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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: Rickettsial diseases are difficult to diagnose in Bangladesh due to low index of suspicion and lack of diagnostic facilities in most laboratories especially in rural areas. Immunofluorescence assay (IFA) is the gold standard serological test for diagnosis of Rickettsial diseases. For serological diagnosis of rickettsial diseases, use of filter paper is an inexpensive and convenient method for collecting, storing, and transporting of blood samples with little space without refrigeration. Current study shows that the rickettsial diseases were present in febrile patients in Bangladesh. The study also compared the results of direct serum by IFA and filter paper serum spot followed by IFA as an alternative way of testing frozen samples. Materials and Methods: This observational study for evaluation of rickettsial diseases from direct serum by IFA and sera dried on blotting paper followed by IFA at the department of Virology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. A total of 152 patients’ sera were selected by systemic random sampling of every 3rd sera of 556 febrile patients who were tested negative for dengue and or Chikungunya virus infection. Forty cases were confirmed by IFA from direct sera. In addition, 60 samples were selected from 152 sera by systemic random sampling of every 3rd sera for blotting on filter paper for further IFA test. Out of 60 sera, 35 were confirmed by IFA from direct sera and of the 35 confirmed positive cases, 31(88.6%) were positive by IFA after blotting paper assay. Taking the IFA of direct sera as gold standard test, the sensitivity, specificity, positive predictive value and negative predictive value of IFA from blotting paper eluted sera were 88%, 100%, 100% and 86% respectively. Conclusion: The study showed the use of filter paper is an inexpensive and convenient method for storing and transporting samples for serological tests like IFA in diagnosis of rickettsial diseases. J Dhaka Medical College, Vol. 28, No.2, October, 2019, Page 153-158

Importance: Hypokalemia is a neglected common manifestation in COVID-19 patients admitted in hospital though it has serious consequences. Coronavirus may cause hypokalemia through disruptions of rennin-angiotensin system, gastrointestinal loss or other unknown mechanisms. Objective: To investigate the prevalence of hypokalemia among patients with moderate to severe COVID-19 and its association with other clinical and laboratory parameters. Design, Setting, and Participants: This was cross sectional observational study conducted at Dhaka medical College Hospital of Bangladesh from June, 2020, to August 2020. Participants were included who were positive for rt-PCR for COVID-19 according to the national guideline. The patients were classified as having severe hypokalemia (plasma potassium 3.5 mmol/L). Results: Prevalence of hypokalemia among patients with COVID-19 was 20.2%, severe hypokalemia (2 patients [1.5%]) and hypokalemia (25 patients [18.7%]). One thirty four (134) patients with positive COVID-19 were included. The mean [SD] age of these 134 patients according to different potassium levels appear to be : 68 [2.83] years for severe hypokalemia , 51.93[11.68] years for hypokalemia and 50.73[14.7] years for normokalemia. Among them, 46 patients were females [34.32%]) and rest were males [65.68%]. Within the total sum of 134 patients, 107 were identified having normokalemia, [79.9%]. 25 patients [18. 7%] had hypokalemia and only two patients [1.5%] were found having normokalemia. Among 134 patients, three commonest symptoms were fever (132 patients [98.5%]), dry cough (123 patients (91.79%) and shortness of breath (122 patients [91.04%]), followed by less common symptoms like fatigue (89 patients [66.410%]), sore throat (60 patients [44.77%]), and diarrhea (44 patients, [32.83%]). Shortness of breath was associated with grades of hypokalemia (P=0.022). Only 26 patients (19.4%) manifested having vomiting/Nausea. The predominant comorbidities found among these 134 participants were Hypertension (68 patients [64.2%]), Diabetes (54 patients [52.9%]), Ischemic heart disease (37 patients [38.1%]) and Asthma (27 patients [31.0%]). The prevalence of comorbidities was not associated with Hypokalemia. Conclusions Prevalence of hypokalemia among patients with COVID-19 is high (20.2%) and appropriate treatment is highly required. J Dhaka Medical College, Vol. 29, No.2, October, 2020, Page 131-137

