Bangladesh Armed Forces Medical Journal

Clinical Features and Treatment Outcome of Pediatric Acute Promyelocytic Leukemia in Combined Military Hospital, Dhaka

Md Azizul Islam — 2024-05-13

Background: Acute promyelocytic leukemia (APML) is a relatively rare blood disease in children that is highly curable with current treatment strategies. It is a distinct type of AML characterized by chromosomal translocations involving the retinoid acid receptor (RAR-A) gene on chromosome 17. It accounts for 20-25% of all AML cases. The aim of this study was to describe the diagnostic features of pediatric APL and the result with ATRA and ATO based protocol.

Methods: It was a descriptive type of cross-sectional study with purposively selected 10 newly diagnosed APML patients treated in the Pediatric Oncology unit of the Department of Pediatrics in CMH Dhaka during the period of 2018 to 2022. Diagnosis of all patients were done by aspirating bone marrow morphology and cytogenetic t(15:17) or t(11:17) transcript. Informed written consent was taken from parents. Data were collected by semi-structured questionnaire and analyzed by Statistical Package for Social Sciences (SPSS version 25).

Results: Among 10 respondents median age was 4.2 years with female predominant (60%). Most common clinical presentations at diagnosis were fever (100%), bleeding manifestations (100%), Hepatomegaly (90%) bony tenderness (90%), splenomegaly (70%), and lymphadenopathy (70%). Almost all the patients had low Hb & low platelet count & WBC were variable. Cytogenetic analysis revealed 90% had PML/RARA positive & 30% had FLT3/ITD positive. All of these patients were treated with trans-retinoic acid (ATRA) based treatment, which led to 80% cases ATRA syndrome. Other common toxicities noticed febrile neutropenia (50%), severe headache (30%), hyperpigmented skin (10%), pseudotumor cerebri (10%) and others. There were 10% relapse cases, which later proceeded to relapse protocol and were in remission. The remaining 90% of patients were alive and in remission until the last day of follow-up.

Conclusion: With ATRA-based treatment overall survival is good achieved remission and only 10% of patients developed relapse.

Bangladesh Armed Forces Med J Vol 56 No (2) December 2023, pp 1-9

Study on Computed Tomography (CT) Guided Transthoracic Fine Needle Aspiration Cytology (FNAC) in the Diagnosis of Intrathoracic Mass Lesions - Not Approachable by USG

Mosammat Arina Sultana — 2024-05-13

Background: Intrathoracic mass is a general issue encountered by the physicians in whole world including Bangladesh. Accurate diagnosis is important for proper management. Percutaneous fine needle aspiration cytology (FNAC) has been extensively utilized and widely accepted as an important means of diagnostic technique. This study was performed to know and justify the computed tomography (CT) guided FNAC as a diagnostic modality for the diagnosis of intrathoracic masses which are non-approachable by ultrasonography (USG).

Methods: It was a descriptive type of cross sectional study and conducted among 30 patients having ultrasonologically non approachable intrathoracic masses during the period of Feb 2016 to July 2016 in Combined Military Hospital (CMH), Dhaka considering selection criteria and informed written consent using purposive sampling technique. FNAC was done in all the patients. After further investigation, a definitive diagnosis was made. The analysis of the surgical specimen, the biopsy, the therapeutic response, and the clinical follow-up all contributed to the ultimate diagnosis. A comparison was done between the cytological and final diagnosis for thirty cases. Ethical issues were properly addressed.

Results: Initially CT guided FNAC was carried out on all patients. Conclusive cytological diagnosis was possible in 28 patients yielding 93.33% diagnostic accuracy. FNAC diagnosed 24 cases as malignant intrathoracic mass, 04 as benign lesion and 02 undiagnosed due to inadequate tissue material. In final diagnosis 25(75%) diagnosed as malignant and 05(25%) diagnosed as benign. Diagnosis of two patients was impossible by FNAC due to inadequate tissue material.

Conclusion: CT guided FNAC of intrathoracic mass allow early diagnosis with lesser trauma and lower cost. This procedure avoided more invasive diagnostic surgery.

