Background: Antimicrobial resistance is a growing concern specially among the critically ill patients who are often treated by multiple antibiotics. But, the data regarding the pattern of antimicrobial resistance in this population are often insufficient. Objective: To observe the pattern of antimicrobial resistance among the patients admitted into the intensive care unit (ICU). Methodology: This prospective observational study was carried out in the ICU of a tertiary care hospital of Bangladesh over 6 months. Samples of blood, urine, tracheal aspirate, wound swab and pus were obtained from the patients, cultured and analyzed. Results: Among 100 subjects, the most common primary diagnoses were aspiration pneumonia (29%) and urinary tract infection (UTI) (24%). Out of 315 samples, microorganisms were isolated from 125 samples (39.68%). The most common sample yielding positive culture was tracheal aspirate (67.2%), and the most frequently isolated microorganisms were Pseudomonas spp. (35%), Escherichia coli (28%), Acinetobacterspp. (24%) andKlebsiellaspp. (18%). Acinetobacterspp., Pseudomonasspp. and Klebsiellaspp.were the commonest resistant organisms. Overall prevalence of resistance to antibiotics were: ceftriaxone 72%, ceftazidime 78.4%, ciprofloxacin 81.6%, gentamicin 84%, meropenem 49.6% andnetilmicin 39.2%. Meropenem was the most sensitive antibiotic against Klebsiellaspp.(66.67%) but Acinetobacterspp.was still resistant to meropenem and amikacin but sensitive to cotrimoxazole (66.67%). Multidrug resistant Pseudomonas, Acinetobacter and, Klebsiella species were found; piperacillin-tazobactam combination showed <40% resistance against them. No single antibiotic showed good efficacy against Acinetobacterspp. Conclusion: The prevalence of antibiotic resistance is high among the ICU patients, and the majority of the isolated organisms are resistant to conventional antibiotics. Bangladesh J Medicine January 2021; 32(1) : 5-11

Sheehan's syndrome is a rare condition characterized by post-partal panhypopituitarism due to necrosis of adenohypophysis resulting from severe post-partum hemorrhage. Lethargy, amenorrhea and failure of lactation are the usual presenting features. Cardiac involvement in Sheehan's syndrome is rare. The case presented here describes dilated cardiomyopathy in a 36-year-old lady who failed to respond adequately to the standard anti-failure treatment. Further investigation revealed the diagnosis of Sheehan's syndrome. Besides other manifestations, cardiac function reverted to normal after giving replacement therapy with glucocorticoid, levothyroxine and sex hormone. Physicians, specially those in developing countries, should have high index of suspicion for the diagnosis of Sheehan's syndrome while dealing with a case of 'peripartal dilated cardiomyopathy'. Persistent amenorrhea and failure of lactation may be important clues in this context. Timely diagnosis and appropriate treatment can lessen the sufferings of the patients.

Background: Vitamin D plays important role in normal functioning of multiple organs of the body. Hypovitaminosis D is known to be prevalent worldwide including the tropical countries. The present study was carried out to evaluate the vitamin D status in Bangladeshi patients undergoing laboratory investigation for vitamin D. Methods: This was a laboratory-based study. Data were extracted from the database of a diagnostic centre of Dhaka city and were analysed. Vitamin D status was defined as follows: deficiency 0 to <20 ng/ml, insufficiency 20 to <30 ng/ml, sufficiency 30-100 ng/ml and potential toxicity >100 ng/ml. Results: A total of 793 plasma vitamin D level reports were analysed. Out of 793 subjects, 269 (33.9%) were male and 524 (66.1%) were female. Majority (62.0%) were between 21 and 60 years of age. Mean (+/- standard deviation) vitamin D level of the study subjects was 21.66 (+/- 18.63) ng/ml. Eighty-six percent had hypovitaminosis D; 61.4% had deficiency and 24.1% had insufficiency. Vitamin D level was found sufficient in 13.1% subjects. Among the deficient subjects, 31.6% were male and 68.4% were female; among the insufficient subjects, 35.1% were male and 64.9% were female. Sixty-eight percent of the deficient subjects belonged to the 21 to 60 year age group, whereas 57.1% of the insufficient subjects were between 21 and 60 years. Conclusion: Hypovitaminosis D is common among the real-world clinical subjects undergoing vitamin D estimation in Bangladesh. Middle-aged females are more likely to be affected Birdem Med J 2019; 9(3): 202-206

