Central Medical College Journal

Correlation between Clinical, Operative and Histopathological Findings of Adnexal Masses – A Study of 50 Cases

Dilara Rahman — 2023-06-19

Background: Adnexal mass has multidimensional diagnosis that may be related to fallopian tube, ovary etc. These masses may be benign, intermediate and malignant. The ability of clinical approach to diagnose the exact pathology of adnexal mass is still a question.

Objective: To explore the correlation of clinical findings with operative and histopathological findings of adnexal masses.

Method and Materials: A prospective and observational study was conducted in a tertiary hospital during the period of July 2015 to December 2015. 69 patients were selected according to purposive sampling and further scrutinized according to selection criteria, which were clinically diagnosed as adnexal mass. All the 50 patients undergone surgical intervention followed by histopathology. All the patients’ data were recorded through a semi-structured data collection sheet.

Result: Study shows clinical and post-operative (per-operative + histopathology) findings of adnexal masses were 54% vs 50% for ovarian endometrioma, 24% vs 22% for benign ovarian tumor and 22% vs 26% for other adnexal masses respectively.

Conclusion: Clinical findings with the help of sonography can guide effectively to the diagnosis of adnexal masses. However, per-operative and histopathological findings are required for the confirmation.

Central Medical College Journal Vol 6 No 2 Jauly 2022 Page: 62-66

Prevalence of Corneal Astigmatism in Age Related Cataract Patient in a Tertiary Eye Hospital

Mohammad Ariful Islam — 2023-06-19

Background: To investigate the magnitude and pattern of pre-existing corneal astigmatism in age related cataract patient.

Method: This prospective observational study was carried out in a tertiary eye hospital from January 2020 to June 2020. We examined 577 eyes of 532 patients who underwent cataract surgery. The mean age at the time of surgery was 61.2 ±7.1 (40 to 100) years. Corneal astigmatism was measured with Auto Refracto Keratometer at least two times for each patient. Astigmatism was calculated from dioptric difference of vertical reading from horizontal reading. With the rule (WTR) astigmatism was considered when steep meridian at 900±200. Against the rule (ATR) astigmatism was considered when steep meridian at 1800±200. Astigmatism is in other direction is defined as oblique.

Result: The pattern of astigmatism was ATR astigmatism in 237 eyes (41%), WTR astigmatism in 165 eyes (28.6%) and Oblique in 175 eyes (30.4%). Prevalence of ATR astigmatism was more than WTR astigmatism and prevalence of ATR astigmatism axis significantly increased with the increase in age. Average corneal power was 45.23D. Corneal astigmatism was 0.0D to 0.5D in 274 eyes (47.5%), 0.51D to 1.0D in 175 eyes (30.3%), 1.01D to 2.0D in 98 eyes (17.0%) and more than 2D in 30 eyes (5.2%) cases. Corneal astigmatism of most cataract surgery candidates fell between 0.50D to 1.50 D in 360 eyes (62.4%) cases.

Conclusion: Thirty five percent (35%) pre-operative patient had 1D or more corneal astigmatism and sixty five percent (65%) had less than 1Dcorneal astigmatism.

Central Medical College Journal Vol 6 No 2 Jauly 2022 Page: 67-70

Pattern and seasonal variations of snake bite in southern part of Bangladesh

Mohammad Nazim Uddin — 2023-06-19

Background: Snake bite is one of the leading causes of mortality and morbidity in many regions, notably the rural tropics, and is a globally overlooked occurrence. Present study is aimed to find the pattern and seasonal variations of snakebite in the southern part of Bangladesh.

Methods: A one-year retrospective survey was done on 554 venomous or non-venomous snake bite patients admitting in a tertiary care hospital Chittagong Medical College Hospital, Bangladesh. Through the administration of a questionnaire, data on snake bites and kinds, date and time of bite and envenomation characteristics were obtained from respondents over a twelve-month period. After data collection, SPSS-20 was utilized for analysis.

