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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

Urinary Tract Infection (UTI) is very common in our day-today clinical practice. Among all the organisms Escherichia coli (E coli) is the most common but antimicrobial resistance becomes an alarming issue for UTI management now a days. Aim of this study is to assess the pattern of antimicrobial resistance to E coli among the UTI patients in Jashore, Bangladesh. This observational study was conducted from February, 2017 to January, 2018 in the district of Jashore, Bangladesh. We recruited 696 patients of both sex with UTI only infected by E coli. We had excluded the patients with UTI caused by other than E coli, female during menstruation, pregnancy, history of taking antibiotics within last 21 days, catheterization within 1 month and pelvic organ & genito urinary tract surgery within 6 months. Evaluation of antimicrobial resistance was done according to the standard bacteriological methods. Mean age of our study cases was 41.46±17.21 years with the range from 15 to 91 years. More than 85% participants were female with a sex ratio was 8:1.5. Reproductive age group ranged from 21 to 50 years was affected most commonly which constituted approximately two-third of our study. Our study revealed that the maximum antimicrobial resistance to E coli was Cotrimoxazole (95.0%), followed by Ceftazidime (75.7%), Gentamicin (70.3%), Amikacin (69.0%), Imipenam (58.9 %,), Cefixime (58.0%), Ciprofloxacin (57.3%), Azithromycin (56.0%), Cefuroxime (46.6%), Cefotaxime (37.4%), Ceftriaxone (35.2%), Meropenem (32.2%), Nitrofurantion (4.7%). With the high magnitude of antimicrobial resistance to E coli among the UTI patients even with extended generation of Cephalosporins, Carbapenams, Ciprofloxacin, Cotrimoxazole, Azithromycin and Aminoglycosides, our recommendation as first line empirical treatment option in UTI should be Nitrofurantoin due to low resistance pattern.

Crying with bloody tear, called haemolacria is a very rare condition in medical practice. There are many conditions such as idiopathic thrombocytopenic purpura, trauma (accidental or induced), factors deficiencies, infections (Epstein Barr virus or bacterial), tumours (malignant melanoma or haemangioma), conjunctival telangiectasia, Rendu-Oslar-Weber disease related to haemolacria. But idiopathic haemolacria may occur in some cases. In our case report, a 17-year-old girl presented with idiopathic bilateral haemolacria and gum bleeding associated with pseudoseizure and psychogenic hyperventilation who was treated and well responded to adequate counselling and Amitriptyline. J MEDICINE JUL 2019; 20 (2) : 106-108

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Atypical presentations may be presented with the common symptoms in Dengue. We, hereby, present a case of Dengue who was admitted in our hospital with the complaints of fever, upper abdominal pain, and vomiting, literally diagnosed as a case of acute pancreatitis.

Abstract AbstractThe impact of diabetes mellitus on the CNS (Central Nervous System) has gained attention only recently. Peripheral neuropathy has been the primary neuroscience focus of diabetes research. Contrary to some early impressions, however, the CNS is not spared by diabetes. Chronically, diabetes mellitus affects the CNS in several ways. Diabetes increases stroke risk and damage, overtreatment with insulin or oral agents can permanently damage the brain, and diabetes may increase the prevalence of seizure disorders. Diabetes changes brain transport, blood flow and metabolism, and may produce a chronic encephalopathy. Acutely, glycemic extremes cause coma, seizures, focal neurolclgical deficits, and impaired consciousness. The pathophysiological basis for these marked CNS abnormalities seen in hypoglycemia, hyperosmolar coma, and ketoacidosis are largely unknown.

Background. Acute poisoning is a common scenario in the emergency department of any general hospital globally, but its pattern may vary in different parts of the world and even may be a different regional variation in the same country. Objective. Our recent study aims to assess the demographic characteristics, psychological aspect, pattern, and treatment outcome in different acute poisoning. Method. The present cross-sectional study was conducted in the medicine department of Jashore Medical College and Hospital from 1st January to 30th June 2018, which recruited 487 eligible cases of admitted acute poisoning patients. Results. The study reveals that the total incidence of acute poisoning in Jashore, Bangladesh, is 17.1 per 100,000 populations over a 6-month period. The mean age of our study population was 27 ± 11 (SD) years with having significant female preponderance in acute poisoning (female: 253/52% and male: 234/48%; p = 0.002). Female subjects were significantly younger than male (p <0.001). Moreover, the total suicidal intension of acute poisoning in our study was 97.3%, whereas the female subjects were more committed to suicidal attempts (p = 0.027). Organophosphorus compounds (OPCs) were the significant leading agents (66.1%, p = 0.029) of acute poisoning, and even, it had been significantly used as suicidal intention of poisoning substance (65.1%, p <0.001) in our observation. Muslim (97.5%, p = 0.005), 10–29 year age group (68.0%, p = 0.002), rural (99.2%), unmarried (51.3%), middle class (50.1%), students (48.9%), and secondary educational background population (76.4%) were more victimized of acute poisoning. Among different factors, familial disharmony constituted of 56.1% cases of suicidal attempt in acute poisoning. Finally, we had observed that the death incidence by acute poisoning in Jashore, Bangladesh, was 1.9 per 100,000 population over a 6-month period. Conclusion. The recent study reveals that there is high incidence of acute poisoning in Jashore, Bangladesh, with a significant amount of death toll. Organophosphorus compound is the most common agent of deliberating self-poisoning in our study due to its easy availability in our agriculture-based community.