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Muhammad Shah Alam,1 ABM Kamrul-Hasan,2 Syeda Tanzina Kalam,3 SM Mizanur Rahman,4 Mohammad Izazul Hoque,5 Md Belalul Islam,6 Ajit Kumar Paul7 1Department of Medicine, Army Medical College, Comilla, Bangladesh; 2Department of Endocrinology, Mymensingh Medical College, Mymensingh, Bangladesh; 3Department of Psychiatry, Comilla Medical College Hospital, Comilla, Bangladesh; 4Department of Medicine, CMH and Army Medical College, Comilla, Bangladesh; 5Department of Hepatology, Comilla Medical College, Comilla, Bangladesh; 6Department of Medicine, Comilla Medical College, Comilla, Bangladesh; 7Department of Endocrinology, Maynamati Medical College, Comilla, BangladeshCorrespondence: ABM Kamrul-HasanDepartment of Endocrinology, Mymensingh Medical College, Charpara, Mymensingh, 2207, BangladeshTel +8801711103905Email rangassmc@gmail.comPurpose: Type 2 diabetes mellitus (T2DM) is associated with an increased risk of nonalcoholic fatty liver disease (NAFLD), and the presence of T2DM tremendously drives NAFLD progression. The use of transient elastography (TE) for assessment of NAFLD has been increasing due to its high sensitivity and specificity. This study aimed to measure liver stiffness in patients with T2DM and ultrasonography (USG)-diagnosed NAFLD and assess the correlations between liver stiffness and other clinical and biochemical parameters.Patients and Methods: This cross-sectional study assessed 205 adult patients with T2DM and USG-diagnosed NAFLD who were being treated at a specialized endocrine private practice in Bangladesh. All subjects underwent TE for hepatic fibrosis assessment, which was performed using a FibroScan® 402 device. A fibrosis score ≥ 9.7 kilopascals (kPa) was used to define advanced fibrosis (≥F3).Results: Out of 205 (65.9% female, mean age 45 ± 27 years, 67.3% obese) patients, the frequencies of Grade 1, Grade 2, and Grade 3 fatty liver on USG were 46.3%, 51.2%, and 2.4%, respectively. According to the TE results, 41 (20%) had advanced fibrosis (≥F3). Subjects with advanced fibrosis had a higher body mass index (BMI), higher levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), and higher frequencies of individuals with elevated ALT and AST and advanced fatty liver grades on USG. The fibrosis score (kPa) was strongly and positively correlated with age, BMI, waist circumference, obesity, serum ALT and AST levels, and the fatty liver grade in USG; the AST:ALT ratio did not correlate with kPa.Conclusion: The data showed that 20% of the subjects with T2DM having NAFLD on USG exhibited advanced fibrosis, demonstrating the need for early diagnosis and treatment of NAFLD in T2DM. The use of TE with other serum markers can be helpful for the diagnosis of advanced fibrosis.Keywords: type 2 diabetes, NAFLD, transient elastography, advanced fibrosis, AST:ALT ratio

Worldwide occurrence of snakebite in pregnancy is little known in medical literature. Furthermore to the best of our knowledge there is no case report on Krait envenomation in pregnancy in Bangladesh. It carries significant fetal wastage and maternal morbidity and mortality. Here we report a mutligravida aged 27 years at her 24 weeks of gestation with krait bite with neuroparesis with good obstetrical outcome.Bangladesh J Medicine Jul 2016; 27(2) : 86-88

Melioidosis (. Burkholderia pseudomallei infection) has yet to be demonstrated systematically in Bangladesh. A prospective, cross-sectional serological survey was conducted in 2010 at six Bangladeshi hospitals. Age, gender, occupation and residential address were recorded. Of 1244 patients, 359 (28.9%) were positive for . B. pseudomallei by indirect haemagglutination assay. Farmers had an increased risk of seropositivity (risk ratio. =. 1.4, 95% CI 1.0-1.8; p. =. 0.03). There was no clear geographic clustering of seropositives. Melioidosis should be considered as a possible cause of febrile illness in Bangladesh. Further studies are needed to establish the incidence of clinical disease and distribution of environmental risk. © 2012 Royal Society of Tropical Medicine and Hygiene.

