Bangladesh Journal of Medicine最新文献

{"title":"Diagnostic Role of CA19-9, CA19-9/CRP Ratio and CA19-9/Total Bilirubin Ratio in Differentiating Benign and Malignant Obstructive Jaundice","authors":"M. G. Azam, Ali Arbab Chowdhury, S. M. Sajjad, I. K. Datta, Md Anisur Rahman, A. Rowshon","doi":"10.3329/bjm.v35i20.73261","DOIUrl":"https://doi.org/10.3329/bjm.v35i20.73261","url":null,"abstract":"Background: Serum carbohydrate antigen (CA19-9) is a tumour marker which is significantly elevated in biliary and pancreatic malignancy. It is also increased in some benign conditions associated with jaundice. So many strategies have been recommended to improve the power of CA 19-9 to differentiate benign and malignant obstructive jaundice. Aims and objective: This study was carried out to explore the diagnostic role of CA19-9, CA19-9/CRP ratio and CA19-9/total bilirubin ratio in differentiating benign and malignant obstructive jaundice. Methods: The present cross sectional analytical study was conducted at Department of Gastrointestinal, Hepatobiliary and Pancreatic Disorders (GHPD), BIRDEM General Hospital, Bangladesh. It included 60 patients with obstructive jaundice diagnosed by clinical, laboratory and radiological investigations. They were divided into two groups; benign (n=29) and malignant (n=31). The nature of obstructive jaundice was obtained by ultrasonography, CT scan, MRCP, ERCP, tumour marker and histopathology. All patients were tested for CA19- 9, CRP and serum bilirubin. Data were analyzed using SPSS version-25.0 software. Results: The mean±SD age (years) of the benign group was 56.90±15.80 and malignant group was 56.97±12.60. The ROC analysis for CA19-9 yielded sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of CA19-9 at cut-off value 70 U/ml were 71%, 49%, 60%, 61% and 61% respectively and area under the curve (AUC) was 0.625. The CA19-9/CRP ratio showed sensitivity, specificity, PPV, NPV and accuracy at cutoff value 5.2 were 80%, 97%, 96%, 82% and 88% respectively and AUC was 0.910. The CA19-9/total bilirubin ratio showed sensitivity, specificity, PPV, NPV and accuracy of at cut-off value 17 were 58%, 51%, 56%, 53% and 55% respectively and AUC was 0.509. Conclusion: CA 19-9/CRP ratio had high diagnostic value in differentiating benign and malignant obstructive jaundice than CA19-9 alone and CA19-9/total bilirubin ratio.\u0000Bangladesh J Medicine 2024; Vol. 35, No. 2, Supplementation: 165-166","PeriodicalId":516125,"journal":{"name":"Bangladesh Journal of Medicine","volume":"131 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141377012","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":"Growth Retardation in Children: How to Face?","authors":"Mohammad Imnul Islam","doi":"10.3329/bjm.v35i20.73392","DOIUrl":"https://doi.org/10.3329/bjm.v35i20.73392","url":null,"abstract":"Growth is an irreversible constant increase in the size of organs and the body from fetal to adulthood. It is positively influenced by parental health, genetic, nutrition, hormonal, and environmental factors.1-3 Growth can be assessed by proper history taking, accurate measurement of growth parameters, determination of growth percentile and trajectory for age and sex.4 According to WHO, weight, height, and head circumference are used for growth assessment of children < 2 years, whereas weight, height, and BMI are used for children>2 years. 4,5 Growth of children will be retarded if their height is more than 2 standard deviations below the mean (3rd percentile) or marked decrease in growth velocity.7 Growth retardation is a burning issue of global health and stunting acts as the most prevalent indicator of child growth failure.In South Asia, the higher prevalence of growth failure was evidenced by 28.6% of global stunting in India and 6.8% in Pakistan.8 In 2017, the prevalence of stunting in Bangladeshi children was 31%, which become 24% in 2022.9 Like other lower middle-income countries, Bangladesh faces a great challenge to achieve growth due to poor socioeconomic conditions, malnutrition, inadequate health care access, poor maternal education, and poor ability of care giving.10 Delayed evaluation and detection of underlying causes make an obstacle in achieving targeted growth in adulthood, increase morbidity, and have far-reaching effects on psychological well-being. Lack of caregivers' knowledge, the disparity between necessity and financial support, less prioritization, and the communication gap between the health service providers and users still become principal issues in the early assessment and detection of growth failure in children of Bangladesh.11 Timely action is now required to combat this challenge and ensure the proper growth of future generations of this nation.