Background: Upper abdominal surgery (like- hepatobiliary surgery, gastrectomy, esophagectomy, hepatictomy, and whipples operations that involve large surgical incisions) lead to severe postoperative pain that lead to higher doses of opoids use in post-operative period as a result incidence of unwanted side effect and respiratory complication increase hospital stay and morbidity. To reduce the use of opioids clonidine can be used as a multimodal analgesic approach. It is reported that clonidine 150mcg intravenous (I/V) produce a similar analgesic effect to morphine 5mg in patient after orthopedic surgery. Because of its dose, route, and surgical variation it is very much important to specify the dose for upper abdominal surgery. Material and methods: After considering the inclusion and exclusion criteria the patients were randomized to receive Group: A (2mcg/kg oral clonidine) and Group: B (4mcg/kg oral clonidine), one hour (60minutes) before surgery as an oral premedication. All groups were compared for preoperative analgesic, sedation and anxiety level along with changes of heart rate and mean arterial pressure prior to premedication and post-operative periods as follows VAS (visual analogue score) pain scores. Result: The post-operative pain measured on VAS showed Group A expressed highest VAS at 6thpost-operative hour Group –B showed highest VAS at 14th post-operative hour. So it is very clear to us that pethedine requirement of Group B (4mcg/kg oral clonidine) is less than Group A (2mcg/kg oral clonidine). The oral premedication with clonidine at 2 microgram per kg or 4 microgram per kg for postoperative analgesia and hemodynamic stability of elective upper abdominal surgery patients. Conclusion: As a part of multimodal analgesic approach, 4mcg/kg oral clonidine premedication is effective to perioperative pain control and keep stable the haemodynamic in upper abdominal surgery J Dhaka Medical College, Vol. 28, No.2, October, 2019, Page 131-135

Background : Chronic renal disease changes both quality and quantity of bone through multifactorial influences on bone metabolism, leading to osteopenia, osteoporosis and increased risk of fracture. The objectives of this cross sectional study are to determine the mean bone mineral density (BMD) and to identify osteopenia and osteoporosis in patients of CKD on maintenance hemodialysis. Methods: Twenty three male and 18 female patients with age between 18 and 50 years were enrolled in this study. The BMD of the lumbar vertebral spine (LV) and the neck of femur (FN) were measured in all patients. Data were analyzed using SPSS version 20.0 software and the level of significance was considered as P

Background: Dengue is an endemic disease for Bangladesh with occasional outbreak. Little is known about the predictors of severe dengue. Methods: This cross sectional study was conducted in the medicine department of Dhaka Medical College from April 2019 to March 2020. Total 199 consecutive patients were enrolled in this study. For the purpose of the analysis, dengue fever was classified as group I and dengue hemorrhagic fever and dengue shock syndrome was classified as group II. Results: The mean (SD) age of the study population was 28.5(12.1) and 87.4% were less than 40 years of age. The male and female ratio was about 3:1. Among the total study population, 149(74.9%) patients had DF, 46 (23.1%) had DHF and only 4 (2%) had DSS on presentation. Baseline demography and clinical presentation did not significantly differ between classical dengue and severe dengue. Previous history of dengue had low association with severity (RR, 95%CI, phi, P value; 1.2, 1.04-1.40, 0.25, 0.001).Most of the laboratory parameters were similar between the groups. The number of platelet count was significantly lower in DHF and DSS [median (IQR) 43500(16500-95250], than DF [median (IQR) 65000(33000-1170000, p-value 0.01] Conclusion: Previous infection with dengue virus and decreasing platelet count are the predictors of the severe dengue. J Dhaka Medical College, Vol. 29, No.1, April, 2020, Page 77-82

Introduction: Carpal tunnel syndrome (CTS) is a clinical syndrome that results from compression of median nerve within the carpal tunnel at the wrist. The aim of this study was to review the clinical and demographic characteristics and electrophysiological patterns of CTS patients who presented to a tertiary care hospital in Bangladesh. Methodology; A descriptive cross-sectional study was conducted on 150 CTS patients at the neurology department, Dhaka Medical College Hospital between January, 2019 to March , 2020 . All the subjects had clinical evaluation and standardized nerve conduction studies of upper limbs (300 limbs) using the same protocol. Results: 228 hands were found to have clinical and electrophysiological features consistent with CTS. There was female predominance (90%) and the highest occurrence of CTS was in the 45-55 years age group. Bilateral CTS was found in the majority of cases ie 78 (52%) and the rest had unilateral CTS. Among those with unilateral CTS, right hand was affected more (41, 57%) than left hand (31, 43%). Most of the cases were idiopathic. Neurophysiological studies showed most patients had mild CTS (121 hands, 53%). Most of the cases were idiopathic (102, 68%). Where a risk factor was found diabetes was commonest one (32) followed by hypothyroidism (12) and pregnancy (4). Conclusion: There was marked female predominance and the 45-55 years age group was predominantly affected. Majority of cases had mild CTS. Bilateral involvement was more common. Right hand was more affected than the left hand. J Dhaka Medical College, Vol. 29, No.2, October, 2020, Page 96-99

