Correlation between Hepatic Vein Wave form Changes on Doppler Ultrasound and the Severity of Diseases in Cirrhotic Patients

Background: Cirrhosis is a common problem and is a leading cause of chronic liver disease. Early diagnosis with assessment of severity of diseases may help prevent the associated complications and patients’ sufferings. Now a days Hepatic venous Doppler can be a tool for diagnosis of cirrhosis and to assess correlation between waveform changes and severity of diseases. Objective: The purposes of this study was to determine the significance of hepatic vein waveform changes on doppler ultrasound in cirrhotic patients and to correlate with liver dysfunction. Materials and methods: This study was carried out in the department of Radiology and Imaging of Enam Medical College and Hospital during January 2017 to May 2018. Doppler waveforms were obtained from right hepatic vein in all the cases and classified as triphasic, biphasic and monophasic. Waveform comparisons were made among patients with differing grades of cirrhosis. Child- Pugh class was used to assess severity of cirrhosis. Doppler sonography was done in 80 patients suspecting of having liver cirrhosis. Data on clinical findings, B mode sonographic findings and hepatic vein doppler ultrasound findings were collected and documented in structured forms. Analysis was done using SPSS - 20. Results: Total of 80 patients who met the inclusion criteria are included in the study with mean age of 45.37±7.64 (range 25-75) years. Among these 57 (71%) were males while 23(29%) were females. On the basis of hepatic function 25 (31%) patients presented in Child-Pugh Class A, 31(39%) with Class B and 24(30%) patients had Class C. Hepatic venous waveform was triphasic in 22 (27.5%), biphasic in 28(35%), and monophasic in 30 (37.5%) cases. Our study revealed 88% (21) of Child- Pugh Class C, 23% (7) of Class B and 8% (2) of class A patients had monophasic HV waveform. The hepatic venous waveform progressively changed from triphasic to biphasic to monophasic with advancing grade of cirrhosis. The relationship of these waveforms change had significant relation with hepatic dysfunction (p < 0.022). Conclusion: Hepatic vein wave form changes reflects the change in hepatic circulation associated with progression of liver cirrhosis. It can be used as a new parameter in the assessment of severity of liver cirrhosis. Thus, alteration in hepatic venous blood flow pattern on doppler ultrasound can be a useful noninvasive tool for evaluating diseases severity in patients with cirrhosis. J MEDICINE 2021; 22: 100-106

Melioidosis: A Neglected Infection in Bangladesh

Bangladesh is an example of a highly populous, agricultural country where melioidosis may be a significantly under diagnosed cause of infection and death. A recent regression model predicted 16,931 cases annually in Bangladesh with a mortality rate of 56%. However, we only manage to confirm (culture) around 80 cases in last 60 years. A lack of awareness among microbiologists and clinicians and a lack of diagnostic microbiology infrastructure are factors that are likely to lead to the underreporting of melioidosis. Melioidosis transmits through inoculation, inhalation and ingestion. Diabetes mellitus is the most common risk factor (12 times higher chance of getting the infection) predisposing individuals to melioidosis and is present in >50% of all patients. The clinical presentation is widely varied and can be mistaken for other diseases such as tuberculosis or more common forms of pneumonia giving rise to its nickname as the “great mimicker”. Disease manifestations vary from pneumonia or localized abscess to acute septicemias, or may present as a chronic infection. Culture is considered the current gold-standard for diagnosis and culture-confirmation should always be sought in patients where disease is suspected. It is strongly recommended that any non–Pseudomonas aeruginosa, oxidase-positive, Gram-negative bacillus isolated from any clinical specimen from a patient in an endemic area should be suspected to be Burkholderia pseudomallei (BP). In addition, based on antibiogram, any Gramnegative bacilli that are oxidase-positive, typically resistant to aminoglycosides (e.g., gentamicin), colistin, and polymyxin but sensitive to amoxicillin/clavulanic acid should be considered as BP. This bacteria is inherently resistant to penicillin, ampicillin, first generation and second-generation cephalosporins, gentamicin, tobramycin, streptomycin, and polymyxin. For intensive phase (10 to 14 days), ceftazidime or carbapenem is the drug of choice. For eradication phase (3 to 6 months), oral trimethoprim/ sulfamethoxazole is the drug of choice. Surgery (drainage of abscess) has an important role in the management of melioidosis. Preventive measures through protective gears could be useful particularly for the risk groups. J MEDICINE 2021; 22: 139-145

