Background: COVID-19 infection caused by the new coronavirus was reported in December by the World Health Organization 2019 in China. The main clinical manifestations of infected patients are fever, cough, and dyspnea. Musculoskeletal symptoms, including myalgia, arthralgia, and fatigue, are nearly constantly present. Objective: To evaluate the musculoskeletal symptoms and their relationship with disease severity in patients with COVID-19 infection attending a tertiary-level hospital in Bangladesh.Materials and Methods: This cross-sectional study, conducted at Dhaka Medical College Hospital, Bangladesh, aimed to evaluate the prevalence of musculoskeletal symptoms and their relationship with disease severity in 113 patients with RT-PCR-confirmed COVID-19. Results: The findings revealed that musculoskeletal manifestations were highly common, present in 82.3% of the patients. The most frequent symptoms were fatigue (77.4%) and myalgia (67.7%), followed by arthralgia (22.6%). The study further established a significant relationship between fatigue and the severity of the COVID-19 illness. Additionally, a notable gender disparity was observed, with female patients reporting significantly higher psychological fatigue scores compared to males. Conclusion: The research concludes that musculoskeletal symptoms, particularly fatigue and myalgia, are predominant clinical features in COVID-19 patients. The association of fatigue with disease severity and its higher prevalence in females underscores the need for clinicians to recognize these symptoms.
A 50-year-old man's initial symptom of acromegaly was diabetic ketoacidosis (DKA). The patient presented with abdominal pain, polyuria, polydipsia, hyperhidrosis, and enlargement of the extremities. His acromegalic features also were macroglossia, and jaw prominence. Lab testing showed hyperglycemia, high HbA1c, and elevated IGF-1. MRI showed a pituitary macroadenoma. After initial treatment following the diabetic ketoacidosis protocol, he was referred to neurosurgeon. DKA is often the presenting feature of type 1 diabetes. It may also occur in type 1 and type 2 diabetes due to severe illness, infections, myocardial infarction, heart failure, pancreatitis, pregnancy, or steroids. In acromegaly, GH induces insulin resistance and poor glucose metabolism. Acromegaly may induce glucose intolerance, however, DKA is rare. Some cases were treated with surgery or somatostatin. This case highlights the need to treat acromegaly in unexplained DKA patients, particularly those with physical symptoms.
Background: Sodomy, or non-consensual anal intercourse, is a legally and socially sensitive issue in Bangladesh, often underreported due to stigma and criminalization under Section 377 of the Penal Code. Forensic investigation of such cases is limited, especially for male and transgender victims. This study reviews the forensic patterns, practices, and challenges associated with sodomy cases reported in 2024. Materials and Methods: A retrospective analysis was conducted on 71 medico-legal sodomy cases documented across 15 health institutions in Bangladesh between January and December 2024. Data included demographic details, injury patterns, forensic findings, time of reporting, and perpetrator relationship. A comparative literature review was undertaken for contextual discussion. Results: Of the 71 cases, 83.1% involved male victims and 16.9% transgender individuals, with 85.9% being minors. Anal injuries were present in 85.9% of cases, predominantly abrasions and tears. Only 12.7% of cases had positive semen detection, mainly among those reported within 24 hours. Most assaults (71.8%) were committed by known individuals. Delayed reporting (over 72 hours in 63% of cases) significantly reduced the forensic yield. Conclusion: Reform is urgently needed in forensic procedures, legal interpretation of Section 377, and victim support systems to improve justice for sodomy survivors in Bangladesh.
Background: Bangladesh is located within a seismically active region influenced by the interactions of the Indian, Eurasian, and Burmese tectonic plates, making the country vulnerable to potentially damaging earthquakes. Despite this geological risk, earthquake preparedness in Bangladesh has historically received limited attention, largely due to the country’s greater exposure to floods and cyclones and the absence of a catastrophic earthquake in recent decades. This relative seismic quiescence has contributed to low public risk perception and inadequate prioritization of earthquake-specific preparedness. In contrast, neighboring South Asian countries have experienced multiple devastating earthquakes, resulting in substantial mortality and a high burden of long-term disability.Materials and Methods: This article is a narrative review synthesizing existing evidence on earthquake risk and preparedness in Bangladesh, with emphasis on the role of Rehabilitation Medicine in disaster management. Relevant literature was identified through searches of PubMed, Google Scholar, and selected grey literature from national and international disaster management and health agencies. Search terms included earthquake, Bangladesh, South Asia, disaster preparedness, rehabilitation, and physiatry. Sources were selected based on relevance to seismic risk, injury patterns, rehabilitation needs, and disaster rehabilitation models, and findings were synthesized thematically. Formal systematic review procedures were not applied.Results: Evidence from South Asia consistently demonstrates that earthquakes result in significant long-term disability, predominantly due to musculoskeletal trauma, spinal cord injuries, and neurological impairments. However, current preparedness frameworks in Bangladesh insufficiently integrate rehabilitation services, workforce planning, and continuity of care across the disaster management continuum.Conclusion: Rehabilitation must be recognized as a core component of earthquake preparedness in Bangladesh. Systematic integration of physiatrist-led rehabilitation teams within disaster management systems is essential to reduce long-term disability, optimize functional outcomes, and strengthen national health system resilience against future seismic events.
