Samira Rahat Afroze

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 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.

Randomized Controlled Clinical Trial Comparing Transurethral Eneucleation and Resection of Prostate and Trans-urethral Resection of Prostate in the Management of Benign Prostatic Hyperplasia

Background: Transurethral resection of prostate (TURP) is the predominant surgical procedure for benign prostatic hypertension (BPH) but is not devoid of complications like capsular perforation, drop in Hb%, drop in Na+, residual adenoma; hence endeavors are evolving to combat such complications. A newer technique transurethral enucleation and resection of prostate (TUERP) has been devised to solve these problems. This study was designed to compare the safety and the efficacy of newer technique, TUERP with widely practiced TURP Methods : This randomized controlled trial was done at BSMMU, after getting ethical approval from the ethical review committee of the institute, from January to October, 2009. A total of 60 BPH patients were purposively enrolled in this study, after obtaining informed written consent and they were randomized as control, Group A (30 patients, underwent TURP) and experimental group, Group B (30 patients, underwent TEURP). Results: The mean preoperative Hb% level of Group A was 15.1 gm% (SD ± 0.5) and perioperative Hb% level was 13.04 gm% (SD ± 6.06). There was significant difference (P 0.05). The mean preoperative Na + of Group A was 140 mmol/l (SD ± 4.1) and perioperative Na+ was 126 mmol/l (SD ± 6.8). There was significant difference (P 0.05). Conclusion: TUERP eliminates drop in Hb% and Na+which are usual consequences following TURP. Thus TUERP can be advocated in the treatment of BPH as it also allows completeresection down to surgical capsule. Birdem Med J 2017; 7(3): 216-220

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