Background: Rheumatoid arthritis (RA) is a systemic inflammatory disease characterized by chronic and erosive polyarthritis causing irreversible joint disability. It is the most common persistent inflammatory arthritis, affecting from 0.5 to 1% of the general population worldwide. Antibodies to citrullinated proteins (anti-CCP antibody) have been described in patients with RA and these appear to be the most specific marker of the disease. Methods: This cross-sectional study was carried out at department of medicine, Sher-E-Bangla Medical College Hospital, Barisal Form July’ 2016 to December’ 2016. All rheumatoid arthritis patients attending at OPD and those got admitted under Medicine Dept, who was satisfying the inclusion and exclusion criteria were included consecutively and purposively in this study. Results: Total 70 cases were included; the mean age was found 46.57±13.10 years in anti-CCP antibody positive group and 44.19±11.21 years in anti-CCP antibody negative group. Female were predominant in both groups. Duration of disease was around 8 years in both groups. Mean ESR was 29.0±22.0 mm in anti-CCP antibody positive group and 12.25±10.6 mm in anti-CCP antibody negative group. Mean rheumatoid factor was 189.4±102.1 U/L in anti-CCP antibody positive group and 66.5±36.0 U/L in anti-CCP antibody negative group. Mean DAS 28 score was 4.6±1.4 and 3.6±1.3 in anti-CCP antibody positive and negative group respectively. The mean difference was statistically significant (p<0.05) between the groups. Patients in disease remission had lower anti-CCP antibody titer than those with low, moderate or high disease activity. Significantly positive correlation (r=0.596; p=0.001) between severity of rheumatoid arthritis and anti CCP antibody level was observed. Conclusion: In RA patients’ disease was more severe in anti-CCP antibody positive group and significantly positive correlation between anti-CCP antibody level with disease severity of RA was observed. BIRDEM Med J 2022; 12(1): 36-40
Histoplasmosis is a mild self-limiting respiratory illness in immune-competent individuals. It disseminates in immune-suppressed states like patients with human immunodeficiency virus (HIV) infection, haematological malignancies, post transplant states and patients receiving immunesuppressive therapy. Here we report a case of disseminated histoplasmosis in a 45 year old diabetic, returning worker who presented with fever, cough, rash, oro-genital ulcer and weight loss. He was anaemic, there was crepitation on lung auscultation and hepatomegaly. Diagnostic workup revealed HIV infection with disseminated histoplasmosis. Intravenous amphotericin B was started along with other supportive therapy and for anti-retroviral therapy he was sent to a referral center. Being an uncommon condition in our perspective, we are reporting the case. DOI: http://dx.doi.org/10.3329/bjmed.v24i2.20221 Bangladesh J Medicine 2013; 24 : 78-81
Introduction: Tuberculosis (TB) is highly prevalent in Bangladesh. The affection of the central nervous system(CNS) is one of the most dangerous manifestations of extrapulmonary tuberculosis. This may take the form of either tubercular meningitis (TBM), tuberculoma, or spinal arachnoiditis. CNS tuberculosis (CNS-TB) carries high morbidity and mortality among all forms of TB. The diagnosis is difficult and often delayed due to the varied and non-specific presentation. Aside from clinical indicators, cerebrospinal fluid (CSF) diagnostic indicators include mononuclear pleocytosis, low sugar levels, and high protein concentrations. It is possible to confirm Mycobacterium tuberculosis in CSF using staining, culture methods, and molecular analysis, but it is difficult. Advanced radiological imaging techniques can often be very helpful in making presumptive diagnoses, but they do not always yield confirm diagnoses. Aim: In our case series, we aimed to highlight the spectrum of presentation of CNS tuberculosis, diagnostic challenges, and initial response to anti-TB drugs. Material and Methods: We report a case series of six patients with CNS tuberculosis admitted to the neurology department between 2022 and 2023. Four of them were prospectively reviewed and two retrospectively. Data on presentation, diagnostic workup, and treatment were analyzed. Result: We presented six cases of CNS TB from 2022 to 2023. Four cases among six had only TBM, two cases had concomitant intracranial tuberculoma and two cases had tuberculosis in the extracranial site. The most common presentation were fever, altered consciousness level, and constitutional symptoms. CSF study was done and revealed increased total protein in all six cases, lymphocytic pleocytosis in 66.67% of cases, a low sugar level in 50% of cases, and raised ADA level in 66.67% of cases. MTB was detected in a polymerase chain reaction (PCR) in one case and was none positive for AFB stain and culture. MRI with contrast showed meningeal enhancement in all six cases, hydrocephalus in 66.67% of cases, and infarction and tuberculoma in 33.33 % of cases. Brain biopsy for histopathological confirmation was not done. All of them had an anti-tubercular therapy and reported good clinical responses at 21-day-follow up. Conclusion: CNS TB should be diagnosed primarily based on compatible clinical features, morphological findings on brain MRI, and CSF findings. In Bangladesh, CNS TB should always be considered an important differential diagnosis in patients with prolonged fever and headache, as well as altered consciousness level, and treatment should be initiated immediately on the basis of strong clinical suspicion, rather than waiting for laboratory confirmation.
Antiphospholipid syndrome (APS) manifests clinically as recurrent venous or arterial thrombosis and/or fetal loss. Diagnosis requires a high index of suspicion during evaluation of women with recurrent pregnancy loss and vascular thrombosis. Low dose aspirin combined with heparin can reduce morbidity and improve the pregnancy outcome. Here we report a case of a 22 year old lady having APS who presented with arthritis, recurrent miscarriages and venous thrombosis. Birdem Med J 2013; 3(1): 44-46 DOI: http://dx.doi.org/10.3329/birdem.v3i1.17126
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