Anwer Khan Modern Medical College Journal

Increasing Trends of In Vitro Fertilization Worldwide

2023-03-06T06:53:37+00:00

Abstract not available

AKMMC J 2022; 13(1) : 1-2

Outcome of Different Treatment Modalities in Non-caseating Granulomatous Mastitis: A Narrative Review

2023-03-06T09:14:20+00:00

Granulomatous mastitis (GM) is a benign inflammatory condition of breast disease that affects women of childbearing age with a history of breastfeeding. The rarity and complex pathophysiology make the diagnosis and management quite dilemmatic for clinicians. This review explored the available treatment options for the disease condition in light of the recent literature. Surgery alone, intervention with or without steroids, antibiotic therapy, abscess drainage, methotrexate therapy, and antibiotics are widely used in different settings. However, surgery (with or without steroids) showed a higher recovery rate along with a lower recurrence rate. Steroid therapy is promising, but its use is limited due to the higher number of recurrences. In addition, the use of methotrexate showed an increased remission rate, but the toxicity profile was still high. However, treatment outcome mostly depends on the severity of the disease and individual physical status, and therefore, a comprehensive evaluation of the patients is crucial. This review recommended the formulation of a standard guideline for uniform management of granulomatous mastitis conditions in our country.

AKMMC J 2022; 13(1) : 47-51

Clinical Spectrum and co morbidities of COVID 19 cases admitted at Anwer Khan Modern Medical College Hospital (AKMMCH): A Retrospective record review

2023-03-06T06:53:38+00:00

Background: Coronavirus diseases 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has induced a sense of panic around the world and has been declared Pandemic by the World Health Organization (WHO) on the 11th March 2020. Bangladesh a country of 17 million people is not an exception regarding COVID-19. It has reported around five lacs COVID-19 cases with seven hundreds of deaths. In dealing those challenges AKMMCH has started opening a COVID-19 unit since July 2020 in order to render services for the admitted cases.

Objective: The objective of this study was to explore the clinical spectrum of COVID-19 admitted cases, co morbidities, in addition to selected socio-demographic characteristics under review.

Material and Methods: This descriptive type of retrospective record review was carried out among 1690 COVID-19 confirmed cases during the period of July-December 2020. Data were generated from hospital COVID unit admission records using a checklist. Data entry and statistical analysis were performed manually and by using computer.

Results: The study revealed that majority of the cases was found within age 31-70 years with mean age 52.58 and standard deviation ± 21.7. About 76% cases were male and 24% were female. It also revealed that the clinical spectrum of COVID-19, 63% & 23% cases were moderate and severe cases respectively and only 9% were critically severe. Majority of the cases had chronic illnesses and the most common co-morbidities were Hypertension (44%), Diabetes (26%) and Cardiac diseases (10%).

Conclusion: It may be stated that male persons with more than 52 years of age were mostly affected by COVID-19 diseases. Usually moderate to critically severe patient were admitted in hospital COVID-19 unit for better treatment. Hypertension, Diabetes, Asthma and Cardiac diseases were found as the most common co-morbidities. A comprehensive case management protocol involving allied disciplines (medicine, cardiology, and endocrinology) can be implemented towards improved services and better out come in particular.

AKMMC J 2022; 13(1) : 3-7

Dyslipidaemia in Schizophrenia

2023-03-06T06:53:39+00:00

Background: Lipid neurochemistry is an important focus in schizophrenia research. Disorder of fatty acid metabolism within the brain tissue play an important role in the pathophysiology of schizophrenia.

Material & Methods: To evaluate the association of dyslipidaemia with Schizophrenia and compare the serum lipid profile with healthy individuals, a cross sectional analytical study was conducted between July 2011 and June 2012 in the Department of Biochemistry, Dhaka Medical College, following approval of a protocol. As per criteria, total 100 cases were included in this study and divided into two groups: Group-I (Diagnosed cases of schizophrenia) and Group-II (Healthy individuals). Written informed consent was taken from all cases. Serum lipid profile (Total Cholesterol, Triglycerides, HDL and LDL) was estimated from both groups by enzymatic determination.

