Journal of Armed Forces Medical College, Bangladesh

Evaluation of Humoral Immune Response in COVID-19 Patients- A Comparative Study

Suraiya Akhtar — 2024-06-10

Background: The novel coronavirus SARS-CoV-2 is a newly emerging virus. Positive detection of SARS-CoV-2 RNA by RT-PCR has been used to confirm SARS-CoV-2 infection. Recently positive detection of IgG and IgM antibodies specific to SARS-CoV-2 has also been recognized as deterministic evidence for confirmed SARS-CoV-2 infection. The antibody response in COVID-19 patient remains largely unknown, and the clinical values of antibody testing have not been fully demonstrated.

Objective: To better clarify the humoral immune response during SARS-CoV-2 infection.

Methods: This cross sectional study was carried out on 200 RT-PCR confirmed COVID-19 cases. For better evaluation of antibody response, patients were divided into two groups, group I and group II, each consisting of 100 persons.

Results: Out of a total 200 cases antibody was detected in 104(52%) cases and antibody not detected in 96(48%) cases. Out of 104 seropositive cases only IgG was detected in 69.2% cases, only IgM in 10.6% cases and both IgG, IgM in 20.2% cases.In group I seropositivity was 68%. IgG, IgM and both IgG, IgM positivity were 58.8%, 14.7% and 26.5% respectively. In group II seropositivity was 36 %. Positivity for IgG, IgM and both IgG, IgM were 88.9%, 2.8% and 8.3% respectively.

Conclusion: As we learn more about the long-term implications of COVID-19 on recovered individuals, antibody tests can be used to increase this understanding of the immune system response to SARS-CoV-2, quantify the magnitude of the COVID-19 outbreak and effectively manage patients.

JAFMC Bangladesh, Vol 19, No 2 (December) 2023: 3-6

Pattern of Anatomy SAQ in First Professional MBBS Examination Question Papers in Public Universities of Bangladesh

Anju Manara — 2024-06-10

Introduction: Assessment is a very important method of measurement of medical education. Anatomy is an essential part of undergraduate medical curriculum. Short answer question (SAQ) has a better content coverage as compared to long essay question.

Objective: To be assess the pattern of SAQ in MBBS first professional written anatomy question papers of public universities of Bangladesh.

Method: The cross-sectional study was conducted at Armed Forces Medical College in the department of Anatomy, Dhaka Cantonment. For this study, SAQ papers of anatomy of nine first professional MBBS examinations of Bangladesh University of Professionals (BUP), Dhaka University (DU) and Chittagong University (CU) from May 2017 to November 2021were collected. These were classified as parts and segments. Each segment was categorized as definition, draw and label, unique and open type. They werecalculated as number of segments as well as total weightage.

Result: On analysis it was found that the percentage of weightage of definition type questions of BUP, DU and CU were 3.53±2.03, 2.43±1.42 and 2.89±1.12; draw and label type 12.84±4.44, 15.98±3.13,17.053±.65; unique type 24.16±9.88,31.33±6.14, 26.47±3.84 and for open type 56.13±4.77,60.72±5.15, 53.73+5.29. Significant difference was found in draw and label type question in between BUP and CU, in unique type question in between BUP and DU and DU and CU, in open type question in between DU and CU.

Conclusion: Different types of SAQ are used to determine the level of cognitive domain. Proper distribution of types of SAQ shall ensure the proportion of these domain mentioned in the curriculum.

JAFMC Bangladesh. Vol 19, No 2(December) 2023: 7-11

Comparison of Monocyte to Lymphocyte and Platelet to Lymphocyte Ratio between Patients with Depression according to Severity of Disease

Mohammad Nesar Uddin Ahmed — 2024-06-10

Background: Depression is one of the most common psychiatric disorders with global public health concern that is linked to systemic inflammation. The monocyte to lymphocyte (MLR) and platelet to lymphocyte ratio (PLR) are partially new markers which may be evaluated with simple blood test and which are shown to be highly informative in showing chronic low grade inflammation associated with pathophysiology of depressive disorder.

Objective: To evaluate the relation of MLR and PLR between patients with depression according to severity of disease.

