Background: Bangladesh is an endemic zone for re-emerging dengue viral infection since 2000. For the last few years, dengue viral outbreak occurs in the rainy season mostly in Dhaka city and seldom sporadic case finds beyond the Dhaka city of Bangladesh. But this outbreak expands also outside the Dhaka city of Bangladesh in 2019. Therefore, with scarcity of data regarding this field in the peripheral part of Bangladesh, we have designed this study among dengue infected patients in Jashore, Bangladesh. Objectives: This observational study aims to assess the clinical presentations, laboratory findings especially hematological changes and outcomes of patients with dengue viral infection at Jashore district in dengue outbreak-2019 in Bangladesh. Methodology: This was an observational study, carried out from 25thApril 2019 to 5thSeptember 2019 during dengue outbreak season in Jashore, Bangladesh. Patients were selected from outpatient department and indoor of a local private hospital in Jashore, Bangladesh who had given informed written consent to participate in our study. Result: Total eligible 77 patients were included in this study. Out of which 70 patients (90.9%) were dengue NS1 antigen Positive on Immunochromatography (ICT) and the rest were anti-dengue IgM antibody positive on ICT method. Around 74 (96.1%) patients had fever as the most common feature in dengue infection. Eighty-seven percentages (87%) of patients had history of headache. Other striking complaints were body ache (66.2%), back pain (51.9%), nausea (55.8%), vomiting (31.2%), anorexia (27.3%), arthralgia (29.9%) and retro-orbital pain (26.0%). Sore throat being a common feature in flu-like illness also found in 18.2% cases. Mean total count of whole blood count (WBC) falls on day 5 (5.76 X 109/L) and then gradually increased. Mean platelet count of study patient was normal throughout the course of the disease process. But, in some cases minimum platelets was found 21 X 109/L at the time of presentation and on day 5 and day 6 which was dropped down to 17 X 109/L. Mean Haematocrit (%) was more or less in a steady state throughout the acute phage of the disease. But, in some cases throughout the hospital stay minimum haematocrit was less than 30% and initially in some cases maximum haematocrit was more than 50% among some dengue infected patients. Total 67 (87%) subjects with dengue viral infection required hospital admission and mean hospital stay was 4 days with a standard deviation (SD) was ±2 days. Blood transfusion was required in only one patient. Around 95% patient was recovered and only 4 cases were referred to the higher centre further better management. Regarding complications, we had found diarrhoea in 9(11.7%) and bleeding disorder in 14.3% patients. Conclusion: In our study, the most common clinical presentations were fever, headache, body-ache, back pain, and gastrointestinal upset. The mean hematological started dropping down from 4th day and gradually improved after 7th day. Some patients developed diarrhea, bleeding disorders and hepatitis as complications during their disease process. We observed a good clinical outcome evident by without having severity and death toll among our study participants. There was very seldom requirement of blood and blood product transfusion in our study. J MEDICINE JAN 2021; 22 (1) : 33-40

BackgroundThe resistance of antimicrobial agents in pathogenic bacteria has become a significant public health problem. According to Magiorakos et al,(1) this pattern occasionally extends to multidrug-resistant (MDR) or extensively drug-resistant (XDR) or even pandrug drug-resistant (PDR). Urinary tract infection (UTI) is considered as a different type of infection which is caused by the abovementioned resistant bacteria. It is known that UTI is the most common infection in the world, especially Bangladesh. This infection is due to the main colonization of normal and opportunistic microflora (2). In the third world country like Bangladesh, the rate of UTI patients is high due to poor hygiene, long time catheterization, uncontrolled sexual intercourse, pregnancy, spermicidal contraception, and the like (3-6).Many of antibiotics and their super generations are used to prevent the UTIs. Unfortunately, several studies indicate that many uropathogens have become resistant to a wide range of antibiotics due to abuse, overuse,

Background: Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL) in the world, and accounts for 30%–40% of all adult NHLs. It is clinically, morphologically and genetically a heterogeneous group of tumors composed of large B cells. This study aimed to determine the clinical features, treatment options, the response rate in a specialized cancer care centre. Methods: This retrospective study included all DLBCL patients registered in the department of Haematology of National Institute of Cancer Research and Hospital (NICR&H), Bangladesh between July 2016 to June 2019. Results: A total of 151cases were included in this study. The mean age was 47 years with a standard deviation (SD) of 15 years. Males (66.2%) were more in the occurrence of DLBCL. We divided the cases into three different entities of DLBCL and non-germinal centre B (non-GCB) variety was the prevalent (46.4%) one. Several types of first-line chemotherapy were used in management and the overall response rate (ORR) was 76.6% and 9.2% of death. The response was found to be significant with B symptoms, stage, and international prognostic index (IPI) score. But no significant difference was observed in outcome among different types of DLBCL after treatment. Conclusion: This retrospective study will help to ascertain the co relation of DLBCL outcome with clinicopathological profile. (edited) J MEDICINE JAN 2021; 22 (1) : 3-6