Results: In the present study male (64.1%) were found more affected than female and the vast majority of snake bite victims are younger Regarding pattern of envenomation, 400(72.2%) patients had no features of envenomation, 37(6.7%) local envenomation with spontaneous bleeding, 35(6.3%) had systemic envenomation, 74(13.4%) had local envenomation and 8(1.4%) had local swelling with neurotoxicity. Most of the patients were male (64.1%), female was mostly housewives (24.9%) and 68.1% were from poor socioeconomic status. Regarding monthly distribution of study patients where most patients were found during May to September and venomous bite were also more common during the month of May to August. Analysis of species of snakes revealed 89(16.1%) were pit viper, 87(15.7%) were dora snake, 23(4.2%) were cobra and 355(64.1%) snake bite were remained unidentified.

Conclusions: During the monsoon season (May to September) in Bangladesh, the incidence of both nonvenomous and venomous snake bites is much high and poisonous snake bites are prevalent during this time. Poor access to health services and superstition regarding dealing with Ozahs are also a common finding in our study.

Central Medical College Journal Vol 6 No 2 Jauly 2022 Page: 71-76

A study on hanging in 167 Cases

Joya Debnath — 2023-06-19

Background: Hanging signifies an asphyxiation form which, by a noose or another constricting band tightened by body weight, is secondary to compression or restriction of the neck structures. Death due to hanging is always suicidal until and unless otherwise specified.

Objective: To evaluate the socio-demographic characteristics in cases of death due to completed hanging in Bangladesh.

Materials and Method: This descriptive study was conducted in the Department of Forensic Medicine, Dhaka Medical College Hospital. The period of study was from July 2020 to June 2022. A total number of 167 autopsies were done during this period on dead bodies that died due to hanging. Points regarding knot of ligature material, injury to neck structures, ligature mark, and stomach condition were noted during post-mortem examinations. All information was noted in a structured data sheet. Data were analyzed using a computer-based programme statistical package for social science (SPSS) for windows version 25.

Result: This study shows maximum number of hanging cases 34.1% were in the age group of 21-30 years. Among the 167 suicide cases by hanging, the majority (69.5%) were male. Majority (56.9%) of the cases were married. Family disputes were most common motive 66(39.5%) and in females, the most common motive was marriage related harassment, particularly in married women 38(22.8%). Soft material like cloth, saree, orna, and dupatta was the preferred material for hanging in this study (85.6%) followed by firm materials (7.8%) like a rope. Hard material like iron wires, cable wires, etc were used very rarely (2.4%) and the victims who used these were almost always male.

Conclusion: This culture has a great socio-economic burden due to the high incidence of suicidal hanging among young adults. The private essence of hanging and convenient access to ligature points and ligature supplies renders suicide avoidance challenging. Marital disappointment, organic disease issues, and dowry abuse are the primary reasons behind suicide hanging. Social, legal and psychiatric interventions are required to prevent suicide.

Central Medical College Journal Vol 6 No 2 Jauly 2022 Page: 77-81

Early postoperative PTH level following total thyroidectomy as a predictor of hypocalcemia: a single center-based study in Bangladesh

Emdadul Hoque — 2023-06-19

Background: Assessment of parathyroid hormone (PTH) following thyroid surgery assists in the prediction of hypocalcemia and permits early intervention and therapy with oral calcium and/or vitamin D supplements.

Methods: This retrospective analysis comprised 141 individuals who had undergone a total or completion thyroidectomy over the previous four years. The blood PTH level was measured 3 hours after surgery to determine its change and to predict hypocalcemia.

Results: Patients were predominately female (75.2%), and the mean age was 48.73 ± 13.44 years. The main surgical procedure was total thyroidectomy (80.14%), and the main cause for surgery was a multinodular goiter (34.04%). A comparable number of patients with each type of thyroid disease (multinodular goiter, papillary thyroid cancer, thyroiditis, Graves’ disease or toxic multinodular goiter were enrolled. Three hours after surgery 93 patients (65.95%) had serum PTH levels of >10 pg/ml (mean 28.06) and 90 patients (68.38%) had normal serum calcium (mean 8.66). Most of these 93 patients (65.95%) didn't require postoperative supplementation, whereas 48 patients (34.05 %) with serum PTH levels less than 10 pg/ml required some form of supplementation; 39 (27.65 %) required both oral calcium and vitamin D supplements, and 9 (6.4 %) required only oral vitamin D supplementation. There was a significant correlation between the 3-h postoperative PTH level and hypocalcemia (P-value 0.000). The type of pathology had no significant association with low serum PTH level after surgery (P-value 0.166).

