The Insight

Observation of Socio-demographic Characteristics and Risk Factor on the Occurrence of Birth Defects

Tue, 28 Nov 2023 00:00:00 -0500

Introduction: Birth defects significantly contribute to neonatal mortality and morbidity worldwide. Socio-demographic characteristics and environmental risk factors have been associated with the occurrence of birth defects. Methods and materials: This case-control observational study was conducted at the Pediatric Surgery and Medicine Department in Dhaka Shishu (Children) Hospital, Bangladesh, from January 2012 to December 2013. A total of 280 infants aged 0-364 days were recruited, with 140 cases presenting structural birth defects, and 140 control infants without any structural birth defects. Detailed socio-demographic and risk factor data were collected and analyzed using SPSS V.16. Results: The mean maternal age of the case and control group were being observed 25.86±5.196 and 23.41±4.65 years which was statistically significant (p=0.001). The mean paternal age in the case and control group were being observed 32.10±5.39 and 29.85±6.38 years which was also statistically significant (p=0.05). Paternal exposure to insecticides, fertilizers, and prolonged sunlight, as well as both paternal smoking and maternal passive smoking, were all significantly more common in the case group (p=0.001). The distribution of birth defects in the case group was most frequently observed within the gastrointestinal system (17.9%), followed by the genitourinary system (15.7%), and cardiovascular system (14.3%). Conclusion: This study highlights the associations of socio-demographic characteristics and environmental risk factors with the occurrence of birth defects in Bangladesh. These findings emphasize the importance of improved parental education, occupational health and safety, and access to prenatal care in rural areas to reduce the risk of birth defects.

High Sensitivity C-Reactive Protein (Hscrp) Level And Its Association with Hyperlipidemia in Children with Nephrotic Syndrome

Tue, 28 Nov 2023 00:00:00 -0500

Background: Hyperlipidemia is one of the important characteristics of nephrotic syndrome (NS) and it is responsible for atherosclerotic changes which can be due to vascular endothelial dysfunction that reflect the inflammatory response to tissue damage. Hyperlipidemia in childhood can induces atheroma formation among susceptible individual. Methods and materials: This cross-sectional analytical study was conducted in the Department of Pediatric Nephrology, National Institute of Kidney Diseases & Urology, Sher-E-Bangla Nagar, Dhaka and Department of Biochemistry, Dhaka Shishu Hospital, Dhaka, from December 2019 to June 2021. Data were collected by using a structured questionnaire. Collected data were analyzed by the SPSS 24. Results: Average age of all study children was 6.44±3.29 years (range: 2 - 12 years) with male predominance in both group A and group B (63.33 and 60%, respectively). Minimal change disease (MCD) was found in majority cases of group A (91.67%). Nephrotic children had significantly higher mean of total cholesterol, triglyceride, LDL, VLDL, and HDL compared to healthy children. The mean±SD (median) of serum hsCRP were higher in nephrotic children than healthy children [2.13±1.70, (1.50) vs 0.86±0.55, (0.60) mg/L, P < 0.001]. Pearson correlation analysis showed that serum hsCRP had significant moderate positive correlation with total cholesterol and LDL, weak positive correlation with triglyceride and VLDL among nephrotic children (p value <0.05). Conclusion: Serum hsCRP was found to be higher in NS children and positively correlated with hyperlipidemia. However, further studies are needed to validate these findings.

Comparative Status of Refractive Errors between Male and Female School Going Children

Tue, 28 Nov 2023 00:00:00 -0500

Background: Refractive errors like myopia, hyperopia, and astigmatism can affect a child's academics and well-being. Investigating their occurrence in male and female schoolchildren is vital for equitable eye care and educational policies, sparking interest in pediatric ophthalmology and public health. Aim of the study: This study aimed to compare the refractive errors between male and female school-going children. Methods and Materials: This observational study took place at Narsingdi Eye Care & Research Centre in Bangladesh from January 2018 to December 2020. It involved 1978 schoolchildren who received detailed eye evaluations and best-corrected visual acuity assessments. Purposive sampling was used, and data analysis was conducted using MS Office tools. Results: Among the total participants (N=1978), in males (n=823), myopia was present in 72.1% of cases, while hypermetropia and astigmatism affected 6.7% and 28.7% of individuals, respectively. For females (n=1155), myopia remained prevalent, affecting 75.2% of participants, while hypermetropia and astigmatism contributed to 5.6% and 28.9% of cases, respectively. These findings highlighted the higher prevalence of myopia in both genders, with slightly more occurrence in females. Conclusion: The findings emphasize a higher prevalence of myopia in both male and female school-going children, with a slightly more pronounced occurrence in females. Additionally, hypermetropia and astigmatism, while less common, displayed consistent distribution patterns across both genders.

A Comprehensive Analysis of Complementary Feeding Practices in Children Under 2 Years with Severe Acute Malnutrition

Tue, 28 Nov 2023 00:00:00 -0500

Introduction: Malnutrition is a global public health issue that affects individuals of all age groups, particularly those who are poor and vulnerable. In developing countries, over 50% of preventable deaths among children under five are attributed to malnutrition. Inappropriate feeding practices are a significant contributor to malnutrition and its associated morbidity and mortality. Aim of the study: The study aimed to comprehensively analyze the feeding patterns of severely acutely malnourished children under the age of two. Methods and materials: This cross-sectional observational study was conducted at the Department of Pediatrics, Sir Salmimullah Medical College & Mitford Hospital (SSMC & MH) in Dhaka over 6 months, from October 2013 to March 2014. The study population consisted of 60 individuals. Data were collected through face-to-face interviews with the mothers of the children immediately after registration. The collected data were analyzed using the Statistical Package for Social Sciences (SPSS) software, version-23.0. Results: The results showed that over 90% of the children were severely wasted, 18.3% were severely stunted, and 16.7% had bipedal edema. The majority of children had complications such as anemia, edema, dehydration, pneumonia, and gastrointestinal issues. There was no statistical significant link was observed between the pattern of complementary food consumption and the different types of malnutrition (p=0.141).Conclusion: The study concludes that there are significant concerns regarding complementary feeding practices in children with severe acute malnutrition. Exclusive breastfeeding rates for the first six months are low, and there is a high prevalence of poor-quality complementary foods.

Preeclampsia in Pregnant Women — Association with Disease Severity

Salma Khatun, Mitra Biswas, Syma Akter, Beauty Begum, Sultana Jasmin — Tue, 28 Nov 2023 00:00:00 -0500

Introduction: Preeclampsia commonly occurs after 20 weeks of pregnancy in consort with proteinuria and the absence of proteinuria, preeclampsia is known in associated with liver dysfunction, thrombocytopenia, and pulmonary oedema and causes severity, chronic disability, and even death or both mothers and babies. The study aimed to understand the severity of preeclampsia in pregnant women. Methods and materials: An observational case-control study was carried out in the Department of Obstetrics and Gynecology, Sir Salimullah Medical College Mitford Hospital, Dhaka from July 2020 to June 2021. A total number of fifty-six preeclampsia women (N=56) were enrolled in the study. Data were collected using the predesigned semi-structured questionnaire. Verbal & written consent was taken before recruiting the study population. Completed data forms were reviewed, edited, and processed for computer data entry. The data analysis was performed using Statistical Package for the Social Sciences (SPSS) Version 25.0. Result: Respondents' mean age was 27.35 ± 4.85 years. Most of the patients (23,41.1%) completed the primary level, majority of the patients (48,85.7%) were housewives. Respondents' mean systolic blood pressure (SBP) was 164.50 ± 18.13 mmHg and mean diastolic blood pressure (DBP) was 110.82 ± 14.86 mmHg and mean β -hCG concentration was 21301 ± 10102 mIU/ml. Conclusion: This finding suggests that preeclampsia women with severe features have developed levels of serum β-hCG. Maternal complications like eclampsia, PPH, and fetal complications like stillbirth, a higher number of NICU admission, and lower APGAR score were significant in PE with severe features than in PE without severe features and controls.

