Central Medical College Journal

Chest CT findings in COVID 19 disease in relation with duration of illness: A study of two hundred cases.

Chinmoy Kumar Saha — 2022-08-31

Chest CT scans of 200 symptomatic patients infected with COVID 19 from different health facilities and home were reviewed for common CT findings in relationship with their clinical symptoms, comorbidities and the time between symptom onset and the initial CT scan was studied in this cross-sectional study. Cases were categorized into three groups according to the timing of HRCT, 10 cases were in early (0-2days), 56 cases in intermediate (3-5days) and 110 cases were in late (6-12days) groups. Chest CT scan images showed bilateral peripheral ground glass opacities 96.63%, pulmonary consolidations 15.9%. Notably 29.54% patient had normal CT scan chest and 60% of them were imaged at early phase. With a longer duration of symptoms, chest CT findings were more typical including GGO, consolidation with greater total lung involvement. Bilateral peripheral GGO was observed in 20% patients at early phase while 53.57% and 64.54% were observed at intermediate and late phase of illness. Among the symptoms cough and dyspnea were observed more related with typical CT changes (95%). Diabetes and Hypertension (58% of patients) were the leading comorbidities that were found related with GGO and other typical CT findings. Mean time duration between symptom onset and positive RT PCR, CT scan changes were 4.79 and 7.55 respectively.

Central Medical College Journal Vol 5 No 2 Jul 2021 PP 70-75

Clinical Profile of Adult Organophosphorus Compound Poisoning in a Tertiary Care Hospital

Md Enamul Hoq — 2022-08-31

Despite the apparent benefits of organophosphate compounds (OPCs) acute organophosphate (OP) pesticide poisoning is an increasing problem worldwide. In a country like Bangladesh, where agriculture is a major component of the economy, these compounds are readily available to the general public. There is paucity of evidence from Bangladesh showing the pattern of organophosphate poisoning (OPP) in healthcare facilities. The aim of this study is to see the clinical profile of organophosphorus compound poisoning in admitted patients of tertiary care hospital.

Methods: This observational cross-sectional study was carried out over all admitted patient with OPC poisoning in the department of Medicine, Cumilla Medical college, Cumilla from July 2019 to January 2020. A total of 100 cases were enrolled in the study. Patients having history of poisoning with OPC compound were stabilized by ABC care system and then assessed according to detailed history, physical examination and paradeniya organophosphorus poisoning (POP) scale.

Results: The mean age was found 25.0±8.0 years and male to female ratio was 1:1.2, were mostly married (78.0%) and most of them from poor family (86%). The commonest manner of poisoning was suicidal (90.0%) with oral ingestion. More than eighty (84.0%) percent patients came from rural area. Commonest symptoms were abdominal pain (88.0%), vomiting (63.0%), excessive sweating (58.0%), salivation (35.0%), breathlessness (34.0%) and lacrimation (27.0%). Total hospitalization period was more than one week and less than two weeks in majority of cases (73%) and mortality rate was 2.0%.

Conclusion: Due to increasing numbers of organophosphorus poisoning cases in younger age groups strict legislature on the availability of organophosphate compounds, preventive measures and appropriate health education should be introduced to decrease the incidence.

Central Medical College Journal Vol 5 No 2 Jul 2021 PP 76-83

Assessment Of The Follicles in Different Age Groups in Post Mortem Human Ovary

Eshrat Jahan Eami — 2022-08-31

Ovary is one of the essential reproductive organs in human being. A detailed histomorphological feature of ovary is an un-debatable for diagnostic and therapeutic purpose for ovarian disease. The standardization of the morphological and histological measurements of ovary in general in Bangladeshi people is essential to increase the knowledge regarding anatomical variation in our population. So a research work on detailed anatomical parameters of ovary is an un-debatable.

Objective: To find out the follicles in different age groups post mortem human ovary.

Methodology: The cross-sectional observational study was carried out in the Department of Anatomy, Sylhet MAG Osmani Medical College, Sylhet in collaboration with the Department of Forensic Medicine, Sylhet MAG Osmani Medical College during the period from January 2016 to December 2016. Sixty pairs of human postmortem ovaries were collected. The inclusion criteria were dead bodies autopsied within 36 hours of death. Considerable signs of decomposition or decomposed dead body, presence of gross ovarian disease and any history of poisoning cases were excluded. All the specimens were examined for morphological parameters but only 18 specimens were examined histological parameters.

Results: The highest total numbers of the follicles were found in the age group A and lowest total numbers of the follicles were in the age group C. The differences of total numbers of the follicles were significant between group-A and group-B (p<0.001); and group-A and group-C (p<0.001); but no significant difference was observed between group-B and group-C (p=0.080).

Conclusion: Histomorphologically, the total number of the follicles is found maximum at reproductive years and is declined through perimenopause and postmenopause.

