I first read Davidson 30 years ago: at that time it was already in its 5th edition. A brief comparison shows that it then contained about 440,000 words in 1,100 pages: the current edition has compressed 625,000 words into 800 pages. I think I bought it as a student because it was cheap: but also because it seemed to be comprehensive and straightforward, and I have used it as a basis for my medical knowledge ever since. So I miss some of the old pictures of the acute skin rashes such as scarlet fever: in fact infectious disease has been transferred to the back and genetic factors take the first chapters. But careful linguistic comparison will still uncover the old phrases which some of us know by heart-there are minor changes such as 'alarming reactions to intravenous iron are uncommon, but have occasionally been noted', which becomes 'alarming systemic anaphyllactic reactions can occur'. Sir Stanley Davidson made 'no attempt to describe every rare disease or syndrome, but devoted most of the space available to those disorders most commonly encountered in practice'. I have grown up with successive editions, and have gradually come to appreciate the problems of the authors in the compression of knowledge. Having got to know many of them personally as real people rather than as names I can still recommend the book. It is the essential starting point for the study of internal medicine and for many doctors will remain their base reference work. The present editors have kept up-to-date and been prepared to prune the dead wood. There are many competitors in the market, and the publishers must take care with layout and illustration, although Davidson is still the best value for money. I will continue to recommend it to my clinical students: they will need to read it and know it to pass final MB. Postgraduates will need to remember the facts, but also to be able to place them in a broader perspective. The older consultant will still happily read it, and to get to know the authors themselves is really to complete your medical education. Dr John Macleod and his team have successfully kept alive the primary objective 'to provide a rational and easily comprehensible basis for the practice of medicine'. The book is economical in price and compact in size, but still contains the essential truths for the practice of good medicine.

Davidson's Principles and Practice of Medicine

Fahr’s disease or Fahr’s syndrome is a rare, neurological disorder characterized by abnormal calcified deposits in basal ganglia and cerebral cortex. Calcified deposits are made up of calcium carbonate and calcium phosphate, and are commonly located in the Basal Ganglia, Thalamus, Hippocampus, Cerebral cortex, Cerebellar Subcortical white matter and Dentate Nucleus. Molecular genetics of this disease haven’t been studied extensively; hence evidence at the molecular and genetic level is limited. Fahr’s disease commonly affects young to middle aged adults. Etiology of this syndrome does not identify a specific agent but associations with a number of conditions have been noted; most common of which are endocrine disorders, mitochondrial myopathies, dermatological abnormalities and infectious diseases. Clinical manifestations of this disease incorporate a wide variety of symptoms, ranging from neurological symptoms of extrapyramidal system to neuropsychiatric abnormalities of memory and concentration to movement disorders including Parkinsonism, chorea and tremors amongst others. Diagnostic criteria for this disease has been formulated after modifications from previous evidence and can be stated briefly, it consist of bilateral calcification of basal ganglia, progressive neurologic dysfunction, absence of biochemical abnormalities, absence of an infectious, traumatic or toxic cause and a significant family history. Imaging modalities for the diagnosis include CT, MRI, and plain radiography of skull. Other investigations include blood and urine testing for hematologic and biochemical indices. Disease is as yet incurable but management and treatment strategies mainly focus on symptomatic relief and eradication of causative factors; however certain evidence is present to suggest that early diagnosis and treatment can reverse the calcification process leading to complete recovery of mental functions. Families with a known history of Fahr’s disease should be counseled prior to conception so that the birth of affected babies can be prevented. This review was written with the aim to remark on the current substantial evidence surrounding this disease.

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Fahr's syndrome: literature review of current evidence.

Acute and chronic pancreatitis

  Flu-like (eg, muscle aches, nausea, vomiting).   Jaundice (ie, yellowing of skin or whites of eyes, dark urine).   Loss of appetite.   Joint pains.   Tiredness.   Young children may show few or no signs or symptoms.   Most people recover fully, but some carry the virus in their blood for a lifetime. Age at the time of infection is a major factor in progression to chronic infection.

Hepatitis B infection.

Adenoviruses have a bipolar nature: they are ubiquitous pathogens that occasionally cause life-threatening diseases or they can be engineered into powerful gene transfer vectors. The goal of this article is to summarize the most recent advances in adenovirus receptor engagement, internalization, endosomal maturation, endosomal escape and trafficking to the nuclear pore. A better understanding of this initial part of the adenovirus lifecycle may identify new mechanistic-based treatments for adenovirus-induced diseases and help in the engineering of more efficient vectors.

An adenovirus traffic update: from receptor engagement to the nuclear pore

Background: Acute pancreatitis is a potentially fatal disease. Mortality and morbidity depends on severity of the disease Objective : To find out the clinical presentation and to optimize the treatments. Method: This hospital based cross sectional descriptive study was performed to find out the clinical presentations of acute pancreatitis from the available clinical, biochemical, haematological and radiological data. Results: A total of 50 cases were studied. Age range was 13 to 74 yrs, with a peak incidence in the fourth decade. Male to female ratio were 1.78:1. Among the known aetiological factors 18% were due to gallstone disease and 10% due to alcoholism. Most common symptoms were upper abdominal pain (96%) and nausea, vomiting (88%). Among the clinical signs most common were abdominal tenderness (92%) and muscle guard (66%). In this study 82% patients had mild and 18% had severe acute pancreatitis. Overall mortality rate was 6%. Mortality was significantly higher (33.33%) in severe acute pancreatitis (33.3% vs 0%). Conclusion: A higher mortality was associated with concomitant medical or surgical diseases, but not to age or sex. A higher mortality was associated with leucocytosis but not to haemoglobin level. Among the biochemical parameters tested, a high blood glucose and serum creatinine level and a lower serum albumin and calcium level were significantly associated with a higher mortality. Bang Med J (Khulna) 2016; 49 : 7-12