Impact on Maternal and Fetal Outcome due to the Causative Organism for PROM

Kumer Tanshen, Panchami Goshwami, Shanta Tribedi, Sarvin Haider — Tue, 28 Nov 2023 00:00:00 -0500

Introduction: In Bangladesh, maternal mortality is 3.2 per thousand live births due to complications of pregnancy and childbirth. Nonscientific intervention in PROM at various levels intensifies the pregnancy complication several times, thereby leading to many more deaths of fetuses and newborns. However, the aetiology of PROM is largely unknown. Methods and materials: Over a period of six months, from July 2011 to December 2011, this study was conducted at the Department of Obstetrics and Gynecology, Mymensingh Medical College Hospital, in Mymensingh, Bangladesh. During this time, 100 PROM patients in all were enrolled in the study. Data were processed and analyzed by the Computer software SPSS (Statistical Package for Social Science). The level of significance was considered when the p-value was less than 0.05. Result: As a result of the maternal outcome, 40 (40%) women developed chorioamnionitis, 10 (10%) had puerperal sepsis, 8(8%) had DIC, and 42 (42%) had no problem. In fetal outcome, patients of 58% were live birth, 42% were still birth, 46% were mature, and 54% were premature, respectively. Besides, birth weights of 66% were <2.5 kg, and 34% were >2.5 kg. Conclusion: So, Chorioamnionitis was the most common maternal complication and poor fetal outcome in premature rupture of the membrane.

Risk Factors for Frequent Relapse Nephrotic Syndrome in Children — A Case Control Study

Tue, 28 Nov 2023 00:00:00 -0500

Introduction: Nephrotic syndrome (NS) is a renal disorder primarily affecting children and characterized by significant proteinuria, low levels of albumin, edema, and high levels of serum cholesterol. Relapses are often triggered by infections, immunizations, and other factors that activate T-cells and increase cytokine production. Methods and materials: This case-control study was conducted at the Department of Pediatrics of Sylhet M.A.G. Osmani Medical College Hospital, Sylhet, for a duration of six months from June 2012 to December 2012. The study included a total of 80 pediatric patients, divided into two groups: the case group and the control group. The collected data were analyzed using Statistical Package for Social Sciences (SPSS), software, version-23.0. Results: In this study children in the FRNS group had a significantly lower mean age (4.05 ± 2.147 years) compared to the control group (5.175 ± 2.435 years) (p=0.0314). Early onset of nephrotic syndrome (age 1-5 years) was more common in the FRNS group (65%) than the control group (47.5%) (p<0.049). Frequent relapse was more prevalent in rural children (75%) than in urban children (55%) (p<0.05). The FRNS group had a significantly higher incidence of UTI and RTI (72%) compared to the control group (38%) (p<0.001). Serum albumin levels were significantly lower in the FRNS group (1.6 ± 0.2 gm/dl) than in the control group (2 ± 0.3 gm/dl) (p<0.001). Conclusion: Several risk factors are significantly associated with frequent relapse nephrotic syndrome (FRNS). These include poor socioeconomic status, rural residency, early age of onset, and low serum albumin at the time of the initial attack and infection.

Risk Factors for Scar Ruptures During Labour in Patients with Previous History of Cesarean Section

Nusur Akhter, Salma Rouf, Feroza Wazed — Tue, 28 Nov 2023 00:00:00 -0500

Introduction: Cesarean scar dehiscence (CSD) is an infrequent yet significant occurrence following lower segment cesarean section (LSCS) surgery. It is often linked to underlying uterine anomalies, such as a cesarean scar. This study aimed to assess the risk factors for scar ruptures during labor in patients with a previous history of cesarean section. Methods and Materials: This was a prospective observational cross-sectional study that was conducted in the Department of Obstetrics and Gynaecology in Dhaka Medical College Hospital, Dhaka, Bangladesh from November 2016 to April 2017. In total 25 women with a previous history of cesarean section with labor pain admitted to the mentioned hospital were enrolled in this study as the study subjects. All cases were selected by purposive sampling technique. Data were processed, analyzed and disseminated by using MS Office tools. Results: This study revealed that in about 24% of cases, the risk factor was a 'history of 1 previous LSCS with oxytocin infusion'. In 16% of cases, risk factors included 'previous 1 LSCS with misoprostol induction' or '1 LSCS with home trial of labor and VBAC attempt'. Additionally, 8% of cases had risk factors like '2 previous LSCS with misoprostol', 'grand multiparity with oxytocin use', or '2 previous LSCS with oxytocin for labor'. Conclusion: In this study, there is every possibility of finding mixed risk factors in case of scar rupture. The combination of misoprostol, oxytocin and previous LSCS claimed the highest rank among the risk factors that was subsequently followed by only previous LSCS.

Comparison of Functional Outcome Between AP Lag Screws Versus Posterior Buttress Plating for Posterior Malleolar Fixation in Tri-Malleolar Ankle Fracture

Tue, 28 Nov 2023 00:00:00 -0500

Background: Posterior malleolar fracture occurs commonly in up to 44% of all ankle fractures. Anterior to posterior lag screw or posterior buttress plate techniques are usually practiced for the operative management of such fractures. This study aimed to compare the functional outcome between anterior to posterior (AP) lag screw versus posterior buttress plating for posterior fixation in tri-malleolar ankle fracture. Methods and materials: This quasi-experimental study was conducted at the Department of Orthopedics & Traumatology, Chittagong Medical College Hospital, Chattogram, Bangladesh from November 2020 to October 2021. The study included 28 patients with ankle fractures, divided into two groups of 14 cases each. Group A received anterior to posterior (AP) lag screw fixation, while Group B underwent posterior buttress plating. Data analysis was performed using MS Office tools and SPSS version 23.0. Result: No statistically significant differences were observed in age (p = 0.64), gender (p = 1.0), or fracture type (p = 0.71) between the AP and posterior buttress plating groups. AOFAS scores showed significant correlations for pain (p = 0.045) and function (p = 0.019). Group A (AP lag screw) had satisfactory functional outcomes in 57% of cases, while Group B had 86% satisfaction. The range of motion in the affected ankle did not significantly differ between the two groups. Conclusion: In terms of AOFAS scores and functional outcomes, the buttress plating method for posterior fixation shows certain advantages over the anterior-to-posterior lag screw technique in the treatment of tri-malleolar ankle fractures.

Clinical and Biochemical Studies of the Gender Specific Risk Factors for Cssardiovascular Disease in Patients of Type 2 Diabetes with NAFLD

Tue, 28 Nov 2023 00:00:00 -0500

Introduction: Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality in individuals with type 2 diabetes mellitus (T2DM). Additionally, the co-occurrence of non-alcoholic fatty liver disease (NAFLD) further exacerbates this risk. While numerous studies have explored the pathophysiological mechanisms underlying CVD in T2DM, there is a notable paucity of research focusing on the gender-specific nuances of this complex interplay. Methods & Materials: A hospital-based observational study was carried out in the Department of Medicine, Cumilla Medical College and Hospital, Bangladesh, from 1^st July to 31^st December 2012. Fifty admitted patients of type2 diabetes with NAFLD were included in this study. Results: Out of 50 patients, 18(36%) were males and 32(64%) were females, with mean age 58.89 ± 8.38 and 54.6 ± 10.1 years respectively. The prevalence of hypertension (p <0.0001), obesity (measured by BMI) (p<0.0001), central obesity (measured by waist circumference and waist hip ratio) (p<0.0001), higher triglyceride levels (p<0.0001), higher LDL-C level (p<0.0001) and lower HDL-C levels (p<0.0001) were significantly higher among the study population. On statistical analysis, we found increasing grades of NAFLD were significantly associated with hypertension (p=0.0083), obesity (p=0.0006), increasing levels of total cholesterol (p<0.0001), ALT (p<0.0001), AST (p<0.0001) and ALP (p<0.0001). Conclusion: In our study we exposed that males exhibited a significantly higher propensity for smoking and possessed higher Body Mass Index (BMI) compared to females. On the other hand, females were more inclined to have higher Waist-to-Hip Ratios (WHRs) overall.

