Lupus Nephritis (LN)

Abstract not available&#x0D; J Dhaka Medical College, Vol. 27, No.1, April, 2018, Page 1-3</jats:p

Menstrual Abnormalities and Associated Hormone Profile In Chronic Kidney Disease Stage 5 Patients

Background: Although menstrual abnormalities and associated hormonal dysregulations are very common in the reproductive age group of Chronic Kidney Disease (CKD) patients, this remains a neglected area. This field had been poorly explored in last ten years worldwide and a few research regarding this area in Bangladesh as well. Aim: To evaluate menstrual abnormalities occurring in CKD stage 5 (CKD5)patients undergoing twice-weekly and thriceweekly maintenance hemodialysis (HD) also in non-dialytic CKD5 patients and to provide more detail information on hormone profile (FSH, LH, Prolactin, Estradiol) of these patients. Materials and method: This obsevational study was conducted in the Department of Nephrology, DMCH, the sample population was also collected from BSMMU and NIKDU from April 2017 to March 2018. A total of 51 CKD stage 5 patients were enrolled in this study. Among them, 34 patients were dialytic (17 of them were taking twice weekly HD and 17 of them were taking thrice weekly HD) and 17 non-dialytic patients at reproductive age were evaluated. Detailed menstrual histories, thorough clinical examinations as well as investigations were done in all the patients. Serum FSH, LH, Estradiol, and Prolactin were evaluated using chemiluminescence immunoassay in the Department of Microbiology of BSMMU. Statistical analysis of the study was done by SPSS-24. The confidence interval was considered at 95% level. P-value &lt;0.05 was considered statistically significant. Results: 100% of non-dialytic CKD5 women had menstrual disorders (72% of patients had secondary amenorrhea, 18% had oligomenorrhoea and 10% had menometrorrhagia). And 73.52% of patients in the HD group had menstrual disorders (29% patients had regular menstruation, 28.5% had secondary amenorrhea, 23.5% had oligomenorrhoea and 19% had menometrorrhagia). With continuation of HD amenorrhea disappeared in 43% of patients in the thrice-weekly HD group, also 22.22% patients in the twice-weekly HD group regained menstruation. Serum LH and prolactin levels were significantly higher in the non-HD group compared to the HD group (p&lt;0.05). Estradiol levels were also higher in HD patients than the non-HD patients. LH and Prolactin levels were also higher in the twice-weekly HD group compared to the thrice-weekly HD group. In the secondary amenorrheic group, serum FSH, LH, Prolactin levels were significantly higher than the other groups having menstrual disorder (p&lt;0.05). Conclusion: Menstrual abnormalities and associated hormonal dysregulations were significantly lower in thriceweekly HD patients compared to the twice-weekly HD patients and significantly lower in twice-weekly HD patients compared to the non-dialytic CKD5 patients. Besides, it is suggested that long-duration dialysis might improve menstrual disorders in such patients as prolactin, LH levels gradually decreased with longer duration of dialysis. J Bangladesh Coll Phys Surg 2022; 40: 45-51</jats:p

Non-Diabetic Renal Disease in Type 2 Diabetic Patients with Nephropathy

Background: In diabetic patients a good proportion of nephropathy is due to nephropathy other than diabetic renal disease. The detection of superimposed primary nondiabetic renal disease in diabetic patients has an obvious prognostic and therapeutic importance.&#x0D; Objectives: To find out the proportion of diabetic subjects suffering from nondiabetic renal disease (NDRD) and to describe histological varieties in appropriate group.&#x0D; Materials and Methods: This crosssectional study was done in Department of Nephrology, Dhaka Medical College &amp; Hospital, Dhaka from August 2015 to October 2016. Total 37 type 2 diabetic patients were selected. Renal biopsy was done and four cases were excluded due to inadequate sample. Tissue was sent for histopathology and direct immunofluorescence (DIF) examination. On the basis of histological diagnosis of biopsy reports patients were divided into three groups. Group I: Isolated NDRD, Group II: NDRD superimposed on diabetic nephropathy (mixed lesion) and Group III: Isolated diabetic nephropathy (DN). Each patient was evaluated for retinopathy from Ophthalmology department. Based on the presence or absence of retinopathy 33 patients were again divided into two groups. Group A includes patients with diabetic retinopathy (DR) and Group B includes patients without diabetic retinopathy.&#x0D; Results: NDRD was found in 57.6% cases, NDRD plus diabetic nephropathy (DN) in 21.2% and isolated DN in 21.2% cases. In Group A (patients with DR) NDRD, DN and mixed lesion were present in 7 (41.2%), 5 (29.4%) and 5 (29.4%) cases. In Group B (patients without DR) NDRD, DN and mixed lesion were present in 12 (75%), 2 (12.5%) and 2 (12.5%) cases respectively. p value (0.189) was not significant.&#x0D; Conclusion: Kidney disease other than diabetic nephropathy can occur in type 2 diabetic patients. In this study NDRD was found in high frequency. Lack of retinopathy is a poor predictor of nondiabetic kidney disease. Therefore, renal biopsy should be recommended in type 2 diabetic patients with risk factors of NDRD for accurate diagnosis, prompt initiation of disease-specific treatment and ultimately better renal outcome.&#x0D; J Enam Med Col 2020; 10(2): 73-78</jats:p

