Showing papers in "Journal of Medicine in 2013"
TL;DR: This investigation showed that most of the clinical isolates of Acinetobacter species were biofilm producers especially from ICU samples and they were multidrug resistant.
Abstract: Purpose: The purpose of this study was to detect biofilm formation in clinical isolates of Acinetobacter species and to observe correlation between biofilm formation and antimicrobial resistance among Acinetobacter isolates. Methods: Two hundred fifty six clinical samples collected from patients who were admitted in Intensive Care Unit (ICU) and on device, patients from Surgery, Medicine, Gynae & Obs and Urology department of Bangabandhu Sheikh Mujib Medical University (BSMMU) and from Burn unit of Dhaka Medical College Hospital were included in this study. Biofilm formation and antibiotyping were performed for the isolates of Acinetobacter species recovered from clinical samples including tracheal aspirates, blood, urine, wound swab, pus, throat swab, endotracheal tubes, burn samples, ascitic fluid, sputum, aural swab, oral swab, cerebrospinal fluid, and catheter tip. Correlation of biofilm formation with antimicrobial resistance pattern among Acinetobacter isolates were also observed in this study. Result: A total of 256 various specimens were studied of which 95 Intensive Care Unit (ICU) and 161 Non ICU samples. Out of 95 ICU and 161 Non ICU samples, Acinetobacter species were isolated from 32 (33.7%) and 20(12.4%) respectively. From 32 ICU and 20 Non ICU Acinetobacter isolates, 28 (87.5%) and 11 (55%) were biofilm producers. Biofilm forming capacity of Acinetobacter species was significantly (p<0.008) greater in ICU than in Non ICU isolates. In both ICU and Non ICU isolates, biofilm forming Acinetobacter species were 100% resistant to amoxicillin, ceftriaxone, ceftazidime, cefotaxime, cefuroxime, and aztreonam. Resistance to antibiotics such as gentamicin, amikacin, netilmicin, ciprofloxacin and imipenem was higher among biofilm forming Acinetobacter isolates in ICU than Non ICU isolates. Susceptibility to colistin was 100% in Non ICU isolates but in ICU it showed 7.1% resistance. Conclusions: This investigation showed that most of the clinical isolates of Acinetobacter species were biofilm producers especially from ICU samples and they were multidrug resistant. Even polymixin resistant Acinetobacter isolates are slowly emerging. This is very alerming for us that biofilm forming multidrug resistant Acinetobacter species represents a severe threat in the treatment of hospitalized patients. So, antibiotic policy and guidelines are essential to eliminate major outbreak in future. DOI: http://dx.doi.org/10.3329/jom.v14i1.14533 J MEDICINE 2013; 14 : 28-32
19 citations
TL;DR: Hyperhomocysteinemia in ischaemic stroke patients has as been determined as vascular risk factor in the authors' study and significant correlation has been found between homocysteine concentration and ischemic stroke.
Abstract: Background: Epidemiologic studies have identified hyper-homocysteinemia as a possible risk factor for atherosclerosis.The aim of my study was based on evaluation of relationship between homocysteinemia with ischemic stroke patients. Methods and materials: It was a prospective observational study conducted in the Department of Neurology, Sir Salimullah Medical College & Mitford hospital, Dhaka. Thirty six consecutive patients with ischemic stroke were analyzed by serum total homocysteine, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglyceride and Equal number of controls same ages were compared with the case group. Result: Mean Fasting blood sugar, serum fasting total cholesterol (TC), serum fasting Low density lipoprotein (LDL) were significantly higher in case group (p=0.001). Serum TC and LDL had a positive correlation with serum homocystine a (p=0.001). Serum High density lipoprotein (HDL) had a negative correlation (p=0.718) and serum triglyceride (TG) had a negative correlation (p = 0.182). Total plasma fasting homocysteine level in case group was 21.89 ± 9.38 imol/l and control group was 12.31 ± 3.27 imol/l, (p=0.001). Elevated fasting homocystein level was found in 75.0% of ischemic stroke patient and in 16.67% of healthy controls (p=0.001). The incidence of hyperhomocysteinemia is higher in ischaemic stroke cases than that in age-sex matched healthy controls. Conclusion: Hyperhomocysteinemia in ischaemic stroke patients has as been determined as vascular risk factor in our study. Significant correlation has been found between homocysteine concentration and ischaemic stroke. DOI: http://dx.doi.org/10.3329/jom.v14i1.14536 J MEDICINE 2013; 14 : 47-51
13 citations
TL;DR: This data indicates that conventional excisional excision is a viable treatment for central giant cell granuloma, and the use of a second type of excision, called a “cell reprograming”, is recommended.
