Chattagram Maa-O-Shishu Hospital Medical College Journal
A multi-disciplinary peer-reviewed journal published by Chattagram Maa-O-Shishu Hospital Medical College. Full text articles available
Chattagram Maa-O-Shishu Hospital Medical College
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Common Presenting Health Problems of Adult in Slum Dwellers of Chattogram City
Background: The rapid growth of urbanization in Bangladesh has created some adverse effects on the overall urban environmental health of the cities. Among all, mass poverty, expansion of poor neighborhood, inadequate supply of urban services such as water, sanitation, waste disposal etc. are mostly responsible for health risks of urban people particularly in low socio-economic condition. A host of environmental and social problems beset the port city of Chattogram due to overcrowding of slums, which is largely blamed on unplanned urbanization. More than four hundred slums accommodating about 1 million of people are scattered across the city. Majority of these slums are situated on the Ice Factory road, along the railway tracks under Dewanhat Bridge, Sholosohor, Pahartali, Chittagong Railway Station, and Lalkhan Bazar MotiJhornaarea. The purpose of the study was to assess the pattern of common health problems of the adult members of the slum dwellers of Chattogram city. Materials and methods: A descriptive type of cross-sectional study was conducted from September to October 2022, using a sample of 321 respondents living in urban slums. Data was collected by face to face interview using a pretested mixed type of questionnaire. After collection, data was analyzed and resultswere presented as tables and figures. Results: Out of a total of 1492 family members of 321 families, there were 744 male and 748 female individuals. The most common presenting health problems among the adult respondents were Back pain and Generalized body-ache (24%), followed by Hypertension (16%), Headache (14%), Generalized Weakness (10%), Diabetes (8%), Asthma (8%), Cough (6%), Fever (5%), Chest Pain (4%), Anaemia (4%). Conclusion: The study concludes that physical structure of the neighborhood, and the physical and mental sufferings of its inhabitants are interdependent. To reduce the sufferings of inhabitants, their health hazards can be reduced with the combined efforts of the Government and the NGOs and the local people as well. Most of the slum dwellers are dependent on the pharmacy for their health problems. They are reluctant to take government health care facilities. Measures should be taken to make these facilities easily available to them. Chatt Maa Shi Hosp Med Coll J; Vol.23 (2); July 2024; Page 3-5
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Glycaemic Status in Different Stages CKD Patients by CKD EPI Formula due to Diabetic Nephropathy
Background: Diabetes is one of the important causes of Chronic Kidney Disease (CKD) in both developed and developing countries. Around one third of diabetic patients develop CKD. Controlling hyperglycaemia may halt the progression of diabetic kidney disease patients to ESRD (End Stage Renal Disease). Worlwide, more than 140 million people suffer from diabetes, making this one of the most common noncommunicablediseases. The aim of the study to find out the glycaemic status of diabetic nephropathy in different stages of CKD. Materials and methods: This is a cross sectional study. This study was done Medicine and Nephrology Department of CMCH over 100 patients during the period June to December 2014. Staging of CKD in this patient will be done by CKD- EPI formula and Glycaemic status was evaluated by fasting and 2HABF and HbA1C. Sociodemographic data was compared. Staging of Diabetic Nephropathy (DN) was evaluated by either urinary Albumin Creatinine Ratio (ACR) or Urinary Total Protein (UTP). Results: Among 100 patients studied regarding sex most of them are male (60%). .Regarding occupational status most of them were engaged in business (33%) and house wife (36%). Average (71%) socioeconomic status commonly foundand most of them were doing moderate works (80%) and most patients were from rural (74%) origin. Dip stick test was found positive among (55%) cases. Fundal examination findings revealed preproliferative retinopathy was commonest (49%). Stage 5 CKD was found in 35% cases rest were at stage 3 and 4. In ultrasonogram study Illdefined corticomedullary differentiation was found in 68% cases. Highest creatinine was found 12.3 and HbA1c was found 13. Relation of CKD stages with Fasting blood sugar (p= 0.473), blood sugar 2 hours after breakfast (p=0.312), HbA1c (p=0.120) were found insignificant and relation with eGFR was found highly significant (p=0.001). Conclusions: This study defined a scenario of Glycaemic status of CKD patients admitted in a tertiary care hospital. No significant relation of Glycaemic status were found with different stages of CKD in our setting. Chatt Maa Shi Hosp Med Coll J; Vol.23 (2); July 2024; Page 6-9
Gender Related Change in Morphometry of Normal Lumbar Intervertebral Disc by MRI in a Tertiary Level Hospital of Bangladesh