Introduction: Since the first detection of corona virus disease (COVID-19) cases in Dhaka, Bangladesh on 8 March, 2020, numbers are rising alarmingly. Clinical data on COVID-19 in Bangladesh is lacking. We report early findings on demographic profile, clinical presentations and short-term clinical outcomes of confirmed COVID-19 patients admitted in a large teaching hospital in Dhaka, Bangladesh with preliminary analyses of their association with mortality. Materials and Methods: In this retrospective cross-sectional study, we included reverse transcription polymerase chain reaction (RT-PCR) confirmed COVID-19 patients aged ≥ 15 years, who were admitted in Dhaka Medical College Hospital (DMCH) between May 2 and 15, 2020, the first two weeks when DMCH started admitting COVID-19 patients. Data were collected between May 25 and 29, 2020 from patients or their attendants through telephone interview by a structured questionnaire, after having appropriate consent, irrespective of outcome. One hundred and eight consecutive patients met inclusion criteria through convenient sampling from ward registrar, 102 patients could be reached over phone and data from two patients were discarded in the data cleaning process. The statistical analysis was done by the Statistical Package for the Social Sciences (SPSS) version 22.0. Results: Among the total participants (n=100), mean age was 41.7±16.3 years, 63% were male and 60% patients had positive contact history. Appearance of symptom to hospital admission time was a median of 6 days (range 1 to 21 days) and mean hospital stay was 7.77 ± 5.62 days. Predominant presenting symptoms were fever (69%), cough (54%), breathlessness (41%), fatigue (40%), anorexia (26%) and diarrhea (19%). Hypertension (21%), diabetes mellitus (16%), heart diseases including ischemic heart disease (IHD) (8%) and renal diseases including chronic kidney disease (CKD) (8%) were frequent comorbidities. Ten out of hundred patients died. Older age (p= 0.001), male sex (p= 0.007), smoking (p= 0.001), breathlessness (p=0.001) and presence of comorbidities (p= < 0.05) were significantly associated with mortality. Conclusion: Frequent positive contact history and significant association of breathlessness, smoking and comorbidities with mortality in our study reinforces that abiding by the prevention and containment process, smoking cessation, ensuring proper oxygen therapy and addressing comorbidities adequately are very important measures to mitigate COVID-19 in Bangladesh like the rest of the world. J Bangladesh Coll Phys Surg 2020; 38(0): 29-36

Introduction: Corona Virus Disease 2019 (COVID-19) is caused by SARS-CoV-2, a newly emergent virus. World Health Organization declared COVID-19 as pandemic on March 11, 2020 for its rapid spreading. Not only to diagnose the disease (confirm case) but also to control and contain the transmission; test, trace and isolation are fundamental. RT-PCR for SARS-CoV-2 is used to detect and diagnose COVID-19 which started in Dhaka Medical College Hospital (DMCH) on 2nd April 2020. In this study we described our observation of RT-PCR done in patients presented in DMCH in the first month after starting the test. Methods: This observational, cross sectional study was done to find out the rate of RT-PCR positivity in suspected COVID -19 patients presented to DMCH from 2nd April to 3rd May, 2020 by the Department of Medicine in association with the Department of Virology. Data was collected from the registry book of the Department of Virology. The rate of RT-PCR for SARS-CoV-2 positivity among the suspected COVID-19 patients and demographical variable was observed. Results: Among the total studied patients (n=3206), 58.8% (n=1886) was male and mean age was 37.7(±14.38784) years. RT-PCR for SARS- CoV-2 was positive in 26.9% (n=864). Mean age was higher in patients positive for test (39.6± 15.9 year vs. 37±14.4 year). Male predominance was more marked in patients with positive PCR test (68.4 vs. 55.9). Conclusion: High rate of positivity of RT PCR for SARSCoV- 2 among the suspected patient for COVID 19 indicated high disease burden and transmission in this highly populated area in the early period of pandemic which should be considered as was alarming. J Bangladesh Coll Phys Surg 2020; 38(0): 67-70

