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Aortopulmonary window (APW) itself is a rare congenital cardiac malformation and its association with Tetralogy of Fallot (TOF) makes it more uncommon. We report a case of APW with TOF who presented at 4-year 10 months of age. As the boy was still in operable state, after thorough preoperative evaluation successful surgical repair was done.

Aim: The study was undertaken with an objective to know the thyroid functions in Type 2 diabetics and to know the spectrum of thyroid dysfunction in Type 2 DM. Methods: The present study included 68OPD and IPD patients of Type 2 DM who attended the Department of General Medicine at Dhaka Medical College Hospital Dhaka. Detailed history and examination were done, fasting blood samples of all the subjects were taken and at the same time samples were tested for HbA1C and thyroid profile (T3, T4 and TSH). Result: in this study 68 established diabetics were screened for thyroid disorders by TFT. Abnormal thyroid function was found in 43 T2DM cases and remaining diabetics had normal thyroid function. Among 68 cases low thyroid function was noted in 20 patients and 18 subjects had Sub-clinical hypothyroidism. Hyperthyroidism was noted in 05 patients. Conclusion: Type 2 diabetes mellitus is a major problem all over the world and many patients of Diabetes Mellitus are associated with thyroid dysfunction. So diabetic patients s should be screened for thyroid disorder especially hypothyroidism. J Dhaka Medical College, Vol. 29, No.2, October, 2020, Page 149-152

Aim: The study was carried out to see the risk factors of Acute Coronary Syndrome in young patients. Materials and Methods: This is a prospective study which was carried out in 60 young patients (18-40 years of age) with a diagnosis of Acute Coronary Syndrome admitted to Dhaka medical college Hospital, Dhaka. over a period of 02 years from January 2016 to January 2018. Acute Coronary Syndrome was diagnosed by clinical history, ECG evaluation and Serum Cardiac enzyme Troponin I and CK-MB estimation. Result: Most of the patients (73%) had a sedentary lifestyle and 50% had dyslipidemia. 40% patients were taking a diet rich in fats, 37% patients were diabetic, 33% were hypertensive, 37% patients consume oral tobacco, 30% were smokers, 13% were obese and 17% were alcoholics. The family history of premature coronary artery disease was present in only 13% of cases. In our study, none of the patients had consumed oral contraceptive pills. Conclusion: The most important modifiable risk factor is the sedentary lifestyle. The commonest non-modifiable risk factor is Male sex. Smoking, oral tobacco consumption, hypertension, diabetes, dyslipidemia, and diet modification are other important modifiable risk factors in young adults. J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 3-6

Aim: The study was carried out to see the Serum Bilirubin, ALT, AST and Alkaline Phosphatase as liver function in liver cirrhotic patient. Method: The study was carried out among 50 well-compensated patients of cirrhosis of liver irrespective of their age, sex, residence & income group. Patient was randomly selected while they were hospitalized in Dhaka Medical College Hospital, Sir Salimullah Medical College & Mitford Hospital and Bangabandhu Sheikh Mujib Medical University. Result: Serum Bilirubin, AST, ALT and Alkaline Phosphatase level were done in 50 (fifty) cirrhotic patient out of whom 38 were male and 12 were female. Mild to severe level of serum bilirubin were documented in 50% patients. Two-fold and fourfold rise of ALT were formed in 48% and 10% cirrhotic patient respectively. Similar pattern of rise of AST also shown in 50% cirrhotic patient. Alkaline Phosphatase value was normal in 92% patient and of 08% two-fold rise of Alkaline Phosphatase Alkaline Phosphatase. J Dhaka Medical College, Vol. 28, No.2, October, 2019, Page 190-191

Hepatitis B virus infection is a major global health problem. There is no specific treatment for acute hepatitis B infection. A safe and effective vaccine, which has been available for more than 30 years, is 95% effective in preventing the development of chronic infection. The employee of Bangladesh Bank and their family member had received 4 doses of Engirex B according to schedule 0, 1,6,12 months without any prior screening test. They received 4th booster dose in 2009.The goal of this study to find out and compare the efficacy and safety of vaccination against HBV without prior screening test. The employee (more than 50years old) underwent annul health check up and their serum HBsAg and Anti-HBs (quantative) were measured in the Immunology department of Bangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) and Popular diagnostic center. HBsAg is measured by MEIA method. Anti-HBs (quantative) are measured by chemiluminescence EIA method. 491 subjects have been studied. Among them 480(97.76%) are HBsAg negative and 11(2.24%) cases are HBsAg positive. Ten out of eleven HBsAg positive cases are male. The average anti- HBs titer of the employee is 610.9958(0- >2000 m IU/ml). The average anti-HBs titer of female (n=90) employee is 713(10- >2000 mIU/ml) and average anti-HBs titer of male (n=390) employee is 587.77(0 - >2000 m IU/ml). Female employee developed higher immunity (73.33%) than male employee (56.41%). So it is presumptive that vaccine is safe and effective and we can continue vaccination without prior screening test.J Dhaka Medical College, Vol. 25, No.1, April, 2016, Page 16-25