Background: In lymphoma, bone marrow infiltration of lymphocytes is a vital information of staging can be done primarily by observer dependent bone marrow study or trephine biopsy. Objective: Aim of this study is to observe the frequency of bone marrow involvement in Non-Hodgkin lymphoma at the time of diagnosis by trephine biopsy and to determine importance of bone marrow trephine biopsy over bone marrow aspiration for staging of Non-Hodgkin lymphoma. Methodology: This was a prospective observational study conducted between January 2014 to July 2014 in department of Haematology, Bangabandhu Shaikh Mujib Medical University (BSMMU) including 30 newly diagnosed patients of Non-Hodgkin’s Lymphoma (NHL) between 15 to 75 years of both sex in non-probability purposive sampling manner confirmed by histopathology of biopsy of lymph node or extra nodal mass. Any secondary disease associated NHL and if there were history of prior chemotherapy was excluded from this study. Detailed clinical history, physical examinations & relevant investigations were recorded in data sheet. After taking written informed consent, these patient’s bone marrow by aspiration and trephine biopsy and peripheral blood sample were sent for study. Results: Comparing bone marrow aspirates (BMA) with bone marrow biopsy (BMB) report revealed that 17 cases were BMB positive among them 12 (70.5%) cases were BMA positive and 5 (29.5%) cases were BMA negative. 13 cases were BMB negative among them 1 (7.7%) case was BMA positive and 12 (92.3%) cases were BMA negative. Statistical analysis revealed significant value (<0.001) that is, there is significant difference observed between two methods to see bone marrow lymphoid infiltration. But in agreement between these two methods we found Kappa (k) value 0.61 indicates a Good agreement between these two tests; that is, we can perform any of these tests to see bone marrow lymphocytes infiltration. Conclusion: Bone marrow study and trephine biopsy can be employed to see lymphoid infiltration in lymphomas with a good agreement; though trephine biopsy has its superiority.

Background: Therapeutic platelet transfusion is necessary to prevent bleeding due to thrombocytopenia in childhood acute lymphoblastic leukaemia (ALL). Platelet concentrates may be transfused as fresh platelet concentrate immediately or with five days of storage after collection Objectives: To compare the platelet count increment between fresh and stored platelet concentrate transfusion in children with acute lymphoblastic leukaemia.  Methodology: This observational study was carried out in the Department of Clinical Pathology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, in collaboration with the Department of Transfusion Medicine and Paediatric Haemato-Oncology, BSMMU, Dhaka. Seventy-two children diagnosed as acute lymphoblastic leukaemia were included in this study. ABO identical whole-blood derived platelet-rich-plasma platelet concentrates (PRP-PCs) were transfused within 24 hours of preparation or 1-5 days of storage. Effectiveness of platelet transfusion was carried out by measuring platelet count prior to transfusion, subsequently 1 hour and 24 hours of transfusion. Result: Post transfusion platelet count at 1 hour and 24 hours with fresh platelet concentrates (FPC) and stored platelet concentrates (SPC) were not statistically significant. Post transfusion platelet increment at 1 hour and 24 hours were also similar in both FPC and SPC. Corrected count increment (CCI) at 1 hour in FPC and SPC were 20.5±10.1 and 18.6 ±6.5 respectively and was statistically not significant (P: 0.168). CCI at 24 hours were 15.5±9.1 and 13±5.8 which were also statistically not significant. Percentage platelet recovery at 1 hour and 24 hours in both FPC and SPC were statistically not significant. But these values in SPC were consistently lower than that of FPC. All the values of FPC and SPC were well apart from the lower limit of CCI and percentage platelet recovery (PPR). It was also observed that 85.1% satisfactory platelet transfusion was achieved with FPC and rest of 14.9% was platelet refractory cases. In 79.5% cases satisfactory platelet transfusion were achieved with SPC and refractory cases were 20.5 %.  Conclusion: One to five day’s stored PRP-PCs are as effective as fresh PRP-PCs to achieve satisfactory platelet increment.

