Sarcoidosis is a multisystem disease characterized by non-caseating granuloma that affects the nervous system occasionally. When neurosarcoidosis infiltrate the pituitary gland leading to panhypopituitarism, result can be devastating. We present here a case of 30-year-old lady who presented with fever and headache for 6 months along with prolonged period of amenorrhea and forgetfulness. She also had increased thirst and polyuria. Her hormone profiles were suggestive of panhypopituitarism. MRI of brain showed a contrast enhancing lesion in the sellar and suprasellar region along with nodular leptomeningeal enhancement . We retrogradely searched for the underlying reason behin`d this .Her MT was 0 along with ground glass opacity in both lung fields in HRCT chest which made the diagnosis of neurosarcoidosis most likely. We treated her with prednisolone to manage neurosarcoidosis and secondary adrenal insufficiency along with sequential hormone replacement with desmopressin and levothyroxine . Follow up MRI of brain done 3 months later showed near complete resolution of lesion along with significant clinical improvement. J Dhaka Med Coll. 2024; 33(2) : 80-86
Background: Although the symptoms of coronavirus disease 2019 (COVID-19) are predominantly respiratory. Headache is one of the most frequent neurological symptoms. There is a wide variation in the prevalence of headaches, and little is known regarding the characteristics and outcomes of headaches in COVID-19 patients. So, this study aimed to determine the characteristics and headache outcomes among COVID-19 patients. Methods: This was a hospital-based prospective cohort study conducted in Dhaka Medical College Hospital from January 2021 to December 2021. Confirmed COVID-19 patients with Reverse Transcription Polymerase Chain Reaction (RT-PCR) were enrolled in the study. The severity of the headache was assessed by the Numerical Rating Scale (NRS, 0-10). All the patients with headaches were followed up by telephonic interviews in the 2nd week and at the end of the 4th week of the onset of the headache. For patients who experienced persistent headaches after 4th week, the impact of headaches on quality of life was assessed with the Headache Disability Index (HDI). Results: We included 362 patients in this study. The majority (52.5%) of the study population belonged to severe COVID-19 infection. Fever was the most common (63.81%) symptom among the study subjects. Headache was present in 19.06% of the patients. The mean (±SD) age of participants was 54(±14.7). Patients having headaches were younger 44.2±13.8 vs 56±13.8, p<0.05) than those have no headaches. Headache was more prevalent among the female (37[53.6%] vs 102[34.8%]). Tension-type headache (TTH) was the most common (60%) headache phenotype. The majority (68.12%) of the cases of headache occurred concomitantly with other COVID-19 symptoms. COVID-19-related headaches were, in most cases, bilateral, pressing, and of moderate intensity. Fever and pre-existing headaches were associated with significantly more frequency, duration, and intensity than COVID-19 headaches (p<0.05). Most patients (86.9%) recovered from headache within 4 weeks of onset. Median (IQR) recovery time was 10 (7.75) days. Nine patients (13.1%) did not recover from headaches in the 4th week of the survey. The Mean (±SD) HDI score was 24.4(±0.76) in patients who experienced headaches at the end of 4th week, which indicates mild disability. Conclusion: This study revealed that headache was present in about one-fifth of the hospitalized patients with COVID-19. Younger age and female gender were significantly associated with headaches. Most of the patients recovered within four weeks of the onset of headache. J Dhaka Med Coll. 2024; 33(1) : 18-26