Result: Fasting serum triglyceride (p<0.03), HDL cholesterol (p<0.001) and LDL cholesterol (p<0.001) between the groups are significantly related. In group-I mean serum HDL cholesterol is reduced, but LDL cholesterol and Triglyceride were elevated in comparison with group-II. No significant relationship was observed in fasting serum total cholesterol in between groups (p>0.05). Result indicates strong association between schizophrenia and dyslipidaemia. That association would increase the risk of developing coronary heart disease in those patients with schizophrenia compared with healthy individual.

AKMMC J 2022; 13(1) : 8-13

Early Metastasis in Different Types of Breast Carcinoma - A Personal Experience

2023-03-06T06:53:41+00:00

Background: Carcinoma breast is one of the leading causes of death in woman today and is the most common cancer among women. More than 2.3 million of women are diagnosed breast cancer each year world-wide. Carcinoma breast may present from an extent of non-palpable lump to a fixed mass with distal metastasis. As presentation is highly variable, management strategy varies even in same stage of disease.

Objective: To identify early metastasis of different types of breast carcinoma and its management.

Materials and methods: This is a prospective type of observational study in 100 cases done in the different surgical units of Dhaka Medical College Hospital (DMCH), Bangabandhu Sheikh Mujib Medical University (BSMMU) and Bashundhara Ad-din Medical College Hospital (BAMCH).Patients were selected clinically and by some standard investigation (FNAC and core biopsy) from January 2006 to December 2018.

Result: Patients at different age groups had suffered from different types of breast carcinoma. Early diagnosis by triple assessments and proper surgical and post-surgical managements reduced both loco- regional and distant metastasis and also reduced both morbidity as well as mortality. Results of treatment and histopathological reports were recorded. It was found that FNAC is cheap and minimally invasive diagnostic procedure with high sensitivity (100%) and specificity (95%).Core needle biopsy is more accurate tissue diagnostic in breast cancer. Down staging has profound symptomatic and cosmetic benefit. In renders inoperable tumors become operable and reduce morbidities.

Conclusion: Early diagnosis and treatment is the mainstay to achieve satisfactory outcome. Screening program especially Self-Breast Examination (SBE) is very much helpful in early diagnosis of disease in our social setting. Screening mammography has had the most substantial impact on the early diagnosis of, and subsequent decrease in mortality from breast carcinoma. Women of 20-40 years of age should have a breast examination every 2-3 yearly. Women of more than 40 years of age should have a breast examination every yearly.

AKMMC J 2022; 13(1) : 14-21

Periodontal Diseases and Associated Factors among Type 1 Diabetes Mellitus Patients from Selected Clinics in Dhaka, Bangladesh

2023-03-06T06:53:42+00:00

Introduction: Periodontal disease and diabetes mellitus are the two most prevalent chronic diseases and global burdens in the world. Periodontal disease comprises gingivitis and periodontitis. An increasing trend of periodontal disease is reported among diabetic patients in Bangladesh. Limited studies have investigated the association between type 1 diabetes mellitus and periodontal disease in Bangladesh. This study, therefore, aims to investigate the association of demographic characteristics, lifestyle factors, diabetic-related factors, and oral hygiene practice with periodontal disease among type 1 diabetes mellitus in Dhaka, Bangladesh.

Methods: Survey and clinical examination of this cross-sectional study were conducted in three well-known clinics in Dhaka. A total of 182 participants were clinically examined based on inclusion and exclusion criteria.

Results: A higher prevalence of periodontitis was found compared to gingivitis among type 1 diabetes mellitus. About 30.2% of the respondents had moderate periodontitis, followed by mild periodontitis 28.6%. The majority of respondents (30.8%) had mild gingivitis and only 14.8% had moderate gingivitis. Furthermore, proportions of periodontitis and gingivitis were positively associated with age [(aOR1.12 (95%cis=1.07, 1.17)] and lower education. A significant association of periodontitis was found with the duration of diabetes [(aOR) 0.95 (95%cis=0.90, 0.99)] and frequency of toothbrushes (42-fold greater).

