Bangladesh Medical Journal

Thyroid Collision Tumour: Concurrence of Two Thyroid Malignancy

Thu, 13 Jun 2024 00:00:00 +0000

Thyroid carcinoma is the most common endocrine malignancy. However, it is exceptionally uncommon for two different thyroid malignancies to co-exist within the same thyroid gland. Herein, we present two cases where two different thyroid malignancies present as collision tumours of the thyroid gland. The hypothesis, epidemiology and management are discussed here. Case presentation: Case 1 was a 60 year-old woman presented with an accidental finding of left neck swelling. Ultrasound neck identified multinodular goitre with a suspicious left thyroid nodule. Ultrasound-guided fine-needle aspiration cytology of left thyroid nodule confirms papillary thyroid carcinoma. She underwent total thyroidectomy with central compartment neck dissection. However, histopathology reports a presence of medullary thyroid carcinoma and papillary microcarcinoma in the left thyroid gland. Case 2 was a 59 years old woman presented with left vocal cord paralysis with rapidly enlarging of a long-standing left thyroid swelling. Computed tomography identified bilateral thyroid swelling with left mass causing compression to the trachea and oesophagus. The patient subsequently underwent a total thyroidectomy bilateral central and left selective neck node dissections and left primary non-selective nerve re-innervation. A collision tumour with components of both Hurthle cell carcinoma and papillary microcarcinoma has been shown in histopathology. Collision tumours of the thyroid pose a diagnostic as well as a therapeutic challenge. They should be treated in a multidisciplinary team environment, and the care should be unique to the patient. The treatment should usually be directed by the most aggressive neoplasm.

Bangladesh Med J. 2023 Jan; 52(1): 30-34

Maternal Atrioventricular Nodal Re-entrant Tachycardia During Pregnancy: Case Report

Priyanka Podder, Joysree Saha — Thu, 13 Jun 2024 00:00:00 +0000

During pregnancy, the physiological changes predispose a woman for the development of new-onset or recurrent arrhythmia. Atrioventricular nodal re-entrant tachycardia (AVNRT) is a common supraventricular tachycardia (SVT) in reproductive age of woman. Although often it is benign in nature but concerning. Electrical cardioversion is safe during pregnancy. Electrophysiological study (EPS) and Radiofrequency ablation (RFA) can be performed in selected patients. Hereby, we report a case of a woman in her second trimester of pregnancy presented with diagnosed case of AVNRT. She was monitored by multidisciplinary team. Electrocardiogram (ECG) and Echocardiogram reveals normal changes. EPS and RFA was done one year back at the time of diagnosis. At her 37 weeks of pregnancy, she developed scar tenderness. Emergency caesarean section was done in presence of cardiologist. Maternal and perinatal outcome were good.

Bangladesh Med J. 2023 Jan; 52(1): 35-38

Obituary news January-2023

Kazi Shafiqul Halim — Thu, 13 Jun 2024 00:00:00 +0000

Abstract not available

Bangladesh Med J. 2023 Jan; 52(1): 39

Drug Abuse of Professional Drivers: Experience from Referral Dope Test

Thu, 13 Jun 2024 00:00:00 +0000

In Bangladesh, drug abuse is one of the dangerous problems among drivers that hamper road safety and make government worry. In that context, this cross-sectional study was conducted in National Institute of Laboratory Medicine and Referral Center (NILMRC) and aims to determine the proportion of drug abuser among professional drivers in Bangladesh. This study also addressed to recognize the various types of abused drugs, the pattern and the trend of drug abusers during study period. Data were collected from online data server of NILMRC during the period of July to December 2022. Bangladesh Road Transport Authority (BRTA) customarily refers urine samples of drivers to NILMRC for dope test. Dope tests were performed in immunochromatographic test (ICT) device and semi-auto analyzer. Dope results and demographic data of drivers were well-kept-up in online server for electronic transfer and use of data. Commonly abused drugs in Bangladesh such as, cannabinoids, amphetamines, opiates, benzodiazepines and alcohol were assessed. A total of 70866 drivers had been tested for six months of study period among them 2720 (3.81%) were found dope test positive. Considering monthly trends from July to December 2022 the highest incidence were found in December where 473 (4.58%) of 10323 drivers were dope test positive; however in November 639 (4.56%) of 14,017, in September 682 (4.07%) of 16757, in October 551(3.62%) of 15221, in August 320 (3.42%) of 9348, then less incidence were found in July 55 (1.05%) of 5200 drivers had been tested positive. There was an increase number of test positive cases were detected during the period from July to December. The highest number drug abuser that is more than two-third (70%) of drivers were found among young adult age group (25-44) years. The five types of abused drugs were tested; among those the highest proportion (91.5%) of abused drug was Cannabinoids, then Benzodiazepines was 5.5%, Amphetamine was 1.3%, Opiates was 1% and Alcohol was 0.8%. No female drivers were found test positive. Cannabinoids was the most common drug of abuse among drivers referred by BRTA, Bangladesh. During this study, there was challenge to different kind illegal means. If the illegal means could be resolute then the data of positive finding would be higher than this finding. So implementation online registration, proper identification by finger print or retinal scanning and providing online reports may minimize the illegal means.

