An Unusual Case of Suicide Attempt Using Intravenous Injection of Kerosene.

Kerosene belongs to the hydrocarbon group of compounds, used as a fuel for lamps, as well as heating and cooking in developing countries. Accidental kerosene poisoning and intoxication usually occur by inhalation or by occupational percutaneous absorption. Adults usually ingest kerosene for the purpose of self-harm, and children may ingest accidentally. Suicidal attempt using intravenous kerosene is an extra ordinary and very rare occurrence. A very few data are available regarding effects of intravenous administration of kerosene and its management.

Comparison of creatinine clearance estimates with routine measured creatinine clearance in hospitalized chronic kidney disease patients.

The aim of this study was to determine the correlation between endogenous creatinine clearance (BSA adjusted), the Modification of Diet in Renal Disease (MDRD) and Cockcroft-Gault (BSA adjusted) equations in a Bangladeshi population with chronic kidney disease. It was an observational study conducted from July 2011 to January 2012 in the department of Medicine of Mymensingh Medical College Hospital, Mymensingh, Bangladesh. A total of 50 cases with diagnosed Chronic kidney disease (CKD) patients participated in this study. Results are expressed as mean and standard deviation (SD). Pearson correlation coefficient (r) was used to compare the results of conventional creatinine clearance on 24 hour urine collection (BSA adjusted) and creatinine clearance calculated by Cockcroft-Gault creatinine clearance (BSA adjusted) and MDRD creatinine clearance (ml/min/1.73m²) equation. Among 50 patients 30(60%) were male and 20(40%) were female. Mean age of the cases was 43±12.96 years with age range from 18 to 65 years. Mean creatinine clearance measured on 24 hours urine collection (BSA adjusted) was 13.86±8.72ml/min per 1.73m². Mean BSA adjusted Cockcroft-Gault creatinine clearance and MDRD creatinine clearance were 27.68±11.26 and 24.46±11.05ml/min per 1.73m² respectively. There was a positive correlation between both the Modification of Diet in Renal Disease (r=0.951, p<0.05) equation and the Cockcroft-Gault (r=0.948, p<0.05) equation with measured creatinine clearance; the former being statistically superior comparing the correlation coefficients. The creatinine based formulas with their inherent property of convenience and cost effectiveness can be a useful tool for monitoring the progression of disease.

Serum magnesium in hospital admitted diabetic patients.

Magnesium depletion has a negative impact on glucose homeostasis and insulin sensitivity in diabetic patients. Low plasma magnesium concentration is a highly specific indicator of poor magnesium status. This case control study was conducted in Mymensingh Medical College Hospital, Bangladesh, from May 2011 to April 2012. This study was done to assess the serum magnesium level in diabetic and non-diabetic patients and to find out the association between serum magnesium, blood glucose and duration of diabetes mellitus. Serum magnesium concentrations were determined in 50 diabetics and 50 age and sex matched non-diabetic patients or attendants for controls. Among the case and control group 32 were male and 18 were female. Mean age of control group was 54.42±2.33 and study group was 55.78±2.43 years. Duration of diabetes of case group in which 50% of patients have diabetes for up to 4 years, 18% of patients have diabetes for 5-9 years, 5% of patients have for 10-14 years and 2% of patients have diabetes for 15 years and above. Serum magnesium concentrations below the normal reference range for study group was 44% and control group was 6%. The mean serum magnesium level of study group was 0.70±0.01mmol/L and that of control group was 0.83±0.02mmol/L. So, the difference in serum magnesium level between two groups were statistically highly significant (p = 0.001). Correlation between FBS and SML of study group, which is negative (r = - 0.182). There is opposite relation among the characteristics as r is negative. And also correlation between 2HAFB and SML of study group, which is negative (r = - 0.06). There is opposite relation among the characteristics as r is negative.

Comparison of salbutamol and ipratropium bromide versus salbutamol alone in the treatment of acute severe asthma.

