Bangladesh Medical Journal 2021-03-24T08:14:47+00:00 Dr Kazi Shafiqul Halim (Zimmu) Open Journal Systems <p>The official organ of the <a title="BMA" href="" target="_blank" rel="noopener">Bangladesh Medical Association</a>. Full text available.</p> Serum C-reactive Protein Predicts Early Mortality in Patients with Decompensated Cirrhosis of Liver 2021-03-24T08:14:27+00:00 Md Atikul Islam Sheikh Mohammad Noor E Alam Dulal Chandra Das Narwana Khaleque M Abul Khair Yousuf Mamun Al Mahtab <p>Serum C-reactive protein is a marker of systemic inflammation, which has been studied to predict mortality and cirrhosis related complication in decompensated cirrhosis&nbsp; of liver. To evaluate the role of serum C- reactive protein as a predictor of early mortality in patients with decompensated cirrhosis of liver. This was a prospective observational study, carried out in the Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka between October 2017 to February 2019. A total of 89 patients with decompensated cirrhosis of liver&nbsp; were included in the study. Baseline serum CRP was measured and patients were longitudinally followed for a period of 30 days. Patients were divided into two groups, survival and non-survival. The groups were compared of CRP level, CTP score, MELD score and cirrhosis related complications. Chi-Square test was used to analyze the categorical variables and Student t-test was used to analyze continuous variables. Receiver-operator characteristic curve was used to detect serum CRP level for prediction of mortality within 30 days. The mean age was found 49.02±13.90 years in survival group and 47.52±11.30 years in non-survival group. Male patients were predominant in both groups. Total WBC count, serum CRP, serum sodium, serum&nbsp; bilirubin, CTP score &amp; MELD score were statistically significant (p&lt;0.05) between the groups. In multivariate analysis, only serum CRP level (OR 1.075, 95% CI, 1.027-1.122%, p=0.001) was found significantly associated with mortality within 30 days. Receiver-operator characteristic (ROC) was constructed, using serum CRP level, which gave a cut off value of 31mg/L, with 78% sensitivity and 90% specificity for prediction of mortality within 30 days. Elevated serum CRP level is an independent predictor of early mortality in patients with decompensated cirrhosis of liver. It was also observed that, high serum CRP level was associated with increased frequency of cirrhosis related complications.</p> <p>Bangladesh Med J. 2020 Jan; 49 (1): 1-6</p> 2021-01-19T00:00:00+00:00 ##submission.copyrightStatement## Morbidities among Eclamptic Women of Lower Socioeconomic Community in a Selected Area of Bangladesh 2021-03-24T08:14:32+00:00 Rehana Pervin Kazi Shafiqul Halim Noor Riffat Ara Syed Monirul Islam Fatema Nargis <p>Eclampsia is a serious obstetric emergency with new onset of grand mal seizure during pregnancy or postpartum women having signs symptoms of pre-eclampsia. The sequel of severe pre-eclampsia and eclampsia includes organ failure, loss of consciousness and finally loss of lives of both mother and fetus. This study aimed to evaluate morbidity of eclamptic women at lower socioeconomic community in a selected area of Bangladesh. This descriptive cross sectional study was conducted at Sheikh Hasina Medical College Hospital (SHMC.T) of Tangail district during the period of January to December 2019. During this period 7918 admitted patients from different sub-districts (Upazilas) of this district in obstetrics ward of SHMC.T were observed and 205 diagnosed eclamptic patients were selected as respondents for this study to detect morbidities. The prevalence rate of eclampsia among the obstetrics patients was 2.6%, where 81% of them were found during antepartum/ intrapartum and rest of them during postpartum period. The mean age of the eclamptic cases was 23.78±4.94 years and more than half of&nbsp;&nbsp; them were in age group 21-30 years. Most of the cases (84%) were from primary level or able to sign or illiterate and rest was secondary level of education. Mean age of marriage and first pregnancy were 17.81±SD2.19 and 19.39±SD2.5 years respectively, where majority of patients were primigravida. Among the multi gravida about one fourth had 2-4 children, 16.09% had 5-6 children, where 1.46% had ≥7 children and more than three-fourth of cases had 34-37 weeks of gestational period. Among cases 95.1% had hypertension, 94.6% edema, 83.9% convulsion, 39.5% headache with blurring of vision, 22.4% severe abdominal pain, 79.0% proteinuria and 9.76% unconsciousness. Incidence of maternal morbidity during study period was 14.36%, among them 