Background: Morphometry of lumbar intervertebral disc is valuable for the diagnostics and therapeutic purposes and also for adequate planning, preparation and preoperative selection of prosthetic implants. This study was aimed to measure the morphometry of all lumbar intervertebral discs in relation to sex. Materials and methods: This cross-sectional analytical study was conducted in the Department of Anatomy, Chittagong Medical College, Chattogram, upon 50 male and 50 female from April 2021 to March 2022. All participants with normal lumber MRI scan as certified by expert radiologist were recruited from Radiology and Imaging department of Chittagong Medical College Hospital (CMCH) as per inclusion criteria. T2 weighted sagittal lumbar normal MRI scans were included in this study. All measurements such as Superior Length of the disc (SL) and Inferior Length of the disc (IL) Anterior Disc Height (ADH) midpoint disc height (MDH) and Posterior Disc Height (PDH) were taken and recorded in a predesigned case-record form. Measurements were presented as mean±SD and were compared by unpaired student’s t test. Data were analyzed by SPSS (Version 26.0). Finally the results were presenters using tables and figures. Results: In this study mean SL and IL of male were greater than female and showed an increase from L1-L2 to L4L5 but unpaired student’s t-test revealed that the difference in SL and IL were not statistically significant in any sex (p>0.05). For ADH, MDH and PDH all mean values were found to be higher in males than in females except for the MDH in the L1-L2 level and for ADH in the level of L5-S1.Also the mean of ADH, MDH and PDH were not statistically significant in relation to sex (p>0.05). Conclusion: The result of the present study provides some baseline information about morphology of lumbar intervertebral disc of normal Bangladeshi population and encourages further research in this field. Chatt Maa Shi Hosp Med Coll J; Vol.23 (2); July 2024; Page 10-14
Prevalence of Hypertension among Doctors Working in Rajshahi Medical College and Hospital
Background: Hypertension (HTN) is a major public health problem in developed and developing countries. This is associated with oxidative stress and also a common cause of Cardiovascular Disease (CVD) amounting to 30% of worldwide death rate. The main objective of this study was to find out the proportion of hypertension among doctors working in Rajshahi Medical College and Hospital. Materials and methods: A cross-sectional type of descriptive study was conducted in Physiology Department in collaboration with Biochemistry Department of Rajshahi Medical College, Rajshahi during period of January 2022 to December 2022. The sample size was 248 and purposive sampling technique was applied. Data were collected from the respondents through a semi-structured questionnaire after taking informed written consent. Results: The study was carried out on doctors aged 25-60 years where 126 (50.80%) were female and 122 (49.20%) were male. Among 248 respondents, 27% were hypertensive, 46% were pre-hypertensive and 27% were normotensive.Among the respondents, who were under antihypertensive medication, 23.08% were in uncontrolled state and respondents who were not under antihypertensive medication, 13.39% were newly diagnosed hypertensive. Risk factors such as prehypertension, less physical exercise, overweight and family history of hypertension, diabetes mellitus, coronary heart disease were very common among the doctors. Conclusions: The study showed that physicians had higher proportion of hypertension. Among the participants, there was an unexpectedly low awareness rate and inadequate blood pressure regulation Chatt Maa Shi Hosp Med Coll J; Vol.23 (2); July 2024; Page 15-19
Initial Experience of Laparoscopic Radical Nephrectomy for Patients with Localized and Locally Advanced Renal Cell Carcinoma
Background: There has been a dramatic increase in the interest X Practice of Laparoscopic urological procedures. Leparoscopic Nephectomy for both Berign and Melignant Diseases of Kidney is incuesingly being performed. The aim of the study to evaluated the results of our initial experiences of laparoscopic nephrectomy cases performed in patients with local and locally advanced renal cell carcinoma. Materials and methods: It was a retrospective study. From July 2020 to July 2023, 17 patients underwent laparoscopic nephrectomy for local and locally advanced renal cell carcinoma. The duration of operation , blood loss, total hospital stay, perioperative complications and follow-up time were evaluated. Results: The mean age of the patients was 56.8 (33-72). Mean duration of operation was 140.4 (75-190) minutes and the duration of hospital stay was 3.2 (2-5) days. Renal vein thrombus in 3 patients perirenal fat tissue invasive in 9 patients. In 2 patients, the tumor exceeded the fascia gerota. The mean follow-up period was 18.3 (6-42).Two patients had lung metastasis during follow- up. Two patients died in the 5th and 36th months following the operation. Conclusion: Radical nephrectomy improves the survival in patients with local and locally advanced renal tumors. Although laparoscopic approach has some difficulties in these patients but the minimal invasive treatment can be safely performed by experienced surgeons. Chatt Maa Shi Hosp Med Coll J; Vol.23 (2); July 2024; Page 20-23
Comparative Study of Flunarizine versus Propranolol in the Prophylaxis of Migraine
