Bangladesh Medical Journal

Obituary news September-2022

Kazi Shafiqul Halim — Tue, 02 Jan 2024 00:00:00 +0000

Abstract not available

Bangladesh Med J. 2022 Sept; 51(3): 51

Diagnosis of Caroli’s Disease: a Rare Case Report

Lubana Akram, Rubaiyat Alam, Md Rukunuzzaman — Tue, 02 Jan 2024 00:00:00 +0000

Caroli’s disease is a rare disease caused by Ductal Plate malformation. Patients may present with history of intermittent abdominal pain, pruritus and/ or symptoms of cholangitis. Cholangitis, liver cirrhosis, and cholangiocarcinoma are

potential complications. It is rarely diagnosed in childhood. A six (06) years old was presented with intermittent abdominal pain, fever, pruritus, and hepatomegaly at the Department of Paediatric Gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. After evaluating history, signs/ symptoms, physical examination, biochemical, ultrasonographic and endoscopic !ndings; this case was provisionally diagnosed as a compensated chronic liver disease with portal hypertension due to cause of cholestasis. Finally magnetic resonance cholangiopancreatography (MRCP) was done for further evaluation and the diagnostic !ndings of MRCP was suggestive of Caroli’s disease. After consultation the MRCP report with Pediatric Surgery Department of BSMMU the patient was advised for liver transplantation due to multifocal involvement of liver. Lastly patient was discharged with supportive management.

Bangladesh Med J. 2022 Sept; 51(3): 43-46

IgA Vasculitis in an Adult Man- a Case Report

Tue, 02 Jan 2024 00:00:00 +0000

IgA vasculitis is rare in adult. A significant portion of adult cases may present with renal involvement. Although most of these cases can be managed symptomatically, some cases may require immunosuppressive treatment. Unless diagnosis and appropriate treatment is initiated early IgA nephropathy in adult may result in chronic kidney disease. Immunoglobulin A vasculitis (IgAV) is an acute disorder causing generalized vasculitis principally involving skin, gastrointestinal (GI) tract, kidneys and joints. Here, a 28 year old man was presented with purpuric rash with leg ulcer, inflammatory arthritis involving multiple joints, abdominal pain and vomiting. He had mild pedal edema and normal blood pressure. Investigations showed raised inflammatory markers, haematuria, and nephrotic range proteinuria with normal liver and renal function. Biochemical and immunological evaluation of lupus nephritis, ANCA associated vasculitis and other causes of glomerulonephritis were negative. Renal biopsy with direct immunofluorescence showed features of IgA nephropathy. Patient was treated with steroid and mycophenolate mofetil with a good response.

Bangladesh Med J. 2022 Sept; 51(3): 47-50

Vaccination and Pandemic Control in Bangladesh: Post Vaccination COVID-19 Positive Cases among Health Care Providers

Tue, 02 Jan 2024 00:00:00 +0000

Vaccination was started on a trial basis in Bangladesh from 27th January, 2021 and started mass vaccination from 7th February, 2021. Since starting of mass vaccination it was noticed that, the health care providers (HCPs) who received two doses of Astra-Zeneca were then reported of being infected. This cross-sectional study was conducted during the period of July to December 2021 and data were collected from July to August 2021. The main objective was to measure the proportion of post vaccinated Corona Virus Disease-19 (COVID-19) positive cases among healthcare providers working in different healthcare facilities in Bangladesh and aimed to collect available evidence to characterize these infections and correlations with different co-morbidities. This study was carried out among 450 vaccinated HCPs who received 2 doses of vaccine at various health care facilities (HCFs) from 32 districts of Bangladesh. Data were collected from HCPs (Doctors, Nurses, Lab technician) who willing to participate irrespective of age and sex. Among the HCPs nearly three-fourth (71.6%) was doctors, 21.3% nurses and 7.1% were lab technologists. Here, most of the (88.0%) respondents were in age group 21 to 40 years and other 22.0% was in age group 41 to 59 years. The number of Male-female respondents was equal and 77.8% of the respondents was Muslim followed by Hinduism (20.2%), Buddhist and Christian 2.0%. Study finds that 27.6% of the respondents was post vaccination COVID-19 positive (PVC-19+) (according to their rt-PCR test result). Less than one-fifth (18.7%) of the respondents had pre-existing co-morbidities among them 8.2% was suffering from hypertension (HTN), 6.0% asthma, 4% Diabetes Mellitus (DM), 2.0% Obesity, 1.1% ischemic heart disease (IHD) and 1.1% was others co-morbidities. Among the PVC-19+ cases most of them (84.6%) were in age group 21-40 years, male-female ratio was 1:0.9 and 81.5% was Muslim. More than three-fourth (77.4%) of positive cases were doctors, 17.7% nurses and 4.8% was lab technicians; among the PVC-19+ cases 87.9% was symptomatic. Three-fourth (75%) of the positive cases had fever, 51.6% had lost of smell and taste, 49.2% showed fatigue/ or malaise, 48.4% dry cough, 43.5% headache, 26.6% runny nose, 25.8% felt muscle pain, 19.4% sore throat, 18.5% shortness of breathing, 14.5% experienced joint pain, 9.7% had productive cough and 32.3% complained for other symptoms and signs. Majority of the PVC+19+ cases (57.26%) developed complications; among them 71.8% had tiredness/ fatigue, 31% difficulty in thinking/ concentrating, 21.1% headache, 19.7% cough, 15.5% dizziness, 14.1% loss of smell or taste, 12.7% joint or muscle pain, 12.7% fast-beating or pounding heart, 11.3% shortness of breathing, 8.5% chest pain and 29.9% developed other complications. Pre-existing co-morbidity was found in 66.94% of positive cases, among those 41.5% HTN, 36.6% asthma, 14.6% DM, 14.6% obesity, 4.9% IHD and 9.8% had others co-morbidity. Chi-square test for independence with α = 0.05 was done to assess association, hypertension (P = 0.009) and asthma (P = 0.001) with PVC-19+ cases was statistically significant. Hypertensive and asthmatic HCPs are more likely to be COVID-19 positive even after complete vaccination. Healthcare providers are at high risk for contracting COVID-19 and might become infected at home or nosocomially while caring for patients or interacting with other staff members. COVID-19 vaccination together with incessant use of personal protective equipment (PPE) might be recommended for HCPs to combat its pandemicity.