Abstract: No Abstract Available J MEDICINE 2013; 14 : 1-3 DOI: http://dx.doi.org/10.3329/jom.v14i1.14589
7 citations
TL;DR: A cross-sectional study was conducted from 1 January 2008 to 30 June 2009 in Hyderabad as mentioned in this paper, where a total of 504 male and female students of class six to ten were selected through simple random sampling.
Abstract: Background: At least 20 million children under the age of 5 years were overweight globally in year 2005. Childhood obesity prevalence has increased by three to four folds globally within past few decades. It is also becoming an important public health problem among Pakistani children due to changes in life style and other factors. This study is aimed to estimate the prevalence of obesity and the associated factors leading to obesity among school students urban city of Hyderabad. Objective: To determine the Prevalence of obesity and factors leading to obesity among high school students of public and private schools of Hyderabad city Pakistan. Methods: A Cross-sectional study was conducted from 01 January 2008 to 30 June 2009 in Hyderabad. A total of 504 male and female students of class six to ten were selected through simple random sampling. They were interviewed by trained data collectors through physical activity and diet questionnaires. Anthropometric measurements were done with calibrated instruments using the age and sex specific BMI cut off points according to WHO growth reference. Data analysis was done on SPSS 16. Results: The prevalence of overweight and obesity was 23% and 15%, respectively, among the boys, while 16% and 8% respectively in girls. When adjusted for other factors multivariate model showed that the girls were protected against obesity, OR=0.33 (0.16-68). Odds ratios for the age groups showed that older children were also protected against obesity. Middle socioeconomic status tertile was more than 3 times more likely to be obese. Conclusions: Childhood obesity is determined by the factors in the home, school and other physical environment and it is recommended that all the stakeholders should take relevant actions for the prevention of the problem. DOI: http://dx.doi.org/10.3329/jom.v14i1.14534 J MEDICINE 2013; 14 : 33-39
6 citations
TL;DR: High persistent fever, profound general weakness, myalgia, headache and itchy skin rash were the usual presenting features of Dengue infection in Border Guard personnel in Bangladesh; however, one patient subsequently developed Guillein Barre Syndrome.
Abstract: Background: Dengue is the most rapidly spreading mosquito-borne viral disease in the world 1 . The rapidly expanding global footprint of dengue is a public health challenge. The endemicity of dengue is also increasing in Bangladesh. This study highlights our current understanding of dengue, including its clinical manifestations, laboratory tests, management and outcome. Objectives: This study was designed to document the presenting features and outcome of Dengue infection in Border Guard personnel. Materials and Methods: It was a prospective observational study which was carried out among outpatient and indoor cases from February 2011 to November 2012 in Border Guard Hospital, Dhaka which is a 300 bedded hospital. Total 200 cases were enrolled. A detailed history, clinical examinations and relevant investigations were done. Data were collected in a predesigned structured questionnaire and analyzed with the help of SPSS-16.0 and Chisquare (X2) Test. Results: A total of 200 adult seropositive Dengue cases of various grade were studied. Among these 152(76%) were male and 48 (24%) were female. Male to female ratio was 3.17:1.The age range of the patients was 18 to 60 years and the mean age 39±12.56 years. Among 200 patients, 112(66%) were Dengue Fever (DF) and 88(44%) were Dengue Haemorrhagic Fever (DHF) including 3(1.5%) cases of DHF Grade lII but none (0%) had Grade-IV DHF. All the patients presented with fever 200(100%), general weakness 200(100%) followed by various skin rash 196(98%), headache 192(96%), myalgia/arthralgia 191(95.5%), retroorbital pain 84(42%). Bleeding manifestation showed in 94(47%) cases of which petechiae was most frequent 86(43%), Haematocrit was normal only in 13(6.5%) patients and 82(41%) had a rise of >20%; Leucopenia was found in 187(93.5%) patients.Only 2(1%) patients had normal platelet count and 03(1.5%) patients had platelet count of less than 10X109 /L. Raised serum alanine aminotransferase (ALT) was observed in 184(92%) of cases. All (200%) the patients recovered completely from the disease; however, one patient subsequently developed Guillein Barre Syndrome. Conclusion: High persistent fever, profound general weakness, myalgia, headache and itchy skin rash were the usual presenting features. Most of the patients recovered well with efficient symptomatic and supportive treatment. Very few cases required blood/platelet transfusion. There was no case fatality in this study group DOI: http://dx.doi.org/10.3329/jom.v14i1.14531 J MEDICINE 2013; 14 : 18-22
4 citations
TL;DR: Investigating sex-habit and STIs of the drug abusers in Bangladesh showed that altering behaviors, especially their drug habit and sexual lifestyle are still the only applicable ways to stop this human catastrophe.
