Journal of medicine最新文献

{"title":"Obituary Vol. 25(2) Professor Dr. Firdous Ara J. Janan","authors":"Editor in Cheif","doi":"10.3329/jom.v25i2.74972","DOIUrl":"https://doi.org/10.3329/jom.v25i2.74972","url":null,"abstract":"Abstract not available \u0000J MEDICINE 2024; 25: 195","PeriodicalId":76013,"journal":{"name":"Journal of medicine","volume":"5 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141641856","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":"Clinical spectrum and risk factors of severe dengue among hospitalized patients - a cross-sectional study during the 2023 dengue epidemic in Bangladesh","authors":"Rafiya Afroz, Aditi Rani Das, Abtahir Rahim Taha, Abdur Rahim, Mohammad Rafiqul Islam","doi":"10.3329/jom.v25i2.74291","DOIUrl":"https://doi.org/10.3329/jom.v25i2.74291","url":null,"abstract":"Introduction: Dengue is a significant public health concern for Bangladesh with recurrent epidemics. This study aimed to investigate the clinical and biochemical presentations and identify risk factors for severe dengue among patients admitted to a tertiary care hospital during the 2023 epidemic in Bangladesh. Methods: This cross-sectional study was conducted at a tertiary care hospital in Bangladesh between July and September 2023. Data were collected from 176 adult patients with serologically confirmed dengue infection. Clinical and laboratory parameters were recorded, and severity of dengue was categorized according to WHO guidelines. Logistic regression was performed to identify predictors of severe dengue. Results: Of the 176 patients included, 113 had severe dengue and 63 had non-severe dengue. The mean age was 34.5 (SD 14.3) years, with a male-female ratio of 1:1.07. Conventional symptoms including fever, myalgia, headache, and retro-orbital pain were present in majority of patients, with warning signs present in twothirds of them. Laboratory findings showed leukocytopenia (53%), thrombocytopenia (25.6%), elevated hematocrit level (4.5%), elevated ALT, AST and ferritin level (36%, 24% and 50% respectively). Logistic regression identified persistent vomiting (aOR 3.22, 95% CI 1.41–8.04), clinical fluid accumulation (aOR 2.23, 95% CI 1.13–5.74), and elevated serum AST (aOR 3.13, 95% CI 1.30–7.79) as predictors of severe dengue. Conclusion: Most dengue cases presented with typical symptoms and warning signs, with associated laboratory abnormalities. Persistent vomiting, clinical fluid accumulation, and elevated serum AST levels upon admission could predict severe dengue.\u0000J MEDICINE 2024; 25: 121-128","PeriodicalId":76013,"journal":{"name":"Journal of medicine","volume":"10 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141640557","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":"Treatment Outcomes of Dipeptidyl Peptidase-4 Inhibitors and Sodium-Glucose Co-Transporter-2 Inhibitors in Diabetes Mellitus with Poor Glycemic Control","authors":"SK Md Humayun Kabir, Md Khairul Islam, Masuma Sultana, Afsana Naznin, Nargis Akter, Md Nur Alam, Adhir Kumar Das","doi":"10.3329/jom.v25i2.74306","DOIUrl":"https://doi.org/10.3329/jom.v25i2.74306","url":null,"abstract":"Background: Diabetes, a progressive disease necessitating multifaceted pharmacological interventions for glycemic control, commonly employs Dipeptidyl Peptidase-4 inhibitors (DPP-4i) and Sodium-Glucose Co-Transporter-2 inhibitors (SGLT-2i). The ongoing challenge lies in determining the superior option for safety and efficacy. Objective: This study aims to describe the treatment outcomes of DPP-4 inhibitors (DPP-4i) and Sodium- Glucose Co-Transporter-2 inhibitors (SGLT-2i) in individuals with diabetes mellitus (DM) receiving metformin with poor glycemic control. Methods: This prospective study was conducted at the Endocrinology Outpatient Department of Dhaka Medical College Hospital, Dhaka, and included 90 individuals with diabetes mellitus who met the selection criteria. Divided into two groups, Group I (n=45) received DPP-4 inhibitors plus metformin, and Group II (n=45) received SGLT2 inhibitors plus metformin. Baseline data, including HbA1c, fasting blood glucose (FBG), blood glucose 2 hours after breakfast, weight, lipid profile, and serum creatinine, were recorded at the first visit and 12 weeks. Safety was assessed based on adverse drug effects. Results: After 12 weeks, both groups exhibited significant reductions in HbA1c, FBG, and postprandial blood glucose levels. However, the SGLT-2i group demonstrated significant improvements in HbA1c (P<0.012), fasting plasma glucose (P<0.003), and postprandial glucose levels (P<0.001), along with a reduction in body weight (P<0.042). Hypoglycemia rates were low and balanced between groups. Notably, SGLT-2i usage correlated with an increased incidence of urinary tract infections (13.33% vs. 6.66% in DPP-4i) and exclusive genital infections (11.11%, P<0.022). Conclusion: Diabetic patients receiving SGLT-2 inhibitors had better glycemic control and body weight improvements in comparison to DPP-4 inhibitors. However, SGLT-2 inhibitors encountered more genital infections than DPP-4 inhibitors.