Methods: This observational study was conducted in the Department of Psychiatry of Jahurul Islam Medical College Hospital (JIMCH), Bajitpur, Kishoregonj between November 2012 and April 2013. Subjects between the age group of 25 and 55 were included in the study that involved 253 subjects with diagnosed depressive disorder according to the criteria of Diagnostic and Statistical Manual of Mental Disorders, Revised Text (DSM IV-TR) who received no pharmacological therapy of depression within the past 01 month. A sociodemographic information form and the Hamilton Rating Scale for depression (HAM-D) were administered. Patients were classified into four groups according to their HAM-D score such as mild, moderate, severe, and very severe depression. Blood sample were taken for biochemical analysis and complete blood parameters were evaluated in the hematology laboratory of JIMCH. All data were expressed as mean±SD. For statistical analysis, Chi-square test (χ2) was used to compare categorical variables, frequencies, and ratios. An independent sample ‘t’ test was used to compare normally distributed variables between two groups.

Results: In the present study, it was found significant differences in the MLR, PLR, monocyte, leukocyte values of the patient group with depression according to severity of disease. Severe and very severe depression had significantly higher MLR levels compared to patients with

mild and moderate depression. On the other hand, mild and moderate depression. On the other hand, mild and moderate depression had significantly higher PLR levels compared to patients with severe and very severe depression.

Conclusion: In summary, the findings of the study reveal that higher HAM-D scores are associated with higher MLR and lower PLR levels in patients with depressive illness compared to patients with lower HAM-D scores. Moreover, a high MLR values supports the view that inflammation is a critical factor in the etiology of depression.

JAFMC Bangladesh, Vol 19, No 2 (December) 2023:12-15.

Effect of Oral and Dental Health on Combat Fitness- A Study Conducted in Military Dental Centre Cumilla

Md Ataul Gani Sarker — 2024-06-10

Background: The effect of oral and dental diseases of the deployed troops can seriously impair the operational activity. Combat fitness on oral and dental aspect means keeping soldier’s oral health in such a state so that they can be quickly deployed, as well as military dental personnel staying in such a way that they can be moved in the front with all of their equipment and materials to treat patients.

Objective: To figure out the present oral health status of Bangladeshi troops and to correlate it’s possible influence on combat situation.

Methods: This descriptive study was carried out in Military Dental Centre Cumilla from 01 March 2020 to 31 March 2022. All uniformed personnel reported to MDC with oral and dental issues were included in this study.

Results: A total of 4597 uniformed personnel were evaluated and treated. Among them sainik and lance corporals were highest 2289(50%). Dental caries was mostly diagnosed condition 1410(31%). In case of acute dental condition irreversible pulpitis cases were most in number 420(35%). Dental restoration was mostly performed procedure 1293(48%) and glass ionomer restoration was done 830(64%) in most of the cases. The dental emergency rate was 230 per 1000 soldier per year.

Conclusion: Disease non battle injury (DNBI) originating from dental pathologies obviously compromise the performance of high intensity missions. In this study, number of dental emergency rate (considering every dental visit) was found 230 per 1000 soldiers per year which is very similar to other countries.

JAFMC Bangladesh, Vol 19, No 2 (December) 2023: 16-20

Can e-TEP be a Better Option than TEP for Inguinal Hernia Repair?

Mohammad Monir Hossain — 2024-06-10

Background: An organ or fatty tissue, like the colon, might abnormally emerge through the wall of the cavity in which it normally resides, for making a hernia. Among different hernias inguinal hernia repair is the most frequently done procedures by surgeons in Bangladesh and worldwide. Now-a-days Laparoscopic repair is performed in this country and accepted by the people. Laparoscopic TEP and e-TEP are excellent procedure for repair of inguinal hernia. In this Centre, we performed both procedures. In Technical aspects e-TEP is better approachable than TEP.

Objective: In this article we present how to overcome the difficulties of TEP technique by doing the enhanced view totally extra peritoneal technique for repair of inguinal hernia.

