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Islam Z.,International Center for Diarrhoeal Disease Research | Jacobs B.C.,Erasmus Medical Center | Mohammad Q.D.,Dhaka Medical College and Hospital | Islam M.B.,Dhaka Medical College and Hospital | And 5 more authors.
Neurology | Year: 2010

Background: Campylobacter jejuni enteritis is the predominant bacterial infection preceding Guillain-Barré syndrome (GBS), an acute postinfectious immune-mediated polyradiculoneuropathy. The purpose of this study was to define the clinical phenotype of GBS and the relation with preceding C jejuni infections in Bangladesh. Methods: We performed a prospective matched case-control hospital surveillance including 100 patients fulfilling the National Institute of Neurological Disorders and Stroke criteria for GBS from 2006 to 2007 in the Dhaka area of Bangladesh. Detailed clinical, electrophysiologic, serologic, and microbiologic data were obtained with a follow-up of 6 months. Results: GBS affected predominantly young adult males living in rural areas. Sixty-nine percent of the patients had clinical evidence of a preceding infection. The most frequent symptom was diarrhea (36%). The majority of patients had a pure motor variant of GBS (92%) with relatively infrequent cranial nerve involvement (30%). Twenty-five percent of patients required respiratory support. Electrophysiologic studies showed that 67% of patients had an axonal variant of GBS. Eleven patients (14%) died, and 23 (29%) remained severely disabled during the follow-up. Positive C jejuni serology was found in an unprecedented high frequency of 57% as compared with 8% in family controls and 3% in control patients with other neurologic diseases (p < 0.001). C jejuni infection was significantly associated with serum antibodies to the gangliosides GM1 and GD1a, axonal neuropathy, and greater disability. Conclusions: We report an unusually high frequency of the axonal variant of Guillain-Barré syndrome in Bangladesh, associated with preceding Campylobacter jejuni infection, severe residual disability, and high mortality. © 2010 by AAN Enterprises, Inc.


PubMed | Khulna Medical College and Hospital, Qilu Hospital, National Taiwan University Hospital, Chao Yang Hospital and 18 more.
Type: | Journal: European journal of cancer (Oxford, England : 1990) | Year: 2016

In premenopausal women with metastatic hormone receptor-positive breast cancer, hormonal therapy is the first-line therapy. Gonadotropin-releasing hormone analogue + tamoxifen therapies have been found to be more effective. The pattern of recurrence risk over time after primary surgery suggests that peri-operative factors impact recurrence. Secondary analyses of an adjuvant trial suggested that the luteal phase timing of surgical oophorectomy in the menstrual cycle simultaneous with primary breast surgery favourably influenced long-term outcomes.Two hundred forty-nine premenopausal women with incurable or metastatic hormone receptor-positive breast cancer entered a trial in which they were randomised to historical mid-luteal or mid-follicular phase surgical oophorectomy followed by oral tamoxifen treatment. Kaplan-Meier methods, the log-rank test, and multivariable Cox regression models were used to assess overall and progression-free survival (PFS) in the two randomised groups and by hormone-confirmed menstrual cycle phase.Overall survival (OS) and PFS were not demonstrated to be different in the two randomised groups. In a secondary analysis, OS appeared worse in luteal phase surgery patients with progesterone levels <2ng/ml (anovulatory patients; adjusted hazard ratio 1.46, 95% confidence interval [CI]: 0.89-2.41, p=0.14) compared with those in luteal phase with progesterone level of 2ng/ml or higher. Median OS was 2years (95% CI: 1.7-2.3) and OS at 4 years was 26%.The history-based timing of surgical oophorectomy in the menstrual cycle did not influence outcomes in this trial of metastatic patients. ClinicalTrials.gov number NCT00293540.


PubMed | Erasmus Medical Center, University of Dhaka, University of Queensland, Bangladesh University and 4 more.
Type: | Journal: BMC cancer | Year: 2016