Background: Propranolol and flunarizine are the most used first-line drugs in the treatment of migraine. There are limited data regarding the use of prophylactic agents available in Bangladesh. This study aimed to compare the efficacy and tolerability of propranolol and flunarizine in prophylactic management. Materials and methods: This was a open label randomized clinical trial. One hundred and fifty migraine patients were recruited from the Outpatient Department of Neurology and Medicine of Chittagong Medical College Hospital from October, 2017 to September, 2018. They were randomized in a 1:1 ratio to receive either flunarizine (n=75) or propranolol (n=75) once daily. Patients were evaluated for attack frequency, pain severity, duration of headache, disability and drug side effects at 6 weeks and 12 weeks. Results: The Flunarizine group showed a reduction in the mean (±SD) frequency of migraine attacks from 10.58±4.11 to 3.25±2.90 per month, intensity of headache per attack from 8.00±1.33 to 3.63±1.87, number of headache days per month from 11.93±4.12 to 3.25±2.90, duration of headache per episode from 21.18±16.15 to 3.13±3.26 and MIDAS (Migraine Disability Assessment Test) score from 23.15±8.77 to 4.70±4.80. In patients treated with propranolol, a reduction in the mean (±SD) of monthly frequency of migraine attacks from 9.64±3.81 to 4.67±3.15, the intensity of headache per attack from 7.99±1.27 to 4.57±1.48, number of headache days per month from 11.66±4.49 to 4.67±3.15, duration of headache per episode from 24.19±19.33 to 4.85±4.31 and MIDAS score from 23.78±10.48 to 6.51±5.36. The percentage of responders at the study endpoint was 58.2% for propranolol and 80.3% for flunarizine. Both the drugs were well tolerated but adverse effects were more in the propranolol group. Conclusion: Flunarizine was more effective and better tolerable than propranolol in prophylaxis of migraine. Chatt Maa Shi Hosp Med Coll J; Vol.23 (2); July 2024; Page 24-28
Magnetic Resonance Angiography Determined Sex-Related Variations in Configuration of Entire Circle of Willis in Bengali Population of Chattogram Division
Background: Magnetic Resonance Angiography (MRA) is a group of techniques based on Magnetic Resonance Imaging (MRI) for imaging of blood vessels. It’s the most widely used method for detecting the morphology of Circle of Willis (COW). By using the 3D-TOF-MRA the present study was aimed to evaluate the anatomical variations in the Circle of Willis between male and female in Bengali population of Chattogram division. Materials and methods: This cross-sectional observational study was conducted in the Department of Anatomy, Chittagong Medical College, Chattogram, upon 60 study subjects (29 were male & 31 were female) by dividing them intotwo groups (£40 years and >40 years of age). For statistical analysis unpaired student’s t-test was done and p-value was considered significant if it was <0.05 at 95% level of confidence. Results: The participant's age range was between 02 -76 years with a mean ± SD age of 35.20±18.25 years. The entire Circle of Willis (COW) variations were evaluated by 3D TOF MRA between male and female. The most common configuration in both sexes was partially complete Circle of Willis (COW). On comparing the prevalence of individual configuration of COW among the gender, no significant difference was observed. Conclusion: Results of the present study provides some baseline data upon which further studies can be performed by other investigators in this field. These findings might also be helpful during the surgery at the skull base. Chatt Maa Shi Hosp Med Coll J; Vol.23 (2); July 2024; Page 29-33
Correlation of Serum Ferritin with Age and Growth in Thalassemia Major Children
Background: Thalassemia is the most prevalent single gene defect in human beings worldwide. Repeated blood transfusions along with chelation therapy are mainstay of treatment in thalassemia patients. However, these recurrent blood transfusions along with inadequate chelation therapy results in iron overload. The study aimed to investigate the serum ferritin level in children with blood transfusion in thalassemia major patients and to know their correlation with age and growth. Materials and methods: A cross-sectional analytical study was conducted including 79 children of thalassemia major in the age group of 5-12 years who were on regular blood transfusion and oral iron chelators from thalassemia unit of Chittagong Medical College Hospital. Serum ferritin was tested and their correlation with age and growth was assessed. Chi square was done to determine the correlation. Results: The age of the patients ranged from 5 to 12 years and 45(56.9%) were males. The mean age at diagnosis of thalassemia was 10.7±4.2 months and mean number of transfusion was 90±29 and ranged between 40-140 transfusions. All of the children were on oral iron chelation therapy and the average age of initiation chelation therapy was 5.7±1.1 years. 64(81%) children had growth retardation. Mean serum ferritin level was 3740.7±2185.8 ng/ml and only 3.8% of the patients had serum ferritin level <1000 ng/ml. Conclusions: This study concludes that serum ferritin is raised and positively correlated with age and growth in thalassemia major patients. So routine evaluation of serum ferritin tests may be advocated for thalassemic patients. Chatt Maa Shi Hosp Med Coll J; Vol.23 (2); July 2024; Page 34-38
Undergraduate Medical Students’ Perception of Academic Environment in Bangladesh: A Gender-Wise and Phase-Wise Evaluation