Methods: It is a non-randomized comparative study. The study consists of patients with laparoscopic hernioplasty for the period of one year (From July 2018 to July 2019). Total 20 cases were included in the study (10 cases of Laparoscopic e-TEP and 10 cases of Laparoscopic TEP). Data were collected by follow up visit, questionnaire and by phone call.

Results: The study consists of 20 patients among whom 10 were placed in group A (e-TEP group) and 10 cases were placed in group B (TEP group). Mean operating time in group A was 108.5 min while in group B was 114 min. Pain scoring in group A was 75% and giving score 1-2 (mild pain). All are male. Mean age for e-TEP was 26.5 years and for TEP was 35.6 years.

Conclusion: Laparoscopic e-TEP provides wide area than TEP for repair of inguinal hernia. It is a surgeon friendly procedure for repairing hernia. It is easier to learn e-TEP than TEP.

JAFMC Bangladesh, Vol 19, No 2 (December) 2023: 21-23

Immunohistochemical Analysis of Glomerular Phospholipase A2 Receptor in Primary and Secondary Membranous Glomerulonephritis

Fatema Akter — 2024-06-10

Background: A common cause of adult nephrotic syndrome (NS) is membranous glomerulonephritis (MGN). The larger portion of MGN in adults is the idiopathic/ primary MGN (iMGN). So many conditions like autoimmunity, malignant tumor, drugs and infections can cause a secondary form of MGN. We can diagnose primary/ idiopathic MGN after the omission of all known secondary causes. As we know M-type phospholipase A2 receptor (PLA2R) on podocytes is the target antigen in the pathogenesis of primary MGN. Phospholipase A2 receptor (PLA2R) can be detected by immunohistochemically. Differences between primary MGN (iMGN) and secondary MGN are essential because of treatment implications.

Objective: To evaluate the histopathological pattern of MGN and to correlate with PLA2R deposition in primary and secondary MGN in a group of Bangladeshi people.

Methods: The research method is descriptive cross- sectional and observational. The study population was 60 patients in the department of Histopathology, AFIP, Dhaka Cantonment, Dhaka for duration of six months period from January 2019 to June 2019. At first, adequate clinical information was taken and categorized as primary and secondary MGN on a clinical basis, thereafter immuno- histochemistry of anti-PLA2R was done from formalin-fixed paraffin block of those cases.

Results: A total of 60 diagnosed cases of MGN, 56 patients were found primary, and 04 were secondary based on clinical data. In my study, all primary MGN was found as PLA2R positive.

Conclusion: The present study exhibits that immuno- histochemistry with anti-PLA2R antibodies can be the best diagnostic method for diagnosis of idiopathic MGN which offers an opportunity for personalized medicine.

JAFMC Bangladesh, Vol 19, No 2 (December) 2023: 24-28

Tension Band Wiring through Cannulated Cancellous Screw for Transverse Patellar Fracture

Md Amgad Hossen Khan — 2024-06-10

Background: One of the commonest orthopedic injuries is Patella fracture. We frequently get and treat it. Different modalities of treatment are available for it. Tension band wiring through two 4mm partially threaded cannulated cancellous screw is an option for patellar fracture stabilization.

Objective: To assess the outcome of tension band wiring through two 4mm partially threaded cannulated cancellous screw for closed displaced transverse patellar fractures.

Methods: A total of 30 patients with displaced transverse patellar fractures were selected. It is a prospective, observational study and was conducted in NITOR, Dhaka during the period from January 2017 to December 2018. We performed ORIF with tension band wiring through cannulated cancellous Screw (4 mm partially threaded cannulated cancellous screw) for all patients. The Iowa knee evaluation score was used for functional assessment.

Results: According to Iowa knee evaluation score, 27 patients had excellent results and 3 patients had good results. Two patients had SSTI and 28 Patients had no complication. Knee stiffness, loss of fracture reduction, implant migration, implant failure were nil.

Conclusion: Tension band wiring through cannulated cancellous screw can be considered as an effective method to treat displaced transverse patellar fractures. Outcome may be excellent to good with few complications.

