Chattagram Maa-O-Shishu Hospital Medical College Journal

Editor’s Role on Plagiarism

M Jalal Uddin — 2023-07-25

Abstract not available

Chatt Maa Shi Hosp Med Coll J; Vol.22 (1); January 2023; Page 1-2

Factors Associated with Exclusive Breastfeeding among Mothers in Rural Chattogram of Bangladesh

Md Shah Alam — 2023-07-25

Background: Exclusive Breastfeeding (EBF) is recommended for the first six months of age by the World Health Organization (WHO). Mothers' good knowledge and positive attitude play key roles in the process of EBF practices. The study aimed to assess maternal knowledge, attitudes, and other factors associated with EBF practices in a rural area of Chattogram, Bangladesh.

Materials and methods: This descriptive cross-sectional study was conducted in two rural private hospital outpatient departments in Lohagara, Chattogram, Bangladesh, during the COVID-19 pandemic from July 2021 to December 2021. Two hundred and forty mothers with children of age 6 to 24 months selected by purposive sampling were interviewed using a questionnaire to elicit information on infant breastfeeding practices and their associated factors. Data were collected throughthe face-to-face interview from hospital's outdoors, following a convenient sampling method. Chi-squared test and binary logistic regression models were used to explore the association.

Results: The prevalence of EBFfor the first six months of an infant's life was 64.6%. Good knowledge (p<0.001) and a positive attitude (p<0.001) toward breastfeeding were significantly associated with EBF practices. A binary multivariable logistic regression model demonstrated that for mothers with SSC or higher-level education (AOR=3.21, 95% CI: 1.20-13.14) family monthly income >50000 BDT (AOR=2.11, 95% CI: 1.04-15.23) normal delivery (AOR=1.99, 95% CI: 1.11-8.23) and hospital delivery (AOR=3.34, 95% CI: 1.67-10.11) mothers were more likely to follow EBF practices compared to their counterparts. Moreover, joint family (AOR=0.32, 95% CI: 0.15- 0.68) and younger mother (AOR=0.42, 95% CI: 0.45-0.99) mothers had less likelihood of EBF practices than their counterparts.

Conclusion: One in every three children in the study sitedoes not breastfeed exclusively, which needs special attention from the policymakers.Besides good knowledge and a positive attitude, the most important predictors were modifiable factors for EBF; hence should be addressed to improve EBF practices.

Chatt Maa Shi Hosp Med Coll J; Vol.22 (1); January 2023; Page 3-7

Impact of Educational Intervention on Knowledge and Attitude of Undergraduate Medical Students Regarding Pharmaceutical Promotion

Fatema Johora — 2023-07-25

Background: Promotional activities conducted by pharmaceutical industries are highly successful to alter physicians' prescribing habit. Undergraduate medical curriculum does not make students to deal with this unwarranted effect. Educational intervention might be a key to address this crucial issue. The aim of this study was to evaluate the impact of educational intervention on knowledge and attitude of medical students regarding pharmaceutical promotion.

Materials and methods: This interventional research was conducted from February 2016 to February 2017. 4th year MBBS students of the four medical colleges of Dhaka city were the study population. A baseline assessment on knowledge and perception of the 4th year MBBS medical students' of the included medical colleges (Control and intervention) was conducted by a questionnaire survey. Number of respondents in control and intervention group was 156 and 243 respectively in pre test. Then, a package of educational intervention including interactive lecture and practical session was delivered to intervention group. After I month of intervention, post intervention data had been collected from undergraduate students to evaluate the effect of intervention on their knowledge and perception by using same questionnaire. Number of respondents in control and intervention group was 152 and 227 respectively in post test. Attitude of the undergraduate students of intervention group was evaluated by a structured questionnaire after one month of intervention. Total 227 students were participated in this survey.