Cancer burden among children and adolescents is largely unknown in Bangladesh. This study aims to provide a comprehensive overview on childhood and adolescent cancers and to contribute to the future strategies to deal with these diseases in Bangladesh.Data on malignant neoplasms in patients aged less than 20 years diagnosed between 2001 and 2014 (N = 3143) in Bangladesh was collected by the National Institute of Cancer Research and Hospital and ASHIC Foundation. The age pattern and distribution of cancer types were analysed and the incidence rates were calculated.The age-standardised incidence rate was 7.8 per million person-years for children (0-14 years) in the last time period (2011-2014). Retinoblastoma (25%) and leukaemia (18%) were the most common childhood cancers. For adolescents (15-19 years), the age-specific incidence rate was 2.1 per million person-years in the same time period. Most common adolescent cancers were malignant bone tumours (38%), germ cell and gonadal tumours (17%), and epithelial tumours (16%). There were more boys affected (M: F ratio 2.0 in children and 1.4 in adolescents) than girls.Cancer incidences were lower than expected most likely due to a low level of awareness about cancer among clinicians and the population, inadequate access to health care, lack of diagnostic equipment and incomplete recording of cases. Improvements on different levels should be made to get a better epidemiologic insight and to detect cancer earlier resulting in a better outcome for affected children and adolescents.


Islam Q.T.,Dhaka Medical College and Hospital | Basher A.,SK Hospital | Amin R.,Dhaka Medical College and Hospital
Journal of Medicine (Bangladesh) | Year: 2012

Background: Dengue remains endemic and frequently intensifies into epidemics in Bangladesh since 2000 resulting in frequent hospitalizations.Materials & Methods: A prospective observational study was carried out to determine the clinical parameters of the subjects for hospitalization and the pattern of presentation of dengue fever in hospital care from July, 2010 to December, 2010.Result: Total 50 cases were selected consecutively and diagnosed clinically as dengue, and were classified into 3 groups, i.e. 25 cases of classical dengue fever, 3 cases of dengue fever with unusual haemorrhage, 22 cases Dengue haemorrhagic fever (DHF-I and DHF-II) and all were discharged uneventfully. Among them 33(66%) were male and outnumbered 17(34%) were female. Mean ages of the subjects were 30.91 ±10.314, 34.33 ± 16.29 and 33.91 ± 14.72 years in respective groups. Majority had profound weakness, headache, myalgia, anorexia, nausea, and vomiting and itching. Diarrhoea, abdominal pain, organomegaly, ascites, and pleural effusion were not infrequent complaints of Dengue haemorrhagic fever patients, whereas occasional complaints in other groups. There is a linear relationship between platelet count and SGPT (p-0.037). Hametocrit value also markely increased in dengue haemorrhagic fever (m- 42.5) but not in dengue fever with unusual haemorrhage (m-31). Biochemical marker specially Hct may be a good predictor to differentiate different presentation of dengue fever.Conclusion: Patients with dengue syndrome showed varied presentation and the symptoms were nonspecific. So much attention has to be paid for early diagnosis and management.


PubMed | Shaheed Suhrawardy Medical College, University of Dhaka, Goethe University Frankfurt, Dhaka Medical College and Hospital and 6 more.
Type: | Journal: The American journal of tropical medicine and hygiene | Year: 2017

We describe 70 cases of monocled cobra (Naja kaouthia) bite admitted to Chittagong Medical College Hospital, Bangladesh. The biting snakes were identified by examining the dead snake and/or detecting N. kaouthia venom antigens in patients serum. Bites were most common in the early morning and evening during the monsoon (May-July). Ligatures were routinely applied to the bitten limb before admission. Thirty-seven patients consulted traditional healers, most of whom made incisions around the bite site. Fifty-eight patients experienced severe neurotoxicity and most suffered swelling and pain of the bitten limb. The use of an Indian polyvalent antivenom in patients exhibiting severe neurotoxicity resulted in clinical improvement but most patients experienced moderate-to-severe adverse reactions. Antivenom did not influence local blistering and necrosis appearing in 19 patients; 12 required debridement. Edrophonium significantly improved the ability of patients to open the eyes, endurance of upward gaze, and peak expiratory flow rate suggesting that a longer-acting anticholinesterase drug (neostigmine) could be recommended for first aid. The study suggested that regionally appropriate antivenom should be raised against the venoms of the major envenoming species of Bangladesh and highlighted the need to improve the training of staff of local medical centers and to invest in the basic health infrastructure in rural communities.