Bangladesh Armed Forces Med J Vol 56 No (2) December 2023, pp 10-16

Laparoscopic Versus Open Mesh Repair of Inguinal Hernia for Military Personnel

Mohammad Monir Hossain — 2024-05-13

Background: An organ or fatty tissue, like the colon, might abnormally emerge through the wall of the cavity in which it normally dwells, a condition known as a hernia. Inguinal hernia repair is among the most frequently done procedures by surgeons worldwide. Treatment includes pure tissue repairs to prosthetic repairs under open or laparoscopic approach. Though so many options are available but none is superior to others. Aim of the study is to compare the effectiveness of laparoscopic hernia repair with open mesh hernia repair.

Methods: The study was a comparative cross-sectional study. The study, which took place between 2016 and 2018, involved 100 cases in the General Surgery department of Combined Military Hospital (CMH), Savar (30 cases of laparoscopic hernioplasty and 70 cases of open hernioplasty). Purposive sampling technique was used to collect data. Data were collected during follow up of patients by using a semi-structured questionnaire. Data were analysed by using Statistical Package for the Social Sciences (SPSS) version 26.0. Informed written consent were obtained from the patients and ethical issues were duly addressed.

Results: There were 100 patients in the study, 30 of whom were assigned to group A (the laparoscopic group) and 70 to group B (the open group). In group A, the mean operating time was 103.67±23.57 minutes, while in group B, it was 50.26±2.57 minutes. In group A, there was a decrease in pain scores, with 90% of patients reporting 1-2 (mild discomfort). Three people are in excruciating pain.

Conclusion: Inguinal hernia repair is a frequently performed general surgery treatment. Because of the large socio-economic impact of inguinal hernia repair, it is the responsibility of the surgeon to consider the most advantageous approach in each given situation. For all patients needing elective hernioplasty, laparoscopic, non-randomized, pre-peritoneal mesh repair for inguinal hernias is a safe, effective method that has clear advantages over open mesh repair.

Bangladesh Armed Forces Med J Vol 56 No (2) December 2023, pp 17-23

Profile and Prevalence of Oral and Maxillofacial Diseases Among Armed Forces Personnel and Their Families in Military Dental Centre, Cumilla

Md Ataul Gani Sarker — 2024-05-13

Background: Oral and maxillofacial diseases encompass a wide range of conditions in and around oral cavity and in maxillofacial region. It includes maxillofacial trauma, cyst and tumour of jaw bones, conditions involving impacted wisdom teeth, oral premalignant and malignant lesions, fascial space infection around maxillofacial region, temporomandibular joint disorder, dental implantology, salivary gland disorder and congenital defects of jaw bones. Maxillofacial region is more vulnerable to sustain injuries in the battlefield. In peace time, various maxillofacial diseases reduce the overall performances of the troops. The aim of this study is to delineate rank wise distribution of armed forces personnel reported with maxillofacial diseases, gender distribution, types of maxillofacial diseases, different types of surgical procedures performed and types of anesthesia used.

Methods: A descriptive cross-sectional study was conducted to assess the prevalence of maxillofacial diseases among the armed forces personnel and their entitled family members during the period of 1st January 2019 to 31st December 2019 in Military Dental Centre, Cumilla. Purposive sampling technique and semi structured questionnaire was used to include the patients in this study.Data were analyzed by using Statistical Packages for Social Sciences (SPSS) version 25.

Results: A total of 170 cases were evaluated and treated. Male patients were 110(65%) and female were 60(35%). Among the military personnel numbers of sainik (privates) were highest 32(35%). Impacted wisdom teeth cases were mostly found 80(47%). In case of impacted teeth mesio angular impactions were most 35(35%). In case of maxillofacial pathological conditions cystic lesions were most in number 22(39%) (n=56). Maxillofacial soft tissue laceration cases were highest 05(29%) (n=17) among all trauma patients. Surgical extraction of wisdom teeth were mostly performed surgery 80(59%) (n=138). In regards to administration of anesthesia, 128(93%) cases were performed under local anesthesia and 10(7%) were under general anesthesia.

Conclusion: The present study imparts valuable perception about the types and prevalence of maxillofacial diseases and the treatment modalities among the armed forces personnel and their families in Cumilla area.

Bangladesh Armed Forces Med J Vol 56 No (2) December 2023, pp 24-30

Evaluation of Pneumonia Among Under-five Hospitalized Children – A Study in A Tertiary Level Military Hospital in Bangladesh

Munshi Sariful Islam — 2024-05-13

Background: Pneumonia is one of the leading causes of mortality among under-five children contributing to 15% of deaths all over the world. More than 95% of all new cases of pneumonia in children less than 5 years occur in developing countries. The aim of this study is to evaluate the socio-demographic characteristics, clinical profile, laboratory parameters and management of hospitalized children presenting with pneumonia.

