Clinical and Hematological Features of Visceral Leishmaniasis at Mymensingh Medical College Hospital.

Visceral Leishmaniasis is the most severe form of leishmaniasis and can be fatal in the absence of treatment. Mortality is very high in untreated cases 90%. Clinical case series document a 5% case fatality rate for kala-azar patients in the hospital as complication of the disease. Nepal, India, Bangladesh, Brazil and Sudan constitute five countries of the world where more than 90% of visceral leishmaniasis occurs. Mymensingh accounted for more than 50% of total kala-azar case reported in Bangladesh. This observational study was done at SKKRC under Mymensingh Medical College Hospital, Mymensingh, Bangladesh from 1st august 2013 to 28th February 2014, to find out various clinical features and hematological picture in visceral leishmaniasis. Total 100 diagnosed case of visceral leishmaniasis was taken. Among total patient male and female were nearly equally affected by kala-azar. All age group were affected by kala-azar from below 2 years to above 50 years. Poor people in the society were affected more by kala-azar. Mymensingh was the highest incidence of kala-azar among different district in Bangladesh. Pyrexia, pallor, weight loss were the main symptoms of visceral leishmaniasis. Abdominal distension, jaundice, vomiting, cough, bleeding manifestation were less frequent symptoms of kala-azar. Hepatosplenomegaly were the frequent sign of kala-azar. Majority of patient had anemia, leucopenia and thrombocytopenia. ESR was frequently raised in kala-azar patient among those patient many had high ESR more than 100 mm in 1st hour. In conclusion prolong fever, progressive pallor, anorexia, weight loss, hepatosplenomegaly in endemic area were the main clinical features of visceral leishmaniasis. Anemia, leucopenia, thrombocytopenia, bi-cytopenia, pancytopenia and high ESR were frequently found hematological pictures in visceral leishmaniasis.

Prevalence of Non-Alcoholic Fatty Liver Disease and Its Biochemical Predictors in Patients with Type-2 Diabetes Mellitus.

Non-alcoholic fatty liver disease (NAFLD) is emerging as the most common chronic liver condition in the Western world and it is commonly associated with type 2 diabetes mellitus (DM). The aim of this study to determine the prevalence of NAFLD and identify the predisposing factors in type 2 DM patients with NAFLD. Total of 258 patients of type 2 DM were included in this observational study in the Department of Medicine, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from 11th May 2013 to 11th November 2013. Patients with characteristic findings on ultrasonography were considered as having fatty liver. They were divided into fatty liver (Group I) and non-fatty liver group (Group II) and were further evaluated by measurement of body mass index, liver function tests and lipid profile. Out of 258 type 2 diabetic patients, 167 (64.7%) patients had fatty liver on ultrasonography. BMI, waist-hip ratio and triglyceride levels in the Group I was significantly higher than Group II. An increase in the levels of ALT, AST, total cholesterol, LDL and a decrease in HDL was observed in Group I as compared to Group II. The prevalence of NAFLD is common among in type 2 diabetic patients and it increases with the rising incidence of obesity. Obesity as well as elevated liver enzymes, triglyceride and cholesterol are significantly raised in NAFLD patients with type 2 DM. It highlights the importance of routine liver function test and lipid profile in subjects with type 2 DM and should be more closely observed for NAFLD and liver complications.

Modified Blatchford Score for Risk Stratification in Adult Patient with Nonvariceal Upper Gastrointestinal Haemorrhage and Their Short Term Hospital Outcome.

Upper gastrointestinal hemorrhage (UGIH) is one of the most common and life-threatening gastrointestinal emergency. There are several risk scores for risk stratification in UGIB patients. The Modified Blatchford score, which relies only on clinical and laboratory parameters, is practical in the emergency setting The Modified Blatchford scoring system also known as Glasgow Blatchford Scoring (GBS) have been developed to stratify risk of non variceal upper gastrointestinal hemorrhage or need of medical or surgical intervention, endoscopic therapy. Objective of this study is to see risk stratification by The Modified Blatchford score and short term hospital outcome in non variceal upper GI hemorrhage patients. The observational study was carried out over a period of 6 months from October, 2014 to March, 2015 in Department of Department of Medicine, Gastroenterology and Surgery Mymensingh Medical College Hospital, Mymensingh. A total of 120 patients with non variceal UGIH were taken for the study during study period. Categorical variables were reported as percentage and Means and proportions were carried out using the Chi-square test (X2-test) of different variables by SPSS software version-18.0. Patients related variables age, sex; and main outcome variables the Modified Blatchford scoring system, Risk stratification, and short term hospital outcome were observed. Age frequency among total cases were 66(55%) <60 years, 50(41.67%) from 60-79 years and 4(3.3%) 80 years or above and sex distribution were 84(70%) were male and 36(30%) were female patients. Blatchford score of patients 1(0.83%) had score 0, 1(0.83%) had score 1, 2(1.67%) had score 2, 2(1.67%) had score 3, 2(1.67%) had score 4, 3(2.5%) had score 5, 12(10%) had score 6; 15(12.5%) had score 7, 16(13.33%) had score 8, 17(14.17%) had score 9, 16(13.33%) had score 10, 15(12.5%) had score 11, 10(8.33%) had score 12, 4(3.33% ) had score 13, 1(0.83%) had score 14, 2(1.67%) had score 15 and 1(0.83%) had score 16. Risk stratification showed 54(45%) had low risk (Mean GBS score 6.19±1.79), 66(55%) had high risk (Mean GBS score 11.03±1.83) Outcome of the patients were observed that 1(0.83%) died, 54(45%) was discharged without any medical or surgical intervention, and 65(54.17%) patients' needs medical or surgical intervention such as blood transfusion and endoscopy. Among total 120 patients with upper GI hemorrhage I have found that GBS score of three or less than three is predictive of low risk of adverse outcomes and can be discharged without any intervention.