Primary inflammatory myo-fibroblastic tumor (IMT) is a very rare tumor. IMT in stomach is so rare that often misdiagnosed as gastric Gastro-Intestinal stromal Tumour (GIST). The prevalence, etiology and pathogenesis of this condition are still uncertain. It usually affects the lung and most commonly found in children and young patients. Despite the use of modern laboratory techniques and imaging, it is often difficult to make the diagnosis of IMT. So, diagnosis of gastric IMT is usually done post‑operatively by immunohistochemistry examination. Usually IMT is positive to SMA and vimentin. Complete surgical excision is the treatment of choice. Though recurrence is common. We report a rare case of gastric IMT in a 58-year-old male patient which was diagnosed as gastric GIST initially.
Background: Anemia, particularly iron deficiency anemia (IDA) and beta-thalassemia trait (βTT), is a prevalent health issue worldwide, especially in resource-limited settings like Bangladesh. Accurate differentiation between these two conditions is vital for effective management, as they have distinct pathophysiologies and treatment protocols.Objectives: This study is aimed to evaluate the reliability of red cell indices derived from automated cell counters to distinguish between IDA and βTT, thereby reducing the need for more invasive and expensive diagnostic methods.Materials and Methods: A total of 150 patients with microcytic hypochromic anemia were included in a cross-sectional analytical study conducted at the Department of Hematology, Dhaka Medical College Hospital. Using automated parameters, eight discrimination indices were calculated. Confirmatory diagnoses were made through hemoglobin electrophoresis and serum iron profiles. Sensitivity, specificity, and predictive values for each index were computed.Results: The study identified 60% of the patients as βTT and 40% as IDA. The best-performing indices for differentiation were the Green and King index (94% correct identification), followed closely by the Red Cell Distribution Width Index (RDWI, 93.33%). RBC count and Mentzer index showed similar performance (87.33%). Both RBC count and RDWI demonstrated 100% sensitivity in detecting IDA. Sensitivity, specificity, and predictive values varied significantly among indices, with the Green and King index exhibiting the highest overall accuracy.Conclusion: This study concludes that red cell indices are effective tools for differentiating between IDA and βTT in resource-constrained settings, facilitating timely and appropriate management. Further studies with larger sample sizes are recommended to validate these findings and enhance diagnostic protocols.
Background: Burning Mouth Syndrome (BMS) is a chronic condition marked by a persistent burning sensation in the mouth, often without visible lesions or a clear cause. Recent studies have suggested a potential link between iron deficiency and BMS, particularly in populations with low serum iron levels.Objectives: This study aims to investigate the relationship between serum iron levels and the prevalence of BMS in a cohort of 190 patients, with a focus on age and gender as contributing factors.Materials and Methods: A cross-sectional observational study was conducted on 190 patients presenting with oral burning sensations. Serum iron levels were measured using standard laboratory methods, and statistical analyses were performed using SPSS software. The study included stratified analyses by age and gender to identify potential patterns in serum iron deficiency.Results: The analysis revealed that 85.3% of the patients had low serum iron levels, with a significant correlation between low iron levels and the presence of BMS symptoms. Stratified analysis indicated that iron deficiency was particularly prevalent among female patients and those over 60 years of age.Conclusion: The findings of this study suggest that serum iron deficiency is a significant contributor to BMS, particularly in women and older adults. These results underscore the importance of routine serum iron assessments in patients with unexplained oral burning sensations, potentially guiding more targeted treatment strategies.