Background: Non-compressive myelopathy (NCM) has a wide temporal and clinical profile with etiology that varies over different geographical locations. The etiology may vary according to age, sex, geographical location and other associated factors. There remains a great deal of heterogeneity in clinical features and imaging findings. The functional outcome also differ according to etiology, extent of involvement and rapidity of the management. Aims: To evaluate the clinical features and functional outcome of patients with non-compressive myelopathy. Methods: This observational study was carried out in the Department of Neurology, Neurosurgery and Medicine of Dhaka Medical College Hospital, Dhaka, during January2018 to December 2019. A total of 84 patients suffering from non-compressive myelopathy were included in this study. Age >18 years, both male and female patients with features of myelopathy admitted within 14 days of onset were enrolled in this study and followed up for 180 days. Results: 40 (47.5%) patients had acute transeverse myelitis (ATM) without spinal shock followed by 26(30.9%) had ATM with spinal shock, 9(10.8%) had multiple sclerosis (MS), 6(7.2%) had neuromyelitis optica (NMO) and 3(3.6%) had neuromyelitis optica specterum disorders (NMOSD). More than one third (38.2%) patients belonged to age 18-20 years followed by 22(26.3%) in 21- 30 years, 20 (23.9%) in 31-40 years, 6(7.2%) in 41-50 years and 4(4.8%) in >50 years. Male to female ratio was almost 2:1. Almost two third (63.1%) patients had paraplegia and 31(36.9%) had quadriplegia. Three fourth (75.0%) patients had sudden onset and 21(25.0%) had insidious onset. More than three fourth (84.5%) patients had sensory involvement. Two third (65.5%) patients had bowel and bladder involvement. The mean Modified Rankin Scale (MRS) score on admission was 4.3±0.86 and 3.13±1.15 at 180 days. The difference was statistically significant (p<0.05) between MRS score on admission and MRS score at 180 days. Almost half (48.0%) patients had improved MRS score, followed by 20(20.0%) static, 16(16.0%) worse. The mean barthel index was 34.35±16.71 and 50.06±19.75 on admission and at 180 days (p value <0.01). More than half (53.0%) patients had improved barthel index, followed by 22(22.0%) worse, 16(16.0%) lost to follow up and 9(9.0%) static. Conclusion: ATM was the most common diagnosis among non-compressive myelopathy; with the 2nd decade of the life being the most common age group and predominantly affecting male. Patients with non compressive myelopathy most commonly presented with paraplegia, sudden onset symptoms, sensory involvement, bowel and bladder dysfunction. More than half of the patient improved at day 180. J Dhaka Med Coll. 2023; 32(2) : 131-138
Background: Early prediction of GDM by measuring a biomarker at first trimester of pregnancy may prevent maternal and fetal complication. Adiponectin, which modulate insulin sensitivity, is secreted from adipose tissue and decreases blood glucose level. The objective of the study was to evaluate the association of maternal first trimester serum adiponectin with development of GDM. Methodology: This longitudinal study was conducted in the BSMMU, Dhaka from June, 2021 to May, 2022 where pregnant women of first trimester were selected by purposive convenient sampling. At first 94 pregnant women were selected after excluding diabetes or previous history of GDM and their serum adiponectin level was measured. Then the participants were followed up at 24-28 weeks of gestation and OGTT was done to detect GDM. ROC was used to decide the best cut-off point of adiponectin level for detection of GDM. The respondents were divided into ‘below cut-off’ group and ‘above cut-off’ group. Differences between two groups were assessed by statistical test. Results: A total 18 respondents developed GDM from both group. In below cut-off’ group, out of 26 respondents 13 developed GDM and remaining 13 were euglycemic. Whereas in above cut-off group, out of 62 respondents, majority 57 were euglycemic and only 5 women developed GDM. ROC analysis of adiponectin level for detection of GDM, a AUC value 0.887 (95% confidence interval 0.802-0.972) was found which was statistically significant (p<0.001). A cut off value of