Conclusions: The findings of this study imply that dentists should emphasize on patients for well metabolic control to prevent the progression of periodontal disease.

AKMMC J 2022; 13(1) : 22-31

Relationship of the antibody level between male and female SARS-CoV-2 infected patients in Dhaka city

2023-03-06T06:53:44+00:00

Background: The Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) created an emergency situation experienced by the world.

Objective: To compare the antibody status after SARS-CoV-2 infection in male and female patients.

Methods: This cross-sectional study was conducted in the Department of Biochemistry and Molecular Biology, BIRDEM General Hospital, from July, 2020 to June, 2021. A total of 154 patients (age 18 – 70 years) infected by SARS-CoV-2 were enrolled for this study. Among them, 78 were male and 76 were female. The study subjects were non-vaccinated. For this study, serum IgG level was measured by the automated analyser. For statistical analysis, the Mann Whitney U test was done.

Results: the age distribution of male and female patients. The age group of 50-59 years comprised most of the male patients in comparison to the female study group. Patients with hypertension, diabetes mellitus were more prone to SARS-CoV-2 infection in both groups. Here male patients had more positive history of comorbidities than female patients. Mann-Whitney U test was done to analyze the data which revealed presence of significantly higher IgG in female patients. Here, p <0.02 which was fairly statistically significant.

Conclusion: The antibody level of female patients was significantly higher than that of male patients after SARS-CoV-2 infection.

AKMMC J 2022; 13(1) : 32-36

Lung Cancer Scenario of NICRH: A Cross Sectional View

2023-03-06T09:14:18+00:00

Introduction: Lung cancer alone and in coalition can deactivate life-wheel. But a very little attention had been paid to address the riddle. This effort is to candle the light on the lung cancer disease.

Objective: This study was conducted to delineate the sociodemographic factors and clinical conditions of lung cancer patients. To determine some associations of SD variables and clinical conditions.

Methods & Materials: This cross-sectional study was conducted in NICRH from July 2017 to June 2018 among 167 LC patients. Data were collected by interview using semi-structured questionnaire and reviewing of check list. Data were checked thoroughly, edited, coded, categorized, cleaned and analyzed using software (SPSS version 23).

Results: This study revealed that mean age of the patients was 56.16 ± SD 9.88. Among which 80.2% were male and 19.8% female. Majority had primary 51.1% education Secondary were 26.4%. Regarding occupation, farmer were 37.1%, businessmen were 20.4% and homemaker were 15.6. The mean income was Tk. 17163 ± SD Tk. 10587. Most had nuclear family 89.2%. Rural inhabitants were 61.1%. In describing cancer type, 81.5% had NSCC and 16.8% had SCC. Regarding clinical condition, 70% had poor, 7.8% had average and 22.2% had severe clinical condition. The residential areas are significantly (χ2, p < .05) associated with clinical conditions. Staging of lung cancer is significantly (χ2, p < .05) associated with clinical conditions.

Conclusion: Socioeconomic factors like age, family income, education, residential condition may affect clinical condition.

AKMMC J 2022; 13(1) : 37-41

Residual astigmatism following cataract surgery

2023-03-06T09:14:18+00:00

Objective: To determine the amount of residual astigmatism following cataract surgery.

Materials and methods: A hospital based observational study was conducted in a tertiary eye hospital, Bangladesh during the period of July, 2013 to June, 2014. Patients was selected for the study who diagnosed as ARC with variable amount of astigmatism (1.5 to 3.5D), and excluded any other ocular pathology or history of previous ocular surgery. Phacoemulsification with PC Toric IOL implantation in all cases. Auto refracto-keratometer was done Preoperative and postoperatively for assessing the astigmatism. Main outcome measured were included preoperative uncorrected visual acuity, postoperative uncorrected visual acuity on 1stPOD, after 1 week and 1month, Preoperative keratometry, Preoperative astigmatism, Postoperative uncorrected keratometry on 1^st POD, after 1 week and 1month, Postoperative uncorrected astigmatism on 1stPOD, after 1 week and 1month

