disseminated Intra-abdominal Hydatid Disease: A Case Report

Hydatid disease in human is common and liver is the most common site of involvement followed by lungs. Within the abdomen, hydatid disease can disseminate to involve spleen, pancreas, mesentery, kidney, ovary, gut, supra-renal glands etc. Such disseminations are usually secondary to rupture of a cyst: spontaneous, iatrogenic or traumatic. Without such a history, primary disseminated intra-abdominal hydatidosis is rare. Here we present such a case.Birdem Med J 2018; 8(1): 75-76

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

Glycemic Status of Type 2 Diabetic Subjects On Different Anti-Diabetic Management

Background: Diabetes mellitus (DM) is a complex multi-system disorder that may lead to diabetes specific complications and target organ damage which can be prevented or delayed by good or strict glycemic control. Our aims were to evaluate the glycemic status of adult type 2 DM (T2DM) patients on different anti-diabetic management, to evaluate role of education and economic status on glycemic control and to correlate glycemic status with complications. Methods: This cross-sectional study was conducted in BIRDEM General Hospital from November 2013 to April 2015. Data were collected in a pre-formed data collection form, purposively and consecutively from 300 T2DM patients who were diagnosed as diabetic for 3 months or more and were compliant, after face to face interview and undergoing the required physical examinations. Then data were compiled and analyzed accordingly. Result: Neither the educational level nor the monthly income had any influence on glycemic control. Only 17% of the patients had good glycemic control (HbA1c <7) in spite of different anti-DM managements. The overall mean HbA1C was 8.9±1.9%, among which the group of patients with medical nutrition therapy had the lowest mean HbA1c level (8.5±1.3%). Chronic kidney disease and polyneuropathy are the two commonest (45% and 40% respectively) complications with a significant (r=1, p=0.000) positive correlation between both macro and microvascular complications of DM with uncontrolled glycemic status. Conclusion: From the current study it can be concluded that glycemic control is rarely achieved and no treatment regimen is superior to other in achieving glycemic control. Patients educational or income level did not have any influence in glycemic control and there is a strong positive correlation between uncontrolled T2DM and it’s complications. Birdem Med J 2017; 7(2): 121-126

Treating Malignancy: Four-Year Experience in Internal Medicine Department, BIRDEM General Hospital

Background: Cancer prevalence in diabetic patients in Bangladesh seems to be increasing as case detection of both diseases are far more than before. Till date no statistical data of diabetic patients with malignancy is available in Bangladesh. Treating both diabetes and malignancy in the same patient is challenging and sometimes requires multidisciplinary support. For such cases BIRDEM General Hospital offers supportive facilities including intensive care, chemotherapy, surgical intervention and oncology day care. Methods: This cross-sectional, observational study was carried out from January 2012 to June 2016 which included cancer patients irrespective of their diabetic status admitted in Internal Medicine Department of BIRDEM General Hospital. With prior informed consent of the patients, data were collected and statistical analysis was done using professional SPSS version 17.0 windows based program. Results: Total number of cancer patients was 114, whose diagnoses were confirmed by histopathological evidence (biopsy/FNAC), radiology reports and cancer markers, as appropriate. Among them 64 (56.1%) were male and 50 (43.9%) were female patients. Age of most of the patients was between 41-60 years (65, 57%). Mean age was 55.16 years in diabetic group and 44.47 years in non-diabetic group. Glycemic status revealed that most of the patients were diabetic (80, 70.2%). Among other co-morbid conditions, hypertension and ischemic heart disease were predominant (17 and 9 cases respectively). Prevalence of more than one comorbidites were marked in the diabetic group (33 cases, p value >0.001). Twenty one categories of malignancies were diagnosed during this study period. Majority of cases were lymphoma (21,18.4%), carcinoma breast (17,14.9%), carcinoma uterus and/or cervix (13,11.4%) and leukaemia (10,8.8%). Common clinical features included palpable lump (21,18.4%), lymphadenopathy (16,14%), anaemia (9,7.9%) and pain (8,7%). The number of patients presenting with multiple signs/symptoms were also significant (32,28.1%). Most patients were treated with chemotherapy (54,47.4%). Many cases warranted a combined approach (46,40.4%). Treatment response showed good response in 57(50%) cases. In 16 patients (14%) condition deteriorated and death occurred in 8 cases (7%). Even after repeated and empathic counseling we lost follow up of 15 cases (13.2%). Conclusion: The scenario becomes complicated when a diabetic patient develops malignancy and vice versa. Complications can arise from either spectrum of the diseases. Managing such cases are often challenging and require multi-disciplinary support. Management outcome of these cases so far in Internal Medicine Department, BIRDEM General Hospital shows a promising future. Birdem Med J 2016; 6(2): 107-111