\u0000Bangladesh J Medicine 2024; Vol. 35, No. 2, Supplementation: 145","PeriodicalId":516125,"journal":{"name":"Bangladesh Journal of Medicine","volume":"19 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141381643","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":"Pancreatic Stone Protein (PSP): a New Biomarker in Sepsis","authors":"Uzzwal Kumar Mallick","doi":"10.3329/bjm.v35i20.73365","DOIUrl":"https://doi.org/10.3329/bjm.v35i20.73365","url":null,"abstract":"Pancreatic stone protein (PSP) is secreted by the pancreas and rises in response to stress induced by systemic infection and sepsis. PSP levels start to increase before the development of clinical signs and symptoms of sepsis. PSP could be useful in the identification of patients with worse outcomes. Pancreatic stone protein performance in the diagnosis of sepsis is, at least, comparable to other biomarkers. The role of PSP in the immune and inflammatory response to infection prompted its identification as a potential biomarker of infection and sepsis. Sepsis is a life-threatening syndrome characterized by a dysregulated host response to an infection that may evolve rapidly into septic shock and multiple organ failure. Management of sepsis relies on the early recognition and diagnosis of infection and the providing of adequate and prompt antibiotic therapy and organ support. A novel protein biomarker, the pancreatic stone protein (PSP), has recently been studied as a biomarker of sepsis and the available evidence suggests that it has a higher diagnostic performance for the identification of infection than the most used available biomarkers and adds prognostic value. PSP can be useful for the early diagnosis of infection and for the triage of patients based on the risk of mortality. The diagnostic ability of PSP may be relevant not only through its sensitivity for timely diagnosis, but also through its negative predictive value, which can lead to a reduction in inappropriate antibiotic prescriptions, which in compliance with antibiotic stewardship strategies. The possibility of performing serial assessments of PSP in ICUs would allow for a sentinel effect of infection in patients hospitalized for non-infectious causes and/or monitoring infection response to antibiotic therapy. The role of pancreatic stone protein in clinical practice is still to be determined.\u0000Bangladesh J Medicine 2024; Vol. 35, No. 2, Supplementation: 151-152","PeriodicalId":516125,"journal":{"name":"Bangladesh Journal of Medicine","volume":"31 36","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141379535","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":"Renal Involvement in Vasculitis: An Evidence-Based Approach","authors":"Md Nizamuddin Chowdhury","doi":"10.3329/bjm.v35i20.73343","DOIUrl":"https://doi.org/10.3329/bjm.v35i20.73343","url":null,"abstract":"Vasculitis represents a heterogeneous group of disorders characterized by inflammation of blood vessels, affecting various organ systems, including the kidneys. Renal involvement in vasculitis poses significant diagnostic and therapeutic challenges due to its diverse clinical manifestations and potential for severe morbidity and mortality. This abstract aims to provide an evidence-based overview of renal involvement in vasculitis, emphasizing a comprehensive approach to diagnosis and management. Epidemiological studies have demonstrated that renal involvement occurs in a significant proportion of patients with systemic vasculitis, including granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilicgranulomatosis with polyangiitis (EGPA). The spectrum of renal manifestations ranges from asymptomatic urinary abnormalities to rapidly progressive glomerulonephritis and chronic kidney disease. Diagnosis of renal vasculitis requires a systematic evaluation, including clinical assessment, laboratory investigations, imaging studies, and renal biopsy. Biomarkers such as anti-neutrophil cytoplasmic antibodies (ANCA) and complement levels aid in the diagnosis and classification of ANCA-associated vasculitis. Imaging modalities such as renal ultrasound, computed tomography (CT), and magnetic resonance angiography (MRA) provide valuable information regarding renal vasculature involvement. Renal biopsy remains the gold standard for establishing the diagnosis, determining the histopathological pattern, and guiding treatment decisions. Histological findings typically include necrotizing crescentic glomerulonephritis, pauci-immune glomerulonephritis, or immune-complex-mediated glomerulonephritis, depending on the underlying vasculitic process. Management strategies for renal vasculitis involve a multidisciplinary approach, incorporating immunosuppressive therapy, supportive care, and treatment of comorbidities. Induction therapy often consists of high-dose glucocorticoids combined with immunosuppressive agents such as cyclophosphamide or rituximab, tailored to the specific vasculitic subtype and disease severity. Maintenance therapy aims to achieve disease remission while minimizing treatment-related toxicity. Recent advances in targeted therapies, including novel biologics and small molecule inhibitors, offer promising alternatives for refractory or relapsing disease. However, optimizing treatment regimens requires careful consideration of efficacy, safety, and individual patient factors. In conclusion, renal involvement in vasculitis represents a complex interplay between immunological dysregulation, vascular inflammation, and end-organ damage. An evidence-based approach encompassing early recognition, accurate diagnosis, and tailored therapy is essential to improve outcomes and mitigate long-term renal complications in affected individuals.