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Background: Organophosphorus compound (OPC) poisoning is an important clinical problem in the developing world and kills an estimated 3,00,000 people every year. In spite of high case fatality rate early and proper management is crucial to save the lives and alleviate the sufferings. Amylase level is an important biochemical marker, which is closely related to severity of acute OPC poisoning. Therefore, to assess Serum amylase level in acute organophosphorus compound poisoning in a tertiary level hospital was the objective of the study. Methods: This research was a hospital based descriptive cross-sectional study and was conducted at the inpatient department of Medicine in Dhaka Medical College. 50 Patient admitted in medicine department due to OPC poisoning and evidenced by history taking and physical examination were included in the study. Ethical issues were ensured properly. After written informed consent history and physical examination were done. Rest of the data were collected by interviewing each patient or from attendant of the patient by using a semi-structured questionnaire. Scoring of the severity were done by researcher himself by Peradeniya Organophosphorus Poisoning (POP) scale (Score range 0 to 11). Values of amylase level were collected from patient record file. All the Data was analysed by computer with the help of SPSS 16. Results: Out of a total of 50 patients, 24 (48%) were males and 26 (52%) were females. OPC poisoning was most frequent (52%) in age group 21-30 years. Mean age was 23.96 ± 6.071 SD. 96% (48) study population were Muslim and rest 4 % (2) were Hindus with diverse occupation. 86% population came from rural area whereas only 14% population reside in urban area. Among them suicidal attempts were seen significantly which was 96% and rest of them were accidental ingestion. Amylase level estimation were done in each case and 32 % (16) patient had elevated amylase level (>100U/L) and 68% (34) patient had amylase level within normal limit. Mean amylase concentration was 62.2U/L (SD±18.77) and among the 16 patients who had elevated serum amylase level mean concentration was 376.56U/L (SD±266.124). Mean amylase level differed significantly between these two groups (p value < 0.0001) estimated by one way ANOVA. Spearman Correlation and One way ANOVA both showed significant association between severity (assessed by POP scale) and elevated level of serum amylase (p value

Background: Attempted suicide or deliberate self-harm by self-poisoning among adult males and females are a major public health problem to be addressed like any other medical condition. In recent years, patterns of self-poisoning are changing. So it is important to know about the substances used in self poisoning and its outcome. Materials and Methods: It was a descriptive type of cross sectional study done in Department of Medicine, Dhaka medical college hospital, Dhaka on100 patients with a history of self-poisoning. Study period was six months. A semi structured questionnaire was used for collection of data. Results: In our study self-poisoning was more prevalent among young age group with female preponderance. Family disharmony (45%) was the commonest cause of self poisoning and most commonly used substance was pharmaceutical drugs. Anxiolytics were the commonest (42 %), organo phosphorus compound (OPC) 20%, mixed drugs 12%, harpic 11%, rat killer 8%, NSAIDs 3%, Dettol 3% and Wheel powder 1%. Out of 90 patients 91.11% patients recovered completely. Death was observed from OPC poisoning. Conclusion: Knowing the pattern and outcome of self poisoning may improve the community based support system through which we can combat against self- poisoning. J MEDICINE JAN 2020; 21 (1) : 20-25

Objectives: To determines the association of National Institute of Health Stroke Scale (NIHSS) score on admission with outcome of acute ischemic stroke during discharge from hospital.Materials & Methods: This hospital based observational study was done in medicine department of Dhaka Medical College Hospital involving 50 patients diagnosed as ischemic stroke on admission. The diagnosis of stroke was established by the clinical presentation, neuroimaging (CT scan/ MRI). They were thoroughly examined and assessed with NIHSS score at admission. All data were be collected by using a preformed data sheet and results were presented in standard method after statistical analysis.Results: Most of the patients were elder than 60 years of age and mean age of the patients was 60.34(±16.1) years at onset with a range of 24 to 76 years. Male were 116 (58%) and female were 84 (42%). Male to female ratio was1.4:1. Majority had hypertension (75.8%) followed by physical inactivity (67%), Diabetes (37.4%), smoking (33%), obesity (23.1%), family H/O stroke (20.9%) and dyslipideamia (15.4%). Higher NIHS score was associated with poor outcome (p value