Bangladesh Med J. 2022 Sept; 51(3): 1-9

Assessment of Severity of Acute Pancreatitis in Children: Systemic Inflammatory Response Syndrome (SIRS) Score

Tue, 02 Jan 2024 00:00:00 +0000

Acute pancreatitis (AP) is a prompt inflammatory process of the pancreas and it may be ranged from mild to severe pancreatitis with variable involvement of regional tissues and remote organ systems. Though there are many scoring systems for adults but scarce of scoring system for assessing the severity of acute pancreatitis among paediatric cases increase their suffering. Systemic Inflammatory Response Syndrome (SIRS) can be useful for assessing the severity of acute pancreatitis in children. It is reported that SIRS has good sensitivity, specificity, positive predictive value and negative predictive value. The aim of this study was to assess the severity of acute pancreatitis in paediatric cases from the scores of SIRS. This cross-sectional descriptive study was coducted in the Department of Paediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh for a period of 1.5 years from May 2019 to October 2020. A total of 25 children with acute pancreatitis were selected purposively and SIRS was evaluated. The sensitivity, specificity, positive predictive value and negative predictive value of SIRS was calculated. Out of 25 acute pancreatitis children, 18 (mean age, 10.27±4.0 years) were diagnosed as mild AP and 7 (mean age, 10.54 ±4.0 years) as severe AP. Fourteen (56.0%) children were male and less than half 11 (44%) of children had pallor and most of them 23 (92%) had abdominal tenderness. There was no statistically significant difference between mild and severe AP in terms of serum lipase, amylase, BUN and CRP (p > 0.05). SIRS score was ≥2 in 7 (100%) severe AP patients and score was ≥2 in 4 (22.2%) mild AP patients and it was statistically significant (p=0.001). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of SIRS score in predicting severe acute pancreatitis was 100%, 77.8%, 63.6%, 100% and 84% respectively. This study finds that SIRS score can effectively assess the severity of acute pancreatitis in the paediatric age group. Systemic Inflammatory Response Syndrome (SIRS) score at admission can be used to assess the severity of acute pancreatitis.

Bangladesh Med J. 2022 Sept; 51(3): 10-17

Association of Serum Uric Acid and Liver Enzymes in Adults at Tertiary Level Hospital in Bangladesh

Tue, 02 Jan 2024 00:00:00 +0000

The level of serum uric acid (SUA) has been linked to metabolic syndrome, diabetes, and cardiovascular disease. The purpose of this study was to evaluate the relationship between SUA and serum liver enzymes in a Bangladeshi adult population. This cross-sectional study was conducted among apparently healthy adults aged >18 years, from March 2019 to February 2020 at the Department of Biochemistry, Sir Salimullah Medical College (SSMC), Dhaka. SUA, liver enzymes, lipid profile and other biochemical markers were measured in the collected samples by using standard methods. All statistical analyses were performed by using SPSS version 22.0 software and p<0.05 was considered statistically significant. A total of 140 subjects were selected and blood sample were collected for biochemical analysis. Among them 70 were male and 70 were female. Serum uric acid (SUA), Alanine transaminase (ALT), Aspartate aminotransferase (AST) and Gamma-glutamyl transferase (GGT) levels were significantly (p<0.001) higher in male than female group. Pearson’s correlation analysis showed that there were significant positive correlation between SUA and serum ALT, AST, GGT (p<0.001). However, it also showed significant positive correlation between SUA and total cholesterol (TC), triglycerides (TG), low density lipoprotein cholesterol (LDL-C), while negative correlation was found between SUA and high density lipoprotein cholesterol (HDL-C) (p<0.001). The role of SUA in the prediction of elevated liver enzymes showed area under the ROC Curve (AUC) 0.839 for ALT, 0.848 for AST and 0.809 for GGT respectively. SUA is positively related with ALT, AST, GGT in adults. More prospective studies are needed to clarify the complex relationship between SUA and liver enzymes in the general population.