Colposcopy Findings of VIA Positive Cases in Detection of Precancerous Lesion of Cervix

Tue, 28 Nov 2023 00:00:00 -0500

Introduction: Cervical cancer is still the second-most frequent malignancy in women overall. According to an epidemiological study conducted by Bangladesh's Cancer Research Institute, 26% of all females with cancer in this country have cervicovaginal carcinoma. The World Health Organization views cervical cancer as a condition that can be avoided. It can be identified in its precancerous phage, which is why. Colposcopy is a diagnostic procedure for determining the presence of preclinical invasive carcinoma and cervical intraepithelial neoplasia (CIN). Methods and materials: A hospital-based observational study was carried out in the Department of Obstetrics & Gynaecology, Comilla Medical College and Hospital from 1st July 2015 to 31st December 2015. Two hundred women who fulfil the selection criteria were included in this study. History and physical examination were recorded. Colposcopy and biopsy were done on all patients after proper counselling, results were tabulated and analysed. Results: All of the 200 cases had undergone colposcopy examination. Among them, 30% showed no abnormality. In 70% lesion was found. All the study subjects were sampled by colposcopy-guided biopsy. The biopsy results showed 8.5% CIN I, 3.5% CIN II, 1.5% CIN III, 1.5% invasive carcinoma and 41.5% chronic inflammatory lesion). Conclusion: This study's findings support the notion that colposcopy and VIA provide pretty satisfactory diagnostic accuracy in the evaluation of cervical pre-malignant conditions. VIA is a method that is suitable for usage in low-resource situations due to several factors.

Surgical Precision — Laparoscopy’s Edge in Ectopic Pregnancy Treatment

Janibul Haque, Nasrin Akter Popy, Nurjahan Begum — Tue, 28 Nov 2023 00:00:00 -0500

Introduction: There is a widespread belief that salpingostomy is the treatment of choice for ectopic pregnancy. The ability to treat most ectopic pregnancies via a laparoscopic approach has been a major advance in gynecological surgery. Although it is clear that laparoscopic treatments are preferable to laparotomy there is no consensus on whether salpingectomy or salpingostomy should be performed, despite over 40 years of research since the introduction of conservative tubal treatment. Methods and Materials: This retrospective single-center clinical study was conducted in a private Hospital, Cumilla, Bangladesh, from January 2022 to June 2023. Results: This minimally invasive technique demonstrated exceptional efficacy and safety in the cohort of 17 patients, aged 18-38, with suspected ectopic pregnancies. The consistent success of laparoscopic salpingectomy, regardless of pregnancy history or ectopic site is noteworthy. The advantages of laparoscopy were evident in the absence of major complications or wound infections. Furthermore, the prompt recovery, as evidenced by the timely removal of the drain tube and stitches, underscores the benefits of this approach. The remarkable outcome of two patients conceiving post-salpingectomy adds an additional layer of significance to the laparoscopic technique. Conclusion: Our study reaffirms that laparoscopy stands as the superior approach in the treatment of ectopic pregnancies. Its minimally invasive nature, coupled with its precision and excellent postoperative outcomes, position it as the gold standard for this critical condition.

Challenges in management of pregnancy in Women with Congenital Heart Disease

Hasina Akhter, Shamima Yasmin, Kamrun Nahar — Tue, 28 Nov 2023 00:00:00 -0500

Introduction: Congenital heart disease (CHD) is a dynamic field with evolving evidence, particularly in the context of pregnancy in women. Presently, due to improved surgical and medical treatments, more individuals with CHD are reaching adulthood, including many women of childbearing age. However, they still face various cardiovascular risks. Aim of the study: This study aimed to evaluate the challenges of congenital heart disease in pregnant women. Methods and materials: This was an observational study that was conducted in Combined Military Hospital (CMH) Dhaka, Bangladesh from January 2020 to December 2021. In total 30 pregnant women with congenital heart disease were enrolled in this study as the study subjects. All the demographic, and clinical information were recorded. Baseline data, collected before or during the first prenatal visit, were retrospectively recorded from various medical records, including electronic and paper sources, as well as referrals from physicians. Results: Maternal cardiovascular risks were notable in unrepaired atrial septal defects (ASD), with arrhythmia (4.50%) and persistent NYHA deterioration (3.00%). Repaired ASDs had similar risks but a higher postpartum hemorrhage rate (16%). Repaired ventricular septal defects (VSD) carried a 2.30% maternal arrhythmia risk, while unrepaired VSDs had lower overall risks. Patent ductus arteriosus (PDA) showed a 1% maternal arrhythmia risk. Tetralogy of Fallot (TOF) had low maternal cardiovascular risks but increased obstetric complications. Conclusion: The study underscores the need for personalized and thorough management of pregnancies in women with congenital heart disease. This approach must take into account the unique characteristics and risks associated with both the mother and the fetus.

A Comparative Study to See The Pregnancy Outcome of Oligohydramnios And Normal Amniotic Volume at Term

Fatematuz Zohura, Dilip Kumar Voumik — Tue, 28 Nov 2023 00:00:00 -0500

Introduction: Oligohydramnios, reduced amniotic fluid, raises risks like growth issues, birth complications, and abnormalities. Detecting and managing it early can cut perinatal problems, mortality, and cesarean rates, improving both maternal and fetal outcomes. Timely interventions for oligohydramnios can significantly enhance the overall well-being of both mother and baby. Aim of the study: This study aimed to compare the pregnancy outcome of oligohydramnios and normal amniotic volume at term. Methods and Materials: Conducted between July to December 2014, this case-control study examined 50 third-trimester pregnant patients with Oligohydramnios alongside 50 randomly chosen controls with normal amniotic levels from Sylhet MAG Osmani Medical College Hospital. Selection followed set criteria, and comprehensive history, examinations, and investigations were conducted through convenient consecutive sampling. Oligohydramnios diagnosis was based on AFI measurements. Results: Both the rate of incidence of oligohydramnios and operative morbidity were higher in primipara cases. The selected outcomes showed significant variations in both groups. There were statistically significant increased chances of FHR decelerations (SD 6.07and mean value), thick meconium, low Apgar score at 5 minutes, birth weight <2.5 kg, admission to NICU, congenital anomalies and neonatal mortality in patients with oligohydramnios. The most common reason to perform a cesarean was fetal distress. Oligohydramnios were related to a higher rate of neonatal ward admission. Conclusion: A high rate of intrapartum complications and ‘perinatal morbidity and mortality’ are associated with oligohydramnios. To reduce perinatal morbidity and mortality, intensive fetal surveillance, and proper ‘antepartum and intrapartum’ care is essential.

Prevalence of Hypoalbuminemia in Critical Dengue Patients of ICU in Tertiary Care Hospital

Tue, 28 Nov 2023 00:00:00 -0500

Introduction: Dengue is a mosquito-borne viral disease endemic in many countries in the tropics and sub-tropics. The disease affects mainly children, but in recent years it has become more of an adult disease. This study aimed to assess the prevalence of hypoalbuminemia in critical dengue patients in the ICU. Methods and materials: This cross-sectional observational study was conducted at Tertiary Care Hospital in Dhaka, Bangladesh from June 2019 to June 2020. Purposively, a total of 100 serologically diagnosed dengue patients admitted to the ICU were included in this study. Data were collected in a preformed data collection sheet prospectively and a descriptive analysis was done in this study. Result: In this study, most patients (53%) were from the 25-30 years age group, with a male preponderance (67%) who mostly belonged to middle-class families (41%). All patients had a fever, followed by, abdominal pain (81%), respiratory distress (73%), mucosal bleeding (59%), and vomiting (39%). The prevalence of hypoalbuminemia was found 72% while thrombocytopenia was observed in 59% of the cases. Clinical signs revealed that most patients developed Acute Respiratory Distress Syndrome (ARDS) (74%), followed by ascites (68%), pleural effusion (53%), and hepatomegaly (21%). Conclusion: Hypoalbuminemia, liver dysfunction, Acute Respiratory Distress Syndrome (ARDS), and thrombocytopenia are common and critical features of dengue infection. Early diagnosis and intervention are vital in preventing complications and fatalities.