Background: Medical education has undergone significant reforms globally with an aimto produce competent doctors. The evaluation of academic environments is crucial in maintaining quality of medical education. Students' perceptions of academic environments are crucial as they influence behavior and success. This study aims to assess gender-wise and phase-wise variations in undergraduate medical students' perceptions of academic environments in Bangladesh which may provide insights for improvement. Materials and methods: This cross-sectional study involved 400 students (Phase 1 to phase 4) from four medical colleges in Bangladesh, selected through random sampling.The Dundee Ready Education Environment Measure (DREEM) questionnaire was used to collect data. The genders and phases were compared by independent t-test and ANOVA, respectively, with the aid of SPSS. Results: Both gender-wise and phase-wise analysis showed a positive perception of overall environment and individual domains. Female students rated SPL (p=0.01), SPT (p.0.00), SPA (p=0.03) and DREEM (p=0.00) significantly higher than males. Phase 1 and 4 showed significant differences in SPL (p=0.01) and DREEM (p=0.04) while phase 2 and 4 revealed significances in SPT (p=0.04), SASP (p=0.01), SPA (p=0.03) and DREEM (p=0.01). Conclusion: Findings from this study may provide guideline to curriculum planners and administrators of the medical colleges for further improvement of academic environment. Chatt Maa Shi Hosp Med Coll J; Vol.23 (2); July 2024; Page 39-44
Detection of Extended Spectrum Beta Lactamase Producing Gram Negative Bacteria in a Tertiary Care Hospital, Chattogram
Background: The frequency of Extended Spectrum Beta-Lactamase (ESBL) producing bacteria among clinical isolates is a serious global health concern that has complicated treatment strategies and is very alarming. So the reporting of ESBLproducing Gram negative bacteria from the clinical samples will be useful for the clinician to select the appropriate antibiotics and to take proper precaution for prevention of these resistant organisms. To study the prevalence of ESBL producers among the Gram negative bacteria and antibiotic susceptibility pattern of these isolates. Materials and methods: This cross sectional study was carried out in the Department of Microbiology of a tertiary care hospital, Chattogram from January 2021 to December 2021. A total of ninety consecutive, nonrepetitive, Gram negative isolates were selected as confirmed ESBL producers, detected by Phenotypic Confirmatory Disc Diffusion Test (PCDDT). Antibiotic susceptibility test was performed on Mueller Hinton agar plate by Kirby Bauer Disc Diffusion method. Results: Out of 300 isolates, 90 (52.63%) were found to be ESBL producers by PCDDT. The isolates of Pseudomonas spp. (37.77%) were the most common ESBL producing bacteria followed by Klebsiella spp. (28.88%), Escherichia coli 39 (22.22%) and others. Maximum (47.93%) ESBL producing bacteria were isolated from woundswab followed by urine (26.44%). Most ESBL producers were resistant to commonly used antibiotics. Amikacin (80%), pipercillin-tazobactam(75%) and meropenem (73%) were the most effective agents for the treatment of ESBL producing bacteria. Conclusion: The findings of this study emphasize the need for a continuous surveillance such as detection of ESBL along with routine susceptibility test will help the clinician to give a strict guideline for antibiotic therapy and reduce the increasing burden of antibiotic resistance. Chatt Maa Shi Hosp Med Coll J; Vol.23 (2); July 2024; Page 45-48
Frequency of Transfusion Transmitted Infection among Healthy Blood Donors Attending Transfusion Medicine Department of Chattagram Maa-O-Shishu Hospital Medical College
Background: Transfusion of blood and blood components, as a specialized modality of patient management, saves millions of lives worldwide each year and reduces morbidity. Transmission of infectious diseases through donated blood is of concern in order to provide safe blood for transfusion which forms an integral part of medical and surgical therapy. The aim of the present study was to analyze the status of transfusion-transmitted infections among the apparently healthy donors to increase awareness of complications of blood transfusion and make the clinicians more vigilant with regard to judicious use of blood. Materials and methods: This retrospective study was carried out in the Department of Transfusion Medicine at Chattagram Maa-O-Shishu Hospital Medical College from January to December 2022. After proper ethical consideration, a total of 7,289 blood donors were included in this study. All the samples were screened for Hepatitis B surface antigen (HBsAg) Hepatitis C Virus (HCV) Human Immunodeficiency Virus (HIV) 1 and 2, Venereal Disease Research Laboratory test (VDRL) and malaria to determine the prevalence of TTI. All the healthy blood donors were 18 to 60 years old. Results: The prevalence of Hepatitis B Virus (HBV) HCV and syphilis was 3.014% and 0.109%, respectively. No blood donor tested positive for malarial parasites or HIV. Strictly maintain the donor selection criteria and mandatory screening of the donor’s blood for HBV, HCV, HIV, malaria and syphilis using sensitive laboratory screening tests to reduce the incidence of TTI in the Bangladeshi population and to ensure the safety of the blood for the recipient. Conclusion: Strictly maintain the donor selection criteria and mandatory screening of the donor’s blood for HBV, HCV, HIV, malaria and syphilis using sensitive laboratory screening tests to reduce the incidence of TTI in the Bangladeshi population and to ensure the safety of the blood for the recipient. Chatt Maa Shi Hosp Med Coll J; Vol.23 (2); July 2024; Page 49-52