Results: 30 eyes of 28 patients were assessed in this study. Due to clear corneal incision during phacoemulsification, the steep meridian became flat significantly from pre-operative keratometry 44.329±1.473D (mean±SD) to 30thpost operative keratometry 43.971±1.431D (mean±SD) having p<0.001. On the other-hand the flat meridian became steeper from pre-operative keratometry 42.225±1.471D (mean±SD) to 30thpost operative keratometry 42.421±1.501D (mean±SD) having p<0.001. Preoperative mean astigmatism [Mean±SD] was 2.104±0.319D, after the first postoperative day, mean astigmatism decreased to 0.954±0.494D with p<0.01, and finally after 1 Month there was significant reduction of pre-operative astigmatism to 0.583±0.413D with p<0.0001. So, the mean pre-operative astigmatism decreased significantly in the successive post-operative days.

Conclusion: Toric Intraocular lens implantation in phacoemulsification surgery can correct pre-existing corneal astigmatism significantly after one month of surgery.

AKMMC J 2022; 13(1) : 42-46

Progressive pseudo-rheumatoid dysplasia -a rare genetic disorder: Case Report

2023-03-06T09:14:21+00:00

Progressive pseudorheumatoid dysplasia (PPRD), also known as spondyloepiphyseal dysplasia tarda with progressive arthropathy (SEDT-PA), is an autosomal recessive disorder, resulting from mutations in the WNT1-inducible signaling pathway protein 3 (WISP3) gene involving the axial skeleton as well as small peripheral joints. Because of rarity here we present a case of 14-year-old boy, 1st issue of consanguineous parents who was presented with pain & gradual development of contracture in 3rd distal interphalangeal joint of right hand when he was 4-year-old, then gradual involvement of other interphalangeal joints of hands, bilateral wrists, elbows, shoulder, knees &ankles occurred over years with the development of contractures and restricted movement. For last few years, he developed difficulty in walking. Clinically spinal scoliosis and coxa vara was present. Mobility of spines and multiple joints including proximal & distal interphalangeal joints of hands, wrists, elbows, shoulders, knees, ankles were restricted with flexion contractures. The gait of the patient was limping. Radiological evaluation showed osteopenia in X-ray of pelvis with both hip joints and both knee joints. Generalized osteopenia, fusiform swelling in distal interphalangeal joint, flexion deformity in distal interphalangeal joint of middle and ring fingers of both hand was shown in X-ray of both hands. MRI of lumbosacral spine showed dorso-lumbar vertebral bodies dysplastic with anterior wedging producing bullet nose. Superior epiphyseal deformity was also noted in lower dorsal bodies suggestive of spondyloepiphyseal dysplasia of dorso-lumbar spine. Genetic study showed homozygous nonsense variation in exon 5 of the WISP3 gene suggestive pathogenic variant. Finally, he was diagnosed as a case of PPRD and treated with physiotherapy, family counseling, and anti-inflammatory medications.

AKMMC J 2022; 13(1) : 52-55

Primary Distal renal tubular acidosis: case series

2023-03-06T09:14:23+00:00

Primary Distal renal tubular acidosis is an infrequent tubular disorder with complex pathophysiology that present with poor growth, skeletal changes and sometimes life-threatening hypokalemia. Here we present two siblings one girl and one boy with a consanguineous parents presented with polyuria, polydipsia, failure to thrive and skeletal deformity. Both cases showed non-anion gap metabolic acidosis with alkaline urine and the younger brother had periodic paralysis due to hypokalemia. After diagnosis and treatment they showed good response with alkali therapy.

AKMMC J 2022; 13(1) : 56-59

Goldenhar syndrome

2023-03-06T09:14:25+00:00

Goldenhar Syndrome or Oculoauriculovertebral Syndrome is a complex syndrome characterized by an association of maxillomandibular hypoplasia, deformity of the ear, ocular dermoid and vertebral anomalies and the most severe form of hemifacial microsomia. Here we describe a 12 years female patient with Goldenhar Syndrome came to Ophthalmology department at Anwer Khan Modern Medical College & Hospital.

AKMMC J 2022; 13(1) : 60-64