Introduction: The outbreak of COVID-19 is taking an unprecedented mental toll on health workers worldwide. So it comes as no surprise that the mental well-being of health care workers of Bangladesh too is in serious jeopardy. This survey was aimed to assess the immediate psychological impact on doctors working in largest Covid-19 dedicated facility in Bangladesh, Dhaka Medical College Hospital. Methods: This cross sectional study was conducted in a single-centre with response received from participating doctors between 31st May to 3rd June, 2020. Mental health variables were assessed via the Athens Insomnia Scale (AIS) and Hospital Anxiety Depression Score (HADS). Results: We received 192 completed questionnaires (response rate, 64.43%) among whom around 50% of the participating doctors reportedly have depression and anxiety symptoms respectively. Among them 104 doctors (54.17%) responded to have insomnia. Around 56% of the responding subjects perceived the highly contagious nature of the SARS-CoV-2 as the most striking threat of COVID-19. Conclusion: Agonizing disease process, high death toll, highly contagious nature of the responsible virus is taking a serious mental toll on physicians in the background of their heightened concern about personal health and family health, scarcity in PPE and adequate hospital facility. Psychological protective measures implemented by the hospital could be helpful. J Bangladesh Coll Phys Surg 2020; 38(0): 50-55

Background: Bacterial bloodstream infections (BSI) are a major problem for health care personnel’s, which leads to high morbidity and mortality of patients. Early and timely diagnosis and appropriate medication will be the best way to save the lives of affected ones. Aim: The aim of the present study was to determine the bacterial profile of bloodstream infections and their antibiotic susceptibility pattern. Methods: This descriptive cross-sectional study was carried out at the Microbiology Laboratory, Popular diagnostic Ltd, Dhanmondi, Dhaka over a three months periods, from November’ 2017 to January’ 2018. A total 822 blood culture samples were screened. The positive blood cultures were examined and the organisms were identified as per standard procedures. Antimicrobial susceptibility testing was performed for all isolates by using disk diffusion technique, according to CLSI guidelines 27. Results: From total blood culture samples, 105 (12.77%) were positive. The most common isolated pathogens were Salmonella Typhi, 59 (56.19.5%). Other isolates are Salmonella paratyphi A & B, 11(10.47%); Eschericia coli 14 (13.33%); Klebsiella spp, 05(04.76%); Acinetobacter spp.11 (10.47%) Enterococcus spp. 02 (01.90%); Staphylococcus aureus, 02 (01.90%) and one Candida spp (0.95%). S. Typhi showed 100% sensitivity against Ceftriaxone and Cefixime, and also more than 80% sensitive against first-line drugs (Chloramphenicol and Co-trimoxazole). Almost all the strains were found resistant towards Nalidixic acid (sensitivity 05.71%). Most of the Staphylococcus aureus and Enterococcus spp were susceptible to Vancomycin and Linezolid. More than 80% of E. coli and Klebsiella spp.are sensitive to Imipenem and Meropenem and least sensitivity show against Ciprofloxacin, Cephradine and Ceftriaxone. Conclusion: Ongoing surveillance for antimicrobial susceptibility remains essential, and will enhance efforts to identify resistance and attempt to limit its spread. J Dhaka Medical College, Vol. 27, No.2, October, 2018, Page 114-122

Aim: This study aimed to evaluate the incidence of extra-axial cerebellopontine angle tumours and to characterize extra-axial cerebellopontine angle tumours. Methods: The study was carried out in Dhaka Medical College for the duration of 2 years from July 2016 to July 2018. All patients with clinical suspicion of CP angle tumours subjected 1.5 T MR imaging system. Total 30 patients were evaluated during this period. Results: Extra-axial CPA tumours accounts for 7-10% of brain tumours. Most common extraaxial CPA tumour is schwannoma (60%), followed by meningioma (27%), epidermoid (7%), arachnoid cysts (7%). 51-60 years is the most common age group involved. Schwannomas are common extra-axial CPA tumours which are enhancing round masses most commonly arise from the vestibular nerve and associated with enlargement of the internal auditory canal. Meningiomas are the second most common extra-axial CP angle tumours which oval or hemispheric lesions with a broad attachment to tentorium or petrous dura matter. Conclusion: MRI is the most sensitive noninvasive modality to characterize extra-axial CPA tumours. MRI identifies the location and extension of the lesions based on their characteristic signal and enhancement pattern on contrast. J Dhaka Medical College, Vol. 27, No.2, October, 2018, Page 104-107

