The Relationships between Thyroid Hormones and the Brain Serotonin (5-Ht) System and Mood: Of Synergy and Significance in the Adult Brain- A Review.

The use of thyroid hormones as an effective adjunct treatment for affective disorders has been studied over the past three decades and has been conformed repeatedly. Interaction of the thyroid and monoamine neurotransmitter systems has been suggested as a potential underline mechanism of action. While catecholamine and thyroid interrelationships have been reviewed in detail, the serotonin system has been relatively neglected. Thus, the goal of this article is to review the literature on the relationship between thyroid hormones and the brain serotonin (5-HT) system. In humans, neuroendocrine challenge studies in hypothyroid patients have shown a reduced 5-HT responsiveness that is reversible with replacement therapy. In the majority of the studies, the effects of thyroid hormone administration in animals will experimentally-induced hypothyroid sates include an increase in cortical 5-HT concentrations and a desensitization of auto inhibitory 5-HT1A receptors in the rap he area, resulting in disinhibition of cortical hippocampal 5-HT release. Furthermore, there is some indication that thyroid hormones may increase cortical 5-HT2 receptor sensitivity. In conclusion, there is robust evidence, particularly from animal studies, that the thyroid economy has a modulating impact in the brain serotonin system. Thus it is postulated that one mechanism, among others, through which exogenous thyroid hormones may exert their modulatory effects in affective illness is via an increase in serotonergic neurotransmission, specifically by reducing the sensitivity of 5-HT1A auto receptors in the raphe area, and by increasing 5-HT2 receptor sensitivity.

New Cholesterol Management Guideline 2013: A Review.

Management of high blood cholesterol is the key point for the treatment and prevention of Atherosclerotic Cardiovascular Disease (ASCVD). Till 2013, Adult Treatment Panel III (ATP III) report was the guideline for the physician for blood cholesterol management. The main feature of this guideline was to achieve a particular target cholesterol level by lifestyle modification, dietary changes and lipid-lowering drugs. But the recently released American College of Cardiology (ACC) and American Heart Association (AHA) guidelines shifted attention to Statin use at high-, moderate- or low-intensity instead of chasing a cholesterol goal. This article reviews the main features of this new guideline comparing to the previous one, where appropriate.

The Role of SPECT-Guided CT for Evaluating Foci of Increased Bone Metabolism Classified as Indeterminate on SPECT in Cancer Patients.

Planar and SPECT bone scintigraphy has played a major role in the staging of many cancers such as breast and prostate cancer, as well as in orthopedics. Integrated diagnostic CT combined with SPECT has helped improve localization and characterization of skeletal lesions, improving diagnostic confidence and helping management decisions, over traditional SPECT. A major advantage has been improved characterization of indeterminate bone lesions and differentiation of benign from malignant lesions due to additional CT information. In this treatise the role of SPECT-guided CT for evaluating foci of increased bone metabolism classified as indeterminate of SPECT in cancer patients is reviewed. Using this approach, the diagnostic confidence in differentiating malignant from benign bone lesions should better with the fused SPECT/CT image than with separate sets of bone scintigraphic and CT images.

Outcome of Upper Gastro Intestinal Haemorrhage - a Hospital Based Prospective Study.

Upper GI bleeding is a common medical emergency with a significant mortality, outcome of which depends upon the cause, appropriate and early intervention in a specialized center. This study was carried out to see the outcome of patient with Upper GI haemorrhage. Fifty cases with episode of upper gastrointestinal haemorrhage, admitted into medicine units of Faridpur Medical College Hospital from January 2011 to December 2011, were studied. Duodenal ulcer was the commonest cause of haematemesis and melaena followed by oesophageal varices, gastric ulcer and erosive gastritis. The peak incidence was among 35 to 45 years of age. Over all male female ratio was 4.55:1 but in case of duodenal ulcer it was 9:1. During hospital stay recurrent bleeding was noted in 10% of patients and during subsequent follow up it was 10% of the total and 50% in case of variceal bleeding group. Over all hospital mortality was 4% .

A Case Report on Recurrent Lepra Reaction-Type 2.