News Article | February 2, 2017
Site: www.techtimes.com

Zika Virus - What You Should Know Ebola - What You Should Know A young Bangladeshi girl may be the first female in the world to be identified with a rare genetic disorder called "tree man syndrome." Sahana Khatun, 10, began growing bark-like warts on her face in late 2016. At that time, her father was not worried. As the warts began to spread, however, Sahana's father grew concerned and travelled from his Bangladeshi village to the capital Dhaka to get help, reports the BBC. The young girl bears unusual bark-like warts on her nose, chin, and ear. She has since been admitted to Dhaka Medical College and Hospital on Jan. 29. According to her father, Mohammad Shahjahan, Sahana started to develop the disease in 2009, when he noticed some rashes on his daughter's face. These are thought to be the symptoms of epidermodysplasia verruciformis or tree man syndrome, a rare genetic disease of which there are only a handful of known cases all over the world. This condition, which causes malignant skin tumors to grow, is thought to be caused by an immune system defect that increases a person's susceptibility to the human papillomavirus. "We don't know yet if this is (one) hundred percent a 'tree man' syndrome," said Dr. Samanta Lal Sen, the chief plastic surgeon at the hospital. Although Sahana's condition is a mild form of the disease, Lal Sen said it is definitely a variety of epidermodysplasia verruciformis. Doctors plan to operate and remove the lesions in Sahana's face next week. Sahana's mother passed away when the young girl was six, and her father works as a laborer. Because of the family's financial state, the hospital will cover all medical and personal expenses of Sahana's treatment. Another patient is receiving treatment at the same hospital for epidermodysplasia verruciformis. Known as the "tree man" of Bangladesh, 27-year-old rickshaw driver Abul Bajandar suffered from tree branch-like growth that sprouted from his feet, fingers, and palms. Before receiving surgery to get the growth removed, Bajandar lived with his condition for years. It grew to a hefty 11 pounds. Since then, Bajandar has had 19 operations to heal his hands. He will receive a few more operations before he is released from the hospital. Lal Sen, who is also treating Bajandar, said that he is now in "good shape" and can write and eat using his own hands. The doctors at Dhaka Medical College hope to do the same for young Sahana. © 2017 Tech Times, All rights reserved. Do not reproduce without permission.


Fakir A.Y.,Dhaka Medical College and Hospital
Mymensingh medical journal : MMJ | Year: 2011

The study was done to determine the clinical, radiological and histopathological characteristics along with the management outcome of differentiated thyroid carcinoma. This Retrospective study included sixty patients with differentiated thyroid carcinoma presented to Department of Otolaryngology and Head-Neck Surgery at Dhaka Medical College Hospital and Apollo Hospitals Dhaka from June 2006 to December 2008. The data of each patient included age, sex, presenting symptoms and signs, provisional diagnosis, preoperative investigations, operation notes, histopathological examination and state at follow up. This study included 28 males and 32 females. The mean age was 42.7 years. Maximum patients presented at 4th decade. The commonest presentation was thyroid swelling followed by lateral neck swelling. Detailed clinical assessment before operative treatment has been done for all patients. Fifty five patients (91.66%) presented with single nodule. Distant metastasis was found in 2 cases. All patients underwent fine needle aspiration cytology which was conclusive in 38 patients (63.33%). All the sixty patients underwent surgical excision; either total thyroidectomy or completion thyroidectomy. Neck dissection was performed in 8 patients. All patients received postoperative radio-iodine. Fifty one cases were papillary carcinoma and 9 cases were follicular carcinoma. Except for one case with local recurrence the remaining cases were disease free on follow up (up to 10-40 months). One patient died with bone metastasis 2 years after operation. Of all thyroid cancers, majority cases are papillary cancer (85%). In contrast to other cancers, thyroid cancer is almost always curable. Most thyroid cancers grow slowly and are associated with a very favorable prognosis. Early diagnosis and treatment of the same is strongly advisable.


Mondol B.A.,Dhaka Medical College and Hospital
Mymensingh medical journal : MMJ | Year: 2010

Tuberculosis can involve any organ system of the body. Although rare tuberculosis of nervous system (NS) is not uncommon in our country. In the nervous system tubercle bacilli can cause tuberculous meningitis, abscess , tuberculoma in brain & spinal cord. Untreated Central Nervous System (CNS) tuberculosis is devastating. Early diagnosis & prompt treatment of NS is essential to avoid morbidity & mortality. Tubercle bacilli causes chronic caseating granulomatous lesion. Tubercular meningitis presents with fever, headache, neck stiffness & cranial nerve palsy. Tuberculoma may present with headache, seizure and focal deficit. In the spinal cord tuberculoma or tubercular abscess may result in para paresis or quadri-paresis. For diagnosis of nervous system tuberculosis CSF analysis and neuroimaging are important. CSF cell count, Gram staining, Culture and Polymerase Chain Reaction (PCR) are helpful for diagnosis. Imaging helps in the diagnosis of tuberculoma and tubercular abscess. Computed tomography (CT) guided Fine Needle Aspiration for Cytology (FNAC) helps to establish the histopathological diagnosis. Use of combination antitubercular drugs for long period (12-18 months) is necessary to treat nervous system tuberculosis.