\u0000J MEDICINE 2024; 25: 107-114","PeriodicalId":76013,"journal":{"name":"Journal of medicine","volume":"5 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141641143","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":"Study on Clinical Profile and Treatment Outcome of Acute Paraquat Poisoning in an Intensive Care Unit in Bangladesh","authors":"A K M Ferdous Rahman, Saifullah Al Kafi, Zannatul Naiem","doi":"10.3329/jom.v25i2.74666","DOIUrl":"https://doi.org/10.3329/jom.v25i2.74666","url":null,"abstract":"Background: Paraquat, one of the most widely used herbicides, is a major cause of self-harm related death in Bangladesh resulting from multiple organ failure. The primary objective aimed to identify the demographic & clinical characteristics of paraquat poisoning and the outcome of different treatment modalities. Materials and Methods: A prospective observational study was conducted over twenty-four months at the Intensive Care Unit of Dhaka Medical College Hospital, a tertiary care referral hospital.Between March 2022 and March 2024, patients presenting with acute paraquat toxicity who fulfilled inclusion and exclusion criteriawere selected by purposive sampling. A total of 42 patients were enrolled in the study.Demographic, clinical, and treatment particulars were collected. The study evaluated the outcomes, including length of stay in the intensive care unit (ICU), the need for mechanical ventilation&hemodialysisandin-hospital mortality. SPSS version 25.0 was used for statistical analysis and reporting. Results: Among the patients, 54.8% were men with a median age of 23.31 years residing in rural areas (85.7%). All cases were suicidal, primarily due to family disputes (40.5%) and personal relationship issues (21.4%). Symptoms included shortness of breath (40.5%), disorientation (28.6%), difficulty in swallowing (14.3%), vomiting (9.5%), and low urine output (7.1%). Most ICU admissions occurred after 24 hours postingestion (59.5%). Organ involvement included acute kidney injury (57.14%), acute respiratory distress syndrome (50%), hepatic impairment (14.3%), pulmonary fibrosis (14.3%), and septic shock (2.4%). Methylprednisolone was administered to 21 patients (50%), with an equal number also receiving methylprednisolone plus cyclophosphamide (50%). Only 10 (23.80%) patients received gastric lavage.The median ICU stay was 6 days (IQR 4-9), while the Median hospital stay was 8 days (IQR 1-12). In-hospital mortality was high, and 41 out of 42 patients (97.8%) died. Conclusion: The rural population is mostly affected by paraquat poisoning for its easy availability,and clinical presentations, particularly pulmonary, renal and multi-systeminvolvement, are significantly associated with high mortality with the limited role of different treatment approaches.\u0000J MEDICINE 2024; 25: 129-135","PeriodicalId":76013,"journal":{"name":"Journal of medicine","volume":"7 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141642371","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":"Clinical Profile and Echocardiographic Evaluation of COPD Patients Admitted in a Tertiary Care Hospital","authors":"K. Islam, Nawsabah Noor, Anjuman Ara Begum, Md Jewel Hoque, M. Rishad, Ahmed Hossain","doi":"10.3329/jom.v25i2.74307","DOIUrl":"https://doi.org/10.3329/jom.v25i2.74307","url":null,"abstract":"Introduction: Chronic obstructive pulmonary disease (COPD) ranks as the fourth leading cause of global mortality, with anticipated increases in prevalence and mortality in the future. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) highlights the importance of considering COPD diagnosis in patients with relevant symptoms or risk factors, confirmed through spirometry. While COPD is preventable and treatable, it often presents with significant extra-pulmonary effects, particularly cardiac manifestations. Echocardiography offers a rapid, noninvasive method to assess these cardiac complications. Objective: This study aimed to investigate the clinical profiles and echocardiographic changes in COPD patients and their correlation with disease severity. Method: Conducted as an observational cross-sectional study, the research took place in the indoor departments of Medicine and Respiratory Medicine at Sir Salimullah Medical College & Mitford Hospital, Dhaka, between May 25th, 2017, and November 24th, 2017; enrolling 105 diagnosed COPD patients aged e”18 years. Data collection involved a structured questionnaire covering socio-demographic details, risk behavior, and respiratory complaints. Physical examinations, spirometry, and echocardiography were conducted for diagnosis, severity grading, and cardiac evaluation, respectively. Statistical analysis employed SPSS software (version-22), presenting results through frequency, percentage, tables, graphs, and figures. Result: The study population was predominantly male (88.6%) with a mean age of 64.1 