Lepra Reactions (LR) comprises immunologically mediated inflammatory states that cause considerable morbidity. Type-2 LR occurs exclusively in patients with the lepromatous end of the leprosy spectrum (BL-LL). In 90% of the cases it follows during or after completion of chemotherapy, generally within 2 years. Here we report a case of type-2 LR. He is a twenty years old fisherman with history of hypopigmented skin lesion 3 years back and was treated as a case of lepromatous Leprosy (LL). After six months of completion of treatment he developed type-2 LR presenting with recurrent bouts of fever, polyarthritis, erythema nodusum, orchitis, mononeuritis multiplex and was treated in Faridpur Medical College Hospital (FMCH) on three occasions within last one and half years.

Pseudomyxoma peritonei: A Review.

Pseudomyxoma peritonei (PMP) is rare clinical entity characterized by abundant extracellular mucinous material in the peritoneal cavity and tumoural implants on the peritoneal surfaces. The origin of PMP is controversial. It often arises from the goblet cells of large bowel or appendix. There is increase in MUC-2 secreting cells and accumulation of excessive mucin secreted by these cells in the peritoneal cavity. A ruptured appendiceal mucinous adenoma is the most common origin. Low grade ovarian malignancy is often associated. Patient may present with growing abdominal masses associated with abdominal pain, nausea, vomiting, fatigue and weight loss. Ultrasonogram and CT scan of the abdomen have role in diagnosis but diagnosis is often difficult before laparotomy or laparoscopy. Debulking surgery with intraperitoneal hyperthermic chemotherapy is the treatment.

Evaluation of Prescribing Pattern of the Private Practitioners in Bangladesh.

A prescription order is a written instruction of doctors to pharmacist to supply drugs in particular form to a patient and the directions to the patients regarding the use of medicines. This study was undertaken to observe the prescribing patterns of the private practitioners in Bangladesh, 430 prescriptions were collected randomly from Dhaka city and analyzed using WHO/INRUD indicators. There were average 3.40 drugs per prescription. Drugs were prescribed in generic name only in 0.20%. About 46.31% drugs were prescribed from the Essential Drug List, only 19% of prescriptions were complete in respect to patient medication information. Antibiotics were prescribed in 70.33% of the prescriptions; injections were prescribed in about 8.35% of the prescriptions.

Improper Inhalation Technique-A Barrier to Good Asthma Control.

Bronchial Asthma (BA) is a chronic airway disorder with significant morbidity and mortality but due to recent advances in the field of medicine most patients with BA can have complete symptom control and live a normal life. There are various routs of drug delivery for asthma control but among them aerosol inhalation is considered the optimal route. A number of pressured Metered Dose Inhalers (MDI) & Dry Powder Inhalers (DPI) are available for this purpose. However inhalation of therapeutic aerosols is not without difficulty, it requires precise instructions on the inhaler maneuvers, which is different from spontaneous normal breathing. Also, the characteristics of the inhaler device have to be suitable for the user. Available data indicate that, lack of knowledge demonstrated by health professionals & patients on the inhalation maneuvers & handling of inhalers resulting in a reduction of therapeutic benefit. The paper reviews the literature concerning the fundamental aspects of inhaler devices, inhalation maneuvers & device selection, in an attempt to increase the knowledge of and to optimize the clinical use of therapeutic inhalers. As a result of which Asthmatics can be kept under good control.

Prospective Study of Bronchial Asthma.

Bronchial asthma is an atopic disease characterized by chronic airway inflammation and hyper-responsiveness. Severe acute asthma is a medical emergency and sometimes difficult to treat. This prospective study was done at Dhaka Medical College Hospital from January 1997 to January 1998. Total 30 patients of bronchial asthma were included in this study. Diagnosis was established on the basis of symptoms, evidence of airflow obstruction and its reversibility by bronchodilator therapy. The age range was 18 to 80 years with a mean 36.64±4.91. Of them, 63% were male and 37% were female. It revealed that all patients had classical triad of dyspnoea, wheeze and cough. Almost all patients (80%) had some precipitating agents for their attack. Regarding treatment of severe acute asthma - Nebulized salbutamol is superior to conventional intravenous aminophylline, as p value of nebulized salbutamol group is <0.001 which is significant. So, severe acute asthma should be managed with nebulized salbutamol instead of intravenous aminophylline.