Abstract: Drug abuse is increasing alarmingly with time among the young-adults in Bangladesh. The objective of the study was to investigate sex-habit and STIs of the drug abusers. A total of 1076 drug abusers undergoing detoxification voluntarily at the Central Drug Addiction Treatment Centre (CTC), Tejgaon, Dhaka were investigated from September 2010 to August 2011. They were selected consecutively on the basis of defined selection criteria. Research instrument was an interviewer questionnaire and blood specimen. Results showed that 82.1% (n=883) were heterosexual and 16.2% (n=174) had no sex. The majority of them (55.3%, n=595) had enjoyed sex with multiple partners. They enjoyed sex with commercial sex sellers (11.1%, n=119) but majority of them (34.2%, n=368) had sex with all categories including spouse. Results also showed that majority of them had unethical sex, of which 24.9%(n=268) had experience about extramarital sex and 30.4%(n=327) premarital sex respectively. Around 55.0%(n=594) of them did not use condom during sex and 21.9%(n=236) used it occasionally. The 14.5%(n=156) of them had signsymptoms of gonorrhea and syphilis, of which 1.8%(n=19) had genital ulcer, 3.7%(n=40) genital discharge and 9.0%(n=97) had both ulcer and discharge respectively. In laboratory analysis, 16.3%(n=175) had STIs positive results, of which 9.9%(n=107) were RPR reactive, 1.8%(n=19) URS reactive and 4.6%(n=49) both RPR and URS reactive respectively. In drug habit, results also showed that 82.6% (n=889) of them had been using heroin and the rests used cannabis (8.6%, n=93), phensedyl (5.4%, n=58) and injections (3.3%, n=25) respectively. Forty two percent (n=455) of them had been abusing it for 1-5 years, 31.4% (n=338) for 6-10 years and 26.3%(n=283) for 11-20 years. Most of them (91.1%, n=980) used multiple illicit drugs and their ultimate choice of drug was heroin (77.3%, n=832). About 22.6%(n=243) addicts abused injection drugs in their lifetime. Altering behaviors, especially their drug habit and sexual lifestyle are still the only applicable ways to stop this human catastrophe. DOI: http://dx.doi.org/10.3329/jom.v14i1.14529 J MEDICINE 2013; 14 : 5-10
3 citations
TL;DR: Estradiol level 1000-2000 pg/ml at mean age of 27.8±4.9 years could be a predictor of ovarian response and pregnancy outcome during COH in women from Gaza Strip, and for women to undergo a more likely successful IFV program, it is recommended to optimize E2 level at 1000- 2000 pg/ ml.
