Introduction: Vitamin D deficiency has been linked to a whole spectrum of diseases including osteoporosis, cancer, diabetes, and cardiovascular and immune disorders. Though Bangladesh is low latitude country, vitamin D Deficiency is serious and wide spread problem in Bangladesh. Physicians of Bangladesh are more vulnerable to low vitamin D status due to long indoor work hours and lack of sunlight exposure in both government & private institute. So, the aim of this study to evaluate vitamin D status among the physicians working around the Bangladesh. Methods: This was a cross-sectional, multicenter study where we enrolled 1112 doctors from 9 different areas of Bangladesh from May 2018 to June 2019. A Blood sample was collected from all participants to measure Serum 25(OH)D and various patient data such as age, gender, BMI, physical activity level during leisure time, use of vitamins and medications, sunlight exposure time, tea/coffee drinking, smoking, H/O comorbidities etc. was collected. Results: Of the 1112 doctors assessed in the study,794 (71.4%) was male and 318 (28.6%) was female. Mean age of the participants was 45.5±11.1 Years. Vitamin D deficiency and insufficiency was found in 734 (65.8%) and 105 (9.4%) participants respectively. Mean vitamin D level was 18.9 ng/ml (±8.6 ng/ml). Less than 5% of participants of Rajshahi, Rangpur, Dhaka, Bogura and Sylhet had sufficient vitamin D level. Vitamin D deficiency was significantly associated with age, obesity, sunlight exposure, physical inactivity, hypertension and vitamin D supplementation. Conclusion: Vitamin D deficiency is very common among physicians of all over Bangladesh. The high prevalence of vitamin D deficiency in the present study points towards urgent need of an integrated approach to detect vitamin D deficiency among health care professionals and treat appropriately. Bangladesh J Medicine January 2021; 32(1) : 31-38

Congenital myasthenic syndromes (CMS) comprise a heterogeneous group of rare inherited diseases in which the neuromuscular transmission in the motor plate is compromised by one or more genetic pathophysiological specific mechanisms are characterized by fatigable weakness of skeletal muscle (e.g., ocular, bulbar, limb muscles) with onset at or shortly after birth or in early childhood; rarely, symptoms may not manifest until later in childhood. The diagnosis of CMS is based on clinical findings, a decremental EMG response of the compound muscle action potential (CMAP) on low-frequency (2- 3 Hz) stimulation, absence of anti-acetylcholine receptor (AChR) and anti-MuSK antibodies in the serum, a positive response to acetylcholinesterase (AchE) inhibitors and lack of improvement of clinical symptoms with immunosuppressive therapy. Pathogenic variants in one of multiple genes encoding proteins expressed at the neuromuscular junction are currently known to be associated with subtypes of CMS. The most commonly associated genes include: CHAT, CHRNE, COLQ, DOK7, GFPT1 and RAPSN. We studied on a sibling presented with progressive fatigability and fluctuating ptosis with frequent exacerbations of muscle weakness during infections since infancy. On both cases CT scan of chest were negative for thymoma, antibodies against the acetylcholine receptor (AChR) and the muscle specific kinase (MuSK) were negative and decremental response on electrophysiological study of Repetitive nerve stimulation (RNS) and EMG were consistent with disease of neuromuscular junction (post synaptic) and they were only on pyridostigmine for long time with marked improvement of symptoms and signs. Considering all scenario both of our cases mostly fits with the autosomal recessive, post synaptic CMS associated with Rapsyn deficiency. Objective : As in Bangladesh, there is inadequate data on the epidemiological profile of CMS, our aim is to describe these cases for their rarity and the difficulty encountered in diagnosis as they are easily confused with Juvenile Myasthenia Gravis (JMG) and familial myopathies. As both the cases are very rare, it should be an original article. Bangladesh Journal of Neuroscience 2019; Vol. 35 (2): 95-103