Results: Proportion of students regarding knowledge and perception about pharmaceutical promotion is significantly increased after intervention (p<0.001). Attitude of undergraduate students of intervention group on 10 different case scenarios related to pharmaceutical promotion have been changed after intervention and it were statistically significant in all 10 case scenarios.

Conclusion: The conducted educational intervention was found effective at undergraduate level to modify knowledge and attitude about pharmaceutical promotion.

Chatt Maa Shi Hosp Med Coll J; Vol.22 (1); January 2023; Page 8-13

Screening of Renal Function among a Group of Physicians Working in a Hospital Who are Often Self Neglected

M A Kashem — 2023-07-25

Background: Prevalence of Chronic Kidney Disease (CKD) has been increasing rapidly worldwide and early screening to detect kidney disease, particularly at its early stages is pivotal to stop its further deterioration. Population-based study on detection at early-stage of kidney disease and it’s prevalence are scanty in our country, especially among the medical professional personnel. Hence taking advantage of the observance of World Kidney Day’ 2020, we conducted a screening pro-gram for kidney disease organized at the Chattagram Maa-O-Shishu Hospital (CMOSH) premises among a group of physicians of the hospital.

Materials and methods: This was a cross-sectional observational study among 67 physicians of different ranks (Medical Officer to Professor) working at CMOSH in different discipline. Age, body weight, height, Body Mass Index (BMI), blood pressure were documented, and urinary protein and serum creatinine were measured at a single sitting. Kidney function was estimated by calculating the Glomerular Filtration Rate (GFR) using the Modification of Diet in Renal Disease (MDRD) formula. Kidney function was classified according to estimated GFR (eGFR) and Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines.

Results: A total of 67 working physicians of the hospital were studied. Majority subjects (30) were in the age group of 20-29 years. Among all 11.9% participants had proteinuria (Trace to 1 plus). The distribution of eGFR was symmetrical, with the majority (70.10%) of subjects in the 60–89 ml/min category, 11.90% had 30-59 ml/min category and only 17.90% of the study population had eGFR > 90 ml/min. An inverse relation between eGFR and age, and a direct relation between eGFR and BMI were observed.

Conclusion: Proteinuria low eGFR levels might be related with future decline in renal function among the studied subjects and so regular health check-up is important to abate the potential epidemic of kidney disease among the health professionals.

Chatt Maa Shi Hosp Med Coll J; Vol.22 (1); January 2023; Page 14-18

Comparative Study of FNAC and Histopathology in Diagnosis of Thyroid Swelling

Md Mukhlesur Rahman — 2023-07-25

Background: Neck swelling is a common clinical presentation in ENT practice and it carries significant morbidity and even mortality if not managed properly. Thyroid swelling being the most common type among them. We conducted a study to assess the role of FNAC in diagnosing the nature of thyroid swelling and comparing its result with histopathology finding. The aim and objectives of this study is to observe the correlation between preoperative Fine Needle Aspiration Cytology (FNAC) and post operative histopathology in the diagnosis of thyroid lesions.

Materials and methods: A cross sectional study was done in the Department of Otolaryngology-Head & Neck Surgery and Department of Pathology, Chittagong Medical College, Chattogram from January 2018 to December 2020. Eighty (80) patients, both male and female of different age groups were included. The selected patients were subjected to clinical examination, routine hematological investigation, thyroid hormone test, USG, thyroid Scan, FNAC and histopathological examinations of the thyroidectomy specimens. Correlation between FNAC and histopathology reports were done in those patients.