Background: Multiple Myeloma (MM) accounts for 1% of malignant tumors and 10%–15% of hematopoietic neoplasms. Bortezomib, a first in class proteasome inhibitor, induces apoptosis and growth arrest and reverse chemoresistence in Myeloma cell and has demonstrated no irreversible adverse effect on haemopoietic stem cell. Dexamethasone increases the response rate. Thus, Bortezomib plus dexamethasone represent highly effective regimen for previously untreated Multiple Myeloma cases and significantly higher response rates approximately 70%– 90% have been observed.This combination thus may serve the basis of future strands of care in Multiple Myeloma patients. Objective: The aim of the study was to assess the efficacy , safety and tolerability of Bortezomib in newly diagnosed cases of Multiple Myeloma patients in Bangladesh. Materials & Methods: This prospective observational study was carried out in the Haematology department of BSMMU from June 2017 to December 2018. Patients received inj. Bortezomib (1.3mg/m2 ) 4 cycles as an intravenous bolus on days 1,4,8,11 in a three week cycle (twice weekly administration) in indoor and same patients as day care basis in outpatients department. Dexamethasone at 40 mg was given intravenously or orally on the day of and day after inj Bortezomib.A self administered questionnaire containing different set of questions regarding Multiple Myeloma were used for data collection. Results: Among the study population, 93% of patients had anaemia followed by bone pain (86%) and renal impairment (39%). Out of 25 patients,complete response achieved in 13 patients (52%), where 4 patients(16%) showed partial response,6 (24%) showed very good partial response and 2 (8%) patients showed no response. The overall response rate was 92% belonged to partial,very goofd partial and no respone respectively. Death occurred in 3 cases (12%). 5 patients (20%) developed Bortezomib induced peripheral neuropathy.Life threatening intracranial haemorrhage occurred in two patients (8%). Death occurred in 3 cases (12%),2 patients due to intracranial haemorrhage and another from cardiac arrest. In this study,S. creatinine, â2 microglobulin and bony lesion variables showed significant association with treatment response. Conclusion: Bortezomib plus dexamethasone is a highly effective and safe regimen for previously untreated multiple myeloma patients. This novel therapy in myeloma represent a new trearment paradigm targeting both tumor and microenvironment which has markedly improve overall response(OR), long progression free survival (PFS) and overall survival (OS)across in all risk groups. Moreover,it can be administered safely in the outpatient setting provided by clinicians. J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 34-41

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

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

Background: Abnormal glucose metabolism is an independent risk factor for poor outcome following acute ischemic stroke. Objective: To evaluate the association between high HbA1c level and poor functional outcome in new onset ischemic stroke patient with diabetes mellitus. Method: This Cross sectional study was carried out in the Department of Neurology, BSMMU, Dhaka, from February 2013 to September 2014 on 50 patients with first attack of ischemic stroke with DM. modified Rankin Scale (mRS) and HbA1c were measured on 14th day of the stroke. During this period other important relevant investigations were also recorded. Result: Majority of the patients (40.0%) were in age group 51-60 years. The mean age was 58.9 ± 9.6 years with a range from 30 to 75 years. Males were 52.0% and females were 48.0%. Male to female ratio was 1.08:1. It was observed that more than one third (36.0%) patients were current smoker, 9(18.0%) were former smoker and 23(46.0%) were non smoker. Majority of the 29(58.0%) patients had hypertension. Mean systolic BP was found 129 ±16 mmHg with a range from 90 to 160 mmHg. The mean diastolic BP was found 81±11 mmHg with a range from 60 to 100 mmHg. HbA1c has significant positive correlation with modified ranking scale on 14th day of stroke [r= 0.504 (p

Introduction: Dengue is now established as one of the most important Arboviral infection in tropical countries. As the epidemic continues worldwide, this Aedes mosquito-transmitted pathogen is considered a major re-emerging tropical disease and significant public health concern. The study was conducted to determine the sero-epidemiology and clinical picture of dengue virus infection among the clinically suspected patients attended in Dhaka Medical College Hospital during January to December 2016.Materials and Methods: The study was carried out on 145 clinically suspected Dengue patients attended in Dhaka Medical College Hospital from January to December 2016 who had fever with temperature >39°C. Blood sample was collected during acute febrile phase of patients and separated sera were tested for NS1 dengue antigen and IgM antibodies using commercial test kits (NS1 by OMC Healthcare (Pvt.) Ltd & IgM antibody by Omega Diagnostics Ltd.).Results: Of the total 145 patients 40 (27.6%) were positive for Dengue NS1 antigen and or IgM antibody test. Of the positive 40 patients, 18 (45%) were positive for NS1, 19 (47.5%) were positive for IgM and 3 (7.5%) were positive for both NS1 and IgM antibody. Major clinical manifestations were fever with arthralgia (79.5%) and retro-orbital pain (50%).Conclusion: Outbreak of Dengue fever is continuing every year and typical presentation of Dengue fever has changed. Arthralgia and retro orbital pain was the most common clinical feature in the present study instead of headache and rash with fever. A large number of suspected dengue cases were negative by Dengue tests for antigen NS1 and IgM antibody which suggests other organisms of similar clinical manifestations are becoming prevalent in Dhaka city.J Dhaka Medical College, Vol. 26, No.2, October, 2017, Page 111-116