Aim: To detect the right ventricular status by echocardiography of COPD patients.Background: Chronic obstructive pulmonary disease is an increasing cause of chronic morbidity and mortality worldwide. Smoking is the major cause and the patients consult with physicians very much late when become complicated. Echocardiography is the main determinant of outcome of COPD patient. We can assess the level of pulmonary hypertension which leads to right heart failure.Methods : This is a cross sectional study. Study place was Department of Medicine, Rangpur Medical College from 1st July to 30 September 2014.Clinically and post bronchodilator Spiro metrically diagnosed cases were taken. Patients were graded into Mild, Moderate, severe and very severe categories according to GOLD criteria. Statistical analysis was done with echo findings of RV dilatation and hypertrophy by using Chi-square test and statistical significance was taken as p < 0.05Results : Mean age was 61.50 (sd±9.76) years with male predominance. Mean duration of disease was 6.80 ( sd ± 4.71) years. Patients had a mean duration of smoking of 23.2 ±3.6 pack years. ECG and Echo findings such as RV dilatation, RV hypertrophy and pulmonary hypertension were showed significant correlation with severity and duration of disease. Diagnosis of cor-pulmonale was clinically 20%, ECG 50% and echocardiographically 92%.Conclusion : COPD is more common in males in 5th to 7th decade with the smoking history of more than 20 pack years. Most patients have moderate to severe disease at presentation. Echocardiography can detect the RV dysfunction in COPD patient earlier. ECG and Echo findings increase as the severity and duration of the disease increases and echocardiography is better than ECG or clinical methods in detecting RV dysfunction.Bangladesh J Medicine Jul 2018; 29(2) : 63-68

Rheumatoid arthritis is an autoimmune disease characterized by joint destruction, disability and disability adjusted life years of a patient. Early diagnosis and appropriate treatment may improve outcome. Diseasemodifying anti-rheumatic drugs suppress the disease progression. Recent guidelines advise early and sustained use of disease-modifying anti-rheumatic drugs of which methotrexate (MTX) and sulfasalazine (SSZ) are the most frequently used. Both drugs are effective, cheap, available and well tolerable. Now days MTX and SSZ are used as monotherapy and in combination. Basically the outcomes of two combinations of drugs are multiplicative. One drug promotes the action of the other. In daily practice interactions are often not well studied when using combinations of Disease Modifying Anti-Rheumatic Drugs (DMARDs). The aim of this study is the use of combination of MTX and SSZ is frequently used in the therapy for RA and has been tested in several clinical trials globally.Medicine Today 2018 Vol.30(2): 89-94

Fahr's syndrome refers to a rare syndrome characterized by symmetrical and bilateral intracranial calcification. We present a 65-year-old female with Fahr disease, presenting with headache with acute ischaemic stroke with left sided hemiplegia. CT scan of brain reveals irregular variable size hyperdense areas are noted in both basal ganglia regions and in both cerebellar hemisphere.Medicine Today 2017 Vol.29(1): 45-46

Back ground : Abdominal tuberculosis is common in Bangladesh and there is a national guide line for its management, which includes six months course of anti tubercular therapy (ATT). This study was done to evaluate the treatment outcome of abdominal tuberculosis following national guide line. Materials and Methods : This prospective study of descriptive nature was done between November 2009 to October 2010 at the department of Medicine, Sir Salimullah Medical College, Mitford hospital, Dhaka, Bangladesh. Total 6 months ATT was given to the selective 50 patients of abdominal tuberculosis following national guide line and out come measurement was done after completion of treatment. Result : Five patients died out of 50 patients during the course of treatment. The range of age was 13-70 years and mean ± SD = 33.2 ± 14.77 and male female ratio was o.72:1. Out of 50 patients 17(34%) patients had Intestinal TB, 24(48%) had Peritoneal TB, 2(4%) had abdominal lymph node TB, and 7(14%) had other types. Three patients of peritoneal TB patient died while rest 2 patients died were diagnosed as intestinal TB. Out of 45 patients who survived, 43(95.6%) improved and 2(4.4%) did not improve. Out of 15(33.3%) intestinal TB patients, 14(31.1%) improved and 1(2.2%) did not improved. Out of total 21(46.7%) peritoneal TB, 20(44.4%) improved and 1(2.2%) did not improve. Remaining 2(4.4%) abdominal lymph node TB, all were improved. In other variety cases (15.6%), all improved. Conclusion : Total 6 months regimen of ATT recommended by national guide line is proved as a complete and effective treatment course of abdominal tuberculosis. J Bangladesh Coll Phys Surg 2016; 34(2): 76-84