Prevalence and Outcome of Intracranial Artery Stenosis in Patients with Acute Ischemic Stroke in a Tertiary Care Hospital

Tue, 28 Nov 2023 00:00:00 -0500

Introduction: A stroke, also known as a cerebrovascular accident (CVA), remains a significant contributor to mortality and morbidity in both developed and developing nations. For individuals experiencing an acute ischemic stroke, intravenous thrombolysis can help restore neurological function if given promptly, and it is advised to be administered as soon as intracranial bleeding is ruled out through CT imaging. Aim of the study: This study aimed to analyze the prevalence and clinical outcome of intracranial artery stenosis in patients with acute ischemic stroke in a tertiary care hospital. Methods and materials: This cross-sectional observational study was conducted at a Tertiary Care Hospital in Dhaka, Bangladesh from July 2021 to July 2022. This study used a purposive sampling technique to select a total of 100 patients as the study population. Data processing and analysis were conducted using MS Office tools, and a descriptive analysis approach was adopted. Result: Intracranial artery stenosis was found in 13% of patients. Besides, 36% had occlusion, and 4% had both. Most of the patients (69%) had hypertension, 72% had diabetes, and 23% had atrial fibrillation. Notably, 92.30% achieved a good outcome after early thrombolysis and thrombectomy if needed, as per the Modified Rankin Scale score. Notably, all patients achieved a good outcome after early thrombolysis, with aspirin and clopidogrel, and with surgical intervention. Conclusion: This study highlights acute ischemic stroke related to intracranial artery stenosis. Patients often have pre-existing conditions, emphasizing risk factor management. Timely intervention, including thrombolysis and thrombectomy, leads to favorable outcomes.

Complications of General Anesthesia in Older Patients

Tue, 28 Nov 2023 00:00:00 -0500

Introduction: General anesthesia is a crucial and widely employed anesthetic procedure utilized in various surgical interventions. Without general anesthesia, many of these surgeries, which are often lifesaving or life-altering, would be impracticable. Nonetheless, it's essential to recognize that all medical procedures carry inherent risks, even when administered by skilled professionals. Aim of the study: This study aimed to assess the complications of general anesthesia in older patients. Methods and materials: This prospective observational study was conducted at the Department of Anaesthesiology, Dhaka National Medical Institute Hospital, Dhaka, Bangladesh from December 2022 to September 2023. The study included 43 elderly surgical patients under general anesthesia. Sampling was purposive, and data were collected using a pre-designed questionnaire and analyzed with MS Office tools. Results: Postoperative complications were quite common, with pain at the operative site (81%), dry mouth or increased thirst (78%), and somnolence (69%) being the most prevalent. Additionally, hoarseness (43%), headache (39%), transfusion requirements (35%), and nausea-vomiting (33%) were notable. Some patients experienced muscle weakness and pain, altered consciousness, urination problems, sensations of cold/chills, and pneumonia. Conclusion: The most prevalent postoperative complications for older surgical patients who have undergone general anesthesia are pain at the surgical site, dry mouth, increased thirst, and somnolence. Physicians should also be prepared to address potential complications such as hoarseness, headache, increased transfusion needs, and nausea and vomiting in these patients.

Frequency of Patent Ductus Arteriosus in Children with Congenital Rubella Syndrome — A Study in a Tertiary Care Hospital

Sun, 21 Jan 2024 00:00:00 -0500

Introduction: Congenital Rubella Syndrome (CRS) has long been characterized by the triad of deafness, cataracts, and cardiovascular malformations (CVMs). The frequency of Patent Ductus Arteriosus (PDA) in children with Congenital Rubella Syndrome (CRS) is a critical topic in pediatric cardiology and infectious disease research. Aim of the study: This study aimed to assess the frequency of Patent Ductus Arteriosus (PDA) among children with Congenital Rubella Syndrome (CRS). Methods and Materials: This cross-sectional observational study was conducted at the Department of Pediatric Cardiology, Combined Military Hospital (CMH), Dhaka, Bangladesh, from June 2020 to June 2021. A purposive sampling technique was adopted. A total of 50 cases with CRS were selected as the study population. Data were collected and processed, and subsequent analysis and reporting were conducted using MS Office tools. Result: Among the total participants, 98% were IgG-positive and 48% were IgM-positive. Out of the 50 study patients, seven cases (14.0%) were diagnosed with pure PDA (Patent Ductus Arteriosus) without any other associated abnormalities. The remaining patients exhibited various combinations of PDA and other cardiac abnormalities. Specifically, thirteen patients (26.0%) were found to have normal cardiac anatomy without any significant abnormalities. Conclusion: Among children with suspected congenital rubella syndrome (CRS), cardiovascular malformations are common. Patent Ductus Arteriosus was found in more than two-thirds of children with congenital heart disease, either occurring in isolation or combination with other congenital heart diseases.

The Postoperative Outcomes of General Anesthesia in Patients after Major Surgery

Md Anwarul Haque, Md Iqbal Hossain, Shymum Shahriar — Tue, 28 Nov 2023 00:00:00 -0500

Introduction: General anesthesia is a drug-induced reversible state comprising unconsciousness, amnesia, antinociception, and immobility, with maintenance of physiological stability. General anesthesia requires managing a complex array of anesthetic agents that act on an intricate web of neural connections or a neural nexus. Aim of the study: This study aimed to analyze the postoperative outcomes of general anesthesia in patients after major surgery. Methods and materials: This prospective observational study was conducted at the Department of Anaesthesiology Dhaka National Medical Institute Hospital, Dhaka, Bangladesh from December 2022 to September 2023. A total of 100 surgery patients managed by general anesthesia were selected as study subjects purposively. After data collection, all data were processed and analyzed by MS Office tools. Result: In this study, the most common surgical procedure was joint replacement, with 25% of the participants, followed by hysterectomy, also at 25%. In most of our patients (59%) with general anesthesia, opioids were administered for pain relief. Most commonly, patients experienced headache (18%) followed by nausea, vomiting, and pulmonary complications (15%). Significantly, 42% of patients experienced delayed reversal from general anesthesia effects, and 41% required a hospital stay until days 4-5. We found deep vein thrombosis in 13% of cases. Conclusion: General anesthesia, while essential for major surgeries, presents certain postoperative challenges that need attention. Patients often encounter extended recovery times and may require prolonged opioid use, leading to longer hospital stays.

Comparison of Stapled Hemorrhoidopexy and Open Hemorrhoidectomy — A Study in a District Level & a Tertiary Care Hospital

Md Mostafizur Rahman, Md Shakhawat Hossain — Tue, 28 Nov 2023 00:00:00 -0500

Introduction: Hemorrhoids are usually managed by hemorrhoidectomy which is associated with postoperative pain, long hospital stay, and a longer convalescence. Stapled hemorrhoidopexy is a newer alternative for the treatment of hemorrhoids. This study aimed to analyze the outcome in patients of both procedures. Methods and materials: This cross-sectional study was conducted at the Department of Surgery at Ibn Sina Medical College Hospital in Kallyanpur, Dhaka, Bangladesh; a tertiary care hospital and in a district-level hospital. All necessary data were collected during and after the surgery. Data were entered using SPSS software. Informed written consent was taken from all patients and all data were kept confidential. Result: In the present study, duration of surgery was 35±5 min in Group A, while 25±10 min in Group B. patients of Group A needed 9.5 hours to return to normal bowel function whereas it was 12 hours in Group B. Patients of Group A experienced comparatively less pain than the patients of Group B. Hospital-stay was much shorter (1.5 days) in cases of Group A patients while longer (2±1) in Group B patients. Postoperative bleeding was also less in Group A. Recurrence rate of the disease was much higher (5.7%) in Group A than Group B (1.0%). Conclusion: This study concludes that, although stapled hemorrhoidopexy is widely used, the long-term outcome is limited. Stapled hemorrhoidopexy offers the benefits of less postoperative pain, less requirement for analgesics, and less pain at first bowel movement, while the chance of recurrence of hemorrhoid is much higher.

Epilepsy, a common sequelae in Children with Cerebral Palsy — A Study in a Tertiary Care Hospital in Bangladesh

Tue, 28 Nov 2023 00:00:00 -0500

Introduction: Cerebral palsy (CP) is the most ordinary motor disability in childhood. It is defined as non-progressive and changing disorders of movement and posture. Basically, cerebral palsy (CP) is a group of disorders that affect a person’s ability to move, balance and posture. On the other hand, epilepsy is a frequent association that affects the brain and causes recurrent seizures. Aim of the study: The aim of the study was to assess the types and nature of epilepsy among children with cerebral palsy. Methods and materials: This case-control study was conducted in the Department of Pediatric Neurology, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh from January 2020 to December 2020. This study was screening by definitive assessment of history, clinical, GMFCS level, MACS level, and CT scan of head. Results: In this study, in analyzing the types of CP of the participants we observed that, 8 (16%) had spastic hemiplegia, 6 (12%) had spastic diplegia, 27 (54%) had spastic quadriplegia, 3 (6%) had dyskinetic and mixed events were found in 6 (12%). On the other hand, among CP without epilepsy cases 21(21%), 36(36%), 15(15%), 1(11%) and 17(17%) were with hemiplegia, spastic diplegia, quadriplegia, dyskinetic and mixed respectively. 56.0% had age at onset of epileptic seizure less than 12 months. Conclusion: Among CP cases epilepsy is most common in spastic quadriplegic CP. Generalized and syndromic epilepsy is a more common type of epilepsy in spastic quadriplegic CP. Focal epilepsy is more common in spastic hemiplegia CP. Epilepsy is earlier age of onset.