A 32 Year old Female with Recurrent Chest Infections with Dizziness

Atrial Septal Defect (ASD) is associated with repeated chest infections. Repeated chest infections, in turn, can lead to bronchiectasis and vice versa. In this case a 32 year old female presented to us with repeated chest infections. Upon thorough examination and investigation, she was found to have both ASD along with bronchiectasis. It also shows the devastating consequences of having two serious illnesses can have on a patients life, specially in low income groups. J MEDICINE 2021; 22: 155-156

Intracranial Brain Volume (ICV) Measurement in Epileptic Male Patient: A 3D CT Study

Objective: Intracranial volume (ICV) is one of the reliable indicators of neurodegenerative disease and premature brain size. Epilepsy is considered a neurological disorder. We aimed to measure ICV in epileptic male samples to identify the relation of ICV and epilepsy control status for their better treatment purpose. Methods: This retrospective study was done using CT images of age-matched control and epileptic male samples. All samples were collected from the archive of the Department of Radiology, Universiti Sains Malaysia (USM) from the 2010-2017 period. A total of 34 male samples were used for this study in two groups, control (n=17) and epileptic (n=17) groups. Control males were those who came for the CT scan and no disease was found. And epileptic male patients were those who came for routine checkups due to epilepsy. MITK 3M3 software was used for the ICV measurement. 2D CT images were converted to 3D CT images to measure intracranial brain volume (ICV) in each group. Two reviewers measured ICV and a reliability test was done between reviewers. Results: According to first reviewer, there is no significant (p=0.455) difference between control, (1287.82 (151.79) mm) and epileptic (1283.28 (65.48) mm) male groups. Results of second reviewer also showed no significant difference (p=0.400) between control (1299.58(144.81)) mm and epileptic (1283.88 (76.08)) groups. Average measurements also did not reveal any significant difference between groups, control is 1293.7 (144.81) mm and the epilepsy group is 1283.58 (69.90) mm (p=0.114). Reliability test results revealed an acceptable internal consistency level in control (97%, p<0.001) and epileptic (77%, p=0.003) groups. Conclusion: We concluded that epilepsy does not affect ICV in the male population. Further study is recommended to seek other indicators which might be affected by epilepsy in the male population. J MEDICINE 2021; 22: 95-99

Serum Amylase Level in Acute Organophosphorus Compound Poisoning in a Tertiary Level Hospital

Background: Organophosphorus compound (OPC) poisoning is an important clinical problem in the developing world and kills an estimated 3,00,000 people every year. In spite of high case fatality rate early and proper management is crucial to save the lives and alleviate the sufferings. Amylase level is an important biochemical marker, which is closely related to severity of acute OPC poisoning. Therefore, to assess Serum amylase level in acute organophosphorus compound poisoning in a tertiary level hospital was the objective of the study. Methods: This research was a hospital based descriptive cross-sectional study and was conducted at the inpatient department of Medicine in Dhaka Medical College. 50 Patient admitted in medicine department due to OPC poisoning and evidenced by history taking and physical examination were included in the study. Ethical issues were ensured properly. After written informed consent history and physical examination were done. Rest of the data were collected by interviewing each patient or from attendant of the patient by using a semi-structured questionnaire. Scoring of the severity were done by researcher himself by Peradeniya Organophosphorus Poisoning (POP) scale (Score range 0 to 11). Values of amylase level were collected from patient record file. All the Data was analysed by computer with the help of SPSS 16. Results: Out of a total of 50 patients, 24 (48%) were males and 26 (52%) were females. OPC poisoning was most frequent (52%) in age group 21-30 years. Mean age was 23.96 ± 6.071 SD. 96% (48) study population were Muslim and rest 4 % (2) were Hindus with diverse occupation. 86% population came from rural area whereas only 14% population reside in urban area. Among them suicidal attempts were seen significantly which was 96% and rest of them were accidental ingestion. Amylase level estimation were done in each case and 32 % (16) patient had elevated amylase level (>100U/L) and 68% (34) patient had amylase level within normal limit. Mean amylase concentration was 62.2U/L (SD±18.77) and among the 16 patients who had elevated serum amylase level mean concentration was 376.56U/L (SD±266.124). Mean amylase level differed significantly between these two groups (p value < 0.0001) estimated by one way ANOVA. Spearman Correlation and One way ANOVA both showed significant association between severity (assessed by POP scale) and elevated level of serum amylase (p value <0.0001). Outcome analysis showed that 47 patients recovered and 3 patients died. Their mean hospital stay was 3.87 (±1.76) days and relationship between serum amylase level and duration of hospital stay and was found to be significant in chi-square analysis (p value- <0.0001). Conclusion: Hyperamylasaemia in OPC poisoning can be used an important biomarker to assess the severity of the patient which may guide the clinicians for further management. J MEDICINE 2021; 22: 119-126