Abstract: Background : Currently, controlled ovarian hyperstimulation (COH) is monitored by serum estradiol (E2) levels which are believed to primarily detect functional activity of follicles. Objective: To evaluate estradiol level as a predictor of ovarian response and pregnancy outcome during COH in women from Gaza Strip. Methods: This prospective cohort study consisted of 75 women attending in vitro fertilization (IVF) at Al-Basma Fertility Center in Gaza City. Blood withdrawal for E2 hormone measurement was performed in all the patients and the number of oocytes and embryos were recorded for each female and the occurrence of pregnancy was followed for three months. Obtained data were computer analyzed using SPSS statistical package version 18. Results : The mean age of the study population was 29.2±5.9 years. Questionnaire interview showed that the cause of infertility was mostly referred to husbands. More than half of women seeking IVF had no children and had repeated IVF. The mean level of E2 showed the highest value of 2194.4 (pg/ml) at age group 26-35 years. However, the difference in E2 levels among the age groups was not significant (F=0.940 and P=0.395). When related to the number of oocytes retrieved, E2 level showed general increase with increase ovarian response, recording values of 1642.7, 1665.1, 2156.8 and 1798.7 pg/ml with 16 oocytes, respectively, but this change was not significant (F=0.219 and P=0.883). The mean level of E2 showed its maximum value of 2143.6 pg/ml in positive pregnancy. However the difference in E2 levels among the different categories of IVF outcome was not significant (F=0.423 and P=0.656). The numbers of total and mature oocytes, and embryo were significantly increased with increased levels of E2, showing a good response at E2 level=1000-2000 pg/ml. The number of mature oocytes showed positive correlations with E2 and number of embryo (r= 0.159, P= 0.177 and r= 0.890, P=0.000, respectively) and negative correlation with age (r=-0.276, P=.017). Conclusion: Estradiol level 1000-2000 pg/ml at mean age of 27.8±4.9 years, could be a predictor of ovarian response and pregnancy outcome during COH. Consequently, for women to undergo a more likely successful IFV program, it is recommended to optimize E2 level at 1000-2000 pg/ml. DOI: http://dx.doi.org/10.3329/jom.v14i1.14537 J MEDICINE 2013; 14 : 52-56
2 citations
TL;DR: In this paper, the authors found a statistically significant association of ischemic stroke with diabetes,hypertension, smoking, homocysteine, Lp(a), hsCRP, LVH, and chronic H.pylori infection.
Abstract: Background: Stroke accounts as one of the leading cause of morbidity and mortality and third most common cause of death worldwide. In a significant percentage of stroke patients no definite cause can be identified. These group of unknown cause, the so-called ‘cryptogenic strokes’ are associated with some novel risk factors and now a major focus for clinical discussion. Objectives: To find out conventional risk factors behind ischemic stroke and to establish correlation between ischemic stroke with elevated lipoprotein(a), Homocysteinemia, elevated High-sensitivity C-reactive protein (hs CRP),Systemic Lupus Erythematous (SLE) and chronic H.pylori infection and carotid intimo-medial thickness(CIMT). Materials and methods: Thirty (30) admitted ischemic stroke patients based on WHO definition and confirmed by axial CT and or MRI Scan. were included. Thirty (30) controls were recruited from close relatives of the patients attending the Medicine OPD without any prior history of stroke or coronary heart diseases. Risk factors were documented on the basis of biochemical tests performed. Results : Statistically significant association of ischaemic stroke with diabetes,hypertension, smoking, homocysteine, Lp(a), hsCRP, LVH, CIMT,H.pylori infection. No association of valvular heart disease, atrial fibrillation, A.N.A was found with ischaemic stroke. Conclusion: In addition to measures that include blood sugar, blood pressure and lipid control routine estimation of Lp(a), homocysteine level, monitoring of atherosclerotic changes in carotid artery by Doppler study, echocardiographic monitoring of LVH should be done so that appropriate steps can be taken to avert an attack of stroke. Lastly early detection and eradication of H.pylori is always advisable to reduce the incidence of ischemic stroke. DOI: http://dx.doi.org/10.3329/jom.v14i1.13165 J MEDICINE 2013; 14 : 11-17
2 citations
TL;DR: A novel approach is needed to assess the importance of knowing the carrier and removal status of canine coronavirus, as a source of infection for other animals, not necessarily belonging to the same breeds.
Abstract: No Abstract Available DOI: http://dx.doi.org/10.3329/jom.v14i1.14592 J MEDICINE 2013; 14 : 99
2 citations
TL;DR: The gain of blood group A antigen in a patient with AML is described, whose red cells showed the 0 Rh (D) - phenotype after induction of remission with one courses of Daunorubicin, Cytarabine.
