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Background: Vitamin B12 deficiency can impair the metabolism of homocysteine, leading to hyperhomocysteinemia that can cause thrombosis in the intracranial blood vessels resulting in a stroke. Case Presentation: A 15-year-old Muslim young boy initially presented with pallor, slurred speech, right facial weakness, and right-sided hemiplegia. On examination, he was found moderately anemic, nonicteric, and with right-sided stroke evidenced by hypertonia, reduced muscle power jerk exaggerated with extensor plantar response. There was no lymphadenopathy, bony tenderness, intellectual impairment, or organomegaly, and normal vital parameters with the unremarkable cardiovascular examination. Laboratory investigations revealed pancytopenia, with reduced Vit B12, folic acid, and moderately increased homocysteine level. Bone marrow study suggestive of megaloblastic anemia. Immunological, infectious screens; and prothrombotic markers were found negative. CT scan of the head revealed a hypodense lesion in the left parieto-occipital region, DWI sequence on MRI Brain revealed diffusion restriction in the same area while an MR angiogram of the Brain revealed occlusion of the left middle cerebral artery due to thrombus sparing a small segment after its origin. In addition, he had MTHFR c677 C>T (Methyl tetrahydrofolate reductase) gene mutation and responded both clinically and biochemically after vitamin B12, folic supplementation along with aspirin in 5 months. Conclusion: Vitamin B12 deficiency along with MTHFR c677 C>T gene mutation has increased the chance of thrombotic stroke. Vitamin B12 supplementation might be beneficial for patients with an MTHFR gene mutation positive. [ABSTRACT FROM AUTHOR]

Background: Erythema induratum of Bazin is a rare manifestation of cutaneous tuberculosis. It may mimic some systemic disorders like sarcoidosis, poly arteritis nodosa, lymphoproliferative disorder, Histoplasmosis, and lupus profundus. Case Presentation: A 38-year young female, diabetic, and hypertensive presented with multiple painful skin lesion over anterior part of her leg for 3 months. These skin lesion used to appear as painful erythematous nodules of variable size and shape over the anterior and lateral aspects of both legs that became ulcerate, healed with hyperpigmentation. On examinations, all of her systemic examinations revealed unremarkable except skin lesion. Punch biopsy from skin lesion revealed lobular panniculitis with granuloma suggestive of erythema induratum and MTB gene Xpert from skin lesion found positive. Thereafter, she was put on anti TB therapy six-month regimens according to the national TB guideline, Bangladesh. After 2 and half months of treatment, her skin lesion disappeared. Conclusion: In a TB prevalent country, erythema induratum should be kept in differential diagnosis along with others. As it is usually underdiagnosed or misdiagnosed because of the absence of typical clinical features of TB, therefore comprehensive investigations like skin biopsy with histopathology, detecting DNA of Mycobacterium tuberculosis by PCR, positive Mantoux test are the cornerstone for confirmatory diagnosis. [ABSTRACT FROM AUTHOR]

Urinary tract infection is one of the most common bacterial infections seen in clinical practice both in developed and developing countries. The causative agents of Urinary tract infection vary from place to place and they also vary in their susceptibility and resistance patterns. This descriptive study aimed to evaluate the antibiotic susceptibility patterns of pathogens isolated from routine laboratory specimens at Dhaka Medical College Hospital. A descriptive cross- sectional study was done from January 2018 to June 2018. A total of 100 mid-stream urine samples from the suspected UTI patients were tested microbiologically and antimicrobial susceptibility test were performed for the isolated pathogens using Kirby-Bauer disk diffusion method with positivity rate of UTI was 90% (90/100). Escherichia coli (39%) was the most UTI causing bacteria followed by Klebsiella 18(18%), Acinetobacter 12(12%), Staphylococci, 9 (9%), Pseudomonas 6 (6%), Enterococcus species 3 (3%) and Proteus 3 (3%). Female 83 (83%) were more affected in comparison with male. Adult female especially age range 18-30 years were found in high risk. Nitrofurantoin, Amikacin and Meropenem were recorded as most sensitive antibiogram for most of the bacteria's whereas cephalosporin showed increased resistance. However, for uncomplicated community acquired UTI, Nitrofurantoin (oral) and Amikacin (Injectable) can be chosen as first line medication. [ABSTRACT FROM AUTHOR]