Bangladesh Med J. 2023 Jan; 52(1): 1-5

Genetic Characterization of Aspergillus flavus and Saccharomyces cerevisae in Tracheobronchial Phlegm of HIV-infected Patients on Antiretroviral Therapy in Jalingo, Nigeria

Nkem Chinedu Awujo, Fyinbu Dennis Ishaku, Chrinius Hammuel — Thu, 13 Jun 2024 00:00:00 +0000

Fungal infections are among the diverse respiratory tract pathogens and account for a proportion of community acquired and nosocomial pneumonias thereby generating concerns particularly in immunocompromised patients. This study aims to genomically extract and sequence fungal DNA using the Basic Local Alignment Search Tool (BLAST) technology for their definitive and confirmatory identification thereby easing off the obstacles in their diagnosis due to similar appearance in their colony and morphology and ultimately determining their infection rates in persons receiving antiretoviral therapy against HIV. Sputa of 100 HIV infected out-patients of a Medical Centre in Jalingo, on anti-retroviral therapy were cultured on Sabouraud Dextrose Agar to isolate fungi species and assess their prevalence and distribution. Fungal colonies characterized culturally and biochemically as Aspergillus flavus and Aspergillus niger were subjected to the BLAST, and the similarities with the biological sequences in the National Center for Biotechnology Information (NCBI) database queried. There were observational variances in the colonial and microscopic appearances of A. flavus and A. niger on Sabouraud Dextrose Agar (SDA) plates and the microscope respectively. The similarities between the queried and biological sequences in the NCBI database, was almost all (99.7%) thus confirming their identity as Aspergillus flavus and Saccharomyces cerevisiae. The overall prevalence of fungi infection was 79.0%. More males (80.0%) than females (78.3%) were infected. In both sexes, fungi were most (92.9%) frequently isolated in patients that were between 30 and 39 years and least (64.7%) in those between 15 and 29 years. There was no established pattern (sex- and age- relatedness) of non-concomitant A. flavus and S. cerevisiae in fifty-seven male and female patients in six age categories even though A. flavus occurred more (48.1%) than S. cerevisae (24.1%) and the prevalence was higher (61.4%) in females than in males (38.6%). The high prevalence of these fungi in the study population, with or without symptoms of cough or fungal disease, mandates an early screening of such infected persons so as to reduce further complications and improve treatment.

Bangladesh Med J. 2023 Jan; 52(1): 6-11

Clinicobiochemical Parameters of Cytomegalovirus IgM and IgG positive Biliary Atresia and their Relation with Serological Titer in Infants.