Bangladesh Med J. 2022 Sept; 51(3): 18-27

Outcome of Early Active and Late Mobilization following Flexor Tendon Repair in Zone ΙΙ of Hand

Tue, 02 Jan 2024 00:00:00 +0000

The functional outcome of flexor tendon injury after repair depends on multiple factors. Postoperative rehabilitation protocol plays an important role after a good repair for better functional outcomes. The aim of this study is to compare the outcome between early active mobilizations versus late mobilizations after flexor tendon repair in zone-II of hand. This Quasi-experimental (Nonrandomized control trial) was conducted from July 2018 to June 2021. Total 30 patients of flexor tendon injury in Zone-II of hand presented within 3 weeks were divided into two equal groups according to envelope technique, late mobilization (No intervention group) group- A and early active mobilization (Intervention group) group-B. All the flexor tendons were repaired with polypropylene 4/0 double strand score sutures and 6/0 epitendinous continuous sutures. In group-A mobilization started after 3 weeks and in group–B, intervention was given by active mobilization which was started at the day of operation. Buck Gramcko functional criteria and Louisville system were used for assessment of final result after 6 months of surgery. Male was predominant, M: F ratio was 3.3:1. Mean age of the respondent was 32.53±9.86 years. Dominant (Right) hand involvement was 70%. Student and service holder were the common involved group. Nearly three fourth (73%) of them had sharp cutting injury. More than half (53.10%) of the injuries were found in ring and little fingers followed by index (20.30%), middle (20.30%) and thumb (6.30%). Mean time interval between injury and operation was 11 days. Adhesion formation was the commonest complication that was 40% in group A and 20% in group B. More satisfactory outcome (87.50%) was found in group- B (Intervention group), that is patients who received early active mobilization; where the level of satisfactory outcome was less (62.50%) in group-A (Non-intervention group), that is patients who received late mobilization (p-value was significant <0.05). Early active mobilization following repair of flexor tendon in zone II of hand ensures better functional outcome with minimum complication compared to late mobilization.

Bangladesh Med J. 2022 Sept; 51(3): 28-36

Health Seeking Behavior and Self-Medication Practice among Undergraduate Medical Students in a Selected Private Medical College in Bangladesh

Tue, 02 Jan 2024 00:00:00 +0000

There is a need to have a formal health program for the medical students, set guidelines for students to follow if they fall ill and provision of rational medication. Students need to be made aware of the dangers of self-treatment and investigation. This cross-sectional study was conducted among the undergraduate medical students of US Bangla Medical College (USBMC), Narayangonj from July to December 2022. The study aims to assess the health seeking behavior and self-medication among the students. Data were collected by interviewing students using a pre-designed questionnaire and twenty Likert items were prepared for data collection. Data were analyzed by using SPSS (Statistical Package for the Social Sciences) version 25. Total 293 students were interviewed, among them male - female ratio was 1.23:1 and the age range of the participants was 17 to 28 years. Most of the (70%) students were belonged to upper-middle class family; where 21% from upper class, 8% from lower middle class, and only 1% from the working class family. Regarding the father's educational status of the students more than two-third (69%) of their fathers completed university degree, 29% completed higher secondary or secondary level of education and few (2%) had informal education. Most of the students (81%) used to take medicine without prescription/ self medication. Among the students around one-fourth of them used to take both paracetamol (26%) and painkiller (24%) as self-medication; where 13% of the students used to take antibiotic. Regarding the opinion of the well established definition of ‘Health’ that is “Health includes physical, mental and social well-being and not just absence of disease/ infirmity” most of the students (90%) gave positive statement (agree 58% and strongly agree 32%); where 5% of them were neutral and rest 5% were disagreed. Nearly two-third (65%) of the students expressed their opinion positively (agree 49% and strongly agree 16%) on “seek help immediately when they develop some physical symptoms” that is they seek immediate help for their illness; where 14% of them were neutral and rest 21% were disagreed. More than one-third (35%) of the students stated the reason for self-medication related to their too busy schedule to visit physician and 21% stated that the illness was too minor for consultation; other reasons were knowledge about the drug and illness, follow old prescription, over the counter drugs etc. Almost one-third (30%) of the students opined positively that public health care facilities provide standard health care, but more than one-third (36%) did not comment and rest one-third (34%) differed on it. Remarkably used self-medicated drugs were paracetamol (26%), painkiller (24%), 13% and others NSAIDs/ Analgesics, Antacid/ PPI, Vitamins, antitussive, antihistamines. The statistical test revealed that there is a strong relationship of their opinion on attention to mental physical well-being for healthy lively-hood between coping ability, seek the best care from college hospital and seek help for sensitive matters other than own college hospital (at 5% level of significance). To ensure better health seeking behavior and good practice knowledge of medical students was not absolutely satisfactory. Awareness regarding demerits of self-medication like antibiotics resistance and side effect of drugs would be build among the students. This study would facilitate for increase of medical knowledge and promotion of higher health-seeking behavior.

Bangladesh Med J. 2022 Sept; 51(3): 37-42