Physicians' Mental Health Conditions at Medical College Hospitals during the COVID-19 Pandemic
Background: The Coronavirus Disease (COVID-19) outbreak in 2019 had a psychological impact on almost everyone, including medical personnel who work mostly in hospitals. Physicians faced incredible levels of workload, which exacerbated many mental health issues in this circumstance. The purpose of the study assess the mental health conditions of physicians at the purposively selected four Medical College Hospitals in Dhaka city. Materials and methods: During the outbreak of COVID 19 in Bangladesh, a hospitalbased cross-sectional study was carried out during the period January to July 2021. ‘The Depression, Anxiety, and Stress Scale-21’ (DASS-21) scale was used to construct this semi-structured questionnaire for data collection during the study period. Results: In terms of the physicians' mental health state, one-fourth (25.9%) had extremely severe depression, one-third (36.0%) had extremely severe anxiety and one-quarter (21.8%) experienced severe stress. It was found that doctors who were married, older and had an average monthly income of £50,000 BDT were more likely to experience depression. Additionally, there was a significant increase in depression among private hospital employees, who also reported feeling stigmatized by their profession and inadequate Personal Protective Equipment (PPE) at work. Doctors who were married, older, and had an income of £50,000 BDT were found to have higher levels of anxiety. Additionally, there was a significant rise in anxiety among private hospital employees, who also reported feeling stigmatized by their profession and having inadequate PPE. Ageing older and having an income of £50,000 BDT were found to be associated with higher levels of stress. Inadequate PPE in the workplace, the stigma associated with one's job and employment in private hospitals were all associated with substantially higher stress levels. Conclusion: In Bangladesh, a significant proportion of doctors experienced anxiety, stress, and depression during the COVID-19 outbreak. To reduce instances of stress, anxiety, and depression in doctors, effective strategies are needed in their workplace Chatt Maa Shi Hosp Med Coll J; Vol.23 (2); July 2024; Page 53-59
Prevalence and Factors Associated with Major Depression Disorder among Rohingya Refugees in Bangladesh
Background: Rohingya refugees are a persecuted minority and one of Myanmar's largest populations of stateless people. Mental health problems, particularly depression, have been identified as a major public health issue for those living in refugee camps in Southeast Bangladesh. The prime objective is to assess the prevalence and factors associated with depression among Rohingya refuges. Materials and methods: A camp-based cross-sectional study with 384 adult refugees was conducted in January to June 2019 at Modhurchora, Kutupalong refugee camp in Cox’s Bazar. Data were collected by face to face interviews through using a semi-structured questionnaire, level of exposure to trauma by Harvard Trauma Questionnaire and depression symptoms by using SIGECAP Questionnaire. Results: The mean age of the Rohingya refugees was 31.9±11.8 years and twothirds of them (66.4%) were from the age group 18-34 years. The mean scores of depression among Rohingya refugees were 6.9±1.2 and 38.3±6.0 by SIGECAPQ and HTQ respectively. Levels of depression by SIGECAPQ scores, about three out of four refugees were suffering from severe depression and by HTQ scores, the majority of the refugees (96.9%) were suffering from severe depression. Conclusion: The study revealed high levels of depression among Rohingya refugees. Addressing these risk factors could be imperative for improving mental health outcomes in this vulnerable population.The study emphasised the significance of providing psychosocial support services in this camp. Chatt Maa Shi Hosp Med Coll J; Vol.23 (2); July 2024; Page 60-64
Detection of Drug Resistance Pattern of Mycobacterium Tuberculosis by Genexpert MTB/RIF Solid and Liquid Culture in Extrapulmonary Tuberculosis
Background: Tuberculosis (TB) remains one of the deadliest communicable diseases. Tuberculosis is caused by Mycobacterium tuberculosis and classified as Pulmonary Tuberculosis (PTB) and Extra Pulmonary Tuberculosis (EPTB). EPTB account for 15-20 % cases of tuberculosis. EPTB diagnosis is challenging due to inadequate sample volume, pauci-bacillary nature and unusual clinical presentation. There are number of tests available for the diagnosis of EPTB but conventional microscopy has low sensitivity and although culture is gold standard method, it takes longer time for yielding positive result. On the other side, GeneXpert due to its rapidity and sensitivity help in early diagnosis and management of tuberculosis. Culture of Mycobacterium Tuberculosis Complex (MTBC) is the accepted reference standard for confirmation of tuberculosis infection and is necessary for Drug Susceptibility Testing (DST). Although solid media has been used for over 100 years, liquid culture media is increasingly being introduced in low and middle income countries for rapid detection of MTBC. To compare the efficacy of solid culture method using Lowenstein Jensen (LJ) media with GeneXpert and liquid culture method using Mycobacterium Growth Indicator Tube (MGIT) 960 for detection of Mycobacterium tuberculosis. Materials and methods: In this cross sectional study 118 suspected EPTB samples including CSF, lymphatic aspirate, pleural fluid, ascitic fluid, synovial fluid, pus were collected. Smear microscopy, culture both in solid media and liquid media using MGIT 960 method and GeneXpert machine were done. Moreover antitubercular drug sensitivity test was done by proportion method in L-J media. Results: Out of 118 samples, GeneXpert detetcs 26 (22.03%) where as the liquid MGIT 960 method detects 27 (22.88%) and solid culture detects 26 (22.03%) positive samples for Mycobacterium tuberculosis. 