Central Medical College Journal Vol 5 No 2 Jul 2021 PP 84-87

Evaluation of Clinical Outcome of Subtrochanteric & Proximal Femur Fracture treated by Interlocking Intramedullary Nail with Side plate

Minhazur Rahman — 2022-08-31

Fractures of the subtrochanteric region and proximal femur can be especially challenging to manage, and they warrant special consideration to obtain consistently satisfactory results. The subtrochanteric zone of the femur is generally considered to include the area extending 5 cm distally from the inferior border of the lesser trochanter, or the junction of the proximal one third and middle third of the femoral shaft. Fractures that have their major displacement in this area are considered subtrochanteric fractures despite the possibility that some of them may extend into the trochanteric area proximally or the distal femoral shaft. The management of fractures of the subtrochanteric region and proximal femur has always held a particular interest for orthopedic surgeons. Biomechanically, the subtrochanteric area of the proximal femur is an area of high stress concentration, which has led to high rates of implant failures in the treatment of these fractures. Current evidence suggested that interlocking intramedullary nail with side plate offer better outcome.

Objectives: To evaluate the operative efficacy and clinical outcome of interlocking intramedullary nail with side plate in the treatment of subtrochanteric & proximal femur fracture.

Methods: This prospective cross sectional study was conducted in Cumilla General Hospital and private Clinics, Cumilla, from April 2018 to November 2019 among the 62 cases of subtrochanteric femur fractures. Objective of this study was to find out a safe, effective management of fracture, early mobility of patient, functional joint motion and short stay in hospital. All patients were treated by interlocking intramedullary nail with side plate. Routine follow up was carried out and outcomes were assessed. Radiographic examination was used to evaluate callus formation and fracture healing in postoperative 1, 3, 6 and 12 months follow-up. Functional recovery was evaluated by Harris Hip Scoring (HHS) system.

Result: In this study, the mean age was 49.3±8.5 years. Among 62 cases 52 cases (83.9%) were male and 10 cases (16.1%) were female. The male and female ratio was 5.2:1. Regarding the causes of injury, out of 62 patients 50 (81%) had a history of fall from height. In 12 (19%) cases, motor vehicle accident was the cause of fracture. Average time of healing was 18 weeks. According to Harris hip score findings, 46 cases were considered as excellent in functional recovery, 11 good, 4 fair and 1 poor. The proportion of the patients with excellent and good recovery was 91.8%.

Conclusion: Study showed interlocking intramedullary nail with side plate provides better functional outcome with early mobility of patients, and fracture unites without joint stiffness and less complication.

Central Medical College Journal Vol 5 No 2 Jul 2021 PP 88-93

Effect of Topical Insulin Versus Normal Saline Dressing in Healing of Diabetic Foot Ulcers

Md Abbas Uddin — 2022-08-31

Diabetic foot ulcer is a common cause of admission in the surgical wards and sometimes the first presentation of this debilitating disease. Numerous topical medication and gels are promoted for ulcer care and healing. Relatively few have proved to be more efficacious than normal saline dressing. This study aimed to compare the effect of topical insulin versus normal saline dressing in healing of diabetic foot ulcers at Rajshahi Medical College Hospital, Rajshahi.

Aims and objectives: To assess the effect of topical insulin versus normal saline dressing in healing of diabetic foot ulcers.

Methods: A total of 60 patients with diabetic foot ulcers were studied in different units of surgical ward of Rajshahi Medical College Hospital from July 2017 to June 2019. Patients were divided into two groups of 30 patients each that is group A (topical insulin) and group B (Normal saline). Ratio, mean, standard deviation, Pearson Chi-Square test were applied appropriately to this study.

Results: Among the 60 patients, majority of the patients were males in both the groups (73.33% in group A and 80.00% in group B) with male to female ratio of 2.7:1 in group A and 4:1 in group B. The mean age in group A was 50.00±7.33 years and in group B it was 53.00±7.80 years, where P=1.00. Among patients with group A significant reduction of mean ulcer area was observed (314.30±171.26 mm2 ) with higher mean percentage reduction (15.30±3.28 percent), whereas, in group B the mean percentage reduction was significantly less (6.35±2.03 percent) with less reduction of mean final ulcer area (110.5±56.23mm2), where P<0.001.

Conclusions: Topical insulin dressing provided better outcome in patients with diabetic foot ulcers by significant reduction in wound area when compared to normal saline dressing.

Central Medical College Journal Vol 5 No 2 Jul 2021 PP 94-101

Prevalence, Clinical Pattern and Presentations of Psoriasis in A Tertiary Care Hospital of Bangladesh

Md Abul Kalam — 2022-08-31

To find out different presentations of Psoriasis in Bangladesh.

Material and Methods: This is a cross sectional study of all dermatology patients with features of psoriasis who attended the dermatology outpatient clinic of the hospital between July 2016 and June 2017. Data was collected on a perform questionnaire. Age, gender and clinical presentations were recorded and analyzed using SPSS version 16.

Results: Psoriasis was found in 1.13% (60/5505) of the study population. There was a male preponderance with a male to female ratio of 1.34:1. The majority of patients seen were in the fourth decade of life. Stress, alcohol, and drugs were the most reported predisposing factors to psoriasis. All types of psoriasis were found, and plaque psoriasis was the most common.

Conclusion: Psoriasis is a one of the common skin diseases with wide range of clinical variation and predisposing factors. The current trend in the management of psoriasis is focused on treating the inflammatory process as well as managing the modifiable environmental triggers.

