Bangladesh Journal of Medicine最新文献

{"title":"Effect of low FODMAP diet in IBS-D patient","authors":"Laila Yesmin Suma, Md Masood Ur Rahman, H. Aftab","doi":"10.3329/bjm.v35i20.73449","DOIUrl":"https://doi.org/10.3329/bjm.v35i20.73449","url":null,"abstract":"Background: Dietary restriction of short chain fermentable carbohydrate oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) has been found to be beneficial in alleviating gastrointestinal symptoms in diarrhea predominant irritable bowel syndrome (IBS-D) patients. This study investigated frequently reported food items with intolerance and the effects following their restriction in addition low FODMAP diet introduction in the management of IBS-D. Methods: This was an interventional study on 115 patients who met the Rome IV criteria for IBS-D, enrolled at Gastroenterology outpatient clinic in Dhaka Medical College Hospital. The participants completed a 7 days food diary & Bristol stool diary before and at the end of study, were assigned to follow a diet restricting high FODMAP & containing low FODMAP for 4 weeks. Symptoms severity was assessed using IBS symptom severity scoring questionnaire. Results: Among 115 participants, majority (95.6%) reported their symptoms related to intake of at least one of the food items, most common were dairy products (76.5%), green leafy vegetables (68.7%), junk food (49.6%), pulses (37.4%), wheat (37.4%), bottle gourd (37.4%), cauliflower (33.9%) and mango (31.3%). Dietary intervention led to greater reductions (P < .001) in average daily scores of abdominal pain frequency, severity, bloating severity, stool consistency, frequency & dissatisfaction with bowel habit compared to baseline in majority of the patients (87%). Food diaries demonstrated good adherence to dietary advice. Conclusion: The majority of IBS-D patients reported certain food items as predominant triggers of their GI symptoms. Following a low FODMAP dietary advice effectively reduced symptoms as well as improved stool consistency & frequency in IBS-D patients.\u0000Bangladesh J Medicine 2024; Vol. 35, No. 2, Supplementation: 169","PeriodicalId":516125,"journal":{"name":"Bangladesh Journal of Medicine","volume":"84 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141378009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An update on management of Acute Upper GI bleeding","authors":"A. Rowshon","doi":"10.3329/bjm.v35i20.73395","DOIUrl":"https://doi.org/10.3329/bjm.v35i20.73395","url":null,"abstract":"Abnormal Bleeding from any site of the body is always an alarming condition. The Upper Gastrointestinal (GI) tract is one of the commonest sites and bleeding from these areas are potentially life threatening which may endanger life when occurs acutely with profuse in amount. Apart from many, Peptic Ulcer and Variceal bleeding from portal hypertension are commonly encountered as to the causes of acute upper GI bleeding. As part of ABC for an emergency patient, Intravenous access, infusion of fluid and transfusion of blood along with pharmacotherapies are commonly practiced strategies for the management of these type of patients and fortunately more than eighty percent patients are relieved from this acute situation with these treatments. Endoscopy and endoscopic therapy for varices and ulcer enhances the outcome of these patients. The timing and their appropriate use is also an utmost importance. In addition to poor visibility due to bloodshed and others,  blood counts especially of haemoglobin level and platelet counts are of paramount importance to ensure safe and effective performance of these procedures.  Coagulopathies genetically acquired , secondary to diseases or medications used by the patients are also important parameters to be considered before Endoscopic procedures. These procedures not only can appropriately diagnose the sites and nature of bleeding but also can assess the indications and type of required endoscopic interventions. The potential chances of re-bleeding and timing of follow up can also be assessed by endoscopy. In addition to Esophageal Band Ligation, Sclerotherapies, Glue injection and Clipping of bleeding vessels, modern modalities of Endo sonic procedures through vascular access are in practice for refractory bleeding. Use of broad-spectrum prophylactic antibiotics has been found to yield better prognosis in terms of morbidity and mortality than it has been thought of for long time. Encrporating these relatively new updated protocols and procedures, the outcome of Acute Upper Gastrointestinal bleeding can be improved.