Comparison of efficacy of labetalol and fentanyl for attenuating reflex responses to laryngoscopy and intubation.

Stress response due to laryngoscopy and intubation has been universally recognized phenomenon resulting in increase in heart rate, arterial, intracranial, and intraocular pressure. Various pharmacological approaches have been used to blunt or attenuate such pressure responses. This prospective, randomized, placebo controlled, double blinded study was designed to compare the efficacy of bolus dose of Labetalol and Fentanyl for attenuating reflex responses to laryngoscopy and intubation. Ninety patients with physical status of ASA I and II were scheduled for elective surgery under standard protocol of general anaesthesia, randomly allocated into three groups, consisting of 30 patients in each group, assigned as C (Control), L (Labetalol), and F (Fentanyl). In control group 10ml of 0.9% saline, in Labetalol group 0.25 mg/kg Labetalol and in Fentanyl group 2µgm/kg of Fentanyl were given intravenously at 3 minutes prior to laryngoscopy and intubation. Pulse rate, systolic, diastolic, mean arterial pressure and rate pressure products (RPP) were recorded before and after premedication, after administration of study drugs and at 1, 3, 5, 10 and 15 minutes after intubation. For statistical analysis of data, ANOVA tests were performed for comparison between groups. There were an increase in heart rate, systolic, diastolic, mean arterial pressures and rate pressure product in all the three groups after intubation in comparison to base line value. But the rise was minimum in L and F group as compared to C group which is statistically significant and also minimum in L group as compared to F group. So Labetalol is better agent for attenuation of laryngoscopic and intubation reflex.

A case of Conn's syndrome presenting with painfull muscular weakness.

We present a case of 30-year-old lady presenting with gradual difficulty in standing up from sitting position for 6 months, pain in arms and thighs, tingling sensation and numbness in palms and soles, increased fluid intake and increased frequency of micturition for the same duration. She was hypertensive for 12 years. On general examination patient seemed depressed and on nervous system examination her power of muscles in both upper and lower limb of both side was 3/5. Plasma sodium at the upper normal range 144mmol/l (normal range 135-146), lower level of serum potassium 1.7mmol/L (normal range 3.5-5.0), high urinary potassium 26.7mmol/l (normal range 1-10), very high serum CPK 4269U/L (for female normal range 10-79), low normal plasma rennin 1.58mg/ml/hr (normal range standing 0.40-8.80, supine 0.30-3.0), high serum aldosterone 1326.39pg/ml (normal range 25-315), high pH 7.45 (normal range 7.36-7.44) and on imaging evidence of an adrenal adenoma on left side was found and the patient was diagnosed as a case of Conn's syndrome.

Relation of different grades of esophageal varices with Child-Pugh classes in cirrhosis of liver.

This cross-sectional observational study was conducted in the Department of Medicine, Mymensingh Medical College Hospital, Mymensingh, Bangladesh over a period of 6 months from October 2011 to April 2012 and was carried out to evaluate the relation of different grades of esophageal varices with Child-Pugh classes of cirrhosis of liver patients. A total 37 patients were included. Child-Pugh score and esophageal varices of each patient were noted. Relation was carried out using the Chi-square test through determining the association of different variables. P value <0.05 was considered significant. Among 37 patients, 27(73%) were male and 10(27%) were female and their frequency of age were found, 7(18.9%) from 18-38 years, 18(48.7%) from 39-59 years and 12(32.4%) from 60 years of age and above. The etiology of liver cirrhosis revealed 18(48.7%) hepatitis B virus, 3(8.1%) hepatitis C virus and 16(43.2%) others causes. Child-Pugh classes were observed 3(8.2%) Class A, 17(45.9%) Class B and 17(45.9%) Class C and grades of esophageal varies were 13(35.1%) F1, 20(54.1%) F2 and 4(10.8%) F3 patients among total. A statistically significant positive relation was found that higher grade of esophageal varices was seen in the more advanced class of Child-Pugh classes with a p value 0.001.