Frequency of Osteoporosis among Chronic Obstructive Pulmonary Disease Patients Attending Respiratory Medicine Out Patient Department, BSMMU.

Osteoporosis is an important systemic manifestation of Chronic Obstructive Pulmonary Disease (COPD). Osteoporosis is a systemic disease of bone which may present as low bone mass and micro-architectural disarray that increases the risk of fracture. The World Health Organization defines osteoporosis as bone density ≥2.5 standard deviations below the bone density of a normal young adult. Osteopenia, a less severe form of bone loss, is defined as a bone density between 1 and 2.5 standard deviations below that reference point. The aetiology of osteoporosis in COPD patients remain unclear, but several factors significantly correspond to reduced bone density in COPD, including older age, female sex and body mass index (BMI). However, the relationship to other factors, such as FEV1, tobacco smoking, physical inactivity and corticosteroid therapy, are still an unresolved issue. This cross-sectional study was done in the Department of Respiratory Medicine, BSMMU from March 2018 to March 2019. A total of 86 patients of which prevalence of osteoporosis is 29.1%, osteopenia 50% and normal BMD in 20.9%, majority of them was belonging to age group 51-60 years. Male were predominant with male-female ratio of 3.5:1. The frequency of osteoporosis was 32.0%, 64.0% and 4.0% in moderate, severe and in very severe COPD patients, respectively. The frequency of osteopenia was 14.0% in mild, 53.5% in moderate, 20.9% in severe and 11.6% were in very severe COPD patients. The p value (p=0.018) was significant for prevalence osteoporosis and osteopenia with increase in severity of COPD. The prevalence of osteoporosis and osteopenia was high in COPD patients under study. The frequency of osteoporosis and osteopenia was more with severity of COPD.

A Community study of obstructive sleep apnea hypopnea syndrome (OSAHS) in middle-aged Bangladeshi population.

Obstructive sleep apnea hypopnea syndrome (OSAHS) is the occurrence of repetitive episodes of complete or partial upper airway obstruction during sleep in association with loud snoring and daytime sleepiness and is a risk factor for hypertension, cardiovascular and cerebrovascular diseases and more. The present study was performed to assess the prevalence as well as the clinical and anthropometric predictors of OSAHS in an urban community of middle aged Bangladeshi population. The study was a cross-sectional, community-based prevalence study which was performed in an urban community in Dhanmondi Thana Pourashava of Dhaka city from July 2007 to June 2008. About 2500 citizens, aged 30-60 years were included in the study. In stage one of the study, they were informed about the polysomnography (PSG) study (stage two of the study) and 2250 of them gave consent. Subjects were then divided into habitual (495) and non-habitual snorers (1755). Among 2250 subjects, the prevalence of obstructive sleep apnea hypopnea (OSAH) in habitual snorers was 48.33% (239/495), and that in non-habitual snorers was 1.66% (29/1755). So, the overall prevalence of OSAH in the screened population was 11.91%, and that of OSAHS was 3.29%. Likewise, the prevalence of OSAH and OSAHS in men were 17.37% and 4.49%, respectively and 6.25% and 2.14% in women. Multivariate analysis revealed that male gender, age, obesity (defined by a high body mass index), waist/hip ratio were significant risk factors for OSAHS. These findings can help us in identifying the prevalence of OSAHS in the community and further planning in the management of obesity and cardiovascular diseases.

Kikuchi-Fujimoto Disease presenting with fever, lymphadenopathy and dysphagia.

Kikuchi Fujimoto Disease (KFD) can present with dysphasia, fever and lymphadenopathy. A young Bangladeshi girl presented with fever, cervical lymphadenopathy, dysphasia, weight loss and skin rash. Antitubercular drugs were given on clinical judgement, with no improvement after one month. Later, fine needle aspiration and histopathology of Lymph Node suggested KFD. Computerized Tomography (CT) scan of neck revealed enlarged retropharyngeal lymphnode (LN) causing pharyngeal narrowing. Oral Prednisolone was given showing improvement and no relapse was encountered. KFD may present with dysphasia uncommonly along with fever and lymphadenopathy. Awareness of this disorder by clinicians and pathologists will help prevent misdiagnosis and inappropriate treatment.

The clinical predictors of hypertension and sleepiness in an Asian population with sleep-disordered breathing.

INTRODUCTION: The objective of this study was to identify the clinical predictors for hypertension and sleepiness in an Asian population with sleep-disordered breathing (SDB). MATERIALS AND METHODS: This is a retrospective, consecutive case series of 228 patients with symptoms of SDB referred to a tertiary level sleep disorders unit. A full sleep history, body mass index (BMI), Epworth Sleepiness Score (ESS), apnoea-hypopnoea index (AHI) and lowest oxygen saturation were recorded. All patients had an in-hospital polysomnogram. AHI > or =5 defined SDB. ESS >8 defined sleepiness. RESULTS: A BMI of 25 had a positive and negative predictive value of 75% and 56%, respectively, for predicting AHI > or =5, area ROC (receiver operating curve) = 0.668. Patients with AHI >5 had 3 times the risk of developing hypertension compared to the population with AHI <5. Using stepwise multivariate analyses with constant, age, BMI and lowest oxygen desaturation were predictors for hypertension. Patients with AHI > or =5 were 1.88 times more likely to have ESS >8. After stepwise multivariate analyses, the subjective complaint of sleepiness and lowest oxygen saturation during sleep were predictors of ESS >8. CONCLUSION: The lowest oxygen saturation attained during sleep was the common factor for hypertension and sleepiness in our Asian SDB population. Mild obesity predisposes to AHI > or =5 in our population, the threshold at which the risk of hypertension is 3-fold compared with AHI <5. The subjective complaint of sleepiness predicted an ESS of >8.