Background: Tetanus remains one of the major public health hazards of the developing world. Mortality is much lower in the developed world because of the availability of facilities, unlike in most developing countries' Objectives: This study was aimed to determine the outcome of tetanus patients admitted in infectious disease unit of Rangpur Medical College Hospital. Methods: A total of 91 cases of tetanus patients were seen in the 18 month period with a mean of 5 cases per month; they are diagnosed and managed for tetanus in the medical wards from January 2011 to June 2012. The data were retrieved from their case records and analyzed. Results: There were thirty one deaths, accounting for an overall mortality of 34.16o.Total fifty six patients were cured among which sixteen (17.67%) were cured with complication and four (4.4%) patient were absconded. Mortality was high 45.84% (11 patients out of 24) ?40 years age, whereas low 29.85 (20 patient out of 87) in <40 yea15 age (45.84% vs 29.85%). Mortality rate was also higher among female than male patients (34.66% vs 33.85%). Farmers experienced more death than non-farmer (4l.l8% vs 29-82%, P<0.05). Mortality was higher in patients who had not received any medical treatment for their wound than in patients who had received it for their wound (52.78% vs 21.81%, p<0.05). Patients with short incubation period of less than one week had higher mortality in comparison with those who had incubation period more than one week (53.33% vs 23.25%, P<0'05). Of the 91 patients, fifty six (64.34%) were alive, though four remained in a persistent vegetative state due to tetanus toxin-induced brain damage and another two required a below knee amputation of the left leg. Hence, 40 were discharged well and 16 were discharged with permanent disabilities. Conclusion: The case fatality rate of tetanus has remained consistently high in the medical college. Factors that were significantly associated with high mortality included older age, and incubation period of less than 7 days. It is recommended that preventive immunization against tetanus be given to all Bangladeshis with secondary vaccination at adulthood.

PAM is a rare parenchymal Lung disease. Very few case report are available about PAM in Bangladesh. It is diagnosed incidentally during chest radiograph. It is a autosomal recessive disease and is associated with sporadic or familial mutation of SLC 34A2 gene. Many patients are asymptomatic and have either normal or restrictive pulmonary function. Some patients remain static and others progress into pulmonary dysfunction, respiratory failure and corpulmonale. The disease is usually discovered up to 40 years and there is no definitive treatment of this disease. Chest radiograph, HRCT used lung biopsy (transbronchial or open) are the main investigations. This patient come with chest pain and dyspnoea on exertion and nonproductive cough and diagnosed as PAM incidentally during chest radiograph. On the basis of clinical features and laboratory finding, we diagnosed him a case of PAM a very rare condition. As there is no definitive treatment, we treat himsymptomatically.Medicine Today 2015 Vol.27(2): 40-43