Pancytopenia is a triad of simultaneous presence of anemia, leucopenia and thrombocytopenia. It is result from a number of disease processes. Both hematopoietic and nonhematopoietic conditions manifest with features of pancytopenia.Methods: This was a cross-sectional study carried out in the Department of Medicine, Dhaka Medical College Hospital between December 2016 to July 2017. We included adult patients of both sexes having age 16 years and above. Criteria for inclusion were persistent pancytopenia on peripheral blood film of more than one week duration. All patients underwent a detailed medical history and full physical examination followed by blood sampling for the investigations. After taking all the aseptic measures and with standard technique the diagnostic bone marrow aspiration and trephine biopsy were done.Results: There were 36 patients with pancytopenia which were included in this study. There were 20 (56%) males and 16 (44%) females with a 1.25:1 male to female ratio and a mean age 47.30 years ± 15.01 SD. The most common complaints were bleeding manifestation (29/36), followed by generalized weakness (27/36) and fever (25/36). Anaemia was the most common (100%) clinical feature followed by jaundice and splenomegaly (6/36). Aplastic anemia was the commonest cause that was observed in 27.78% (10/36) cases followed by Megaloblastic anemia 16.67% (6/36) and erythroid hyperplasia 13.88% (5/36).Conclusion: Aplastic anaemia is leading cause of pancytopenia in this study followed by megaloblastic anaemia and hypersplenism being second and third common causes respectively. Pancytopenia should be suspected on clinical grounds when a patient presents with unexplained anemia, prolonged fever and tendency to bleed.J Dhaka Medical College, Vol. 26, No.2, October, 2017, Page 157-161

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

not available J Bangladesh Coll Phys Surg 2021; 39(3): 152-153

Introduction: Rockall score is used for risk assessment in acute upper gastrointestinal haemorrhage for intervention and prediction for risk of rebleeding and mortality.Methods: This is a cross sectional hospital based observational study carried out among patients presented with haematemesis with or without melaena in the department of Medicine, Dhaka Medical College Hospital from April, 2013 to March 2014 in one hundred consecutive cases. Rockall score done before and after endoscpy.Results:Patients mean age found 45.12±14.9 years with 4:1 male to female ratio. Service holder were (26.0%) and 91.0% were married. Almost half (48.0%) was educated. Combined haematemesis and melaena was presenting feature in 62.0% patients among them 72.0% arrived in hospital within 24 hours of onset. Comorbidity was found in 42.0% cases and 13% took NSAID. Oesophageal varix was found in 25.0%. No death observed in 18% haematemesis patients, one died from melaena (1 of 5) but most died (4 out of 5) from combined haematemesis and melaena. All the 5 death occurred in 89% rebleeding cases. No death observed in 34% patients having pre endoscopic Rockall Score d” 2; as well as in 44% cases post endoscopic Rockall score d”5 score. Mean duration Hospital stay was 6.36±4.5 days.Conclusions: Rockall score is useful in predicting outcomes in acute upper gastrointestinal haemorrhage.Bangladesh J Medicine Jan 2018; 29(1) : 13-25

Lifestyle modifications have key role in the management of diabetes. Awareness about the changes in lifestyle can play a vital role in the management of diabetes. There is a need of health education programs for diabetics and general population. As the diabetes is a slow progressive disease which causes target organ damage if not control. Study shows that controlled diabetics has also risk of target organ damage. Managing a diabetic patient needs to be combination of diet, discipline and drugs. Only drugs is given by the physician but the other two control parameter like diet and discipline is done by the patient himself. Life style modification can bring this two factor under control. Here we have studied 100 diabetic patient with following results.J Dhaka Medical College, Vol. 25, No.1, April, 2016, Page 46-52

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

not availableJ Bangladesh Coll Phys Surg 2016; 34(4): 233-242

not availableJ Bangladesh Coll Phys Surg 2015; 33(4): 237-244

not availableJ Bangladesh Coll Phys Surg 2017; 35(2): 48-50

This was a case of a 21 years old young man presenting with recurrent oral and genital ulcers, multiple nodules over all the four limbs and lower limbs’ pain. However, as these were so much painful, it hampered his daily life. We were also in doubt that whether this was really Behcet’s disease. We finally could diagnose it which was rare in Bangladesh. DOI: http://dx.doi.org/10.3329/jdmc.v23i1.22710 J Dhaka Medical College, Vol. 23, No.1, April, 2014, Page 134-139