Background: Resistant hypertension (rHTN) is a common complication in chronic kidney disease (CKD) patients, often driven by identifiable secondary etiologies.Objectives: This study aimed to identify the prevalence of specific etiological factors in CKD patients with rHTN and evaluate the hemodynamic response one month after initiating targeted treatment.Materials and Methods: A prospective observational study was conducted on 64 CKD patients with rHTN. All patients were stabilized on a maximal regimen of amlodipine, prazosin, bisoprolol, and indapamide. They were screened and treated for hyperuricemia (febuxostat), secondary hyperparathyroidism (doxercalciferol), hyperprolactinemia (cabergoline), and renal artery stenosis. Blood pressure (BP) was reassessed after one month. Data were analyzed using descriptive statistics and a paired samples t-test in jamovi 2.6.44.Results: The prevalence of secondary factors was high: hyperuricemia 78.1% (n=50), secondary hyperparathyroidism 76.6% (n=49), and hyperprolactinemia 46.9% (n=30). Renal artery stenosis was confirmed in 3.1% (n=2). Targeted therapy led to a significant mean reduction in BP from 191.8/101.6 mmHg to 132.7/79.2 mmHg (mean reduction: -59.1/-22.4 mmHg, p<0.001).Conclusion: Resistant hypertension in CKD is frequently driven by treatable secondary factors. A systematic etiological workup followed by targeted intervention alongside conventional therapy leads to a profound improvement in BP control.
Background: Adult early-onset type 2 diabetes mellitus (T2DM), is increasing worldwide, including Bangladesh. The clinical characteristics and patterns of complications differ significantly between adult early-onset (<40 years) and usual-onset (≥40 years) type 2 DM.Objectives: This study aimed to describe the clinical characteristics of adult early-onset T2DM in Bangladeshi patients and to identify associated risk factors.Materials and Methods: This cross-sectional study was carried out including 185 T2DM patients in an outpatient settings. Clinical characteristics, probable risk factors, and laboratory findings were collected from patients’ history and medical records. Participants were categorized into early-onset (<40 years) and usual-onset (≥40 years) groups. Data were analyzed using percentages, mean ± standard deviation, independent sample t-test, Chi-square test, and multivariate regression analysis where appropriate.Results: Early-onset T2DM accounted for 41.6% of cases, while 58.4% were usual-onset. The mean age at diagnosis of DM in the early-onset group was 33.66 ± 4.08 years. Higher educational status, longer duration of diabetes, poor glycemic control (HbA1c ≥8%), and higher fasting blood glucose levels were significantly more common among early-onset patients. Early-onset DM was significantly associated with increasing HbA1c categories. Family history of diabetes, obesity, and hyper triglyceridemia were more frequent in the early-onset group. Most vascular complications were more prevalent in the usual-onset group, except peripheral neuropathy, which was more common in early-onset patients.Conclusion: Type 2 diabetes is emerging as a significant health concern among young adults in Bangladesh. Early diagnosis and effective glycemic control are crucial to reduce long-term complications and disease burden.
The COVID-19 pandemic posed unprecedented challenges to global health systems, leading to the urgent development and deployment of vaccines to mitigate the spread of the virus and reduce morbidity and mortality. Vaccination programs were instrumental in controlling the pandemic, but they also sparked discussions about potential adverse events, particularly those related to autoimmune disorders. Vitiligo is a chronic autoimmune skin condition characterized by the destruction of melanocytes, resulting in the loss of skin pigmentation. While the exact etiology of vitiligo remained unclear, it is believed to involve a complex interplay of genetic, environmental, and immunological factors. Emerging reports raised questions about the potential association between COVID-19 vaccination and the onset or exacerbation of autoimmune conditions like vitiligo. This led to growing interest in understanding whether COVID-19 vaccines, which elicited robust immune responses, could potentially trigger or worsen vitiligo in predisposed individuals. Addressing these concerns was critical to ensuring vaccine confidence and providing comprehensive guidance to patients, particularly those with pre-existing autoimmune conditions or a family history of vitiligo. This article aimed to explore the relationship between COVID-19 vaccination and vitiligo, examining the evidence available at the time and its implications for clinical practice.