Background: Pancreatic cancer carries a poor prognosis; at operation approximately 25% of patients are found to have unresectable tumours even though CT has demonstrated that they are resectable. At our tertiary care centre, we intended to find out if there is an optimum cut-off value for the CA 19-9 level preoperatively that will indicate that the pancreatic cancer is unresectable despite radiologic imaging that suggests otherwise according to receiver operating characteristic (ROC) curve analysis. Objective: To evaluate the clinical value of serum CA19-9 levels in predicting the resectability of pancreatic carcinoma according to receiver operating characteristic (ROC) curve analysis. Materials & Methods: This study prospectively analyzed the clinical and imaging data including preoperative CA19-9 level in 25 patients with pancreatic cancer who underwent surgical resection in the department of surgery, DMCH from February 2012 to January 2013. Resectability of pancreatic cancer was evaluated at least by preoperative bolus-contrast, triple-phase helical computer tomography (CT) scan. ROC curve was plotted for the CA19-9 levels. The point closest to the upper left-hand corner of the graph were chosen as the cut-off point. The sensitivity, specificity values of CA19- 9 at this cut-off point were calculated. Results: Resectable pancreatic cancer was detected in 09 (36%) patients and unresectable pancreatic cancer was detected in 16 (64%) patients. The cut-off point of CA19-9 level was calculated to be 188 U/mL and the sensitivity and specificity of CA19-9 at this cut-off point were 86.67% and 80.00% respectively. Conclusion: Preoperative serum CA19-9 level is a useful marker for further evaluating the resectability of pancreatic cancer. Thus increased serum levels of CA19-9 (> 188 U/mL) can be regarded as an ancillary parameter for unresectable pancreatic cancer. J Dhaka Med Coll. 2024; 33(1) : 3-6
Background: Renal cell carcinoma (RCC) represents the commonest form of kidney cancer, constituting approximately 90% of all diagnosed kidney cancer. Patients with over expression of BCL-2 in renal cell carcinoma have a poorer prognosis. BCL-2 expression in RCC may assist in the targeted therapies and improve patient management. Aim: To evaluate the expression of BCL-2 in histomorphologically diagnosed renal cell carcinoma and its association with histopathological stage (pT). Methods: This cross-sectional study was conducted in the Department of Pathology, Dhaka Medical College, Dhaka, from March 2021 to February 2023 among purposively included 60 histomorphologically diagnosed RCC patients. Immunostaining with BCL-2 antibody was also done and findings were recorded. Statistical analysis was carried out using the SPSS software version 25. Results: A total of 26 (43.3%) patients were in pT2 stage, 24 (40.0%) patients belonged to pT1 stage and the remaining 10 (16.7%) patients were in pT3 stage. Positive expression of BCL-2 was detected in 37 (61.7%) cases while 23 (38.3%) patients had negative BCL-2 expression. BCL-2 expression was significantly associated with pT stage (p=0.035). Conclusion: BCL-2 immunomarker, combined with histopathological staging can identify individuals at high risk for kidney cancer. BCL-2 expression is crucial for patients with cancer that does not respond to chemotherapy. J Dhaka Med Coll. 2024; 33(2) : 69-73
Background: Functional constipation is a common pediatric dilemma. It causes psychological stress, behavioural abnormality and growth impairment. In our country constipation in children is frequently overlooked and desired evaluation is often ignored. Factual knowledge viewing risk factors of constipation will lead to proper evaluation and early diagnosis which will ensure timely management of constipation. Methods: This was cross-sectional study, carried out in Paediatric Gastroenterology & Nutrition Department, BSMMU from January to December 2022. Total 75 children aged 2-16 years were enrolled here. Samples were collected purposively from outpatient department with consent of parents. Diagnosis of functional constipation was made by Rome IV criteria. Children who fulfilled ROME IV criteria were evaluated for risk factors of constipation. Result: We included 75 children in our study where 56% were male and 44% were female. Constipation was more prevalent in 6 to 10 years (42.7 %). Most common risk factors were unhygienic (69.3%), inadequate toilets (61.7 %) in academic area and during school hours child’s embarrassment (65.1%) to use toilet. We observed long duration academic activity (48 %), reading in madrasa (46.6 %), screen time more than two hours (60 %), preference of indoor games (56 %) and child maltreatment (physical abuse 10.6 %; emotional abuse 25.3 %; familial disharmony 18.6 %) as potential risk factors. Inadequate fibre (53.3%) & fluid intake (50.6%), regular junk food consumption (48%) and cow’s milk ingestion (34.7 %) were diet related influence of FC. Conclusion: Infrequent number and unclean toilet in academic premises, child’s embarrassment to use toilet during school hours, long duration educational activity, use of screen time daily two hours or more, preference of indoor games & lack of physical activity, child maltreatment and familial disharmony were found as frequent risk factors. Regular cow’s milk ingestion, junk food consumption, inadequate Fiber and fluid intake and regular were frequent dietary risk factors. J Dhaka Med Coll. 2024; 33(2) : 74-79
