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A case of disseminated histoplasmosis in a 56-year-old apparently healthy male without any history of travel to endemic zone is described. The patient presented with fever with cough, respiratory distress and disorientation. Physical findings include fever, shortness of breath, reduced level of consciousness and hypotension. Diagnosis was confirmed by presence of Histoplasma capsulatum in bone marrow aspirate. This report illustrates the importance of recognizing the possibility of histoplasmosis in Bangladesh where mimickers of histoplasmosis like pulmonary tuberculosis and visceral leishmaniasis are extremely common. [ABSTRACT FROM AUTHOR]

Oculomotor palsy is a recognized uncommon complication in herpes zoster ophthalmicus. A case of herpes zoster ophthalmicus with ophthalmoplegia is reported. A 15 year old boy presented with ptosis, chemosis, proptosis, ophthalmoplegia involving IVth and VIth cranial nerve following vesicular eruption on his right forehead. He was treated with oral acyclovir and oral steroids. He made a partial recovery with improvement of ptosis, proptosis but with residual VIth nerve palsy. [ABSTRACT FROM AUTHOR]

Tuberculosis involving the anorectal region is a rare extrapulmonary form of the disease. We report two cases of isolated rectal tuberculosis with different presentations. On both instances, diagnosis was confirmed by histological examination and treated with anti-tuberculous drugs with successful outcome. [ABSTRACT FROM AUTHOR]

Cerebrotendinous xanthomatosis (CTX) is a rare genetic lipid storage disease. CTX is characterised by childhood-onset cataract, adolescent to young adult-onset tendon xanthomas and adult-onset progressive neurological dysfunction (dementia, psychiatric disturbances, pyramidal and/or cerebellar signs and seizures). A 32-year-old male patient presented to us with the features of this rare genetic metabolic disorder. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 55 year old male presented with history of difficulty in deglutition, dimness of vision, and headache. Magnetic resonance imaging (MRI) shows hyperintense lesion on T2 and hypointense on T1 and was diagnosed with rhabdomyosarcoma (RMS), whcih is very uncommon in adult population. Options in treating RMS includes radiotherapy, combination of chemotherapy, and surgery depending on the clinical stage of the tumor.

A quiz concerning a 30-year-old man presented with headache, vomiting, loss of vision, and nausea in which clinical examination reveals right sided extensor plantar reflex, is presented.

The article presents a case study of 54 year old male patient who complained with diffuse pain of his shoulders, upper limbs and chest for three months and the pain worsens due to movement.

Objective: Invasive deep fungal infections have become a major cause of morbidity and mortality over the past three decades. Organ transplantation, the use of aggressive chemotherapy and the availability and widespread use of immunosuppressive treatments for many medical ailments have resulted in large populations of patients who are at risk of fungal infections. We report our experience to increase awareness of the clinical spectrum of disseminated fungal infection and its similarity to other infections and malignancy. Materials and Methods: Case reports from different medical institution for last 6 months were searched through case registry and recent scientific presentation and publications. Results: Recently a case of Histoplasmosis was reported in Dhaka Medical College Hospital (DMCH) where a 57 years old male presented with low grade fever for 3 months, backache followed by progressive weakness of both lower limbs , there was spastic paraplegia with sensory loss upto the level of D10. An open biopsy from paravertebral soft tissue showed histopathological features consistent with histoplasmosis. Other deep fungal infections e.g. pulmonary blastomycoses, mucormycoses and pulmonary aspergilloma were also reported in DMCH and Bangabandhu Shiekh Mujib Medical University (BSMMU) and RMCH. Conclusion: As these fungal infections are not commonly encountered in our country and most of the dissemination has similar clinical features of chronic inflammatory process and malignancy, we need a high index of suspicion to diagnose with different diagnostic approach. Bangladesh may be experiencing increase load of disseminated fungal infections and awareness is now very important to explore its underlying aetiology. [ABSTRACT FROM AUTHOR]

Thyrotoxic crisis is a life threatening condition which requires urgent detection and management. Due to its wide variety of presentation its diagnosis can be difficult in some cases and high index of suspicion is required for its diagnosis. We report a case of 45 year old lady presenting with fever, jaundice and passage of loose stool whose thyroid hormone profile proved her to be suffering from thyrotoxic crisis. [ABSTRACT FROM AUTHOR]

Use of dentures is not an uncommon practice. Swallowing of such dentures can give rise to variable symptoms ranging from chest pain, dysphagia, oesophageal perforation, and erosion of a vessel leading to haemorrhage or rarely gastric outlet obstruction. Here we present a case of 62 year old man presenting with chest pain, dyspepsia, early satiety leading to occasional self induced vomiting . Upper GI endoscopy was performed which revealed an impacted denture in duodenum. [ABSTRACT FROM AUTHOR]