Background: Altered level of consciousness is a very common medical emergency resulting in considerable mortality & morbidity. Accurate diagnosis & prompt management can reduce the complications to a great extent. There are various aetiologies of impaired consciousness including infective & metabolic causes as well as cerebrovascular accidents. This study described clinical outcomes of the patients relating to specific aetiologies of the illness.Objectives: To explore the common aetiologies of altered consciousness & to determine the clinical outcomes of the patients after one month in a tertiary level hospital of Bangladesh.Methods: This hospital based prospective observational study was conducted in Medicine department of Dhaka Medical College Hospital (DMCH) from December 2013 to May 2014. Sample size was 100 & the data was collected by structured questionnaire. Purposive sampling method was applied using inclusion & exclusion criteria. Statistical analysis of the result was obtained by using SPSS-16.Results: The mean age of the study patients was found 48.7 years with range from 19-92 years. Majority (58%) of the patients were male. Stroke was identified as the commonest (39%) aetiology of impaired consciousness followed by meningo-encephalitis (19%), septicemia (10%) & poisoning (10%). Among metabolic encephalopathy diabetic ketoacidosis was 3%, hypoglycemia 1% and hepatic, uremic & hypertensive encephalopathy was 3%, 4% & 1% respectively. Overall death rate was higher among patients with stroke (26%), ICSOL (50%), ADEM (50%) than those with meningoencephalitis (5.3%), septicemia (20%) & poisoning (10%).Conclusion: Infective & metabolic causes of impaired consciousness showed better outcome than structural & vascular aetiologies of brain.J MEDICINE July 2017; 18 (2) : 80-85

Acquired hemophilia is a rare but acquired bleeding diathesis caused by autoimmune depletion of Factor VIII or IX. Diagnosis of Acquired Hemophilia requires clinical acumen. The condition is often under diagnosed as because it is rare and patients usually don’t have any unusual personal or family history of bleeding episodes. Acquired hemophilia has an equal sex distribution. So, clinicians should suspect acquired hemophilia in any patients with unexplained persistent and profound bleeding from uncommon soft tissues and mucosa and having prolonged activated partial thromboplastin time (APTT) without other causes. Here we will report a 50-year-old lady presenting with recurrent spontaneous bruises and joint pain and swelling for 2 years. On examination we found multiple bruises and ecchymosis of different sizes with varying colour changes from bluish to greenish over different parts of her body including face, right shoulder, right elbow joint and 2nd and 3rd PIP joints. Lab findings showed decreased Hemoglobin with prolonged APTT which didn’t correct in mixing study. After exclusion of other possible pathological conditions and on the basis of lab criteria we diagnosed the case as Acquired Hemophilia. She was successfully treated with blood transfusion, recombinant activated factor VIII, Steroid and supportive treatments and was discharged with improving symptoms, stable hematocrit and resolving bruises.J MEDICINE July 2017; 18 (2) : 119-122

Background: Aspiration Pneumonia is a common complication in patients with altered consciousness if general supportive care is not taken properly. There is no national study on incidence of aspiration pneumonia in hospitalized patients with altered consciousness. This study was done to see the incidence of aspiration pneumonia in patients with altered consciousness admitted in a tertiary care hospital in our country. Methods: This was a prospective observational study conducted among the 50 adult patients of aspiration pneumonia with altered consciousness admitted in the medicine department of DMCH, during January 2010 to December 2010. Aspiration pneumonia was confirmed by clinical examination and laboratory investigations. Assessment of altered conscious patient was done by application of the Glasgow Coma Scale. Case record forms with appropriate questionnaire were filled for all patients. Results: The mean (±SD) age was 38.9±17.3 years. Maximum numbers (24.5%) of patients were found in the age group of 51-60 years. Male female ratio was 3:1. Fever, chest pain and productive cough were the most common clinical features. Stroke (64%), Encephalitis (16%) and Hepatic encephalopathy (16%) were found as main precipitating factors.DOI: http://dx.doi.org/10.3329/jom.v15i1.19853 J Medicine 2014; 15: 14-17

