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Immunophenotyping of leukemia cells is useful for detecting leukemia cell line, determining maturation stage and identifying aberrant antigens which act for individual treatment monitoring and detection of residual disease. A total of 104 newly diagnosed cases of acute myeloid leukemia were identified at hematology department in National Institute of Cancer Research and Hospital from January 2020 to December 2021.We detect Immunophenotypic pattern in newly diagnosed cases of acute myeloid leukemia. We also determine the frequency and pattern of aberrant expression of CD markers in acute myeloid leukemia patients. Mean age of patients was 35 years (SD±16 years) with male to female ratio was 1.53:1. Most frequent morphologic subtype was AMLM2 constituting 33.6% of all AML cases. Lineage specific markers HLADR, CD13, CD33, MPO, CD117 and CD34 were expressed in 80%, 89%, 95%, 77%, 74% and 62% cases of all AML cases respectively. Among 104 AML patient, aberrant CD expression was observed in 36% cases. The most frequently observed aberrant markers were CD7 and CD19 lymphoid markers, that were expressed in 15.38% and 14.42% cases respectively. Less frequent aberrant cCD3, CD10, CD5 and cCD79a antigens were expressed in 2.88%, 1.92%, 0.96% and 0.96% cases respectively. Immunophenotyping is essential in diagnosis and sub-classification of AML and expression of aberrant CD antigens is common in acute myeloid leukemia. These findings suggest the necessity for a more extensive study to evaluate the prognostic significance of aberrant CD marker expression in AML and to improve the accuracy of diagnosis and classification of AML. J MEDICINE 2022; 23: 106-111

Objective: Febrile neutropenia (FN) is viewed as the most decimating oncological crisis particularly inchemotherapy-incited patients. The primary objective of the study was to identify the total directexpenditure of patients during febrile neutropenia with clinical consequences and the secondary aim wasto find out the factors associated with higher cost. Materials and Method: This was a single-centered hospital-based study in the largest and only specializedcancer care centre in Bangladesh in the government sector. This prospective study was done in theinpatients’ department of the National Institute of Cancer Research and Hospital from April 2020 toJanuary 2021. The primary outcome was the out-of-pocket patient payments (adjusted by governmentsubsidy) per FN episode. Univariate analysis and multiple linear regression were conducted to identifythe factors associated with higher costs. Results and Discussions: A total of 101 patients were enrolled in the study. The mean (SD) age was33.49 (±15.79) years. Of the 101 participants, 63.4% were male. Among the patients, 13.9% died during theepisode and 86.1% recovered. Having co-morbidities and COVID-19 were associated with an increasedrisk of death. The mean cost was US$ 999.44 (±499.05) and the mean length of hospital stay was 21.98(±9.3) days. The longer hospital stay was significantly associated with higher costs. Conclusion: This study will help to ascertain the hospital cost and clinical outcome of FN whichultimately can help in policymaking strategy. J MEDICINE 2022; 23: 48-53

CML presenting with isolated extreme thrombocytosis is rare. We reported a 47 years old man who presented with history of right sided lower abdominal pain, vomiting, significant lethargy and chest tightness. Patient was mildly anaemic and abdominal examination revealed no organomegaly. On investigation, he was found to have extreme thrombocytosis (2050x109/L) and mild leucocytosis (31.7 x109/L) with mild anaemia. In view of extreme thrombocytosis, he was investigated for myeloproliferative disease especially essential thrombocythemia. He was found to be positive for BCR-ABL by reverse transcription PCR (RT-PCR) and negative for JAK2, CALR, MPL mutations. Ultimately, he was diagnosed as a case of CML with an atypical presentation. He received imatinib 400 mg/day and achieve complete haematological response at 15 days.

Background: Diffuse Large B-Cell Lymphoma (DLBCL), most common Non-Hodgkin Lymphoma (NHL) variety, is an aggressive, fast-growing form comprising up to 40% of all cases globally. Objective: To observe the treatment outcome of different subtypes of Diffuse Large B-Cell Lymphoma (DLBCL) after first-line chemotherapy and also the association with IHC, presenting age, sex, and IPI score with outcome. Methodology: This is a retrospective data analysis included all DLBCL patients registered in the department of Haematology of National Institute of Cancer Research and Hospital (NICRH) between July 2016 to June 2019. Results: Total 188 cases were included in this study and mean age was 48 years with a Standard deviation of 15 years with Male (69.1%) predominance. We divide the cases into three different entities of DLBCL [Germinal Centre B-cell like (GCB), Non-GCB and others (NOS) among them Non-GCB variety was the prevalent (47.3%) one. After first line chemotherapy 52.1% complete remission with 7% death was observed in overall outcome. There was no significant difference in outcome among different types of DLBCL after chemotherapy based on Han’s algorithm. Rituximab with CHOP has significantly better outcome than CHOP alone arm (p: 0.021). Conclusion: This limited database study of NICRH will help to ascertain the outcome of DLBCL after first-line chemotherapy in Bangladesh.

