Journal of Current and Advance Medical Research

Surgical Reconstruction of Old and Neglected Tendo Calcaneus Injury: Experience of 20 Cases in Bangladesh

Wed, 29 Nov 2023 00:00:00 +0000

Background: Treatment of old and neglected rupture of Tendo calcaneus is difficult due to formation of wide gap between the two ends.

Objective: This present study was aimed to assess the post-operative outcomes of surgical reconstruction of old and neglected Tendo calcaneus injury.

Methodology: This was a non-randomized clinical trial which was conducted at Department of Orthopedic Surgery, Ad-Din Sokina Women’s Medical College, Jashore, Bangladesh from January 2017 to December 2020 for a period of 4 years. The patients aged between 18 to 60 years were selected for this study after fulfilling the inclusion and exclusion criteria.

Results: All patients were non diabetic and normotensive. Affected Tendons were on both sides. Out of 20 patients 16 male and 04 were female. Twenty patient from 18 to 60 year were included in this study and obtained excellent result with this reconstruction surgery. Success rate was considered almost 100 present. Only one patent developed mild wound infection.

Conclusion: Old neglected rupture of Tendo calcaneus is very difficult problem as patients become unable to walk properly.

Journal of Current and Advance Medical Research, January 2023;10(1):3-6

Characteristics of Carotid Artery among Ischemic Heart Disease Patients with or without Diabetes Mellitus

Wed, 29 Nov 2023 00:00:00 +0000

Background: Involvement of coronary artery can vary among the ischemic heart disease patients with or without diabetes mellitus.

Objective: The purpose of the present study was to assess the characteristics of carotid artery among ischemic heart disease patients with or without diabetes mellitus.

Methodology: This case-control study was conducted in the Department of Cardiology at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. The study was carried out from July 2003 to June 2005 for a period of two years. Patients who had coronary artery diseases or ischemic heart diseases and diabetes mellitus undergoing coronary angiography were selected as case of this study. In control group, age, sex match patients of IHD undergoing CAG not having DM were included. Every patient was clinically examined by detailed history and physical examination during entry into study. ECG, chest X-ray, echocardiogram, blood sugar (fasting), blood 2 hrs. after 75gm of glucose and or breakfast were analyzed. Coronary angiography was done in all patients through femoral approach by modified Seldinger technique. Carotid arteriography was performed selective and nonselective method by Hunter head or right Judkin's catheter in standard AP, lateral and oblique views.

Results: A total number of 100 patients were included in this study. Of them 50 patients were coronary artery disease with diabetes mellitus and another 50 patients were coronary artery disease without diabetes mellitus. Morphological character of the lesion was also assessed. The mean age was found 57.48 years with 6.04 standard deviation (SD) in DM and 55.64 years with 6.34 standard deviation in NDM group and also 56.56 years with 6.49 standard deviation in the whole study population. The value of unpaired t-test was 0.158 and it was insignificant (p>0.05). The common site of lesion was bifurcation, internal carotid, common carotid and external carotid artery which were 13 cases, 9 cases, 4 cases and 1 case respectively. The individual vessel involvement was 9(18.0%) cases in right, 6(12.0%) cases in left, and 3(6.0%) cases in both in DM group whereas 5 (10.0%) cases in right, 3(6.0%) cases in left, and 1(2.0%) case in both in NDM group. It observed that out of 100 study subjects 10 had complex carotid lesion in DM and 4 in NDM.

Concussion: In conclusion the common site of lesion was bifurcation and internal carotid artery mostly in right side.

Journal of Current and Advance Medical Research, January 2023;10(1):7-12

Distribution of Diseases and their Prescription Pattern at Outpatients Department of Gynecology and Obstetrics in a Tertiary Care Hospital in Bangladesh

Wed, 29 Nov 2023 00:00:00 +0000

Background: Different gynaecological and obstetrics conditions are commonly encountered by the physicians in the outdoor patient.

Objective: The purpose of the present study was to observe the distribution of diseases and their prescription pattern at outpatients Department of Gynaecology and Obstetrics in a tertiary care hospital in Bangladesh.

