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Abnormal liver tests are common (60%) in some point of Systemic Lupus Erythematosus (SLE) illness. In rare cases, severe cholestasis may invite diagnostic dilemma. Here we reported a 48-years-old female SLE patient with severe cholestasis (serum bilirubin 37mg/dl) and her management in a financial constrain situation. J MEDICINE 2022; 23: 162-164

A 40-year-old woman had been suffering of many symptoms of Behçet’s disease (BD) since her childhood without being diagnosed. She had recurrent mouth ulcers and from the age of 21 vulva ulcers followed by loss of vision due to central retinitis and later also ankle arthritis. At the age of 31, uveitis due to BD was diagnosed. The fact that BD is often not recognized in Bangladesh explains the marked delay in her diagnosis. The initial central retinitis responded well to oral glucocorticoids, azathioprine and cyclosporine, but in the course of time she became refractory to these agents. Considering her financial constraints, low dose Infliximab (3mg/kg) was used resulting in a remarkable but temporal improvement, she came in remission by using 5mg/kg regimen with increased interval time. We summarize the treatment options for ocular involvement in BD patients Conclusions: In countries like Bangladesh diagnosis of Behçet’s disease can be delayed. Early cooperation of dermatologists and eye surgeons with rheumatologists is necessary. Most cases of resistant ocular BD can nowadays be successfully treated with anti TNF-agents. Promising results are published with other biologics for refractory and multi-resistant cases.

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

Background: The purpose of this study was to assess the efficacy and safety of intraarticular Hylan G-F 20 and triamcinolone acetonide 80 mg (TA) in primary knee osteoarthritis (OA) refractory to standard care in a developing country. Methods: After injection of either Hylan or TA, patients were seen at 12 and 26 wk. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, pain, stiffness (100 mm visual analogue score), and European Quality of Life (EQ) score were measured as well as radiographic joint space change and joint severity grade. Results: The 26-week study was completed by 24 patients receiving Hylan (45 knees) and 21 receiving TA (38 knees). The primary outcome (improvement ≥40% of total WOMAC scores) at 12 wk in the Hylan group was 30 (66.7%) and in the TA group 5 (13.2%) (P

It has been well-documented that chronic arsenic exposure can lead to skin lesions, atherosclerotic diseases and cancers. The findings of association between arsenic exposure and diabetes mellitus indicate additional risk to human health. However, some studies reported inconsistent association. The aim of this study was to assess the association of chronic arsenic exposure through drinking water with risk of type 2 diabetes mellitus. To this end, a cross-sectional study was conducted among randomly selected 300 individuals aged 30 years and older in Comilla and Jhenaidah District of Bangladesh. Individuals with arsenic-related skin lesions were defined as subjects exposed to arsenic. This study included 150 exposed subjects and recruited from Comilla district where drinking water (groundwater) is heavily contaminated with arsenic. Likewise, 150 subjects unexposed to arsenic were recruited as reference population from Jhenaidah district where groundwater is known not to be contaminated by arsenic. Diabetes was defined if fasting blood glucose (FBG)>6.1 mmol/L following World Health Organization (WHO) guidelines. The common odds ratio for diabetes mellitus among subjects exposed to arsenic was 3.5 (95% confidence interval 1.1-10.9). After adjustment for age, sex and BMI, the Mantel-Haenszel weighted prevalence ratio was 3.5(95% CI: 1.1-11.1), 3.7(95% CI: 1.1-11.8) and 4.4(95% CI: 1.1-17.2) respectively. The indicated relationships were significant (P

Aim To develop a translated and culturally adapted Bengali version of the WHO Fracture Risk Assessment Tool (FRAX®) and to test its feasibility, content validity and reliability. Method The English FRAX was translated and culturally adapted for use in Bangladeshi populations following established forward–backward translation methods and being extensively field-tested. The final version was interviewer-administered to 130 consecutive osteoporotic patients between 40 and 90 years of age. For test–retest reliability, the questionnaire was re-administered after 14 days in 60 odd serial-numbered patients. Results To better match with the Bengali culture, several adaptations were made to the FRAX items, including replacements and additions for tobacco, prednisolone and alcohol use. The response rate of the pre-final Bengali version of FRAX was 100% and all patients could understand the questions. Test–retest reliability (Pearson's r) in osteoporotic patients was > 0.93 for all items. Conclusion The culturally adapted Bengali version of the FRAX appears to be an acceptable and reliable instrument. Further studies are needed to confirm the ability of the tool to accurately predict the 10-year probability of hip and major osteoporotic fractures in the Bengali population

Objective Little is known about gut lesions in AS patients in a developing country, such as Bangladesh. Methods Full colonoscopy, including the terminal ileum, was performed in 60 AS patients and 20 controls, without diarrhoea, to study macroscopic and microscopic lesions. Results In the colon, in 60 AS patients 17 macroscopic lesions were found, of which 11 were in the rectum; only one lesion was found in 20 controls. The prevalence of microscopic lesions in the ascending colon, sigmoid colon and rectum was 51, 44 and 50 in patients, respectively, and 13, 9 and 8 in controls. In the terminal ileum, macroscopic and microscopic lesions were seen in 21/56 and 43/56 AS patients, respectively, and in 1/20 and 9/20 controls. In the AS group, macroscopic (38.5 vs 5%, P