Background: Bronchoscopy can play a major role in both diagnosis and treatment. Diagnostic bronchoscopy is a useful tool for the diagnosis of pulmonary lesions particularly bronchogenic carcinoma and pulmonary tuberculosisAim: To find out the role of fibre-optic bronchoscopy in the diagnosis of pulmonary diseases.Methods: This observational study was conducted in the Indoor patient, Department of Medicine in Rangpur Medical College Hospital. Of all patients aged 18 years and above Undiagnosed pulmonary lesion in the medical wards between October 2012 to October 2014.Results: Out of 256 cases, mean age ±SD was 61.01(±11.51), minimum age was 23 and maximum age was 86 years. Majority 84% were male and 16% were female. Most of the respondent were smoker whereas (82%). Most common presenting complains were cough, dyspnoea, haemoptysis and fever 83%, 59.3%,53% and 36% respectively. General Physical examination findings, 97% were anamia and clubbing were 41% and cyanosis 02%. Respiratory system examination findings, 54% were features suggestive of complete collapse, 15% features suggestive of consolidation and 31% normal chest findings. Chest x-ray findings of the study population, 25.8% were dense homogenous opacity involving right or left lung field, 17.9% were complete collapse of affected lungs , 5.5% were right middle lobe collapse, 4.3% Unilateral hilar lymphadenopathy, 7.03% were elevation of hemidiaphragm of affected site and 7.03% were pleural effusion. 6.6% patient had normal CxR. In present study shows bronchoscopic findings in patients studied, Vocal cord paralysis were 9.3%, Right main bronchus were 15.6% , Right upper lobe bronchus were 7.03% , Right middle lobe bronchus were 7.8%, Right lower lobe bronchus were 9.8%, Left main bronchus were 14% , Left upper lobe 4.3%, Left lingular were 1.9% and Left lower lobe bronchus were 9.3%.In this study shows histologhical findings majority 18% were squamaus cell carcinoma,8.2% were small cell carcinoma,2.3% were adeno carcinoma,6.6% infiltration of Inflammatory cell and granuloma 1.2%.Conclusion: In this study male are predominant. Most of the respondent was smoker. Most common presenting complains were cough, haemoptysis, fever and chest pain. Most of general physical examination findings were anamia and clubbing. Respiratory system examination findings were features suggestive of complete collapse, features suggestive of consolidation and normal chest findings. chest x-ray findings of the study population were complete collapse of affected lungs, rtight middle lobe collapse, Dense homogenous opacity involving right or left lung field, Unilateral hilar lymphadenopathy. Bronchoscopic findings were vocal cord paralysis, right main bronchus, right upper lobe bronchus, right middle lobe bronchus, right lower lobe bronchus, left main bronchus, left lingual and left lower lobe bronchus. Histologhical findings majority were squamaus cell carcinoma. Most of the patient poorly differentiated carcinoma among the study subjectsBangladesh J Medicine Jan 2016; 27(1) : 16-21

Background: Pleural effusion remains the most common manifestation of pleural pathology. Sometime it is difficult to differentiate between tuberculous and malignant pleural effusion on routine cytological and biochemical examination. So pleural biopsy is an important tool for evaluating undiagnosed pleural effusion.Aim: To find out the role of pleural biopsy in the diagnosis of unilateral pleural effusion.Methods: This observational study was conducted in the Indoor patient department of Medicine in Rangpur Medical College Hospital from 01.01.2014 to 30.06.2014. All patients having unilateral pleural effusion above the age of 15 years irrespective of sex, race and religion was enrolled in this study.Results: Total fifty cases were enrolled in this study. Age of the patients varied from 16 to 78 years (Mean ±SD, yrs: 47±31.0). Thirty six (72%) patients were male and fourteen (28%) were female. 9 patients (18%) were of higher socio-economic status, 13 (26%) patients were from lower class, and 28 (56%) were from middle class. Majority (36%) of the patients were farmer, followed by 22% were businessman, 18% were service holder and 16% were housewives. Out of 50 patients, Nineteen patients (38%) were smoker and rests (62%) were non-smoker. Common presenting complaints were fever (78%), respiratory distress (62%), cough (56%), chest discomfort (38%) and weight loss (32%). General physical examination findings revealed 62% having different grades of anaemia followed by clubbing in 22% cases. Respiratory system examination revealed 56% having left sided pleural effusion followed by 44% right sided pleural effusion. 36% shows shifting of trachea. Regarding pleural fluid analysis, color of pleural fluid was straw in most cases (42%) and sixteen cases (32%) had hemorrhagic fluid. Mean total cell count in pleural fluid was 1449.1/c.mm. Most (88%) had lymphocyte predominance. Mean protein in pleural fluid was 5.6 gm/liter. Radiological examination revealed that maximum patient (56%) having left sided effusion and total 18 patients having shift of trachea. Close pleural biopsy for histopathological study revealed maximum (36%) were different types of malignancy, 24% chronic granulomatous inflammation consistent with tuberculosis, 16% shows non-specific chronic inflammation and 24% cases showed no abnormal findings or pleural tissue not available or inadequate tissue for histological report. Out of total 18 cases of malignancy, 08 revealed adenocarcinoma, 03 revealed metastatic adenocarcinoma, 02 revealed non-hodgkin’s lymphoma, 02 malignant mesothalioma and 03 of them revealed poorly differenciated carcinoma.Conclusion: In this study male are predominant. Most of the respondent was non-smoker. Most common presenting complains were fever, respiratory distress, cough, chest discomfort and weight loss. Most of general physical examination findings were anamia and clubbing. Respiratory system examination findings were features suggestive of pleural effusion (56% left sided and 44% right sided), 36% having shift of trachea. chest x-ray findings of most (56%) of the study population were left sided pleural effusion. Close pleural biopsy for histopathological study revealed maximum (36%) were different types of malignancy followed by chronic granulomatous inflammation consistent with tuberculosis (24%).Bangladesh J Medicine Jul 2016; 27(2) : 62-67