The Role of Azithromycin to Achieve Early Remission and Relapse Reduction in Children with Primary Nephrotic Syndrome — Randomized Controlled Trial

Tue, 28 Nov 2023 00:00:00 -0500

Introduction: Nephrotic Syndrome (NS) is a common kidney disorder in children, marked by various complications. The standard treatment involves corticosteroids, but their prolonged use can lead to side effects. To address this, researchers have explored the potential of Azithromycin (AZM), an antibiotic with immune-modulating properties, as an adjunct to corticosteroid therapy. Methods and materials: This prospective randomized controlled trial was conducted at the Department of Paediatric Nephrology, National Institute of Kidney Diseases & Urology, Sher-E-Bangla Nagar, Dhaka, from November 2019 to June 2021. The study enrolled children aged 1-12 years with primary nephrotic syndrome (NS) during their initial episode and relapse, totaling 108 patients who provided informed written consent from their parents. Results: Initial attack NS patients, mean time to achieve remission was significantly lower in group A (7.74±2.78 days) who received azithromycin and prednisolone then group B (11.11±3.32 days) who received only prednisolone. (p<0.001). Similarly, among relapse case of NS, mean time required for remission was significantly lower in group C (7.63±2.54 days), who received prednisolone and azithromycin than group D (9.19±2.70 days), who received prednisolone only (p<0.034). In initial attack NS patients, number of relapse was lower in group A (20.0%) than group B (48.0%). [P<0.021] Similarly, among relapse patients, number of relapse was lower in group C patients (38.4%) than group D patient (48.0%).[p< 0.492] Conclusion: This study explored the impact of azithromycin treatment on initial and relapse cases in children with primary Nephrotic Syndrome (NS), and concluded that adding azithromycin along with prednisolone provided a greater benefit.

Evaluation of Security of Roeder’s Knot in Laparoscopic Appendicectomy and Cholecystectomy

Tue, 28 Nov 2023 00:00:00 -0500

Introduction: Laparoscopic surgery has gained significant attention in recent years due to its suitability for the treatment of appendix and gallbladder diseases, offering a less invasive surgical approach. The practical application of laparoscopic appendicectomy and cholecystectomy presents several advantages. Aim of the study: This study aimed to evaluate the security of Roeder’s knot in laparoscopic appendicectomy and cholecystectomy. Methods and materials: This was an experimental study that was conducted at the Department of Surgery in Jahurul Islam Medical College & Hospital, Kishorgonj, Bangladesh from Jan 2020 to Dec 2021. A total of 100 patients undergoing laparoscopic appendicectomy and cholecystectomy admitted in the Surgery ward of the mentioned hospital were enrolled in this study as the study subjects purposively. For data analysis, MS Office tools and SPSS Version 23.0 were applied. Results: Among the total patients who underwent laparoscopic appendicectomy, 94.3% had a smooth recovery without complications, while 5.7% experienced complications. On the other hand, among the total patients who underwent laparoscopic cholecystectomy, 90% had an uneventful recovery, and 10% experienced complications. Regarding the time required to perform Roeder's knot, the mean duration for laparoscopic appendicectomy was 50±3.40 seconds, while for laparoscopic cholecystectomy, it was 125±7.90 seconds. Conclusion: The security of Roeder’s knot in stump closure in laparoscopic appendicectomy and cholecystectomy is sufficient which is evident by the lower rate of stump leakage and complication rate.

Assessment of Risk Factors and Outcome of Operative Procedures of Genital Prolapse

Shabnam Rahman, Amena Begum, Kamrun Nessa — Tue, 28 Nov 2023 00:00:00 -0500

Introduction: Genital Prolapse is a common gynecological problem, especially in developing countries. There is a scarcity of information on genital prolapse in our country and research works based on post-operative outcomes are very few. So, this study aimed to analyze the risk factors & outcome of operative procedures of genital prolapse. Methods and materials: This cross-sectional study was conducted at the Department of Obstetrics and Gynecology Department of Shaheed Tajuddin Ahmad Medical College Hospital, Gazipur, Bangladesh. The study was conducted from July 2019 to December 2019. All data was collected by interview, physical & lab examination using a structured questionnaire containing all the variables of interest. After data collection, statistical analysis was done by statistical package for social science (SPSS) software. Result: It was observed that history of abdominal surgery was found in 6(6%) patients, vaginal delivery was found in 100 (100%) patients, home delivery was in 90 (90%), the majority 44(44%) patients had prolonged labor during delivery, and 2% had instrumental delivery. In this study, 80(80%) patients had 2^nd degree of uterine prolapses, 15(15%) patients had 1^st degree & only 5(5%) patients had 3^rd degree of uterine prolapses. Conclusion: The study concluded that most of the cases of genital prolapse were acquired in nature and mainly related to childbirth injuries. The patients with genital prolapse mostly were in the 6^th decade. Moderate cystocele, moderate rectocele, and urethrocele stress incontinence were more frequent conditions of the patients.

Efficacy of Granulocyte Colony Stimulating Factor (G-CSF) to Manage Neutropenia in Acute Lymphoblastic Leukemia (ALL) and Non-Hodgkin’s Lymphoma (NHL)

Tue, 28 Nov 2023 00:00:00 -0500

Introduction: Leukemia and NHL are the two most common malignancies in childhood. Nowadays children with malignant diseases have an excellent chance of survival around 75%. The incidence of neutropenia depends upon several factors including dose intensity, chemotherapy, the prior history of the patient, and the presence or absence of co-morbid condition. Aim of the study: This study aimed to assess the effect of G-CSF on neutropenia in patients of ALL and NHL and to see the duration of fever as compared to the control group. Methods and Materials: Children from 2 years to 12 years of age who had absolute neutrophil count (ANC) <500 /cumm, and attended in Paediatric Hematology and Oncology Department of DMCH, from July 2012 to July ’13 were selected purposively. Data analysis was carried out with the help of SPSS (Statistical Package for Social Science) Windows software program. Results: Among 30 patients, 22 ALL patients and 8 NHL patients were included in group A, and 6 ALL patients and 4 NHL patients were included in group B. There was male predominance. The mean ANC was found 710.73±213.3/cumm in group A and 531±307.9/cumm in group B. The mean difference was statistically significant (p<0.05) between the two groups. groups. The mean duration of fever was found 11.07±3.08 days in group A and 13.6±4.03 days in group B which was statistically significant (p<0.05) between the two groups. Conclusion: This study concludes that G-CSF therapy significantly increases the absolute neutrophil count reduces the duration of fever and therefore lowers the infection rate.

Demographic and Clinical Profile of COVID-19 Positive Pregnant Women — Study in a Tertiary Care Hospital in Bangladesh

Kazi Nazma Begum, Farjana Akther, Sumaiya Bushra — Tue, 28 Nov 2023 00:00:00 -0500

Introduction: Since the declaration of COVID-19 as a global pandemic, several studies have been conducted to examine associated factors. Limited studies have focused on pregnant women infected with COVID-19 in Bangladesh. Pregnant women may be susceptible to coronavirus infection because of physiological changes in the circulatory and immunological parameters. Aim of the study: This study aimed to evaluate the demographic and clinical profile of Covid-19 positive pregnant women. Methods and materials: This was a cross-sectional study that was conducted in the department of Obstetrics & Gynaecology, Mugda Medical College, Dhaka, Bangladesh from 26 March 2021 to 21 July 2022. A total of 94 pregnant women diagnosed as COVID-19 patients by RT-PCR tests were enrolled in this study as the study subjects. A convenient purposive sampling technic was used in sample selection. All data were processed, analyzed and disseminated by using MS Excel and SPSS version 23.0 program as the necessity. Results: In the study, 23% had comorbidities like HTN, DM, CKD, asthma, or CVD. One-third were in their 2nd pregnancy, 30% in their 3rd pregnancy, and 45% were nulliparous. COVID-19 symptoms included fever (96%) and cough (91%). Abnormal levels of hemoglobin (13%), FBS (40%), WBC (45%), neutrophil count (94%), lymphocyte count (89%), and platelet count (9%) were observed. Conclusion: COVID-19 infection rates appear higher among pregnant women in their 2nd and 3rd pregnancies. The most common symptoms for pregnant COVID-19 cases are fever and cough, while lower abdominal pain is a prevalent pregnancy symptom in these patients.