" Lutembacher's Syndrome " - A Case Report.

Lutembacher's Syndrome is a rare heart disease comprises ASD (congenital) secundum with Mitral stenosis (Rheumatic origin). The patient Md. Mosharraf Hossain, 72 years old man, non diabetic, non hypertensive, smoker admitted in FMCH on 10.10.2010 with the complaints of respiratory distress and chest pain for 10 days. He had a previous history of Rheumatic fever in early childhood. There was history of recurrent attack of Rheumatic fever. Subsequently he developed MS from Rheumatic carditis. ASD was congenital in origin. If diagnosis could be done earlier, surgical closure of ASD with replacement of mitral valve bears a good prognostic value. Our patient is in elderly age and already developed pulmonary hypertension, operative procedure is not suitable. So the patient should be kept in conservative treatment.

Incretin-Based Antidiabetic Agents: A New Option for Type-2 Diabetes Mellitus.

Type 2 Diabetes Mellitus (T2DM) is a complex disease with the co-existence of several pathophysiological abnormalities. Both microvascular and macrovascular complications are the main causes of morbidity and mortality, which develops due to endothelial dysfunction. Upregulation of reactive oxygen species, chronic inflammatory and hypercoagulable states are the pathologic basis of vascular dysfunctions in T2DM. To overcome all these abnormalities, different classes of antihyperglycaemic agents have developed. Unfortunately none is able to show satisfactory glycaemic control and to modulate vascular dysfunction. Incretin hormones are secreted from intestine during meal, which enhance insulin secretion and inhibit glucagon secretion from the pancreas. The incretin effect is severely reduced or absent in T2DM. Incretin-based new antidiabetics, both Dipeptidyl Peptidase-4 (DPP-4) inhibitors (Saxagliptin, Sitagliptin, Vildagliptin) and Glucagon Like Peptide-1 (GLP-1) analogs (Exenatide) are now being used globally. They are almost equally effective as conventional antidiabetics like Sulphonylureas (SU), Metformin (MET), Thiazolidinediones (TZD) and insulin when given as monotherapy or combined with SU, MET or TZD as second line agent. Incretin-based agents do not cause hypoglycaemia, produce weight loss in spite of weight gain and do not retain salt or water and almost no gastrointestinal (GIT) symptoms. The agents correct vascular dysfunctions and dyslipidaemia and can be given in elderly and renal impaired patients.

Ventricular Tachycardia – Life Threatening Cardiac Arrhythmia – A Case Report.

Ventricular tachycardia (VT) & ventricular fibrillation (VF) are the most common immediate life threatening complications after acute myocardial infarction. These complications occur in about 5-10% of patients who admitted in hospital and are thought to the major causes of death who die before reaching hospital and to take medical attention. Immediate defibrillation will usually restore sinus rhythm. Prompt pre-hospital resuscitation and defibrillation can save many more lives. Our patient, Mr. Abdul Malek, aged about 55years, hailing from west Naodoba, Jajira, Sariotpur, non-hypertensive, non-diabetic, smoker was admitted in MMW, FMCH on 23/03/10 with the complaints of chest discomfort, shortness of breath, sweating and vomiting. During admission his pulse and BP was non-recordable, ECG shows VT. Immediately the patient was transferred to CCU from MMW. Patient was kept in cardiac monitor and arranged for DC shock. After giving 200 joules DC shock patient reverted to sinus rhythm .His pulse was recordable and reasonable blood-pressure was regained. Then the patient was treated with antiplatelets, anti-coagulant, nitrates and prophylactic iv Lignocaine. Subsequently oral anti-arrhythmic drug Amiodarone was started. The recovery of the patient was un-eventful and was discharged after 10 days without any further complication.

Silicosis - A Case Report.