CIPO (Chronic Intestinal Pseudo-Obstruction) is an uncommon heterogeneous clinical syndrome of variable severity, featured by disordered GI (gastrointestinal) motility, and its presentations simulate those of recurrent partial or complete intestinal obstruction in the form of radiologically dilated small or large intestine with air-fluid levels in the absence of any identifiable mechanical cause. It results from a complex disordered interaction amongst the altered gut flora/microbiota, the enteric smooth musculature (myopathies), the enteric nervous system (neuropathies), the intestinal endocrine system (endocrinopathies) and mesenchymopathies, etc. It poses a definite challenge to the treating physicians, despite some improvement in diagnostic and therapeutic strategies. Because of non-specific symptoms and clinician’s lack of discretion, there is every possibility of misdiagnosis. Commonly imaging, manometry and sometimes histopathological examination of biopsy specimens are undertaken as diagnostic tools. With surgical advancements, small gut transplantation is an expected treatment option for advanced CIPO. In general, the CIPO patients have increasingly worsening chronic symptoms, with poor prognosis, warranting nutritional and surgical interventions. This review article explains the features of CIPO and the latest avantgarde management strategies, with a view to upgrading clinicians' knowledge about CIPO, categorically summarizing the diagnostic tools and other issues to enlighten the clinicians, resulting in easy, quick, accurate and exact diagnosis of this clinical syndrome for proper and adequate treatment without delay, improving the patients’ quality of life, minimizing sufferings. This review, in addition further focuses to the significance of continued research for more elaborately searching the etiology and the more effective management strategies of CIPO patients. KYAMC Journal. 2024; 15(02): 94-104
Background: Arteriovenous fistula creation is essential for hemodialysis in patients with end-stage renal disease. The choice between local anesthesia and brachial plexus block can impact clinical outcomes.Objective: To compare effectiveness, safety, and patient outcomes associated with local anesthesia (Group A) and brachial plexus block (Group B) in Arteriovenous fistula creation.Materials and Methods: A Cross-sectional study was conducted between September 2022 and June 2023 at the Department of Cardiac Anesthesia & CICU, Khwaja Yunus Ali Medical College & Hospital, Sirajganj. A total of 124 patients were equally divided into two groups: Group A (local anesthesia, n=62) and Group B (brachial plexus block, n=62). Pain levels (measured using a visual analog scale), surgical success rates, postoperative recovery times, and complications were analyzed. Statistical significance was determined using a p-value <0.05.Result: Pain control was significantly better in Group B (mean pain score of 2.1 ± 0.5) compared to Group A (mean pain score of 4.5 ± 1.0) (p < 0.001). The surgical success rate was 95% in Group B and 90% in Group A (p = 0.33). Postoperative recovery times were faster in Group B, with 75% discharged within 24 hours, compared to 55% in Group A (p = 0.03). Group B also had fewer complications, with a hematoma rate of 3%, compared to 10% in Group A (p = 0.04).Conclusion: Brachial plexus block provides significantly better pain relief, faster recovery, and fewer complications compared to local anesthesia in Arteriovenous fistula creation. The results suggest BPB as the superior anesthetic method. KYAMC Journal Vol. 15, No. 04, January 2025: 156-162
Background: Studying the prevalence of vitamin D deficiency in pregnant women and its relationships to parity, BMI, and employment status was the study's goal.Materials and Methods: An observational study was carried out in the Department of Gynecology and Obstetrics at Khwaja Yunus Ali Medical College Hospital (KYAMCH), Enayetpur, Sirajganj, Bangladesh, between December 2023 and July 2024. The study involved 188 pregnant women who gave informed consent. On their initial visit, blood was drawn, and in the hospital lab, an automated immunoassay analyzer was used to measure the patient's 25 (OH) D3 level. Results were then tabulated and analyzed.Results: Of the 188 pregnant women, only 14 (or 7.50%) had levels of vitamin D between 30 and 100 ng/ml, that is a sufficient level of vitamin D3. Within this group, the mean (SD) level of vitamin D was 41.1±10.8. Of the study individuals, 48 (25.6%) had vitamin D insufficiency (20-29 ng/ml) with a mean (SD) value of 22.6±2.3, and 126 (68.87%) had vitamin D deficiency with serum level <20 ng/ml and a mean (SD) value of 13.8±3.9. The combined amount of vitamin D insufficiency (less than 30 ng/ml) and deficiency made up 92.50%, with a mean (SD) of 16.2±5.6. Out of the group of people lacking in vitamin D, 26 (16.25%) had a mean of 8.1±1.3 and a vitamin D level less than 10 ng/ml.Conclusion: Vitamin D inadequacy and insufficiency are highly prevalent among pregnant women attending OPD at KYAMCH, a tertiary care hospital in Northern region of Bangladesh. Correcting vitamin D insufficiency during pregnancy is important because it plays a critical role in the health outcomes for both the mother and the fetus. KYAMC Journal Vol. 15, No. 04, January 2025: 169-172
Hypokalemia is common in clinical practice. But severe hypokalemia can cause rhabdomyolysis followed by AKI. Rhabdomyolysis is the breakdown of skeletal muscle fibers with leakage of muscle contents into circulation. Hypokalemia-induced rhabdomyolysis is a result of skeletal muscle hypoperfusion leading to ischemia. Acute kidney injury is a potential complication of severe rhabdomyolysis and it can be life-threatening. KYAMC Journal Vol. 15, No. 04, January 2025: 199-200
