Chameleons of Multiple Sclerosis: A Case Series

Multiple Sclerosis (MS) presents diagnostic conundrums due to its resemblance to various neurological conditions in young patients. In this case series, we described three cases highlighting the diagnostic challenges in differentiating neurological conditions that mimic MS in young patients. A 23-year-old female presented with blurred vision and bilateral lower limb weakness, initially suggestive of MS, but was later diagnosed with metastatic disease. Another young female with quadriplegia, initially misidentified as having transverse myelitis or ADEM vs. MS, was later found to have extensive medullary and spinal cord ischemia. A young male, initially diagnosed with MS, was later identified as having CNS vasculitis. These cases underscore the diverse spectrum of conditions that can mimic MS, emphasizing the need for comprehensive patient history, meticulous clinical examination, and relevant laboratory investigations to avoid misdiagnosis. Seemingly straightforward clinical scenarios can be deceptively challenging. Collaboration among experienced faculty members is crucial in reaching accurate diagnoses and providing appropriate treatment

Acute kidney injury due to star fruit ingestion: A case report

Star fruit (Avarrhoa carambola) is a fruit from oxalidace family. lt is found in many countries of the world including Bangladesh. But its ingestion or drinking star fruit juice may lead to intoxication especially in patients with chronic kidney disease and manifestations might be neurological or nephrological. lt may also cause acute kidney injury in patients with previously normal renal function. Here we are presenting a case who presented with acute kidney injury after star fruit ingestion with previously unknown renal function impairment. The etiology was confirmed by histopathological exami­nation after doing renal biopsy. This renal function impairment is mainly due to oxalate crystal induce nephropathy which is richly abundant in star fruit. His renal function was improved ·with conservative management. Physicians should be alert to consider the ingestion of star fruit as a cause of acute kidney injury in a patient even in the absence of previous renal function impairment

MO219EMPHYSEMATOUS PYELONEPHRITIS IN BANGLADESH

Abstract Background and Aims Emphysematous pyelonephritis (EPN) is an uncommon, acute and severe form of necrotizing infection of the renal parenchyma, collecting system and/or perinephric tissues and is characterized by accumulation of gas within these structures. Patients may present with fever, loin pain, vomiting and shock. Risk factors for EPN include diabetes mellitus (DM), renal stone, obstructive uropathy and immunosuppression. In this report, we describe the clinical, laboratory and imaging characteristics of patients with EPN in Bangladesh. Method This systematic review included all previously published English literature containing information regarding EPN in/or from Bangladesh. Literature search was conducted via “PubMed” using the key words “Bangladesh” and “emphysematous pyelonephritis”. We also searched through Bangladesh Journals Online (BanglaJOL) for articles published in local journals. The search engine “Google” was also used to identify articles. All literature searches were conducted up to 10th January 2021. Unpublished but well-documented EPN cases (28 cases) were added. Cases mentioned elsewhere with inadequate information and possible repetition were excluded. Results Seventeen papers were identified from published literature including 10 case reports, two original research articles, one image and four conference abstracts and one research paper was identified from other source. From them, two case reports were excluded because EPN occurred in non-Bangladeshi nationals; one image and four conference abstracts were also excluded because of inadequate information for cases. Finally, a total of 10 papers (total 92 cases) were eligible for analysis, to which 28 unpublished but well documented cases were added. Among the total 120 cases, females were 92 (76.7%). Age of the patients ranged between 20 and 77 years. DM was the commonest risk factor (118, 98.3%); 16 (13.3%) patients had chronic kidney disease and nine (7.5%) had renal stones. Patients presented with fever (112, 93.3%), loin pain/renal angle tenderness (96, 80%), dysuria (76, 63.3%), altered sensorium (21, 17.5%), anorexia (93, 77.5%), vomiting (101, 84.2%), dehydration (77, 64.2%) and shock (18, 15%). Patients had neutrophil leukocytosis (total white cell counts 11,700–54,200/cmm of blood) and 22 (18.3%) patients had thrombocytopaenia. All patients had high erythrocyte sedimentation rate (36–117 mm/1st h) and C-reactive protein (24–199 mg/L). Overall glycaemic status was poor [random blood glucose during admission was 6.8–35.5 mmol/L and glycated haemoglobin (HbA1c) was 6.2–16.1%]. Fifty six (46.7%) patients were complicated by acute kidney injury (AKI) and 32 (26.7%) patients had hyponatraemia. Diagnosis of EPN was confirmed by computed tomography scan. One patient had EPN in ectopic right kidney, two patients had EPN along with emphysematous cystitis and two patients were complicated with psoas abscess. According to Huang and Tseng classification, five (4.2%) patients had class 4 EPN, 35 (29.2%) patients had class 3, 66 (55%) patients had class 2 and 14 (11.7%) patients had class 1 EPN. Escherichia coli was the most common (67, 55.8%) organism identified on urine culture and 17 (14.2%) patients were complicated by bacteraemia. All patients were treated with resuscitative measures, intravenous antibiotics and other supportive measures. Forty one (34.2%) patients required surgery/interventions [nephrectomy in 19 (15.8%), percutaneous drainage in two (1.7%), open drainage in 20 (16.7%)]. Duration of hospital stay was 6–37 days. Nine (7.5%) patients died in hospital. Conclusion EPN occurred predominantly among female diabetic patients. Clinical presentation included fever, loin pain, dysuria, vomiting, altered sensorium and shock. Class 2 EPN was common. Almost half of all EPN cases developed AKI. One-third EPN cases required surgical interventions including nephrectomy. In-hospital mortality was 7.5%. </jats:sec