The aim of the study was to assess the association of metabolic syndrome in patients with acute coronary syndrome and the impact of metabolic syndrome on clinical outcome. Total 210 ACS patients were included in this study and divided in group I & II on the basis of presence or absence of MS respectively. Among the study patients mean age in group I and group II was 52.99 ± 11.49 years and 53.34 ± 12.54 years respectively. Among the risk factors, hypertension (70%vs 15%), dyslipidemia (100 vs. 97%), diabetes mellitus (36.4% vs. 6%) were significant between two groups. Mean waist circumference recorded was 103.12 ± 4.15 in group I and 96.50 ± 6.43 in group II which was significant. Present study showed, in hospital outcome was worse in group I in comparison to group II and was significant, like cardiogenic shock (11% vs. 1%), LVF (28.2% vs. 16%), and CVD (5.45 vs. 0%). But there were no significant difference in heart block, tachyarrhythmia, cardiac arrest, reinfarction and death. Complications were far more in group I than in group II (14.5% vs. 52.0%) which was also highly significant. So, we conclude that the presence of MS in patients suffered from ACS was associated with a greater incidence of in-hospital cardiovascular complications and mortality.DOI: http://dx.doi.org/10.3329/jom.v15i1.19857 J Medicine 2014; 15: 31-35

A 27 year old male presented with painful swelling of right knee joint for the last 6 months. Initially it was diagnosed as a case of reactive arthritis and was treated with NSAID with intraarticular steroids without significant improvement. Two months after the initial episode he again developed painful swelling of the right knee joint with severe abdominal pain and high grade fever. There was an ill defined ovoid mass in the right iliac fossa with generalized tenderness. ESR was raised and the ultrasonography revealed loculated ascites with appendicular lump. CT scan of the whole abdomen showed appendicular lump. FNAC from the lump showed tuberculosis. Joint fluid aspiration showed neutrophilic leucocytosis with the Total count 50,000/cmm. AFB was not found. So septic arthritis was diagnosed, but as the patient was not improving we send the patient to orthopedic department for synovial biopsy but they refused as it was septic. So a diagnosis of disseminated Tuberculosis was made with the involvement of right knee joint, appendix and peritoneum. He was put on anti TB and well responded.DOI: http://dx.doi.org/10.3329/jom.v15i2.20702 J MEDICINE 2014; 15 : 153-155

We report a case of a 45-year-old gentleman presenting with numbness of both legs and hands. He has anemia, spastic quadriplegia with exageraterd tendon jerks with lose of vibration and position sense. Investigations revealed combined deficiency anemia with low serum vitamin B12. His MRI of cervicel spine was normal. Endoscopically he had atrophic gastritis. Ultimately he was dignosed as a case of sub-acute combined degeneration of spinal cord due to pernicious anemia. Patient was treated with injection vitamin B12 and well responded. On his followup, he had significant clinical improvement. This is a reversible condition if early diagnosis can be made and vitamin B12 therapy promptly given. Delayed treatment can result in irreversible neurological impairment.DOI: http://dx.doi.org/10.3329/jom.v14i1.14585 J MEDICINE 2013; 14 : 85-87