Abstract: Gain of red blood cell antigens has been described in patients with acute myelocytic leukemia (AML). This paper describes the gain of blood group A antigen in a patient with AML. At the time of diagnosis the patient’s red cells showed the 0 Rh (D) - phenotype. After induction of remission with one courses of Daunorubicin, Cytarabine, her blood group was changed to A Rh (D) - phenotype. DOI: http://dx.doi.org/10.3329/jom.v14i1.14559 J MEDICINE 2013; 14 : 77-79
2 citations
TL;DR: This study found Diabetes as the leading cause of ESRD accounting 44.1% of whole population and kidney failure among the Haemodialysis patients.
Abstract: Diabetes is one of the leading causes of ESRD and the no of diabetes patients is increasing day by dayIn the developed world it is the first and foremost cause of renal failure However in the developing countries it has been considered as second most common cause after GNThis study was a cross sectional study conducted during Oct 2010 to Sept 2011, in the dept of Nephrology, Dhaka Medical College and Hospital to determine the cause of renal failure with specific object to find out the leading cause of ESRD among the Haemodialysis patients This study found Diabetes as the leading cause of ESRD accounting 441% of whole population DOI: http://dxdoiorg/103329/jomv14i114595 J MEDICINE 2013; 14 : 62-64
TL;DR: A significantly higher treatment success was found in patients supervised by lady health workers compared to other types of treatment support, and the overall treatment success rate was 85.1%.
Abstract: Background: Tuberculosis (TB) is a major cause of mortality and is affecting millions of people in third world countries. In DOTS patients are monitored facility based and treatment supporter based; by these two ways patients are observed for the treatment. The aim of the study was to explore the role of treatment supporters and their impact on the treatment outcomes. Material and Method: The study was a cross-sectional survey within routine TB control program operational context. All sputum smear positive TB patients diagnosed, registered in public sector, urban and rural diagnostic centre during year 2008 with available outcomes were included in the study. Data was collected during August- October 2010 from 15 health facilities of 451 patients. Results: The majority of the patients (89.6%) were provided with treatment supporters. In 404 (89.6%) cases in which treatment supporters were provided, 203 (50.2%) were lady health worker, 46 (11.4%) were community health worker and health facility worker, and 155 (38.4%) were family member and community volunteer. 384 (85.1%) were categorized as “treatment success”, 31 (6.9%), as “transferred out”, 17 (3.8%), as “dead”, 16 (3.5%) as “defaulted” and three (0.7%) as “treatment failure”. The treatment success rates in patients supervised by lady health worker, community health worker and health facility worker, and family member and community volunteer was 93.1%, 89.1% and 73.5%, respectively. Conclusions: We found a significantly higher treatment success (93.1%) in patients supervised by lady health workers compared to other types of treatment support. The overall treatment success rate was 85.1%. DOI: http://dx.doi.org/10.3329/jom.v14i1.14535 J MEDICINE 2013; 14 : 40-46
TL;DR: A case of third ventricular tubercular abscess with triventriculomegaly that was managed by ventricULoscopic drainage and third ventriculostomy though preoperative diagnosis & surgical planning was different is reported.
Abstract: Intracranial tuberculomas are rather common lesions in developing world.Tuberculomas are usually located in cerebellum, basal ganglia and cerebral hemispheres, particularly in frontoparietal region.Less common sites include the corpus callosum, quadrigeminal plate,the cerebellopontine angle, the retro-orbital region, the anterior optic pathway and the supraseller region.The central nervous system (CNS) involvement comprises approximately 10–15% of all tuberculous infections. Brain tuberculosis is usually parenchymal. Intraventricular tuberculosis is very rare and only little number of cases has been reported. Intraventricular tubercular abscess is further rarer. Here we report a case of third ventricular tubercular abscess with triventriculomegaly that was managed by ventriculoscopic drainage and third ventriculostomy though preoperative diagnosis & surgical planning was different. DOI: http://dx.doi.org/10.3329/jom.v14i1.11415 J MEDICINE 2013; 14 : 72-73
TL;DR: CXR and CT scan findings imply that the male patient and his younger sister had 2 case of pulmonary alveolar microlithiasis (PAM), and his sister had very similar findings.
