Cryptococcal Meningoencephalitis in an Immunosuppressed Patient with Chronic Lymphocytic Leukemia

Cryptococcal meningoencephalitis, an invasive fungal infection caused by an encapsulated fungus Cryptococcus neoformans should be suspected in immune compromised individuals with defective cell-mediated immunity and patients on immunosuppressive drugs with recent development of fever, confusion and loss of consciousness. A rapid diagnosis is fundamental for decreasing morbidity and mortality from cryptococcal disease. Cerebrospinal fluid (CSF) study and simple stain like India Ink Stain can be performed for diagnosis of cryptococcal meningoencephalitis. Here, we report a case of cryptococcal meningoencephalitis in chronic lymphocytic leukemia (CLL) patient on immunosuppressive drugs diagnosed by CSF study and India ink stain which responded dramatically with antifungal agents after diagnosis. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 87-89

Early Pregnancy Failure: Medical versus Surgical Management

Introduction: Misoprostol is increasingly used to treat women who have a failed pregnancy may be due to blighted ovum (anembryonic gestation), incomplete abortion, missed abortion, inevitable abortion in the first trimester. Medical treatment with Misoprostol is an alternative to conventional surgical treatment. Use of Misoprostol is simple, highly acceptable, noninvasive and preferred by women. In addition to surgical risk and patient's preference, medical evacuation reduces the need for hospital stay and the overall management cost. Objective: To determine the efficacy and safety of Misoprostol for evacuation of uterus in early pregnancy loss and to compare the result with surgical evacuation. Materials and Methods: It was a prospective randomized study conducted on 50 patients at the department of Obstetrics and Gynaecology, Border Guard Hospital, Dhaka during the period from February 2018 to July 2019. Here 25 patients received Misoprostol as medical treatment and 25 patients received surgical treatment. Results: Of the 25 women assigned to receive Misoprostol, 19(76%) had complete expulsion by 24 hours and 22(88%) by 7 days. Complete evacuation after 1st dose was 68% and after 2nd dose 88%. Misoprostol treatment failed in 3(12%) cases and required surgical evacuation. Among the respondents 80% women stated that they would use Misoprostol again if the need arises. Conclusion: Medical treatment with Misoprostol is a cheaper alternative to surgery. Given its success rate near about 88% with mild side effects controllable with additional medication and above all patient’s satisfaction, it should be prioritized over the evacuation curettage in patients who meet the treatment criteria. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 63-67

Profile of Herpes Zoster Patients with Co-morbidities: Cross-sectional Observation at a Tertiary Level Hospital in Dhaka

Introduction: Herpes zoster (HZ) is characterized by an extremely painful vesicular rash, which may be complicated by secondary infection and post-herpetic neuralgia. To date, multiple risk factors associated with HZ have been established, including endocrine diseases, immunosuppressive conditions, cancers, and other chronic medical conditions. Objectives: To assess the profile of herpes zoster associated with co-morbid condition. Methods and Materials: This cross sectional study was conducted among purposively selected 130 HZ patients in the department of Dermatology and Venereology, Combined Military Hospital (CMH) Dhaka from January 2017 to December 2018. Data were collected through face to face interview using pretested semi-structured questionnaire. Results: Out of 130 patients, majority of the patients were male (69.2%) and mean age was 53.5±9.8 years and majority gave the history of chicken pox 60% and common site of involvement were chest (right and left) 33.1% and 48.5%, upper back (right and left) 30.8% and 43.1% and upper right arm 33.1%. About 66.9% patients gave the history of having co-morbid condition like Diabetes 30.8%, Stroke 9.2%, Hypertension 2.3%, Myocardial infarction 3.8%, Peptic ulcer disease 10.0%, Malignancy 2.3%, Tuberculosis 2.3% and Irritable bowel syndrome 2.3%. Conclusion: Based on our study finding, we can conclude that herpes zoster is a disease that is associated with other co-morbid conditions. If herpes zoster is an early manifestation of undiagnosed co-morbid condition, patients should undergo testing for undiagnosed disease when they present with herpes zoster. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 40-43

