BIRDEM Medical Journal

Demographic, clinical and biochemical profile of patients with polycystic ovary syndrome: a study in a tertiary care hospital of Bangladesh

Tue, 28 May 2024 00:00:00 +0000

Background: Polycystic ovary syndrome (PCOS) is a common and heterogeneous endocrine disorder, marked by irregular or absent menstrual cycles, excess androgens and polycystic ovaries. The prevalence and diagnosis of PCOS vary depending on the clinical criteria employed, with a prevalence as high as 8-13% when using the Rotterdam criteria. This study was designed to assess the demographic, clinical and biochemical profile of patients with PCOS.

Methods: This cross-sectional study was conducted in the Department of Obstetrics & Gynecology, Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2015 to December 2016. The study included 51 women aged 20-35 years with PCOS. Participants were selected using convenient sampling. Data was collected through a semi-structured questionnaire and analyzed using MS Office tools and SPSS Version 23.0.

Results: The mean age and BMI of our participants were 25.0±32 years and 27.0±3.1 kg/m2 respectively. The most common symptom was oligomenorrhoea (74.5%) and the ultrasonographic finding was polycystic ovary (92%). The mean s. testosterone and D2 serum luteinizing hormone (LH) were 1.8±0.9 ng/ml and 12.7±6.7 mIU/mL respectively and s. LH/FSH ratio was increased in 30 (58.8%) patients. The mean fasting insulin, fasting blood glucose and HOMA IR were 27.3±10.7 ìU/ml, 5.1±0.8 mmol/L and 4.1±1.3 respectively. Regarding lipid profile status of study subject, 68.60 % had high LDL and 60.60% had high triglyceride level.

Conclusion: The most common clinical feature was oligomenorrhoea and polycystic ovary in ultrasonography. LDL cholesterol and triglycerides were higher in comparison to total cholesterol in PCOS cases.

BIRDEM Med J 2024; 14(2): 65-69

Clinical and laboratory profile of patients with endstage renal disease on maintenance hemodialysis: experience from a tertiary care center of Bangladesh

Tue, 28 May 2024 00:00:00 +0000

Background: Hemodialysis has become an increasingly safe and well tolerated therapy for patients with endstage renal disease (ESRD). The aims of this study were to evaluate clinical and laboratory profile of the ESRD patients undergoing maintenance hemodialysis.

Methods: This cross-sectional study was carried out in the Department of Nephrology and Dialysis of BIRDEM General Hospital, Dhaka, Bangladesh from November to December, 2015. After taking informed consent from the patients, clinical data were taken from history and physical examination findings and laboratory data were collected from record books of the patients.

Results: Total patients were 107, male were 78 and female were 29. The mean age was 57.3 ± 11.4 years. Mean duration of chronic kidney disease (CKD) was 5.7 ± 4.2 years. Diabetic nephropathy was the most common (43%) cause of CKD. Maximum duration of dialysis was 6.5 years with mean of 1.73 ± 1.25 years. Over twothirds (68.2%) of the patients were on thrice-weekly dialysis and rest (31.2 %) were on twice-weekly dialysis. In majority (91.6%) of the patients dialysis was initiated through temporary catheter. Eighty five percent of the patients were on anti-hypertensive medications. The mean pre-dialysis systolic and diastolic blood pressures were 151 and 85 mm Hg respectively and the mean post-dialysis systolic and diastolic blood pressures were 146 and 80 mm Hg respectively. Mean hemoglobin was 9.01 gm/dl, mean ferritin was 947.6 ìg/dL. Sixty five percent patients were on treatment for anemia, with either erythropoiesis-stimulating agent (ESA) or iron or both. Eighty five percent patients had been vaccinated against Hepatitis B virus. The mean serum calcium, phosphate and parathyroid hormone was 8.87 mg/dL, 5.69 mg/dL and 245.2 pg/mL respectively. About one-third (31.2%) patients had history of hospitalization in last six months and 23% patients had plan for renal transplantation.