Abstract: Pulmonary alveolar microlithiasis is a disease of unknown etiology. The disorder affects people at every age beginning from the early childhood. It usually occurs in a sporadic form, but an autosomal recessive form has been described, especially in patients from the Mediterranean countries. Our cases were in one family. A 44 years old man and his younger(35 years old) sister. Both of them complaint of dyspnea, bluish discolouration of face and extremities (acrocyanosis), clubbing, and coughing We evaluate both of them. These are findings in the male patient, and his sister had very similar findings. CXR and CT scan findings imply that we had 2 case of pulmonary alveolar microlithiasis (PAM). DOI: http://dx.doi.org/10.3329/jom.v14i1.14583 J MEDICINE 2013; 14 : 80-82
TL;DR: This data indicates that conventional excision of central giant cell granuloma is a viable alternative for central nervous system prolapse preoperatively and the use of a second line of treatment is likely to be beneficial.
Abstract: No Abstract Available. DOI: http://dx.doi.org/10.3329/jom.v14i1.14624 J MEDICINE 2013; 14 : 70-71
TL;DR: A diagnosis of isolated splenic tuberculosis was confirmed after a splenic puncture and histopathological examination and abdominal ultrasonography revealed splenomegaly with multiple small hypoechoic lesions within the spleen.
Abstract: Tuberculosis of spleen is an extremely rare clinical entity. It often poses diagnostic difficulties as microbiological confirmation of diagnosis is not easy. We encountered two casas who presented with prolong fever but no other symptoms. Laboratory data provided no specific information for diagnosis. Abdominal ultrasonography revealed splenomegaly with multiple small hypoechoic lesions within the spleen. A diagnosis of isolated splenic tuberculosis was confirmed after a splenic puncture and histopathological examination. DOI: http://dx.doi.org/10.3329/jom.v14i1.14586 J MEDICINE 2013; 14 : 88-90
TL;DR: A 30-year old male who had a massive tumour in the left thorax was revealed as a Primitive Neuro-Ectodermal Tumor (PNET) compatible with ASKIN’s Tumour by CT-guided fine needle aspiration and immunohistochemical studies showed positive staining for CD99.
Abstract: Askin’s Tumour (Synonym: Primitive Neuro-Ectodermal Tumor) is a rare neoplasm of the chest wall. In 1979 Askin and Rosai described an unique clinicopathological entity, characterised as a malignant small-cell tumour of the soft tissues of the chest wall in childhood and adolescence. We report on a case of a 30-year old male who had a massive tumour in the left thorax. The clinical symptoms were cough and increasing dyspnoea. The tumour was revealed as a Primitive Neuro-Ectodermal Tumor (PNET) compatible with ASKIN’s Tumor by CT-guided fine needle aspiration. Immunohistochemical studies showed positive staining for CD99. In our case , radiotherapy followed by chemotherapy was given. Microscopy and immunohistological stain of the specific marker—neuron-specific enolase—are essential. Multimodal treatment allows a long-term survival, but often the prognosis is variable. DOI: http://dx.doi.org/10.3329/jom.v14i1.14588 J MEDICINE 2013; 14 : 94-97
TL;DR: No Abstract Available DOI: http://dx.doi.org/10.3329/jom.v14i1.14541 J MEDICINE 2013; 14 : 65-69
Abstract: No Abstract Available DOI: http://dx.doi.org/10.3329/jom.v14i1.14541 J MEDICINE 2013; 14 : 65-69
TL;DR: A rare case of primary non-Hodgkin’s Lymphoma in a 52-year-old female presented with a large mass in the right lobe of thyroid, established by fine needle aspiration cytology followed by surgery and finally confirmed by histopathology.
Abstract: A rare case of primary non-Hodgkin’s Lymphoma in a 52-year-old female presented with a large mass in the right lobe of thyroid. The diagnosis was established by fine needle aspiration cytology (FNAC) followed by surgery and finally confirmed by histopathology. DOI: http://dx.doi.org/10.3329/jom.v14i1.14584 J MEDICINE 2013; 14 : 83-84
TL;DR: A case of an atypical presentation of acute myeloblastic leukaemia who presented with neurological features and skin eruption is reported.