Background: Anterior cervical discectomy and fusion (ACDF) is a challenging surgical procedure where appropriate patient selection is very important for operation outcome and choice of surgical procedure. The first-line treatment strategy for managing cervical disc herniation is conservative. In some cases, surgery is indicated either due to signs and symptoms of severe and progressive neurological deficits, or failure of proper conservative treatment. Treatment of cervical disc herniation using ACDF has been successfully reported in the literature. Objectives: The aim of this study is to determine the outcome of ACDF in the treatment of symptomatic cervical disc herniation. Methods: It is a retrospective study conducted in Dhaka Medical College Hospital (DMCH) and other private hospitals from January 2013 to December 2022. We evaluated 28 patients who had undergone ACDF for cervical disc herniation in 35 levels. Fusion was attained with autologous iliac bone graft with additional anterior plating or cages. Radicular pain, neck pain and patient satisfaction with the treatment were scored using the visual analogue scale (VAS), ODI and Odom’s criteria. Results: A total of 28 patients fulfilled the inclusion criteria. Out of these, 21(75%) patients were male. The age range was from 21 to 65 with a mean age of 47.45 years. 10 patients (35.71%) had disc herniation at C5/6 level and 7(25%) patients had at C6/7 level. Regarding clinical assessment, the ODI percentage has decreased and VAS for neck and radicular pain also showed a significant reduction. Odom’s criteria was applied to determine the outcome of the procedure. Excellent results were noted in 20 (71.42%) patients. 5 (17.85%) patients had good results. 3 patients (10.71%) had fair and no patient had a poor outcome. Conclusion: ACDF is a successful surgical technique for the management of cervical disc herniation among Bangladeshi people. J Dhaka Med Coll. 2024; 33(2) : 63-68
Background: Alopecia areata (AA) is a common autoimmune disease in which autoantigens play an important role in activating T lymphocytes. Vitamin D is associated with various autoimmune diseases and Vitamin D receptors are strongly expressed in hair follicles and their expression in keratinocytes is necessary for the maintenance of the normal hair cycle. Several studies showed that there is an influence of vitamin D on patients with AA. Aims and Objectives: To find out serum 25-Hydroxy vitamin D level in patients with AA and its relationship with severity of the disease in a tertiary care hospital. Method: This cross-sectional study was conducted at the Department of Dermatology and Venereology in Dhaka Medical College Hospital (DMCH), Dhaka, from January 2019 to December 2019. A total of sixty-four subjects were enrolled. Among them thirty-two patients were with clinically diagnosed AA cases (Group A) and thirty-two healthy age and gender matched controls without AA (Group B). Serum 25-Hydroxy vitamin D was analyzed by the automated analyzer. The levels of serum 25-Hydroxy vitamin D were categorized as deficient (<20 ng/ml), insufficient (20 to 29.9 ng/ml) and normal (e”30 ng/ml) and the Severity of Alopecia Tool (SALT) score was used to assess the severity of the disease. p-value <0.05 was taken as significant. Statistical analyses were performed with SPSS version 25.0. Results: The mean age of Group A was 30.56 ± 13.52 years and Group B was 34.97 ± 13.03 years. The mean serum 25-Hydroxy vitamin D level was significantly lower in patients with alopecia areata (13.38± 7.36 ng/mL) as compared to the healthy group (23.16 ± 10.36 ng/mL) (p < 0.0004). Deficient, insufficient and normal Vitamin D levels among Group A vs Group B were (88% vs 44%), (9% vs 41%) and (3% vs 16%) respectively with significant difference (p- value 0.001) between the groups. There was a significant negative correlation between serum 25-Hydroxy vitamin D level and SALT score (r=-.509, p=0.003). Conclusions: This study revealed that the prevalence of serum 25-Hydroxy vitamin D deficiency was significantly higher in alopecia areata group compared to healthy group. There was a significant inverse correlation between its level and alopecia areata disease severity. J Dhaka Med Coll. 2023; 32(2) : 100-106