\u0000Bangladesh J Medicine, 2024; Vol. 35, No. 2, Supplementation: 133-134","PeriodicalId":516125,"journal":{"name":"Bangladesh Journal of Medicine","volume":"6 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141380535","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":"Navigating the Complexities: Challenges in Diagnosing and Managing Constrictive Pericarditis","authors":"C. Singha, Subas Subedi","doi":"10.3329/bjm.v35i20.73466","DOIUrl":"https://doi.org/10.3329/bjm.v35i20.73466","url":null,"abstract":"Constrictive pericarditis poses a diagnostic and management challenge due to its varied etiology and subtle clinical presentation. This study aimed to elucidate these complexities by analyzing a cohort of six patients diagnosed with constrictive pericarditis over one year. The mean duration of diagnosis was found to be one & half years, indicating significant delays in recognition. Tuberculosis was the predominant etiology observed in four patients, followed by COVID-19 in one, and idiopathic causes in one case. Remarkably, all patients, except two, experienced prolonged delays in diagnosis, underscoring the diagnostic challenges inherent in this condition. Despite all patients being candidates for radical pericardiectomy, only four underwent surgery with financial constraints preventing two from accessing surgical intervention. Tragically, one patient succumbed to operative complications, highlighting the risks associated with surgical intervention. However, the remaining operated patients are currently faring well, emphasizing the potential benefits of timely surgical management. This study underscores the importance of early recognition and appropriate management strategies in mitigating the morbidity and mortality associated with constrictive pericarditis. Further research is warranted to refine diagnostic algorithms and optimize therapeutic approaches for this challenging condition.\u0000Bangladesh J Medicine 2024; Vol. 35, No. 2, Supplementation: 175","PeriodicalId":516125,"journal":{"name":"Bangladesh Journal of Medicine","volume":"43 s148","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141376265","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":"Judicious Use of Kinase Inhibitors in Rheumatology Practice","authors":"Syed Atiqul Haq","doi":"10.3329/bjm.v35i20.73577","DOIUrl":"https://doi.org/10.3329/bjm.v35i20.73577","url":null,"abstract":"The advent of kinase inhibitors has significantly transformed the therapeutic landscape in rheumatology, offering novel and effective options for managing autoimmune and inflammatory diseases. This presentation explores the judicious use of kinase inhibitors, emphasizing patient selection, monitoring strategies, and managing adverse effects. Kinases, particularly protein kinases such as Janus kinases (JAKs), play pivotal roles in cellular signaling pathways, influencing inflammation, immune response, and cell proliferation. The presentation begins by elucidating the mechanisms of action of different JAK subtypes and their roles in cytokine-mediated signaling pathways via the JAK-STAT pathway. It highlights the importance of differentiating between various JAK inhibitors, including first-generation inhibitors like tofacitinib, baricitinib, and peficitinib, and second-generation inhibitors such as upadacitinib, filgotinib, and deucravacitinib. These inhibitors vary in selectivity and therapeutic applications, necessitating careful patient-specific consideration. Key considerations for patient selection are discussed, including absolute contraindications such as active infections, malignancies, and severe organ failures, as well as conditions warranting cautious use, such as advanced age, cardiovascular diseases, and previous malignancies. To mitigate potential risks, the importance of comprehensive patient preparation, including infection screening, vaccination, and optimization of comorbid conditions, is emphasized. Detailed monitoring protocols are outlined, focusing on regular assessments of disease activity, drug toxicity, and laboratory investigations. Strategies for managing common adverse effects, including infections, cytopenias, elevated liver enzymes, and thrombo-embolic events, are presented. The presentation underscores the necessity of a multidisciplinary approach to patient care involving collaboration among rheumatologists, infectious disease specialists, and other healthcare providers. This presentation aims to optimize the use of kinase inhibitors in rheumatology by integrating scientific insights and clinical guidelines. It aims to enhance patient outcomes while ensuring safety and efficacy in treatment. This comprehensive approach seeks to balance therapeutic benefits with potential risks, thereby advancing the standard of care for patients with rheumatic diseases.