Background: Arsenic Trioxide (ATO) as a single agent, has proven efficacy in inducing molecular remission in patients with Acute Promyelocytic Leukemia (APL). It is commonly used to treat relapsed APL. But there is Limited study on ATO in the management of newly diagnosed cases of APL. The concerned study was done to evaluate the effectiveness and outcome of ATO in remission induction of new cases of APL in the context of a limited resource hospital in Bangladesh. Methods: From March 2008 to March 2010, 20 patients with Promyelocytic Leukemia (PML) / Retinoic Acid Receptor α (RAR α) + newly diagnosed APL were enrolled. All patients were treated with a regimen of single-agent arsenic trioxide till remission at our center. After remission the regimen was administered on outpatient basis. Results: Overall 15 (75%) patients achieved complete hematological remission. 12 (80%) patients achieved molecular remission after induction phase and 3 (20%) after completion of consolidation phase. At a median follow up of 36 months (Range 25 -44 months), Disease Free Survival (DFS) and Overall Survival (OS) 86.6% and 85.3% respectively. Relatively young patients with long form of t (15;17) had shown good response with this response. However, the response is slower than All Trans Retinoic Acid (ATRA). Patients presenting with high White Blood Cell (WBC) count, low platelet count, variable form of t (15;17) are found to respond poorly. The toxicity profile, in the majority, was mild and reversible. Treatment cost was also reduced than that of conventional regimen. Conclusion: Single-agent arsenic trioxide as used in this study in the management of newly diagnosed cases of APL is safe, cost beneficent and is associated with durable responses. But additional interventions as combining ATRA with ATO would probably required in high risk cases.

Background: Haematological malignancy and its treatment produce multiple symptoms that significantly distress patients and impair function. Symptoms caused by treatment may delay treatment or lead to premature treatment termination and residual treatment-related symptoms often complicate post treatment rehabilitation. When treatment is no longer possible, symptom control becomes the focus of cancer care. Objectives: The study was aimed to determine the symptom burden of the haematological malignancy patients. Methods: A cross sectional study was conducted from July 2015 to June 2016 among the haematological malignancy patients. A total of 316 haematological malignancy adult (age ≥18 years) patients were purposively selected from haematology department of two tertiary level of hospitals in Dhaka city. Face to face interviews were taken from the diagnosed haematological malignancy patients admitted in the hospital and attending outdoor using questionnaire based on symptom distress scale (SDS). Results: Mean age was 39 years and most of the patients suffering from Acute Leukemia 162(51.3%). Mean monthly family income was around 22235 taka and 120(37.9%) patients were unemployed. Patients with haematological malignancy had a considerable physical and psychological symptom burden which ranged from 94.3% for fatigue to 8.5% for difficulty in concentration. Physical symptoms such as fatigue 127 (40.2%), change in appetite 86 (27.2%), pain1 81 (25.6%), insomnia44 (13.9%) caused severedistress and psychological symptoms include change in appearance 37 (11.7%) and outlook 33 (10.4%) were sever distressing. Significant association (p<0.001) was to be found between occupation and symptom distress where 82 (68.4%) unemployed and 51 (66.3%) housewife had moderate/sever symptom distress. Respondents who managed their treatment expenditure by loan and asset sell 11 (84.6%) had significant(p=0.004) moderate/sever distress. Patients having less than one month of diagnosis 47(72.3%) and admitted in inpatient 114 (66.6%) had significant higher moderate/sever symptom distress(p=0.03) and (p<0.001) respectively. Conclusion: Patients with haematological malignancy were likely to have multiple symptoms and comprehensive symptom assessment was suggested throughout. The introduction of supportiveor palliative care services during times of increased symptom burden may assist haematologists and other careers in the management of their patient’s distress and quality of life. Bangladesh Med Res Counc Bull 2020; 46(3): 196-203

Background: Multiple Myeloma (MM) represents approximately 15% of all hematological malignancies. Despite the use of high-dose chemotherapy followed by stem cell rescue MM remains incurable at present. The goal is to control the disease as much as possible, providing the best quality of life to patients for the longest duration. Currently, CTDa (attenuated Cyclophosphamide, Thalidomide, Dexamethasone) is the best option of treatment as it is cost-effective, with no need for hospitalization with a good response. Objective: To find out the symptomatic responses and toxicities of CTDa in Multiple Myeloma patients. Materials and Methods: 25 patients of newly diagnosed MM patients were treated in the Haematology Department, Bangabandhu Sheikh Mujib Medical University (BSMMU) from July 2016 to July 2017. The mean age of the patients was 54 years, Male female ratio was 1.5:1 and most of the patients were farmers. After induction of 4 to 6 cycles of CTDa all patients were followed up at 6th and 12th weeks. At follow up we evaluated improvement of weakness, bone pain, Hb%, ESR, monoclonal protein, ß2microglobulin, bone marrow plasma cells and serum calcium and albumin level. Adverse effects, such as peripheral neuropathy, thromboembolic events, hyperglycemia, constipation, rash, and somnolence were also assessed. Results: Among 25 patients, complete response achieved only 13 patients (52%), where 20% and 16% of patients belonged to partial or no response respectively. The death occurred in 2 cases (12%). Conclusion: CTDa is a gentle approach to treat an especially frail group of patients, since virtually all patients ultimately relapse. KYAMC Journal Vol. 11, No.-3, October 2020, Page 124-128