Systemic Lupus Erythematosus with Takayasu’s Arteritis - A Rare Co-existance

We report the case of a 30-year-old normotensive, nondiabetic lady diagnosed case of Systemic Lupus Erythematosus(SLE); who came with the complaints of limb claudication. After clinical and lab evaluation she was diagnosed as a case of Takayasus Arteritis along with SLE. Though the co- existence of SLE and Takayasu’s Disease is very rare, we should search for the development of arterial occlusive diseases in SLE cases if the patient has got suspicious symptoms. J MEDICINE 2021; 22: 146-149

Routine blood report and common laboratory parameters in COVID-19: Experience from Bangladesh

Background: The present study aimed to describe the association of hematological parameters and common clinico-epidemiological features wit hdisease severity among COVID-19 patients. Methods: This is a hospital based observational study done in Dhaka Medical College Hospital from 01 July 2020 to 15 September 2020. Findings from hematological tests along with patient clinic-pathological features were recorded from a total of 309 COVID-19 patients. All the data were analyzed by SPSS 23.0 software. Results: Among the studied hematological parameters hemoglobin percentage, total WBC count, lymphocyte percentage, platelet count, CRP, serum ferritin, d-dimer, and ESRwere significantly associated with disease severity (p<0.05). Association was found between disease severity and other biochemical markers, such as AST, ALT, LDH, and serum bilirubin. Conclusion: With limited resources these cheap, yet highly indicative biochemical markers could be used to assess, treat, and prognose COVID-19 patients in Bangladesh. J MEDICINE 2021; 22: 132-138

Post COVID-19 condition: our understanding and preparedness

not available J MEDICINE 2021; 22: 86-87

COVID-19 Induced Immunosuppression resulting in Pulmonary Mucormycosis : A Long COVID sequalae

With increasing incidence of Severe Acute Respiratory Distress Virus 2(SARS -CoV -2) in India, there has been growing reports of super infections in post covid 19 period. Long COVID refers to persistence of COVID19 symptoms for weeks to months. While most common manifestation of long COVID is fatigue and ill health, it may lead to development of life-threatening complications like Pulmonary Mucormycosis. We report a case of 54 year young, non-diabetic previously healthy male who had moderate COVID19 treated with low dose steroids and recovered completely, only to present with hemoptysis 3 months later on High Resolution Computed Tomography Scan of the Chest and Rhizopus fungi on bronchoalveolar lavage confirming Post Covid Pulmonary Mucormycosis in non-immunocompromised host. Patient was managed with dual antifungal therapy intravenous Liposomal Amphotericin B and Posaconazole for 3 weeks, followed by oral Posaconazole. J MEDICINE 2021; 22: 150-154

Impact of Training Modules on Physicians’ Perspective of COVID-19: An Online Survey

Background: The outbreak of COVID-19 has remained a massive challenge for healthcare workers specially physicians. Effective professional training has a crucial role in preparing doctors for responding to pandemics. Objective: To assess the effectiveness of existing training modules on enhancing knowledge, ensuring safe practice, and improving behavior on COVID-19 among physicians. Methods: This is a descriptive, cross-sectional, online survey; where a virtual questionnaire was used to collect data through online professional platforms. A pre-tested survey tool was employed to assess the impact of professional training on infection prevention and control. Results: Total 161 physicians participated in this survey from 15 different countries. Most of the respondents (72%) received training from various sources like the workplace (60%) and international agencies (21%), through the in-person or online format. Knowledge assessment revealed advanced (43%) and competent (40%) understanding by the participants. Improving knowledge progression was displayed by the cohort who received professional training (p<0.00). Physicians’ positive behavior and good practices were observed with the training modules. Conclusion: It became evident from this study, that professional training is effective in enhancing knowledge, improving behavior, and ensuring safe practices. Hence, designing such training modules for the physicians is warranted to tackle ongoing and future pandemics. J MEDICINE 2021; 22: 107-113