\u0000Bangladesh J Medicine 2024; Vol. 35, No. 2, Supplementation: 181","PeriodicalId":516125,"journal":{"name":"Bangladesh Journal of Medicine","volume":"49 s170","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141376596","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":"Challenges in Diagnosis and Management of Non-Tuberculous Mycobacterial infection: Report of two cases","authors":"I. Reza, M. Rishad, Md ayakub Nabi, Md Zahir Uddin, H. Ahasan","doi":"10.3329/bjm.v35i20.73434","DOIUrl":"https://doi.org/10.3329/bjm.v35i20.73434","url":null,"abstract":"Non-tuberculous mycobacteria (NTM) can cause a wide range of infections, from affecting the lungs (pulmonary) to the other parts of the body (extrapulmonary) like skin, soft tissue, surgical wounds, and areas around catheters and implants. A significant challenge is that NTM infections are often misdiagnosed as tuberculosis. This case series highlights these difficulties by exploring two patient experiences. The first case involves a 48-year-old man who developed a prolonged fever following coronary artery bypass grafting (CABG) surgery. He also presented with enlarged liver and spleen (hepatosplenomegaly). Imaging studies revealed a large saccular aortic ascending aneurysm. While surgery (ascending aortic and proximal arch replacement) addressed the aneurysm, the definitive diagnosis came later. Histopathological and microbiological examinations ultimately revealed the culprit to be NTM. In second case, a 56-year-old male underwent a laparoscopic bilateral total extraperitoneal inguinal hernia repair. However, he experienced persistent serous drainage from the incision site post-surgery. To investigate the cause, discharge was collected and subjected to various tests: Microscopy, Gram stain, Ziehl-Neelsen (ZN) stain, GeneXpert for MTB. Initially, the ZN stain appeared positive, leading to the initiation of anti-tuberculosis medications. However, the patient failed to respond to this treatment. Therefore, a PCR test for Non-tuberculous Mycobacteria (NTM) was performed. This test returned positive, confirming the diagnosis of NTM infection rather than tuberculosis.Our Aim is to raise awareness among healthcare professionals through these case reports. A high degree of suspicion is necessary for accurate diagnosis as NTM infections often mimic the symptoms of other bacterial infections, making them difficult to distinguish.\u0000Bangladesh J Medicine 2024; Vol. 35, No. 2, Supplementation: 166.","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":"141377655","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":"Obscure Gastrintestinal Bleeding","authors":"Ramila Shrestha","doi":"10.3329/bjm.v35i20.73401","DOIUrl":"https://doi.org/10.3329/bjm.v35i20.73401","url":null,"abstract":"Obscure Gastrintestinal Bleeding is one of the most challenging disorders faced in gastrointestinal practice.Obscure gastrointestinal bleeding is defined as bleeding from the gastrointestinal tract that persists or recurs after a negative initial evaluation using gastroscopy, colonoscopy and radiological imaging.The underlying etiology can be found on initial evaluation in 10–20% of cases. Recurrent or persistent bleeding occurs in approximately half of OGIB patients (5%). OGIB is be classified as overt or occult bleeding. Overt OGIB is clinically  bleeding that recurs or persists after a negative  initial endoscopy, colonoscopy and radiological evaluation. Where as occult OGIB is defined as iron deficiency anaemia with or without a positive fecal occult blood test.The main reason for a negative initial evaluation because of intermittent  bleeding, The patient may present  anaemia, dehydration .The common etiologies of OGIB are carcinoid,GIST,adenocarcinoma,lymphoma,ampullary adenoma. Clinical presentation include ,nature of bleeding(eg.hemetemesis,hematochezia or melaena) ,bleeding diathesis,medication use,comorbidities (eg.valvular heart disease,vasculitis).High miss rate include for lesions in initial endoscopic evaluation with standard esophagogastroduodeoscopy(EGD) and colonoscopy. The mainstay in the management of these patients has ,traditionally the use of invasive procedures such as intra-operative enteroscopy.The introduction of video-capsule endoscopy (CE),Balloon-assisted enteroscopy (BAE).The introduction of video capsule endoscopy,balloon-assisted enteroscopy,spiral enteroscopt and computed tomography entergraphy(CTE) have largely replaced invasive surgical procedures, that can change in the approach to diagnosis and management of OGIB.