Results: In this study, age range of the patients were 11 years to 70 years. Out of 80 patients of thyroid swelling, the most of the patients 28(35%) were 31-40 years of age groups. out of 80 patients of thyroid swelling, 26(26.25%) were male and 59(73.75%) were female and male female ratio was1:2.81. On FNAC 64(80%) were non neoplastic and 16(20%) were neoplastic. Out of 64(80%) of non neoplastic lesions, 62(77.50%) were nodular goitre and 2(2.5%) were lymphocytic thyroiditis and out of 16(20%) neoplastic thyroid swelling, 2(2.50%) were follicular lesion, 12(15%) were papillary carcinoma, 1(1.25%) was follicular carcinoma and 1(1.25%) was suspicious for malignancy. On histopathology, out of 80 patients of thyroid swelling 60(75%) were non neoplastic and 20(25%) were neoplastic. out of 60(75%) non neoplastic, 59 (73.75%) were nodular, 1(1.25%) was Lymphocytic thyroiditis and out of 20(25%) neoplastic lesions, 3(3.75%) were follicular adenoma,13(16.25%) were papillary carcinoma,3(3.75%) were follicular variant of papillary carcinoma and 1(1.25%) was follicular carcinoma.

Conclusion: It is concluded from the present study that female are more affected in our region. Non neoplastic lesions of the thyroid were more common (Nodular goitre being the commonest) than neoplastic lesions (Papillary carcinoma being the commonest). FNAC is essential diagnostic tool for thyroid swelling but final diagnosis to rule out thyroid cancer is surgical excision and histopathology.

Chatt Maa Shi Hosp Med Coll J; Vol.22 (1); January 2023; Page 19-22

Admission Lipid Profile and Discharge Outcome in Ischemic and Hemorrhagic Stroke

Akramul Azam — 2023-07-25

Background: Changes in the lipid profile have been suggested as a risk factor for developing ischemic stroke. Their role in hemorrhagic stroke is not clear. The study aimed to evaluate the lipid profile levels and discharge outcomes of patients who were admitted to a tertiary hospital in Bangladesh and also to determine the difference in the lipid profile of patients with ischemic and hemorrhagic stroke.

Materials and methods: This retrospective analytical study included 65 hospitalized stroke patients from the Neurology Unit of Chittagong Medical College Hospital. Data regarding age, sex, risk factors of stroke, lipid profile [Total Cholesterol (TC) Triglyceride (TG) Low-Density Lipoprotein cholesterol (LDL-C), and High-Density Lipoprotein Cholesterol (HDL-C)] levels, and discharged outcomes [Favourablemodified Rankin Scale (mRS)score £2 and unfavourable-mRS >2] were extracted from the register and compared between ischemic and hemorrhagic stroke patients.

Results: Out of 65 patients, 55 (84.6%) had ischemic and 10 (15.4%) had hemorrhagic stroke. Hypertension (67.7%), smoking (50%), diabetes (40%), and family history of stroke (38.5%) were common risk factors. The most common lipid abnormality was high LDL-C (86.2%), followed by low HDL-C (63.1%), high TG (47.7%), and high TC (35.4%). There was no difference in the lipid profile ofischemic and hemorrhagic stroke patients. Forty-seven (72.3%) patients were in poor functional status during discharge and discharged outcome was not associated with admission lipid profile. Compared to patients with unfavorable outcomes, patients with favorable outcomes at discharge were significantly younger, had shorter durations of hospitalization, had lower mRS scores at admission.

Conclusion: Dyslipidemia in the form of high LDL-C and low HDL-C were common in stroke patients be it infarct or hemorrhage. There was no difference in the lipid profile of the two categories of stroke.

Chatt Maa Shi Hosp Med Coll J; Vol.22 (1); January 2023; Page 23-27

Risk Assessment of Cyclophosphamide and Mycophenolate Mofetil after Induction Treatment of Lupus Nephritis: A Single Center Quasi-Experimental Study

Rosanna Bintey Kamal — 2023-07-25

Background: The comparative safety of immunosuppressive drugs such as cyclophosphamide and mycophenolate mofetil for patients with lupus nephritis remains controversial. The study aimed to investigate the specific side effects of cyclophosphamide and mycophenolate mofetil in lupus nephritis patient after induction treatment.