Melanosis Coli is described as black or brown discoloration of the mucosa of the colon. It is a benign condition, which arises from anthraquinone laxative abuse and usually has no symptoms of its own. Though not a very rare condition, to the best of our knowledge, no case has been reported on melanosis coli in Bangladesh . Here we report a case of middle aged lady presenting with passage of blood mixed stool for one year. Colonoscopy was performed which revealed melanosis coli and which was later confirmed by histopathology. Not thought to be a pre malignant condition, it has been found in some patients with other diseases. [ABSTRACT FROM AUTHOR]

In this article the author comments on the violence experienced by doctors from patients and families worldwide. Results of research shows that causes of this type of abuse include delay in attending to patients, restraining patients, administering medications, drug intoxication, dissatisfaction with treatment and disagreement with physicians. The authors believe that the said abuse will affect doctor's quality of work life and their families. To prevent the scenario from happening, they suggest that physicians should learn martial arts for self defense.

A medical picture quiz related to the diagnosis of a 40-year-old healthy man with sudden unilateral blindness, is presented.

Background: In our country, there are many studies on stroke, its associated conditions and their effect on stroke patient's outcome, but a few studies on electrolytes status in stroke patients have been done in our country, even outside. Method: A total number of 100 randomly selected, clinically and CT proven acute stroke patients were studied at medicine units of Dhaka Medical College Hospital. Electrolytes status in different type of acute stroke patients and their association with some common clinical presentation were identified and correlated. Result: Out of 100 patients, 29% were in between 51-60 years age group & 72% were male and 28% were female patients. Majority 53% patients had Ischaemic stroke, 45% Intracerebral haemorrhage (ICH) and only 2% had Subarachnoid haemorrhage (SAH). 53% of total acute stroke patient had dyselectrolytaemia. Among 100 acute stroke patients, 66.66% haemorrhagic stroke and 28.30% ischaemic stroke patients had headache (p<0.05). 70.66% haemorrhagic and 30.23% ischaemic stroke patients had vomiting (p<0.05). 53% of total acute stroke patient had dyselectrolytaemia. Among 100 acute stroke patient 49 (49%) presented with vomiting from which 73.46% had dyselectrolytaemia (p<0.01). 54 (54%) presented with headache from which 74.07% had dyselectrolytaemia (p<0.001). 62.22% of haemorrhagic stroke (p<0.05) & 43.39% of ischaemic stroke (p>0.05) patients had dyselectrolytaemia. Total 36% of all stroke patients had serum sodium imbalance & 31% had serum potassium imbalance. In haemorrhagic stroke & ischaemic stroke patients, hyponatraemia (17% & 13%), hypernatraemia (1% & 3%), hypokalaemia (19% & 11%), hyperkalaemia (0% & 1%), hypochloraemia (9% & 6%) respectively. Conclusion: In haemorrhagic stroke, the incidence of electrolytes imbalance was more than ischaemic stroke and which were mostly hyponatraemia and hypokalaemia. [ABSTRACT FROM AUTHOR]

Background: Alcohol is one of the most important causes of liver disease. In Bangladesh, alcoholism is not a usual practice among the general population as there are social and religious barriers against it. But in the Hill tracts, there is no social stigma in taking alcohol. Relatively little is known about this aspect in Bangladesh. This small-scale study was done to identify the spectrum of liver disease among tribal people. Material and Methods: A descriptive, observational clinical study was conducted for a period of six months (1st July, 2007 to 31st December, 2007) on a series of 50 tribal alcoholic people, collected from General Hospital and the tribal community of Rangamati Hill District. Subjects were included from both the urban and rural area of different socioeconomic classes. History, meticulous clinical examination and investigations were done to detect the pattern of alcohol induced liver injury. Results: Among the 50 cases, 47 patients were male and 3 were female cases. Both regular and irregular drinkers were included. The common symptoms of liver disease among tribal alcoholics were yellow coloration of sclera (24%), nausea & vomiting (20%) and weight loss (14%). The common findings were jaundice (24%), anemia (20%), ascites (10%), edema (10%) and hepatosplenomegaly (20%). Liver function tests revealed only 17 patients had mild to severe form of hepatocellular damage. Hyperbilirubinemia was found in 34% participants. AST/ALT ratio more than 2 was found in 32% subjects. Ultrasonography was done in 46 out of 50 subjects: 29 cases reported as normal (63.04%), fatty liver in 5 (10.87%), acute hepatitis in 5 (10.87%) and chronic liver disease in 7 (15.22%) cases. Liver biopsy was possible in 4 suspected cases (clinically and biochemically) of alcoholic liver cirrhosis and histology supported the clinical diagnosis in these cases. So, alcohol induced liver damage was noticed only in 17 cases. Nearly two-thirds of the participants were free from any form of liver disease. Conclusion: Despite the presence of risk factors for developing alcoholic liver disease, the prevalence was found to be low among the tribal alcoholic participants in this study. [ABSTRACT FROM AUTHOR]