Abstract: Leukemia cutis is not a common manifestation of leukemia but when present it indicates poor prognosis. Here we report a case of an atypical presentation of acute myeloblastic leukaemia who presented with neurological features and skin eruption. DOI: http://dx.doi.org/10.3329/jom.v14i1.14587 J MEDICINE 2013; 14 : 91-93
Journal Article•
TL;DR: In this article, the case of a 41 year old male with repeated admissions of symptomatic hyponatremia (seizures, behavioural abnormalities) who presented to us in a mute state.
Abstract: We report the case of a 41 year old male with repeated admissions of symptomatic hyponatremia (seizures, behavioural abnormalities) who presented to us in a mute state. Evaluation of the hyponatremia revealed hypopituitarism and his symptoms completely subsided on therapy with eltroxin. Keywords: Abnormal behaviour, Seizures, Hypopituitarism
TL;DR: A novel approach is proposed to evaluate the importance of knowing the carrier and removal status of canine coronavirus as a source of infection for other animals and its application in humans is investigated.
Abstract: No Abstract available DOI: http://dx.doi.org/10.3329/jom.v14i1.14593 J MEDICINE 2013; 14 : 100
TL;DR: A 45-year-old gentleman presenting with numbness of both legs and hands is dignosed as a case of sub-acute combined degeneration of spinal cord due to pernicious anemia, spastic quadriplegia, and combined deficiency anemia with low serum vitamin B12.
Abstract: We report a case of a 45-year-old gentleman presenting with numbness of both legs and hands. He has anemia, spastic quadriplegia with exageraterd tendon jerks with lose of vibration and position sense. Investigations revealed combined deficiency anemia with low serum vitamin B12. His MRI of cervicel spine was normal. Endoscopically he had atrophic gastritis. Ultimately he was dignosed as a case of sub-acute combined degeneration of spinal cord due to pernicious anemia. Patient was treated with injection vitamin B12 and well responded. On his followup, he had significant clinical improvement. This is a reversible condition if early diagnosis can be made and vitamin B12 therapy promptly given. Delayed treatment can result in irreversible neurological impairment. DOI: http://dx.doi.org/10.3329/jom.v14i1.14585 J MEDICINE 2013; 14 : 85-87
TL;DR: CHB management decision varies from physician’s perspective and is not always based on scientific decision; management of CHB can be improved through CME (continual medical education) and practical training.
Abstract: Aims: Aim of this study was to analyze diagnostic and therapeutic trends of physicians regarding Chronic Hepatitis B (CHB) in Karachi since Pakistan is endemic area for viral hepatitis B. Methods: A questionnaire was distributed to about 100 physicians / doctors in different hospitals of Karachi. The questionnaire assessed diagnostic trends, prescribing habits for Chronic Hepatitis B (CHB) treatment and patients monitoring and follow ups by the physician. Results: About 100 doctors from Karachi participated in the study (response rate: 72%). 34.72% doctors had experience of treating less than 10 patients per month. Majority of the doctors (79.16%) used HBsAg (anti-HBsAg seroconversion), (61.11%) used liver function tests (LFTs) and hepatitis B virus (HBV) DNA levels were used by doctors (47.22%) as diagnostic parameters for CHB. HBV-DNA levels were the most commonly used parameter to confirm diagnosis and was used by 86.11 % doctors. Treatment of CHB was started upon various indications i.e. 58.33% doctors used HBV DNA level when it is e”20,000 IU/mL (105 copies/mL) ; 36.11% used HBV DNA when it is e” 2000 IU/mL (104 copies/mL) and 29.16% doctors used Serum alanine aminotransferase (ALT) when it was elevated for 3-6 months. Most of the doctors (38.88%) had experience with Interferon alfa and Pegylated IFN-a 2a, (26.38%) with Lamivudine and (25%) with Entecavir. For treatment, 41.66% of doctors recommended Pegylated IFN-a 2a for HBeAg positive CHB patients whereas 22.22% of doctors treated HBeAg negative CHB Patients with Entecavir. HBV DNA levels and alanine aminotransferase (ALT) levels were most commonly used to monitor therapy by 73.61% and 52.77% doctors respectively. Frequency of follow-up was after 3 months by most of the doctors (63.88%). According to 23.61% doctors, 5 to 10% of patients required add- on treatment or switching from