Unusual presentation of a Hydatid cyst: a case report

Hydatid disease is a parasitic disease, which is most commonly caused by Echinococcus granulosus. It is endemic in many parts of the world. However, Hydatid disease can occur in almost any part of the body. Isolated omenal hydatid cyst is one of the least common sites. A case of very unusual omental hydatid cyst is presented here which was diagnosed in the Department of Radiology &amp; Imaging, Dhaka Medical College Hospital, Dhaka, and subsequently confirmed by histopathology. DOI: http://dx.doi.org/10.3329/jdmc.v22i2.21546 J Dhaka Medical College, Vol. 22, No.2, October, 2013, Page 216-218</jats:p

Effect of Allopurinol in Chronic Kidney Disease Progression in Asymptomatic Hyperuricaemic Subjects

This was a hospital based prospective, interventional study which included CKD stage 3- 5 patients with higher level of uric acid (male&gt;7mg/dl, female&gt;6mg/dl). The objective of the study was to evaluate the effect of allopurinol in chronic kidney disease (stage 3-5) progression in asymptomatic hyperuricaemic patients.One hundred and twenty patients were distributed in two groups. Sixty patients were placed in treatment group and sixty in control group. Purposive sampling technique was followed. In the study mean age was 49 (±9) years in treatment group and 45 (±11) years in control groups. Male were predominant in both groups. There were no significant difference in baseline characteristics between treatment group and control group (p&gt;0.05). Sixty patients of treatment group were administered a dose of 100 mg/d of allopurinol. Follow up assessment was done at basally, at 4 months and at 8 month after starting treatment. No significant differences were seen between baseline SBP, DBP, Hb and HbA1c with 4th month and 8th month follow up in both treatment group and control group, but mean Hb was significantly decreased in control group from the baseline after 8 month. Serum uric acid was decreased in treatment group while it was significantly raised from the base line at 4th month and 8th month in control group. In treatment group serum creatinine was decreased and eGFR was raised from the baseline after 8 month. On the other hand, in control group serum creatinine was significantly raised and eGFR was significantly decreased from the baseline at 8th month. While comparing between two groups results showed means of serum uric acid was significantly decreased in treatment group compared to control group after 8th month. There was a negative correlation between Uric Acid with eGFR after 8 month of allopurinol treatment although this finding was not statistically significant. So, allopurinol may have a protective role in CKD progression by decreasing serum uric acid level in patients with chronic kidney disease stage 3 - 5 with asymptomatic hyperuricaemia.J Dhaka Medical College, Vol. 25, No.1, April, 2016, Page 5-15</jats:p

Hemodialysis Catheter-Related Blood Stream Infection: Rates, Risk Factors And Pathogens

Background: Central venous catheters (CVC) are an important means of delivering hemodialysis (HD) to patients who require immediate initiation of dialysis. Haemodialysis (HD) catheter-related bloodstream infections (CRBSIs) are a major complication of long-term catheter use in HD. Aims: This study was conducted to identify the rates, risk factors and spectrum of infecting organisms of Hemodialysis catheter-related blood stream infection (CRBSI). Methods: This prospective Observational study was carried out in the Department of Nephrology, Dhaka Medical College Hospital, Dhaka during January 2018 to July 2019. A total of 125 patients with Central Venous Catheter for Hemodialysis were included in this study. Results: Twenty four patients with a mean age of 42.9±17.5 years were confirmed to have CRBSI with a rate of 6.6 per 1000 catheter days in Temporary Uncuffed Catheter group and 1.4 per 1000 catheter days in Permanent Cuffed Catheter group. Independent risk factor associated with CRBSI was diabetes. 70.8% patients had gram-negative infections, 4(16.7%) patients had gram-positive infections and 3(12.5%) patients had polymicrobial infections. Pseudomonas species (37.5%) were the most common identified bacteria. Conclusion: The rate of CRBSI in Hemodialysis patients was significant and the only identified risk factor was diabetes mellitus. Infection by Gram-negative bacteria was noteworthy among the patients. J Dhaka Med Coll. 2021; 29(1): 3-8</jats:p

