BIRDEM Medical Journal

The roles and responsibilities of editors in biomedical journals

Muhammad Abdur Rahim — 2024-01-29

Abstract not available

BIRDEM Med J Jan 2024; 14 (1): 1 - 2

Birdem News Vol. 14(1)

Muhammad Abdur Rahim — 2024-01-29

Abstract not available

BIRDEM Med J 2024; 14(1): 57

From the Desk of Executive Editor Vol. 14(1)

Muhammad Abdur Rahim — 2024-01-29

Abstract not available

BIRDEM Med J 2024; 14(1): 58

Evaluation of hysterosalpingography findings in women with infertility

Shahana Shermin — 2024-01-29

Background: Hysterosalpingography (HSG) helps in diagnosis of uterine and fallopian tube abnormalities. Use of HSG in investigating infertile women may provide important information useful to the gynaecologists during treatment planning. The aim of this study was to review the pattern of HSG findings in patients being advised to do the investigation for infertility evaluation.

Methods: This cross-sectional observational study included 150 patients undergoing HSG at Popular Diagnostic Centre, Shantinagar, Dhaka, Bangladesh from March to October 2022. All the patients were duly counseled and a written informed consent was obtained. The HSGs were performed between the 7th and 11th day of the menstrual cycle with iodine containing water-soluble contrast media iohexol (Imiro™). A non-steroidal antiinflammatory drug (NSAID) was given 20 minutes prior to the procedure. All the patients were given prophylactic antibiotic. The clinical data and radiological findings were tabulated and analyzed.

Results: The age of the infertile women ranged between 18 and 45 years, with a mean ± SD of 28.18 ± 5.69 years. Majority of the patients (73.3%) were referred due to secondary infertility and 32.72% of them were from 25-29 years group. The mean ± SD duration of marriage (in years) was 7.9 ± 4.3 and that of subfertility (in years) was 4.4 ± 2.8. HSG revealed either uterine or tubal pathology in 34.7% patients and 3.3% patients had abnormalities in both uterus and fallopian tubes. The commonest abnormality reported was bilateral tubal blockade in 19 patients, 4 in primary subfertility and 15 in secondary subfertility patients. Uterine abnormalities were observed in 8.7% patients and arcuate uterus was the commonest (4.70%) finding.

Conclusion: HSG revealed either uterine or tubal pathology in one-third of patients and 3.3% patients had abnormalities in both uterus and fallopian tubes. Uterine abnormalities were also detected in 8.7% of the study subjects. Wide and wise application of HSG can avoid the practice of unnecessary and sometimes more aggressive procedures in evaluation of women with infertility.

BIRDEM Med J 2024; 14(1): 3-9

Microbiological profile of community acquired pneumonia in diabetic patients and their antibiotic sensitivity pattern in a tertiary care hospital of Bangladesh

Tanvir Ahmed — 2024-01-29

Background: Diabetes mellitus is an immunosuppressive state leading to increased susceptibility to various infections. Pneumonia, urinary tract infection, skin and soft tissue infection are more common in diabetic population. Pneumonia in diabetic patient is often atypical, caused by more virulent organisms and associated with increased antibiotic resistance. The predisposition for infection may also be based on conditions that interfere with normal clearance mechanisms and on disturbance of pulmonary immune cell function. Several aspects of immunity such as polymorphonuclear leukocyte function (i.e. leukocyte adherence, chemotaxis and phagocytosis) and bactericidal activity of serum are depressed in patients with diabetes. This study was designed to evaluate the microorganisms most commonly causing community acquired pneumonia in diabetic patients.

Methods: This descriptive type of cross-sectional study was conducted in Department of Medicine, BIRDEM General Hospital from 25th March 2018 to 24th September 2018. Total 50 diabetic patients with community acquired pneumonia were included. Detail demographic data were collected and recorded in structured case report form. Clinical examination and relevant investigation were done. Antibioctic sensitivity pattern of isolated organisms were studied.

Results: Mean age of the patient was 53.4 ± 11.5 years. Male and female ratio was 1.6:1. In this study Klebsiella pneumoniae was found to be the most prevalent 14 (30.4%), followed by Streptococcus pneumoniae 11 (23.9%). Among the Gram-positive cocci, Streptococcus pneumonia 11 (23.9%) was the predominant, followed by Staphylococcus aureus in 6 (13.0%) patients. Bacterial antibiotic sensitivity pattern to ceftriaxone, ceftazidime, cefixime and amoxycillin were as follows: Klebsiella pneumonia (57.1%, 14.2%, 28.5%, 21.4% respectively), Streptococcus pneumonia (45.5%, 54.5%, 36.3%, 0% respectively). Present study shows that maximum patients (72.0%) were having uncontrolled glycemic status. In this study, most of the growth of all the bacteria (Klebsiella 64.2%, Staphylococcus 72.8%, Pseudomonas 60.0%, Acinetobacter 100%, E. coli 100%) occurred in patients with poor glycemic control (HbA1c ³7.0%).

