ABSTRACT
Stress-related gastric ulceration and their perforation have become history because of the research and development of highly effective anti-ulcer drug and their affordability and availability across our country. We present an interesting and thought-provoking case of a 46-year-old female, with stress-related gastric perforation who developed the complication in a span of only 2 days of physiological insult.
ABSTRACT
A 42-year-male presented to the surgical emergency with features of severe gastric outlet obstruction. On investigation, upper gastrointestinal series showed features suggestive of a near complete gastric outlet obstruction. Endoscopy revealed multiple antral ulcers with near complete pyloric stenosis, features suggestive of complications arising out of antral ulcers. Biopsy report revealed Brunner’s gland hyperplasia. A unique aspect about the case is the finding of antral ulcers associated with Brunner’s gland hyperplasia. The patient underwent laparoscopic distal gastrectomy with gastrojejunostomy. A high index of suspicion of Brunner cell hyperplasia in case of the patient presenting with features suggestive of pyloric stenosis is the crux of diagnosis in view of the malignant potential of Brunner cell hyperplasia.
ABSTRACT
Background: Uric acid is an independent risk factor for cardiovascular disease. Hospital admission for ischemic heart disease (IHD) is increasing rapidly in our country. Although studies were conducted abroad regarding association of serum uric acid with in-hospital outcomes in patients with acute coronary syndrome (ACS), no data is yet available to show the association in our country. Objective: The objective of this study was to assess the association of serum uric acid level on admission with in-hospital outcomes of the patients with ACS. Materials and Methods: This cross sectional comparative study was done in the Department of Cardiology, Dhaka Medical College Hospital (DMCH) from January to December 2012. After proper ethical consideration total 93 ACS patients were enrolled in the study by nonrandom sampling. Serum uric acid of all subjects was measured within 24 hours of admission. Then in-hospital outcomes were observed in all subjects. Results: The frequency of hyperuricemia among ACS patients was 24.7% (22.54% in male and 31.82% in female). Hyperuricemic patients significantly developed heart failure (30.4% vs 11.4%, p=0.032) and conduction defect (13.0% vs 1.4%, p=0.017) than normouricemic subjects. The mean ejection fraction was significantly lower in hyperuricemic patients than patients with normal uric acid level (50.87 ± 10.27% vs 55.94 ± 6.66%). The mean ± SD duration of hospital stay of hyperuricemic group was significantly longer in patients with ACS (8.26 ± 1.18 vs 7.51±1.18 days, p=0.010). Conclusion: The measurement of serum uric acid level, an easily available and inexpensive biochemical tool, might turn out as a valuable risk marker for prediction of in-hospital outcomes in patients with ACS.
ABSTRACT
Background: Diabetes mellitus is one of the most important risk factors of coronary artery disease. Admission hyperglycemia adversely influences the outcome of acute coronary syndrome patients. The study was conducted to compare the various diagnostic methods for the detection of undiagnosed diabetes mellitus in acute coronary syndrome patients with admission hyperglycaemia in Bangladeshi population. Methods: It was a cross sectional comparative study involving 157 patients with admission blood glucose level e”7.8 mmol/l. Fasting plasma glucose, Glycated haemoglobin, pre-discharge oral glucose tolerance test was measured in all subjects and comparison of performance of different methods was done. Results: Oral glucose tolerance test revealed that in spite of admission hyperglycaemia, 57 (36.3%) patients were diabetic and 52 (33.12%) patients had impaired glucose homeostasis and 48 (30.57%) patients had normal glucose metabolism. Undiagnosed diabetes could not be adequately predicted with admission plasma glucose, fasting plasma glucose or HbA1c alone (area under the ROC curve 0.589, 0.825 and 0.852 respectively). Conclusion: Admission hyperglycaemia does not diagnose diabetes reliably in a stressful condition like acute coronary syndrome. Although neither admission plasma glucose, fasting plasma glucose, nor HbA1c level were as good as oral glucose tolerance test in detecting true diabetes, but combined fasting plasma glucose & HbA1c were found to be more sensitive & specific screening tool for detecting unknown diabetes in acute coronary syndrome patients with admission hyperglycaemia.