9.4% pulmonary edema, 1.5% renal failure, 0.98% HELLP (Hemolysis, Elevated liver enzyme level and Low Platelet level) syndrome, 0.98% coma and 1.5% placental abruption. Caesarean delivery was 79.2% and 11.70% was detected as postpartum haemorrhage. Among fetal morbidity 19.5% intrauterine growth restriction, 48.8% low birth weight, 39.6% birth asphyxia, and 58.5% preterm baby. During follow up only persistent hypertension was found as morbidity of eclampsia, 19.5%, 9.8% and 7.32% at 2nd week, at 6th week and at 6th months respectively. Regarding health care services 93.7% had available facility and 41.5%, 47.8% and 10.7%&nbsp; lived in &gt;10 kilometers (kms), 5-10 kms and less than 5 km distance respectively. Regarding MCH services; only 5.9% patient received antenatal care (ANC) ≥4 times; more than half of them incompletely received ANC &lt;4 times and 42.0% never visited for ANC. This study reveals various matters of maternal and fetal morbidities commencing from eclamptic condition in lower socioeconomic community. Here important factors for morbidities in eclamptic women like lack of ANC/ PNC, availabilities of MCHC services and others. Pulmonary edema, renal failure, HELLP syndrome, coma and placental abruption are important maternal morbidities.&nbsp; Prematurity, low birth weight, intrauterine growth restriction and birth asphyxia are foremost fetal morbidities. Availabilities of MCH services, complete visit for ANC/ PNC and early diagnosis and management of eclamptic women positively reduce morbidity and will prevent eclampsia.</p> <p>Bangladesh Med J. 2020 Jan; 49 (1): 7-13</p> 2021-01-19T00:00:00+00:00 ##submission.copyrightStatement## A Comparative Study of Rotaviral Antigen Detection by ELISA and ICT in Children below Five Years with Acute Diarrhoea in A Tertiary Care Hospital 2021-03-24T08:14:36+00:00 Farjana Binte Habib Mohammed Mirazur Rahman Md Moynul Haque Shib Prasad Sinha Suborna Dey Nusrat Noor Tanni Muhammad Arif Un Nabi Azima Akter Jhuma Md Nazmul Hasan <p>Rotavirus is responsible for acute severe watery diarrhoea in young children. Early and rapid detection of rotavirus infection can help to reduce inappropriate administration of antibiotics and has future positive impact on prevention of drug resistance. This cross-sectional study was designed to determine the role of rotaviral antigen detection by ICT from stool sample of acute diarrhoeal children below five years admitted in Sylhet MAG Osmani Medical College Hospital, Sylhet and was carried out in the department of microbiology in collaboration with the department of paediatrics during the period from 1st January&nbsp; to 31st December, 2018. Total 184 children of under five years of age with acute watery diarrhoea were enrolled in this study. Rotaviral antigen was detected by ELISA (Enzyme Linked Immunosorbent Assay) and ICT (Immunochromatographic test) from stool samples. Out of 184 stool samples, rotaviral antigen was found positive in 84 and 86 cases by ICT and ELISA methods, respectively. ICT showed sensitivity of 90.70% and specificity of 93.88% when compared with ELISA. The rotavirus infection was found highest in male children (61.90%) and in age group of 7 to 12 months (51.89%). Considering the importance of rotaviral diarrhoea, rapid detection of rotavirus infection by ICT is essentially needed and should be practiced routinely as it is relatively reliable, easy to perform and cost-effective. It is particularly important in Bangladesh, where diarrhoea is still contributing a significant proportion of mortality and morbidity in under five children.</p> <p>Bangladesh Med J. 2020 Jan; 49 (1): 14-18</p> 2021-01-19T00:00:00+00:00 ##submission.copyrightStatement## Comorbidity and it,s Impact on COVID-19 Affected Patients in COVID-19 Dedicated Hospital of Bangladesh 2021-03-24T08:14:39+00:00 Irin Hossain Ashekur Rahman Mullick Manzurul Haque Khan Kazi Shafiqul Halim M M Aktaruzzaman Shah Golam Nabi Md Shafiur Rahman - Md Shahin <p>The Wuhan City of China evidenced unknown aetiology pneumonia cases at the end of December 2019. On 7 January 2020, the causative agent was identified as a novel coronavirus (2019-nCoV), currently referred to as SARS-CoV-2, and coronavirus disease as COVID-19. Older adults and people of any age who have underlying medical conditions, such as hypertension and diabetes, have shown worse prognosis. The aim of this study to evaluate the risk of serious adverse outcomes in patients with COVID-19 by stratifying the comorbidity status. We conducted a retro-prospective study of 405 patients admitted into the Mugda Medical College and Hospital, Dhaka,Bangladesh.