BackgroundBangladesh saw its most severe dengue outbreak in 2019, with the highest number of deaths reported. This study investigated the clinical characteristics, severity spectrum, and potential outcomes of dengue in patients admitted to a tertiary care institution in Dhaka. MethodsThis prospective observational study was done between May 2019 to April 2020. A total of 478 nonstructural protein 1 (NS1) antigen positive confirmed dengue cases were finally enrolled. The dengue patient's stratification and severity grading were performed according to the World Health Organization (WHO) dengue guidelines, for diagnosis, treatment, prevention, and control (2009). In addition, in-hospital outcomes were assessed in terms of mortality. ResultsThe patient's mean age was 33.90±15.82 (SD) years. The male-to-female ratio was 1.23:1. In addition to fever, the most common symptoms were myalgia (67.78%) and rashes (58.58%). According to WHO classification 33.90% of patients (n=162) were in group A, 49.40% (n=236) were in group B, and 16.70% (n=80) were in group C. The overall mortality was 1.23% in groups A, 2.97% in group B, and 11.25% in group C. The mortality was higher in the more severe group with statistical significance (p<0.001). The mean hospital stay time was significantly less in the surviving group (survival vs. death: 3.07±1.78 vs. 5.61±3.13 SD {days}, p<0.001). Leukopenia and thrombocytopenia were commonly seen in all of the severity groups. ConclusionDengue epidemics are increasing in Bangladesh. Many group B and C cases are fatal. To reduce mortality and morbidity, health care providers must remain alert. This challenge requires public health interventions and hospital readiness.

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The Suppression of gastric acid by long term use of PPI may decrease iron and vitamin B12 absorption and might be causing iron and vitamin B12 deficiency anaemia.  This comparative cross-sectional study was conducted among patients with peptic ulcer disease from November 2017 to March 2020; attending in the Internal Medicine department of Bangabandhu Sheikh Mujib Medical University (BSMMU). A total of   80  patients were included and divided into group-A (PPIs user) and group-B (non-PPI user), each group containing 40 patients each. The group-A  included patients who were taking PPIs for more than one year and  aged from  18 to 70 years and group-B the control group who were not taking PPIs for atleast 1(one) year. The data were analysed by Statistical Package for the Social Sciences (SPSS) version 20.0 (SPSS Inc., Chicago, IL, USA).The study shown that male were  18(45%) and 19(47.5%) in group A and B respectively  and female were 22(55%) and 21(52.5%) in group A and B respectively. The mean age of male and female was (year) 45.35 ± 12.46, 44.85 ± 15.24, respectively. Most of the patient took omeprazole 62.5% follwed by, esomeprazole 20%, pantoprazole 12.5%, rabeprazole 5%. About 47.5% of the patient took PPI for more than 2 years, and 52.5% took between 1-2 years. The mean (±SD) haemoglobin (Hb) level was 10.93±2.00 g/dl amongst  group-A and  13.16±1.68g/dl in group-B, the difference is statistically significant (P<0.001). The mean serum iron of the PPI users (group-A) was 46.43±22.79, and of non-PPI users (group-B) was 84.95±33.18, the difference between iron level between two group was statistically significant (odds ratio -6.38  ; CI-2.28-17.84 and P-value <0.001). The PPI user group, mean vitamin B12 was 449±166.99 and in non-PPI group it was 432.85±175.93, which was statistically nonsignificant (P-value -1.00). Amongst all the participant low serum concentrations of iron, ferritin and transferrin were found 23(57.5%), 18(45%) and 27(67.5%), respectively  in Group-A (PPI user group) and 7(17.5%), 7(17.5%) and 8(20%) respectively in Group-B (PPI-non user).The difference was statistically significant (p<0.05) between the two groups. But the value of TIBC was found to be high in 36 (90.0%) participants in both groups, which was statistically non-significant(p=0.33). Hematocrit (HCT)  were low in 35 (87.5%) participants in Group-A and 25(62.5%) in Group-B. The difference was statistically significant (p<0.05). Low MCV was found in 10(25%) in the PPI user group and 4(10%) in the non-user group, whish was statistically non-significant. No significant differences in vitamin B12 concentrations (pg/ml) 449±166.99 vs 432.85±175.93 were found between groups A and group B, respectively. There was a weak negative Pearson’s correlation shown in ascatter diagram between duration of PPI use, and the iron level of group A (n=40) (r=-.311, p=.051). A negligible Pearson’s correlation was seen in the scatter diagram between the duration of PPI use, and vitamin B12 level of group A  (r=+.05 p=.977). This study showed a significant decrease in haemoglobin, haematocrit, iron, ferritin, transferrin saturation in participants taking PPIs for more than one year, compared with age and gender-matched controls. No significant change of MCV, TIBC (Total Iron Binding Capacity) and vitamin B12 were noticed between groups. In conclusion, the study found  a significant decrease in hematologic indices and iron profile among patients receiving PPIs for longer than one year. There was no  substantial change of Vitamin B12 levels was detected between long-term PPIs users and non PPIs user groups. So, from the study it is suggested that  judicial prescription of long-term PPIs must be practiced. However, the small sample size and short study duration were the limitation of the study. Bangladesh Med J. 2021 January; 50(1) : 27-32