Methods: A descriptive cross-sectional study was conducted among 178 children aged between 02-59 months who were admitted into Paediatrics ward of Combined Military Hospital (CMH), Jashore during the period of July 2020 to December 2021were evaluated. Data were collected by a trained physician from history, clinical examinations, laboratory findings and chest x-ray immediately after admission using a structured questionnaire with purposive sampling technique. All x-ray films were evaluated by radiologist and paediatrician independently.

Results: A total of 178 cases suffering from pneumonia were studied. Among them majority (87.08%) of children were below 36 months of age with the highest frequency of pneumonia was seen bellow 12 months (42.70%) age group. 112(62.92%) patients were male and 66(37.08%) patients were female with male-female ratio 1.7:1. Most of the patients were of normal birth weight (81.46%), fully immunized (84.27%), better maternal education, from nuclear family (81.46%) and were exclusive breast feed (70.22%). Fever, cough, breathing difficulty, tachypnoea and crackles were present nearly all patients with pneumonia. Chest x-ray suggestive of bronchopneumonia in most of the cases (91.01%). All patients received antibiotics, duration of hospital stay ranged from 03 to 14 days, mean stay was about 05 days. Nearly all the patients (97.52%) were recovered and discharged with advice.

Conclusion: Most of the patients with pneumonia were below 36 months of age with male predominance. Fever, cough, fast or difficult breathing were as a feature of pneumonia. Prompt administration of antibiotics to children with pneumonia significantly reduces the morbidity and mortality.

Bangladesh Armed Forces Med J Vol 56 No (2) December 2023, pp 31-37

Coping Strategies for Financial Burden of Family for the Children with Autism Spectrum Disorder

Mahbubur Rahman Bhuiyan — 2024-05-13

Background: Autism Spectrum Disorder (ASD) is a neurodevelopment disorder and an emerging public health issue globally which is associated with huge burden to the family, community and the nation. Study was conducted to find out the coping strategies for financial burden of the family with ASD children.

Methods: A cross-sectional study on 154 children with ASD was carried out from July 2015 to June 2016 where data were collected from two special schools and two specialized hospitals of Dhaka city. Data were collected by face-to-face interview with semi-structured questionnaire following systematic random sampling technique. Informed written consent was taken from the parents.

Results: Majority (73.4%) of the children were male and average monthly family income and total treatment cost was Tk. 41785.7 and Tk. 23076.62 respectively. However, coping strategies were adopted by the family “changing lifestyle” (96.8%), “accepting the reality” (100%), “minimizing family investment” (90.3%). Again, 52.5% families minimized family investment as coping strategies, 52.2% families had financial constraint as consequences of financial burden, which were significantly higher in comparison with others (p<0.05).

Conclusion: ASD foist huge financial burden to the families of affected children. To compensate this financial burden, families adopted different coping strategies like changing lifestyle, taking social support, relying on religion, minimizing family investment, accepting reality etc. Appropriate early diagnostic facilities should be available to estimate the actual burden of the country.

Bangladesh Armed Forces Med J Vol 56 No (2) December 2023, pp 38-44

Evaluation of Keratoconus Patients Refractive Status Before and after Corneal Collagen Cross-linking

Shafiul Ashraf Rubel — 2024-05-13

Background: Corneal Collagen Cross Linking (CXL) incorporated with riboflavin solution activated by UV (Ultraviolet) irradiation is a modern promising treatment protocol for keratoconus. Evaluation of the clinical effect of CXL treatment on keratoconus patients was the aim of this study.

Methods: This Quasi Experimental (before-and-after) study was comprised with 50 patients, having progressive keratoconus (progression was documented by Corneal Topography), reported to Cornea Clinic, CMH Dhaka, from February 2022 to January 2023. Before and after the CXL procedure; un-corrected and best-corrected visual acuity of study population was documented using Snellen visual acuity chart. Auto-refractometry readings were also noted.