An Evaluation of Palliative Care Services at Different Settings — Patients’ Perspective

Imru-Al-Quais Chowdhury — Tue, 28 Nov 2023 00:00:00 -0500

Introduction: Palliative care into the continuum of care of chronic life- threatening illnesses can improve the quality of life of patients and their family, upholding the dignity and meeting the care needs of people at the end of their lives. The present study aimed to evaluate the delivery of palliative care from patients’ perspective. Methods and materials: This cross section quantitative study was carried out among 108 palliative patients selected conveniently to evaluate the palliative care services at different settings by face-to-face interview with pretested structured questionnaire. Result: A total of 108 palliative patients participated, with most receiving homecare (41.6%) and the rest split between outpatient (39.9%) and inpatient (18.5%) services. The majority was females (60.2%), married (70.4%), and had primary education (56.5%). Cancer (50%) and stroke (22.3%) were the leading diagnoses. Using the CES-P scale, over 87% were satisfied with clinical and interpersonal aspects of care. However, organizational factors like environment and availability had mixed reviews, with up to a third dissatisfied. Regarding preferred treatment settings, home-based care was overwhelmingly favored across disease types, with no significant differences (p=0.089). A significant association was found between patients' level of dependency and preferred care location (p<0.05), with more independent patients favoring outpatient and home-based options. Conclusion: It may be concluded that PC services in Bangladesh is satisfactory from patients’ perspective. This study may serve as a quality improvement initiative to identify the strengths and weaknesses of PC service delivery, which can be used to plan and conduct further studies.

Knowledge and Awareness of Adult Patients and Relatives about Diabetes Mellitus in a Primary Health Care Hospital

Mohammad Abdus Sattar, Arunima Kamal, Anjan Kumar Saha, Sushanta Boidya — Sun, 21 Jan 2024 00:00:00 -0500

Introduction: To assess the knowledge & awareness about diabetes mellitus (DM) among the adult patients and accompanying persons attending at Upazilla Health Complex, Tungipara, Gopalganj. Methods and Materials: The study was a cross sectional type of descriptive study. A structured questionnaire for formal face-to-face interview about the family history, symptoms, complications, preventive measures and communicability of DM was administered to the adult patients and accompanying persons attending at the Upazilla Health Complex, Tungipara, Gopalganj. Results: A total of 325 respondents gave their comments for the study. Statistically significant differences observed in the percentage of respondents mentioned diabetes symptoms and risk factors by age, gender and educational status. Those with history of diabetes in the family indicated diabetes symptoms and diabetes risk factors more precisely. The percentage of respondents indicated diabetes complications was higher among males and awareness about diabetes complications increased with the age. Knowledge about diabetes complications was higher among the respondents with educational status ‘graduate and above’. Knowledge about diabetes prevention methods was higher among males. Awareness about diabetes prevention methods increased with age and educational status. Individuals with a history of diabetes in the family were more aware of diabetes prevention methods. Conclusion: Knowledge and awareness of certain aspects of diabetes among the adult patients and accompanying persons attending at the UHC, Tungipara is poor. More health education is needed to address these deficiencies in order to equip them with the knowledge to positively help their community to reduce the burden of DM on society.

Impact of Calcium and Vitamin D Supplementation on Bone Mineral Content in Children Diagnosed with Thalassemia

Tue, 28 Nov 2023 00:00:00 -0500

Introduction: This study aimed to assess the effect of vitamin D and calcium supplementation on osteoprotection in children with thalassemia. Methods and Materials: Twenty-nine children aged 5-18 years were administered oral vitamin D (600 IU/day) and calcium (500 mg/day) for a duration of one year. Dual-energy X-ray absorptiometry (DXA) was used to measure bone mineral content at the beginning of the study and after 12 months. Additionally, serum 25-hydroxy vitamin D, Serum parathyroid hormone, calcium and phosphate levels were assessed at baseline, 6 months, and 12 months. Results: The mean (SD) bone mineral content increased significantly from the baseline value of 9.3 g to 11.7 g. Similarly, the mean (SD) vitamin D level increased from the initial value of 17.0 ng/mL to 24.7 ng/mL. Conclusions: Supplementing with oral vitamin D and calcium enhances bone mineral content in children diagnosed with thalassemia over a period of one year.

Assessment of Lipid profile variation in Pre and Post-Menopausal Women in relation with Weight — Study in Rural area

Mohammad Nasimul Goni, Md Sarwar Hossain, Syeda Muslema Akhtary, Rasheda Pervin — Tue, 28 Nov 2023 00:00:00 -0500

Introduction: Menopause is a permanent physiological state with cessation of menstruation due to loss of ovarian function and reduction in the production of estrogen.¹. The lipid profile changes during menopause for a variety of reasons. Objectives: The aim of the study was to evaluate the lipid profile variation in pre and post-menopausal women in relation with weight. Methods: This Prospective observational study was carried out in private chamber in Rupganj Upazila in Narayanganj, Bangladesh during the period of July 2021 to June 2022. The study population consisted of 92 female, among them 46 are apparently healthy pre-menopausal women between the age limits of 20-48 years and 46 are post-menopausal women between the age limits of 45-70 years. Statistical analyses of the results were obtained by using windows-based Microsoft Excel and Statistical Packages for Social Sciences (SPSS-24). Results: According to this study, the serum levels of TC, TG and LDL-C were significantly higher in post-menopausal women in comparison to pre-menopausal, irrespective of BMI (P < 0.05). Similarly, HDL-C levels were significantly lower in post-menopausal women as compared with pre-menopausal women of similar BMI (P < 0.05). Conclusion: As compared to the reproductive age group, the postmenopausal women had a rise in TC, TGs and LDL-C level, and a decrease in HDL-C level. These alterations are independent of BMI, since they were observed in overweight women in both pre and post-menopausal women.

Infertility in Women with Polycystic Ovary Syndrome — A Management Dilema

Tue, 28 Nov 2023 00:00:00 -0500

Introduction: The illness known as polycystic ovarian syndrome (PCOS) is diverse in nature, with its etiology and pathology believed to result from the interplay of genetic and environmental factors throughout intrauterine and postnatal development. Methods and Materials: This cross-section observational study was carried out in Al manar hospital and SIBL hospital. The duration of the period from July 2021 to June 2022. A total of 150 patients were participate in the study. After collection, the data were checked and cleaned, followed by editing, compiling, coding and categorizing according to the objectives and variable to detect errors and to maintain consistency, relevancy and quality control. Statistical evaluation of the results used to be obtained via the use of a window-based computer software program devised with Statistical Packages for Social Sciences (SPSS-25). Results: Maximum (42%) patients were within the age group of 25-30 years. Only 4.84% had more than 40 years of age. Mean (±SD) age was 26 ± 11.6 years. Regarding age of marriage maximum (77.6%) of the patients’age of marriage was 13-18 years. 46.67% of the patient were underweight, 40% were within normal range and 13.33% were overweight. Regarding Pharmacological measures, 40% patients were given Clomiphene citrate, 20% Letrozole and 6.67% gonadotropin therapy. About 33.33% were under gone Ovarian drilling. Here, Success rate for Pharmacological measures was 72% (N=100) And Success rate for Ovarian drilling was 65% (N=50). Conclusion: Comprehensive evaluation of the infertility is required to rule out alternative reasons of infertility in PCOS. PCOS therapy is still debatable because it is a common syndrome and the leading cause of infertility. Lomifene citrate and letrozole are also considered first-line treatments. The second line of treatment is gonadotrophin therapy and ovarian drilling.

