Objective:To document the clinical,biochemical and imaging phenotypes of immunocompetent patients with adrenal histoplasmosis.Methods:The clinical,biochemical and radiologic data of 18 immunocompetent patients[age:45....Objective:To document the clinical,biochemical and imaging phenotypes of immunocompetent patients with adrenal histoplasmosis.Methods:The clinical,biochemical and radiologic data of 18 immunocompetent patients[age:45.00(39.25,56.25)years,median(IQR),m/f(16/2)]with adrenal histoplasmosis presenting in the Department of Endocrinology,BSMMU between 2014 and 2020 were retrospectively analyzed.Results:All patients were seronegative for HIV infection,and 27.8%(5/18)had well controlled diabetes mellitus.The median duration of the symptoms was 6.00(IQR:4.00,11.25)months.All had significant weight loss,anorexia and weakness.Fever was present in 61.1%(11/18)patients and night sweat was present in 27.8%(5/18)cases.Hypotension and hyperpigmentation were present in 55.6%(10/18)and 66.7%(12/18)cases,respectively.Three of 18 patients presented with adrenal crisis.Hyponatremia occurred in 55.6%(10/18)cases,but none had hyperkalemia.Thirteen of 18 patients had adrenal insufficiency whereas 83.3%(15/18)had high adrenocorticotropic hormone.CT scan revealed bilateral adrenal enlargement in all cases with oval shape and regular margin.All were hypodense having radiodensity 21-90 hounsfield unit,and 11.1%(2/18)were heterogeneous in contrast enhancement.None had noticeable calcification whereas 1.1%(2/18)cases had central necrosis with peripheral rim enhancement.Hepatomegaly was present in 6 cases,splenomegaly in 3 cases and 5 patients had abdominal lymphadenopathy.Histoplasmosis were confirmed by positive fine needle aspiration cytology of adrenal tissue.Conclusions:Adrenal histoplasmosis should be considered in the list of differentials of bilateral adrenomegaly in immunocompetent individuals even living in non-endemic areas.展开更多
BACKGROUND:Bangladesh is situated in the intermediate prevalence region of hepatitis B virus (HBV).The lifetime risk of acquiring HBV infection in Bangladesh is greater than 40%.It has been estimated that this virus i...BACKGROUND:Bangladesh is situated in the intermediate prevalence region of hepatitis B virus (HBV).The lifetime risk of acquiring HBV infection in Bangladesh is greater than 40%.It has been estimated that this virus is responsible for 10%-35%cases of acute viral hepatitis,35.7%cases of fulminant hepatic failure, 33.3%-40.5%cases of chronic hepatitis and 46.8%cases of hepatocellular carcinoma in Bangladesh.The aim of this study is to compare the correlation between HBV DNA load and grade and stage of liver disease in patients with chronic hepatitis B(CHB). METHODS:Percutaneous liver biopsies done in 159 CHB patients revealed 62.9%(100 patients)had wild type HBV infection and the rest 37.1%(59)had pre-core/core promoter mutant HBV infection.HBV DNA load was measured using PCR in all patients. RESULTS:In the wild type CHB group,97%(97 patients) had moderate to high HBV DNA load and 3%(3)had low to moderate HBV DNA.In the pre-core/core promoter mutant group,74.6%(44 patients)had moderate to high HBV DNA and the rest 25.4%(15)had low to moderate HBV DNA.The patients with moderate to high HBV DNA of the patients with wild type CHB,78.4%(76 patients) had minimal to mild chronic hepatitis(HAI-NI 0-8)and 21.6%(21)had moderate to severe chronic hepatitis(HAI- NI 9-18).66.6%(2 patients)and 33.3%(1)patients with low to moderate HBV DNA load had minimal to mild and moderate to severe chronic hepatitis respectively.In the moderate to high HBV DNA group,77.3%(75 patients) patients had minimal to moderate fibrosis(HAI-F 0-2)and 22.7%(22)(HAI-F 3-4)had severe fibrosis to cirrhosis.These figures were 33.3%(1 patient)and 66.6% (2)respectively in the patients with low to moderate HBV DNA load.On the other hand in case of patients with pre-core/core promoter mutant type CHB,in the moderate to high HBV DNA group,79.5%(35 patients)had minimal to mild chronic hepatitis(HAI-NI 0-8)and 20.5%(9)had moderate to severe chronic hepatitis(HAI-NI 9-18).93.3% (14)and 6.7%(1)patients with low to moderate HBV DNA load had minimal to mild and moderate to severe chronic hepatitis respectively.In the moderate to high HBV DNA group,68.2%(30 patients)had minimal to moderate fibrosis(HAI-F 0-2)and 31.8%(14)(HAI-F 3-4)had severe fibrosis to cirrhosis.These figures were 86.7%(13)and 13.3%(2)respectively in patients with low to moderate HBV DNA load. CONCLUSIONS:The study shows that high HBV DNA load does not correlate with necro-inflammatory activity or extent of fibrosis in the liver in patients with either wild type or pre-core mutant type CHB.展开更多
Intramedullary upperdorsal epidermoid tumor is very rare. As far as we know, a small number of epidermoid tumors in the spinal cord have been reported in the journal for a long time. Most of the time, the spinal cord ...Intramedullary upperdorsal epidermoid tumor is very rare. As far as we know, a small number of epidermoid tumors in the spinal cord have been reported in the journal for a long time. Most of the time, the spinal cord epidermoids are intradural extramedullary. We are reporting a case of a 21-year-old young man with paraplegia and upper dorsal pain for 6 months with normal physical findings. Magnetic resonance imaging scan shows that spinal intramedullary space occupying lesions in the dorsal 2/3 (D2/3) level. Total clearance was accomplished by performing laminectomy. Day to day paraplegia was improved. Histopathology was confirmed as an epidermoid tumor from two different centers.展开更多