years. Most patients (94.2%) were smokers with a mean pack-year history of 22.03. All patients presented with cough and shortness of breath, and 88.5% had wheezing. Spirometry revealed moderate COPD in 40% of patients, with a distribution across all severity grades. Echocardiography showed abnormalities in 52.4% of patients, with tricuspid regurgitation, pulmonary hypertension, and right ventricular dilatation being the most frequent findings. A significant correlation was observed between C OPD severity and the presence of these echocardiographic abnormalities. Conclusion: Clinical examination unveiled common respiratory findings, while echocardiography demonstrated diverse cardiac manifestations in COPD patients. A significant proportion of patients exhibited normal findings on X-ray and echocardiography. The study highlights the prevalence of moderate COPD severity and the association between very severe COPD and specific cardiac complications, emphasizing the importance of comprehensive assessment and management strategies for COPD patients.\u0000J MEDICINE 2024; 25: 115-120","PeriodicalId":76013,"journal":{"name":"Journal of medicine","volume":"1 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141642489","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":"Exploring Plasmid-Mediated Quinolone Resistance Gene Diversity among Ciprofloxacin-Resistant Proteus Species in a Tertiary Care Hospital of Bangladesh","authors":"S. Afroz, Nurjahan Begum, Moonmoon Shormin, Hasbi Ara Mostofa, S. Shamsuzzaman","doi":"10.3329/jom.v25i2.74667","DOIUrl":"https://doi.org/10.3329/jom.v25i2.74667","url":null,"abstract":"Background: Increased resistance to fluoroquinolones has been observed in members of the Enterobacteriaceae, including Proteus species. The extensive use of fluoroquinolones and the presence of plasmid-mediated quinolone resistance (PMQR) genes are believed to contribute significantly to fluoroquinolone resistance. This study highlights the prevalence of ciprofloxacin-resistant Proteus species and the presence of specific PMQR genes among them, emphasizing their potential role in quinolone resistance. Method: The study included 30 ciprofloxacin-resistant Proteus isolates collected from wound swab, pus, urine, and blood samples. Identification of Proteus species was performed using culture and biochemical tests. Antibiotic susceptibility test was conducted using the Kirbey-Bauer disc-diffusion method. The minimum inhibitory concentration (MIC) of ciprofloxacin among ciprofloxacin-resistant Proteus species was determined using the agar dilution method. The study aimed to detect specific PMQR genes, namely aac(6´) lb-cr, qnrA, qnrB, qnrD, and qnrS, using polymerase chain reaction (PCR). Result: A total of 42 Proteus species were isolated from 310 various samples. Among the Proteus isolates, 71.43% were ciprofloxacin resistant. The study found that 30% of ciprofloxacin-resistant isolates were positive for aac(6´) lb-cr gene, 13.33% for qnrA and qnrS respectively and 10% for qnrD gene. In total, 60% of ciprofloxacin-resistant Proteus isolates were positive for at least one PMQR gene. The qnrB gene was not detected among ciprofloxacin-resistant Proteus species. The MIC of ciprofloxacin ranged from 8 μg/ml to 128 μg/ml among ciprofloxacin-resistant Proteus isolates. Conclusion: This study suggests aac(6´) lb-cr, qnrA, qnrS, and qnrD genes are emerging in Proteus species, potentially contributing to the development of quinolone resistance and has implications for clinical management and public health.\u0000J MEDICINE 2024; 25: 149-154","PeriodicalId":76013,"journal":{"name":"Journal of medicine","volume":"5 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141642129","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 Adult Male with Multiple Skin Lesions","authors":"Shifat E Mahmud Talukder, Ronita Akhter, Mohammad Mahfuzul Hoque, Md Shafiqul Bari","doi":"10.3329/jom.v25i2.74298","DOIUrl":"https://doi.org/10.3329/jom.v25i2.74298","url":null,"abstract":"Leishmaniasis, caused by Leishmania spp. and transmitted by infected female phlebotomine sandflies, manifests in various forms. These include visceral, cutaneous, and post-kala-azar dermal leishmaniasis (PKDL). The World Health Organisation (WHO) has officially validated Bangladesh as the first country to eliminate visceral leishmaniasis. However, sustaining this achievement is challenging if PKDL cases remain unchecked because PKDL patients act as human reservoirs. Here, we depict a case of PKDL with mixed skin lesions involving the face and multiple body parts. We hope this will raise a concern among us to be vigilant for such cases and maintain the success of eliminating visceral leishmaniasis.