Background: Determining postgraduate study preferences and the choice of a conducive work environment are crucial for the development of a country's healthcare system. As an overpopulated South Asian country, Bangladesh must assess the interests of medical students and doctors in specialized fields and plan to create sufficient job opportunities for healthcare professionals, maximizing the use of limited resources.Objective: To assess the fascination of the medical students and doctors for post-graduation subjects and their preference for selection of future workplaces.Materials and Methods: This observational study was conducted among MBBS students and doctors at Khwaja Yunus Ali Medical College (KYAMC), Enayetpur, Sirajganj, from July to December 2024. A total of 246 participants, aged 20 to 30, were randomly selected, including 119 males and 127 females. Data was collected through a self-reported questionnaire that included demographic information and questions about their interests, reasons for selecting postgraduate specialties, and preferred workplaces.Results: The study found that 86.58% of participants were interested in postgraduate studies in clinical fields. Among them, 21% chose Internal Medicine, 17% selected Surgery, and 13% opted for Obstetrics and Gynecology. Other popular specialties included Radiology (16.66%), Endocrinology and Metabolism (13.82%), and Medical Oncology (10.16%). Regarding preferred workplaces, 56% favored the Government sector, while only 18.6% preferred the private sector.Conclusion: This study explored the factors influencing the selection of postgraduate specialties and workplace preferences. In the future, the findings of this research will assist policymakers in developing new policies for the healthcare sector. KYAMC Journal Vol. 15, No. 04, January 2025: 163-168
Background: There is a lack of available services including rehabilitation intervention for children with physical disability living in rural Bangladesh. Rehabilitation in Bangladesh is not a health priority and rehabilitation teamwork has been reported to have multiple challenges including few trained rehabilitation workforce, poor inter-specialty relationships, and scarcity of assisted devices for rehabilitation. Objective: To provide a comprehensive overview of the training program and assess the knowledge and skills acquired by trainees in developing countries. Additionally, to investigate potential strategies for moving forward and planning the effective implementation. Materials and Methods: Six days training was designed by Enablement Nepal with ice-breaking session, experience sharing, group working and presentation by participant, game of life played by participant, CBR establishment and ICF implementation, group work regarding CP child examination, goal set up, home visit, environmental barriers detection of that child in school and family and proposed solution. About twelve participants of different professional like physiatrist, physiotherapist, occupational therapist, rehabilitation facilitator, social worker, CBR worker attended six days interactive classes, group-works, home visit, field visit under supervision of instructor. Pre-training evaluation sheet and after-work questionnaire reveals thought differences of participant. Result: The outcomes of the training reflected a dynamic and continuous learning process. Participants, driven by their interests and diverse perspectives, actively took part in the training sessions. After the program, participants expressed a range of opinions and reactions concerning the training methods and their potential implementation. The mixed expressions highlighted the varied experiences and perspectives brought by the trainees. Conclusion: The participants acknowledged that similar training initiatives would further enhance their understanding and broaden their perspectives regarding functional rehabilitation. This underscores the importance of continuous training and collaborative efforts to address the challenges associated with caring for children with CP in low-resource settings. KYAMC Journal Vol. 15, No. 04, January 2025: 173-177
Therapeutic Plasma Exchange (TPE) is a vital extracorporeal procedure used in the management of various neurological, autoimmune and hematological disorders by eliminating pathological plasma components such as autoantibodies, immune complexes, toxins and inflammatory mediators. Its therapeutic efficacy has been particularly notable in conditions such as Guillain-Barré Syndrome (GBS), Thrombotic Thrombocytopenic Purpura (TTP) and myasthenia gravis. TPE works through apheresis technology, applying principles of mass transfer and diffusion to restore immune homeostasis and reduce disease burden. This review explores the current clinical applications of TPE, its underlying mechanisms and patient outcomes based on existing literature. Additionally, it highlights the procedural variations including intermittent and continuous TPE, centrifugation and filtration-based methods, and discusses both the clinical benefits and potential complications associated with the therapy. Furthermore, the review examines the critical socioeconomic challenges faced in implementing TPE in low-resource settings, such as limited healthcare infrastructure, economic barriers, policy gaps and lack of awareness. Emerging research also points to potential new indications for TPE, including its adjunctive role in managing severe COVID-19 cases and certain hepatic, dermatological and toxicological emergencies. As the therapeutic landscape evolves, efforts must be made to optimize treatment protocols, ensure standardized practices and make TPE more accessible across healthcare systems worldwide. Addressing these gaps is crucial for translating its proven benefits into broader clinical impact. KYAMC Journal Vol. 15, No. 04, January 2025: 189-194