Methodology: This cross-sectional study was carried out among patients attending the outpatient’s department (OPD) of Obstetrics and Gynaecology from October 2014 to April 2015 in Rajshahi Medical College and Hospital, Rajshahi, Bangladesh. The demographic details, average number of drugs per prescriptions, percentage of drugs prescribed by generic names, percentage of encounters with an antibiotic and an injection prescribed, percentage of drugs prescribed from essential drug list (EDL) of Bangladesh, percentage of encounters with prescription of antiulcerant, NSAID, multivitamin and multimineral, iron preparation and a calcium preparation were noted.

Results: A total number of 384 prescriptions were collected from Out Patient Department of Obstetrics and Gynaecology of Rajshahi Medical College and Hospital, Rajshahi, Bangladesh. Among 384 prescriptions date, name and age of the patient was written in 384 prescriptions which was 100.0% cases. Weight was written in 190(49.5%) and absent in 194(50.5%) prescriptions. Strength of drugs were written in 11(2.9%) prescriptions and not written in 373(97.1%) prescriptions. Duration of treatment was written in 100.0% prescriptions. Subscription is absent in 100.0% prescriptions. Direction to the patient was present in all prescriptions, but follow up advice were written only in 9(2.3%) prescriptions. Sign present in all prescriptions. There were about 169(44.0%) prescriptions have written the diagnosis and 215(56.0%) prescriptions did not have any diagnosis written.

Conclusion: In conclusion the date, name and age of the patient are written in all prescriptions and strength of drugs are absent in almost all prescriptions.

Journal of Current and Advance Medical Research, January 2023;10(1):13-18

Comparison of Miniperc and Standard Percutaneous Nephrolithotomy in the Treatment of Renal Stone: An Open Level Parallel Arm Randomized Control Trial

Wed, 29 Nov 2023 00:00:00 +0000

Background: Treatment of renal stone is very crucial for the outcomes of the patients.

Objective: The purpose of the present study was to compare the Miniperc and standard percutaneous nephrolithotomy in the Treatment of Renal Stone.

Methodology: This randomized control trial was conducted in the Department of Urology at National Institute of Kidney Diseases and Urology, Dhaka and some private hospitals in Dhaka city of Bangladesh from July 2016 to November 2017 for a period of one and half year. Patients from 18 to 65 years of age with renal calculi ( 2cm) were selected on the basis of plain X-ray and ultra-sonogram of KUB region, from Urology outpatient Department (OPD) in National Institute of Kidney Diseases and Urology (NIKDU), Dhaka and some private hospitals in Dhaka city. Patients were selected in every alternate sequence (odd numbers for Miniperc in Intervention group and even numbers for Standard PCNL, control group). All patients underwent PCNL of both the procedures under general anesthesia and received intravenous broad spectrum antibiotics.

Results: A total number of 60 patients were selected for study of which 30 patients were underwent miniperc and 30 patients were undergoing standard PCNL. The mean age of miniperc group and PCNL group were 34.43±11.09 and 36.70 ± 12.27 years respectively. An overall stone clearance rates was 93.33 (28) in intervention group and 6.67 % (2) was not cleared. Among the control group an overall stone clearance rates were 96.67% (29) and 3.33% (1) was not cleared. Stone clearance rates were not significant. The mean operative time (min) of intervention group was 97.47±15.03 and the mean operative time (min) of control was 86.37±17.73 Operative time was significant between the groups (p<0.05).

Conclusion: In conclusion the rate of clearance of intervention group is not statistically significant.

Journal of Current and Advance Medical Research, January 2023;10(1):19-24

Age and Gender Differences with Clinical Presentation of Patients with Histopathological and CT-Scan Confirmed Parapharyngeal Mass

Rehana Khanam, Shafeya Khanam, Tasnia Kabir, Ehsanul Kabir — Wed, 29 Nov 2023 00:00:00 +0000

Background: Parapharyngeal Mass can occur in different age and gender group with varied clinical features.