ABSTRACT
Background: In epidemiological studies and clinical trials renal function has been shown to be an independent predictor of coronary artery disease (CAD). We conducted this study to find out the association between creatinine clearance rate (CCr) and coronary angiographic severity in patients with (CAD). Method: It was a cross sectional study carried out in the department of Cardiology, Dhaka Medical College Hospital, Dhaka during the period of April, 2011 to March, 2012. All the patients with Ischaemic heart disease (IHD) admitted in the department of Cardiology who fulfill the inclusion and exclusion criteria and underwent coronary angiogram were taken as sampling population. Sampling technique was purposive and sample size was 118. By Cockcroft-Gault formula, CCr was estimated from serum creatinine. Coronary angiographic severity of coronary artery disease was assessed by vessel score and stenosis score. Statistical analysis was carried out by descriptive statistics, correlation coefficient test and one way ANOVA test. Level of significance was set at 0.05. Results: Mean CCr among study subjects was 72.57 ± 17.78 ml/min. Vessel score showed 18.6% had normal coronaries, 37.3% single vessel disease, 31.4% double vessel disease and 12.7% triple vessel disease. There was significant positive relationship between serum creatinine and vessel score, and also negative relationship between CCr and vessel score. The study also showed significant negative correlation between CCr and stenosis score. Conclusion: Angiographic severity of coronary artery disease is associated with degree of renal dysfunction. Decreased creatinine clearance is associated with more extensive CAD.
ABSTRACT
Cushing's disease in children is not rare but in infants it is quite rare and an important medical condition needing proper line of investigations and management options. Craniopharyngioma as a cause of Cushing's disease is well reported and practical inference of the condition is of clinical importance. Craniopharyngioma generally affects children at 5 - 10 years of age and is rarely seen in infancy. It usually manifests as endocrinological deficits such as short stature, delayed puberty, and obesity. We report the case of a 7 months old infant who presented with obesity and Cushing's disease associated with Craniopharyngioma
ABSTRACT
Aging is inevitable and getting old in a healthy way is everybody's dream. Loss of memory, osteoarthritis, cataract, benign prostate hypertrophy, psychological disorders and other degenerative changes are few examples of diseases coming as part and parcel with old age. Unani system of medicine offers certain principles known as Asbab-e-sitta zarooriya or six essential requisites of life. These when kept in balance, not only keep one healthy but delay the process of aging. Apart from this there are recommendations of certain Ilaj-bittadabeer [Regimental therapy], and Ilaj-bil-ghiza [Dietotherapy] to rejuvenate the body system. There are certain drugs in Unani system of medicine which are now proven to have antioxidant properties, used for protection of Hararat-e-ghariziya [Vital Power]. In this paper, all this will be presented in a systematic and practical way under the following headings: Asbab-e-sitta zarooriya [Six essential requisites of life] llaj bit tadabeer [Regimental therapy]. Ilaj bil ghiza [Dietotherapy]. llaj bil dawa [Drug therapy]. These when followed will act as a prophylaxis for delaying the process of aging and preventing old age diseases
ABSTRACT
Chronic breast abscesses [CBA] are different from acute breast abscesses in many respects. They are usually a sequelae of some underline breast pathology and unless the primary cause is removed simple drainage of pus results in recurrence or fistulae formation. Unlike acute breast abscess, overt signs of inflammation are often absent. In this series of 20 cases of CBA, there were six cases of duct ectasia, three of tuberculosis, three of nipple inversion, two of galactocoele and one of carcinoma, while five were the result of inadequate drainage of acute abscesses. Diagnosis was mainly by clinical assessment aided by aspiration of pus and FNAC. Ultrasound and mammography had low diagnostic accuracy of 32% and 43% respectively. Treatment included major duct excision in four cases, single duct excision in two, incision and drainage with biopsy in two, excision of abscess cavity in five, nipple eversion in three, quadrantectomy in two and mastectomy in one case. We conclude that CBA should be recognised as a separate entity necessitating diagnosis of the primary cause and a pathogensis based treatment