Introduction: The Severe Cutaneous Adverse Drug Reactions (SCADRs) are rare but life-threatening as these encompass drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and acute generalized exanthematous pustulosis (AGEP). Objective: To estimate the incidence of SCADRs and to find out the cause in Bangladesh. Materials and Methods: 50 patients with SCADRs were studied over a period of 1 year from January 2015 to December 2015 in the Department of Dermatology, Combined Military Hospital, Dhaka. Data were collected from the informant and recorded in structured Case Report Form. Quantitative data were expressed as mean and standard deviation and qualitative data as frequency and percentage. Results: Clinical diagnosis of the study subjects recognized 46.0% cases as SJS, 28(19.0%) as TEN, 16.0% as DRESS and 10.0% as AGEP. The maximum incidence (46%) was seen in the age group of 31-50 years; mean age of the patient was 37.42+5.3 years. Male and female ratio was 2.84:1. Anticonvulsant group of drugs could give rise to maximum incidence of SCADRs. Carbamazepine was responsible in 22.0% cases of SCADRs, followed by Phenytoin in 16.0% patients and Phenobarbital in 14.0% cases. Conclusion: SCADRs were seen mostly with the anticonvulsant drugs belonging to Carbamazepine and Phenytoin group. SCADRs deserve continuous monitoring to plan preventive strategies. Journal of Armed Forces Medical College Bangladesh Vol.12(2) 2016: 71-75

Objectives: Hepatitis B virus (HBV)-related chronic liver disease is a common health problem in our country. About 5.2 to 7.8% population of Bangladesh is chronic HBV carriers. There is no long-term follow-up study of asymptomatic HBV carriers in our country. Aim of the present study is to know the outcome of these cases in 10 years.Materials and methods: Twelve hundred and eighty-six cases of asymptomatic HBsAg-positive individuals were evaluated and followed up for 10 years at gastroenterology department, combined Military Hospital, Dhaka Cantonment, from January 2000 to December 2009.Results: Age of the patient's ranges from 3 to 50 years (mean, 27 ± 6 years). Majority cases were males 1,236 (96.12%). Baseline alanine aminotransferase (ALT) >45 IU/l was found in 168 (13.06%) cases. Ultrasonography revealed coarse hepatic echotexture in 62 (5.63%) cases out of 1,200 cases. Hepatic histology revealed chronic hepatitis in 318 cases (35.02%) and cirrhosis of liver in 24 cases (2.64%), hepatocellular carcinoma 1 (0.11%), fatty liver in eight (0.88%) out of 908 cases. After follow-up, compensated cirrhosis of liver was found in 90 (15%) cases, decompensated liver disease in 50 (8.33%) cases and hepatocellular carcinoma (HCC) in 42 (7%) out of 600 cases. Twenty (3.33%) cases died due to liver failure, HCC and other complications. Spontaneous HBsAg seronegativity occurred in five cases out of 600 cases (0.83%), and spontaneous HBeAg seroconversion occurred in 10 cases out of 180 cases (5.55%). Conclusion:Asymptomatic HBsAg-positive carriers should not be considered as inactive disease. They should be followed up every 3 to 6 months to know activity of the disease and development of complications. Antiviral treatment should be instituted in cases of active liver disease.

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The ampulla of Vater encompasses the openings of both the common bile duct (CBD) and pancreatic duct (PD). Presently ERCP has allowed better observation of the papillae in ectopic locations. The diagnosis of ectopic papillae can be done by radiological studies also but they are expensive and not affordable by all patients so most of the cases of ectopic papillae are identified by ERCP. An ectopic location, distal to the second part, in the third or fourth parts of duodenum has been described frequently but a proximal location is rare. Only a few cases have been found to be located in the gastric, pyloric and duodenal bulb areas. We report three such rare cases of anomalous ectopic ampullae discovered during the performance of ERCP from the Department of Gastroenterology, Combined Military Hospital, Dhaka and also a short review of the literature. In these three subjects one papilla was located in the pylorus and other two in the first part of the duodenum. All of them presented with features of choledocholithiasis with cholangitis. They were successfully managed by therapeutic ERCP. Clinical implications of these rare anomalies and anatomical variations can assist the gastroenterologists in effective patient management.

Introduction: Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer. It occurs most often in people with chronic liver diseases, such as cirrhosis caused by hepatitis B or hepatitis C infection. It is the fifth most common liver cancer globally and also a common cancer in Bangladesh. Treatment is difficult; however newer oral drug Sorafenib is available in our country which is promising. Objectives: To evaluate the efficacy of TKI Sorafenib on advanced and non-resect able primary HCC in Bangladeshi patients. Materials and Methods: This clinical trial was conducted on 38 diagnosed patients of advanced hepatocellular carcinoma (stage-3 and Child-Pugh Class-C) over a period of 3 years from May 2014 to July 2017 in the department of Oncology, CMH Dhaka. The patients receive Sorafenib 200-400 mg twice daily till disease progression ceases or increases and there are no unacceptable toxicities. Efficacy was observed in terms of overall survival, progressive free survival (PFS), drug compliance and common toxicities. Results: In 24 months of follow –up period from the date of Sorafenib taken, median overall survival was 7.73 months. The median overall survival was 8 months (range 8.13-27.43 months) in 42.4% patients. The median PFS is 3.5 months (range 1.2-5.8 months). Common toxicities found were anorexia, weakness, yellow colouration of skin and mucosa, HTN, rash and diarrhoea. Conclusion: In Sorafenib treated Bangladeshi advanced HCC patients, the median overall survival was found to be significant and compatible with some of the international publication. Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 16-18