Background: Patients experiencing stroke with Left Ventricular Systolic Dysfunction (LVSD) face elevated mortality rates, heightened dependency, prolonged hospitalization, increased ICU referrals, and greater complication risks compared to those without LVSD. Objective: This study aims to evaluate the outcomes differences of ischemic stroke patients with and without LVSD, as well as within subgroups of LVSD severity. Materials and Methods: The study was Conducted in the Department of Neurology, Dhaka Medical College and Hospital (DMCH) from January 2022 to December 2023. In this prospective cohort study we enrolled 117 acute ischemic stroke patients meeting predetermined inclusion and exclusion criteria. LVSD diagnosis was established through echocardiography. Patient outcomes, including hospital duration, ICU necessity, mortality, and modified Ranking Scale (mRS) scores, were assessed and compared. Results: Among the 117 patients, 61 were classified under stroke with LVSD, while 56 were without LVSD. The mean(SD) age was 65.50(9.94) years for LVSD and 63.78(10.85) years for non-LVSD patients. Male predominance was observed in both groups, with 83.6% males in the LVSD group and 67.9% in the non-LVSD group. Mortality rates at hospital and the first month were 5.4 times higher in LVSD patients compared to non-LVSD patients (9.8% vs. 1.8%, p- value 0.029). Total 3-month mortality was nearly three times higher in LVSD patients (27.9% vs. 10.7%, p <0.05). mRS scores indicated significantly poorer functional outcomes at 1 and 3 months for LVSD patients compared to non-LVSD patients. (mRS >2 in 95.1% vs 83.9%) at 1 month and mRS >2 in 68.9% vs 39.3% at 3 months). Length of hospital stay was longer for LVSD patients (median [IQR] 10 [8-15] days) compared to non-LVSD patients (median [IQR] 7 [4-11] days). Need for ICU referral of the ischemic stroke patients with LVSD was 2.3 times more than non-LVSD patients (32.8% vs 14.3%, p- value 0.029). Conclusion: Ischemic Stroke patients with LVSD exhibit poorer clinical outcomes, higher mortality rates, increased dependency, prolonged hospital stay and greater need for ICU referral compared to those without LVSD. J Dhaka Med Coll. 2024; 33(1) : 32-41
Background: This study aimed to assess the diagnostic role of the Abductor Pollicis Brevis - First Dorsal Interosseous (APB-FDI) Index in the diagnosis of Amyotrophic Lateral Sclerosis (ALS) among the Bangladeshi population. It also compared its diagnostic performances with first dorsal interosseous first dorsal interosseous and abductor digiti minimi (FDI-ADM) and (ADM-APB) ratios measuring the split hand phenomenon. Methods: This cross-sectional study was carried out in the Department of Neurology, Sir Salimullah Medical College & Mitford Hospital, and Dhaka Medical College Hospital, Dhaka, from March 2019 to September 2021. It also determined the APB-FDI index in ALS patients and compared the findings with age and gender-matched healthy control and disease control (Hirayama disease). The data was analyzed with receiver operating characteristic (ROC) curves and calculated area under the curve (AUC) for each ratio. Integrated discrimination improvement (IDI) and Decision Curve Analysis (DCA) to compare diagnostic accuracy over FDI-ADM and ADM-APB ratios. Results: Total 43 people were studied with ALS, 30 healthy people, and 10 Hirayama patients. The cutoff values of APB-FDI Index, ADM-APB ratio, and FDI-ADM ratio are 4.27, 1.04, and 2.20 respectively. The APB-FDI Index has a high AUC of 0.9, with good sensitivity and specificity. However, for Hirayama disease, the APB-FDI Index cutoff value is 11.6. The APB-FDI Index is clinically effective with optimal threshold probabilities identified through the Youden-Index ((APB- FDI Index-0.72, ADM-APB CMAP amplitude ratio-0.51, and FDI-ADM CMAP amplitude ratio- 0.17). Its standardized net benefits exceed healthy control and Hirayama when risk thresholds are between 0.1 and 0.8. The IDI results showed that the APB-FDI Index was superior to the ADM-APB ratio and FDI-ADM ratio. Conclusion: APB-FDI Index is the sensitive, specific, and early diagnostic marker for ALS. J Dhaka Med Coll. 2024; 33(1) : 7-17