文摘Objective:To document the clinical,biochemical and imaging phenotypes of immunocompetent patients with adrenal histoplasmosis.Methods:The clinical,biochemical and radiologic data of 18 immunocompetent patients[age:45.00(39.25,56.25)years,median(IQR),m/f(16/2)]with adrenal histoplasmosis presenting in the Department of Endocrinology,BSMMU between 2014 and 2020 were retrospectively analyzed.Results:All patients were seronegative for HIV infection,and 27.8%(5/18)had well controlled diabetes mellitus.The median duration of the symptoms was 6.00(IQR:4.00,11.25)months.All had significant weight loss,anorexia and weakness.Fever was present in 61.1%(11/18)patients and night sweat was present in 27.8%(5/18)cases.Hypotension and hyperpigmentation were present in 55.6%(10/18)and 66.7%(12/18)cases,respectively.Three of 18 patients presented with adrenal crisis.Hyponatremia occurred in 55.6%(10/18)cases,but none had hyperkalemia.Thirteen of 18 patients had adrenal insufficiency whereas 83.3%(15/18)had high adrenocorticotropic hormone.CT scan revealed bilateral adrenal enlargement in all cases with oval shape and regular margin.All were hypodense having radiodensity 21-90 hounsfield unit,and 11.1%(2/18)were heterogeneous in contrast enhancement.None had noticeable calcification whereas 1.1%(2/18)cases had central necrosis with peripheral rim enhancement.Hepatomegaly was present in 6 cases,splenomegaly in 3 cases and 5 patients had abdominal lymphadenopathy.Histoplasmosis were confirmed by positive fine needle aspiration cytology of adrenal tissue.Conclusions:Adrenal histoplasmosis should be considered in the list of differentials of bilateral adrenomegaly in immunocompetent individuals even living in non-endemic areas.
文摘BACKGROUND:Bangladesh is situated in the intermediate prevalence region of hepatitis B virus (HBV).The lifetime risk of acquiring HBV infection in Bangladesh is greater than 40%.It has been estimated that this virus is responsible for 10%-35%cases of acute viral hepatitis,35.7%cases of fulminant hepatic failure, 33.3%-40.5%cases of chronic hepatitis and 46.8%cases of hepatocellular carcinoma in Bangladesh.The aim of this study is to compare the correlation between HBV DNA load and grade and stage of liver disease in patients with chronic hepatitis B(CHB). METHODS:Percutaneous liver biopsies done in 159 CHB patients revealed 62.9%(100 patients)had wild type HBV infection and the rest 37.1%(59)had pre-core/core promoter mutant HBV infection.HBV DNA load was measured using PCR in all patients. RESULTS:In the wild type CHB group,97%(97 patients) had moderate to high HBV DNA load and 3%(3)had low to moderate HBV DNA.In the pre-core/core promoter mutant group,74.6%(44 patients)had moderate to high HBV DNA and the rest 25.4%(15)had low to moderate HBV DNA.The patients with moderate to high HBV DNA of the patients with wild type CHB,78.4%(76 patients) had minimal to mild chronic hepatitis(HAI-NI 0-8)and 21.6%(21)had moderate to severe chronic hepatitis(HAI- NI 9-18).66.6%(2 patients)and 33.3%(1)patients with low to moderate HBV DNA load had minimal to mild and moderate to severe chronic hepatitis respectively.In the moderate to high HBV DNA group,77.3%(75 patients) patients had minimal to moderate fibrosis(HAI-F 0-2)and 22.7%(22)(HAI-F 3-4)had severe fibrosis to cirrhosis.These figures were 33.3%(1 patient)and 66.6% (2)respectively in the patients with low to moderate HBV DNA load.On the other hand in case of patients with pre-core/core promoter mutant type CHB,in the moderate to high HBV DNA group,79.5%(35 patients)had minimal to mild chronic hepatitis(HAI-NI 0-8)and 20.5%(9)had moderate to severe chronic hepatitis(HAI-NI 9-18).93.3% (14)and 6.7%(1)patients with low to moderate HBV DNA load had minimal to mild and moderate to severe chronic hepatitis respectively.In the moderate to high HBV DNA group,68.2%(30 patients)had minimal to moderate fibrosis(HAI-F 0-2)and 31.8%(14)(HAI-F 3-4)had severe fibrosis to cirrhosis.These figures were 86.7%(13)and 13.3%(2)respectively in patients with low to moderate HBV DNA load. CONCLUSIONS:The study shows that high HBV DNA load does not correlate with necro-inflammatory activity or extent of fibrosis in the liver in patients with either wild type or pre-core mutant type CHB.
文摘Intramedullary upperdorsal epidermoid tumor is very rare. As far as we know, a small number of epidermoid tumors in the spinal cord have been reported in the journal for a long time. Most of the time, the spinal cord epidermoids are intradural extramedullary. We are reporting a case of a 21-year-old young man with paraplegia and upper dorsal pain for 6 months with normal physical findings. Magnetic resonance imaging scan shows that spinal intramedullary space occupying lesions in the dorsal 2/3 (D2/3) level. Total clearance was accomplished by performing laminectomy. Day to day paraplegia was improved. Histopathology was confirmed as an epidermoid tumor from two different centers.
