A 22-year old woman visited the LAMB Hospital, Parbatipur, Dinajpur, Bangladesh, in February 2010, with exertional dyspnea for three weeks. She had had a normal vaginal delivery four months ago; 2-dimensional echocardiogram showed severe left ventricular dysfunction and biventricular thrombi, which resolved without complications after anticoagulation. Biventricular thrombosis with peripartum cardiomyopathy is quite a rare finding, and its clinical course and proper management is not known. No such case has previously been reported in Bangladesh.
Background: Proton pump inhibitors (PPIs) are one of the most frequently prescribed classes of drugs in the world in the treatment of peptic ulcer, dyspepsia and gastro-oesophageal reflux. Objectives: To determine demographic, clinical response and practice characteristics of PPIs among the patients attending the out-patient department of a tertiary care hospital. Materials and Methods: In this prospective observational study 100 patients attending the out-patient department and taking oral proton pump inhibitors (PPI) for different symptoms and duration were included. Patient’s socio-demographic characteristics, PPI-related information (duration, frequency of use, doses and classes of PPIs) and symptomatic responses after taking PPI were noted. Drugs or diseases that influenced the intake of PPI were also recorded. Investigations done before or during PPI use and their findings were also noted. Results: Omeprazole (43%) and esomeprazole (35%) were the most frequently prescribed PPIs. Most of the patients (52%) were on PPI therapy for 1−3 months. Majority of the patients (72%) had taken PPIs on daily basis and 19% patients had taken irregularly or occasionally. Dosing frequency of PPIs prescribed were twice daily in most of the patients (77%). Sixty seven percent (67%) patients had taken PPI prescribed by doctors and 33% patients had taken PPI prescribed by non-doctors. Common indications for prescribing PPIs were heart burn (54%), upper abdominal pain/discomfort (38%) and bloating (33%). Symptoms reappeared after stopping the PPI in most of the patients (40%) and 35% patients had satisfactory relief of symptoms with PPI. Conclusions: Omeprazole and esomeprazole are the most frequently prescribed PPIs. Majority of the patients had taken PPIs on daily basis. In around one-third of the patients PPIs were prescribed by non-doctors. Common indications for prescribing PPIs were heart burn, upper abdominal pain/discomfort and bloating. Symptomatic responses varied after taking PPI and symptoms reappeared after stopping the PPI in most of the patients. J Enam Med Col 2020; 10(1): 10-16
Medications can cause several complications in the esophagus and lead to medication-induced esophageal injury. This study was carried out among patients diagnosed as medication-induced esophageal injury from June 2015 to October, 2018 in the Department of Gastroenterology, Enam Medical College and Hospital, Savar, Dhaka to investigate clinical and endoscopic characteristics of medication-induced esophageal injury as well as outcome of these patients with treatment. Patients diagnosed as malignancy, viral or fungal esophagitis, esophageal varix, corrosive and sclerotherapy induced ulcer and GERD were excluded. Clinical and endoscopic characteristics of patients diagnosed as medication-induced injury were analyzed. After given treatment, clinical improvements as well as mucosal healing of oesophageal injury were noted. Thirty seven patients were diagnosed as medication-induced esophageal injury. Their median age was 40; 17 were males and 20 were females. Common symptoms were chest pain (94.6 %), odynophagia (78.4 %) and dysphagia (62.2 %). Symptoms appeared between 3 hours to 15 hours after ingestion of medication. Predisposing factors for 75.67% of the patients were related to taking the medicine with insufficient water or in recumbent position, or both. The main causative agents were antibiotics, Non-steroidal anti-inflammatory drugs (NSAIDs) and Alendronate sodium. Common diseases that required treatment with these drugs were various urinary system diseases, osteoporosis and