Background: Febrile seizure is a common pediatric emergency. This is the most common type of seizure in children aged 6 months to 6 years constituting 30% of all seizure types. Despite the high clinical burden of febrile seizure, little advance has been made in understanding its etiology. This study was undertaken to find out whether low serum zinc level is a risk factor of febrile seizure in children. Methodology: This case-control study was conducted in department of Pediatrics, Dhaka Medical College Hospital, Dhaka from March, 2021 to February, 2022. Sixty-nine children presenting with febrile seizure, fulfilling inclusion criteria were enrolled as cases, along with similar number (sixty-nine) of age and sex matched healthy controls. Venous blood samples were obtained and analyses of serum zinc levels were done. Results: The results of cases and controls were compared. Data were analyzed through SPSS (version 26) software. Significance for the statistical tests (Chi Square test & unpaired t-test) were determined at a probability value of less than 0.05 (p<0.05). Mean age of the respondents was 21.53±11.52 months in case group and 24.33±16.80 months in control group. Majority (59 to 62%) patients were male in both groups and majority (95.65%) of cases were simple febrile seizure and mean duration of seizure was 10.46±5.60 minutes. The mean serum zinc was found 76.84±14.16 µg/dl in case group and 81.59±13.28 µg/dl in control group. The difference between the case and control group was significant (P value = 0.044). ROC curve showed OR= 2.21, cut off value =84.5 (<65 µg/dl), p = 0.045, 95% CI, sensitivity = 71.0%, Specificity = 50.0%. Conclusion: Serum zinc was found to be significantly low in children with febrile seizure than that of febrile children without seizure. However further large-scale studies are needed to generalize the result of this study. J Dhaka Med Coll. 2024; 33(2) : 49-55
Background: Olfactory dysfunction (OD) is well-established and is a key symptom of COVID-19 Although ample data are available regarding olfactory dysfunction in non-hospitalized COVID- 19 patients, there are knowledge gaps about the frequency, severity, and duration of OD in hospitalized COVID-19 patients. So, we conducted the study to determine the outcome of olfactory dysfunction in hospitalized patients with COVID-19. Methodology: This was a hospital-based prospective cohort study conducted in Dhaka Medical College and Hospital. RT-PCR-positive COVID-19 patients who matched the inclusion and exclusion criteria were enrolled in the study. A visual analog scale (VAS, 0-10 cm) assessed the severity of olfactory dysfunction. All the patients were followed up by telephonic interviews on the 10th and 30th day after the onset of olfactory dysfunction to assess the outcome of olfactory dysfunction. Olfactory-specific quality of life (QOL) was assessed in those patients who did not recover olfactory function completely at the 30th day follow-up. Results: We enrolled 277 patients in this study. A total of 90(32%) had olfactory dysfunction. Hyposmia was the most common type of olfactory dysfunction (54.22%), followed by anosmia (40.96%), hyperosmia, and parosmia (2.41%). The Mean age (SD) of the study subjects was 51.8(14.8) years, and the mean age(SD) of the patients with olfactory dysfunction and without olfactory dysfunction was (51.06[10.01]and 52.17[15.34]) years, respectively(p>0.05). there was no gender discrepancies between the groups (50[60.24%] vs 112[59.89%], p>0.05). The majority (53.7%) of the study subjects had severe COVID-19 infection, but olfactory dysfunction was more common among mild COVID-19 patients. In 85.54% of cases, Olfactory dysfunction was associated with taste dysfunction and/or headache. Olfactory dysfunction was completely resolved in 46.99% of cases within 10 days and 87.95% within 30 days. Median (IQR) recovery time from olfactory dysfunction was 14.00 (11.00) days; Recovery time was significantly more in severe COVID-19 patients than in mild COVID-19 patients (p<0.05). Ten patients did not recover after 30 days but showed a lower severity of olfactory dysfunction than the 1st survey. The mean (SD) quality of Life (QOL) score in sQOD-NS was 15(4.4), which indicates a higher score reflecting the better olfactory-specific QOL. Conclusion: Olfactory dysfunction was present in about one-third of the hospitalized patients with COVID-19. Most of the patients recovered within 30 days of the onset of dysfunction, suggesting a favorable prognosis. J Dhaka Med Coll. 2023; 32(2) : 107-116