Background and aims SLE patients often suffer from both specific, non specific skin lesions and infections. This study was aimed to observe frequency of lupus specific and non-specific skin lesions, skin infections and factors related to infections. Methods This observational study was conducted in SLE clinic of BSMMU, Bangladesh. A total 148 patients were enrolled and followed for 1 year. Patients were evaluated at baseline, special and final visits. Clinical definitions and dermatologist opinion were used for diagnosis of skin lesions. Patient’s demographics, SLE lesions, infection as well as relevant laboratory tests were recorded. Multivariate analysis was done for risk factors. Ethical clearance was obtained from IRB of BSMMU. Results A total 131patients (126 women and 5 men) completed the study period; their mean age was 28.75±8.17 years. Frequency of skin lesions and infections were 71.76% (94) and 26.7% (35) respectively. Specific lupus lesions were malar rash 75.44% followed by DLE, 15.78%. Photosensitivity (72.6%), non-scaring alopecia (67.9%), mucosal ulcer (47.6%), raynaud’s phenomenon (23.8%) and hyper-pigmentation (23.8%) were notable non-specific skin lesions. Common skin infections were tineasis (42.85%), herpes infections (34.26%), paronychia (20%) and scabies (17%). High SLEDAI score, low complements, prednisolone (>10 mg/day) and use of immunosuppressive agents at present or in past were found risk factors for skin infections. Conclusions Skin infections were high in this study. Tineasis, herpes infections, paronychia and scabies were common. Active disease, use of prednisolone >10 mg/day and immunosuppressive therapy were observed risk factors. Vaccinations and judicious use of drugs might reduce the rate of skin infection.

Background and aims The tubercular infections (TB) are most important cause of morbidity and mortality in SLE patients worldwide and an ongoing alarming issue in developing countries. This study was aimed to observe frequency and risk factors of tuberculosis in SLE patients. Methods This observational study was carried out in SLE clinic of BSMMU, Bangladesh. A total 230 consecutive SLE patients were enrolled. Patient’s clinical characteristics, history of TB, SLEDAI score, cumulative doses of immunosuppressants were recorded. In clinically suspected cases tuberculin test, chest X-ray, spot and first morning sputum for AFB, Gene Xpert MTB/RIF, ADA, FNAC and tissue biopsy were requested along with routine tests. The multivariate logistic regressions were done for risk factors. Ethical clearance was obtained from IRB of BSMMU. Results Out of 230 patients TB was documented in 23 (10%) subjects. Among TB cases 16 women and 7 men. Mean age of patients was 27.56±9.3 years and mean duration of occurrence of tuberculosis after SLE diagnosis was 4.26±5.38 years. Cough, night sweat, fever, anorexia were significant presenting features. Present and past TB was observed in 10 and 13 cases respectively. Fifteen and 8 patients had pulmonary and extra pulmonary TB respectively. Organ involvement pattern was multi-lobed lungs, joint, meninges, lymph nodes, peritoneum and pleura. None had drug resistance. Active disease (SLEDAI score), intake of prednisolone >500 mg were notable risk factors. Conclusions Frequency of tuberculosis was high (10%) in SLE patients. Awareness including prevention of flares and judicious use of steroids might reduce the rate of TB.

Objectives: This study was aimed to determine the names and alcohol content or strength of different alcoholic beverages used in different parts of Bangladesh and also to determine contamination with heavy metals and bacteria in some samples. Methods: Eight different types of alcoholic beverages consumed in different parts of Bangladesh were collected and studied in the laboratory of Bangladesh Council of Scientific and Industrial Research (BCSIR). Before sending to the laboratory, samples were stored in a refrigerator at temperature 4-8 degree Celsius. In all samples, strength of ethanol content was studied. Among the samples, Dochuani and Tari was tested for heavy metal, Chubichi and Pochani studied for total viable micro-bacterial contamination. Results: In this study one sample was from Khagrachari (Hilly area) not been reported as manufacture site by the Department of narcotics control of Bangladesh before. Out of eight samples, one was of a Brand company (Keru & Co) and others homemade. Highest concentration, 81.56% was observed in Spirit followed by 37.7% in Dochuani and lowest 2.2% in Tari. Insignificant amount of heavy metal detected in Dochuani and Tari. There was no viable micro-bacterial contamination in samples tested. Conclusions: Without knowing the strength, people are using different types of homemade alcoholic beverages as such in a risk of health hazards as well as death. A national survey need to be conducted to obtain how many types of alcoholic beverages being manufactured, their strength and true picture of alcohol use so that strategy plan can be developed of its healthy use if needed at all.