\u0000Bangladesh J Medicine 2024; Vol. 35, No. 2, Supplementation: 142","PeriodicalId":516125,"journal":{"name":"Bangladesh Journal of Medicine","volume":"102 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141376826","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":"Biomarkers in sepsis: the present and the future","authors":"F. Chowdhury","doi":"10.3329/bjm.v35i20.73387","DOIUrl":"https://doi.org/10.3329/bjm.v35i20.73387","url":null,"abstract":"Sepsis is a complex and potentially life-threatening condition characterized by a dysregulated host response to infection and leading to organ dysfunction. Adult sepsis is neglected, and we are still looking for an effective biomarker which can predict and diagnose sepsis. In low-middle-income countries, where access to diagnostics is difficult and cost is a considerable issue, clinicians often treat a case on an empirical basis. Clinicians often rely on different scores such as SOFA, qSOFA, SIRS, NEWS, and MEWS which are not comprehensive and have many limitations. Identifying biomarkers that can aid in the diagnosis, prognosis, and management of sepsis is an area of active research. WBC count and C-reactive protein are probably the most used markers to predict sepsis. Although not a new biomarker, procalcitonin, serum albumin and lactate have gained significant attention for their role in guiding antibiotic therapy in sepsis. Its levels correlate with the severity of infection and response to treatment. Inflammatory cytokines such as interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), and tumour necrosis factor-alpha (TNF-alpha) play crucial roles in the immune response during sepsis. Monitoring their levels may provide insights into the inflammatory state and prognosis of septic patients. Heparin-binding protein 1 (hbp-1), serum calprotectin, Micro-RNAs (miRNAs), presepsin, endothelial markers, sepsis index (SI) and others are on the pipeline with promises. It's important to note that while these biomarkers hold promise, further validation and standardization are needed before their widespread clinical use in the management of sepsis. The cost of those markers, access for impoverished populations, requirement of logistics will be the other challenging factors.\u0000Bangladesh J Medicine 2024; Vol. 35, No. 2, Supplementation: 140-141","PeriodicalId":516125,"journal":{"name":"Bangladesh Journal of Medicine","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141381630","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":"Low Bone Mineral Density in Chronic Pancreatitis","authors":"Sanjoy Kumar Paul, H. Aftab","doi":"10.3329/bjm.v35i20.73454","DOIUrl":"https://doi.org/10.3329/bjm.v35i20.73454","url":null,"abstract":"Background: Chronic pancreatitis (CP) is associated with irreversible pancreatic dysfunction which lowers the bone mineral density. Bone disease is an under-recognized cause of morbidity in chronic pancreatitis. The aim of the study was to evaluate the changes found in bone mineral density and serum vitamin D level in patients with chronic pancreatitis. Methods: This cross-sectional study was carried out in the department of Gastroenterology, Dhaka Medical College Hospital from April 2022 to June 2023. Thirty-five eligible patients diagnosed with chronic pancreatitis in different stages were enrolled. Bone Mineral Density (BMD) was estimated by Dual Energy X-ray Absorptiometry (DXA) and serum vitamin D level was measured by radioimmunoassay (RIA). Results: The study participants (22 males; 13 females) had mean age of 37.69 ± 12.79 years, duration of illness was 6.90 ± 3.82 years, and mean Body Mass Index (BMI) of 20.58 ± 3.47 kg/m2. Half of the patients (48.6%) were smoker. Most of the patients 25(71.4%) had tropical chronic pancreatitis. Seventeen (48.6%) patients had normal BMD, 14(40%) patients had osteopenia and 04 (11.4%) patients had osteoporosis according to WHO criteria. Serum vitamin D deficiency was found in 80% of patients with mean value of 15.92 ± 7.21 ng/ml. Significant differences were observed in body mass index, smoking status and disease duration between normal and low BMD group. Multiple linear regression showed only smoking was independently negative predictive of low bone mineral density. Conclusion: Low BMD reflecting osteopenia is more common in chronic pancreatitis patients in course of disease progression. It demands physician’s attention to bone health in chronic pancreatitis patients.\u0000Bangladesh J Medicine 2024; Vol. 35, No. 2, Supplementation: 171","PeriodicalId":516125,"journal":{"name":"Bangladesh Journal of Medicine","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141381319","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}