The use of nebulized Ipratropium bromide, quaternary anticholinergic bronchodilators in combination with beta-agonist for the treatment of acute asthma in adults is controversial. In a view of different recommendation the present study is undertaken in Bangladeshi patients. Combination of inhaled Ipratropium bromide and Salbutamol provides greater bronchodilatation than mono therapy with Salbutamol alone in acute severe asthma. Patients of severe asthma (PEFR <50% of predicted) were enrolled into control group (Salbutamol only) and case (Salbutamol + Ipratropium bromide) group. After measurement of peak expiratory flow, patient received 3 doses of 2.5 mg Salbutamol (n=40) only or 3 doses of both 2.5mg Salbutamol and 500mcg Ipratropium bromide at an interval of 20 minutes (n=40) through a jet nebulizer. Peak flow was reassessed 30 & 60 minutes after treatment. Peak flow at baseline was similar in two groups. Then at 30 minutes after nebulization, the mean±SD percentage increase in peak flow was greater in combination group (60.01±35.01%) than Salbutamol group (44.47±25.03%) with difference of 16% (p=0.025). At 60 minutes the percentage increase in peak flow was about 32% greater in combination group than Salbutamol group (94.44±33.70% vs. 62.57±29.26%, p=0.000) and combination group reached percentage predicted peak flow more than 60% while Sabutamol group did not. Ipratropium Bromide and Salbutamol nebulized combinedly have better bronchodilating effect than Salbultamol alone in acute severe asthma.

Prediction of oesophageal varices in cirrhosis of liver patients by serum ascitic albumin gradient.

This hospital based observational study was carried out to evaluate the relation between serum ascitic albumin gradient and oesophageal varices in cirrhosis of liver disease patient. This was a hospital based observational study on 50 cases of diagnosed cirrhosis of liver disease patients in department of medicine of Mymensingh medical college Hospital, Mymensingh, Bangladesh from 8th January 2012 to 07th July 2012 for a period of 6 months. The study showed age frequency 5(10%) were from 21-30 years, 15(30%) were from 31-40 years 15(30%) were from 40-50years, and 15(30%) were from ≥51 years of age. Out of 50 patients, 38(76%) were male and 12(24%) were female patients. The etiology of liver cirrhosis was hepatitis B virus in 22(44%), hepatitis C virus in 4(8%), alcohol in 1(2%) and others in 23(46%) patients. Twenty four (48%) patients had SAAG value 1.1-1.49, 21(42%) patients had SAAG value 1.5-1.99, 5(10%) patients had Serum Ascitic Albumin Gradient (SAAG) value >2.0 and 16(32%) patients had no oesophageal varices, 11(22%) patients had small straight varices (F1) esophageal varices, 18(36%) patients had less than one-third of the esophageal lumen (F2) oesophageal varices, 5(10%) patients had more than one-third of the esophageal lumen (F3) esophageal varices. The degree of SAAG demonstrate significant statistical association with presence or absence of oesophageal varices (p=0.023) and grades of the oesophageal varices (p=0.001) in patients with cirrhosis of liver disease. So, it was predicted that the presence of oesophageal varices in cirrhosis of liver disease patients with high SAAG without performing endoscopy of upper GIT.

Comparison of salbutamol with normal saline and salbutamol with magnesium sulphate in the treatment of severe acute asthma.

This study compared the efficacy and safety of nebulized magnesium sulphate with salbutamol to normal saline with salbutamol as the initial treatment of severe acute asthma patients. The present study was designed as a randomized open controlled clinical trial. The study was conducted Mymensingh Medical College Hospital over a period of 11 months from December 2009 to October 2010. Patients admitted with severe acute asthma having inclusion criteria were the study population. Among 120 study population 60 were in salbutamol with magnesium sulphate group and 60 were in salbutamol with normal saline group. The study finding showed that peak flow at baseline was similar in two groups. At 10 minutes after nebulization, the mean±SD percentage increase in peak flow was greater in magnesium sulphate group (20±4%) than in the normal saline salbutamol group (13±3%). At 20 minutes the percentage increase in peak flow was greater in magnesium sulphate group (35±7%) than in the normal saline salbutamol group (24±6%) p value <0.001. Magnesium sulphate plus salbutamol group reached PEF near to 60% which is not in saline salbutamol group. There was no significant changed in respiratory rate, pulse rate, systolic, diastolic blood pressure and clinical evidence of unwanted adverse effect.

Assessment of anaemia in patients with rheumatoid arthritis.