A rare syndrome, Dyke-Davidoff-Masson Syndrome (DDMS), with a diagnostic conundrum, and the way it was solved is presented. DDMS is one among the syndromes associated with refractory epilepsy. We have come across a case of Dyke-Davidoff-Masson syndrome while investigating a case of refractory epilepsy. When cerebral hemi atrophy is associated with the radiological features of osseous hypertrophy of calvarium, hyper-pneumatisation of sinuses dilatation, DDMS is to be considered.Bangladesh J Medicine Jan 2014; 25 (1) : 31-34

Background: Rheumatoid arthritis is a chronic, autoimmune, inflammatory disorder of unknown aetiology that is characterized by symmetric synovitis and the propensity to cause joint destruction, disability and premature death. Disease-modifying anti-rheumatic drugs (DMARDs) slow the natural course of the disease, reduce joint damage and pain, and retard loss of function and disability. Disease modifying agents should be started as early as possible. A number of studies demonstrating the effectiveness of combinations of DMARDs in early RA.Methods: This is a comparative descriptive type of study was conducted in the Department of Medicine, Rangpur Medical College and Hospital, Rangpur & Medicine Specialists Chambers, Rangpur, over a period of 2 (two) years from July 2010 to June 2012 on newly diagnosed RA patients on the basis of ACR criteria. The 30 patients were divided into 3 groups. Group I got MTX, Group II got SSZ and Group III got MTX & SSZ. Purposive consecutive sampling method was employed. The objective of the study was to evaluate the outcome of patients of rheumatoid arthritis treated with MTX or SSZ alone versus MTX and SSZ in combination. The primary outcome measure was change in DAS28.Results: The mean DAS 28 score baseline was found 7.23±0.44 in group I, 7.29±0.39 in group II and 7.86±0.41 in group III. The mean DAS 28 score end of the study was 4.24±0.39 in group I, 4.85±0.54 in group II and 3.08±0.36 in group III. The difference was statistically significant (P<0.001) among the three groups. There is no toxicity found in any group. Regarding side effects, the difference was not statistically significant (P>0.05) among the three groups.Conclusion : This study suggests that the mean changes in the DAS28 score significantly lower in those who received combination therapy compared with those who received either MTX or SSZ alone during one year follow up.Bangladesh J Medicine Jul 2015; 26 (2) : 67-75

The clinical evidence of neurological menifestations associated with asphyxia is described as hypoxic ischaemic encephalopathy (HIE). A variety of metabolic problems are present in asphyxiated newborns including hypoglycemia, hypocalcemia, hypomagnesemia and others metabolic abnormalities. Some of these biochemical disturbances may trigger seizure or potentiate further brain damage. This cross sectional case-control study was done in Mymensingh Medical College Hospital, to identify the association of hypoglycemia, hypocalcemia, hypomagnesemia in neonates with perinatal asphyxia. Study period was six months. Sample size was 60. Among total sample 30 term asphyxiated newborns of <24 hours age were case and equal number term healthy newborns <24 hours age were control. The main clinical presentations were delayed cry after birth along with respiratory distress, convulsion and absence of cry in asphyxiated newborns. Major physical findings were cyanosis, convulsion and tachypnoea in asphyxiated group. The mean value of serum calcium level was significantly lower in asphyxiated newborns (7.37 ± 0.10mg/dl) than control value (8.04±0.09mg/dl). Hypocalcemia was found among 23.33% babies in case group. On the contrary, hypocalcemia was found in single baby among control group. The mean value of serum magnesium was significantly lower in asphyxiated newborns (1.83 ± 0.04mg/dl) than control value (1.96 ± 0.05mg/dl). Hypomagnesemia was found among 3(10%) newborns but none was found among control group. Hypoglycemia was found in 7(23.33%) cases though the mean value of blood glucose was higher in case group (5.72 ± 0.62mmol/l) than control group (4.87 ± 0.15mmol/l) difference was not statistically significant. Combined hypoglycemia, hypocalcemia and hypomagnesemia were found in 1(3.33%) case; combined hypoglycemia and hypocalcemia were found in 2(6.67%) cases; and combined hypocalcemia and hypomagnesemia were found in 1(3.33%) case. During the study period, 3(10.0%) cases were expired but no death occurred among control group. This study shows isolated or combined hypoglycemia, hypocalcemia, hypomagnesemia are frequently found in newborns with perinatal asphyxia. So, it is necessary to monitor blood glucose, serum calcium and also serum magnesium among asphyxiated newborns for proper management.