\u0000J MEDICINE 2024; 25: 191-192","PeriodicalId":76013,"journal":{"name":"Journal of medicine","volume":"12 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141642142","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":"Dengue: The Enduring Endemic Challenge in Bangladesh","authors":"Goutam Saha, Mrinal Saha, Mili Saha","doi":"10.3329/jom.v25i1.70530","DOIUrl":"https://doi.org/10.3329/jom.v25i1.70530","url":null,"abstract":"Abstract not available\u0000J MEDICINE 2024; 25: 78-82","PeriodicalId":76013,"journal":{"name":"Journal of medicine","volume":"74 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139386277","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":"The Quest for an Effective Dengue Vaccine: Hope or Hype","authors":"F. Chowdhury, Quazi Mamtaz Uddin Ahmed, Shrebash Paul","doi":"10.3329/jom.v25i1.70361","DOIUrl":"https://doi.org/10.3329/jom.v25i1.70361","url":null,"abstract":"Several trials are ongoing to develop a safe and effective vaccine to prevent dengue virus (DENV) infections, especially avoiding the risk of antibody-dependent enhancement. Only three of them (Dengvaxia/CYTTDV, Takeda TAK-003, and NIH TV-003/TV-005) have shown promising results. The issue of ‘hyperendemicity’ and ‘quasi-species the major challenge behind developing a successful vaccine. The overall efficacy of first successful vaccine ‘Dengvaxia’ showed 30.2%–60.8% efficacy with limited protection against DEN 1 and DEN 2. In Bangladesh, since 2019, outbreaks have mostly been caused by DEN 2 and DEN 3, and the trend is predicted to continue for the coming years. TAK-003 gives almost no protection against DEN 3, which is the most notorious serotype encircling Bangladesh. The overall efficacy of this vaccine is 62%, with limited protection against DEN 4. NIH TV-003/TV-005 currently shows more promise with an overall efficacy of 80%. However, we have to wait until June 2024 for the final results. All of these vaccines are safe and effective for travelers. However, for mass vaccination, a country should make a decision based on their prevalent serotypes and the potential serotypes that might cause the next epidemic. To gather these data, a robust serotype- and genotype-based surveillance system and warning system should be in place.\u0000J MEDICINE 2024; 25: 58-67","PeriodicalId":76013,"journal":{"name":"Journal of medicine","volume":"57 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139385817","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":"Role of Home Blood Pressure Monitoring in Treatment Follow-up by Hypertensive Patients Cohort","authors":"Farjana Pervin Nupur, Mohammad Mahfuzul Hoque, Wafia Najifa, S. Afrin, Sarmistha Biswas, S. M. Masuduzzaman, S. Deb, Md. Titu Miah","doi":"10.3329/jom.v25i1.70521","DOIUrl":"https://doi.org/10.3329/jom.v25i1.70521","url":null,"abstract":"Background: The main benefit of home-based blood pressure monitoring (HBPM) is the potential approach to reduce the risk of white-coat hypertension (HTN) and to encourage patients to take ownership of their condition. This study was conducted to assess the role of HBPM in treatment follow-up in a cohort of hypertensive patients.\u0000Materials and methods: This was a prospective observational study conducted from December 2017 to May 2018. A total of 100 patients fulfilling the inclusion and exclusion criteria were selected by purposive sampling from Medicine Outdoor of Dhaka Medical College Hospital (DMCH). In total, 100 hypertensive patients were enrolled, and informed consent was obtained. Subsequently, the study subjects received information and training on BP self-management and performed 2 resting measurements per day for 4 days per week for 3 months. All measurements were performed using validated BP monitors.The study endpoints included patient awareness, attainment of BP goals, adherence to antihypertensive treatment, lifestyle modification, assessment of discrepancy between office and HBPM, and white coat HTN or masked HTN at 3 months. SPSS version 22.0 was used for data analysis and reporting.\u0000Results: Overall, the mean age was 57.76 ±12.60 years with a range of 34 – 80 years. Males were more prevalent than females, and the ratio was 1.17:1. The majority of cases (76.0%) had established HTN with a history of taking medication, whereas others were non-compliant with medications. Among them 47% had obesity, and 24% had diabetes mellitus. Of the patients, 91% adherence to HBP monitoring, 84.0% adherence to medication, and 75.0% achieved their target BP. The achievement of target blood pressure was significantly higher among the study subjects who adhered to HBP monitoring, and the p-value was < 0.04 (Fisher’s Exact test).\u0000Conclusion:  In a cohort of patients with arterial hypertension, information, and training on BP self-measurement and direct involvement of patients using HBPM led to improvement in BP control and could be an effective method by incorporating it into the usual care of hypertensive patients in the hypertension management center of the community.\u0000J MEDICINE 2024; 25: 17-23","PeriodicalId":76013,"journal":{"name":"Journal of medicine","volume":"48 23","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139384751","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}