Abstract

Snake bite is an important but often under-recognized public health problem in Bangladesh, with an incidence density one of the highest in the world, which may be 623.4/100,000 person years. The proportion of poisonous snake bites is 10 to 45%, with the reported mortality 0.5 to 22%. Among the 82 species of snakes, 28 are venomous; bites by green pit vipers, cobras and kraits are the most commonly identified ones. High population density, widespread agricultural activities, numerous venomous snake species and lack of functional snake bite control programs favour the high burden of snake bites. Poorer rural populations are the main victims, imposing considerable socioeconomic impact. Treatment of snake bite is largely dominated by traditional snake charmers (Ozha) or 'Kaviraj' offering unscientific practices and healers, causing undue delay and precluding standard medical management. Delayed presentation to the hospital, lack of availability of antivenom and modern management facility are the main causes of death. Antivenoms are entirely dependent on import, are expensive, and are not 'customized' to local needs. Auxiliary intensive care facilities are not widely available; health care personnel often lack necessary expertise. However, the trend is changing. Public awareness is growing, health care personnel are being trained, and a national guideline for snake bite management has been formulated. Further research, introduction of modern diagnostic facilities, local manufacture of antivenom, and above all, integrated approach on the part of Government, policy-makers and international community can change the outlook of snake bite as a neglected tropical condition in Bangladesh.

No abstract

Background: Physical comorbidity is quite common in older adults. When psychiatric and medical conditions co-occur, the combination is associated with elevated symptom burden, functional impairment, decreased length and quality of life, and increased costs of treatment. To estimate the proportion and patterns of physical comorbidity in elderly psychiatric patients. Methods: A retrospective observational study was carried out in the Geriatric Clinic of National Institute of Mental Health and Hospital (NIMHH). Patient registry of the clinic was used to collect required information and 113 consecutive older adults with psychiatric disorders who attended the clinic in a three-month period, were enrolled for the study. Psychiatric diagnoses were made by psychiatrists, according to DSM-5 criteria. Medical diagnoses were made by specialist physicians by reviewing physicians’ prescriptions. Data analysis was done by using SPSS 23.0. Results: Most of the patients (58.4%) belonged to the 7th decade. Among 113 patients 90 (79.7%) had only psychiatric illness & 23 had (20.4%) comorbid physical disorders. Depressive disorders (30%) and dementia (22.1%) were the most common psychiatric reasons for consultation. Among the associated physical comorbidities hypertension (43.5%) and diabetes (34.8%) were the most commons. Conclusion: Co-occurrence of psychiatric and physical disorder conditions is very common in a clinical setting. Physical comorbidity may influence follow up consultation pattern. Bangladesh J Medicine July 2022; 33(1) : 40-43

Adult onset Still’s disease (AOSD) is a rare systemic inflammatory disease of unknown etiology and pathogenesis that presents in 5 to 10% of patients as fever of unknown origin (FUO) accompanied by systemic manifestations. We report an interesting case of a 63-year-old Bangladeshi male who presented with one-month duration of FUO along with, severe weakness, oral thrush, high WBC count, low RBC count and low hemoglobin concentration. After extensive workup, potential differential diagnoses were ruled out and the patient was diagnosed with AOSD based on the Yamaguchi criteria. The case history, incidence, pathogenesis, clinical manifestations, differential diagnoses, diagnostic workup, treatment modalities, and prognosis of AOSD are discussed in this case report.J Dhaka Medical College, Vol. 25, No.2, October, 2016, Page 142-147