Organophosphorus compounds (OPC) poisoning is a major public health problem in low and middle income countries. The incidence varies from country to country depending on easy availability of poison, socio-economic condition and educational background of the people. This study aimed to determine the frequency, outcome and aetiological aspect of OPC poisoning patient admitted in Rangpur medical college hospital. It was a cross sectional study carried out in the department of Medicine, Rangpur medical college hospital from 1st December 2011 to 30th November, 2012. During the study period a total of 703 patients have been studied. The most of the patients were between the age of 18- 40 years (91.9%), male (51.6%), married (71.3%) and from rural areas (67.8%). People of different occupations were involved in OPC poisoning, house-wives were the maximum (33.6%) followed by farmers (31.7%). 92% cases were suicidal and 8% accidental. Familial disharmony was the prime cause (92.3%) of suicidal motive. 88% of the patients were survived and 5% died. OPC poisoning is an important health care problem in our country. Improved awareness, restricting availability and banning more toxic organophosphorus compounds will reduce the incidence of OPC poisoning. DOI: http://dx.doi.org/10.3329/medtoday.v26i1.21313 Medicine Today 2014 Vol.26(1): 46-48

Objectives: This aim of the study was to evaluate CRP and the risk factors in ischaemic stroke. Methods: This case control study was carried out from January 2006 to December 2007 in the department of Neurology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka in all the OPD and admitted stroke patients meeting the inclusion and exclusion criteria. Results: Out of 30 patients with ischaemic stroke 28(93.3%) patients had positive C-reactive protein value. 37% stroke patients were smoker. Mean total cholesterol, triglyceride and LDL level were higher and mean HDL level was lower among stroke patients in comparison to controls. 17% of stroke patients were suffering from diabetes mellitus & 80% of stroke patients were hypertensive. Conclusion: C-reactive protein is elevated in the acute phase of ischa emic stroke and could present a prognostic marker.DOI: http://dx.doi.org/10.3329/jom.v15i1.19859 J Medicine 2014; 15: 41-47

Bangladesh Journal of Medicine, Vol 24 No 1, 2013, Page 20-24 DOI: http://dx.doi.org/10.3329/bjmed.v24i1.15031

Tuberculosis is creating immense adverse social and economic burden in Bangladesh. Tuberculous Meningitis results from the haematogenous spread of primary or postprimary pulmonary disease or from the rupture of a subependymal tubercle into the subarachnoid space. Infection of the CNS is one of the most devastating clinical manifestations of tuberculosis This study aimed to see the presentation of tuberculous meningitis patients in tertiary level hospital of Bangladesh. This cross sectional study was carried out in the Department of Neurology, SSMC, Dhaka from June 2011 to July 2012. In the present study, thirty meningitis patients were enrolled, among the subjects 11.7 % were aged below 20 years, 53.3% were aged between 20 - 39 years, 16.7% were aged between 40 - 49 years and 18.3% were aged above 50 years. Regarding sex 56.7% were male and 43.3% were female. Most prevalent symptom was fever (91.7%). Among others, headache (70%), altered consciousness (45%), vomiting (43.3%) and neck stiffness (28.9%) were notable. The distribution of the study subjects by physical sign 55.0% had anemia, 95.0% had neck rigidity, 10.0% had cranial nerve palsy, 46.7% had kernig's sign and 20.0% had long tract sign. Regarding GCS score 10.0 % had GCS score less than 8, 18.3 % had between 9 – 12 and 71.7% had over> 12.The Laboratory finding among the study subjects 3.3% showed positive gram stain and 43.7% showed MT over 10 mm. In response to treatment 93.3% responded to anti TB out of 30 TBM subjects. This study demonstrated that presentation of tubercular meningitis is different in different patient.TBM is the severe form of extra-pulmonary tuberculosis occurring in 7.0- 12.0% of TB patients in developing countries with high rate of mortality due to delay in diagnosis and proper treatment. DOI: http://dx.doi.org/10.3329/medtoday.v25i1.16069 Medicine Today 2013 Vol.25(1): 32-35