01 (1.8%) case was detected as multidrug resistant TB. Conclusion: GeneXpert have significant role in diagnosing EPTB patient within shorter period of time. But GeneXpert can detect only rifampicin resistance where as DST in L-J media detects other first line drugs sensitivity too. Liquid culture method using MGIT 960 yields more positive result than solid culture, also liquid culture shows rapid identification of Mycobacterium tuberculosis. Chatt Maa Shi Hosp Med Coll J; Vol.23 (2); July 2024; Page 65-68
Exploring the Professional Status of Female Dental Surgeons Practicing in Chattogram
Background: Any profession should aim for success and achieving these goals requires dedication. An accomplished person had a happy, balanced existence and, as a result, was well-liked by all. Self-sufficient people or those who look to their family for direction may also struggle with making decisions. But socially imposed gender roles, such the idea that males should support their families while women stay at home, have made it harder for women to juggle work and family obligations. Despite the fact that both genders work comparable hours, women are more likely than men to experience family interference. From this angle to determine the current professional position of female dentists in their practice. Materials and methods: It was a descriptive observational study conducted from July to December 2023. A purposive sampling technique was utilized to collect the data. the total number of respondents were 120. A semi structured pretested questionnaire was given to female dental surgeons who were actively working in the Chattogram city area, visiting various hospitals, clinics, medical colleges and personal private chambers according to inclusion and exclusion criteria. Data was analyzed by using Microsoft excel and SPSS version 25, presented with various tables, graphs and percentages. Results: The findings of the study indicate that the age range of female dentists practicing in different locations is between 24 and 50 years. In addition to their private practice 18% dental surgeons operate in the employment both in government and private sectors, while 75% work exclusively in the private practices. Approximately 91% female dentists are doing only graduation course while PhD and MS are 1% each only. 42% of them have assumed leadership positions at their places of practices, 27% of them are satisfied with their profession as a whole. Conclusion: Presently, there is an upward trend in the quantity of female dentists, the majority of whom are private practitioners due to the scarcity of suitable employment prospects and their desire for flexibility. In academic position the number of female dentists is still very low. Chatt Maa Shi Hosp Med Coll J; Vol.23 (2); July 2024; Page 69-73
Knowledge, Attitude and Practice regarding Malaria Control among Suspected Cases at Selected Primary Health Care in Cox’s Bazar
Background: As part of Sustainable Development Goal Malaria is aimed to zero indigenous transmission among country within 2030 and as part of this elimination from Cox’s Bazar planned within 2025.This study aimed to assess Knowledge, Attitude and Care Seeking as well as reported cleanliness practice among suspected malaria patients to enhance chance from control to elimination phase. Materials and methods: A cross sectional survey was conducted on 127 participants following convenient sampling who attended selected primary healthcare of endemic area during September to October 2023. A pretested semi structured questionnaire was used and data analysis done by excel following SPSS26. Results: Age range between 18-80 years with a mean (±SD) age of 35.95 (±14.32) years. 55.12% were male and 48.8% were poor.Though all participants had heard about malaria,95.3% correctly answered that only mosquito bites transmit malaria, 92.1% could mention at least one malaria symptom but only 7.9% knew they need to test within first 48 hours. When 86.6% reported owning a bed netbut 53.5% reported sleeping under a net. Outof 127 participants, 45.7% had good knowledge of malaria, 36.2% had good practice regarding malaria preventive measures, and 44.9% had a positive attitude regarding malaria. Conclusions: Overall, the study found some evidence gap in Care seeking and reported cleanliness prevention practices although there is reasonable knowledge and positive attitude present. Chatt Maa Shi Hosp Med Coll J; Vol.23 (2); July 2024; Page 74-78
Pattern of Musculoskeletal Manifestations in Patients with Diabetes Mellitus
