Muhammad Abdur Rahim

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.

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.

Prevalence and determinants of metabolic syndrome among newly diagnosed type 2 diabetic subjects according to different criteria.

BACKGROUND AND AIM Metabolic syndrome (MS) is becoming a serious global public health problem. The prevalence of MS differs in different population by using different definitions. Present study aimed to find out the prevalence and determinants of MS among newly diagnosed type 2 diabetes (NDT2D) according to different criteria. SUBJECTS AND METHODS This cross-sectional analytic study was conducted among 281 subjects selected purposively from the OPD of BIRDEM. Information on lifestyle factors and disease history were collected using a semi-structured questionnaire by face to face interview. The three definitions of MS used in this study are from the International Diabetes Federation (IDF), a modified version of the ATP III criteria for Asian populations (modified ATP III) and World Health Organization (WHO) criteria. Adjusted odds ratio and confidence limit were generated through logistic regression. RESULTS The overall prevalence of metabolic syndrome among the study subjects according to modified ATPIII, WHO and IDF criteria were 79% (95% CI: 74.2-83.8), 81% (95% CI: 76.4-85.6) and 68% (95% CI: 62.6-73.5) respectively. The prevalence of metabolic syndrome among female were higher compared to males in all the criterias. Female gender (OR=5.93), family history of diabetes (OR=1.92), overweight (OR=6.2), and obesity (OR=5.13) were found as important confounders associated with metabolic syndrome. CONCLUSION The prevalence of the metabolic syndrome among NDT2D is considerably higher in our population which may indicate considerable risk of cardiovascular diseases in future. Female gender, family history of diabetes, overweight and obesity are important confounders of MS in this population.

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

Rifampicin Induced Acute Interstitial Nephritis in a Patient with Tubercular Lymphadenitis: A Case Report

Rifampicin is one of the most effective anti-tubercular agents. Among its rare adverse effects, acute interstitial nephritis (AIN) is noteworthy. Here, we describe the case history of a 55-year-old female with tubercular lymphadenitis who developed rifampicin induced AIN upon re-exposure and recovered satisfactorily without requiring steroids. Rifampicin induced AIN should be kept in mind when patients present with acute kidney injury as prompt diagnosis and discontinuation of the drug has excellent prognosis.

Bardet-Biedl Syndrome: A Case Report

Bardet-Beidl syndrome is a rare autosomal recessive disorder having heterogeneous clinical manifestations including rod-cone dystrophy, polydactyly, obesity, learning difficulties, development delay, speech deficit, diabetes mellitus, congenital heart disease etc. Most of these symptoms are not present at birth but appear and progressively worsen during the first and second decades of life. The combined occurrence of diabetes mellitus and retinitis pigmentosa is rare. Here, we present such a case. Birdem Med J 2018; 8(2): 184-186

Body Mass Index: Where We Will Go by The Year 2030!

Background : The prevalence of diabetes mellitus is increasing throughout the world, mostly type 2 diabetes mellitus and largely contributed by increasing body mass index (BMI). This study was designed to compare BMI of newly detected diabetic patients in two different Bangladeshi cohorts spaced over 25 years. Methods : This was a retrospective study from hospital records from two cohorts: 1981 to 1985 and 2006 to 2010. Patients were divided in 4 groups according to BMI and comparison was made. BMI of newly detected diabetic patients from 2011 and 2012 were also compared. Results : Age at diagnosis of diabetes was lower in 2006-2010 group than 1981-1985 group. Frequency of diabetes at lower BMI has fallen by half in 2006-2010 group when compared with those of 1981-1985 group. Frequency of diabetes at higher BMI groups has an increasing trend in 2006-2010 group than in 1981-1985 group. Conclusion : Results from this study concludes that there is an increasing trend of diabetes detection at lower age group and with higher BMI among Bangladeshi population. Birdem Med J 2018; 8(2): 99-102

Community Acquired Acute Kidney Injury from Edible Agents: Report from a Developing Country, Bangladesh

Toxin is a common cause of community acquired acute kidney injury (AKI) which includes environmental toxins like plant toxins as well as various drugs and chemicals which are usually ingested for medicinal as well as recreational purposes. Averrhoa carambola (Star fruit/ Kamranga) and Avorrhoa bilimbi are two such commonly used traditional remedies. They belong to family Oxalidaecae and contain high-levels of oxalic acid. AKI may occur after consuming concentrated juice due to deposition of oxalate crystals in the renal tubules. Here we present two patients who developed AKI after ingestion of freshly made juice from A. bilimbi and star fruit. Both patients were diabetic and the juice was ingested on empty stomach with the belief of improving glycemic status. Initial presentation was GI upset in both scenarios. Patient with A. bilimbi toxicity had diabetic nephropathy and required hemodialysis. Renal biopsy revealed deposition of polarizable oxalate crystals in the patient who consumed A. bilimbi and acute tubular necrosis in the patient with star fruit toxicity. All cases regained normal renal function within three months. We also present a patient who ingested raw fish gallbladder as a remedy for asthma. The patient presented with AKI within five days of ingestion and required hemodialysis. His highest serum creatinine was 10.4mg/dl and fell to 1.7 mg/dl after four weeks. Cyprinol and related compounds in fish gallbladder are thought to be the cause of acute tubular necrosis in such cases. The fourth patient developed AKI with rhabdomyolysis after consuming a locally made energy drink. He also required dialysis and serum creatinine gradually improved from 7.2mg/dl to 1.4mg/dl at discharge. The possibility of toxicity of caffeine, adulteration with other chemicals or ascorbic acid toxicity causing oxalate nephropathy could not be excluded. All four patients developed AKI caused after ingesting easily available products and are presented here for public awareness. We believe proper knowledge and education can reduce toxin induced AKI in our society.