Student Perception of Current Pharmacology Teaching Methods

Nazia Mahmud Badhon — Tue, 28 Nov 2023 00:00:00 -0500

Introduction: The primary objective of this research was to understand the perception of medical students regarding the teaching and learning methods of pharmacology in a medical college associated with a tertiary care hospital. Methods and Materials: A questionnaire-based study was conducted among 3^rd phase of MBBS & 2^nd phase BDS students at the MH Samorita Medical College. The questionnaire, consisting of 22 pre-validated points, was carefully designed to assess the students' views on various teaching and learning approaches. Results: The analysis was carried out on a sample of 150 medical students from the tertiary care hospital. The results indicated that 80% of the participants preferred faculty members to employ more Audio-Visual aids to enhance their learning experience. Additionally, 78.67% of the students advocated for the inclusion of case-based learning in the curriculum, while 86.67% expressed a desire for more clinical pharmacology content. Interestingly, 28% of the students felt that MCQs (Multiple Choice Questions) should be incorporated into the assessment of academic performance. As for the ideal teaching method, 13.33% of the students believed that didactic lectures were the most effective. Moreover, a majority of 65% considered the combination of an LCD projector and a blackboard as the ideal teaching/learning medium for pharmacology. Conclusions: This study highlights the preferred teaching and learning methods in pharmacology that would contribute to the overall improvement of students' learning experiences.

Socio-demographic Profile of Patients with Foreign Body in Upper Aero-Digestive Tract

Tue, 28 Nov 2023 00:00:00 -0500

Introduction: Otolaryngologists face significant diagnostic and therapeutic challenges when dealing with foreign bodies (FBs) in the upper aero-digestive tract. Most ENT surgeons will eventually have to deal with a patient who has lodged a foreign body in their Upper Aero- Digestive Tract (UADT), which can cause serious complications if immediate measures are not taken. Objectives: To study different types of foreign bodies (FB) that impacted in Upper Aero- Digestive Tract (UADT) in patients of different sociodemographic area that help in further management plan. Methods and Materials: A hospital based cross-sectional study was done in Department of Otolaryngorhinology and Head- Neck surgery, Dhaka Medical College Hospital from23^rd March 2019 to 22^nd September 2019. Purposive sampling technique was applied for study. Data were collected from the informant and recorded in structured case report form. Data was processed and analysed with the help of computer program SPSS version-22 and Microsoft excel. Result: In this study majority of patients 35(70.0%) belongs to age 0 to 10 yrs (Mean age 6.1±2.8). Male to female ratio was 1.7:1. In this study 21 (60.0%) children attended in hospital with foreign body impacted in nose, whereas in all patients of age group 21-30 year were found oesophageal foreign body. In this study, foreign body were commonly impacted in nose (42%), in oesophagus (20%) and throat (38.0%).Types of foreign bodies include metallic foreign bodies (36.0%), Non-metallic (44.0%) and living FB (20.0%). Among them rural subjects were predominant (68.4% vs. 25.8% in rural and urban respectively). Conclusion: Otorhinolaryngeal foreign bodies remain frequent occurrence particularly in the younger age group 9 years old or less and high index of suspicion suggested and early intervention to prevent the morbidity and mortality from complications.

Risk Factors, Symptoms and Prevalence of Ischaemic Stroke in the Adults — A Single Centre Study

Tue, 28 Nov 2023 00:00:00 -0500

Introduction: A stroke, classified as a serious cerebrovascular event, has the potential to impair an individual's motor capabilities and result in long-term disability. A stroke can manifest as either an ischemic or hemorrhagic event. Both forms of stroke exhibit a considerable overlap in terms of etiological variables. Objective: The objective of this study was to determine the primary etiological factors contributing to ischemic stroke, as well as their connection and prevalence. Methods and Materials: This cross-sectional observational study was conducted at the Department of Neurology in Cox’s Bazar Medical College and Hospital, Cox’s Bazar, Bangladesh, from January 2021 to January 2022. A total of 100 diagnosed Ischaemic stroke patients were enrolled in this study.. Clinical examination and CT scan were conducted to diagnosis Ischaemic stroke. Collected data were analyzed using Statistical Package for Social Sciences (SPSS) software, version, 23.0. The ethical clearance of this study was obtained from the Institutional Review Board of Cox’s Bazar Medical College, Cox’s Baxar, Chattogram, Bangladesh. Results: Among the 100 patients, most of the patients (49%) were 60–69 years old, whereas the lowest proportion was (1%) 40–49. The sample had (91%) male and (9%) female. The study also observed that (61%) patients were businessmen, (25%) service workers, (8%) homemakers, and (11%) professionals. Initial ischemic stroke symptoms were hemiplegia (91%), speech slurring (94%), and vision blurring (85%), which may involve amaurosis fugax, few people vomited (6%).The study observed that the pulse rate Mean and SD was 85.75 ± 9.61 and systolic blood pressure was 143.25 ± 11.89 during the general system test. Additionally, the average diastolic blood pressure was 93.9 ± 7.12. Our investigation observed 98% extensor plantar reaction and 96% brisk or excessive jerk. The history of the patients indicated that 77% of patients smoked, (92%) had hypertension, (89%) had diabetes, 80% had a positive family history of atherosclerotic events, (85%) has sedentary lifestyle, and (95%) had uncontrolled dyslipidemia. Finally, the study investigated brain CT scan data, showing that (78%) of participants had hypodense cerebral cortical areas and (22%) did not change. Conclusion: This study investigated, smoking, hypertension, diabetes, positive family history, atherosclerotic events, sedentary lifestyle uncontrolled dyslipidemia are the common risk factors of Ischaemic Stroke. This study also investigated hemiplegia, speech slurring, vision blurring and vomiting were the common symptoms of Ischaemic Stroke and (78%) of the study patients had hypodense cerebral cortical areas.

Efficacy of P16 in Biopsy Samples in the Diagnosis of High Grade Cervical Intraepithelial Neoplasia — An Observational Study

Tue, 28 Nov 2023 00:00:00 -0500

Introduction: Invasive cervical cancer is preceded by a precancerous lesion known as cervical intraepithelial neoplasia (CIN). The majority of low-grade CIN lesions (CIN-1) spontaneously resolve without any medication, with only a tiny percentage progressing to high-grade lesions (CIN 2 and CIN 3) and cervical cancer. Objective: To evaluate the performance of P16 in the diagnosis of high-grade cervical intraepithelial neoplasia in biopsy samples at a Bangladeshi tertiary care facility. Methods and Materials: This retrospective observational study was conducted at Bangabandhu Sheikh Mujib Medical University in Dhaka. The study focused on 75 cases with histological diagnoses of CIN 2 and CIN 3/CIS. These cases were selected from the pathology department's archive, covering the period from June 2014 to December 2015. The fresh H&E sections and previous H&E sections were examined. 47 cases were ultimately available for examination after meeting the selection criterion. Of these 47 instances, 11 had CIN 3, and 36 had a CIN 2 diagnosis. All underwent P16 immunostaining. Results: Out of the 47 cases, 36 were diagnosed as CIN 2 (76.59 %) and 11 cases as CIN 3 (23.40%). The age of the study patients ranged from 25 to 70 years with a mean age of 41.4 +11.5 years. Around 60% of the study patients belonged to the age group 31- 50 years. In all 11 (100%) of the CIN 3 cases, P16 immunostain was found positive. 10 (27.77%) of the CIN 2 cases had positive P16 immunostain results. Conclusion: Because of the presence of immature squamous metaplasia, reactive epithelial alterations, atrophy, or tangential sectioning, the diagnosis of CIN 2 exhibits intraobserver and interobserver variability.

Stroke in the Young Adults and Its Risk Factors — A Case-control Study

Tue, 28 Nov 2023 00:00:00 -0500

Introduction: Stroke is a complex pathological condition that results in brain impairment across many age groups. In the past, stroke was predominantly considered a condition affecting older individuals but now it has revealed the occurrence of several stroke subtypes among young adults. Objective: The aim of this study was to determine the prevalence of stroke among the young adults and its risk factors. Method: This case-control study was conducted at the department of Neurology during January, 2021 to December, 2021 in Cox Bazar Medical College Hospital, Chattrogram, Bangladesh. Results: The mean age of the case group (n=58) was 23.31±2.01 years and 77.58% were male, 22.41% were female while in the control group (n=42), the mean age was 23.02±2.27 years and 50% were male and 50% were female. In the case group, .87.93% patients smoked, 93.10% had hypertension, 94.82% had diabetes, 13.79% had vasculitis, 20.68% had SLE, and 27.58% had cardiac arrhythmia while in the control group, 50% patients smoked, 69.04% had hypertension, 54.76% had diabetes, 2.38% had vasculitis, 4.76% had SLE, and 0% had cardiac arrhythmia(p<0.05)%)except vasculitis. The case group had 93.10% grey-white matter distinction and 87.93% CT hypodensity while no alteration was observed in the control group’s brain CT images(p=0.000). Conclusion: This study investigated that hemiplegia, slurring speech, blurring of vision, and headache are the major clinical presentations of the stroke in the young adults and smoking, hypertension, diabetes, SLE, and cardiac arrhythmia are the significant risk factors of occurring stroke in the young adults.