PubMed | Dhaka Medical College and Hospital
Type: Journal Article | Journal: Mymensingh medical journal : MMJ | Year: 2016

Large Intracerebral hematoma (ICH), compounded by perihematomal edema can produce severe elevations of intracranial pressure (ICP). Decompressive craniectomy (DC) beneficially addresses mass effect. Therefore this study is aimed to prove that decompressive craniectomy with durotomy has better outcome in patients with spontaneous supratentorial ICH than conservatively treated patients. This Quasi-Experimental study was carried out in the Department of Neurosurgery, Dhaka Medical College & Hospital (DMCH), Dhaka, Bangladesh from July 2012 to December 2013 using purposive sampling procedure. A total of 80 admitted adult hypertensive patients with spontaneous supratentorial ICH were enrolled in the study population fulfilling all selection criteria. Of them 40 patients underwent decompressive craniectomy with durotomy was considered as surgical group and 40 patients were treated conservatively was considered as conservative group. All the cases were continuously followed up and GCS score at 7(th) day of treatment (D7) and at discharge was recorded. MeanSD hematoma volume was 56.9113.72ml in surgical patients and in conservative group 51.8013.58ml. Outcome measured by modified Rankin Scale at 3 months. Sixty percent (60%) patients had good outcome (mRS 0-4) and 40% patients had poor outcome (mRS 5-6) in surgical group. On the other hand, 52.5% patients had good (mRS 0-4) and 47.5% had poor (mRS 5-6) outcome in conservative group. In logistic regression analysis, conservative group was 3.643 times more prone to develop poor outcome than surgical group which was statistically significant (95% CI, 1.040-13.047; p value <0.05) and volume of hematoma [OR (95% CI), 1.131(1.059-1.207); p value <0.001)] was the most important predictor of outcome. This study indicates that decompressive craniectomy with preservation of brain integrity in patients with spontaneous supratentorial ICH is feasible and safe. It can be a useful alternative surgical procedure in the treatment of spontaneous supratentorial ICH.


PubMed | Dhaka Medical College and Hospital, Bangabandhu Sheikh Mujib Medical University and Bangladesh University of Engineering and Technology
Type: Journal Article | Journal: Ultrasound in medicine & biology | Year: 2015

Proposed here is a breast tumor classification technique using conventional ultrasound B-mode imaging and a new elasticity imaging-based bimodal multiparameter index. A set of conventional ultrasound (US) and ultrasound elastography (UE) parameters are studied, and among those, the effective ones whose independent as well as combined performance is found satisfactory are selected. To improve the combined US performance, two new US parameters are proposed: edge diffusivity, which assesses edge blurriness to differentiate malignant from benign lesions, and the shape asymmetry factor, which quantifies tumor shape irregularity by comparing the tumor boundary with an ellipse fitted to the lesion. Then a new bimodal multiparameter characterization index is defined to discriminate 201 pathologically confirmed breast tumors of which 56 are malignant lesions, 79 are fibroadenomas, 42 are cysts and 24 are inflammatory lesions. The weights of the multiparameter bimodal index are optimally computed using a genetic algorithm (GA). To evaluate the performance variation of the index on different data sets, the tumors are categorized into three classes: malignant lesion versus fibroadenoma, malignant lesion versus fibroadenoma and cyst and malignant lesion versus fibroadenoma, cyst and inflammation. The test results reveal that the proposed bimodal index achieves satisfactory quality metrics (e.g., 94.64%-98.21% sensitivity, 97.24%-100.00% specificity and 96.52%-99.44% accuracy) for classification of the aforementioned three classes of breast tumors. Its performance is also observed to be better in totality of the quality metrics sensitivity, specificity, accuracy, positive predictive value and negative predictive value as compared with that of a conventional bimodal index as well as unimodal multiparameter indices based on US or UE. It is suggested that the proposed simple bimodal linear classifier may assist radiologists in better diagnosis of breast tumors and help reduce the number of unnecessary biopsies.

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