Introduction: Bangladesh recorded the first case of 2009 pandemic influenza A (H1N1) virus infection on 18th June 2009. This report describes the clinical and epidemiological characteristics of both the indoor and outdoor patients reporting in Flu Ward and Flu Corner of Dhaka Medical College Hospital. Methods: This cross-sectional study was done on highly suspected 833 registered outdoor (flu corner) and 28 indoor patients admitted in Flu ward of Dhaka Medical College Hospital during the study period of August 2009 to November 2009. A suspected case was defined as an influenza-like illness and either a history of travel to a country where infection had been reported in the previous 7 days or an epidemiologic link to a person with confirmed or suspected infection in the previous 7 days. A confirmed case was defined by a positive real-time reverse-transcriptase polymerase chain reaction (RT-PCR) assay. Results: Most of the patients were in between 20 to 30 years age group. Indoor patients presented with mostly fever (92.85%), rhinorrhea (71.42%), shortness of breathe (89.28%) and cough (64.28%). Maximum duration of fever in indoor patients was 4 days. RT-PCR from throat swab sample for H1N1 tested positive in 9 (32.14%) indoor patients. Out of the 833 outdoor patients 596(71.54%) patients had fever, 585(70.22%) had cough, 410(49.21%) had rhinorrhea and 314(37.69%) had sore throat. Only 2(7.14%) admitted patients died of flu. Conclusion: Despite widespread infection mortality rate is quite low. Prompt implementation and adherence to national guidelines on 2009 pandemic influenza A (H1N1) should be encouraged. [ABSTRACT FROM AUTHOR]

Background: Compared with general population mortality rates are 10-20 times higher among patients with end stage renal disease, with 50% of this excess burden being attributable to cardiovascular disease. This excess risk is not entirely explained by elevation of traditional risk factors. Elevation of several Non-traditional risk factors associated with an increased risk for cardiovascular disease in CKD and haemodialysis dependent patients. Methods: It was a case control study which included total 96 subjects, 48 were non-dialysis CKD patients, 22 Heamodialysis dependent patients and 26 healthy controls. Non-traditional risk factors homocysteine, fibrinogen, CRP, factor VII activity and haemoglobin estimated and compared with normal control population. Results: The study revealed that homocysteine , fibrinogen , CRP, factor VII significantly increased and haemoglobin was significantly low in both non-dialysis CKD and haemodialysis dependent patients in comparison to control group. Mean homocysteine 15.38, 27.30, 23.76 μmol/L in control, non-dialysis CKD and haemodialysis dependent patient respectively. Fibrinogen in control , non-dialysis CKD and haemodialysis dependent patient were 180.25 , 264.10 , 259.59 mg/dl respectively. CRP level in control, non-dialysis CKD and haemodialysis dependent patient were 3.90, 52.59, 17.31 mg/L respectively. Factor VII activity in control was 94.18%, whereas in non-dialysis CKD it was 103.97%, and 106.18 % in haemodialysis dependent patient. haemoglobin was 13.85 gm/dl in control , but in nondialysis CKD it was 8.08 gm/dl, and in haemodialysis dependent patients 9.46 gm/dl .cardiovascular disease in nondialysis CKD 54.56% and haemodialysis dependent patients 59.4% Conclusion: Haemoglobin is low and levels of homocysteine, fibrinogen, CRP, factor-VII activity are increased among the patients with CKD and haemodialysis dependent patients. [ABSTRACT FROM AUTHOR]

Objective of the study was to see the frequency of isolation of Mycobacterium among different extrapulmonary specimens. The study was carried out at NTRL (National Tuberculosis reference laboratory), NIDCH Bangladesh during January 2008-June 2009. This study was carried out retrospectively by analyzing NTRL laboratory data. A total of 514 extra-pulmonary specimens from different treatment centre of Dhaka was analyzed. Clinical specimens, such as lymph node aspirate, pleural fluid, urine, stool, gastric lavage, pus, ascitic fluid, cerebrospinal fluids, etc was collected. Lowenstein-Jensen media was used for culture and antimicrobial susceptibility testing. Mycobacteria were isolated from 113 extra-pulmonary specimens. Male and female ratio was almost equal among positive cases. The commonest source of isolation was lymph nodes(frequency 55.8%) and lymph node aspirate( frequency 68.4%) pleural fluid (frequency10.6%).Anti-microbial susceptibility of the isolates to the four first line anti-tuberculosis drugs, rifampicin, isoniazid, streptomycin and ethambutol was tested, susceptibility rate was 100%.The results suggest that,, emphasis should be placed on laboratory diagnosis and treatment of extra-pulmonary tuberculosis. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 55 years old normotensive lady presented with progressive shortness of breath and palpitation and was diagnosed hyperthyroidism and was treated with antithyroid drugs while her treatment of heart failure was optimized.