Background and Purpose: The development of type 2 diabetes mellitus (T2DM) is caused by a combination of genetic factors and lifestyle factors like obesity, lack of physical activity and stress. T2DM can develop in chronic liver disease (CLD) though its actual mechanism is not fully understood. In case of hepatitis B virus (HBV) related CLD, HBV infection has been directly related to development of abnormal glucose metabolism by pancreatic islets cell injury. Development of Insulin resistance in case of hepatitis C virus (HCV) is the key pathogenesis of development of type 2 diabetes. We aimed to study the magnitude of the problem of T2DM among the patients with various types of CLD and to find out the association of diabetes mellitus with the demographic and clinical characteristics of the patient admitted in Medicine ward in Dhaka Medical College Hospital.Methods: This was an observational cross sectional study of 60 patients admitted into department of Medicine, Dhaka Medical college hospital between June, 2013 to December, 2013. It included all patients ?18 years of age and admitted with CLD. A diagnosis of CLD was made clinically by any 2 stigmata of liver disease and biochemical, ultrasonographic, endoscopic evidence of esophageal varices ± liver biopsy.Results: Of the total 60 CLD patients, 40 (66.7%) suffered from chronic HBV infection, 11 (18.3%) chronic HCV infection and alcoholic liver disease 5 (8.3%), Autoimmune 1 (1.7%), Wilson disease 1 (1.7%) and unknown cause were 2 (3.3%). Among the study subjects 21.67% had overt Diabetes Mellitus and it was found to be highest among those with chronic hepatitis C (36.4%) and those with chronic hepatitis B (20%) alcohol (20%). Type 2 DM was significantly higher among the CLD patients aged more than 50 years or more.Conclusions: It can be concluded that the occurrence of diabetes and impaired glucose tolerance (IGT) could be a matter of great concern in CLD patients, indicating towards the need for regular monitoring of the glycemic status in these patients, which would have a definite role upon the treatment strategy.J MEDICINE July 2017; 18 (2) : 68-74

Arterial Hypertension is the most common cardiovascular disease and is a major public health problem in both developed and developing countries. The aim of the study was to assess renal involvement in hypertensive patient by renogram, which is not detected by conventional biochemical test. This was a cross sectional observational study. Consecutive 30 hypertensive patients admitted in the medicine wards from March, 2006 to April, 2007 in Rajshahi Medical College Hospital, Bangladesh were taken as case. Informed consent was taken from all the study patients or from their attendants. Detail history was taken from each patient or from their attendants' then clinical examination and relevant investigations were done. Emphasis was laid to find out renal involvement in long standing hypertensive patients by renogram. After initial selection; laboratory investigations like Urine for R/M/E, Blood Sugar 2ABF, S. Creatinine, USG of KUB, ECG and Hb% were done for every patients. All patients included in this study renogram were done. Majority of the patient (40%) were between the age of 41-50 years and Male: Female ratio was 3:2. Most of the patient lead a moderately active life (66.67%). Serum Creatinine was raised in 23.33% patient whereas renal parenchymal insufficiency evidenced by renogram was found in 50% case. In this study, we found that a significant number of cases (26.67%) having renal parenchymal insufficiency were not detected by S. Creatinine level, but detected by renogram. Renogram is superior to conventional biochemical renal function test for early detection of hypertensive nephropathy.Faridpur Med. Coll. J. Jan 2016;11(1): 11-14

Introduction: Enteric fever is highly prevalent in Bangladesh. Multidrug resistant salmonella Typhi is emerging throughout the world as well as in Bangladesh. Observing recent sensitivity pattern will help in choosing proper empirical antibiotics in resource limited country like Bangladesh as culture facilities is not available throughout the country.Materials and Methods: The study included 86 S. typhi isolates from blood cultures of patients suffering from suspected typhoid fever who attended the outpatient clinics or were admitted in Islami Bank hospital in Dhaka during January 2015 to July 2017.Results: A total of 86 S. typhi isolates were included in the study. Mean age of the study population was 22.06±17.1 and there was male 44 (51.2%) predominance. All the isolates of S. typhi were sensitive to Meropenem. Highest resistance was observed against Amikacin (62.4%) closely followed by Co-timoxazole (48.4%) and Amoxiclav (46.5%). The S. typhi isolates showed low-level resistance against Ceftriaxone (1.16%), Cefuroxime (4.6%), Azithromycin(13.9%), Levofloxacin (11.6%).Conclusions: According to findings of this study it can be advised that oral form of Cefuroxime, Levofloxacin and Azithromycin can be used as a first line. Then if patient is nonresponsive Ceftriaxone might be used. Meropeman should be reserved for selective cases.J MEDICINE Jan 2018; 19 (1) : 15-17