Objective: The purpose of the present study was to see the age and gender differences with clinical presentation of patients with histopathological and CT-scan confirmed parapharyngeal mass.

Methodology: This was a cross sectional type of study. This study was carried out in the Department of Radiology and Imaging at Dhaka Medical College, Dhaka, Bangladesh. This study was carried out from January 2014 to December 2016. Clinically suspected cases of para pharyngeal space mass lesions attended in the otolaryngology and Radiology & Imaging department of Dhaka Medical College, Dhaka, Bangladesh were enrolled in this study. The patient in this study was evaluated according to the management plan for surgery followed in Otolaryngology department, which includes History, Clinical examination, CT-scan and Histopathology. Detail history about the illness, chief complains taken in formatted history sheet. All patients were undergone CT examination of neck in the Department of Radiology and Imaging at Dhaka Medical College, Dhaka. After resection of the mass, the specimen was sent to histopathological examination to the Department of Pathology at Dhaka Medical College, Dhaka, Bangladesh.

Results: Male and female ratio was 2.57:1. Maximum 54% patients were belonged to 21-40 years’ age group followed by 38% 41 and above age group and 8.0% up to 20 years’ age group. Mean (±SD) age of the patients was 37.76 (14.82). Presence of mass, fever, malaise, pain, otalgia or fullness in ear, dysphagia, facial nerve dysfunction, trismus, dyspnea and deviation of tongue were the main presenting features of this study. Out of all lesions 58% were in left parapharyngeal space and 42% were in right. Of all patients, 20% had nerve sheath tumour (14% schwannoma & 6% neurofibroma), 6% had paraganglioma, 14% had chronic nonspecific lymphadenitis, 12% had tuberculosis, 16% had squamous cell carcinoma (invasion from adjacent spaces). Parotid pleomorphic adenoma (6%) & mucoepidermoid carcinoma (4%). Rests had, lipoma (4.0%), branchial cleft cyst (4.0%), lymphoma (6.0%), and abscess (2.0%). After histopathological evaluation 24% were malignant and 76% were benign.

Conclusion: In conclusion majority of the study population are young adult male presented with mass, fever and malaise.

Journal of Current and Advance Medical Research, January 2023;10(1):25-30

Anthropometric Analysis Between Naso Aural Inclination and Their Correlation in Bangladeshi Buddhist Rakhain Ethnic Females

Wed, 29 Nov 2023 00:00:00 +0000

Background: There is no available anthropometric data on the facial features of the Rakhain population of Bangladesh.

Objective: The aim of the study was to describe a standard of normative facial anthropometric values related to the facial height of adult healthy Bangladeshi Buddhist Rakhain females.

Methodology: This cross-sectional observational study was carried out in the Department of Anatomy, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from January 2011 to December 2011 for a period of one (01) year. Adult healthy Bangladeshi Buddhist Rakhain females in the age group of 18 to 30 years were included as the study population. The standard of normative facial anthropometric values related to facial heights were measured by upper facial height (UFH) and lower facial height (LFH).

Results: A total number of 100 adult healthy Bangladeshi Buddhist Rakhain females were recruited for this study. The mean with SD of LFH was 56.40(±5.49) and the mean with SD of UFH was 46.68(±3.34). LFH was significantly greater than UFH.

Conclusion: In conclusion, the standard of normative facial anthropometric values related to LFH is significantly greater than UFH among the adult healthy Bangladeshi Buddhist Rakhain females.

Journal of Current and Advance Medical Research, January 2023;10(1):31-34

Comparison of Open Lichtenstein Repair and Laparoscopic Transabdominal Preperitoneal of Inguinal Hernia: A Pragmatic RCT in Bangladesh

Wed, 29 Nov 2023 00:00:00 +0000

Background: Laparoscopic inguinal hernia repair has emerged as an effective alternative to open Lichtenstein mesh repair for inguinal hernias.

Objective: The purpose of the present study was to compare the surgical outcomes of laparoscopic trans-abdominal pre-peritoneal (TAPP) and open Lichtenstein mesh repair for the treatment of inguinal hernia.