Intravenous thrombolysis (IV r-tPA) - a key intervention to reduce disability from acute ischaemic stroke – An editorial

HN Sarker — Tue, 28 Nov 2023 00:00:00 -0500

Stroke, also known as a cerebrovascular accident (CVA), is one of the leading causes of mortality and morbidity in both developed and developing countries ^[1]. Currently, stroke is the third leading cause of death worldwide ^[2] and the most common cause of severe physical disability.

About 180–300 patients per 100 000 population presents annually with a stroke and the incidence rises steeply with age. The incidence is rising in many lower- and middle-income countries in association with less healthy lifestyles.

About 85% of stroke occurs due to cerebral infarction due to inadequate blood flow to part of the brain, and most of the remainder due to intracerebral haemorrhage.

Cerebral infarction is caused by thromboembolism secondary to atherosclerosis in the major extracranial arteries (carotid artery and aortic arch) in about 60% cases, about 20% of infarctions due to embolism from the heart, and a further 20% are due to thrombosis in situ caused by intrinsic disease of small perforating vessels (lenticulostriate arteries), producing so-called lacunar infarctions.

Cerebral infarction takes some hours to complete. Affected area consists of an infract core and surrounding potentially salvageable penumbra. The infract core results from irreversible necrosis due to occlusion of blood vessel and the ‘ischaemic penumbra’ is the surrounding area which suffers from hypoxia due to

hypoperfusion and results in loss of function, but is not enough to cause permanent damage. This area of brain tissue (the so-called ‘ischaemic penumbra’) regains its function if the occluded blood vessel is recanalized and is the key target for modern treatment of stroke i.e. thrombolysis. The ischaemic penumbra is a dynamic process, existing even in the centre of the infarct for a short period of time before irreversible necrosis sets in and propagates to the neighbouring tissues over time, and may persist for more than 12 h after the onset of stroke symptoms.

Modern management of stroke includes rapid assessment, admission and early specialist management in a stroke unit, thrombolysis for acute ischaemic stroke (AIS), early use of aspirin in AIS and appropriate physiological monitoring. Thrombolysis for AIS is a key intervention that can reduce disability from stroke. Alteplase (IV r-tPA) within 4.5 hours of stroke onset remains the standard of care for most ischemic stroke patients. If eligible, all acute ischemic stroke patients should receive Alteplase (IV r-tPA).

Inclusion Criteria for IV r-tPA are

Clinical diagnosis of ischemic stroke causing measurable neurologic deficit.
Onset of symptoms <4.5 hours before beginning treatment; if the exact time of stroke onset is not known, it is defined as the last time the patient was known to be normal or at neurologic baseline.
Age ≥18 years.

But, patient should be selected carefully by considering Exclusion Criteria which are

Current intracranial hemorrhage
Subarachnoid hemorrhage
Active internal bleeding
Recent (within 3 months) intracranial or intraspinal surgery or serious head trauma, presence of intracranial conditions that may increase the risk of bleeding (e.g., some neoplasms, arteriovenous malformations, or aneurysms)
Bleeding diathesis
Current severe uncontrolled hypertension.

As the timeframe is 4.5 hours after onset of symptoms (though better result is observed within 3 hours), CT scan/MRI should be done to exclude haemorrhage and some haematological test such as platelet count, PT and APTT should be advised.

Although it is desirable to know the results of these haematological tests, thrombolytic therapy should not be delayed while results are pending unless there is clinical suspicion of a bleeding abnormality or thrombocytopenia ^[3], the patient is currently on or has recently received anticoagulants (eg, heparin, warfarin, a direct thrombin inhibitor, or a direct factor Xa inhibitor) ^[4], or use of anticoagulants is not known^[5]. Otherwise, treatment with intravenous tPA can be started before availability of coagulation test results but should be discontinued if the INR, PT, or aPTT exceed the limits stated in the table, or if platelet count is <100,000/ mm³.

About 20% of stroke patients die within a month of the event and at least

half of those who survive are left with physical disability. Intravenous tPA reduces poststroke disability significantly. National Institute of Neurological Disorders and Stroke rt-PA Stroke Trial showed that patients treated with recombinant tissue plasminogen activator (rt-PA, specifically alteplase) within 3 h of the onset of AIS were at least 30% more likely to have minimal or no disability at 3 months, with no significant change in mortality^[6]. Benefits of intravenous tPA are shown in the following table.

Protocol of Massive Transfusion (MTP) — A Systematic Review

Nahida Sultana, ABM Rashedul Amir, Jesmin Rahman — Tue, 28 Nov 2023 00:00:00 -0500

Introduction: MTP has been widely adopted for the care of bleeding trauma patients but its actual effectiveness is uncertain even today. MTP is an efficient way of ensuring of blood components to rapidly exsanguinating patients. For effective management of severely injured patients, regardless of etiology (trauma, obstetrical, surgical), effective preparation of MPT is needed. Methods and Materials: This review included 9 original studies that reported the effect of the implementation of an MTP on trauma patients. It shows that MTP implementation improves overall survival, with a statistically significant reduction in the overall mortality. The total study population was 4245. Results: MTP significantly reduced the overall mortality for trauma patients (OR 0.71 [0.56-0.90]). No significant reduction was seen in either the 24-hour mortality (OR 0.81 [0.57-1.14]) or the 30-day mortality (OR 0.73 [0.46-1.16]). In GMS MTP patients, there was a statistically significant increase in the percentage of platelet units wasted (MTP 12.8% vs non-MTP 8.1%; p ¼ 0.046). This increase was also seen in trauma MTP patients (MTP 12.2% vs non-MTP 4.0%; p < 0.001). No statistically significant difference was found in 24 -h death rate (15.0% vs. 23.8%, p = 0.181). The ABC scoring system used for trauma patients had a sensitivity and specificity of 81.8% and 41.2%, respectively. Conclusion: MTP may be used for both trauma and non-trauma patients to improve the outcomes of patients.

Fatal Meningoencephalitis in a COVID-19 Patient in Bangladesh — A Rare Case Report

Naser Ahmed, Niaz Mostafa, Manik Chandra Das, Nazmul Islam, Debashish Das — Tue, 28 Nov 2023 00:00:00 -0500

Introduction: The following case report delves into a unique and intricate manifestation of COVID-19 involving meningoencephalitis and a traumatic subdural hematoma (SDH). This particular case centers on a 54-year-old woman who had a complex medical history, including pre-existing conditions such as diabetes, hypertension, chronic kidney disease, and ischemic heart disease. This case is particularly noteworthy due to the simultaneous occurrence of meningoencephalitis and a traumatic SDH in a COVID-19 patient with an extensive list of comorbidities. Case Presentation: The patient's presentation was undeniably complex, necessitating careful examination and intervention. Her underlying health conditions, including diabetes, hypertension, chronic kidney disease, and ischemic heart disease, established a challenging backdrop for managing her COVID-19-related complications. The initial mild fever progressed to severe respiratory distress and neurological symptoms, leading to her admission to the Intensive Care Unit. At this point, her condition was characterized by a Glasgow Coma Scale (GCS) score of 10/15 and an oxygen saturation (SaO2) of 88% on room air. Diagnostic tests left no room for doubt, confirming both SARS-CoV-2 infection and elevated inflammatory markers. Conclusion: This extraordinary case underscores the intricate interplay of COVID-19 with various comorbidities, resulting in a complex clinical presentation. Of particular interest is the concomitant occurrence of meningoencephalitis and a traumatic subdural hematoma in a patient grappling with multiple pre-existing health conditions. The diagnostic challenges presented by the absence of advanced tests like cerebrospinal fluid RT-PCR for SARS-CoV-2 cannot be overstated.