Quazi Tarikul Islam

Toxicology in Medical Practice- Time for revolutionary change

The toxicology has long been the neglected topic and dealt with less importance. But the burdon of the disease and the morbidity and mortality is biggest in this respect. According to Directorate General of Health service of Bangladesh health bulletin 2017 report the number of poisoning is 1.6%, 6.9% and 5.9% among all causes of morbidity in primary,secondary and tertiary health care centers. In tertiary care centre the poisoning related mortality is 1.97%, in district hospital it is 3.28% while in primary health care centre it is 4.9% among ages more than 5 yrs with national trends of mortality of 2.83%1.

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

Chikungunya - An Emerging threat for Bangladesh

Bangladesh J Medicine 2017; 28: 54-55 Chikungunya fever is an emerging viral disease transmitted to humans by mosquitoes. Chikungunya Virus (CHIKV) is an arbovirus of the alphavirus genus (Togaviridae family). The Aedes aegypti and Aedes albopictus mosquitoes are the main vectors responsible for transmission of Chikungunya. In 1952, a young man in Tanzania admitted to hospital with fever, rash and arthralgia. Eventually he was diagnosed as the first case of Chikungunya.1 In 2005– 2006, a severe outbreak occurred on Reunion Island in the southwestern part of the Indian Ocean. Other islands in this area were affected during the same period. Estimated 300,000 people was infected and 237 patients died. The factors favoring this epidemic included viremic travelers from Africa, to an immunologically naive population. Mutation of the Chikungunya virus that expanded the mosquito vector from the Aedes aegypti to the Aedes albopictus which was common on the island.2-4 Mutation (E1A226V) improves replication and transmission efficiency in Ades. albopictus as well as the original Ades. aegypti, outbreaks spread to the Indian subcontinent.3 India has been suffering from outbreaks of Chikungunya since 2005 with variable severity. India and Bangladesh are two neighboring countries which share some similar epidemiological pattern.

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

Velvety, hyper pigmented and fissured skin: Multiple myeloma-associated skin light chain amyloidosis

A 60-year old man presented on 24/12/2016 with tingling, burning sensation and numbness in the hands and feet, progressive muscle weakness and wasting for 1 year; dryness, thickening, darkening and fissuring of skin over all body for 6 months. Patient also had complained generalized aches and pains and occasional low grade fever. He did not have Diabetes or Hypertension. In spite of receiving calcium and vitamin supplements, there was no improvement. Examination revealed an ill looking but cooperative elderly man with mild anaemia, tenderness over sternum and other bony areas, hyper pigmented, thick velvety, fissured skin all over body ,there was no peri orbital purpura. Muscles of hand, forearm, feet, and leg were wasted with reduced muscle power and tone. Ankle jerks were absent bilaterally and all sensory modalities were impaired in the distal part of limbs. Investigations showed a persistently elevated ESR over 100 mm of Hg , normocytic anaemia VELVETY, HYPER PIGMENTED AND FISSURED SKIN: MULTIPLE MYELOMA-ASSOCIATED SKIN LIGHT CHAIN AMYLOIDOSIS