Non-alcoholic fatty liver disease (NAFLD) is the term used to describe the alcohol-like liver injury that occurs in the absence of alcohol abuse (alcohol consumption of over 20 g/day excludes the condition). It includes a range of histological abnormalities including simple steatosis or fatty liver, non-alcoholic steatohepatitis (NASH) and NAFLD induced cirrhosis. Its increasing prevalence in western countries, the diagnostic difficulties by noninvasive tests, and the possibility of progression to advanced fibrosis and even cirrhosis make NASH a challenge for physicians. NASH is frequently associated with type 2 diabetes and the metabolic syndrome, and several genetic and acquired factors are involved in its pathogenesis. Insulin resistance plays a central role in the development of a steatotic liver, which becomes vulnerable to additional injuries. Several cyclic mechanisms leading to self-enhancement of insulin resistance and hepatic accumulation of fat have been recently identified. Excess intracellular fatty acids, oxidant stress, tumor necrosis factor, and mitochondrial dysfunction are causes of hepatocellular injury, thereby leading to disease progression and to the establishment of NASH. Intestinal bacterial overgrowth also plays a role, by increasing production of endogenous ethanol and proinflammatory cytokines. Therapeutic strategies aimed at modulating insulin resistance, managing risk factors, including reduction of weight normalizing lipoprotein metabolism, and down regulating inflammatory mediators with probiotics have promising potential. 1. Assistant Professor of Medicine, BSMMU. 2. Assistant Professor of Pharmacology, Pioneer Dental College. 3. Junior Consultant, Shibpur Health complex, Narsingdhi. 4. Associate Professor of Medicine, BSMMU. 5. Professor & Chairman, Department of Medicine, BSMMU. Introduction NAFLD comprises a spectrum of liver disease characterized from simple fatty liver (macrovascular fatty change), to nonalcoholic steatohepatitis (NASH), and to cirrhosis in absence of alcohol consumption in amounts considered detrimental to the liver1. In 1980, Dr. J. Ludwig from the Mayo Clinic in Rochester, Minnesota was the first to coin the term NASH. Synonyms of NASH are pseudoalcoholic hepatitis, alcohol-like hepatitis, fatty liver hepatitis, steatonecrosis, and diabetic hepatitis. Cryptogenic cirrhosis is a common cause of liverrelated morbidity and mortality in USA. NAFLD is now recognized as the most common cause of cryptogenic cirrhosis2. NAFLD affects 10 to 24% of general population in various countries. The prevalence increases to 57.5%3 to 74%4 in obese persons. NAFLD affects 2.6% of children and 22.5% to 52.8% of obese children5. The prevalence of T2 Diabetes Mellitus varied between 10 to 75% and the prevalence of hyperlipidemia varied between 20 to 92 %6. Staging / spectrum of NAFLD NAFLD begins with fatty liver, progressing through NASH, and ending with cirrhosis. Fatty liver (steatosis), a harmless condition, is characterized by accumulation of fat in the liver cells without inflammation or scarring. Fatty liver is defined as fat, largely triglyceride exceeding 5% of the liver weight. When the fat content in the liver is 10%, fat begins to appear in many hepatocytes, and exceeds 30% of the weight; almost all of the hepatocytes contain a large drop of fat. It can be roughly estimated by how much of the acinus has fat laden hepatocytes; the involvement is characterized as mild for the pervienular third only, moderate for two-thirds, and severe for the entire acinus7. Only a fraction of patients with simple fatty liver will develop NASH, which involves fat accumulation J MEDICINE 2007; 8 : 17-27

Dengue fever was not recognized as a major public health hazard in Bangladesh before 1999 outbreak, so there was little evidence and awareness in this regard. A prospective observational study was carried out to determine the risk group of patients suffering from dengue syndrome; clinical parameters of the subjects for hospitalization and the pattern of presentation of dengue fever in hospital care in different medicine units of Dhaka Medical College hospital from July 2000 to March 2001. Total 150 cases were selected randomly and diagnosed clinically as dengue, and were classified into 3 groups, i.e. 18 cases of classical dengue fever, 127 cases of dengue hemorrhagic fever (DHF-I and DHF-II) and 5 cases of dengue shock syndrome (DSS), and were discharged uneventfully. Among them 125(83.3%) were male and 25(16.7%) were female. Mean ages of the subjects were 26.75 ±3.69, 27.59 ± 1.18 and 10.67 ± 2.33 years in respective groups. Mean temperature was 103.45±0.28, 103.08±0.13, and 104.00±1.00 °F with mean duration was 5.50±0.51 days, 6.12±0.2 days, and 5.00±1.15 in respective groups. Majority had profound weakness, headache, myalgia, anorexia, nausea, and vomiting. Diarrhoea, abdominal pain, organomegaly, ascites, and pleural effusion were frequent complaints in group-3 patients, whereas infrequent complaints in other groups. Haemorrhagic manifestations were common in group 2 and 3 patients, melaena being the most common manifestations.  DOI = 10.3329/jom.v7i1.1355 J MEDICINE 2006; 7: 3-9