The present cross-sectional study was conducted in the Department of Medicine, Mymensingh Medical College Hospital, Mymensingh from December 2009 to November 2010 to find out the association of iron deficiency, in anaemia with rheumatoid arthritis and to find a sensitive and less invasive marker to differentiate iron deficiency anaemia from the anaemia of chronic disease. A total of 45 patients of rheumatoid arthritis were provisionally included in the study. Of them, 12 patients were excluded as they did not allow for aspirating the bone marrow, leaving 33 patients to complete the study. The mean age of the patients was 42.6 years (22-66 years) with female to male ratio being roughly 3:1. Majority (97%) of the patients presented weakness followed by 78.8% dizziness, 54.5% palpitation, 24.2% pallor, 12.1% breathlessness, another 12.1% smooth tongue and 6.1% nail change. About 79% of the patients were positive for RA test and nearly 70% of patient had moderate anaemia. The mean serum ferritin was significantly reduced in patients with hypochromic with or without microcytic anaemia than that with normocytic normochromic anaemia (p<0.001). While total iron binding capacity was found to be significantly increased in patients with iron deficiency anaemia than that in patients with anaemia of chronic disease (p<0.021). The serum iron level was considerably reduced in the former group than that in the later group (p<0.066). Bone marrow iron grading revealed 48.5% of the patients with iron depleted and 51.5% with iron repleted. Serum ferritin level of patients with iron depleted bone marrow was significantly decreased than that in patients with iron repleted bone marrow (p<0.001). Serum iron level of the former group was also reduced than that of the later group (p<0.133). Total iron binding capacity was significantly raised in patients with iron depleted group than that in patients with iron repleted group (p<0.001). The study finds that anaemia of chronic disease and iron deficiency anaemia frequently coexist in patients with rheumatoid arthritis and serum ferritin and total iron binding capacity are considered good indicator for differentiating iron deficiency anaemia from the anaemia of chronic disease. Serum iron levels will not help for differentiating.

Risk factors of non-alcoholic fatty liver disease.

This case control study was carried out in Mymensingh Medical College Hospital, Mymensingh, Bangladesh and Dhaka Medical College Hospital, Dhaka, Bangladesh from November 2010 to October 2011 to find out the risk factors of non-alcoholic fatty liver disease. A total of 90 participants (45 cases and 45 controls) were included. A higher proportion of patients with age >45 years were found in case group compared to control (51.1% vs. 15.6%). The mean age was significantly higher in case group 49.8±12.6 years. Males demonstrated their predominance in both case (62.2%) and control (68.9%) groups, although the two groups did not differ in terms of sex distribution. Body mass index demonstrates that 26.7% of patients in case group were of normal weight, 46.7% overweight and 26.7% obese. In the control group, two-thirds (68.9%) of the patients were of normal weight and 24.4% overweight and 7.8% obese. Diabetes and hypertension were significantly present in the case group than those in control counterparts 75.6% vs. 15.6% and 86.7% vs. 15.6 % respectively. The mean fasting blood glucose, ALT, total cholesterol and triglycerides were significantly higher in case group compared to control group 7.8±1.3 vs. 5.4±2.5mmol/L (p<0.001); 39.1±12.4 vs. 30.3±14.1IU/L, (p=0.002); 239.9±14.3 vs. 183.3±11.4mg/dl, (p<0.001) and 183.6±12.5 vs. 133.5±16.0mg/dl, (p<0.001) respectively. However, no significant difference was observed between the case and the control groups in terms of HDL cholesterol (35.9±1.2 vs. 38.0±1.1mg/dl, p=0.203). Majority of the patients in case group (88.9%) exhibited increased echogenicity of liver on ultrasonogram as opposed to 15.6% in the control group.

Relation of different grades of esophageal varices with Child-Pugh classes in cirrhosis of liver.

