Autoimmune pancreatitis presenting as obstructive jaundice

A 71 years cachexic male presented with sign symptoms of biliary tract obstruction. There was a large mass in the head of pancreases with raised CA 19.9. But elevated serum lipase raised the suspicion of paocreatitis. Elevated immunoglobu­lin IgG4 confmned this case as a auto immune aetiology. Initially there was much difficulty to differentiate auto immune pancreatitis from pancreatic carcinoma but after successful stenting and a course of corticosteroids, patient improved dramatically along with nonnalisation of all the radiological, bio-chemical and immunological parameters

Acromegaly Presenting as Cardiac Failure - A Case Report

Acromegaly is characterized by chronic hypersecretion of growth hormone (GH) and is associated with increased mortality rate because of the potential complications such as cardiovascular disease, respiratory disease, or malignancy, which are probably caused by the long-term exposure of tissues to excess GH, for at least 10 years, before diagnosis and treatment. Here we are reporting a case of acromegaly who initially presented with features of left ventricular failure for which she got herself admitted in CCU and was treated conservatively. Later on, after clinical examination and investigations she was diagnosed as a case of mitral regurgitation due to cardiomyopathy caused by acromegaly. After the successful transsphenoidal resection of the pituitary microadenoma, the level of GH was normalized and heart failure improved. Key words: acromegaly; heart failure; Pituitary microadenoma. DOI: http://dx.doi.org/10.3329/bsmmuj.v4i2.8644 BSMMU J 2011; 4(2):122-12

Acute kidney injury due to star fruit ingestion: A case report

Star fruit (Avarrhoa carambola) is a fruit from oxalidace family. lt is found in many countries of the world including Bangladesh. But its ingestion or drinking star fruit juice may lead to intoxication especially in patients with chronic kidney disease and manifestations might be neurological or nephrological. lt may also cause acute kidney injury in patients with previously normal renal function. Here we are presenting a case who presented with acute kidney injury after star fruit ingestion with previously unknown renal function impairment. The etiology was confirmed by histopathological exami­nation after doing renal biopsy. This renal function impairment is mainly due to oxalate crystal induce nephropathy which is richly abundant in star fruit. His renal function was improved ·with conservative management. Physicians should be alert to consider the ingestion of star fruit as a cause of acute kidney injury in a patient even in the absence of previous renal function impairment

Genitourinary melioidosis in a Bangladeshi farmer with IgA nephropathy complicated by steroid-induced diabetes mellitus

Melioidosis is an emerging infectious disease in many countries including Bangladesh. Genitourinary infection due to Burkholderia pseudomallei is a well-recognized manifestation although less commonly reported in Asia than Australia. Here, we report case history of a 38-year-old Bangladeshi farmer, diagnosed with IgA nephropathy and on oral prednisolone, who presented with features of urinary tract infection. Diagnostic workup confirmed genitourinary infection due to B. pseudomallei and diabetes mellitus. He was treated with ceftazidime followed by the combination of co-trimoxazole and doxycycline. After two-year follow-up, he was free of symptoms with no recurrence of melioidosis. In the context of growing evidence of melioidosis endemicity in Bangladesh, physicians should be aware and include melioidosis as differential in appropriate clinical scenario. Melioidosis may cause urinary tract infections and should be suspected in high-risk groups like farmers and in the presence of risk factors such as diabetes mellitus and other immunosuppressive conditions

Autoimmune pancreatitis presenting as obstructive jaundice

A 71 years cachexic male presented with sign symptoms of biliary tract obstruction. There was a large mass in the head of pancreases with raised CA 19.9. But elevated serum lipase raised the suspicion of paocreatitis. Elevated immunoglobu­lin IgG4 confmned this case as a auto immune aetiology. Initially there was much difficulty to differentiate auto immune pancreatitis from pancreatic carcinoma but after successful stenting and a course of corticosteroids, patient improved dramatically along with nonnalisation of all the radiological, bio-chemical and immunological parameters

Emphysematous Pyelonephritis in a 32-Year-Old Diabetic Female

Emphysematous pyelonephritis is a rare, severe, necrotizing renal parenchymal infection characterized by gas accumulation in kidney(s) with or without involving surrounding tissues. Patients with diabetes mellitus are the usual sufferers. Here we describe a case history of a young Bangladeshi diabetic lady who presented with dysuria, fever and abdominal pain. Investigations confirmed left sided emphysematous pyelonephritis. She responded to and recovered with intravenous antibiotics

A study on knowledge of patients with end stage renal disease towards dialysis in a tertiary care hospital in Dhaka city

Background and objective: There are approximately two million patients suffering from end stage renal disease (ESRD) worldwide requiring renal replacement therapy (RRT) in the form of dialysis. There are very few statistics regarding the knowledge and attitude towards dialysis among ESRD patients in Bangladesh. The present study was undertaken to understand the existing knowledge of the patients with ESRD regarding dialysis. Methods: This cross sectional descriptive study was done on 104 patients with ESRD requiring immediate dialysis. This study was conducted in the department of Nephrology, BIRDEM General Hospital, Dhaka, Bangladesh over a period of six months. After obtaining informed consent the participants were given a self-administered questionnaire that included questions on socio-demographic status, age, gender, different aspects of knowledge about dialysis and the reasons to accept and refuse dialysis for the treatment of ESRD. Results: A total of 104 patients with ESRD were enrolled in the study. The mean age was 54.20(±11.82) years, 87.5% were more than 40 years of age, and 72.1% were male. Eighty two percent mentioned diabetes as the cause of kidney disease. About half of the respondents (52.88%) knew dialysis as an option for the treatment of ESRD followed by kidney transplant (11.54%). A few (7.3%) mentioned medicine and dietary modification as the treatment. There was no statistical association between prior knowledge and agreeing to do dialysis (χ2= 0.7814; p=0.376699). Most of the patients (78%) gathered knowledge about dialysis from doctors. Seventy two patients (69.2%) agreed to do dialysis. Among them 37 patients (51.4%) agreed as they considered it as a part of treatment and 32 patients (44.4%) agreed because they were advised by doctors. Reasons for refusal to do dialysis were - fear of death (59.37%), financial constraints (31.25%) and lack of availability of dialysis centre (9.37%) Among study populations, only 20 patients (19.2%) mentioned about peritoneal dialysis (PD) and all of them (100%) were informed by doctors. Conclusion: The present study has demonstrated that prior knowledge on dialysis has no influence on the decision to do dialysis for the treatment of ESRD. Availability and access to dialysis facility and counseling on beneficial aspects of dialysis is required to motivate the patients for dialysis with ESRD. In addition to health care providers, social media may play an important role in promoting public awareness regarding dialysis as a treatment modality of ESRD. IMC J Med Sci 2017; 11(1): 11-1