Materials and methods: It was a quasi-experimental study performed in the Department of Nephrology of Chittagong Medical College Hospital. A total of 100 patients of lupus nephritis who fulfilled the designated criteria were enrolled in this study by non-probability voluntary sampling method. The treatment was given on patient’s choice. After screening and treatment initiation, patients were assessed at 12 and 24 weeks. All the data were compiled in a structured case record form.

Results: In the present study 48 patients (53.3%) in mycophenolate mofetil group and 42 patients (46.7%) in intravenous cyclophosphamide group completed 24 weeks of induction treatment of lupus nephritis. Infections were common in both treatment groups but significantly higher with intravenous cyclophosphamide group ((33.3% vs. 8.3%). Upper gastrointestinal syndrome occurred with 20(41%) patients in mycophenolate mofetil group and 7(16.7%) patients in intravenous cyclophosphamide group (RR=5.8333). Regarding other adverse effect, 10 patients of intravenous cyclophosphamide and two patients of mycophenolate mofetil group had amenorrhea (23.8% vs.4.2%). Alopecia (11.9%) was seen only by intravenous cyclophosphamide group ((RR=0.0798).

Conclusion: Induction therapy with Mycophenolate mofetil was superior to intravenous cyclophosphamide in lupus nephritis in this study. Mycophenolate mofetil appeared to be better tolerated than cyclophosphamide.

Chatt Maa Shi Hosp Med Coll J; Vol.22 (1); January 2023; Page 28-32

Measles Infection and Vaccination Status against Measles in Children during 2019-2020: A Hospital Based Study in Chattogram

Asma Ferdousi — 2023-07-25

Background: Despite widespread availability of a safe and cost-effective vaccine, Measles outbreak is reported from different regions of Bangladesh in the recent past. This study was aimed to Identify the related features of Measles infection in children during the upsurge of Measles infection in Chattogram during 2019-2020, when Bangladesh was about to achieve Measles elimination.

Materials and methods: This prospective observational study included all the Measles infected children admitted in the Pediatric Ward of Chittagong Medical College Hospital, Chattogram during the period from September 2019-February 2020. In this hospital patients up to 12 years after neonatal period are admitted. Patients whose guardian did not give consent were excluded. Measles cases were diagnosed clinically according to case definition criteria by WHO. Demographic, clinical features, Measles vaccination status of both affected children & their mother and associated complications were recorded in a predesigned form. Data were analyzed and results were given in a tabulated form. The aim of this study was to evaluate the characteristics of Measles infection and their vaccination status in children during its upsurge in 2019-2020.

Results: Affected children 13(20%) were suffered in spite of vaccination. Among the 65 affected children 44 (67.6%) were below one year of age, youngest one was 2 months old. Male to female ratio was 1.8:1. 80% (n=52) children were not vaccinated, 35 of them not yet attained the age of vaccination. 17 children attained the age but vaccination was delayed due to cough and cold, fever, bronchopneumonia or Measles itself. Complications were common among them, Bronchopneumonia 47 (72.3%) and Purulent conjunctivitis 38 (58.5%). There was no case fatality.

Conclusion: Children are being affected by Measles before attaining the age of first dose of vaccination and incompletely vaccinated or unvaccinated children have a role in the upsurge of Measles.

Chatt Maa Shi Hosp Med Coll J; Vol.22 (1); January 2023; Page 33-37

Adherence to Anti-Seizure Medications in Children with Epilepsy Attending a Tertiary Care Center in Bangladesh

Dhananjoy Das — 2023-07-25

Background: Epilepsy is one of the most common neurological morbidities in children worldwide. Anti-Seizure Medication (ASM) is the mainstay of epilepsy treatment. Adherence to Anti-Seizure Medication (ASM) is the key to achieving seizure remission. So this study aimed to assess the adherence to anti-seizure medication among children with epilepsy and to identify the factors that influence adherence.