Introduction: Non-alcoholic fatty liver disease (NAFLD) is a distinct clinicopathologic entity characterized histologically by a spectrum ranging from simple steatosis to steatohepatitis (NASH), cirrhosis and even hepatocellular carcinoma (HCC).Objective: To determine the incidenceand identify the risk factors of NAFLD in non-obese patients.Methods: It was a cross sectional study done in Department of gastroenterology, Nuclear Medicine and ultrasound, Radiology and Imaging, Virology, Biochemistry, BSMMU, Dhaka from March 2012 to June 2014. The patients more or equal to 18 years, non-obese were included. In this study total 190 patients were enrolled.Results: Among them 38 patients were with fatty liver and 152 patients without fatty liver on the basis of ultrasonogram. Where 141 were male and 49 were female with mean age was 49.24 + 9.05 years. Among total, 18.9% had diabetes mellitus, 28.4% had dislipidaemia 24.4% had history of hypertension. Total 18.9% patients having history of diabetes mellitus, normal vs fatty liver disease (20% vs 42.1%, p

Background: Arrhythmias are often a manifestation of structural heart diseases but may occur in the context of non cardiac diseases even in an otherwise normal heart. It may be supraventricular or ventricular. Among the arrhythmias premature complexes (ventricular & atrial) are most common type of arrhythmia occurs in patients with or without significant heart disease.Objective: In this study, the aim was to find out the aetiological pattern of premature ventricular and atrial complexes and their consequence on morbidity and mortality, demographical pattern of patients with ectopic beats, to find out aetiological factors leading to development of premature complexes, to find out common clinical presentations and to differentiate the PVCs which are more benignMethods: It was a cross sectional study. This study was carried out in the Department of Medicine and Department of Cardiology of Sir Salimullah Medical College and Mitford Hospital, Dhaka from 1st May 2008 to 15th September 2008. A total 50 consecutive patients irrespective of age, sex and occupation having atrial and ventricular premature complexes on ECG attending at OPD and admitted in indoor were included in this study. Results: Among the three types of premature complexes 9 patients with APCs (also includes 2 patients of premature junctional complex) and 41 patients with PVCs were included. The ratio of patients with PVCs and APCs in this study.8.2: 1.8. In this study 41 patients of PVCs were studied. Among them 37 patient that is 90.3% patients had structural heart disease and the commonest cause was IHD (63.4%), 9.7% had HTN with LVH, 7.3% had DCM, 4.87% had HOCM, one patient had myocarditis ( 2.4%) and one had MVP with sick sinus syndrome (2.4%). Among the 9 patients of APC 4 patients that is 44.44% were suffering from COPD with corpulmonale which was the most commonest cause of APCs.Conclusions: Ventricular arrhythmias are more common than atrial arrhythmia and IHD is the single most common cause of arrhythmia. Ectopic beats in patients with otherwise normal hearts are more prominent at rest and disappear with exercise. Treatment is not necessary, unless the patient is highly symptomatic.J MEDICINE July 2015; 16 (2) : 97-102

Biopsy from the distal second part of duodenum is now widely accepted as a useful and simple way to evaluate patients with malabsorption or other small intestinal diseases.Histological findings of the second part of duodenum in tropical countries are different from that of other countries. Histological appearance of the second part of the duodenum may be changed due toceliac disease, tropical sprue, tropical enteropathy and some other conditions. As Bangladeshi people, we are exposed to different infection always due to its geographical distribution. Normal histological appearance of second part of duodenume.g. standard villous architecture, length, villous crypt ratio, IELcounts of our country in not known. The main objective of our study was to see the normal histological appearance of second part of duodenum in our country so that we can differentiate from abnormal condition. This observational study was carried out in the Department of Gastroenterology & Pathology, Bangabandhu Sheikh Mujib Medical University, (BSMMU)during the period of July 2010 to June 2011. A total of 116 patients were included from out patientdepartment and admitted patient in the department of Gastroenterology during the study period. Among the total numbers, the mean age was 32.7±9.77 (±SD) years.In our study, 48.27% subjects had finger shaped villous with normal height, 27.58% had both normal and broad villous, 22.41% subjects showed mixed findings of normal, broad and blunted villous and only 1.7% subjects showed broad and blunted villous without normal architecture. In our study, the highest IEL count was 62 cells per 100 epithelial cells and lowest value was 16. Mean value IEL/100 cells were 32.52 ±8.63 (±SD) and 95%CI was 1.57. The result of the study was very similar to Asian people but a little different from the western population.DOI: http://dx.doi.org/10.3329/jom.v16i1.22385 J MEDICINE 2015; 16 : 23-26

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