Delta Medical College Journal

Successful Management of Early Cervical Ectopic Pregnancy with Single Dose Methotrexate

Wed, 07 Feb 2024 00:00:00 +0000

Cervical ectopic pregnancy is an uncommon but a potentially life-threatening condition due to risk of severe haemorrhage and occasional need of hysterectomy. Transvaginal ultrasonogram is a key way to diagnose such a case. Early detection and conservative approach of treatment could limit the morbidity and preserve fertility in many cases. Here, we present a case of cervical pregnancy diagnosed by ultrasonogram at 6 weeks of gestation and treated successfully by a single dose of intramuscular methotrexate.

Delta Med Col J. Jan 2021;9(1):58-61

Clinicopathologic Features and Outcome of COVID-19 Patients Attended at a Secondary Hospital in Bangladesh during the Pandemic

Wed, 07 Feb 2024 00:00:00 +0000

Background: Coronavirus Disease 2019 (COVID-19) is an acute respiratory disease
that can present varieties of clinical and pathologic manifestation. Sometimes it present
with severe manifestation which ultimately lead to respiratory failure and death.
COVID-19 patients with other comorbidities may develop a life-threatening situation.
Objective: To describe the clinicopathologic features and outcome of COVID-19
patients admitted in Combined Military Hospital (CMH) Rangpur, Bangladesh.
Materials and method: This cross-sectional study was conducted at CMH Rangpur,
Bangladesh, from 1 May 2021 to 30 August 2021 among purposively selected 416 cases
of COVID-19 positive patients. Data were collected from the medical records of the
hospital admitted patients in a structured case report form. Results: Highest numbers of
the respondents were in the age group of 31-50 years (49.03%) with male predominance
(72.28%). About 89% were Muslim and 54.81% were educated up to higher secondary
level. Fever (90.86%) was the common presenting symptoms followed by cough
(73.55%), sore throat (30.28%). About 24.51%, 23.07%, 11.05% had hypertension,
diabetes mellitus and respiratory comorbidities respectively. Lymphopenia (75.24%)
and elevated C-Reactive Protein (54.08%) were observed in most of the cases. Only
8.17% patients had critical illness that needed intensive care unit admission. Majority
(91.82%) fully recovered from the illness while 1.92% expired. Conclusions: The most
commonly reported symptom was fever (90.86%) among all the COVID-19 positive
patients. Majority (62.25%) of the patients belonged to mild cases. Overall mortality
was 1.92%. In most cases the clinical presentation is that of a respiratory infection with
symptom severity ranging from a mild influenza like illness.

Delta Med Col J. Jan 2021;9(1):3-8

Assessment of Risk Score for Developing Type 2 Diabetes Mellitus among Bangladeshi Adults Using Indian Diabetes Risk Score

Nazma Akter — Wed, 07 Feb 2024 00:00:00 +0000

Background: Different studies support the utilization of risk-assessment scoring systems in quantifying individual’s risk for developing type 2 diabetes mellitus (T2DM). Thus, a simple risk-assessment scoring system for early screening of T2DM among Bangladeshi adults would be beneficial to identify the high-risk adults and thus taking adequate preventive measures in combating DM. Objective: The purpose of the study was to calculate the risk assessment score for developing type 2 DM among Bangladeshi adults using IDRS (Indian Diabetes Risk Score) tool and to assess the association of different risk factors of IDRS tool with the risk score. Materials and method: The cross sectional observational study was conducted among randomly sampled 482 adult Bangladeshi male and female subjects. The study population consisted of non-diabetic adults visiting the outpatient department (OPD) of Medicine, MARKS Medical College & Hospital, a tertiary care hospital in Dhaka, Bangladesh, from June 2018 to May 2019. A Semi-structured questionnaire consisting of demographic characteristics, risk factor profile of Indian Diabetes Risk Score (IDRS) was used. All the participants were assessed and categorized as high (IDRS ≥60), moderate (IDRS 30-50) and low risk (IDRS <30) based on the risk score of IDRS questionnaire. Data were entered and
analyzed in SPSS. Results: Out of 482 subjects, female were 53.3%. The Mean (±SD) age of the study subjects was 38.92±1.12 years. According to IDRS score, 50.4% of the study subjects were at moderate risk and 37.3% were at high risk of developing diabetes; (p<0.05). The mean IDRS was significantly higher among female than male subjects (p<0.001). A statistically significant association of diabetes risk with different age group, waist circumference, level of exercise and positive family history for diabetes were seen. Conclusion: About 88% of the study subjects were at moderate to high risk of having diabetes, hence screening for risk factors is of utmost importance so that
interventions can be initiated at an early stage.