Pseudomonas aeruginosa infection in cystic fibrosis patients

Cystic Fibrosis is an autosomal recessive genetic disease where the lung is heavily colonized by biofilm forming Pseudomonas aeruginosabacteria. Biofilm due to its thick wall and presence of extracellular polymeric substances confers bacteria with a much higher resistance against antimicrobial compounds and environmental stress. Research has revealed the presence of extracellular DNA (eDNA) in significant amounts in the biofilm walls of such bacteria. Although the exact role of eDNA has not been elucidated but research prompts that eDNA to have significant role in stabilizing the biofilm complex structure as well as providing the bacteria with resistance against antimicrobial and antibiotic compounds. The presence of eDNA prompted research to use DNase as a biofilm destabilizing agent. Under experimental conditions, DNase has shown to dissolve early forming biofilm walls especially when used in combination with antibiotics therefore suggesting the use of DNase as an effective treatment strategy in CF patients. But ambiguity arises when some recent studies showed that P. aeruginosa can opportunistically use DNase for its survival advantage by using the enzyme to access phosphate, carbon and nitrogen constituentsof the DNA in nutrient limited conditions; and also by using the DNase to degrade the DNA component of neutrophil extracellular traps. These apparent contradictions call for more thorough investigations into the role of eDNA and DNase in CF biofilm infection. DOI: http://dx.doi.org/10.3329/jdmc.v22i1.15689 J Dhaka Medical College, Vol. 22, No. 1, April, 2013, Page 77-86</jats:p

Bone Mineral Density to Identify Osteopenia and Osteoporosis in Patients of CKD on Maintenance Hemodialysis

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.&#x0D; 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 &lt;0.05.&#x0D; Results: The mean BMD in the LV (L2-L4) was 1.18 ± 0.19 gm/cm2 in male and 1.04 ± 0.13 gm/cm2 in female patients (P =0.011). The mean BMD in the FN was 0.90 ± 0.19 gm/cm2 in male and 0.77 ± 0.15 g/cm2 in female patients (P = 0.022). Based on the World Health Organization criteria, 26.0% of the male and 22.2% of the female patients in our study had normal BMD; 39.2% male and 38.9%female patients had osteopenia, while 34.8% male and 38.9% female patients had osteoporosis .This study showed a marked decrease in mean BMD in the cortical bone (FN) compared with trabecular bone (LV) (P = 0.001) as well as in female patients on maintenance hemodialysis compared with male patients . Significant negative correlation (r= -0.480; p=0.001) was found between duration of hemodialysis and bone mineral density (BMD) in lumbar spine and femoral neck.&#x0D; Conclusion: The measurement of BMD is a good non-invasive screening test for renal bone disease and that a high number of patients with CKD stage 5 on maintenance hemodialysis have markedly decreased BMD.&#x0D; J Dhaka Medical College, Vol. 29, No.1, April, 2020, Page 3-11</jats:p

Clinical CHaracteristics of Diabetic Ketoacidosis in Type 2 Diabetes Mellitus in Bangladesh Adult Patients

J Dhaka Medical College, Vol. 21, No. 2, October, 2012, Page 131-139 DOI: http://dx.doi.org/10.3329/jdmc.v21i2.15299</jats:p

Distribution of Pruritus and Its Association With Serum Parathormone Level in Chronic Kidney Disease (Stage-5) Patients On Maintenance Hemodialysis

Background: Pruritus is a common manifestation in patients on hemodialysis. The aim of this study is to determine the distribution of pruritus and evaluate the association between pruritus and serum parathormone levels in chronic kidney disease patients on maintenance haemodialysis.&#x0D; Methods:This analytic, descriptive, cross-sectional study was performed over 191 patients of maintenance haemodialysis in 2014. Information related to the patients including age, gender, residence, pruritus was extracted from questionnaires. Serum levels of intact parathormone were measured &amp; data were analyzed.&#x0D; Results: 68% of the patients had pruritus. The Mean ± SD of serum parathormone was 53.25±7.96 pg/ml in patients with pruritus and 81.91±9.34 pg/ml in patients without pruritus. Our study showed that most patients with pruritus had normal serum parathormone levels and no significant association was found between pruritus and serum parathormone levels.&#x0D; Conclusion: serum parathormone level may not play a role in uraemic pruritus in these patients.&#x0D; J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 54-59</jats:p

Association Between Pruritus With Serum Calcium, Phosphate Levels And Ca-Po4 Product in Chronic Kidney Disease (Stage-5) Patients On Maintenance Hemodialysis