Medical Quiz: Images Vol.6(2)

Abstract not availableBirdem Med J 2016; 6(2): 139-140</jats:p

Evidence of expanding geographic distribution of melioidosis in Bangladesh: reports of three cases

Melioidosis is an emerging infectious disease in Bangladesh. Reported cases are mostly diagnosed among inhabitants of central and north-east zone of the country. We report three cases of melioidosis occurring among patients with diabetes mellitus and chronic kidney disease from not well-known endemic areas within the country. Patients presented with fever, anorexia and weight loss. Laboratory reports confirmed growth of Burkholderia pseudomallei from blood and urine. These cases are reported to increase awareness among physicians regarding melioidosis occurring beyond the so-called hot spots in Bangladesh. BIRDEM Med J 2021; 11(3): 239-242</jats:p

Cancer Classification from Gene Expression Using Ensemble Learning with an Influential Feature Selection Technique

Uncontrolled abnormal cell growth, known as cancer, may lead to tumors, immune system deterioration, and other fatal disability. Early cancer identification makes cancer treatment easier and increases the recovery rate, resulting in less mortality. Gene expression data play a crucial role in cancer classification at an early stage. Accurate cancer classification is a complex and challenging task due to the high-dimensional nature of the gene expression data relative to the small sample size. This research proposes using a dimensionality-reduction technique to address this limitation. Specifically, the mutual information (MI) technique is first utilized to select influential biomarker genes. Next, an ensemble learning model is applied to the reduced dataset using only the most influential features (genes) to develop an effective cancer classification model. The bagging method, where the base classifiers are Multilayer Perceptrons (MLPs), is chosen as an ensemble technique. The proposed cancer classification model, the MI-Bagging method, is applied to several benchmark gene expression datasets containing distinctive cancer classes. The cancer classification accuracy of the proposed model is compared with the relevant existing methods. The experimental results indicate that the proposed model outperforms the existing methods, and it is effective and competent for cancer classification despite the limited size of gene expression data with high dimensionality. The highest accuracy achieved by the proposed method demonstrates that the proposed emerging gene-expression-based cancer classifier has the potential to help in cancer treatment and lead to a higher cancer survival rate in the future

Mycoplasma pneumoniae-Induced-Stevens Johnson Syndrome: Rare Occurrence in an Adult Patient

Stevens-Johnson syndrome (SJS) is an uncommon occurrence in Mycoplasma pneumoniae (M. pneumoniae) infection (1–5%) and has been mainly reported in children and young adults. We present a case of SJS in a 32-year-old male induced by M. pneumoniae infection. This patient presented with fever, cough, and massive occupation of mucus membranes with swelling, erythema, and necrosis accompanied by a generalized cutaneous rash. He clinically responded after treatment with antibiotics and IVIG. SJS is usually a drug-induced condition; however, M. pneumoniae is the commonest infectious cause and should be considered in the differential diagnosis