Materials and methods: It was a cross-sectional study involving Infants and children aged six months to twelve years old with seizure disorder irrespective of etiology, taking anti-seizure medications for more than six months and receiving mono or polytherapy were enrolled as the study subject. Self-reporting measures were used to assess adherence. Patients' caregivers were interviewed for the assessment of adherence. Descriptive statistical analysis was used to analyze the data, and univariate analysis with a chi-square test was used to observe the association between the variables and adherence.

Results: The mean±SD age of the participants was 34.75 ± 38.39 months. A significant association was found between the age of the respondent and compliance with anti-seizure medication (30.5± 27.25 vs. 39.99±36.67 months p=0.012). Males were more than females 28(70%) Vs. 12(30%). Most of the study subjects were belonging to lower-middle-class families 13(33.3%). The generalized onset of seizure was the frequent type of seizure 28(70%). The majority of the participants 24 (60%) did have a seizure with structural etiology. Most of the study subjects received monotherapy 34(85%). Sodium valproate 19(47.5%) was the most frequently used drug. Seizure remission was found in 28(70%) of the study population. No significant association was found between the treatment outcome and adherence to antiseizure medication (ASM). Adherence to ASM was found in 55% of this study. Unable to afford cost was found to be the main cause of non-adherence 14(35%). There is a significant association found between the duration of taking ASM and compliance with ASM (7.05 ± 5.3 vs. 17.56± 15.43 months p=0.005).

Conclusion: Adherence to Anti-Seizure Medication (ASM) is low in our study. Unable to afford cost was the main factor accountable for non-adherence appropriate interventions are needed to improve ASM compliance and consequently treatment outcome.

Chatt Maa Shi Hosp Med Coll J; Vol.22 (1); January 2023; Page 38-43

Relationship between HbA1c with Hypoglycaemic Attack and Diabetic Complications of Patients Admitted in a Tertiary Hospital

Jishu Deb Nath — 2023-07-25

Background: Hypoglycemia is a major complication of diabetes mellitus and common causes of admission in hospital. Those who have long duration of diabetes having poor glycemic control, frequently experienced such events were self treated at home. The present study pointed to identify whether hemoglobin A1c (HbA1c) a marker of average plasma glucose, relates with severe hypoglycemia and diabetic complications or not.

Materials and methods: A retrospective observational study was conducted in the Department of Medicine, Maa-Shishu-O-General Hospital, Agrabad, Chattogram from April 2019 to September 2021. Total 36 patients were selected, as presenting in Medicine Department with documented hypoglycaemia. All data was taken meeting exclusion criteria and analysed.

Results: Hypoglycaemic episodes mostly occurred in elder cases (>61 year of ages) n=16, 44% and HbA1c mostly belongs to between 7.6 to 8 groups. Confusion is the most common presentation, N=63, 63.9%. Neuropathy was found as common complication, (30.6% , n=11) cases and most of the neuropathy found in HbA1c 7.6 to 8.5 groups 54.54% , n=6 . Most of the patients were taking sulfonylurea group of drugs 47.2% , n=17, and mixed acting insulin n=21 ,58.3%.

Conclusion: Hypoglycemic admission is not related to extensive Diabetic control rather with related to elder patients , various Diabetic complications and injudicious use of ant diabetic agents.

Chatt Maa Shi Hosp Med Coll J; Vol.22 (1); January 2023; Page 44-47

Comparison between Effects of Fentanyl and Dexmedetomidine as Sedative in Elective Caesarean Section Under Subarachnoid Anaesthesia

Md Enayet Karim — 2023-07-25

Background: Regional anaesthesia has become an important anaesthetic technique now a days. The use of spinal (Subarachnoid) anaesthesia is often limited by the unwillingness of patients to remain awake during surgery. Pharmacologically induced tranquility improves acceptance of regional technique. This study compares Fentanyl and Dexmedetomidine in terms of onset and recovery of sedation, haemodynamic effects, respiratory effects and adverse effects of both the drugs during elective Caesarian section under spinal anaesthesia.