Conclusion: Diabetic nephropathy was most common cause of ESRD. A temporary dialysis catheter was the most common initial vascular access. Near two-thirds patients were on thrice weekly dialysis. Our patients’ blood pressures were controlled with medication but were mildly anemic and had mild mineral abnormality.

BIRDEM Med J 2024; 14(2): 70-74

Relationship of vitamin D deficiency with motor functions of Parkinson’s disease

Tue, 28 May 2024 00:00:00 +0000

Background: Parkinson’s disease (PD), a neurodegenerative disorder, is associated with substantial public health and economic burdens. Low levels of vitamin D are a common finding in patients of PD. This study was conducted to assess the serum vitamin D level in PD patients and to investigate the relationship of the vitamin D level with motor functions of PD.

Methods: This cross-sectional study was conducted in Department of Neurology, BIRDEM General Hospital, Dhaka from 1st July, 2022 to 30th June, 2023. A total of 120 participants, 60 patients with PD and 60 healthy controls were enrolled and informed written consent was taken. Healthy controls were the attendants of the cases who gave informed written consent for the study. Information on socio-demographic characteristics, clinical features, laboratory parameters and neurological examinations were assessed. A semi-structured questionnaire was used for data collection and data was analyzed with Statistical Package for Social Science (SPSS) version 24.0.

Results: Mean vitamin D level was significantly lower among the patients with PD compared to controls (25.97±3.44 ng/ml vs 38.47±5.08 ng/ml, p<0.01). Among all the cases of PD, 90% had bradykinesia, 85% had tremor, 71.7% had rigidity and 70% had postural instability. Modified Hoehn and Yahr score (H&Y) has been used for the staging of the motor disability associated with PD. According to Modified H &Y score, 53.3% patients were in stage 1-2, 26.7% in stage 2-3 and 20% in stage >3. The mean vitamin D level was 28.43±2.43, 24.06±1.57 and 21.92±1.62 in stage 1-2, stage 2.5-3 and stage >3 respectively and vitamin D level decreased significantly with advancement in stages of PD (p<0.01).

Conclusion: Patients who had low vitamin D level was associated with more advanced stage of PD.

BIRDEM Med J 2024; 14(2): 75-80

Evaluation of post-COVID depression, anxiety and stress among hemodialysis patients from an urban centre of Bangladesh

Tue, 28 May 2024 00:00:00 +0000

Background: Psychological effects of COVID-19 have been documented in different studies. Patients with endstage renal disease (ESRD) on regular hemodialysis are more vulnerable to this effect due to economic and social burden attached to their co-morbidities. This study was designed to evaluate degree of depression, anxiety and stress in patients on maintenance hemodialysis who were COVID-19 survivors and compare it with those who never had COVID-19.

Methods: It was an observational study conducted among patients of ESRD getting regular hemodialysis on outdoor basis in Square Hospital. Total 156 patients were included in the study who were divided into two groups, 52 patients getting regular hemodialysis who suffered from COVID-19 in the year before study period (October, 2021 to March, 2022) were selected as COVID group and 104 age and sex matched patients of ESRD taking maintenance hemodialysis, who never had COVID-19 were taken as the non-COVID group. Data were collected via face-to-face interview and was recorded in a pre-formed two-part questionnaire with one part containing patient’s demographic characteristics and the other part included the 21 questions in accordance with depression, anxiety stress scale 21 (DASS21) scale to measure the degree of depression, anxiety and stress in that individual patient.

Results: According to DASS21 score, prevalence of anxiety (75% versus 37.7%, P value 0.009), depression (62.5% versus 27.4%, P value 0.008) and stress (67.3% versus 40.6%, P value 0.01) in COVID group was higher than non-COVID group. Prevalence of mild and severe depression in COVID group was higher than non-COVID group. Prevalence of moderate, severe and extremely severe anxiety and all degrees of stress (mild, moderate, severe and extremely severe) were significantly higher in COVID group than non-COVID group.