migraine. During endoscopy, 25 had only ulcer, 7 had only erosion and 5 had both ulcer and erosion. Most of the ulcers and erosions were located at the middle third of the oesophagus with a rate of 70%, and 58.3% respectively. Appearance of the ulcer was oval, circular, kissing and geographical shaped and their sizes vary between 6 mm to 18 mm and single or multiple in numbers. All the patients were treated with proton pump inhibitors (PPIs) or sucralfate, and the causative drugs were discontinued. Symptoms resolution occurred within 5 to 12 days after treatment and mucosal healing were detected in all patients after 4 weeks who were performed endoscopy. Almost every kind of medication, particularly doxycycline, NSAIDs can cause oesophageal ulcer and erosion. It can be successfully treated with PPIs and discontinuation of the causative medication and prevented by warning patients about drinking water sufficiently and sitting up while taking the pill. Faridpur Med. Coll. J. Jan 2019;14(1): 2-7
Background: Asthma is a chronic inflammatory disorder of the airways. Relevance of highly sensitive C-reactive protein (hs-CRP), an acute phase reactant and a sensitive marker of low-grade systemic inflammation in bronchial asthma has not been fully studied.Objectives: Reported studies have found an inverse relationship between lung function and markers of systemic inflammation. The aim of this study was to clarify the relationship between serum level of hs-CRP and bronchial asthma.Materials and method: In this study, hs-CRP was measured in 60 patients with asthma and 40 healthy control subjects. Of all asthmatics, 39 patients had partially controlled and uncontrolled asthma and 21 patients had asthma during exacerbation.Results: Highly sensitive CRP was significantly higher (p<0.000) in asthmatic patients as compared to the control group. In asthmatics with exacerbation, serum hs-CRP was significantly higher than in partially controlled and uncontrolled asthmatic patients (p<0.006) and control subjects (p<0.0001).Conclusion: Serum hs-CRP may be a non specific marker of asthma and its exacerbation.Delta Med Col J. Jan 2018 6(2): 62-67
Introduction: Stroke is a major cerebrovascular disease is one of the most common Neurological diseases. It is the second leading cause of death worldwide. Cerebrovascular disease threatening human health and life with high morbidity, disability and mortality. Major risk factors of ischaemic strokes are hypertension, diabetes, and dyslipidaemia. High sensitivity C-reactive protein (HsCRP) is an inflammatory marker which appears to be a strong predictor of risk factor and prognostic marker of Ischaemic stroke. Objective: To find the acute course of HsCRP and its association with short term prognosis following Ischaemic stroke. Methods: A Cross sectional observational study at Dept. of Neurology, Enam Medical College Hospital, Savar, Dhaka, Bangladesh From March 2020 to April 2021. Total number of subjects in this study were 101 with power 80% (persons aged 30 years & above; both male and female). Both sexes and their plasma high sensitivity C-reactive protein (HsCRP) level was measured within 48 hours of admission and on the 5th day after admission. Results: The study showed that the level of HsCRP did not change significantly when measured within 48 hours of onset of Ischaemic stroke and on 5th day after stroke (p=0.335) - the prognosis and severity remained same when followed for 5 days. It, also, showed that the level of CRP ≥ 3 within 48 hours of admission is associated with increased severity and mortality of stroke (Z=14.4; p<0.0001). Conclusion: HsCRP level provides rapid and reliable information regarding severity & prognosis in patients with Ischaemic stroke. The level of HsCRP does not change significantly when measured within 48 hours of onset of Ischaemic stroke and on 5th day after stroke. Also, the level of CRP on 5th day was same as within 48 hours of stroke - the prognosis and severity remained same. If confirmed by larger, longitudinal studies this association may be used as a tool to assess the severity and prognosis in a patient with Ischaemic strokes.