This cross-sectional observational study was conducted in the Department of Medicine, Mymensingh Medical College Hospital, Mymensingh, Bangladesh over a period of 6 months from October 2011 to April 2012 and was carried out to evaluate the relation of different grades of esophageal varices with Child-Pugh classes of cirrhosis of liver patients. A total 37 patients were included. Child-Pugh score and esophageal varices of each patient were noted. Relation was carried out using the Chi-square test through determining the association of different variables. P value <0.05 was considered significant. Among 37 patients, 27(73%) were male and 10(27%) were female and their frequency of age were found, 7(18.9%) from 18-38 years, 18(48.7%) from 39-59 years and 12(32.4%) from 60 years of age and above. The etiology of liver cirrhosis revealed 18(48.7%) hepatitis B virus, 3(8.1%) hepatitis C virus and 16(43.2%) others causes. Child-Pugh classes were observed 3(8.2%) Class A, 17(45.9%) Class B and 17(45.9%) Class C and grades of esophageal varies were 13(35.1%) F1, 20(54.1%) F2 and 4(10.8%) F3 patients among total. A statistically significant positive relation was found that higher grade of esophageal varices was seen in the more advanced class of Child-Pugh classes with a p value 0.001.

Diagnostic evaluation of supraclavicular lymphadenopathy.

Patients presented with the supraclavicular lymphadenopathy in the medicine department have a strong suspicion of serious illness like tuberculosis, sarcoidosis, toxoplasmosis and malignancy of lymphnode, blood, lung, upper GIT, breast, ovary, testes, and other sites of body. This prospective type of observational study carried out in the indoor and out patient department of medicine of Mymensingh Medical College Hospital over a period of 6 month from April 2011 to September 2011 to diagnose the causes of supraclavicular lymphadenopathy. Patient of either sex, 18 years or above presented with supraclavicular lymphadenopathy were included. Biopsy or FNAC were done. The study showed that mean age of the patient of supraclavicular lymphadenopathy that finally diagnosed as malignant was 49.7 years and that of non malignant was 33.7 years. Male patient have suffered more (60%) from malignant disease than that of female patient (40%). Discrete, hard, non tender either fixed or non fixed supraclavicular lymphadenopathy was found malignant (18 of 18 cases, 100%) and discrete, firm, tender lymphnode were found non malignant (5 of 5 cases, 100%). Increased frequency (11 of 28, 39.3%) of granulomatous inflammation from the tuberculoid lymphadenitis were found among the patient undergone supraclavicular lymphnode biopsy. FNAC result was also of simillar type and finally it was found that frequency of tuberculosis (20 of 53, 37.7%) was highest and bronchial carcima was the second most frequent diagnosis (14 of 53, 26.4%). This study showed that supraclavicular lymphadenopathy is associated mostly with serious disease like tuberculosis and malignancy.

Pattern of poisoning in a tertiary level hospital.

This cross sectional observational study was carried out in the Department of Medicine, Mymensingh Medical College Hospital over a period of 4 months from January 2012 to April 2012 to assess the clinico-epidemiological condition of different types of poisoning and to evaluate immediate hospital outcome. Suspected case of poisoning aged 12 years or above of either sex was included. Patients of paediatric age group, having other co-morbid condition and died before clinical evaluation were excluded. This study revealed that rural people (76.9%), aging 20-30 years (46.3%) were mostly affected in poisoning. Patients belong to low socioeconomic group (65.3%), illiterate (26.5%) and educated up to primary level (29.9%) were mostly identified. Regarding the occupation this study showed student (30.6%) and farmer (25.2%) were predominantly involved. In this series organophosphorus compound (63.9%) poisoning was in the top of the list followed by benzodiazepine (6.8%). Suicidal attempt (81.6%) was found as a motive of poisoning in maximum cases. Among the precipitating factors quarrel with spouse, girl or boy friend (46.9%) were significant in number. In this study outcome was measured as complete recovery (92.5%) and death (3.4%).

Seasonal variation in types of stroke and its common risk factors.

The present descriptive cross-sectional study was conducted in the Department of Medicine, Mymensingh Medical College Hospital, Mymensingh, Bangladesh over a period of one year during November 2009 to October 2010. The study was conducted to describe the variations in types of stroke (ischemic stroke and hemorrhagic stroke) during summer and winter. An attempt was also made to observe the frequency of common risk factors of stroke by seasons. A total of 292 patients of any age irrespective of sex fulfilling the WHO criteria of acute stroke and confirmed by CT scan were selected from consecutive admission in the Department of Medicine, Mymensingh Medical College Hospital. Detail history and thorough clinical examinations were done. Routine and relevant investigations were carried out. The mean age of the patients was 59.9±14.3 years. A male preponderance was observed in the study. In summer 66% of patients and in winter 34% of patients were presented. Ischemic stroke was present in 54.1% patients and 45.9% patients had haemorrhagic stroke. The study found that the frequency of ischaemic stroke during summer (62.4%) was significantly greater than that during winter (37.8%). The frequency of haemorrhagic stroke during winter (62.2%) was significantly greater than that during summer (37.6%). Hypertension was the most important risk factor and other risk factors were smoking, diabetes mellitus, tobacco chewing, ischemic heart disease, dyslipidemia, oral contraceptive pill, alcohol consumption, atrial fibrillation and past history of stroke. Increasing age was also noted as a risk factor (60.7% >60 years). Most of the risk factors were homogenously distributed between two seasons and between ischemic and haemorrhagic group. Hypertension was significantly higher in haemorrhagic stroke patients compared to ischemic stroke patients.