Background: Hemodialysis is one of the treatment of end stage renal disease. Disturbance in calcium and phosphate metabolism are observed in these patients. One of the most common cutaneous manifestations in patients on hemodialysis is pruritus. The aim of this study is to evaluate the association between pruritus with serum calcium and phosphate levels in these patients.&#x0D; Methods: This analytic, descriptive, cross-sectional study was performed in 2014 over 191 patients of maintenance haemodialysis. Information related to the patients age, gender, residence, pruritus, duration and frequency of dialysis, was extracted from questionnaires. Serum levels of calcium, phosphate and albumin were measured &amp; data were analyzed.&#x0D; Results: 68% of the patients had pruritus, of whom 48.2% had serum calcium levels below the normal range. The Mean ± SD of serum calcium, phosphate, Ca-PO4 product, and duration of dialysis were 8.77±1.22 mg/dl, 3.82±1.18 mg/dl, 34.17±12.69, and 18.01±11.94 months respectively in patients with pruritus and 9.24±1.15 mg/dl, 3.40±1.36 mg/dl, 35.75±13.02, and 17.84±16.01 months respectively in patients without pruritus. Our study showed that most patients with pruritus had serum calcium levels in the below normal range.&#x0D; Conclusion: Good control of serum calcium levels may have a role in reducing uraemic pruritus.&#x0D; J Dhaka Medical College, Vol. 27, No.2, October, 2018, Page 127-133</jats:p

Clinical Pattern of Intra-cranial space occupying lesion in Tertiary Level Hospital

Background : The term “Intra-cranial space occupying lesion” (ICSOL) is defined as any neoplasm, benign or malignant, primary or secondary, as well as any inflammatory or parasitic mass lying within the cranial cavity. Advances in intracranial imaging have made the detection of intracranial lesions relatively accurate and enabling us to focus on the etiology of these space-occupying lesions. Many reports suggested that both incidence and pattern of intracranial space occupying lesions are subject to considerable geographic and racial variations. Knowledge of the regional peculiarities of these lesions will help in identifications of possible risk factors.&#x0D; Materials and Methods: This observational study was done in the department of medicine of Mymensingh medical college hospital, Bangladesh from November, 2011 to April, 2012 to evaluate the clinical pattern of ICSOL among the 75 adult admitted patients. Patient aged more than 15 years of either sex with symptoms and signs of ICSOL and at least one CT or MRI evidence in favour of diagnosis were included.&#x0D; Results: The highest participation (22.7%) was observed from 55-64 years age group. Mean age of the participants was 54.35±18.68 years. Neoplastic tumor was (25.8%) in 15-24 years age group and non neoplastic lesion was (31.8%) in 55-64 years age group, among participants (76.0%) came from rural areas and 24% from urban. Population regarding the occupation 30.7% were housewives, 21.3% were service holders and 20.0% are farmers. Headache was the most common symptom noted in 93.33% of patients. Nausea/ vomiting, difficulty in limb movement and imbalance were the other most common three symptoms. In this series intracerebral hemorrhage was found in 53.3% of patients, Astrocytoma was the second most common (20.0%). Meningioma was found in 8% of the participants and another 8% had metastatic lesions in their brain. There were two cases of schwanoma while tuberculoma was diagnosed in another two participants (2.7%).&#x0D; Conclusion: Patients with symptoms and signs of ICSOL should be dealt with great care and CT or MRI helps to evaluate them for early diagnosis and proper management.&#x0D; J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 17-22</jats:p

Naphthalene Induced Hemolysis With Acute Kidney Injury in a g6pd Deficient Boy

Naphthalene is a chemical substance which is widely used as moth repellent, insecticide and deodorizer. Naphthalene mothballs are potent hemolytic agents specially for pediatric group and Glucose 6 phosphate dehydrogenase (G6PD) deficient individuals. Our patient, a 14-year-old boy got admitted in our institution with progressive pallor, jaundice, hematuria and oliguria. He used to chew naphthalene mixed flavored raw rice for the last six months. On investigation he was found to have features of intravascular hemolysis and AKI necessitating hemodialysis with blood transfusion. His G6PD activity was below normal. After seven sessions of Hemodialysis (HD) his renal function recovered and discharged accordingly. One month post discharge follow up was normal. J Dhaka Med Coll. 2021; 29(1): 123-126</jats:p