the previous regimen. According to most doctors (68.05%), polymerase chain reaction (PCR) - negativity was an important indication of improved response and outcome to anti-viral therapy. Conclusion: CHB management decision varies from physician’s perspective and is not always based on scientific decision. Mostly doctors used HBV DNA level as indication for treatment when it is e” 2000 IU/mL (104 copies/mL) and prescribed Interferon alfa and Pegylated IFN-a 2a to their patients. Monitoring of therapy was usually done by observing HBV DNA levels and alanine aminotransferase (ALT) levels of patients and frequency of follow-up was after 3 months by most of the doctors. Add- on treatment or switching is also required by some patients and improved response to treatment was assessed by PCR negativity. Management of CHB can be improved through CME (continual medical education) and practical training. DOI: http://dx.doi.org/10.3329/jom.v14i1.14538 J MEDICINE 2013; 14 : 57-61
TL;DR: No Abstract Available DOI: http://dx.doi.org/10.3329/jom.v14i1.14625 J MEDICINE 2013; 14 : 101-102
Abstract: No Abstract Available DOI: http://dx.doi.org/10.3329/jom.v14i1.14625 J MEDICINE 2013; 14 : 101-102
TL;DR: A teenage boy of 19 years without traditional risk factors for coronary artery disease, presented with typical anginal pain with ST-T changes in anterior leads and elevated cardiac troponin T, and further investigations revealed elevated LP, serum homocysteine and low HDL probably playing a contributory role.
Abstract: A teenage boy of 19 years without traditional risk factors for coronary artery disease, presented with typical anginal pain with ST-T changes in anterior leads and elevated cardiac troponin T. Investigation revealed the patient having apical hypertrophic cardiomyopathy with normal coronary angiography and a spade shaped apex on LV angiography. With a diagnosis of microvascular infraction, further investigations revealed elevated LP (a), serum homocysteine and low HDL probably playing a contributory role. DOI: http://dx.doi.org/10.3329/jom.v14i1.14557 J MEDICINE 2013; 14 : 74-76
TL;DR: A novel approach is needed to assess the importance of knowing the carrier and removal status of canine coronavirus, which is known to be a source of infection for other animals and humans.
Abstract: No Abstract Available DOI: http://dx.doi.org/10.3329/jom.v14i1.14591 J MEDICINE 2013; 14 : 98
TL;DR: Thyroiditis has both thyrotoxic and hypothyroid phase but they are self limiting, so before giving specific therapy, thyroiditis must be excluded.
Abstract: Background: Thyroiditis-inflammation of thyroid gland includes a group of individual disorders having many different clinical presentations, aetiopathogenesis and histology. Sometimes they are overlapping on their presentations. Objectives: To see the clinical biochemical profile and to observe a short term outcome of the patients presented with different types of thyroiditis. Materials & methods: 50 cases with clinical suspicion of thyroiditis were randomly selected. Clinical history, Physical examination and serum T3, T4, TSH was done in every patient and FNAC of thyroid gland & TMab (Thyroid microsomal antibody) was estimated in some. They were followed up at three monthly intervals with the measurement of TSH. Results: Cases were subdivided in to 3 groups. Among them subacute thyroiditis were 19 (38%), 26 (52%) were Hashimotos thyroiditis and 5(10%) were silent thyroiditis. The subacute group presented with features of hyperthyroidism, negligible RAIU (radioactive iodine uptake) and FNAC ( Fine Needle Aspiration Cytology) showed granulomatous thyroiditis. During follow up (57%) became hypothyroid at 3 months, (26%) euthyroid and (15%) in thyrotoxic state. After 9 months (87%) was hypothyroid and (5.26%) thyrotoxic. At 12 months (94%) was euthyroid and one thyrotoxic. Hashimotos group presented in hypothyroid state, RAIU test were variable. FNAC showed lymphocytic infiltration in all patients. They were found 100% hypothyroid after 1 year. Silent Thyroiditis group were in hyperthyroid state with negligible RAIU. After 12 month (60%) became euthyroid and (40%) remain hypothyroid. Conclusion: Thyroiditis has both thyrotoxic and hypothyroid phase but they are self limiting. So before giving specific therapy, thyroiditis must be excluded. DOI: http://dx.doi.org/10.3329/jom.v14i1.14532 J MEDICINE 2013; 14 : 23-27