Ureteric Endometriosis: a 39 Years Old Lady Presented with Cyclical Lower Abdominal Pain

Abstract not available&#x0D; J Dhaka Medical College, Vol. 27, No.1, April, 2018, Page 98-101</jats:p

Effect of Concurrent Chemo Radiation in the Treatment of Locally Advanced Carcinoma of Tongue

This quasi experimental study was conducted to observe the effects and toxicities of concurrent chemo radiation in locally advanced tongue cancer from January 2009 to December 2009 in the Radiotherapy Department of Chittagong Medical College Hospital. A total number of forty patients were purposively selected according to inclusion criteria. Among them, 30 patients presented with lesion in anterior two third &amp; 10 patients in posterior one third. Thirty patients were male &amp; ten were female. All of the patients having betel nut chewing habit &amp; 90% were smoker &amp; tobacco leaf chewer. The mean age of patient was 56.25 years. All patients received chemotherapy on D1, D8, D15, D22, D29, D36, D43 &amp; 66 Gy external beam radiotherapy in 200 cGY/day in six and half weeks. Pretreatment status of mean size of primary lesion of anterior two third and posterior one third of tongue cancer patients significantly decreased in last follow up. Mean size of lymph nodes significantly decreased from pretreatment to last follow up in both anterior two third and posterior one third of tongue cancer patients. Over all response of patients treated with concurrent chemo radiation only three patients of anterior two third &amp; one patient of posterior one third showed complete response followed by seventeen patients of anterior two third &amp; five patients of posterior one third showed partial response. Response is better in stage III than stage IV patients in both anterior two third and posterior one third of tongue cancer. The common toxicities are mucositis, skin reaction, anemia &amp; leucopenia in both anterior two third and posterior one third of tongue cancer patients. In the treatment of locally advanced carcinoma of tongue, coneurrent chemoradiation showed better symptom improvement, manageable toxicities. So, concurrent chemoradiation may be one of the treatment modality in locally advanced carcinoma of tongue patients. Period of study and number of patients were small. So, long term follow-up and large number of patients should be included to conduct more in-depth research and more specific comments.&#x0D; JCMCTA 2012; 23(1): 36-41</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

A-V Fistula Blood Flow and Complications: A One Year Survey

Background: Worldwide haemodialysis(HD) is the mostly used method of renal replacement therapy. Arteriovenous fistula use is on rise due to Fistula First Initiative due to least complications of fistulae than catheters.But they are also subjected to many complications. Thereby appropriate surveillance of the fistulae is important.Objectives: To measure the blood flow as well as fistula related complications in study population. Materials and Methods: This was a cross sectional study, conducted in the department of Nephrology, Dhaka Medical College Hospital during September 2010 to December 2011.Total 118 subjects were included in the study. Besides visualization technique colour Doppler ultrasonogram of fistula and  echocardiography were performed for each patients. Results: Most of the patients had adequate fistula flow. Aneurysm was most common complication. Many subjects were suffered from primary and secondary fistula failure. Conclusion: Arterio-Venous fistula is subjected to many complications and appropriate surveillance should be launched to detect complications and to prevent fistula failure.DOI: http://dx.doi.org/10.3329/jom.v15i2.20681 J MEDICINE 2014; 15 : 110-113</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

Evaluation of Thyroid Function Tests among Chronic Kidney Disease Patients attended at a Tertiary Care Hospital in Dhaka City

Background: Serological status of thyroid hormones is important among chronic kidney disease patients.&#x0D; Objective: The purpose of the present study was to see the status of thyroid hormones among chronic kidney disease patients.&#x0D; Methodology: This cross-sectional study was done From January 2013 to December 2013 in the Department of Nephrology, Dhaka Medical College Hospital. A total of 50 diagnosed cases of adult male with different stages of CKD (CKD stage 3, 4, 5 and 5D) patients along with age-matched 51 healthy individuals were included. Serum Thyroid hormone T3 done by [1251] RIA kit, T4 done by T4 [1251] RIA kit, TSH level done by Turbo TSH [1251] IRMA kit.&#x0D; Result: A total number of 101 patients were recruited for this study of which 51 cases were in the group A and the rest of the 50 cases were in the group B. The mean serum T3 level was found 1.85±0.7 nmoL/L in group A and 2.79±0.55 nmoL/L in group B (p&lt;0.05) which indicated that low serum T3 level was significantly associated with CKD. The mean serum T4 level was found 104.65±34.9 nmol/L in group A and 138.8±31.5 nmol/L in group B (p&lt;0.05). Serum TSH level of the study patients showed that the mean serum TSH level was found 4.23±4.6 mIU/L in group A and 2.06±2.5mIU/L in group B (p&lt;0.05).&#x0D; Conclusion: In conclusion the mean with SD of serum level of T3, T4 and TSH were significantly associated with chronic kidney disease.&#x0D; Journal of National Institute of Neurosciences Bangladesh, July 2022;8(2):147-151</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