Background: Musculoskeletal complications of diabetes have been generally ignored and poorly treated as comparedto other complications. Hence we carried out this study to find the prevalence of musculoskeletal manifestations indiabetes mellitus and its relation with age, gender and control of diabetes. Materials and methods: In the present study 100 patients of Diabetes Mellitus (DM) were studied. This was a cross sectional observational study carried out in Physical medicine and Rehabilitation Out Patient Department (OPD) of Chattagram Maa-OShishu Hospital Medical College between October 2020 to March 2021. P urposive sampling was done. Duration of diabetes, control of diabetes and any musculoskeletal complaints were noted. Correlation of musculoskeletal manifestations with age, occupation, duration of diabetes, and control of diabetes was evaluated and statistical analysis was done. After collection of all data those were analyzed by SPSS 20. Results: Among the 100 patients of DM more patients were female (72%) and most were at age group 41 to 50 years (45%). Duration of DM showed 35% patients were suffering from DM for 11- 15 years and 21% were suffering from DM for 16 -20 years. Regarding different musculoskeletal complications among DM patients adhesive capsulitis was (11%), curpal tunnel syndrome was (6%), OA knee was (10%) and planter fasciitis was (8%). Other less common complications were also found . Different complications in relation with age, gender differences and control status of DM were not significant. Conclusions: Musculoskeletal manifestations are frequent in diabetis mellitusand common complications are more among patients with higher age and findings are not related with control of diabetes. Chatt Maa Shi Hosp Med Coll J; Vol.23 (2); July 2024; Page 79-83
Study on Skin to Subarachnoid Space Depth of Pregnant and Nonpregnant Female in Cox's Bazar
Background: During the procedure of sub subarachnoid block the anaesthesiologist has to face the challange of insertion of spinocain needle puncluring the skin through the tissues upto the subarachnoid space. The skin of subarachnoid space depth (SSD) varies considerably at different levels of spinal canal. It also varies from patient tyo patient at the same level as per age, sex and body mass index in pregnant and non pregnant women. To measure the skin to SSD among Non-Pregnant and pregnant women in our population. To compare and to derive a formula for predicting SSD. Materials and methods: This prospective, observational study was carried out by the Department of Anesthesiology and Critical Care at Cox's Bazar Medical College Hospital from December 2021 to June 2022. Total of 224 female patients participated in this study. Non-pregnant women, and pregnant women were the two categories of patients. After doing a lumbar puncture, SSD (Subarachroid Space Depth) was measured. A method for predicting SSD was developed using statistical analysis, correlation, and study of the association between SSD and patient variables. Results: The mean SSD was 5.03±0.74cm. SSD was substantially higher in the pregnant group (4.54±0.47cm) than in the female non-pregnant sample (4.32±0.45cm). Conclusion: The SSD was dependent exclusively on BMI in both study groups. In our study, Craig's formula had the strongest correlation with the measured SSD. Key words: Lumbar puncture; Pregnant female; Subarachnoid space. Chatt Maa Shi Hosp Med Coll J; Vol.23 (2); July 2024; Page 84-87
Exploring Medical Students’ Knowledge and Attitude Towards Medical Ethics: A Multicenter Study
Background: Medical professionals must have a firm knowledge of medical ethics in order to practice sound medicine. It is a part of our MBBS curriculum and aids in educating future physicians about medical ethics and developing a positive attitude towards them. This study aimed at assessing the knowledge and attitude of 5th year MBBS students of four government and non-government medical colleges of Chattogram towards medical ethics. Materials and methods: A descriptive cross sectional study was done in Chattagram Maa-O-Shishu Hospital Medical College, Chittagong Medical College, BGC Trust Medical College and Marine City Medical College from August 2023 to October 2023. A total of 400 MBBS 5th year students voluntarily participated in this study. A structured questionnaire including knowledge and attitude towards medical ethics was distributed among the students. Five point Likert Scale (Strongly agree, agree, neutral, disagree and strongly disagree) was used to determine the knowledge and attitude towards medical ethics. Percentages and Frequencies were used to assess the knowledge and attitude. Data was analyzed by Statistical Package of Social Sciences version 24. Results: In this study, out of 400 students, 152(38%) were male and 248(62%) were female. The age range of the participants was 22-29 years. The common source of knowledge on medical ethics was lectures (85%) followed by books (71%), internet (31%), seminars (24%), journals (15%) and television (12%). Approximately 377 (94.25%) of students agreed that conduct of the doctor carries utmost importance. Approximately 351 respondents (87.75%) disagreed with the notion that patient secrets can be disclosed. About 295(73.8%) answered that law of Bangladesh does not permit Euthanasia. 384 (96%) were aware that medical ethics is an integral part of their MBBS syllabus and 303(75.8%) knew that their institution has an Institutional Ethical Committee. Conclusion: Undergraduate students in this study had a moderate to good knowledge on medical ethics. Chatt Maa Shi Hosp Med Coll J; Vol.23 (2); July 2024; Page 88-95