Background: The obstetric patient may suffer with any surgical/medical condition necessitating intensive care unit (ICU) admission. When admission ctiteria is fulfilled then early admission to Intensive Care Unit can reduce the maternal mortality. Aim: To observe the causes of Intensive Care Unit admissions, interventions, complications and maternal outcome. Materials and Methods: The study was a prospective longitudinal study conducted in the ICU of Dhaka medical college hospital Dhaka Bangladesh. The study period was 01/05/ 2019 to 30/04/2020. All the patient who had obstetric related complication were enrolled in this study. Data was collected from patient, patient’s attendants, patient’s clinical parameter and hospital documents (history sheet, investigation sheet and treatment sheet) and written in the pre-formed data sheet. The information obtained was type of admission, antenatal or postpartum, age, parity, obstetric status, primary diagnosis, associated medical and surgical condition, referral or inpatient shift to ICU, reason for ICU admission, mode of delivery, details of supportive interventions, complications. Results: The total admissions to the ICU were 272 obstetric patients. The mean maternal age was 24 ± 4. 2 years. Most of them were house wives (70%), daily laborers 10% and others contribute to 20%. Majority of the patients were multipara (68%). The more common indications of ICU admission were septic shock (26%) antepartum eclampsia (21.6%), hypovolemic shock (17%), post-partum eclampsia (8%), AKI following LUCS (8.8%), Peripartum cardiomyopathy (5. 8%).Highest number of patient (58.08%) come from obstetric ward and lowest number patient (4.41%) from medicine ward. 55.88 % patients required mechanical ventilation and mean duration of mechanical ventilation is 3 days. The duration of ICU stay varied from 2 -5 days in 191 cases ,6 to 10 days in 40 cases and more than 31days in 1 cases. Transfusion of Blood and blood products was needed in 66. 8% of patients and 11.39% patient required haemodialysis. 75 patient developed complications among those septicaemia (21 patient) was the highest, 11 patient AKI ,13 patient ARDS, 9 patient DIC and 4 patient pneumothorax. The survival rate is 61.01%. Conclusion: Septic shock was the major cause of ICU admission. About two third patients discharged alive. J Dhaka Med Coll. 2023; 32(2) : 124-130
Background: Growing pains is the most common benign unexplained limb pain in childhood that tends to self-limit once the child reaches adolescence. The present study aimed to get the details knowledge and compare different demographic and clinical characteristics of growing pains (GP). Methods: This cross-sectional study was conducted from August 2021 to September 2022 at National Centre for Control of Rheumatic Fever and Heart Diseases, Dhaka, Bangladesh. Children of 3-12 years irrespective of sex with unexplained limb pain suspected of growing pains were included in the study. Suspicion of growing pains was based on inclusion criteria and exclusion criteria from the definition of Peterson. By collaboration of clinical history, detailed physical examination, result of relevant laboratory and radiological tests confirmatory diagnosis was made. Findings: Among 220 children with unexplained limb pain 73.2% were diagnosed clinically as growing pains. Boys were predominant (52.2%) among children with GP; 60.9% of them were between 5 to 8 years and the mean age was 7.05±2.32 years. The pain was mostly bilateral and calf muscles were the most common sites. Pain was more frequent at night and half of the children complained about pain occurring several times a week. Massaging was the most effective measure followed by oral anti-inflammatory analgesics for pain relieving. The pain was associated with daytime over-activity and a history of GP among siblings. Conclusion: Growing pains was diagnosed among three-fourths of children with unexplained limb pain. Daytime over-activity, obesity, and a positive family history may be the potential risk factors. Demographic and clinical characteristics of growing pains in the Bangladeshi paediatric population were typical as reported in other studies. J Dhaka Med Coll. 2023; 32(2) : 117-123