Comparative study on methotrexate and hydroxychloroquine in the treatment of rheumatoid arthritis.

This study was done to see the efficacy and tolerability of methotrexate and hydroxychloroquine in the Treatment of Rheumatoid Arthritis. It was an open label controlled clinical trial, done in Mymensingh Medical college hospital. Fifty six patients were selected by random sampling method, 28 were included in methotrexate group and another 28 for hydroxychloroquine group using inclusion & exclusion criteria. Primary efficacy variables (DAS28, daily naproxen), secondary efficacy variables, and safety measurement variables studied both clinically & laboratory investigations. The data were analyzed by computer with the help of SPSS. The student's t test was used as test of significant. The mean age of the patients at diagnosis was almost identically distributed between methotrexate and hydroxychloroquine group (41.7±12.2 vs. 42.9±9.2 years, p=0.659). Disease activity at baseline was found to be almost homogeneous to each group except CRP which was observed to be significantly higher in methotrexate group than hydroxychloroquine group (p<0.001). Disease activity at 1 month of treatment reduced in the methotrexate group than those in hydroxychloroquine group (p<0.05 in each case). After 3 and 6 months of treatment, disease activity decreased significantly in both groups (p<0.001 and p<0.05 respectively). The average daily dose of NSAID (Naproxen) decreased significantly (p<0.001). Safety variables at 6 month were within normal physiological ranges and did not differ in groups (p>0.05) indicating that both methotrexate and hydroxychloroquine were effective and safe to use in rheumatoid arthritis. The difference in the incidence of adverse effects, total or individual, was almost nil.

Cardiovascular complications of chronic renal failure - an updated review.

Chronic kidney disease (CKD) is a worldwide public health problem. Cardiovascular disease (CVD) is frequently associated with CKD, which is important because individuals with CKD are more likely to die from CVD than to develop kidney failure. CVD in CKD is treatable and potentially preventable and CKD appears to be a risk factor for CVD. In order of incidence and frequency systemic hypertension, left ventricular failure, congestive cardiac failure, ischemic heart disease, anaemic heart failure, rhythm disturbances, pericarditis with or without effusion, cardiac tamponade, uraemic cardiomyopathy are various cardiovascular complications encountered in patients with chronic renal failure. A patient may present with one or more complications of cardiovascular system. The survival rate and prognosis to a great extent depends on proper management of these complications. Use of regular dialysis and renal transplant has changed the death pattern in developed countries but it is still a major problem in developing country. The aim of this article is early detection of CKD and proper management of it thereby preventing the major cardiovascular complications.

Fasting glycaemic and lipidaemic status in acute coronary syndrome patients within 24 hours of onset of chest pain.

This is a descriptive type of cross sectional study done in Mymensingh Medical College Hospital during the period of June 2008 to November 2009 to estimate and analyze the fasting blood glucose (FBG) and fasting lipid profile of acute coronary syndrome (ACS) patients within 24 hours of onset of chest pain. Total 50 patients of either sex diagnosed as acute coronary syndrome whose fasting blood sample would have been collected within 24 hours of chest pain were included. Among 50 patients 42(84%) were male and 8(16%) were female. Age range was 30-80 years with a mean ± SD of 50.74 ± 12.05 years. Among 50 ACS patients, 9 patients (18%) suffered from unstable angina (US), 2(4%) from non-ST segment elevation myocardial infarction (NSTEMI) and 39(78%) suffered from ST segment elevation myocardial infarction (STEMI). Study results revealed 41(82%) patients had euglycemia (70-110 mg/dl), 2(4%) patients had impaired fasting glucose (IFG) (110-125 mg/dl), and 7(14%) patients had hyperglycemia (>126 mg/dl). Dyslipidemia found in 38(76%) patients. Among them total cholesterol (TC) >200mg/dl in 14(28%), decreased level of HDL-C (< 40 mg/dl in male and <50mg/dl in female) in 22(44%), increased level LDL-C ≥ 130 mg/dl in 13(26%), and TG >150 mg/dl was found in 16(32%) patients.