Central Medical College Journal Vol 5 No 2 Jul 2021 PP 102-105

Prognostic Role of Cardiac Troponin I after Percutaneous Coronary Intervention in Stable Coronary Disease

Md Ibrahim Khalil — 2022-08-31

Cardiac troponin I is a highly sensitive and specific marker of myocardial necrosis. In addition to the strong diagnostic role of cardiac troponin I its prognostic value has become increasingly well established for patients presenting with acute coronary syndrome. However, there have been conflicting reports on the value of troponin in the setting of PCI is stable and unstable coronary disease.

Objective: To assess the role of cardiac troponin I in predicting outcome after PCI.

Methods and results: CTnl was measured immediately before and at 8 hrs and at chest pain after PCI in 80 consecutive patients with stable coronary artery disease. Twenty of them with post procedural CTnl level 50.4 ng/ml were excluded because of the inability to do repeat estimation of CTnl at chest pain. Among the rest sixty patients, thirty had post procedural troponin <0.4 ng/ml were considered as group I and thirty had post procedural rise of CTnI >0.4 ng/ml were considered as group II. CTnl level, 0.4 ng/ml was consider as cut off value for grouping patients was based on ACC/ AHA/ ISCAI 2005 guide line definition of peri procedural myocardial infarction. The study end point was the following adverse cardiac events-recurrent angina, cardiogenic shock, significant arrythmias, congestive heart failure, Q wave MI, repeat PCI/ CABG, death during hospital stay and at 30 days follow up. In this study base line parameters like age, sex, BMI, risk factors, anginal class, base line ECG and LVEF showed no statistically significant difference between the two groups. Angiographic parameters such as types of lesion and procedural complications shows statistically significant difference between two groups. In-hospital adverse cardiac events after the procedure was significantly higher in group II than group 1 (P<0.01). The mean duration of post procedural hospital stay was also significantly higher in group II than group 1 (P<0.01). At 30 days follow up there has no incremental risk of adverse cardiac events.

Conclusion: CTnl rise at peri procedural myocardial infarction level was observed in 37.5% of this study patient. This level of CTnl was significantly predictive of an increased risk of adverse cardiac events at hospital follow up.

Central Medical College Journal Vol 5 No 2 Jul 2021 PP 106-115

From the Desk of Editor-in Chief Vol 5(2)

Md Mahabubul Islam Majumder — 2022-08-31

Abstract not available

Central Medical College Journal Vol 5 No 2 Jul 2021 PP 65

Monkeypox

Mostaque Ahmed — 2022-08-31

Abstract not available

Central Medical College Journal Vol 5 No 2 Jul 2021 PP 66

Management of Fractured Endodontically Treated Tooth by Fibre Optic Composite Post-Core-Crown: A Case Report

Mahrufa Hoque — 2022-08-31

The restoration of endodontically treated tooth is a subject that has been evaluated and discussed widely in the dental literature. The goal of dental treatment is to provide optimal oral health, aesthetics and functions. The successful treatment of a badly broken endodontically treated tooth depends not only on the success of the endodontic treatment but also on good prosthetic reconstruction. The prosthetic treatment on a seriously damaged, endodontically treated tooth often requires an endodontic post as an additional retention element for core build up prior to crown restoration. This case report presents a male patient of 22 years of age with prosthetic crown fracture of endodontically treated maxillary left central incisor tooth. The following clinical case represents the clinical steps involved in the utilization of a fibre-reinforced composite post-core in a maxillary left central incisor and the subsequent treatment with a full veneer crown.

Central Medical College Journal Vol 5 No 2 Jul 2021 PP 126-130

Fitness to Fly in Patients with Lung Disease

Mohammad Sana Ullah Sarker — 2022-08-31

These cases may go unrecognized, and even among those who are known to be hypoxemic, some do not use supplemental oxygen. During air travel in a hypobaric hypoxic environment, compensatory pulmonary mechanisms may be inadequate in patients with lung disease despite normal sea-level oxygen requirements. In addition, compensatory cardiovascular mechanisms may be less effective in some patients who are unable to increase cardiac output. Air travel also presents an increased risk of venous thromboembolism. Each year worldwide, more than 2.75 billion passengers travel by air, 736 million in the United States alone1. One study reports that over an approximately 3-year period, there were 11,920 In-flight medical emergency calls made by airlines to a medical communications Center; this was estimated to represent almost 1 medical emergency for every 600 flights2. Respiratory symptoms accounted for 12% of this in-air emergencies. The development of respiratory symptoms during flight was associated with an increased risk of hospitalization after air travel (odds ratio [OR], 2.13), second only to possible stroke (OR, 3.36). A previous study reported an average of 72 in-flight deaths per year3, from a population representing approximately 50–60% of the total estimated number of worldwide passengers for that period. Of those deaths, 69% occurred in passengers with no known previous medical illness3 as such, a thorough assessment of patients with chronic lung disease and cardiac disease who are contemplating air travel should be performed.

Central Medical College Journal Vol 5 No 2 Jul 2021 PP 116-125