Background: In the developing countries where TB is endemic; an ideal test for tuberculous meningitis should be economic, minimally invasive, of high accuracy and quick to perform.In many countries, also in India, several studies were conducted to establish the ADA activity as a sensitive and specific test of tuberculous meningitis.So it is very much needed to evaluate the diagnostic role of CSF ADA in tuberculous meningitis in Bangladesh. Aim: This study aimed to find out CSF ADA as a sensitive and specific test for early diagnosis of tuberculous meningitis. Methods: This case control study was carried out in the Department of Neurology, SSMC and Mitford Hospital, Dhaka from June 2011 to July 2012, to evaluate ADA activity in CSF for diagnosis of tuberculous meninigitis. Results: In the present study, sixty meningitis patients were enrolled. Of which, 30(50%) were tuberculous meningitis (TBM) taken as cases and rest 30(50%) were non-tuberculous meningitis (NTBM) taken as control.The CSF ADA activity from TBM patients was compared with CSF ADA from non-TBM infectious meningitis patients. The mean CSF ADA activity was found to be significantly higher in CSF of TBM patients, 14.01 ± 12.4 (1.0–65.2), mean ± SD with range, than in the CSF from non-TBM infectious meningitis, 7.2 ± 8.2 (1.8–49.1) P = 0.01.A cut-off value of >7.6 U/L for the TBM patients was calculated from the mean ±SD of the non-TBM patients.The ADA sensitivity is 81.82%,specificity 65.31%,accuracy 68.33%, PPV 34.62%,NPV 94.12%, positive likelyhood ratio 2.3 and lastly negative likelyhood ratio 0.2 for infectious TBM when this cut-off value was used.ROC curve shows area under curve of .736 suggests a moderate accuracy of the test in detection of tuberculous meningitis. Conclusion: This study demonstrated that ADA activity in the CSF of TBM patients, using a cut off value 7.6 U/L, can be useful for the early differential diagnosis of TBM. This test can be performed in any pathology laboratory where more sophisticated methods are not available. Bangladesh Journal of Neuroscience 2013; Vol. 29 (2) : 79-87

Dengue is a viral febrile illness, which has become a major international public health concern including Bangladesh, spectrum of illness ranging from dengue fever (DF) to life threatening dengue haemorrhagic fever (DHF), dengue shock syndrome (DSS) and ultimately death. The clinical profiling and outcome during epidemic dengue outbreak was observed in Dhaka Medical College Hospital in 2000 to 2001. One hundred and fifty patients were systematically observed. Male female ratio was 5:1 with severity of illness in younger patients. Hundred percent patients had fever with 83% having generalized weakness. The severe cases(DHF) were having sudden sustained temperature of 103 degree farenheight. Majority have abdominal symptoms(>80%) while 10% had respiratory only. Sixty percent have hepatomegaly while 40 % spleenomealy while 80% of DHF had ascites. Above 75% cases of Dengue haemorhagic fever had positive tourniquet test while melaena was the commonest mucosal bleeds. No fatality was observed in this study although variability of discharge was seen in different groups. Keyword: Clinical, Profile, Outcome, Dengue, Hospital DOI: http://dx.doi.org/10.3329/jom.v12i2.6733 JOM 2011; 12(2): 131-138