Background: Patients with active cancer are considered to be a high-risk group during the COVID- 19 pandemic. Reports of studies on the impact of COVID-19 infection on cancer patients in Bangladesh are sparse. This study was conducted to describe the clinical presentation and assess the outcome of COVID-19 infected cancer patients. Methods: In this prospective study, we enrolled 43 patients with active cancer from different cancer hospitals in Dhaka, Bangladesh who were tested positive for RTPCR of COVID-19. The study period was from August to October 2020 (three months) following ethical approval and informed written consent was ensured. The data were collected in a structured questionnaire form by interviewing the patients/relatives and from medical records of inpatient and outpatient departments and analyzed by SPSS version 25. Results: The mean age of the 43 study participants was 49.2 (±13.6) years with a male predominance (60.5%). The common primary malignancies were leukaemia (27.9%), carcinoma of the colon (18.6%), and carcinoma of the breast (14%). Diabetes (30.2%) and hypertension (27.9%) were the common co-morbidities. The most frequently found symptoms were fever and cough 67.4% each. Severe and critical illness were found in 27.9% and 2.3% cases respectively. 35 (81%) patients survived from COVID-19 and death was observed in 8 (19%) patients.There was no significant association of age, gender, primary malignancy type, and major co-morbidities with the outcome. Severe and critical illness were found to be significantly associated with higher mortality. Conclusions: COVID-19 related mortality is higher in cancer patients than in the general population. Mortality depends on the severity of COVID-19 in these patients, associated with severe & critical cases. Bangladesh J Medicine July 2021; 32(2) : 90-94

Background: Multiple Myeloma (MM) represents approximately 15% of all hematological malignancies. Despite the use of high-dose chemotherapy followed by stem cell rescue MM remains incurable at present. The goal is to control the disease as much as possible, providing the best quality of life to patients for the longest duration. Currently, CTDa (attenuated Cyclophosphamide, Thalidomide, Dexamethasone) is the best option of treatment as it is cost-effective, with no need for hospitalization with a good response. Objective: To find out the symptomatic responses and toxicities of CTDa in Multiple Myeloma patients. Materials and Methods: 25 patients of newly diagnosed MM patients were treated in the Haematology Department, Bangabandhu Sheikh Mujib Medical University (BSMMU) from July 2016 to July 2017. The mean age of the patients was 54 years, Male female ratio was 1.5:1 and most of the patients were farmers. After induction of 4 to 6 cycles of CTDa all patients were followed up at 6th and 12th weeks. At follow up we evaluated improvement of weakness, bone pain, Hb%, ESR, monoclonal protein, ß2microglobulin, bone marrow plasma cells and serum calcium and albumin level. Adverse effects, such as peripheral neuropathy, thromboembolic events, hyperglycemia, constipation, rash, and somnolence were also assessed. Results: Among 25 patients, complete response achieved only 13 patients (52%), where 20% and 16% of patients belonged to partial or no response respectively. The death occurred in 2 cases (12%). Conclusion: CTDa is a gentle approach to treat an especially frail group of patients, since virtually all patients ultimately relapse. KYAMC Journal Vol. 11, No.-3, October 2020, Page 124-128

Dengue is a common arboviral infection in South-East Asia. It has various atypical manifestations; acute pancreatitis is one of them. Though the exact pathogenesis is not known, many mechanisms have been postulated. We present a case of a 32-year-old lady who presented with fever, upper abdominal pain and vomiting. She was subsequently diagnosed to have acute pancreatitis (AP) due to dengue fever (DF). She was treated conservatively for dengue fever and recovered completely. In DHF abdominal pain is an alarming feature. Though less common, AP should be kept in mind as a cause of acute abdominal pain in dengue.

Scrub typhus is an acute febrile illness caused by a Gram-negative obligate intracellular bacterium named Orientia tsutsugamushi. Although this zoonotic disease is common in tropical and subtropical regions, it is often underreported in Bangladesh. We present a case of scrub typhus in a 15-years-old male who presented with fever, eschar, hepatitis, and positive serology and got complete recovery with doxycycline.