Background: Aluminium phosphide is used to control rodents and pests in grain storage facilities. It produces phosphine gas, which is a mitochondrial poison. Unfortunately, there is no known antidote for aluminium phosphide intoxication and the mortality rate is very high. This type of poisoning (known as Kerry or Rice tablet poisoning) is common in Comilla region in Bangladesh. Methods: The study was an observational study and was conducted in the Department of Medicine and in Emergency Room of Comilla Medical College Hospital, Comilla, between February and August, 2013. Twenty five cases of Kerry tab. Poisoning were studied about their causes, clinical features, treatment and outcome. Results: Most of the patients (92%) were female and age range was 15-45 yrs. Familial disharmony was the main reason of their suicidal attempts. This poisoning was common in Chandina, Sadar, Debidar, Burichong, B.para, Muradnagar and Daudkandi upazillas of Comilla District. Vomiting and features of shock were the major clinical menifestations. Routine ECG was not done to these patients. Most of the patients (80%) were referred to higher centres in Dhaka after the primary management. Only 20% patients were survived due to early stomach wash and supporting medical management. One patient who survived also mentioned of taking date expired Kerry tablet. Conclusion: Strict implementation of nationwide pesticide regulation, including restricting the availability of poison, being aware of its toxicity and providing improved medical management and improved intensive care facilities can further reduce the mortality due to AlP toxicity as there is no antidote available presently. DOI: http://dx.doi.org/10.3329/jdmc.v23i1.22685 J Dhaka Medical College, Vol. 23, No.1, April, 2014, Page 3-6

Though it is long known that irregular intake of antihypertensive may cause harm, but still there is much lack of awareness among the patients in this matter. This case controlled study was done in Dhaka Medical College Hospital, Dhaka, to determine the relationship between discontinuation of antihypertensive drugs and the risk of stroke among hypertensive patients. Number of cases was 72. Control group was selected via random sampling of stroke free treated hypertensive group, similar in age to stroke cases. Sampling technique was random systematic sampling. The relationship was determined employing statistical methods including Chi-square (?2) test using computer programs, and significant association between discontinuation of antihypertensive and development of stroke in hypertensive adult patients was found ?2(1,N= 103) = 32.637, p

Context: 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 microbial aspect of aspiration pneumonia in hospitalized patients with altered consciousness. This study was done to see the microbial aspect of aspiration pneumonia in patients with altered consciousness admitted in a tertiary level hospital in Bangladesh. Methods: A prospective observational study was done on 50 adult patients of aspiration pneumonia with altered consciousness admitted in the medicine department of medicine, Dhaka Medical College Hospital, Dhaka, between January and December 2010. Aspiration pneumonia was confirmed by clinical examination and laboratory investigations. Hematologic measurements, chest x-ray, blood gas analysis, estimation of blood urea, serum creatinine and random blood sugar were done in all patients. Sputum for gram staining and culture & sensitivity as well as blood culture & sensitivity were done in patients who were diagnosed as aspiration pneumonia clinically and radiologically. Validated sputum was cultured in blood agar, chocolate agar and McConkey’s agar media. Blood culture was done in trypticase soya broth, blood agar, chocolate agar and McConkey’s agar media. Results: The mean age was 38.9±17.3 years. 35 (70%) patients were male and 15 (30%) patients were female. Blood culture was found positive in 30.8% patients who developed aspiration pneumonia among the study patients. In sputum for Gram staining, only Gram positive Cocci was present in 46.15%, only Gram negative Bacilli was present in 38.46%, mixed Gram positive cocci and Gram negative bacilli was present in 7.7% and Gram negative Coccobacilli was found in 7.7% patients who developed aspiration pneumonia among the study patients. In growth positive cases (n=11) sputum culture revealed 45.45% streptococcus pneumoniae, 36.36% Klebsiella pneumoniae, 9% Pseudomonas species and 9% Haemophylus influenzae. The mean duration of hospital stay was 8.12±2.42 days with ranging from 4 to 14 days DOI: http://dx.doi.org/10.3329/jdmc.v22i2.21517 J Dhaka Medical College, Vol. 22, No.2, October, 2013, Page 110-114

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

Pulmonary tuberculosis is one of the commonest infectious diseases in developing countries including Bangladesh. Hepatic involvement is common in disseminated tuberculosis which may be symptomatic or asymptomatic. But isolated hepatic TB without any symptoms is a rare presentation. We report a case of isolated hepatic TB in a 40 year old housewife who presented with low grade fever, vague abdominal pain and weight loss. She had no pulmonary or hepatic complains. We diagnosed the case when ultrasonogram of abdomen showed multiple space occupying lesions from where FNAC was done and sent for histopathology and Z-N staining and revealed hepatic TB. DOI: http://dx.doi.org/10.3329/jdmc.v23i1.22706 J Dhaka Medical College, Vol. 23, No.1, April, 2014, Page 121-123