Delta Med Col J. Jan 2021;9(1):9-16

Complication Patterns of Loop Ileostomy

Tangera Akter, AFM Anwar Hossain, Shahanara Yeasmin — Wed, 07 Feb 2024 00:00:00 +0000

Background: Loop ileostomy is a temporary diversion of small intestinal contents towards exterior through anterior abdominal wall. Though it is a good procedure for a better outcome of primary surgery it has itself many complications. Objective: To determine the clinical spectrum of loop ileostomy complications. Materials and method: This prospective study was conducted from January, 2017 to December, 2017. Consecutive 30 patients requiring loop ileostomy were enrolled in the study by purposive sampling and were categorized into Group A requiring emergency surgery and Group B planned for elective surgery. Data regarding sociodemographic, clinical, surgical and outcome profile were recorded in a pre-structured, interview and observation based, peer reviewed data collection sheet. Data were compiled, edited and analyzed with SPSS version 23. Data were presented as mean and standard deviation, frequency percentage and median with range. Results: The mean age of the patients were 32.79±5.19 years (age range: 20-43 years) and 49.16±6.17 years (age range: 28-76 years) in Group A and Group B respectively with sex ratio of male to female of 4:1 and 3:1. Out of 10 patients in Group A, 4(40%) patients underwent resection anastomosis with ileostomy and primary repair with loop ileostomy whereas 2(20%) patients underwent exteriorization of multiple perforation site. In Group B among 20 patients, 9(45%) underwent low anterior resection with loop ileostomy and 5(25%) patients underwent left hemicolectomy with loop ileostomy. Out of 10 patients in Group A, 5(50%) patients each suffered from skin excoriation and major wound infection. On the contrary, among 20 patients in Group B, 11(55%) and 4(20%) patients suffered from skin excoriation and stomal obstruction. Only skin excoriation was evident as statistically significantly higher in Group B than in Group A (p 0.03). Among the general complications, electrolyte imbalance (60% vs 40% in Group A and B respectively) and respiratory tract infection (10% each in Group A and B) were evident. Conclusion: Skin discoloration, skin edema, major and minor wound infection, prolapse, skin excoriation and stomal obstruction are the different spectrum of loop ileostomy complications in our perspective. Among them skin excoriation is much higher in routine cases than emergency surgery.

Delta Med Col J. Jan 2021;9(1):17-22

A Study among Chemical Suicidal Victims: Situation Analysis

Sanjida Akhter — Wed, 07 Feb 2024 00:00:00 +0000

Background: Suicide by poisoning is the act of intentionally killing oneself by using various chemical substances and it is the most common and widely used method in developing countries like Bangladesh. Objective: The objectives of this study were to find out the socio-demographic characteristics and possible reasons among the chemical suicidal victims. Materials and method: This was a descriptive type of cross-sectional study, held in the Morgue of department of Forensic Medicine of Dhaka Medical College (DMC), Dhaka, Bangladesh, from July 2016 to June 2018. Victims were selected purposively according to the availability in the morgue of Dhaka Medical
College. Data were collected from the relatives of the victims and the verbal consent of the doctors who performed autopsy at DMC morgue. Results: A total of 50 victims of suicide using chemical substances as revealed by autopsy findings from the DMC morgue were enlisted in this study. Victims of suicide not using chemicals were excluded from this study. Half (50.0%) of the suicidal deaths by poisoning cases were aged 20 or below. Majority (66.0%) of the victims was male. Organophosphorus compound was found in 58.0% cases, followed by diazepam (8.0%) and barbiturates (4.0%), after receiving chemical analysis report. Conclusion: Pesticides are the most commonly used suicidal agent particularly in low and middle-income countries like ours. So, social awareness regarding this issue is very much needed.