\u0000Bangladesh J Medicine 2024; Vol. 35, No. 2, Supplementation: 141","PeriodicalId":516125,"journal":{"name":"Bangladesh Journal of Medicine","volume":"79 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141378115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary PCI-A Real Life Challenge in Bangladesh","authors":"S. M. M. Zaman","doi":"10.3329/bjm.v35i20.73374","DOIUrl":"https://doi.org/10.3329/bjm.v35i20.73374","url":null,"abstract":"Primary percutaneous coronary intervention (PPCI) stands as a cornerstone in the management of acute coronary syndrome, offering significant mortality benefits when promptly administered. Despite the proven efficacy of Primary PCI, its utilization rate in Bangladesh remains alarmingly low, averaging merely 4-6%. However, its implementation in Bangladesh faces multifaceted challenges reflective of the country’s healthcare landscape. Different studies explore the real-life challenges encountered in delivering PPCI in Bangladesh, where access to specialized PPCI center is limited, health insurance coverage is deficient, public awareness regarding the criticality of timely intervention remains inadequate, delayed hospital presentation due to hesitancy and congested urban traffic exacerbating pre-hospital delays were assessed. Addressing these challenges requires a multifaceted approach involving healthcare policy reforms, establishment of more PPCI-capable centers, expansion of health insurance coverage, and extensive public health campaigns aimed at raising awareness about the significance of timely intervention in acute coronary events. By mitigating these barriers, Bangladesh can enhance the accessibility and utilization of PPCI services, ultimately improving outcomes for patients afflicted with acute coronary syndrome.\u0000Bangladesh J Medicine 2024; Vol. 35, No. 2, Supplementation: 135-136","PeriodicalId":516125,"journal":{"name":"Bangladesh Journal of Medicine","volume":"1 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141378773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treating tuberculosis in special situations","authors":"M. Kafle","doi":"10.3329/bjm.v35i20.73388","DOIUrl":"https://doi.org/10.3329/bjm.v35i20.73388","url":null,"abstract":"Treatment of Mycobacterium tuberculosis infection (tuberculosis disease) involves the use of multiple antimicrobials over several months. Therapy directed against tuberculosis (anti-tubercular therapy, or ATT) consists of rifampicin and isoniazid given daily for 6 months and pyrazinamide and ethambutol given daily for 2 months. This therapy might need customization in some special situations. Chronic kidney disease (CKD) is a special state where the individual possesses higher risk of developing tuberculosis disease as compared to non-CKD population. Patients on dialysis may be up to 10 times the risk. Furthermore, drug metabolism and excretion is also abnormal in this situation. Ethambutol and pyrazinamide are excreted by the kidneys. Therefore, if failed kidneys can’t adequately remove the drugs, accumulation to toxic levels might be the fate.\u0000In glomerular filtration rate (GFR) of more than 30ml/min, normal antitubercular regimen may be utilized following the lower end of the recommended dosing per kg body weight with vigilant surveillance for adverse events. In conditions of advanced CKD, ethambutol needs dose adjustment according to the level of GFR as guided by serum creatinine level. However, to ensure optimal therapeutic levels of the drugs and avoid subtherapeutic levels, switching the schedule of therapy from daily to thrice weekly at full dosage has also been recommended. This should follow the directly observed strategy as followed in the treatment of tuberculosis. These strategies may work well for drug susceptible infections but in cases of drug resistant disease, susceptibility pattern should be followed. In hemodialysis patients, antitubercular drugs should be administered after hemodialysis. Patients with solid organ transplantation are at higher than normal risk for tuberculosis. This risk has been mentioned to be as high as 30 times. Furthermore, by the virtue of their use of immunosuppressive drugs, use of rifampicin in the antitubercular regimen is tricky. Rifampicin induces the metabolism of calcinurine inhibitors, demanding up titration of these immunosuppressive drugs by double or more the previous dose. Moreover, some authorities suggest replacing rifampicin by rifabutin. In conclusion, treatment of tuberculosis needs customization in special circumstances.\u0000Bangladesh J Medicine 2024; Vol. 35, No. 2, Supplementation: 141-142","PeriodicalId":516125,"journal":{"name":"Bangladesh Journal of Medicine","volume":"27 31","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141379203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurotoxicity and acute oxalate nephropathy in a Chronic kidney disease patient due to plant toxin (Bilimbi fruit -Averrhoabilimbi) : case report from a primary care center of Bangladesh","authors":"Chinmay Podder Saha, N. Chowdhury, CS Podder, N. Chowdhury","doi":"10.3329/bjm.v35i20.73465","DOIUrl":"https://doi.org/10.3329/bjm.v35i20.73465","url":null,"abstract":"Averrhoabilimbi, commonly known as bilimbi fruit, belongs to the family of Oxalidaceae and share similar physical and biochemical characteristics to star fruit, which is a well recognized cause of acute oxalate nephropathy and neurotoxicity. There are few reported individual cases regarding neurotoxicity and oxalate nephropathy, due to ingestion of bilimbi fruit, attributed to its high oxalate content and caramboxin like neurotoxin. But, till now there is no such reported case from a primary care center, to have both of these rare complications due to bilimbi fruit ingestion in a single patient. Here we report a case of a 62 years old lady, who presented with sudden onset behavioral changes, agitation, confusion, followed by acute symptomatic seizure and subsequently acute kidney injury and its complications following ingestion of bilimbi fruit. After meticulous history taking and thorough evaluation, she was diagnosed with aforementioned diagnosis and later on successfully managed in the limited resource facility.