Conclusions: This study results concluded that CAP in diabetic patients are more frequently due to Gram negative bacilli like Klebsiella pneumoniae, Pseudomonas and also Staphylococcus aureus and they are resistant to commonly used antibiotics. So, effective treatment of community acquired pneumonia in diabetic patients should be guided by sputum culture results.

BIRDEM Med J 2024; 14(1): 10-15

The relationship between duration of diabetes mellitus and bone mineral density in postmenopausal female diabetic patient with diabetic retinopathy

Maria Siddika Mira — 2024-01-29

Background: Diabetic retinopathy is a complication of diabetes caused by high blood sugar level affecting the eyes. The duration of diabetes appears to be an important risk factor for fractures. Chronic hyperglycemia is widely documented to have an effect on bone health, causing fragility, mechanical strength decrease and an increased susceptibility to fracture due to altered bone matrix microstructure and aberrant bone cell function, despite normal or increasing bone mineral density (BMD). The purpose of this study was to see the relation between duration of diabetes mellitus and BMD in postmenopausal female diabetic patient with diabetic retinopathy.

Methods: This cross-sectional study was conducted at the Department of Ophthalmology, BIRDEM General Hospital, Dhaka, Bangladesh during June 2019 to March 2021.After completing their entire ophthalmic examination, 68 post-menopausal female patients between the age of 45 and 70 who had type 2 diabetes with or without diabetic retinopathy (34 in each group) were chosen by using a non-probability sampling technique. After receiving informed written consent, they underwent BMD testing (of lumber spine and femoral neck) at the Institute of Nuclear Medicine and Allied Science (INMAS) by using dual energy x-ray absorptiometry.

Results: The mean BMD of lumbar spine was found -2.25±0.91 in diabetic retinopathy group and -1.69±0.99 in without diabetic retinopathy group. The difference was statistically significant (p<0.05). The mean BMD of femoral neck was found -2.4±0.9 in diabetic retinopathy group and -1.9±1.1 in without diabetic retinopathy group. The difference was statistically significant (p<0.05). There was a negative correlation between the duration of diabetes mellitus and the BMD of the lumbar spine (r= -0.699; p=0.001) and the femoral neck (r= -0.695; p=0.001) in diabetic retinopathy patients. There was a negative correlation between the duration of menopause and the BMD of the lumbar spine (r= -0.405, p= 0.018) and the femoral neck (r= -0.395, p= 0.021) in diabetic retinopathy patients. There was also a negative correlation between the duration of diabetes mellitus and the BMD of the lumbar spine (r= -0.418; p=0.014) and the femoral neck (r= -0.384; p=0.025) in without diabetic retinopathy patients. Negative correlation was also found between the duration of menopause and the BMD of the lumbar spine (r= -0.785; p=0.001) and the femoral neck (r= -0.802; p=0.001) in without diabetic retinopathy patients. But in case of diabetic retinopathy patient there was more statistically significant reduction of BMD with increasing duration of DM.

Conclusion: Patients with diabetes mellitus for a longer period of time with diabetic retinopathy have considerably lower lumbar spine and femoral neck BMD than patients without diabetic retinopathy.

BIRDEM Med J 2024; 14(1): 16-22

Effects on heamodynamics and postoperative analgesic requirement after major abdominal surgeries: comparison between continuous epidural infusion of 0.2% ropivacaine and 0.125% bupivacaine

Md Shafiul Alam Shaheen — 2024-01-29

Background: Major abdominal surgeries induce neuro-humoral changes responsible for postoperative pain, various organ dysfunctions and prolong hospitalization. Inadequate pain therapy prolongs the hospital stay and increases the mortality rates. Epidural analgesia confers excellent pain relief leading to a substantial reduction in the surgical stress response. Type 2 diabetic patients have multiple comorbidities with cardiovascular complication and they are more vulnerable to pain. The purpose of this study was to compare the effect of ropivacaine and bupivacaine with fentanyl on haemodynamic and postoperative analgesic requirement of type 2 diabetic patients for major abdominal surgeries.