A Study on Clinical Presentation and Histological Diagnosis of Lymphadenopathy Patients Admitted In Department of Medicine in A Tertiary Hospital.

Lymphadenopathy is a common problem encountered in day to day clinical practices in Bangladesh. It is an abnormal increase in size and/or altered consistency of lymph nodes. The condition generally is not a disease itself but a symptom of one of many possible underlying problems. So it is very much essential to achieve a correct diagnosis of patients presenting with lymphadenopathy. This cross sectional study carried out at the Department of Medicine, Mymensingh Medical College Hospital (MMCH), Mymensingh over a period of 6 months from January 2014 to June 2014. This study was carried out to evaluate the clinical presentations and to see the ultimate diagnosis by appropriate investigations of lymphadenopathy patients. It is a male predominance study. Metastatic carcinoma (Met. Ca) belonged to relatively higher age group, tuberculosis (TB) and acute leukaemias belonged to younger age group and lymphoma belonged to middle age group. Among 50 cases metastatic carcinoma comprises total 14(28%), lymphoma 13(26%), tuberculosis (TB) 12(24%), acute leukaemia 7(14%), non-specific (Non Sp.) 4(8%) cases. Among lymphoma non Hodgkin's lymphoma (NHL) was 10 (20%) then Hodgkin's disease (HD) was 3(6%) and among acute leukaemia acute lymphoblastic leukaemia (ALL) was 5(10%) and acute myeloblastic leukaemia (AML) was 2(4%) cases. Most of the patients belong to younger age groups, 32% cases were from 18-30 years. Most of the patients had generalized lymphadenopathy. Biopsy of lymph node was done in 60% cases. Fine needle aspiration cytology (FNAC) was done in 24% cases. Bone marrow study (BMD) was done in 14% cases include all cases of leukemia. Among 50 patients correct clinical diagnosis were found 100% cases of ALL and non-specific infection, 80% cases of metastatic carcinoma, 66.66% cases of AML and NHL, 62.5% cases of TB, 50% cases of HD. AML and ALL were diagnosed by bone marrow study. Over all 70% of clinical diagnosis were found correct in this study. In conclusion malignancy, lymphoma and tuberculosis were the most common cause of lymphadenopathy patients. Most of the cases were diagnosed by taking appropriate history and examination but FNAC, biopsy and bone marrow study were need for final diagnosis.

Management of adult Still's disease-an update.

Adult Still's disease (ASD) is not uncommon disease. It is recognized as multi-systemic inflammatory disease of unknown aetiology. There is no significant racial and geographical distribution of the disease. In most of the cases-onset of disease course occur before the age of 35. Its main feature is the combination of symptoms, such as fever higher than 39°C, cutaneous rash during fever peak, polyarthritis, lymphadenopathy, raised white blood cell count, abnormalities of liver metabolism, raised serum ferritin etc. None of these signs is significant to establish the diagnosis. Some diagnostic criteria have been developed for diagnosis of ASD. Among them Yamaguchi criteria is superior to others in respect of its sensitivity and specificity. Some bacterial and viral infections, other rheumatic diseases, malignancy and drug hypersensitivity can also mimic ASD. The aim of treatment of ASD is to limit the intensity of the symptoms and to control disease evolution. Various types of drugs including biological agents are now promising to treat ASD.

Guillian-Barre syndrome.