1068 randomly sampled adult Bangladeshi people were studied during a period of six months from October 2004 to March 2005. It was a randomized, prospective study. Cases that fulfilled two criteria of metabolic syndrome (MetS) were evaluated to see pattern and types of MetS. Out of 1068 patients, 110 (10.3%) fulfilled the inclusion criteria. 101 (9.4%) cases were labeled as metabolic syndrome according to NCEP ATP III criteria, 09 cases had only two criteria. 40 cases were male & 70 cases were female (M:F= 1:1.8). Mean age of patients with was 44.88, ranging from the age of 20-68 years. Majority (55%) of the patients were in the age group of 30-49 years. Half of the cases had BMI 30-34.9. Mean body weight of male was 85.9 kg and of female was 78.2 kg. Mean waist circumference of male was 41.7 inches and of female 40 inches. Mean HDL for male was 38.3 mg/dL and for female is 40.2 mg/dL. Mean Triglyceride for male was 172.1 and for female was 169.3 mg/dL. Mean total cholesterol for male was 216.7 and for female was 207.6 mg/dL. Mean systolic blood pressure (SBP) for men is 162 mm Hg & diastolic blood pressure (DBP) 99 mm Hg and for female mean SBP 155 and DBP 96 mm Hg. Metabolic syndrome is more prevalent in the 3rd and 4th decade of life in both sexes. It is almost twice common in female than male. Combination of hypertension, obesity & dyslipidemia comprises nearly 40% of its presentation. 1. Professor and Head, Department of Medicine, Rajshahi Medical College. 2. Resident Physician (Medicine), Rajshahi Medical College Hospital 3. M. Phil Pharmacology (Thesis part) Student, Rajshahi Medical College. 4. Professor of Medicine, Rajshahi Medical College. 5. Research Assistant, Rajshahi Medical College Hospital. 6. Professor of Medicine, Dhaka Medical College. 7. Assistant Professor, Department of Medicine, Dhaka Medical College Correspondence : Prof. Quazi Tarikul Islam. Professor and Head. Department of Medicine, Rajshahi Medical College. E-mail: prof.tarik@gmail.com disease as well as increased mortality from cardiovascular disease and all causes.2-4 Beyond CVD and type 2 diabetes, individuals with metabolic syndrome seemingly are susceptible to other conditions, notably polycystic ovary syndrome, fatty liver, cholesterol gallstones, asthma, sleep disturbances, and some forms of cancer.5 Although there are divergent criteria for the identification of the MetS, they all tend to agree that the MetS core components include obesity, insulin resistance, dyslipidemia, and hypertension.6 The first formal definition of the MetS was put forth in 1998 by the World Health Organization (WHO).7 The European Group for the Study of Insulin Resistance (EGIR) published a separate set of criteria shortly thereafter. 8 In 2001, the NCEP: ATP III published a new set of criteria based on common clinical measurements: Waist circumference (WC), blood lipids, blood pressure, and fasting glucose Table-I.9 J MEDICINE 2009; 10 : 48-51

Hepatitis B virus infection is an important public health problem with significant morbidity and mortality. Recombinant hepatitis B vaccination for the prevention of hepatitis B virus infection is in practice in different parts of the world since its availability in 1986. Government of Bangladesh has also included hepatitis B vaccine in EPI schedule since 2005. This study was carried out to assess the seroconversion status among hepatitis B vaccinated individuals. A total of 190 individuals including 150 vaccinated persons and 40 non-vaccinated apparently healthy individuals were included as study population. Sources of vaccinated persons were from both EPI and non-EPI schedule of vaccination. Age and sex matched non-vaccinated individuals served as controls for the study. All individuals constituting the study population were screened for HBsAg by Immunochromatographic strip test and only HBsAg-negative persons were included for estimation of their anti-HBs titer. Out of 150 vaccinated individuals, 133(88.67%) were found to have anti-HBs titer in the protective level (e"10 IU/L), while 17(11.33%) individuals had anti-HBs titer below the protective level (