Methodology: This single centered, pragmatic randomized controlled trial was conducted in the Department of Surgery at 300 bed hospital, Narayanganj, Bangladesh from January 2018 to June 2020 for a period of two and half year. Patients who were presented with reducible, primary/recurrent, complete/incomplete inguinal hernias among male and female in more than or equal to 18 years of age were selected as study population. Lichtenstein mesh repair was performed which was compared with the laparoscopy group. Open Lichtenstein repair was done under spinal anesthesia with lightweight poly propylene mesh. Laparoscopy was performed by trans-abdominal pre-peritoneal (TAPP) technique under general anesthesia and heavy weight mesh was used. The hospital stay, operating time, post-operative complications like superficial wound infection, seroma formation, scrotal swelling as well as early recurrence and chronic groin pain were compared among these group.

Results: A total number of 90 patients presented with inguinal hernia were recruited for this study of which TAPP was performed in 25 cases and 65 cases were undergone Lichtenstein repair. The mean age of laparoscopy and open group of patients were 49.28±9.9 years and 55.05±14.4 years respectively (p-0.03). The mean operation time was 85±10.31 minutes and 52.1±15.36 minutes in laparoscopy and open group respectively (p-0.000). The mean post-operative hospital stay was 2.9±0.78 days and 2.9±0.71 days in laparoscopy and open group respectively (p-0.94). In this study 21 (23.3%) patients developed 25 different early and late post-operative complications, out of which 15 (23.1%) in open group and 06 (23.3%) in laparoscopy group (p-0.52). One early recurrence was reported after 6 months follow up in laparoscopy group. Chronic groin pain was reported in 7 cases of which 5 (7.7%) cases in open group and only 2 (8.0%) cases in laparoscopy group (p-0.002).

Conclusion: In conclusion the surgical outcomes of laparoscopic TAPP performed by a young surgeon in Bangladesh has given a clinically better result than open Lichtenstein repair considering hospital stay, seroma formation, wound infection, scrotal swelling and chronic groin pain.

Journal of Current and Advance Medical Research, January 2023;10(1):35-40

Association between Serum Electrolyte Level and Outcomes among Hospitalized Liver Cirrhosis Patients Presented with Hepatic Encephalopathy Admitted at a Tertiary Care Hospital

Wed, 29 Nov 2023 00:00:00 +0000

Background: Hepatic encephalopathy is the most common and debilitating complication among the patients with cirrhosis. Electrolyte derangement is greatly related to recurrence and outcome of patients hospitalized with hepatic encephalopathy.

Objective: This study was aimed to find out the association between these two variables in our setting.

Methodology: The study was a cross-sectional study and conducted among 100 patients admitted with hepatic encephalopathy. Diagnosis and staging of hepatic encephalopathy were done based on West Haven staging, and severity of liver cirrhosis by the MELD (Model for End-Stage Liver Disease) scoring, and the outcomes were determined by the condition of the patients during discharge. Baseline serum electrolyte level was done for all the study participants.

Results: Among 100 patients, male-female ratio was 7:3 with an average (standard deviation) age 56.25(±14.8) years. Most common causes of hepatic encephalopathy were infection (40.0%), gastrointestinal bleeding (30.0%), electrolyte abnormality (30.0%). Outcomes of hepatic encephalopathy were complete recovery (75.0%), needed ICU admission (15.0%) and death (10.0%). This study found no co-relation between baseline electrolyte and complete recovery of these patients and no association with the outcome of the patients.

Conclusion: Baseline serum electrolyte have no significant influence on recovery of the patients with hepatic encephalopathy with liver cirrhosis.

Journal of Current and Advance Medical Research, January 2023;10(1):41-46

Embracing the Potential of Deep Brain Stimulation Surgery: A Path to Hope and Progress

Jalal Uddin Mohammad Rumi — Wed, 29 Nov 2023 00:00:00 +0000

Abstract Not Available

Journal of Current and Advance Medical Research, January 2023;10(1):1-2