Thu, 13 Jun 2024 00:00:00 +0000

Cytomegalovirus (CMV) associated Biliary atresia (BA) is one of the clinical classification of Biliary atresia (BA). There is a hypothesis that CMV IgM positive BA is a clinically different entity and prognosis is poor. The aim of this study was to evaluate the clinical and biochemical parameters of CMV IgM and CMV IgG positive BA in one to six month old infants and their relation with serological titer. This cross-sectional study was carried out from January 2019 to June 2022 in the department of Pediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. A total of 48 infants were included in this study as study subject who were diagnosed as biliary atresia with positive CMV IgM & CMV IgG. After taking written informed consents data were taken from parents or legal guardians by using a structured questionnaire. Data were analyzed by statistical package for social sciences (SPSS), version- 23. Majority of the cases (58.3%) were in 2-4 month of age group, 70.8% were male and male-female ratio was almost 2.5:1. Regarding birth history most of the infants (95.8%) were term baby and two-third (66.7%) of them was appropriate for gestational age (AGA). This study observed the onset of jaundice among the infants, here 60.4% of them detected jaundice jaundice within 7 days, 22.9% within 7-14 days and 16.7% after 14 days. About three fourth (73%) of infants presented with intermittent pale stool and more than one-fourth (27%) had persistent pales tool. One fourth 12(25%) patient had features of coagulopathy. The mean of total bilirubin, direct bilirubin, alanine transaminase (ALT) and gamma-glutamyl transpeptidase (GGT ) were 11.89±4.0, 8.27±3.42, 162.67±103.09 and 669.46±543.57 respectively; The mean of the titers of CMV IgM and CMV IgG were 50.84±33.09 and 82.40±53.79 respectively. The prolong international normalised ratio (INR ) was in 30.8% of infants and mean INR was 2.44±2.54. Study finds that CMV IgM titer level was correlated with total bilirubin (r=-0.256; p<.05) and direct bilirubin (r=-0.365; p<.05); where CMV IgG titer level was correlated with age (r=-0.362; p<.05) and INR (r=0.271; p<.05). It may be concluded as increase in age would increase titer of IgG and increase in titer of IgG is associated with increase coagulopathy. Elevated levels of CMV IgM titer correlated with bilirubin level or cholestasis.

Bangladesh Med J. 2023 Jan; 52(1): 12-17

Diagnosis and Prognosis of Neonatal Septic Arthritis from it’s Early Clinical Characteristics: Experience from a Tertiary Care Hospital

Thu, 13 Jun 2024 00:00:00 +0000

Neonatal septic arthritis (NSA) is an unusual illness, but fatal clinical condition and must be diagnosed and treated properly in order to save the neonate's joints and life. High rate of morbidity and mortality may result from NSA if left untreated. Majority of NSA cases in developing countries present themselves late at the health care facilities, making the diagnosis difficult and sometimes overlooked by health care providers. Although septic arthritis has already been investigated but cases of NSA from developing countries are under reported. The goal of the study was to better understand the clinical and microbiological characteristics of neonates with septic arthritis as well as their prognosis of treatment. This prospective observational study was conducted in Neonatal Intensive Care Unit (NICU) of Department of Neonatology and Out Patient Department (OPD) of Orthopaedics, Banga bandhu Sheikh Mujib Medical University (BSMMU). Total 30 neonate presented with acute septic arthritis were included in this study. Data were collected by reviewing record from NICU and disease course, investigation profiles, treatment record of neonates were noted as recorded during the time of hospital stay or attending in OPD. For the assessment of prognosis clinical and radiological findings of all cases were followed-up for 12 months of age. Collected data of neonates with septic arthritis from record review were processed and analyzed by Statistical Package for the Social Sciences (SPSS) and result of analyzed, finally data were presented as in tables and graphs. This study finds that nearly two-third (63%) of the neonates were male and knee joint was most frequently involved, accounting more than two-third ( 67%) of all single joint involvements. All of the cases were anemic and had high C-reactive protein (CRP) level. Joint aspirate samples culture showed that the most prevalent (41%) organism was Klebsiella, followed by Acenotobacter and Seratia. Gram-negative bacteria predominated (91%). Most of the patient (76%) had favorable prognosis after treatment. Clinical evaluation and start of intravenous antibiotics should be given priority in suspected cases. Prompt surgical intervention and consistent follow-up in a tertiary hospital are necessary for the best results.

Bangladesh Med J. 2023 Jan; 52(1): 18-23

Pattern of Eosinophil and Neutrophil/ Lymphocyte Ratio in Different Stages of Chronic Kidney Disease.

Thu, 13 Jun 2024 00:00:00 +0000

Various expensive interventions are used to diagnosis the different stages of chronic kidney disease (CKD). This research is aimed to determine the pattern of eosinophil and neutrophil/ lymphocyte ratio in different stages of CKD. Data was collected in January 2023 from the patients of CKD and from their files of reports. Permission was taken from the patients. The individuals were from civil hospital Karachi and they were the patients of CKD. Sample size was 200. There was irregular pattern of eosinophil and neutrophil/lymphocyte ratio in different stages of CKD. The eosinophil count and neutrophil/ lymphocyte ratio were higher in higher stages of CKD. The eosinophil and neutrophil/ lymphocyte ratio were higher in higher stages of CKD and the pattern was irregular. Study finds that eosinophil and neutrophil/ lymphocyte ratio were higher and the pattern was irregular in higher stages of CKD.

Bangladesh Med J. 2023 Jan; 52(1): 24-29