Materials and methods: This randomized clinical trial included 60 ASA (American Society of Anaesthesiologists) grade I patients between age 20-40 years undergoing elective caesarean sections under subarachnoid anaesthesia during the period January 2022 to June 2022.Patients were randomly allocated to one of two groups: Fentanyl group (Group F, n=30), who received Fentanyl in a single dose of 0.5mcg/kg and Dexmedetomidine group (Group D, n=30), who received Dexmedetomidine in a single dose of 2mcg/kg. Spinal anaesthesia was conducted by injecting a hyperbaric solution of 0.5% bupivacaine 3ml through a 25G spinal needle at L3-4 level. All parameters were documented at 5 min intervals until arousal of the patient. The onset of sedation i.e. time from iv (Intravenous) injection of Fentanyl or Dexmedetomidine to closure of eye lids (OAA/S score of 3) and the arousal time from sedation i.e. time from closing of the eye lids to OAA/S score of 5 (Patient is awake clinically) were noted. Any complication during operation was documented. The patient’s satisfaction with the sedation was assessed by the 5 point ‘Likert verbal rating scale.’

Results: There was no significant difference of mean blood pressure and mean heart rate between the two groups in different time intervals (p>0.05). Time of onset of sedation was comparable between Fentanyl and Dexmedetomidine (p value 0.210). The arousal time i.e. duration of sedation was significantly longer with Dexmedetomidine than Fentanyl (p<0.05). Fentanyl was associated with significantly higher incidence of some adverse effects like nausea, vomiting than Dexmedetomidine (46.66% vs 13.33%, p<0.05). Significant percentage of patients was satisfied with Dexmedetomidine than Fentanyl (86.66% vs 20%,p<0.001).

Conclusion: The study showed that the arousal time i.e. duration of sedation was significantly longer with Dexmedetomidine which is beneficial for the patient in single dose technique for sedation. Moreover, Fentanyl was associated with high incidence of some adverse effects like nausea, vomiting. Thus it is recommended that Dexmedetomidine is a better choice than Fentanyl for sedation in single dose technique during subarachnoid block for caesarean section.

Chatt Maa Shi Hosp Med Coll J; Vol.22 (1); January 2023; Page 48-52

Cytological Findings in Testicular FNAC in Azoospermia Patient: A Study of 395 Cases

Md Saiful Islam — 2023-07-25

Background: In the age of assisted reproduction, search for the cause of male infertility is increasing in numbers. As finding of obstructive azoospermia give the male a hope there are increased requisition to the cytopathologist to evaluate the spermatogenesis status of a male. The aim of the study was to see the cytomorphological pattern in azoospermia patients and to determine the procedure's safety.

Materials and methods: From January 2015 to June 2022, in Chattogram, Bangladesh, 395 patients with azoospermia were taken in this descriptive study. After all aseptic precautions and local anesthetization aspiration was done from both testes. Cytomorphological analysis was done in the following classes i) Positive for spermatogenesis ii) Hypo-spermatogenesis iii) Early maturation arrest iv) Late maturation arrest v) Sertoli cell only vi) Atrophic.

Results: Cytological diagnosis yielded 161 (40.76%) positive for spermatogenesis, indicating obstructive azoospermia, seconded by 'Sertoli cell only' in 115 (29.11%) patients. Both conditions were highest in the age group of 31-40, 93(57.76%) and 72 (62.6%). Hematoma was seen in 04(1.01%) cases and extended period of pain was experienced by 05 (1.26%) patients.

Conclusion: FNA of the testis is a much simpler and easily accessible procedure to assess the spermatogenesis status of an azoospermia patient.

Chatt Maa Shi Hosp Med Coll J; Vol.22 (1); January 2023; Page 53-56

Cognitive Status In Thalassemia

Wahida Akter — 2023-07-25

Background: Thalassemia is one of the most common chronic and genetic hematological disorder. This chronic disease challenges the individual at the physical, emotional, cognitive level and disrupts the quality of life because of persistent anemia and hypoxia. The aim of study is to assess the cognitive status in thalassemia.