Cirrhosis is a chronic liver disease characterized by diffuse fibrosis and nodule formation leading to distortion of normal liver architecture. The initial stimulus is hepatocyte necrosis. A wide variety of liver diseases can lead to cirrhosis, including viral hepatitis (B, C and D), alcohol, metabolic diseases (eg. haemochromatosis, Wilson’s disease, NASH, α1 anti-trypsin deficiency, type IV glycogenesis), cholestatic liver disease, auto-immune hepatitis, Budd-Chiari syndrome, drugs (eg. methotrexate, amiodarone), etc. The aetiology of cirrhosis remains unknown in a significant number of cases, giving rise to the entity of cryptogenic cirrhosis. In the UK, this figure stands between 5–10% [1]. In Bangladesh, the common causes of cirrhosis remain viral hepatitis (B and C) and NASH [2].

Scrub and murine typhus infections are under-diagnosed causes of febrile illness across the tropics, and it is not known how common they are in Bangladesh. We conducted a prospective seroepidemiologic survey across six major teaching hospitals in Bangladesh by using an IgM enzyme-linked immunosorbent assay. Results indicated recent exposure (287 of 1,209, 23.7% seropositive for Orientia tsutsugamushi and 805 of 1,209, 66.6% seropositive for Rickettsia typhi). Seropositive rates were different in each region. However, there was no geographic clustering of seropositive results for both organisms. There was no difference between those from rural or urban areas. Rickettsia typhi seroreactivity was positively correlated with age. Scrub typhus and murine typhus should be considered as possible causes of infection in Bangladesh.

Catheter-Associated Urinary Tract Infection (CAUTI) is a common health care associated infection worldwide and is result of wide spread use of urinary catheter and inappropriate antibiotics use. Cause of CAUTI is formation of pathogenic biofilm in the inner surface of indwelling urinary catheters and its early detection prevents various hazards as well as economic impact. This observational prospective study was done to see relationship between the pattern of microorganism in urine and biofilm and their antibiotic sensitivity patterns in 100 patients in Comilla medical college hospital, Comilla, Bangladesh. Selected patients had undergone catheterization for urinary retention or incontinence. The urine collected by suprapubic puncture and biofilm from indwelling catheter for culture and sensitivity. 90% of urine samples and 100% biofilm showed growth of uropathogens. E.coli was the most frequently isolated pathogen (60%), followed by Klebsiella spp (14%). Multibacterial isolates was found from biofilm in 15 samples with long term catheterization. Biofilm strains displayed relatively high resistance against tested antibiotics. Highest sensitivity pattern found for E.coli in urine and biofilm for imipenem (95% vs. 92%), lowest for ciprofloxacin (20% vs. 16%). Catheter biofilm resistant to all tested drugs were found for E.coli in 6.95% and klebsiella in 5.55%. Urine samples resistant to all tested antibiotics only in E.coli 3.33%. E.coli was the most frequent isolate which showed the higher sensitivity to carbapenems, and lowest to the quinolones. Correlation was observed between biofilm production and multidrug resistance. A large-scale prospective studies suggested to make a guideline to manage UTI specially CAUTI.

There are remarkable advances in the treatment of chronic hepatitis B (CHB) in the last few years. Unfortunately, prolonged antiviral treatment is associated with increasing risk of drug resistance/viral breakthrough (VBT), which may lead to flare-up and rapid decompensation. We have designed this study to predict the pretreatment and on-treatment factors responsible for development of VBT.This study was conducted during the period of February 2000 to November 2007. We have included 423 patients who received lamivudine (LAM) therapy for at least 1 year and at least 2 follow-ups at 6 months' interval. Follow-up period was 12-78 months. Chi-square test, student's t test, and logistic regression analysis were performed to prove the validity.Of the 423 study cases, 367 (86.8%) were of male patients and 261 (61.7%) patients were HBeAg positive; the age of the patients was 30.8 +/- 12.9 years. Development of VBT was 4.4, 22.8, 45.3, and 74% at 1, 2, 3, and 4 or more years, respectively. Pretreatment high HBV DNA (P = 0.005) and female sex (P = 0.01) were associated with VBT and pretherapy ALT (P = 0.698), HBeAg status (P = 0.273), and age (P = 0.059) were not associated. Duration of treatment, failure to lose HBeAg at 1 year, and HBV DNA nonresponder at 6 months were significantly (P = 0.001) associated with development of VBT.Persistence of HBeAg at 1 year and HBV DNA nonresponder at 6 months are good predictors of development of VBT.