Gaucher’s disease (GD) is a lysosomal storage disorder due to glucocerebrosidase deficiency; it’s one of the rare genetic diseases for which therapy is now available. Lysosomal storage of the substrate in cells of the reticuloendothelial system leads to multisystem manifestations, including involvement of the liver, spleen, bone marrow, lungs, and nervous system. Three different subtypes have been identified: Type 1, non-neuropathic form, adult onset; type 2, acute neuropathic form, infantile onset; type 3, neuropathic form, juvenile onset. The diagnosis is confirmed by presence of less than 15% activity of the enzyme Glucocerebrosidase in peripheral leucocyte with presence of Gaucher cells in macrophase monocyte system, is the pathological hallmark. Enzyme replacement therapy (ERT) is now available. We are reporting a case here which presented with cytopenia and massive splenomegaly. This case has been presented to focus on the importance of clinical examinations, differentiating from other diseases of similar manifestations, enzyme activity and bone marrow study for early diagnosis. [ABSTRACT FROM AUTHOR]

Gaucher's disease (GD) is a lysosomal storage disorder due to glucocerebrosidase deficiency; it's one of the rare genetic diseases for which therapy is now available. Lysosomal storage of the substrate in cells of the reticuloendothelial system leads to multisystem manifestations, including involvement of the liver, spleen, bone marrow, lungs, and nervous system. Three different subtypes have been identified: Type 1, non-neuropathic form, adult onset; type 2, acute neuropathic form, infantile onset; type 3, neuropathic form, juvenile onset. The diagnosis is confirmed by presence of less than 15% activity of the enzyme Glucocerebrosidase in peripheral leucocyte with presence of Gaucher cells in macrophase monocyte system, is the pathological hallmark. Enzyme replacement therapy (ERT) is now available. We are reporting a case here which presented with cytopenia and massive splenomegaly. This case has been presented to focus on the importance of clinical examinations, differentiating from other diseases of similar manifestations, enzyme activity and bone marrow study for early diagnosis. [ABSTRACT FROM AUTHOR]

Essential thrombocythemia represents a rare risk factor for ischemic stroke. Uncontrolled proliferation of megakaryocytes sustained increases circulating platelet count and thrombotic risk. Many patients suffering from the disease may have no symptoms for a long time. We present a case of 60 year old lady with ischemic stroke who was a known case of essential thrombocythemia. And the cerebrovascular event was the complication of essential thrombocythemia as she quit treatment. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus is responsible for significant morbidity and mortality around the world though there is huge development regarding its treatment. Many studies showed that functional health literacy has a great impact on diabetes outcome. The study assessed the relationship between functional health literacy and glycemic control in a sample of urban diabetic patients. Materials and methods: A cross-sectional study was conducted in Bangladesh University of Health and Science Hospital, Jurain, Dhaka from January to December 2014 that included adult diabetic patients on the basis of defined selection criteria following the purposive sampling method. Functional health literacy was assessed with the short form Test of the Functional Health Literacy in Adults (s-TOFLA). Recent HbA1c was used as a measure of glycemic control and categorized into tight, fair and inadequate glycemic control. Regression models were controlled for demographic data, diabetes duration, treatment regimen, diabetes knowledge and assistance for taking medications. Results: Following the s-TOFLA scale, 60.5% of the diabetic patients had inadequate functional health literacy of them, 89.3% had inadequate glycemic control (HbA1c>8%). And those who had adequate functional health literacy (24%) of them 68.8% had tight glycemic control (HbA1c ≤7%). Overall 63.0% of the respondents had inadequate glycemic control. In linear regression model low s-TOFLA scores, longer diabetes duration and lack of assistance for taking medications were associated with higher levels of HbA1c. In fully adjusted model s-TOFLA score was the variable which was more strongly associated with HbA1c (b = -0.60, P<0.001). Conclusions: The study found that low health literacy is consistently associated with inadequate glycemic control. [ABSTRACT FROM AUTHOR]