Material and methods: This is a cross-sectional observational type of study that was performed in Autism and Child Development Center of Chattagram Maa Shishu–O–General Hospital. Children aged 6 to 16 years with thalassemia of different catagories were enrolled as study subjects. Study period was six months. Cognitive status of this study subject was assessed by WICS-IV equipment.

Results: Among the 50 study subjects, Hb E b thalassemia was the most common type of thalassemia 39(78%). 2(4%) patient took oral chelating agent, 18 (36%) were under injectable, 20(40%) were found taking both oral and injectable and 10(20%) were observed not under any iron chelation therapy. Regular iron chelation therapy was found in 22(44%) cases.10(20%) cases had normal intelligence,19(38%) cases had mild mental retardation and 21 (42%) had moderate mental retardation. Among the 10 patients who do not use any chelation therapy,8(80%) patients had moderate retardation and 2(20%) had mild mental retardation. On the other hand, among the 40 patients who were having iron chelation therapy, 10(25%) patients showed normal level of intelligence, 17(42.5%) had mild mental retardation and 13(32.5%) had moderate mental retardation. In different score of WISC-IV, it was found that working memory and processing speed were poorer than verbal comprehension and perceptual reasoning in different type of thalassemia. This study also showed poor cognition is more prominent in thalassemia major and Hb E beta thalassemia.

Conclusion: Cognitive status of the study subjects who take regular iron chelation therapy is much better than those who do not take iron chelation therapy. Hence, iron chelation therapy is proved to have better cognitive outcome for thalassemia patients with iron overload.

Chatt Maa Shi Hosp Med Coll J; Vol.22 (1); January 2023; Page 57-61

Views of Final Phase Undergraduate Medical Students’ of Bangladesh about the Socio-Economic and Institutional Factors that Influence Their Future Career

Hadi Md Habib Ullah — 2023-07-25

Background: Medical education is one of the most stressful field of education because of its highly demanding professional and academic requirements. There is a significant amount of factors as predictors of medical career decision-making: perceptions of specialty characteristics gained from curricular, extracurricular and personal experiences in health care, personal career needs (e.g Expected income, career options, status, work-life balance, labor content, lifestyle and working hours) and gender. An understanding of the factors which influence doctors’ career choices and how attitudes vary among doctors who choose different specialties, is important for all those involved in the teaching and training of doctors. This study was done to explore views of final phase undergraduate medical students of Bangladesh about the Socio-Economic & Institutional Factors that influence their future career selection.

Materials and methods: This descriptive cross sectional study was conducted among 784 students randomly selected from eight medical colleges of Bangladesh, in the period of January 2019 to December 2019 with a pre tested self-administered questionnaire.

Results: Study revealed that a total of 784 students responded, out of which 318(40.6%) males and 466(59.4%) female. Among them 726(92.6%) students wanted to do postgraduation. The leading reasons for selecting future career were future workload 255(38.2%), future workplace 272(39.8%) social status 242(35.6%) and scope of job 244(36.1%). Career choice also influenced by teachers as a role model 244(34.3%)

Conclusion: Study recommended that career counseling during and after completion of graduation in the medical college, this stimulate students to gain experiences in different specialties.

Chatt Maa Shi Hosp Med Coll J; Vol.22 (1); January 2023; Page 62-65

Absolute Neutrophil Count in Diagnosis of Neonatal Sepsis : A Hospital Based Cross Sectional Study

Rana Chowdhury — 2023-07-25

Background : Sepsis is the leading cause of neonatal death in developing countries. Delay in initiating treatment can considerably increase the morbidity and mortality. So early diagnosis is important.Traditional methods such as blood culture do not provide a rapid diagnosis. Absolute neutrophil count is one of the important hematological markers for diagnosis of sepsis. The purpose of the study to see the absolute neutrophil count in diognosis of neonatal sepsis.