Methods: This prospective, double blind, randomized study were conducted in sixty patients who were going to be operated for major abdominal surgeries from 1st January 2022 to 30th June 2022 at the department of Anaesthesiology and Surgical ICU, BIRDEM General Hospital, Shahbagh, Dhaka, Bangladesh. The study population was randomly divided into group R & group B with 30 patients in each group. Every patient received an epidural block in the sitting position at the T8-9 or T9-10 level via 18 G Touhy needle. Each patient in group R received 0. 2% ropivacaine with 2 μgm. fentanyl / ml solution through epidural catheter @ 6 - 14 ml / hr. and group B received 0.125% bupivacaine with 2 μgm. fentanyl / ml solution through epidural catheter@ 6 - 14 ml / hr.

Results: Peroperative mean systolic blood pressure, mean diastolic blood pressure, mean arterial blood pressure and heart rate were more stable in group R but statistically not significant (p>0.05) and in post operative period group R patients had significantly lower mean visual analogue scale (VAS) score than group B which was statistically significant (p<0.05) but additional analgesic requirement were slightly higher in group B which was not statistically significant (p>0.05).

Conclusion: The results of our study suggest that epidural analgesia using ropivacaine 0.2% infusion is more effective than bupivacaine when used for postoperative pain relief and ropivacaine can be used as a safe alternative to bupivacaine for major abdominal surgeries.

BIRDEM Med J 2024; 14(1): 23-30

Presentation and clinical profile of Turner syndrome: experience at a tertiary care hospital in Bangladesh

Sabrina Jasim — 2024-01-29

Background: Turner syndrome (TS) is a chromosomal disorder caused by complete or partial X chromosome monosomy that manifests various clinical features depending on the genetic background of affected girls. This study was designed to describe the presentation and clinical spectrum of patients with Turner Syndrome to create awareness for early referral.

Methods: Our study included karyotype-proven TS patients aged 0-18 years who attended the Paediatric Endocrinology & metabolism outpatient department of BIERDEM Women and Children Hospital during the years 2018-2022. Retrospective data on the initial presentation, clinical spectrum and chromosomal abnormalities of patients diagnosed with Turner syndrome were extracted from the departmental database.

Results: A total number of sixty patients were diagnosed as Turner Syndrome during the study period. The mean age was 10.6±4.0 year. The mejority (63.4%) were diagnosed between 11-18 years, between 5 to 10 years of age 21.7% and 15 % were diagnosed before the age of 5 years. The common presentation complaints were short stature (75%), delayed puberty (50%) and among patients diagnosed before age one year pedal edema (8%). Common dysmorphic features were wide spaced nipple (41.6%), webbing of neck (35%), low hair line (25%), short neck (21.7%), increased carrying angle (20%) & hyperconvex nail (20%). Most of the patients presented with the karyotyping 45,XO (61.7%) followed by 46,XX/45,XO (217%). Among the associated comorbidities cardiac defects was the most common, occuring in 23.4 % of the TS cases. This was followed by dyslipidemias (10%), autoimmune hypothyroidism (8.3%), obesity (6.6%) and Type 1 DM (1.6%). Behavioral problem was found in 8.3% of patients with TS. Other manifestations included speech delay (5%), hearing problem (3.3%) and repeated otitis media (1.6%).Hypoplastic uterus with streaky ovaries were found in 91.6% cases & renal anomalies were found in 8.3% patient (horse shoe kidney 5%, hydronephrosis 1.6% & ectopic kidney in 1.6% case).Luteinizing hormone and follicular stimulating hormone was raised in 90% case with TS.

Conclusions: The majority were diagnosed and referred to Paediatric Endocrinologists after 5 years of age. A high degree of clinical suspicion can help us diagnose these children earlier. If TS is diagnosed earlier, growth can be achieved up to their maximum potential and also identification and address of comorbidities will provide better life.

BIRDEM Med J 2024; 14(1): 31-37

Comparison between high-performance liquid chromatography and chemiluminescent immunoassay platforms in determining vitamin D levels in healthy population

Arif Mahmud — 2024-01-29

Background: Accurate measurement of serum vitamin D level is crucial for diagnosis and managing vitamin D deficiency, as associated with various health problems. High-performance liquid chromatography (HPLC) is commonly used methods for measuring serum vitamin D levels, but limited research has compared their performance with other available and reasonably less expansive method of testing Vitamin D levels like, Chemiluminescent immunoassay (CLIA). This study is intended to see the reliability of CLIA method compared with HPLC in measuring serum 25-hydroxyvitamin D [25(OH)D] levels in apparently healthy individuals.