Conclusion: Psychological burden was significantly higher among ESRD on maintenance hemodialysis following COVID-19 than similar patients who did not previously suffer from COVID-19.

BIRDEM Med J 2024; 14(2): 81-86

Associations and autoimmunity in hypothyroidism among the pregnant ladies attending a tertiary care hospital of Bangladesh

Tue, 28 May 2024 00:00:00 +0000

Background: Autoimmune hypothyroidism in pregnancy is a very commonly encountered issue in daily clinical practice. There is an obvious demand for universal screening and treatment with levothyroxine to reduce unwanted events. The aim of the study was to find out the association and autoimmunity among the newly detected hypothyroidism during pregnancy.

Methods: This cross-sectional, observational study enrolled 175 pregnant women recruited by convenient sampling from the Department of Obstetrics and Gynecology, BIRDEM General Hospital, with or without diabetes. FT4 and thyroid autoantibodies were advised to those patients who had elevated TSH above the American Thyroid Association 2011-defined trimester-specific reference ranges. TSH, FT4, and anti-thyroid antibodies were tested using the chemiluminescent technique by the ADVIA centaur, Siemens. Data were analysed by SPSS version 25. Non-parametric tests were chosen for statistical analysis.

Results: One hundred nineteen (68%) were found in second gravida or more and 56 (32%) were found in primigravida. Among the patients, 54 (30.9%) had a history of past abortion, 34 (19.4%) had a history of subfertility, and 28 (16%) had a family history of thyroid disease. Fifty (28.6%) of the pregnant women had thyromegaly. History of subfertility and a family history of thyroid disease and thyromegaly were significantly (p =.036, p <.001, p <.001) higher in hypothyroid group. TPO antibodies were positive in 69.6% of hypothyroid subjects.

Conclusions: It is pertinent to do universal screening of all pregnant ladies including those with high risk factors for hypothyroidism in the first trimester of pregnancy to guide comprehensive management of hypothyroidism and improve the pregnancy outcomes.

BIRDEM Med J 2024; 14(2): 87-92

Role of ceftazidime-avibactam on multi-drug resistant and extensively drug resistant gramnegative bacterial isolates

Tue, 28 May 2024 00:00:00 +0000

Background: Infections caused by multi-drug resistant (MDR) gram-negative bacteria are becoming very common and now pose a serious public health threat worldwide, as they are difficult to treat due to few treatment options and are associated with high morbidity and mortality. The combination of ceftazidime with the b- lactamase inhibitor avibactam seems to be the right choice in this situation. The aim of the study was to evaluate the in vitro activity of ceftazidime-avibactam and other commonly used antibiotics on MDR and extensively drug resistant (XDR) Enterobacterales and Pseudomonas aeruginosa (P. aeruginosa).

Methods: This observational study was conducted in the Department of Microbiology, BIRDEM General Hospital, Dhaka, Bangladesh during January to June, 2022. To report in vitro data for ceftazidime-avibactam on gram-negative isolates a total of 130 (3rd generation cephalosporin resistant) MDR major gram-negative isolates from 65 urine and 65 pus/wound swab samples were taken. Besides, a total of 150 XDR (only colistin sensitive) major gram-negative bacterial isolates from urine and pus/wound swab samples were also taken for this study. Only Esch. coli, Klebsiella sp., P. aeruginosa were included for this study.

Results: Esch. coli (79.4%) was most prevailing in urine and P. aeruginosa (97.3%) in pus/wound swab sample. Esch. coli and Klebsiella sp. showed 100% resistance to amoxicillin-clavulunate in urine and pus/wound swab sample. MDR Esch. coli and Klebsiella sp. showed 73.5% and 68% resistance to piperacillin–tazobactum whereas 2.9% and 0.0% to meropenem. A total 9.2% resistance were seen in ceftazidime-avibactum among all MDR major gram-negative isolates and 82.7% ceftazidime-avibactum were resistance to XDR major gram-negative isolates.