Correlation of Hypocalcemia with eGFR in Chronic Kidney Disease: A Cross Sectional Study in Marine City Medical College and Hospital
Background: Chronic Kidney Disease (CKD) poses a significant global health challenge. Its ramifications include advancing to End-Stage Renal Disease (ESRD) developing various complications stemming from compromised kidney function, and heightened vulnerability to Cardiovascular Disease (CVD). Interestingly, even within the bounds of normalcy, lower serum Calcium (Ca) levels emerge as a risk factor for precipitating a swift decline in estimated Glomerular Filtration Rate (eGFR) in CKD. Through extensive multivariable correlation analyses, it's been unveiled that serum calcium levels exhibit a correlation with eGFR. The current study aims at elucidating a link between serum calcium levels and eGFR among CKD patients. Materials and methods: A cross-sectional study was conducted from January 2023 to December 2023, by the Department of Biochemistry in conjunction with the Department of Nephrology at Marine City Medical College & Hospital (MCMCH). Purposive sampling was employed to recruit a total of 224 subjects of 18 years and above, after following the inclusion criteria and obtaining permission from ethical/institutional review board (IRB). The study population was grouped as CKD: stage III (eGFR 30-59 ml/min/1.73m²) stage IV (eGFR 15-29 ml/min/1.73m²) and stage V (eGFR<15ml/min/1.73m²). A comprehensive clinical profile was documented for each participant, encompassing key variables such as serum creatinine, serum calcium and eGFR. Results: The study revealed Male predominance (54%) with mean age 56.22±12.78. Among the study population 173 (77.2%) subjects had low serum calcium level (<8.5 mg/dl) of which 127 subjects were in CKD stage V. ANOVA test was significant for serum creatinine, serum calcium and eGFR in different stages of CKD. Pearson’s correlation showed positive correlation between the eGFR and low serum calcium with a significant association of CKD stages (stage III, IV, V) with decreased serum calcium level in the study cases [c2 = 14.90; p= 0.0005]. Conclusion: The study revealed a significant association between Hypocalcemia and decreased eGFR in CKD. Chatt Maa Shi Hosp Med Coll J; Vol.23 (2); July 2024; Page 96-100
Feminization of the Medical Profession : Bangladesh Perspective
Abstract not available Chatt Maa Shi Hosp Med Coll J; Vol.23 (2); July 2024; Page 1-2
Gastric Volvulus in a 42 Year Old Male: A Case Report
Background: Gastric volvulus is a rare clinical entity defined as an abnormal rotation of the stomach around itself beyond physiological range .The diagnosis is made very late as the clinical suspicion is low and mostly diagnosed on imaging or on the surgery table. The purpose of the study to reminding readers of this issue and emphasize the necessity for further research on how to deal with in the best way. Case Presentation: A case of gastric volvulus in a 42 year old male, who presented with abdominal pain, persistent vomiting and retching- a late diagnosis was reached by Barium meal study, after repeated failure to navigate the stomach (Pyloric opening) in consecutive upper GI Endoscopies. Later surgical treatment cured the patient. Conclusion: Although the symptoms like pain and vomiting are common in abdominal diseases and upper GI Endoscopy is a doorstep investigationeven than the diagnosis is made late as the clinical suspicion of gastric volvulus isvery infrequent. To orient the clinician we intend to report this case. Chatt Maa Shi Hosp Med Coll J; Vol.23 (2); July 2024; Page 101-103
Dermatitis Artefacta : A Rare Case of Psychodermatological Disorder
Background: Dermatitis Artefacta (DA) or Factitious Dermatitis (FD) is a self-inflicted dermatological condition. It is more common in female. It has an underlying motive to assume a sick role for a secondary benefit. This act of deliberate self harm is to reduce the hidden sufferings of emotional distress. Due to polymorphism of the lesions and strong denial of the self-infliction of the injury there is always a diagnostic dilemma. Here we report an interesting case of DA with a confusing presentations where diverse and innovative means for self-inflicting injuries were produced. But initially it is difficult to diagnose the skin lesions, if proper history is not taken providing enough time and lack of proper examination of the lesion further add the difficulties. Case Presentation: Miss Y, 15 years old female, hailing from a nearby Upzilla of Chattogram, got herself admitted 10th July 2023 at Chattagram Maa-O-Shishu Hospital with the complaints of multiple skin eruption with bleeding from the lesions in both arms and lower limbs for three months. The lesions were bizarre, with a tapering end at various stages of healing, and were not compatible with any known dermatological disorder. Her mini mental state examination was normal and she had no delusions or hallucinations. Conclusion: Lack of proper identification of the underlying psychiatric disturbances may be the major cause of treatment failure and loss of follow up. Key words: Dermatitis artefacta; Dermatologist; Factitious dermatitis; Polymorphism; Psychiatry. Chatt Maa Shi Hosp Med Coll J; Vol.23 (2); July 2024; Page 104-107