MO098: Emphysematous Pyelonephritis in Bangladesh over a Decade, 2012–2021

Abstract BACKGROUND AND AIMS Emphysematous pyelonephritis (EPN) is an acute and severe form of necrotizing infection of the renal parenchyma, collecting system and/or perinephric tissues, and it is characterized by accumulation of gas within these anatomic locations. Common presenting features are fever, loin pain, vomiting and shock. Risk factors for EPN include diabetes mellitus (DM), renal stone, obstructive uropathy and immunosuppression. In this report, we describe the clinical, laboratory and imaging characteristics of patients with EPN in Bangladesh. METHOD This systematic review included all previously published English literature containing information regarding EPN in/or from Bangladesh. Literature search was conducted via ‘PubMed’ using the key words ‘Bangladesh’ and ‘emphysematous pyelonephritis’. We also searched through Bangladesh Journals Online (BanglaJOL) for articles published in local journals. The search engine ‘Google’ was also used to identify articles. All literature searches were conducted up to 31 December 2021. Unpublished, well-documented EPN cases (six cases) were added. Cases mentioned elsewhere with inadequate information and possible repetition were excluded. RESULTS Twenty two papers were identified from published literature (first case in January, 2012), including 11 case reports, 4 original research articles, 2 images and 5 conference abstracts, and 1 research paper was identified from other source. From them, two case reports were excluded because EPN occurred in non-Bangladeshi nationals; two images and five conference abstracts were excluded because of inadequate information for cases. Finally, a total of 13 papers (total 148 cases) were eligible for analysis, to which six unpublished but well-documented cases were added. Among the total 154 cases, females were 136 (88.3%). The age of the patients ranged between 20 and 85 years. DM was the most common risk factor (146, 94.8%) and nine (5.8%) had renal stones. Patients presented with fever (136, 88.3%), loin pain/renal angle tenderness (102, 66.2%), dysuria (79, 51.3%), altered sensorium (22, 14.3%), anorexia (93, 60.4%), vomiting (111, 72.1%), dehydration (78, 50.6%) and shock (18, 11.7%). Patients had neutrophil leucocytosis (total white cell counts 11 700–54 200/cmm of blood) and 22 (14.3%) patients had thrombocytopaenia. All patients had high erythrocyte sedimentation rate (36–117 mm/1st h) and C-reactive protein (24–199 mg/L). Overall glycaemic status was poor [random blood glucose during admission was 6.8–35.5 mmol/L and glycated haemoglobin (HbA1c) was 6.2–16.1%]. Fifty nine (38.3%) patients were complicated by acute kidney injury (AKI) and 35 (22.7%) patients had hyponatraemia. One patient had EPN in ectopic right kidney, two patients had EPN along with emphysematous cystitis and three patients were complicated by psoas abscess. According to Huang and Tseng classification, 6 (3.9%) patients had class 4 EPN, 41 (26.6%) patients had class 3, 93 (60.4%) patients had class 2 and 14 (9.1%) patients had class 1 EPN. Escherichia coli was the most common (77, 50%) organism identified on urine culture, and 23 (14.9%) patients were complicated by bacteraemia. In one patient, EPN was due to genitourinary tuberculosis. All patients were treated with resuscitative measures, intravenous antibiotics and other supportive measures. Forty four (28.6%) patients required surgery/interventions [nephrectomy in 22 (14.3%), percutaneous drainage in two (1.3%), open drainage in 20 (13%)]. The duration of hospital stay was 6–37 days. Ten (6.5%) patients died in hospital. CONCLUSION EPN occurred predominantly among female diabetic patients with clinical presentation of fever, loin pain, dysuria, vomiting, altered sensorium and shock. Class 2 EPN was the most common. Over one-third of all EPN cases developed AKI. Nearly one-third required surgical interventions including nephrectomy. In-hospital mortality was low, 6.5%. </jats:sec