Introduction: Primary headache disorder, characterized by recurrent headache is the most prevalent disease leading to widespread ill health and impaired quality of life. Headache is one of the most common cause of patient attending neurology clinic. Amitriptyline, flunarizine and topiramate are common drugs in the treatment of primary headache. Objective: To compare the efficacy of drugs namely Amitriptyline, flunarizine and topiramate in the treatment of primary headache. Methods and Materials: This is the retrospective data analysis study was contacted at Dept. Of Neurology, Enam Medical College Hospital, Savar, Dhaka, Bangladesh from March to June 2022. Data analysis of primary headache patients treated with amitriptyline, flunarizine and topiramate. On their first, second and third subsequent visits, Headache Impact Test 6 Scoring was done by a medical person. Patients were treated clinically. After the third follow up data were analyzed using SPSS version 20.0. Categorical variables were compared by chi-square test, paired sample t-test, ANOVA test and Welch test. Results: A total of 121 patient data was analyzed. Most patients were between 16 to 40 years of age (54.34%) followed by 41-60 years of age (33.80%) with minimum age of 16 years and maximum age of 60 years respectively. Among the patients in the study group, the majority were female (85%). All three medications: amitriptyline, flunarizine and topiramate were able to significantly lower Headache impact test -17.23 ± 6.643, -14.06 ± 7.155, -15.82 ± 5.907 respectively (P-<0.001). Amitriptyline was found to be better than other two drugs in reducing Headache Impact Test. Conclusion: Primary headache is a common presentation in neurological OPD. Female between ages 16-60 years had more primary headache. Amitriptyline, flunarizine and topiramate all are effective in the treatment of primary headache. Though tension type of headache is the most common type of headache, amitriptyline seems to be equally effective in treatment with other primary headaches.
Intestinal tuberculosis (TB) most commonly affects ileo-caecal region. Isolated gastric and duodenal involvement without pulmonary infection is rare. The presentation of these patients varies. Patients may present with haematemesis, non-healing chronic ulcer, mimicking malignancy, gastric perforation and gastric outlet obstruction. High degree of suspicion is needed for early diagnosis of gastro-duodenal TB. A young female patient who was being treated as a case of nonhealing chronic ulcer was referred for treatment. Histopathological examination of endoscopic biopsy specimen of the patient showed presence of granulomas composed of epitheloid cells and Langhan’s giant cells with caseation with no evidence of tuberculosis at pulmonary or other body sites. After anti-tubercular chemotherapy there was resolution of symptoms and healing of ulcers. This case of isolated gastro-duodenal TB is reported for its rarity. J Enam Med Col 2019; 9(3): 189-192
Bladder cancer is the second most common malignancy of genitourinary tract. About 20% cases are muscle invasive and most of the non-muscle invasive bladder cancer progressed to muscle invasion with time. The standard care for organ confined muscle invasive bladder cancer is radical cystectomy followed by urinary diversion. Orthotopic bladder substitution is considered standard urinary diversion after radical cystectomy in patients who have no urethral malignancy and intact external urethral sphincter. Neobladder constructed from ileum as described by Studer is considered standard and followed by most centers worldwide since 1985. We modified the procedure to improve the outcome and minimize post-operative complications by reducing the length of ileum used for construction of neobladder in 37 patients. Voiding, storage function and complications were evaluated during follow-up period up to 24 months after surgery. Three patients died during follow-up period of which 2 from metastatic disease and one from unrelated cause. Daytime and night-time continence rates were 86.49% and 78.38% respectively. Average functional capacity (437ml), maximum flow rate(15.7ml/s) and mean post void residual urine (44ml) during the period of evaluation. Clean intermittent self-catheterization needed in 67.57% patients due to incomplete emptying during early postoperative period but after 3 months most of the patients learnt to void without any aid. Upper tract dilatation found in one patient due to stricture at urethrovesical junction and required endoscopic incision and dilatation later. 12 patients had an urodynamic study at 12 months after surgery and found low pressure reservoir with small residual urine in all cases. Modified ileal neobladder is a safe and reliable procedure with satisfactory short-term result. Bangladesh Journal of Urology, Vol. 22, No. 1, January 2019 p.20-24
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