Subacute Sclerosing Panencephalitis (SSPE) is a rare but devastating slowly progressive neurological disorder that typically occurs 6 to 10 years following an initial measles virus infection. SSPE remains a critical concern in the context of historical measles infections, particularly in unvaccinated populations. This case-based review focuses on the clinical features and diagnostic challenges for SSPE. Here, we demonstrate two cases that highlight the variability in presentation and progression of the disease. The distinctive feature of SSPE is the gradual deterioration of neurological function, with progressive cognitive impairment, seizure and motor dysfunction leading to severe disability. But the clinical presentation of SSPE can often be subtle, and initial symptoms may be mistaken for other developmental disorders that leading to diagnostic difficulty. Thus, a high index of suspicion is essential. The combination of clinical features, EEG findings, and CSF analysis can provide a comprehensive approach to diagnosis. Enhanced EEG techniques and CSF analysis have been emphasized for early detection, with several studies showing that early intervention can lead to better outcomes. Atypical presentation of SSPE must be recognized in area with high incidence. EEG findings were found to be the most important indicator for diagnosis. The review emphasizes the importance of early recognition and diagnosis to manage the progression of SSPE. While there is currently no curative treatment, symptomatic management and supportive care can improve quality of life for affected individuals. Increased awareness among clinicians regarding the late sequelae of measles virus infection is important for timely diagnosis and intervention. Ongoing research is needed to refine diagnostic methodologies and explore potential therapeutic modalities. J Dhaka Med Coll. 2023; 32(2) : 139-144
Background: Cerebral venous sinus thrombosis (CVST) one of the important type of venous stroke. With the advent of the newer imaging technique, it is now increasingly diagnosed in our country. There are limited studies regarding venous stroke specially about its outcome in Bangladesh. So, we conducted the study to observe the clinical profile, risk factors and outcome of the patient with cerebral venous sinus thrombosis at 3-month in a tertiary care hospital. Methods: This Prospective cohort study was carried out in the Department of Neurology, Dhaka Medical College Hospital during January 2022 to December 2023. The patients suffering from cerebral venous sinus thrombosis confirmed by imaging were included in this study. The outcome was assessed with mRS score. Results: We included 58 patients with venous stroke, among them about 2/3rd were female. The mean age (SD) of the was 36.46(13.56). Most of the patients were between 20 and 40 years. The most common clinical presentations were headache 54(93%), vomiting 36(62%) and seizure 21 (36.2%). The focal neurologic deficit was present in 17(29%) and papilledema in 33(56.89%) of the patients. The risk factors for CVST identified in the study included CNS infections 22 (41%), then pregnancy and puerperium 8(62%), intake of OCP and other hormonal preparation 6(90%), COVID -19 infection and post vaccination (6.90%), and idiopathic 34(48%). D-dimer was elevated in half of the patients. The commonest sinuses involve were transverse sinus 31(65.51%), and superior sagittal sinus 13 (43.10%). Multiple sinuses involvement was present in more than 2/3rd cases. The mean (SD)hospital stay was 12.4 (3.8) days. At 3-month 44(76%) had mRS 2 score and only 10% patient died. Mortality was higher among males, who had multiple sinus involvement and multiple comorbid conditions. Conclusion: CVST largely affect the young female, mostly present with headache vomiting and seizure. Generally, the outcome is good with conventional treatment. J Dhaka Med Coll. 2024; 33(2) : 56-62