\u0000Bangladesh J Medicine 2024; Vol. 35, No. 2, Supplementation: 174-175","PeriodicalId":516125,"journal":{"name":"Bangladesh Journal of Medicine","volume":"6 24","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141380630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypertriglyceridemia-induced Acute Pancreatitis Treated with Insulin Therapy: A Case series","authors":"L. Nizhu, Ahmed Mursel Anam","doi":"10.3329/bjm.v35i20.73477","DOIUrl":"https://doi.org/10.3329/bjm.v35i20.73477","url":null,"abstract":"Hypertriglyceridemia is a condition where high levels of triglycerides in the blood can cause recurrent episodes of acute pancreatitis. The risk of acute pancreatitis becomes significant when serum triglyceride levels exceed 1000 mg/dL. Although the severity of hypertriglyceridemia-induced acute pancreatitis may be related to higher HTG levels in the early stages, the overall clinical outcomes are similar to other causes. The initial management of HTG-AP differs from routine recommendations and poses additional diagnostic and therapeutic challenges. This retrospective case series describes our experience with hypertriglyceridemia-induced acute pancreatitis at our acute medicine department and emphasizes the role of insulin therapy in its management.\u0000Bangladesh J Medicine 2024; Vol. 35, No. 2, Supplementation: 180","PeriodicalId":516125,"journal":{"name":"Bangladesh Journal of Medicine","volume":"33 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141379398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gitelman Syndrome: Three Cases of a Rare Genetic Disorder in a Tertiary Care Hospital","authors":"Abtahir Rahim Taha, Hossain Shahbaz, Rahim Abdur, Rafiqul Islam","doi":"10.3329/bjm.v35i20.73459","DOIUrl":"https://doi.org/10.3329/bjm.v35i20.73459","url":null,"abstract":"Gitelman syndrome is a salt-losing tubulopathy caused by mutation of genes encoding sodium chloride (NCCT) and magnesium transporters in the thiazide-sensitive segments of the distal nephron. It is characterized by renal potassium wasting, hypokalemia, metabolic alkalosis, hypocalciuria and hypomagnesemia. Here we present three cases those we encountered in Shaheed Suhrawardy Medical College Hospital.A 20-year-old male who was a soldier of Border Guard Bangladesh presented to us with muscle cramps and tingling & numbness for last 05 days. On examination, we found normotension with positive trousseau’s sign. Investigation revealed hypokalemia with hypomag-nesemia. 24 hours urinary electrolytes were indicating urinary loss. As ABG revealed metabolic alkalosis and urinary calcium creatinine ratio was <0.15, we sealed our diagnosis to Gitelman syndrome.A 34- year-old normotensive school teacher who experienced hypokalemia four years ago and was on potassium supplement on demand came to us with sudden onset, rapidly progressive quadriplegia for last 05 days. This time symptom didn’t resolve after taking potassium supplement. On Examination, we found flaccid quadriplegia with diminished jerks. Investigation revealed hypokalemia with hypomagnesemia. On further digging, we found diminished 24 hours urinary calcium as well as metabolic alkalosis on ABG.The final one that we encountered was a 40-year-old female normotensive housewife who presented with generalized weakness as well as tingling & numbness for last 10 days. Physical examination was inconclusive but Investigations revealed hypokalemia, hypomag-nesemia&Metabolic alkalosis. Hypocalciuria was evident from both 24 hours urinary calcium & urinary calcium creatinine ratio.In all occasions, all other possible differentials were excluded. We opted for genetic mutation study as well as family screening but in vain. In a nutshell, any electrolyte imbalance shouldn’t be only managed by supplementation rather finding out the route of loss & arterial blood gas analysis may be a key to the ultimate diagnosis.\u0000Bangladesh J Medicine 2024; Vol. 35, No. 2, Supplementation: 172-173","PeriodicalId":516125,"journal":{"name":"Bangladesh Journal of Medicine","volume":"30 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141377642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delirium in Critical Illness Patients and the Potential Role of Vitamin B supplements in the management of Delirium","authors":"Adnan Shareef, M. Islam, KM Nasif, S. Roy, AM Anam","doi":"10.3329/bjm.v35i20.73431","DOIUrl":"https://doi.org/10.3329/bjm.v35i20.73431","url":null,"abstract":"Background: Delirium is a symptom of acute brain dysfunction and affects around 30% of patients admitted in Intensive care unit (ICU) and High dependency unit (HDU). The high incidence of delirium in the critical care setup inspired the ‘HDU team’ of Square Hospital to form an integrated approach to CNS monitoring and delirium management in critically ill patients. Methods: This randomized control trial was conducted in the adult HDU of a multidisciplinary hospital in Bangladesh from 16-Oct-2022 to 15-Oct-2023. The study included 2104 patients admitted during this period with ‘Sepsis’ and ‘Delirium’, confirmed by 4AT and DSM-V criteria. Patients showing cognitive improvement on correction of sepsis were excluded. Results: Addition of Vitamin B supplements showed statistically significant cognitive improvement (163 out of 204, p<0.001) in patients with delirium within 4 days. Better clinical improvements were observed in patients receiving Combination of Vitamin B (B1+B6+B12) supplements in comparison to patients receiving thiamin alone (84.6% vs 75%), although there was no statistical difference. Conclusion: Small number of studies and heterogenicity make it impossible to draw conclusions confirming the use of thiamin or vitamin B combination supplement as the best option in the prevention and treatment of delirium in critically ill patients. So, there is a need of large-scale, high quality randomized control trials to confirm the beneficial effects of these vitamins.\u0000Bangladesh J Medicine 2024; Vol. 35, No. 2, Supplementation: 163","PeriodicalId":516125,"journal":{"name":"Bangladesh Journal of Medicine","volume":"324 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141380910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recent Advancements in the Management of Obesity","authors":"Ahmed Hossain","doi":"10.3329/bjm.v35i20.73377","DOIUrl":"https://doi.org/10.3329/bjm.v35i20.73377","url":null,"abstract":"Obesity is an increasing global health concern. Its worldwide prevalence continues to rise, estimated by the World Health Organization to have almost tripled since 1975 to affect more than 650 million adults in 2016. It is closely associated with severe chronic co-morbidities, which remain the leading causes of death.\u0000lifestyle changes alone rarely lead to sustained weight loss, particularly in this era of ‘obesogenic’ environment. Compared with lifestyle interventions alone, all medications approved for obesity management are more effective for long-term weight loss and improvements in cardiometabolic risk factors. Older obesity medications are associated with mean weight losses in the range of 5–10%. Some medications exhibit inadequate efficacy and dangerous side effects.\u0000 Improved understanding of the gut-brain axis has inspired the pursuit of novel medications aiming to provide sustainable and safe weight loss. The new generation of agents, including the injectable incretin analogues semaglutide and tirzepatide are associated with sustained mean weight reductions of 15–20%, along with substantial benefits on a range of health outcomes. The combination pharmacotherapies have demonstrated significantly greater efficacy in weight loss compared to the individual drugs. Bariatric surgical methods are widely employed surgical interventions for treating obesity. They provide more effective and long-lasting outcomes but carry a relatively higher risk of complications, which limits their widespread adoption. Bariatric surgeries are considered the treatment of choice for patients with a BMI >40 kg/m2 or BMI >35 kg/m2 with severe associated comorbidities. Several novel endoscopic devices and procedures are promising due to their satisfactory results, relatively lower cost, and lower risk. As minimally invasive surgery is favored by patients, there has been significant development in endoscopic weight reduction procedures and devices. Several newer therapeutic approaches such as probiotics, topical lotions, transcatheter bariatric embolization, low insulin method, or gene therapy have gained attention.\u0000Bangladesh J Medicine 2024; Vol. 35, No. 2, Supplementation: 132","PeriodicalId":516125,"journal":{"name":"Bangladesh Journal of Medicine","volume":"10 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141377000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spectrum of Erythema Nodosum: A case series","authors":"Mohammed Baieas Chowdhury, M. Tonmoy, Rafiq Un Nabi Siam, Benojeer Akter, Khondoker Shoaib Hossain, Gourav Dey Sarker, Nandita Paul, Akhak Ahmed","doi":"10.3329/bjm.v35i20.73436","DOIUrl":"https://doi.org/10.3329/bjm.v35i20.73436","url":null,"abstract":"Erythema nodosum (EN) is a common acute nodular septalpanniculitis, characterized by the sudden onset of erythematous, firm, solid, deep nodules or plaques painful on palpation and mainly localized on extensor surfaces of the legs. The changes resolve without skin ulcerations spontaneously within a few weeks (mean 2–8). Skin symptoms may be associated with arthralgia, fever, and weaknessThese nodules are characterized by a typical histological appearance regardless of the etiology, marked by acute inflammation of the dermo-hypodermic junction and interlobular septa of the hypodermic fat.Erythema nodosum can occur due to a vast number of underlying causes including but not limited to idiopathic, infectious, and a variety of noninfectious causes. Its occurrence is for the clinician a signal for a wider diagnosis and determination of the cause of occurrence of symptoms. Here we discuss 3 cases of EN of different etiologies and was treated accordingly.\u0000Bangladesh J Medicine 2024; Vol. 35, No. 2, Supplementation: 167","PeriodicalId":516125,"journal":{"name":"Bangladesh Journal of Medicine","volume":"77 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141377520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}