Conclusion: This analysis presented high susceptibility rates to ceftazidime-avibactam against Enterobacterales strains as well as for MDR phenotype and ESBL phenotype. Ceftazidime- avibactam also achieved the second highest activity result against P. aeruginosa strains including MDR and carbapenem-resistant (CR) phenotypes. These data highlight the need for continued surveillance of antimicrobial activity to treat infections caused by CR phenotypes and for which the options are extremely limited as well as the need for novel antimicrobials.

BIRDEM Med J 2024; 14(2): 93-98

Cauda equina syndrome due to primary extraskeletal Ewing’s sarcoma: a diagnostic challenge

Rumana Habib, Dilruba Alam, Mehruba Alam — Tue, 28 May 2024 00:00:00 +0000

Ewing’s sarcoma causing cauda equina syndrome is a rare entity. We report case history of a 20-year-old man who presented with features of cauda equine syndrome preceded by 4-month history of pain in the buttock and tip of the coccyx. Magnetic resonance imaging revealed a lesion within the spinal canal at S1–5 level and a large lobulated heterogeneously enhancing mass lesion in pelvic cavity in sacral region. Excisional biopsy revealed Ewing’s sarcoma by characteristic features on histologic analysis and immunohistochemistry. Patient was referred to oncologist for combined chemotherapy with radiotherapy.

BIRDEM Med J 2024; 14(2): 99-102

Severe leptin deficiency in a case of Prader-Willi syndrome: a management challenge

Fahmida Zabeen, Noorjahan Begum, Nurun Naher — Tue, 28 May 2024 00:00:00 +0000

Prader-Willi syndrome (PWS) is a rare multi-systemic genetic disorder with hyperphagic obesity. This complex syndrome is caused by lack of expression of paternally derived genes on chromosome 15q11-13. In classical PWS, major diagnostic features include neonatal hypotonia, feeding problem in infancy, rapid weight gain after infancy, hyperphagia, developmental delay, hypogonadotropic hypogonadism and characteristic facial features. With age, this disorder is further complicated with the development of scoliosis, juvenile diabetes and sleep apnea. Obesity is the most significant health problem for PWS patients. The cause of hyperphagia in PWS is unknown and likely multifactorial. Among the anorexigenic hormones, serum leptin concentration, which signals satiety to the hypothalamus, is found to be appropriately increased in proportion to higher fat mass in patients with PWS. Thus, unusually low plasma leptin levels or relative loss of sensitivity to leptin in PWS subjects could be an important factor in their obesity. We report a young girl with PWS with severe leptin deficiency, morbid obesity and type 2 diabetes mellitus.

BIRDEM Med J 2024; 14(2): 103-107

Chronic shoulder pain – a rare presentation of renal cell carcinoma: a case report

Tue, 28 May 2024 00:00:00 +0000

Renal cell carcinoma is a common malignancy and may present with metastatic disease. While metastasis to bones is common, it is uncommon to be the predominant presenting feature. Here, we present case history of a 40-year-old man suffering from chronic regional shoulder pain that poorly responded to medications and physiotherapy and later diagnosed as metastatic renal cell carcinoma. This case stresses that chronic monoarthritis or regional pain syndromes, without an obvious aetiology and poor response to symptomatic and general measures, should guide for an in-depth investigation to find the aetiology.

BIRDEM Med J 2024; 14(2): 108-111

Global warming, climate change and heatwave

Jamal Uddin Ahmed — Tue, 28 May 2024 00:00:00 +0000

Abstract not available

BIRDEM Med J 2024; 14(2): 61-64

BIRDEM News

Muhammad Abdur Rahim — Tue, 28 May 2024 00:00:00 +0000

Abstract not available

BIRDEM Med J 2024; 14(2): 112

From The Desk of Executive Editor

Muhammad Abdur Rahim — Tue, 28 May 2024 00:00:00 +0000

Abstract not available

BIRDEM Med J 2024; 14(2): 113