Study on Guillain-Barré Syndrome in A Tertiary Level Military Hospital

Introduction: Guillain-Barre Syndrome (GBS) is an acute, frequently severe and fulminant polyradiculopathy that is autoimmune in nature and that causes acute neuromascular failure. The condition is quite common in Bangladesh. GBS is an autoimmune and post-infectious immune disease. Objectives: To see the different presentation and outcome of GBS in combined military hospital (CMH) Dhaka. Materials and Methods: This was a retrospective observational study conducted on all the GBS patients admitted in the Neurology Ward of CMH Dhaka from January 2005 to July 2010. Total 25 patients clinical and laboratory data including CSF analysis, electrophysiological study data were collected from patients’ case sheet. Results: Among the 25 GBS patients male was 22 (88%) and female 03(12%) and most common age group affected was 31-40 years comprising of 09(36%) patients. The most common types of GBS patients were acute inflammatory demyelinating polyneuropathy (AIDP) 17(68%) patients and 10(40%) patients were found to have history of upper respiratory tract infection (URTI). Albuminocytological dissociation was found in 20(80%) patients in CSF study. Intravenous immunoglobulin therapy was given to 13(52%) patients, of them 09(36%) patient needed mechanical ventilation; rest 12(48%) patients were treated conservatively. The final outcome was full recovery 22(88%) patients, 02(8%) patients had residual disability and only one patient died after 2 years of GBS. Conclusion: GBS is an important cause of peripheral neuropathy. Patient should be monitored carefully because a significant number of patients ultimately require mechanical ventilation for respiratory failure which may be of sudden onset. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 44-46

Prevalence of Non-Communicable Diseases among Retired Military Personnel

Introduction: Non-communicable diseases (NCDs) have become burning issues worldwide, especially among the elderly individuals. Bangladeshi elderly is also susceptible cohort to NCDs for its recent epidemiologic transition and the NCDs is casting as prominent risk for major mortality and morbidity related issues. Objectives: To find out the prevalence of common NCDs and its risk factors among the Bangladeshi retired military personnel. Methods: This cross-sectional study was conducted among the retired military personnel admitted in Combined Military Hospital (CMH), Savar from January 2019 to July 2019. A face-to-face interview was carried out among the respondents using a semi-structured questionnaire. Results: Among 153 retired military personnel; most common NCDs were hypertension (80.4%), diabetes mellitus 66.7%, ischemic heart disease37.3% and only 3.9 % had low back pain. Most of them accessed their health in CMH (66.7%), where 17.6% reported to Govt. hospital and only a minor portion (15.7%) to private hospital. Moreover, 70.6% of them were not willing to regular health check-up. Conclusions: The most common NCDs were hypertension, diabetes mellitus and ischemic heart disease. This study concluded with a few intervention strategies and community-based health promotion programs to reduce the burden of NCDs among the retired military personnel. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 35-39

Socio-demographic and Clinical Profile of Covid-19 in Children

Introduction: The corona virus disease 2019 (COVID-19) is a pandemic disease. Infection by COVID-19 in children is not so common but gradually the numbers of children affected with COVID-19 are increasing day by day. The epidemiological importance and clinical pattern in children with COVID-19 is now a challenge to be described by the clinicians. Objectives: To describe socio-demographic and clinical characteristics of COVID-19 infected children. Material and Methods: This cross sectional observational study was conducted among 58 COVID-19 children who were admitted in COVID-19 dedicated Kurmitola General Hospital (KGH), Dhaka from March 2020 to July 2020. Their signs, symptoms, sex, age distribution, laboratory results and familial contact were analyzed. Results: Among 58 most of the children (63.8%) were in school going age (5-15years). The number of female (39) was more than male (19) and female-male ratio was 1:0.48. Most of the children (75.9%) came from urban lower middle socioeconomic group. About 84.4% children were affected from family member. Among all, (8.6%) patients had no symptoms. Main symptoms of the children were cough (36.2%), only fever (22.4%), fever with cough (8.62%) and diarrhoea (5.2%). About 12.06% of the children had additional symptoms including sore throat, nasal congestion, fatigue, headache, body ache, vomiting, abdominal pain, convulsion and rash, 6.9% had respiratory distress and one child came with convulsion. About 12.1% patients showed lymphopenia, 18.9% showed leucopenia, 13.8% patient had neutrophillia. C-Reactive Protein (CRP) and serum ferritin were high in only 12.1% and 8.6% cases respectively. There were 29.3% patients who had normal Chest X-Ray and 58.6% had mild lesion, 8.6% had bilateral consolidation and 3.4% had patchy opacities. Conclusions: COVID-19 is not so common in children and usually presents with mild form or no sign symptoms clinically and by laboratory analysis. But it is noteworthy that they may play role in transmission of disease. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 72-75