JAFMC Bangladesh, Vol 19, No 2 (December) 2023: 29-31

Effect of Lemongrass (Cymbopogon Citratus) Essential Oil Inhalation on Brain Waves in Healthy Female Adults

Israt Jahan — 2024-06-10

Background: Industrialization of society and competitive lifestyle have made our daily life full of stress and people are searching for a convenient way to cope with this. Effect of lemongrass fragrance on brain functions can be analyzed through power spectral analysis of quantitative electroencephalogram (EEG).

Objective: To assess the effects of lemongrass (Cymbopogon Citratus) essential oil aroma inhalation on EEG in healthy female adults in awake state by power spectral analysis.

Methods: This self-controlled trial was conducted in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka from March 2022 to February 2023. Thirty healthy female volunteers from this campus participated in this study. Each subject had undergone three successive sessions of baseline, water and essential oil mist inhalation and EEG recording afterwards. Statistical test was done by Student’s paired ‘t’ test and Wilcoxon matched pair signed rank test by using SPSS v.25.

Results: Mean ± SD of absolute power of alpha brain wave were significantly higher (p˂0.0001) after inhalation of essential oil mist compared to both baseline and water mist inhalation in all brain regions. The absolute power of beta wave after essential oil mist exposure was significantly higher compared to baseline and water mist exposure in frontal (p=0.0001; p=0.0005), parietal (p=0.0009; p=0.005) and occipital regions (p<0.001). No significant change after inhalation of water mist compared to baseline.

Conclusion: Lemongrass essential oil inhalation is effective to induce conscious relaxation, calmness with increased attention and vigilance by increasing power of alpha and beta waves in healthy female adults.

JAFMC Bangladesh, Vol 19, No 2 (December) 2023: 32-36

Quarantine and Isolation in COVID-19: An Assessment of the Level of Knowledge of Undergraduate Students

Tangila Islam — 2024-06-10

Background: Coronavirus disease 2019 (COVID-19) is an emerging contagious disease and also a global health concern. Globally, this pandemic has become a prodigious threat to all, particularly affecting the undergraduate students to continue their studies in Bangladesh.

Objective: To assess the level of knowledge regarding quarantine and isolation of coronavirus disease among undergraduate students.

Methods: This cross-sectional study was conducted from January 2020 to December 2020 among conveniently selected 194 undergraduate students from four universities in Dhaka, Bangladesh. Data were collected electronically through Google form using a semi-structured questionnaire.

Results: The mean age of students was 22.77±1.93 years which ranged from 19-29 years. Three-fourths (75.3%) of students resided in urban settings and four-fifths (80.9%) came from joint families. The students had good knowledge about quarantine (79.4%) and average knowledge about isolation (51.0%). Levels of knowledge about quarantine were statistically significant with age group, residence, family type and monthly family income. Levels of knowledge about isolation were significantly associated with family type and monthly family income.

Conclusion: These results may lead to good public health practices among undergraduate students and also in the community. In this situation, increasing the knowledge of undergraduate students regarding quarantine and isolation can play an important role in improving the current situation.

JAFMC Bangladesh, Vol 19, No 2 (December) 2023: 37-41

Successful Management of Necrotizing Fasciitis of Perianal Region due to Kobiraji Maltreatment for Hemorrhoids

Md Hanif — 2024-06-10

Necrotizing fasciitis (NF), an invasive soft-tissue infection that affects the fascia superficially and spreads quickly along subcutaneous tissue. It is a medical- surgical emergency. The patient may have symptoms that are not consistent with the clinical findings, such as a temperature, evidence of local inflammation, and acute pain. Patients typically present at a later stage, but because there are few cutaneous signs in the early stages, diagnosis might be difficult. Thus, a high index of suspicion plays a crucial role in the NF diagnosis. Furthermore, intraoperative diagnosis frequently serves as a confirmation. The cornerstones of the treatment include analgesia, hydration and electrolyte control, intravenous antibiotics and prompt surgical debridement.

JAFMC Bangladesh, Vol 19, No 2 (December) 2023: 42-46

Mask Wearing Practice- First Line Defence against Communicable Diseases

Mushtaq Ahmad — 2024-06-10

Abstract not available

JAFMC Bangladesh, Vol 19, No 2 (December) 2023: 1-2