结节病易误诊,据王洪武等~([1])收集国内18篇关于此病误诊的文献,误诊率高达63.2%,当然有误诊就会有误治,如孙永昌等~([2])报道26例结节病在影像学检查诊断的第一印象中拟诊结核5例,其中就有2例完成规范的抗结核治疗,为此应引起临床对本病诊治的重视。

Sarcoidosis

The study group.

Irritable bowel syndrome

Many studies have shown that hyperinsulinemia and/or insulin resistance are related to various metabolic and physiological disorders including hypertension, dyslipidemia, and non-insulin-dependent diabetes mellitus. This syndrome has been termed Syndrome X. An important limitation of previous studies has been that they all have been cross sectional, and thus the presence of insulin resistance could be a consequence of the underlying metabolic disorders rather than its cause. We examined the relationship of fasting insulin concentration (as an indicator of insulin resistance) to the incidence of multiple metabolic abnormalities in the 8-yr follow-up of the cohort enrolled in the San Antonio Heart Study, a population-based study of diabetes and cardiovascular disease in Mexican Americans and non-Hispanic whites. In univariate analyses, fasting insulin was related to the incidence of the following conditions: hypertension, decreased high-density lipoprotein cholesterol concentration, increased triglyceride concentration, and non-insulin-dependent diabetes mellitus. Hyperinsulinemia was not related to increased low-density lipoprotein or total cholesterol concentration. In multivariate analyses, after adjustment for obesity and body fat distribution, fasting insulin continued to be significantly related to the incidence of decreased high-density lipoprotein cholesterol and increased triglyceride concentrations and to the incidence of non-insulin-dependent diabetes mellitus. Baseline insulin concentrations were higher in subjects who subsequently developed multiple metabolic disorders. These results were not attributable to differences in baseline obesity and were similar in Mexican Americans and non-Hispanic whites. These results support the existence of a metabolic syndrome and the relationship of that syndrome to multiple metabolic disorders by showing that elevations of insulin concentration precede the development of numerous metabolic disorders.

Prospective Analysis of the Insulin-Resistance Syndrome (Syndrome X)

A comparison of the contribution of systolic versus diastolic blood pressure to risk of coronary heart disease and the role of mean arterial pulse pressure and systolic lability have been examined prospectively in 5,127 men and women during 14 years of biennial follow-up studies. Similar gradients of risk of subsequent coronary heart disease were observed whether persons were classified by their systolic or diastolic pressure, and no “safe” or critical level could be identified. Assessment of the net effect of each, employing discriminant analysis, indicated a stronger association of systolic than diastolic pressure with risk of coronary heart disease. Neither the systolic and diastolic pressure measurements in combination nor the pulse pressure and the mean arterial pressure measurements alone discriminated better than the systolic measurement alone. Systolic lability did not predict incidence of coronary heart disease independently of the associated level of blood pressure. There was a trend of declining relative importance of diastolic and a corresponding increase in the importance of systolic pressure with advancing age. Only in those under 45 was diastolic pressure predominant. The level of casually obtained blood pressure was a good predictor of coronary heart disease. The current practice of assessing the importance of blood pressure at all ages largely on the basis of diastolic pressure and the commonly held view concerning the innocuous nature of an elevated level of systolic pressure in the elderly requires reevaluation.

Systolic Versus Diastolic Blood Pressure and Risk of Coronary Heart Disease???The Framingham Study

Abstract not availableTAJ 2012; 25: 90-96

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Hepatitis B e Antigen–Negative Chronic Hepatitis B

Naturally Bangladesh has notremained isolated from the developments on theseissues.Within the framework of WHO's definition ofhealth as a state of complete physical, mental andsocial well-being, and not merely the absence ofdisease or infirmity, reproductive health addressesthe reproductive processes, functions and systemat all stages of life. Reproductive health, therefore,implies that people are able to have a responsible,satisfying and safe sex life and that they have thecapability to reproduce and the freedom to decideif, when and how often to do so. Implicit in thisare: the right of men and women to be informed ofand to have access to safe, effective, affordableand acceptable methods of fertility regulation oftheir choice, and the right of access to appropriatehealth care services that will enable women to gcsafely through pregnancy and childbirth andprovide couples with the best chance of having ahealthy infant.The common denominators of poor reproductivehealth are poverty and ignorance. Poor people wholack adequate food, basic health care, or moderncontraception suffer grave consequences. Themajor categories of illness and mortality of poorwomen relating to reproductive health are:malnutrition and anaemia, common infectiousdiseases, complications of pregnancy, sexuallytransmitted diseases, HIV/AIDS, unsafe abortionand female genital mutilation.

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Reproductive Health and Rights

The study was conducted to assess the clinico-pathological profile of 50 liver abscess cases. This study showed that liver abscess is more common in male than in female. In present study Amoebic Liver Abscess (ALA) is much more common than Pyogenic Liver Abscess (PLA) and almost all the cases belonged to low or medium socio-economic class from rural areas. This may be due to poor living conditions, over crowding and unhygienic practices which leads to fecal contamination of food and drinks which help in transmission of amoeba. Liver abscess has correlation with consumption of indigenous alcohol. Ultrasonogram is an easy, widely available non-invasive and dependable investigation to diagnose liver abscess. In the absence of sophisticated investigations (e.g. Serum antibody against amoeba) at hand, only aspiration and study of pus is a good guide to confirm and to differentiate ALA from PLA. Complications like recurrence, pleuro-peritoneal involvement or rupture of the abscess are not common. doi: 10.3329/taj.v21i1.3218 TAJ 2008; 21(1): 44-49

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Clinico-Pathological Profile of Liver Abscess in a Teaching Hospital

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

Tuberous sclerosis, also known as tuberous sclerosis complex (TSC), is an autosomal dominant, multisystem, neurocutaneous disorder characterized by development of widespread hamartomatous lesions involving skin, brain, kidney, retina etc. Contrary to the popular belief, the disease has variable degree of expressivity and not all patients have the severe debilitating form. We report two cases of tuberous sclerosis complex in a family and then the literature is reviewed. Keywords: Tuberous sclerosis, neurocutaneous syndrome, hamartoma, phakomatosis DOI:10.3329/jom.v11i1.4284 J Medicine 2010: 11: 94-98

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Arm Saifuddin Ekram

Papers

Hepatitis B e Antigen–Negative Chronic Hepatitis B

Reproductive Health and Rights

Clinico-Pathological Profile of Liver Abscess in a Teaching Hospital

Clinical profile of acute pancreatitis in a teaching hospital

Tuberous Sclerosis Complex in a Family