&nbsp; Among 405 cases, mean age was 46.33 years. About 216 (53.3%) patients were male. Almost&nbsp; 322 (79.5%) patients were managed inside Dhaka city. The most common symptom was fever on or after hospitalization (71.9%). Of the 405 cases the prevalence of specific comorbidities was: hypertension (n=141, 34.8%), other cardiovascular diseases (n=42, 10.4%) cerebrovascular diseases (n=7, 1.7%), diabetes (n=140, 34.6%), COPD (n=4, 1.0%), chronic kidney diseases (n=65, 16.0%), malignancy (n=4, 1.0%) and asthma (n=51,12.6%). Overall, 307 (75.8%) patients discharged alive during the time frame of this study. 98(24.2%) patients died, 63 (15.6%) were admitted to the ICU and 16 (4.0%) received invasive ventilation. Patients with comorbidities should take all necessary precautions to avoid getting infected with SARS CoV-2, as they usually have the worst prognosis. There is a need for a global public health campaign to raise awareness, on reducing the burden of these comorbidity illnesses causing deaths in COVID-19- infected patients.</p> <p>Bangladesh Med J. 2020 Jan; 49 (1): 19-25</p> 2021-01-19T00:00:00+00:00 ##submission.copyrightStatement## Study on Early Childhood Adversities of Orphans Rearing in Orphanages 2021-03-24T08:14:41+00:00 Fahad Mahmood Nirmeen Rifat Khan Md Ziaul Islam Tasmia Shahreen Md Noor Ashad Uz Zaman <p>Orphans spread a significant mass of our absolute child folks and this study was planned to determine the early childhood adversities of orphans that may attract them in various violence and perilous fortune lead further that in the end have a long-standing psycho-social impact on their adulthood. This was a cross-sectional study that was completed among 301orphans of both genders. The subjects were chosen by convenient sampling technique based on specific inclusion criteria and maintaining ethical issues. The study was directed from January to December 2017 in different orphanages of Chittagong and Dhaka city. The examination uncovered, maximum (84%) of participants were male and the rest (16%) were female. Among them, around 44.9% of them were matured from 10-12 years followed by 37.9% matured between 13-15 years. The majority (62%) of the participants had education up to primary/equivalent level. A maximum (69.77%) of them lost their father and 17.94% of them lost both of their parentages. The study revealed, physical assault (30.2%), serious domestic accident (27%), and life-threatening illness/injury (33.6%) had higher frequencies than other events that happened with the participants personally. Additionally, events like traffic transportation accidents (47.3%), serious domestic accidents (36.8%), and physical assault (28.3%) had higher frequencies than other events experienced through observing to transpiring. Then again, transportation accidents, domestic accidents (ꭓ2 =32.673, p&lt;0.05), physical assault, life-threatening illness/injury were experienced among 16-18 years of aged orphans personally where assault with a weapon and sexual assault (ꭓ2 =14.637, p&lt; 0.05) were more frequent among 13-15 years old gathering.</p> <p>Bangladesh Med J. 2020 Jan; 49 (1): 26-32</p> 2021-01-19T00:00:00+00:00 ##submission.copyrightStatement## Effects of Iron and Amloki (EmblicaOfficinalis) on Serum Zinc Level in Anaemia with Pregnancy 2021-03-24T08:14:43+00:00 Tahmina Akter Qazi Shamima Akther Saima Haque Lisa Mst Ariza Sultana Farhana Sultana Sharmin Nahar Sunjida Akter Suma Sayeda Tasnim Kamal Tamanna Binte Habib Farhana Rahman <p>Pregnancy is associated with several trace elements deficiency in developing countries. Supplementation of iron in iron deficiency anaemia (IDA) has several side effects including alterations of serum zinc level. Traditionally, amloki is used as a well known supplement in pregnancy, which is rich in trace elements.To determine the effects of iron and amloki on serum zinc level in IDA with pregnancy. The study was a non blind, non random sampling interventional type of clinical trial. This study was performed in the Department of Physiology, Dhaka Medical College, Dhaka on 43 pregnant women between 13th to 20th weeks of gestation with IDA from July 2016 to June 2017.&nbsp; They were recruited from Outpatient Department of Obstetrics and Gynaecology of Dhaka Medical College Hospital. Anaemic pregnant women supplemented with oral iron and amloki were considered as study group (A) and control group (B) were with only iron supplementation for 45 days. Serum zinc level was estimated in the laboratory of the Department of Soil, Water and Environment, University of Dhaka, Bangladesh.