Fever, sore throat, cough, and shortness of breath are the characteristic clinical manifestations of coronavirus disease 2019 . As the epidemic spreads, it is evident that the infection can affect not only the lungs but also other organs. By attaching to the angiotensin-converting enzyme-2 receptor (ACE-2), the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces lung injury. SARS-CoV-2 can also cause damage to the heart and blood vessels as these organs have abundant ACE-2 receptors. Here, we present a 28-year-old lady with shortness of breath, chest pain, low blood pressure, and a pulse rate that fluctuates widely. She had SARS-CoV-2-induced myopericarditis after further testing. Initially, we treated her with high-dose prednisolone and other supportive medications. Then, we also added colchicine and ibuprofen due to the initial poor response, and the result was satisfying after two weeks of treatment.

In Bangladesh, tuberculosis and leprosy are endemic mycobacterial diseases; however, co-infection is rarely seen. Our patient had a high-grade fever, symmetrical polyarthritis, polymorphous erythematous lesions, widespread lymphadenopathy, peripheral neuropathy, bilaterally thickened ulnar nerves, and claw hands. A lymph node biopsy revealed tuberculosis having acid-fast bacilli with caseating epithelioid histiocytic granuloma. Cutaneous lesions and sural nerve biopsies indicated borderline lepromatous leprosy. Fite-Faraco stain showed the presence of lepra bacilli in the biopsied sural nerve. Mantoux test showed 15 mm induration in 72 hours. Nerve conduction study (NCS) showed severe sensory-motor polyneuropathy (axonal) of all four limbs. Prednisolone and thalidomide for severe type-2 lepra response and category-01 antituberculosis medication and multidrug therapy for multibacillary leprosy improved the patient's condition. Bacille Calmette-Guérin (BCG) vaccination in the community might protect against tuberculosis and leprosy, thus reducing such coinfection. However, reduced cell-mediated immunity might promote latent tuberculosis reactivation or super-infection in individuals with multi-bacilli illnesses.

Castleman disease (CD), a heterogenous lymphoproliferative disorder resulting from immune dysregulation, is a very rare disease in clinical practice. The clinical spectrum of Castleman disease is wide and its treatment options are mostly based on case reports and case series. To date, two clinical and four histological types have been described. It has recently been successfully demonstrated that the pathogenesis of multicentric Castleman disease (MCD) has a direct association with human immunodeficiency virus (HIV) and human herpes virus 8 (HHV-8) infection which is why further studies are necessary. Here, we report an unusual case of MCD not associated with HIV and having a histological diagnosis of the hyaline vascular type that presented with acute renal impairment and subcutaneous abnormal lymphatic proliferation.

Melioidosis has lately expanded its endemic areas to encompass the Indian subcontinent, despite being well-known in Southeast Asia and Northern Australia.Though cases have been reported from Bangladesh, it might be a significantly underdiagnosed cause of infection & death in this agricultural country. We report a case of melioidosis with multiple abscesses & fulminant sepsis in a 55-year-old farmer diagnosed based on pus samples, which revealed gram-negative bacillus Burkholderiapseudomallei. Bangladesh J Medicine 2022; 33: 308-311

Autoimmune hemolytic anaemia (AIHA) can be caused by many diseases like connective tissue disease, lymphoproliferative disorder, certain infections and various medications. The coronavirus disease 19(COVID-19) can cause an increased risk of thrombosis. But, the association of AIHA with COVID-19 is not well understood. Here, in this case report a 45-year-old man who presented with fever, cough, anaemia and splenomegaly. On further investigation, he was confirmed as severe COVID-19 case with AIHA. Subsequently he was managed with prednisolone with good results. BSMMU J 2021; 14 (COVID -19 Supplement): 57-59