Hypoparathyroidism is a condition where level of parathyroid in blood is very low or undetectable. Hyporapathyroidism is associated with structural changes in bones and can present clinically with spondylo-articular features. This review focuses on the skeletal manifestations of hypoparathyroidism & spondylo-arthropathic features in hypoparathyroidism, understansding the histomorphological and microscopic changes in bone, spondylo-articular changes, and the diseases which mimic spondyloarticular features of hypoparathyroidism. Spondylo-articular features of hypoparathyroidism can resemble ankylosing spondylitis. It is important to differentiate hypoparathyroid-related spondyloarthropathy from ankylosing spondylitis because the management for the two disorders is different. The clinical profile, biochemical parameters, and radiological features aid in differential diagnosis. Studies have suggested several patterns to differentiate this clinical entity from ankylosing spondylitis. DOI: http://dx.doi.org/10.3329/jdmc.v22i1.15630 J Dhaka Medical College, Vol. 22, No. 1, April, 2013, Page 72-76

Objective: The study was carried out to find out the health care seeking practice among the elderly women attending a selected hospital in Dhaka city. Materials and methods: This was a cross sectional study and included 164 women aged 60 years and above. The study was carried out from March to June, 2001, at Prabin Hitayishi Hospital, Bangladesh Associated of Aged and Institute of Geriatric Medicine (BAAIGM), Agargaon, Sher E Bangla Nagar, Dhaka. Results: In the present study, 58.5% women were aged less than 65 years, 51.2% were illiterates, 65.9% were married, only 7.3% were living with their spouse, 86.6% were housewives, only 9.8% had self income, 25.6% were earning between Taka 10,001 and 15,000 per month, and 41.5% were staying in families with 7 8 members, 90.2% had regular daily bath, 80.5% with soap, 90.2% brushed their teeth at least once a day, only 12.2% were taking regular exercise, 70.7% had knowledge about self health care, however, only 22% were on regular health check up, 12.2% women thought egg, milk, fish, meat and fruits were good for health. Regarding old age diseases, 43.9% knew about diabetes, 39% high blood pressure, 36.6% heart, 17.1% respiratory and 2.4% orthopaedic diseases. Most common diseases were eye (26.8%), cardiovascular and orthopaedic (19.5%) and ENT (14.6%). Other diseases were gastrointestinal (9.8%), respiratory (7.1%), dental and endocrine (4.9%). Conclusion: Old women of our society should be made aware on old age diseases and self health care practices. DOI: http://dx.doi.org/10.3329/jdmc.v22i1.15602 J Dhaka Medical College, Vol. 22, No. 1, April, 2013, Page 30-33

Introduction : Hepatitis B virus is encountered sporadically throughout the year in Bangladesh. Bangladeshi physicians are also in a great risk for this blood-borne virus. To find out the seroprevalence of HBV and vaccination rate among the physicians, was the aim of this study. Methods : The study was an observational study and was conducted in the department of Medicine of Dhaka Medical College Hospital, Dhaka between April and September, 2012. Eighty physicians of department of Medicine were searched for hepatitis B virus with the help of a structured questionnaire. Physicians, who were found not vaccinated, were also investigated for HbsAg positivity by ELISA method. Results: Eighty five percent physicians were found vaccinated. Remaining 15% (12/80) physicians were investigated for HbsAg positivity but all were found negative. Vaccinated physicians who checked antibody titre (35.3%), were found well immunized. Fifty percent physicians experienced needle stick injury 2-5 times in their lifetime and 20% physicians did not use protective equipments during any invasive procedure. Conclusion: HBV remains a major cause of morbidity and mortality in Bangladesh. Hence, our physicians who were not vaccinated and also found HbsAg negative, should complete their vaccination schedule as early as possible. DOI: http://dx.doi.org/10.3329/jdmc.v22i1.15540 J Dhaka Medical College, Vol. 22, No. 1, April, 2013, Page 11-15

not availableJ Bangladesh Coll Phys Surg 2017; 35(2): 100

not availableJ Bangladesh Coll Phys Surg 2017; 35(1): 47

not availableJ Bangladesh Coll Phys Surg 2016; 34(2): 124

not availableJ Bangladesh Coll Phys Surg 2016; 34(1): 52

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 (

DOI: http://dx.doi.org/10.3329/jdmc.v20i1.8562 J Dhaka Med Coll. 2011; 20(1) : 1-3.