Although hypothyroidism may cause a wide range of muscle disturbances, an overt myopathy may rarely present as an isolated initial presentation of hypothyroidism. The frequency of myopathy in hypothyroidism ranges from 30 to 80%. The major muscular symptoms are weakness, muscular cramps and myalgia. Laboratorial investigation generally shows increased levels of muscle enzymes and low serum thyroid hormones, with high thyrotrophic-stimulating hormone (TSH) elevated. The electrophysiological study reveals myopathy, neuropathy or mixed pattern. The treatment consists in hormone replacement and the prognosis is good in most of the cases. We report two cases that developed cramps, myalgia, and weakness, one of them presented as a polymyositis-like syndrome. The muscle enzymes were increased with a raised level of TSH. The myopathy was the initial manifestation of hypothyroidism in these cases. Both the patient was treated by replacement of thyroxin with significant clinical and biochemical improvement. DOI = 10.3329/jom.v8i1.1379 J MEDICINE 2007; 8 : 32-36

Sclerosteosis is a rare autosomal recessive disorder, characterized by progressive, generalized bony overgrowth of the calvarium and mandible with cranial nerve entrapment and raised intracranial pressure, and abnormalities of the digits. Due to narrowing of the foramina of the cranial nerves, facial nerve palsy, hearing loss and atrophy of the optic nerves can occur. It is clinically and radiologically very similar to van Buchem disease, both of which shows generalized hyperostosis and sclerosis leading to a markedly thickened and sclerotic skull, with mandible, ribs, clavicles and also long bones. Van Buchem disease is differentiated from sclerosteosis by the absence of hand malformations and a large stature. Here we describe a case of a 45 years-old-female presented with progressive enlargement of right side of mandible, continuous pain in the right side of the face, right sided lower motor type of facial palsy, bilateral sensory neural type of hearing loss along with polydactyly and syndactyly. The final diagnosis of sclerosteosis was made by clinical features and radiological findings and exclusion of other causes of hyperosteosis. The particular interest of this paper is to present a case of sclerosteosis, and to demonstrate the differences between that entity and other sclerosing diseases of bone. Keywords: Sclerosteosis; van Buchem disease; Hyperosteosis DOI: 10.3329/jom.v11i2.5477 J MEDICINE 2010; 11 : 207-211

This prospective experimental study was done in the Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical Universiry, Dhaka from 1st January 2008 to 31st July 2008 to observe the effects of ADL instructions on patients with osteoarthritis of the knee. A total of 60 patients with OA – knee were selected. Out of 60 patients 28(46.7%) were female and 32(53.3%) were male. The female to male ratio1.14:1. Age distribution varied from >40 years to

A total of 106 patients of osteoarthritis of knee were selected for the study. Out of 106 patients 26.41% were male and 73.58% were female. The female and male ratio is 2.78: 1. Mean age was 49.68 ± 9.16 years and house wives were maximum in number 75 (70.8%). They were divided into two groups, 52 patients in group–A, were treated with NSAID plus Exercise and another 54 patients in group-B, were treated with NSAID only. In both group patients were treated for six weeks duration. The improvement was assessed with WOMAC scoring system. Student’s‘t’ test was to see the level of significance. In present study, the patients groups those who received NSAID plus Exercise, improved more significantly (p= 0.001) than those who received NSAID only. So it can be concluded that quadriceps muscle strengthening exercise is effective in the patients with OA knee. Keyword: Osteoarthritis, Knee, Exercise. DOI: http://dx.doi.org/10.3329/jom.v12i2.8418 JOM 2011; 12(2): 120-124

A 13 year old boy presented with obesity, reduced vision, mental retardation, hypogonadism, delayed development and learning difficulty. On examination, he had polydactyly, moon face, bilateral gynaecomastia, small penis and testis. Retinitis pigmentosa was found on fundoscopy. With these typical features, he was diagnosed as a case of Laurence-Moon-Bardet-Beidle syndrome. It is a rare autosomal recessive disorder with mutation in 6 loci identified so far. It is commonly found in communities with high inter-family marriage. Clinical features appear early in childhood and diagnosis is usually done by puberty. Prominent features include rod-cone dystrophy leading to blindness, postaxial polydactyly, central obesity, learning disability, hypogonadism in males, renal dysfunction with increased risk for renal cell carcinoma. DOI: http://dx.doi.org/10.3329/jom.v13i1.10083 JOM 2012; 13(1): 97-99