Conclusion: Asymptotic individuals with PTH levels less than 10 pg/ml, who are regarded as being in the high-risk category, can start taking calcium and/or vitamin D supplements early if their PTH levels are measured at 3 hours following complete thyroidectomy. To predict hypocalcemia, more research is required to compare the outcome of early serum PTH level with the day one serum PTH level following complete thyroidectomy.

Central Medical College Journal Vol 6 No 2 Jauly 2022 Page: 82-89

Predictors of 6-month follow-up Outcome of Drug Treatment in Schizophrenia in a tertiary hospital of Bangladesh

Mohammad Shahid Ullah — 2023-06-19

Background: Schizophrenia may have a better outcome in low- and middle-income countries. In Bangladesh short-term outcome of drug treatment of schizophrenia is also better. It is required to see the predictors of outcome of drug treatment of schizophrenia in Bangladesh.

Objectives: General objective of this study is to assess the outcome of 6-month follow-up of patients with schizophrenia. Specific objective of this study is to find out the predictors of 6-month follow-up outcome of drug treatment in schizophrenia.

Methods: Patients with a SCID-1/P diagnosis of schizophrenia (n=42) were assessed prospectively at baseline, at 6-week and at 6-month follow-up. Socio-demographic and relevant variables and questionnaire for family support and previous work record for the study were read in front of the patients and guardians and were filled up by the researcher. Psychopathological measurements were applied at base line by researcher and at 6-week and at 6-month by research assistant for the study population.

Results: Follow-up data were available for 38 patients at 6-month and among them 86.85% achieved partial remission, 7.89% had not responded and 5.26% had relapsed. In multivariate analysis by General Linear Model Analysis of socio-demographic and relevant variables with the mean BPRS score as outcome in this study we found that age, education, marital status and history of previous work record were significantly associated with the 6-month treatment outcome. Conclusions: Drug treatment outcome of schizophrenia in Bangladesh is better in short-term follow-up. Increase family support and early management by drugs should be a target for intervention.

Central Medical College Journal Vol 6 No 2 Jauly 2022 Page: 90-96

From the Desk of Editor in Chief Vol.6(2)

Md Mahabubul Islam Majumder — 2023-06-19

Abstract not available

Central Medical College Journal Vol 6 No 2 Jauly 2022 Page: 57

Osteoporosis

Md Mahabubul Islam Majumder — 2023-06-19

Abstract not available

Central Medical College Journal Vol 6 No 2 Jauly 2022 Page: 58

Instructions for Authors Vol.6(2)

Editor In Cheif — 2023-06-19

Abstract not available

Central Medical College Journal Vol 6 No 2 Jauly 2022 Page: 59-61

Thoracic Segmental Spinal Anesthesia in Patient with Severe COPD in Open Cholecystectomy

Md Kutub Uddin Khan — 2023-06-19

Background: Regional anesthesia is preferred in most of the chronic obstructive pulmonary disease (COPD) patients to avoid intra- and postoperative complications related to general anesthesia. Herein we reported a case of empyema gall bladder with severe COPD who went for an open cholecystectomy under thoracic segmental spinal with epidural anesthesia. He had substantial dyspnea on routine household activities (NYHA Class III). He had history of several hospital admissions with acute onset of dyspnea and was treated with bronchodilators and systemic steroids. He had no history of other comorbidity. The patient was scheduled for an emergency laparotomy followed by open cholecystectomy. Postoperative recovery was uneventful allowing the patient to be discharged on the 5th POD.

Central Medical College Journal Vol 6 No 2 Jauly 2022 Page: 97-100