Postpartum Health Care Seeking Behaviour among the Rural Women in Bangladesh

Introduction: Pregnancy and childbirth is an important event in the life cycle of women and their health during this period is very much vital for the mother and children. Maternal mortality ratio (MMR) of a country is an important indicator of the overall health status of mother. Objectives: To assess the health care seeking behaviour of postnatal women in rural Bangladesh. Materials and Methods: This cross sectional study was conducted at Chaturia in Dhamrai upazilla of Dhaka district from January 2019 to March 2019 among purposively selected 196 rural women of reproductive age who had at least one living child. Data were collected by face-to-face interview using pretested questionnaire. Results: Among 196 respondents average monthly family income was 12561 Taka with SD of 10462 taka. Majority of them were housewives and about two-third (64.8%) were educated above secondary level. 70.9% respondents had their delivery of last child in a government health care center and 37.8% deliveries were conducted by nurses which was followed by government doctors (36.2%). Majority (62.2%) had their health checkup within 42 days, 59.2% of them had checkup for three or more times and the checkup were done by government doctors (60.2%). 47.1% of the respondents experienced high grade fever as postpartum complication. Statistically significant association (p<0.05) were revealed between age group of the respondents with health personnel conducted deliveries and also between educational level of the respondents with place of delivery of last child. Conclusion: Awareness, motivation and infrastructural development play a vital role in utilizing the government healthcare services by the postnatal women in rural Bangladesh. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 80-83

Congenital and Structural Heart Disease: Fixing up of Holes, Wrong Routes and Tracts

not available JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 1-3

Knowledge and Attitude of Medical Students towards the Corona Virus-19 Pandemic Situation

Background: COVID-19 has created a worldwide health emergency status and super spreading in the community of Bangladeshi population causing morbidity and mortality. Objectives: To find out the knowledge and attitude of medical students towards the Covid-19 pandemic during the lockdown situation. Methodology: This online cross sectional study was conducted from 1st to 31st May 2020 during the lockdown period in Bangladesh. Sample collection proforma was uploaded on the Google forms and links were shared on different social platforms. Data was analyzed by SPSS IBM version 22.00. Results: A total of 269 responses were obtained. The majority of the participants 167 (62.1%) were female and 102 (44.6%) belonged to an age group of 20-24 years. Most of the 91(33.8%) participants were 4th years students followed by 87(32.3%) from 3rd year. Majority of participants 230(85.5%) believe COVID-19 affect all age group, 187(69.5%) thinks that it affect the elder people seriously, 115(42.8%) thinks specific treatment may be available for COVID-19, 184(68.4%) says COVID-19 infection is preventable, 242(90%) opted for government lockdown and 225(83.6%) believed physical distancing is needed to prevent spread of this disease. Most of the participants 232(86.3%) complained about absence of diagnostic facilities in their neighboring area, 231(85.9%) thought common sign symptoms included dry cough, fever, fatigue and difficulty in breathing, most 234(87%) of the respondents thinks early supportive and symptomatic treatment can be helpful in cure of COVID-19 infection, 230(85.5%) gave positive opinion about isolation from the people who are infected with the COVID-19 virus is an effective way to reduce the spread of the virus . Regarding 14 days quarantine period 222(82.5%) give positive answer, 169(62.8%) thought COVID-19 would affect world economy badly, 172(63.9%0 thought common people are facing problem to collect daily needs, 184(68.4%) gave positive response that COVID-19 pandemic affects mental health of population, 93(34.6%) thought the situation may be controlled soon, majority 97(36.1%) answered they may be satisfied by current practices and initiatives taken by the government, almost all participants 265(97.4%) appreciated the efforts of healthcare providers for their society, 262(97.4%) of the participants thought there is need of more general awareness about COVID-19 pandemic and 260(96.7%) recommended procedure for repeated washing hands. Conclusion: An increasing awareness is needed amongst the local population regarding COVID-19 is required. It will lend hands in preventing spread of COVID-19 with minimal secondary transmission. More elaborate survey studies are required in future that can provide supportive data in developing and implementing public health policies regarding COVID-19 pandemic in our country. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 22-26

Awareness on Heart Diseases among Bangladesh Army Personnel

Introduction: Heart diseases are global public health problem. In 2015, 14.31% of total death in Bangladesh was due to coronary heart disease. Moreover in 2016, 2(two) recruits and 1(one) officer of Bangladesh army encountered sudden death due to cardiac arrest. Objective: To ascertain the level of knowledge, awareness and health practice regarding the threat of cardiovascular diseases among Bangladesh Army personnel. Materials and Methods: This cross-sectional observational study was conducted among 242 members of Bangladesh Army in different training centers and school under Army training and doctrine command (ARTDOC), units of 19 infantry division, Battle group of ARTDOC and Head quarter (HQ) ARTDOC, from February to July 2017. Results: Among the respondents, 56.2%, 45% and 44.6% respectively mentioned tobacco smoking, obesity and sedentary life style are the causes of heart disease and 62%, 42%, 31%, 10% and 2% mentioned that chest pain, shortness of breathing, sweating, radiating pain in jaw and extremity and snoring-sleep apnea are the symptoms and signs of heart disease. Conclusion: From the study it was revealed that, majority of the respondents had poor level of knowledge on awareness of heart disease. Adequate effort may be taken to increase the awareness by expert professionals and social media. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 47-50