Materials and methods: This is a hospital based cross sectional study conducted from January to June 2014. A total of 100 sick neonates admitted in the Neonatal ward of Chattagram Maa Shishu O General Hospital (CMSOGH) with suspected neonatal sepsis (Based on history and physical examination) constituted the study population. Investigation sent for Absolute neutrophil count, C-reactive Protein (CRP) and blood culture. The collected data was analyzed by statistical software packages SPSS method version 15.

Results: A total of 100 sick neonates of both sexes with suspected sepsis were enrolled in this study, out of which most of the patient showed neutropenia (66%), C-reactive protein positive 65% and blood culture positive 33%. Within the Creactive protein positive patients 78.8% patient had neutropenia (c2 =17.711, p= .001). From blood culture positive patients 85% showed neutropenia (c2 =8.510, p= 0.014).

Conclusion: Neutropenia is a common hematological finding in neonatal sepsis along with other screening test and neutropenia is more significant than neutrophilia.

Chatt Maa Shi Hosp Med Coll J; Vol.22 (1); January 2023; Page 66-70

Clinical Predictors of Sodium Disturbance in Children Presenting with Acute Watery Diarrhea in a Tertiary Hospital of Bangladesh

Ferdous Ara — 2023-07-25

Background: Sodium disturbances, either hyponatremia or hypernatremia, are the most common electrolyte imbalance encountered in managing children with acute watery diarrhoea. Early diagnosis and prompt management of these conditions by identifying clinical predicting factors in diarrheal children under 5 years of age are critically essential to prevent deaths in such children, especially in resource-limited settings. Our study aimed to evaluate clinical predicting factors associated with sodium disturbance in children hospitalized with acute watery diarrhea.

Materials and Methods: In this cross-sectional study, 121 children of 2 months to 5 years of age admitted in the Department of Pediatrics, Chittagong Medical College Hospital, Chattogram for acute watery diarrhea were included. Clinical features and sodium levels on admission were recorded. Children were grouped in hyponatremia (serum sodium <135mmol/l), hypernatremia (serum sodium >145mmol/l) and normonatremia (serum sodium 135–145mmol/l) and compared.

Results: Of the 121 children, 18 (14.9%) were hyponatremic, 71 (58.7%) isonatraemic, and 32 (26.4%) hypernatraemic. Logistic regression analysis revealed that children who did not receive ORS before admission, had severe dehydration and lethargy on admission would be more likely to have hyponatremic dehydration. Children who were younger, received concentrated ORS, thirsty and had convulsions on admission would be more likely to have hypernatremic dehydration than children with isonatremia.

Conclusion: The type of ORS used and age appears to be good predictors of sodium disturbance in children admitted with AWD.

Chatt Maa Shi Hosp Med Coll J; Vol.22 (1); January 2023; Page 71-75

Advanced Abdominal Pregnancy of 32 Weeks with Alive Baby: A Rare Event

Adiba Malik — 2023-07-25

Background: Abdominal pregnancy is a rare form of ectopic or extrauterine pregnancy with an incidence of 1:10000 and 1:30000. Advanced abdominal pregnancy is extremely rare with high maternal and perinatal mortality.

Case Presentation: We report a case of abdominal pregnancy at 32 weeks gestation with persistent abdominal pain and severe anemia, who was referred from another hospital to our center with an Ultrasonogram, missed the diagnosis of abdominal pregnancy, which was confirmed in our center as abdominal pregnancy at 32 weeks with live fetus. With laparotomy a 1.2 kg female baby was born without much difficulty and post operative recovery was uneventful. But the baby died at 27Th post operative day.

Conclusion: High index of clinical suspicion is necessary for early diagnosis of abdominal pregnancy and timely laparotomy with multidisciplinary surgical team can save the life of a mother.

Chatt Maa Shi Hosp Med Coll J; Vol.22 (1); January 2023; Page 76-78