Background: Ischaemic priapism is one of rare presentation of Chronic myeloid leukaemia due hyper viscosity and it needs urgent urological intervention. Objective: To evaluate the need of urological intervention in Priapism with Chronic Myeloid Leukaemia (CML). Methodology: This is a retrospective study from January 2014 to July 2019 in the department of Urology, DMCH. Among 126 patients 6 were diagnosed as Priapism with CML. Records of these patients were evaluated and analyzed. Results: Among 126 patients 6 patients were diagnosed as priapism with CML Mean age of the patient was 46.7 years, 2 of them were farmer and 2 had history of taking herbal drugs immediate before sexual intercourse and developed Priapism. Five patients were newly diagnosed as CML after admission in Urology ward. Of these six cases five were managed with minimal invasive procedure such as intermittent pseudo-ephedrine injection and wide bore needle corporal aspiration with pseudo-ephedrine irrigation as emergency management, only one needed surgery that was proximal shunt. After emergency management all patients were sent to hematologist for definite management of CML. Conclusion: Priapism with CML is a medical emergency which need immediate minimal intervention with concomitant haematological management.

Depression is a common mental disorder that presents with depressed mood, loss of interest, feelings of guilt or low self-esteem. It affects an estimated one in 15 adults (6.7%) in any given year. One in six people (16.6%) will experience depression at some point in their lifetime. It can strike at any time; but usually it first appears during the late teens to mid-20s. Women usually experience depression more than men. Depression is one of the most common mental health issues among physicians worldwide due to high-intensity training and work overload. Recent systematic reviews and meta-analysis indicated that the prevalence of depression among physicians worldwide was around 28.8% which is quite higher than in the rest of the general population. Depressed physician makes more medical error than others. The burden of depression could lead to a low quality of life, ultimately suicidal attempts. So identifying risk factors for depression must be addressed and solved properly with utmost priority. This article reviews the prevalence of depression in physicians based on recently published literature related to this arena. J Enam Med Col 2020; 10(1): 39-42

Background: Cushing’s syndrome is caused by excessive activation of glucocorticoid receptor. Iatrogenic Cushing syndrome is the prevalent one world -wide .Patients with Cushing’s syndrome has a high prevalence of osteoporosis. Objective: To see the prevalence of osteoporosis in Iatrogenic Cushing’s syndrome patient. Method: This descriptive cross-sectional study included 211 diagnosed case of Cushing’s syndrome during the time period of December 2013 to December 2018 in outpatient department of Dhaka Medical College and Health and Hope Hospital. Final diagnosis was done on the basis of clinical feature, serum basal cortical level and BMD. We found male were prevalent one (56%).80.56% showed biochemical evidence of Cushing’s syndrome. BMD was done in 113 patients compared with a reference population by means of T score, 17.69% patient in osteoporotic range. Conclusion: The prevalence of osteoporosis and osteopenia is age and sex independent. Judicial use of steroid and co administration with calcium, bisphosphonate can prevent osteoporosis. Treatment with bisphosphonates should be considered in all patients (irrespective of age) with Cushing’s syndrome with a low BMD to reduce fracture. Bangladesh J Medicine Jan 2020; 31(1) : 18-21

In December 2019 the world has come to know a new coronavirus disease named COVID-19. It has affected mainland China mostly and has spread to all continents of the world except Antarctica. Patients mostly have come with a flu-like illness and non-specific gastrointestinal symptoms to a lesser extent. In most cases, home isolation is effective. However, cases of moderate to severe pneumonia and acute respiratory distress syndrome (ARDS) require hospitalization and few cases need mechanical ventilation. Older adults with a pre-existing medical illness suffer more. Different newer molecular techniques are developed to confirm the diagnosis. Currently, there is no existing treatment and vaccine. Different anti-microbials are on trial. Infection prevention practice is the best for now. With its highly contagious nature and increasing panic among nations, the world is waiting for definitive newer treatment options and a potential vaccine. This narrative review has compiled the updated information about COVID-19 in the hope that it will be helpful to the medical professionals in their knowledge and be prepared for the outbreak of a pandemic.

Key Words: Wilson's Disease; Neuropsychiatric disorder; ceruloplasmin; Penicillamine; Zinc acetateDOI: 10.3329/bmj.v39i2.7038Bangladesh Medical Journal 2010, 39(2) pp.50-52