Silicosis is not an uncommon disease in Bangladesh as a good number of people are exposed to silica dust in their working places. Again pulmonary tuberculosis is also common here, the risk of which is increased by about 30 folds in silicosis. In the reported case, a young stone cutter of 40 years was admitted to Faridpur Medical College Hospital with progressive dyspnoea, dry cough and radiological appearance of multiple small and a large nodular pulmonary mass. Two of his brothers, also stonecutter, died of similar disease. In this context the patient was diagnosed as a case of chronic complicated silicosis and treated symptomatically as there is no curative treatment. A good number of people are engaged in stone cutting in our country including Faridpur district and are vulnerable to this progressive and non-curable disease. To aim of this case report is to make those people to be aware about the condition, so that they can protect themselves by taking appropriate measures (i.e. using protective mask) and should monitored their condition by regular chest x-ray. If early signs of silicosis is detected the worker should changed their job.

Urinary Bladder Tuberculosis – A Case Report.

Genito-urinary tuberculosis is an infrequent but not uncommon condition in countries with high incidence of tuberculosis like Bangladesh. A female patient of 25 years was admitted into Faridpur Medical college Hospital with acute retention of urine with history of haematuria, dysuria, fever and difficulty in urination for about three years. USG revealed few masses in the urinary bladder, later proved by histopathological examination as granulomatous lesion consistent with tuberculosis. Anti-TB treatment was given and the masses were removed surgically. With this treatment recovery of the patient is satisfactory and symptoms are disappearing. The aim of this study to make internist more efficient to diagnose the disease by strong clinical suspicion and relevant laboratory investigation, otherwise such uncommon disease and its complications may endanger life of such patient.

Outbreak Of Nipah Encephalitis In Greater Faridpur District.

Nipah viral encephalitis is one of the fatal re-emerging infections especially in southeast Asia. After its outbreak in Malaysia and Singapore; repeated outbreaks occurred at western part of Bangladesh especially in Faridpur region. Besides, sporadic attacks appear to occur in the country throughout the year. Here two Nipah outbreaks in greater Faridpur district in 2003 and 2004 are described along with brief review on transmission of the virus. Where the history of illness among patients are very much in favour of man to man transmission. Moreover the death of an intern doctor from Nipah encephalitis who was involved in managing such patients in Faridpur Medical College Hospital strongly suggests man to man transmission of this virus. So, aim of this review article to make the health personnel and general people be aware about man to man transmission of virus, so that they can adapt personal protection equipment (PPE) for their protection against this deadly disease.

Profile Of Clinically Suspected Encephalitis Patients Admitted To Faridpur Medical College Hospital, Bangladesh.

Encephalitis is a relatively common clinical diagnosis of admitted patients in Faridpur Medical College Hospital. This is significant because there was an outbreak of Nipah Virus (Ni-V) encephalitis in Faridpur district in 2004 with 34 cases including 26 deaths. Recent death of an intern doctor of FMCH from Ni-V encephalitis further emphasizes the gravity of situation. In this study a total number of 100 cases of clinically suspected encephalitis patients were studied for different clinical parameters. This is a retrospective study using data from hospital records. Majority of patients presented with neurological features (85%), 6% with pulmonary, 7% with combined neurological and pulmonary, and 2% with other features. 5-18 years age group comprises the highest number 44%, followed by >18 years age group 34%. Male-female ratio was 33:17. July to November was the period of maximum number of admission, the highest being in August. Patient from all upazillas of Faridpur were admitted, the highest being from Sadar Upazilla. 48% of the patients recovered, 19% expired and 7% were referred. In this context, further prospective study is urgently required to find out the epidemiological characteristics of Nipah virus encephalitis in Faridpur region.

Prevalence Of Hematological Disorder: A Bone Marrow Study Of 177 Cases In A Private Hospital At Faridpur.

Bone marrow examination of 177 cases of suspected hematological disorders was carried out in a private hospital at Faridpur from May 2007 to August 2009. Among the malignant hematological disorders, Acute Myeloid Leukemia (AML) was the most common disorders (27.69%) followed by Acute Lymphoblastic Leukemia (9.04%), MDS (7.91%), CML (7.34%) and Multiple Myeloma (1.69%). Among the non-malignant hematological disorders, Combined (both iron and folic acid and /or Vitamin B12) deficiency anemia was the most common disorders (24.87%) followed by Aplastic anemia (10.74%), ITP (6.21%), and Kala-azar (2.82%).