&nbsp; For statistical analysis, Paired Student’s‘t’ test and Unpaired Student’s‘t’ test were considered using SPSS 22.0 version. Significant decrease (p&lt;0.001) of serum zinc level was observed after intervention of iron in both groups. In this study, there was no significant difference in serum zinc level in between study and control group. It can be concluded that oral iron supplementation causes decrease in serum zinc level in IDA with pregnancy. Amloki shows no significant role in preventing decrease of serum zinc level in this study.&nbsp; Emblicaofficinalis (amloki) is traditionally used to treat iron deficiency anaemia. It can increase haemoglobin concentration and decrease side effects of iron supplementation.</p> <p>Bangladesh Med J. 2020 Jan; 49 (1): 33-37</p> 2021-01-19T00:00:00+00:00 ##submission.copyrightStatement## Stress and Coping Status among Caregivers of Major Psychiatric Patients 2021-03-24T08:14:45+00:00 Sinthia Tasmin Hafiza Sultana Aysha Haque Md Moinul Islam Mohammad Rashidul Alam Kazi Shafiqul Halim Md Golam Abbas <p>Caregivers play an important role for the treatment and wellbeing of the psychiatric patients. Constant caregiving role exert stress on the caregiver which is usually handled by them. This cross-sectional study aimed to assess the level of stress and coping status among conveniently selected 171 care givers of major psychiatric patients at National Institute of Mental Health (NIMH), Dhaka. Data was collected by the pre-tested semi-structure questionnaire blended with perceived stress and coping scale through face to face interview. Average coping status was found in most of the (70%) care givers; good coping status was found in more than one fifth (21%) of the caregivers and few (02%) caregivers had poor coping status. Stress and coping status was found (p&lt;0.05) significantly related. This study finds the perceived stress among all the caregivers under study population; where high level of stress were perceived by more than three fourth of the caregivers and moderate to low level of stress were perceived by most of the caregivers. Caregiver-centric interventions, services and programs are recommended to plan and implement so that they should not compromise their caregiving work.</p> <p>Bangladesh Med J. 2020 Jan; 49 (1): 38-44</p> 2021-01-19T00:00:00+00:00 ##submission.copyrightStatement## Autoimmiune Hepatitis in Children: Two Case Report 2021-03-24T08:14:29+00:00 - Md Benzamin Zannatul Ferdous Sonia - Md Rukunuzzaman Khan Lamia Nahid Bishnu Pada Dey Kamal Hossen Kaniz Fathema Mukesh Khadga Mohammad Majharul Islam <p>Autoimmune hepatitis (AIH) is the disease of immune mediated inflammation of liver. Presentation of AIH in children is variable, ranging from acute hepatitis to cirrhosis of liver and also as only asymptomatic raised ALT. AIH can present at any age and female are more affected. Here we are presenting two cases. Case 1 presented with jaundice and H/O epistaxis, having cutaneous echymosis, hepato-splenomegaly and ascites. Case 2 was a diagnosed case of Systemic Lupus Erythematosus (SLE) presented with only persistent raised of serum ALT. Both were diagnosed as autoimmune hepatitis on the basis of positive auto antibodies, histopathology of liver tissues and exclusion of all other causes of acute and chronic hepatitis.</p> <p>Bangladesh Med J. 2020 Jan; 49 (1): 45-50</p> 2021-01-19T00:00:00+00:00 ##submission.copyrightStatement## A 30-Year-Old Male Patient of Miliary Tuberculosis Presented with Pancytopenia and Intracerebral Haemorrhage Mimicking Brain Tumor in MRI 2021-03-24T08:14:35+00:00 Quazi Mamtaz Uddin Ahmed Md Nazmul Hasan <p>Unlike to fever, pancytopenia is a rare hematological manifestations of tuberculosis and intracranial haemorrhage as well. Here we report a case of disseminated tuberculosis presented with pancytopenia and intracranial haemorrhage. The patient presented with prolonged pyrexia, weight loss and subsequently unconsciousness and convulsion. After the diagnosis of tuberculosis with pancytopenia and intracerebral haemorrhage flowed by convulsion, he was treated with category-1 standard anti-tubercular therapy and anticonvulsant. After completion of the anti-tubercular drug his fever completely subsided and gained weight and pancytopenia was improved. But he is still on anti-convulsant medication with good control of seizure.</p> <p>Bangladesh Med J. 2020 Jan; 49 (1): 51-54</p> 2021-01-19T00:00:00+00:00 ##submission.copyrightStatement## Obituary News January-2020 Vol 49(1) 2021-03-24T08:14:31+00:00 Kazi Shafiqul Halim <p>Abstract not available</p> <p>Bangladesh Med J. 2020 Jan; 49 (1): 55</p> 2021-01-19T00:00:00+00:00 ##submission.copyrightStatement##