Methods: In this analytical cross-sectional study, we evaluated the reliability of CLIA method and compared to HPLC as standard, in measuring serum 25-hydroxyvitamin D [25(OH)D] levels among apparently healthy individuals. Serum samples from 76 participants were analyzed using both HPLC and CLIA.

Results: In the HPLC method, the mean ± SD and median of 25(OH)D levels were 24.73 ± 17.80 ng/ml and 19.67 ng/ml, respectively. In the CLIA method, the mean ± SD and median of 25(OH)D levels were 29.96 ± 21.59 ng/ml and 22.59 ng/ml, respectively. Our results showed differences in mean and median values of 25(OH) D levels between the two methods, with higher values obtained from CLIA. However, there was a significant correlation between results obtained from both methods, indicating reasonable diagnostic accuracy. The coefficient of variation was higher in CLIA, suggesting higher variability in measurements. The Intraclass Correlation Coefficient for consistency was high in both methods, indicating good agreement between repeated measures. The Area Under the Curve for differentiating normal or low 25(OH) D levels and determining deficiency or not was high for both methods, indicating good diagnostic performance.

Conclusion: Our study suggests that while there are differences in results between CLIA and HPLC methods for measuring serum vitamin D levels, both methods show reasonable diagnostic accuracy in a real-world clinical setting. Factors such as laboratory setup, resource availability, and population characteristics should be considered when choosing a method for measuring serum vitamin D levels.

BIRDEM Med J 2024; 14(1): 38-42

Laparoscopic completion cholecystectomy: experiance in BIRDEM General Hospital

Md Ezharul Haque Ratan — 2024-01-29

Background: After cholecystectomy, patients often present with post-cholecystectomy syndrome. Among a handful of causes, remnant gallbladder pathology is a rare entity. We are here presenting a series of remnant gallbladder pathology cases, who were managed laparoscopically.

Methods: A prospective study of post-cholecystectomy syndrome patients who showed remnant gall bladder stones in ultrasonogram. Data on diagnostic workup, management and the challenges encountered in handling such patients were collected.

Results: Eight patients presented with remnant gall bladder stones, between January 2011 to June 2019. Six of them were female. These patients presented a variable time period after initial surgery, earliest after 3 months, with persistent pain in right hypochondriac region. Difficult cholecystectomy was documented in operation notes of two cases. Seven of them were managed by laparoscopic completion cholecystectomy.

Conclusion: A symptomatic gallbladder remnant after cholecystectomy is rarely seen. However, the diagnosis should be considered in patients with recurrent biliary symptoms after a difficult cholecystectomy. Completion cholecystectomy is challenging both for patient as well as the surgeon but it is the definitive treatment for such cases. Laparoscopic completion cholecystectomy is our recommended technique.

BIRDEM Med J 2024; 14(1): 43-48

A case of organophosphate induced delayed motor neuropathy without any sensory involvement

Mohammad Mainul Hasan Chowdhury — 2024-01-29

Organophosphate induced delayed neuropathy is a sensory-motor distal axonopathy that usually occurs after ingestion of certain organophosphate compound. It is usually characterized by distal degeneration of axons of peripheral nervous systems, predominantly in lower limbs and occurs within 2–6 weeks after exposure. Clinical features include cramping muscle pain, distal numbness, paresthesia, followed by progressive weakness and loss of deep tendon reflexes in affected limbs. Electrophysiological studies reveal a motor axonal neuropathy characterized by reduced amplitude of the compound muscle potential and normal or reduced nerve conduction velocities. We report a case of 29-year-old male patient who developed progressive lower limbs weakness over four weeks after ingestion of chlorpyrifos based insecticide. His nerve conduction study revealed motor axonal neuropathy without any sensory involvement affecting both lower limbs.

BIRDEM Med J 2024; 14(1): 49-52

An elderly patient with Bickerstaff brainstem encephalitis: a case report

Md Rashedul Islam — 2024-01-29

Bickerstaff brainstem encephalitis is a rare autoimmune inflammatory disorder characterized by the triad of ophthalmoplegia, ataxia and decreased consciousness. It is considered as a variant of Miller Fisher syndrome and Guillain-Barré syndrome but differentiated by the presence of clinical features of central nervous system involvement. Here, we present a case of Bickerstaff’s brainstem encephalitis with classical clinical features, suggestive radiological findings and positive anti-GQ1b antibody.

BIRDEM Med J 2024; 14(1): 53-56