Results: Among the 50 study subjects; 26 (52%) were men and 24 (48%) were female, age was 24.14 ± 5.07 (mean+SD) years and age range was 18-35 years. Mean preoperative spherical power was −1.84 ± 0.82 Diopter (D) and mean cylindrical power was −3.66 ± 0.97 D. Postoperatively, mean spherical power was found −1.15 ± 0.55 D and mean cylindrical power was −2.87 ± 0.99 D. After CXL treatment; significant vision improvement found in 15 (30%) patients (p<0.05).

Conclusion: Despite strengthening the corneal stromal collagen bond and halting the keratoconus progression, CXL treatment stabilize the refractive status of keratoconus patient and also in some extent, it improves vision.

Bangladesh Armed Forces Med J Vol 56 No (2) December 2023, pp 45-50

Effectiveness of Lung Ultrasound for Diagnosis of Acute Respiratory Distress Syndrome in Mechanically Ventilated Patients

Aminur Rahman — 2024-05-13

Background: Acute respiratory distress syndrome (ARDS) requires rapid diagnosis for early intervention and improved outcomes. Lung ultrasound may be a reasonable alternative to chest X-ray for the identification of ARDS but the effectiveness of lung ultrasound in ARDS diagnosis is still uncertain. The objective of the study is to explore the efficacy of lung ultrasound (LUS) for diagnosis of ARDS in mechanically ventilated patients.

Methods: A cross sectional study was conducted among 75 patients in Critical Care Centre, Combined Military Hospital, Dhaka from September 2021 to January 2022. The study was approved by the ethical committee in the hospital. In this study, the Bedside Lung Ultrasound in Emergency (BLUE) protocol for the immediate diagnosis of acute respiratory failure was followed. Purposive sampling technique was used. Data were analyzed by using Statistical Package For Social Sciences (SPSS) version 25.0.

Results: A total of 75 patients were assessed. Among them male were 42(56%) and female 33(44%). The median age of patients was 48 years (Interquartile range 30-60). Primary diagnoses were pneumonia (22.67%), pulmonary oedema (20%), sepsis (20%) and trauma (17.33%). A total of 34(45.33%) patients fulfilled ‘CXR-based Berlin Definition’ and a total of 36(48%) patients were diagnosed as ARDS by ‘LUS-based Berlin Definition’. Considering the ‘CXR-based Berlin Definition’ as reference standard, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of lung ultrasound were 85.29%, 82.92%, 80.55%, 87.18% and 84% respectively.

Conclusion: Lung ultrasound can be an effective tool for the diagnosis & management of ARDS in the intensive care unit.

Bangladesh Armed Forces Med J Vol 56 No (2) December 2023, pp 51-57

Iron in Drinking Water and its Impact on Human Health –A Study in Selected Units of Jalalabad Cantonment

Irtika Rahman — 2024-05-13

Background: Prevalence of diseases due to appearance of excessive amount of iron in drinking water is increasing day by day. Often people are unaware about the harmful effects of excess iron that may be present in drinking water. Sometimes they overlook minor symptoms. Adequate study was not conducted before to rule out actual scenario. The aim of this study is to represent the detrimental effect of excessive iron in drinking water as well as to create awareness to get rid of it.

Methods: A cross-sectional study was carried out in 17 units of 17 Infantry Division, Jalalabad Cantonment, Sylhet covering the period of January 2019 to May 2019. Total 52 participants were selected purposively who had been suffering from various kinds of abdominal symptoms; their source of drinking water was marked. Water was collected from 5 different sources to see iron level. Again they were monitored after establishing Reverse Osmosis water filter. Iron level at drinking water was also tested each time at laboratory by Atomic Absorption spectrometry method. Informed written consent was taken from the patients. A semi-structured questionnaire was developed and data were collected by face to face interview. Analysis was done by using Statistical Package for the Social Sciences (SPSS version 25).

Results: Among 52 respondents, maximum i.e. 25(48.07%) developed moderate to severe constipation followed by 16(30.76%) developed dyspepsia and while others i.e.11(21.15%) had both the symptoms. Symptoms were most severe among the persons who used to drink water having highest concentration of Iron (1.9 mg/L). After establishment of Reverse Osmosis water purifier the iron concentration in water reduced significantly and only 4(8%) had constipation and 6(12%) had dyspepsia.

Conclusion: Iron is a natural constituent of drinking water. But considering the harmful impact of excessive iron present in drinking water to human health, regular monitoring should be ensured to identify the risk group.

Bangladesh Armed Forces Med J Vol 56 No (2) December 2023, pp 58-64