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Clinical profile of acute pancreatitis in a teaching hospital

Miss Merry, 17 years old girl hailing from Barobila., Patkelghata, Satkhira was admitted in Khulna Medical College Hospital on 27-06-2010 with the complaints of fever, convulsion and unconsciousness for 7 days. She has also some hearing impairment, behavioral abnormalities and stunted growth since her childhood. On examination she was deeply unconscious, anaemic and febrile. CT scan of brain reveals multiple bilateral symmetrical calcification seen in the brain parenchyma involving basal ganglia, thalamus, para ventricular region, and cerebellar nucleus. Multiple ill defined hypodense areas are seen in the both parieto-occipital region, suggestive of Fahr's syndrome with meningoencephalitis. DOI: http://dx.doi.org/10.3329/bmjk.v45i1-2.13628 Bang Med J (Khulna) 2012; 45 : 33-35

Fahr's syndrome

Background: Hepatitis B virus infection is an important public health problem with significant morbidity and mortality. Recombinant hepatitis B vaccine for the prevention of hepatitis B virus infection is in practice in different parts of the world since its availability in 1986. Government of Bangladesh has also included hepatitis B vaccine in EPI schedule since 2005. Materials and methods: This study was carried out to assess the seroconversion status among hepatitis B vaccinated individuals. A total of 190 individuals including 150 vaccinated persons and 40 non-vaccinated apparently healthy individuals were included as study population. Sources of vaccinated persons were from both EPI and non- EPI schedule of vaccination. Age and sex matched non-vaccinated individuals served as controls for the study. All individuals constituting the study population were screened for HBsAg by Immunochromatographic strip test and only HBsAg-negative persons were included for estimation of their anti-HBs titer. Results: Out of 150 vaccinated individuals, 133(88.67%) were found to have anti-HBs titer in the protective level (>10 IU/L), while 17(11.33%) individuals had anti-HBs titer below the protective level ( 0.05). Vaccinated individuals from lower socioeconomic condition have had comparatively low rate of protective antibody than people from middle and upper classes. Conclusion: Recombinant HB vaccine induces good level of protective immunity among vaccinated persons. Keywords: Hepatitis B; hepatitis B vaccine; seroconversion; Bangladesh DOI: 10.3329/jom.v11i2.5461 J MEDICINE 2010; 11 : 143-150

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Seroconversion after Recombinant Hepatitis B Vaccination

Acute pancreatitis is an acute inflammatory process of the pancreas that can range from mild interstitial pancreatitis to severe pancreatitis with pancreatic necrosis with variable involvement of regional tissues and remote organ systems. The incidence of pancreatitis varies in different countries and depends on causes e.g, gallstones, alcohol, metabolic factors and viral infections. Gall stones continue to be the leading cause of acute pancreatitis in most series. Alcohol, hypertriglyceridemia and drugs are also a common cause of acute pancreatitis. Gall stone pancreatitis is more common in women than in men. Alcohol is also a common cause of acute pancreatitis. Alcoholic pancreatitis is more common in men, and usually occurs in individuals with long standing alcohol abuse. The increased frequency of acute pancreatitis may be due to the rising incidence of obesity, a risk factor for the development of gallstones and by extension, gallstone pancreatitis. Acute pancreatitis occurs when there is abnormal activation of digestive enzymes within the pancreas. This occurs through inappropriate activation of inactive enzyme precursors called zymogens or proenzymes inside the pancreas, most notably trypsinogen. Acute pancreatitis is typically rapid in onset and most commonly encountered in its mild form. While mild cases are often successfully treated with conservative measures, such as fasting and aggressive intravenous fluid rehydration, severe cases may require admission to the intensive care unit or even surgery to deal with complications of the disease process. Acute pancreatitis may be accompanied by life threatening complications as well as significant morbidity and mortality despite treatment. Bang Med J (Khulna) 2017; 50 : 35-40

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Acute pancreatitis- a clinical update

This hospital based cross sectional descriptive study was performed to find out the prognostic factors of acute pancreatitis from the available clinical, biochemical, haematological and radiological data. A total of 50 cases were studied. Peak incidence was in the fourth decade. Among the known aetiological factors 18% were due to gallstone disease, 10% alcoholism, 4% pancreatobiliary ascariasis, but 60% were idiopathic. In this study 82% patients were had mild and 18% had severe acute pancreatitis. Overall mortality rate was 6%, mortality was significantly higher (33.33%) in severe acute pancreatitis (33.3% vs 0%). A higher mortality was associated with concomitant medical or surgical diseases, leucocytosis. Other factors associated with a higher mortality were high blood glucose, serum creatinine level and a lower serum albumin and calcium level. This study highlights the need of further study with more detailed recording of relevant data from primary care hospital to find out the clinical pattern of complications and prognostic factors in our country. Keyword: Acute Pancreatitis; Prognosis; Mortality DOI: 10.3329/jom.v12i1.6927 J Medicine 2011; 12 : 21-25

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Abdul Ahad

Papers

Clinical profile of acute pancreatitis in a teaching hospital

Fahr's syndrome

Seroconversion after Recombinant Hepatitis B Vaccination

Acute pancreatitis- a clinical update

Study of Prognostic Factors of Acute Pancreatitis in a Teaching Hospital