Delta Med Col J. Jan 2021;9(1):23-27

Prolapsed Lumbar Intervertebral Disc (PLID) Surgery and Our Experiences

Wed, 07 Feb 2024 00:00:00 +0000

Background: Herniated lumbar disc is the most common specific cause of low back pain. Surgery results in better outcome for cases with exclusive severe radicular pain and health-related quality of life improves after lumbar disc herniation (LDH) surgery. Objective: To determine the outcome of lumbar disc herniation surgery and to assess the effect of factors that could predict the outcome of surgery. Materials and method: This observational study was done in Delta Medical College & Hospital, Mirpur, Dhaka, during March 2016 to January 2019. We evaluated 54 patients who had undergone operations for lumbar disc herniation using three different surgical techniques (laminectomy, fenestration and discectomy, and spinous process osteotomy) for low back pain and radicular pain. Results: Forty six (85.19%) patients were male and 8(14.81%) were female. Age range was 18-60 years. Forty nine (90.74%) were new patient and 5(9.26%) had recurrent disc prolapse. Diagnosis was confirmed by MRI. Fifty (92.59%) patients had no pain after surgery and only 2(3.70%) patients needed reoperation and 2(3.70%) had occasional pain. Conclusion: Surgery for lumbar disc herniation is effective in reducing radicular pain. All three surgical approaches resulted in significant decrease in preoperative radicular pain and low back pain, but 100% good outcome was not achieved.

Delta Med Col J. Jan 2021;9(1): 28-32

Variation of Shapes of Spleen of Bangladeshi People

Wed, 07 Feb 2024 00:00:00 +0000

Background: Spleen is a haemo-lymph organ and belongs to the reticuloendothelial system of human body. The spleen plays a central role in the pathophysiology of several potentially severe diseases and increasing application of sophisticated procedures in radiology and surgery requires a profound knowledge of the gross and histomorphological aspects of the human spleen and also its vascular pattern.
Objective: The present study was carried out to minimize the dependency on foreign standards and to identify the morphological changes with a view to establish a data related to spleen of Bangladeshi people. Materials and method: A cross sectional descriptive study was performed on 65 postmortem human spleen (34 of male and 31 of female) by purposive sampling technique and their different shapes were noted. Dissection was performed according to standard autopsy techniques. Results: There were variations of the shapes of the spleen, 2 were found disc shaped (3.07%), 2 were irregular (3.07%), 21 were oval (32.30%), 7 were tetrahedral (10.76%), 8 were
triangular (10.76%) and 26 were wedge shaped (40.0%). Conclusion: From the present study, it was concluded that six types of shapes of spleen were observed, common shapes were wedge and oval shape, with less frequent occurrence of triangular and tetrahedral
and few were disc and irregular. The finding of the present study will be of fundamental importance to medical teaching and also to clinicians.

Delta Med Col J. Jan 2021;9(1):33-36

Opportunistic Salpingectomy: A New Scope of Preventing a Deadly Disease

Shahana Shermin, Aysha Noor — Wed, 07 Feb 2024 00:00:00 +0000

Background: Symptoms of ovarian cancer are non-specific and often do not arise until the cancer is in a late stage. Such late onset of symptoms and the lack of an effective screening test result in diagnosis at an advanced-stage for most patients of ovarian cancer. The fimbrial end of the fallopian tube has recently been suggested as the site of origin for epithelial ovarian cancers (EOC). Therefore, a change in practice with opportunistic salpingectomy (OS) at the time of hysterectomy has been advocated for prevention of ovarian cancer. Different gynaecological societies have published statements in favour of opportunistic salpingectomy in women at average population risk for ovarian cancer prevention. In recent years, salpingectomy has been increasingly performed for tubal sterilization also. We have gone through the available scientific publications and international guidelines in preparing this brief review in an attempt to
be familiar with the recent updated views regarding this issue.

Delta Med Col J. Jan 2021;9(1):37-57

Artificial Intelligence in Laboratory Medicine

Md Rezwanur Rahman — Wed, 07 Feb 2024 00:00:00 +0000

Abstract not available

Delta Med Col J. Jan 2021;9(1):1-2