Guillian-Barre syndrome (GBS) is the most common cause of acute flaccid paralysis. All age groups can be affected, more common in elderly. Campylobacter jejuni, a major cause of bacterial gastroenteritis worldwide has become recognized as a most frequent antecedent pathogen for GBS. A prospective case-controlled study showed, positive C. Jejuni serology was found in an unprecedented high frequency of 57% as compared to 8% in family controls and 3% in control patients with other neurological diseases. In GBS there is molecular mimicry between epitops found in the cell walls of some micro-organisms and gangliosides in schwann cell membrane. Diagnosis is mainly clinical. The mainstay of treatment of GBS is supportive care and prevention of complications. Respiratory failure and autonomic dysfunction are the common causes of death from GBS. Plasma exchange and intravenous immunoglobulin therapy shorten the duration of ventilation and improve prognosis. Overall, prognosis of GBS is good. Eighty percent of patients recover completely within 3-6 months, 4% die, and the remainder suffers residual neurological disability. GBS may be prevented by development of a vaccine against C. Jejuni. Early and specific diagnosis is important to ensure a favourable outcome.

Prevalence of Diabetic Nephropathy in Patients Attending the Endocrine Department of Mymensingh Medical College Hospital.

Diabetic nephropathy (DN) is the leading cause of end-stage renal disease worldwide. Due to severe morbidity and mortality of DN and limited effective therapies, research has mainly focused on prevention of this debilitating illness by modification of risk factors. Aims of this study were to find out the prevalence of diabetic nephropathy, its factors and to correlate the functional status of the kidney. This cross-sectional study was conducted in the Department of Endocrinology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from 1st January 2013 to 30th June 2013. A total 105 patients having clinical diagnosis of Diabetes mellitus were enrolled in this study. Data were collected by interview of the patients, clinical examination and laboratory investigation. Data was analyzed using the Chi-square test for Categorical variables and unpaired Student's 't' test for differences in means for continuous variables. P value <0.05 was considered significant. With DN (30.5%) patients 21.1% had micro-albuminuria and 9.5% had macro-albuminuria. The mean age for the DN patient was 47.9±14.7 years and male female ratio was 1:1. BMI was found significantly low in patients with DN (p<0.05). Prolonged duration of diabetes (>5 years) and uncontrolled diabetes were found as significant risk factors associated with DN. Other risk factors were hypertension, family history of hypertension, family history of diabetes mellitus and irregular treatment of diabetes mellitus. Mean serum creatinine, mean estimated glomerular filtration rate (GFR) and mean blood sugar level was 1.3±0.6mg/dl, 69.4±26.7ml and 15.6±7.1mmol/L respectively in DN patients. Relation was significant for higher serum creatinine and lower eGFR values (p<0.05). Prevalence of diabetic nephropathy was 30.5%. Long standing diabetes (>5 years) and uncontrolled diabetes were the important risk factors for the development of diabetic nephropathy. Diabetic nephropathy is associated with higher serum creatinine and lower eGFR values.

Platelet Count as a Severity of Chronic Obstructive Pulmonary Disease.

Chronic Obstructive Pulmonary disease (COPD) is a heterogenous respiratory disease characterized by a progressive, not fully reversible airflow limitation associated with an abnormal inflammatory response of the lung to noxious stimuli. It is a disease presenting with pulmonary inflammation as well as a systemic one. Measurement of inflammatory marker is difficult but platelet count estimation is easy and less costly. This descriptive, cross-sectional study was carried out at Department of Medicine, Mymensingh Medical college Hospital, Mymensingh, Bangladesh for a period of twelve months among fifty-nine COPD patients. Data were collected through interview, physical examination and laboratory investigations. Statistical analysis was performed using SPSS version 22.0 for consistency and completeness. Age range of the patients was 40 to 49 years with a mean of 56.3±10.9 years. Age group 40-49 years contained the highest number (19; 32.3%) of patients. Majority 57(96.6%) of the respondents were male. Thirty seven (62.7%) of patients were illiterate. Majority 56(94.9%) of patients resided in rural area, of them most 38(64.4%) were farmers. According to Spirometric measurement among 59 respondents of COPD patient, 3(5.1%) were in GOLD stage-I, 9(15.3%) in GOLD stage-II, 27(45.8%) in GOLD stage-III and 20(33.9%) in GOLD stage IV group. Mean platelet count (10³/µl), 241.6±86.5 was found in mild, whereas 315.0±47.7 in moderate, 337.2±76.3 in severe, and 412.4±67.5 in very severe group of COPD patients. So increase in platelet count is statistically significant in severity of COPD. In conclusion, platelet count measurement is less costly to categorize COPD and may be a diagnostic marker.