Journal of Dhaka Medical College

Journey of the Orthopaedics In Bangladesh

Fakrul Amin Khan — Sun, 29 Jan 2023 00:00:00 +0000

Abstract not available

J Dhaka Med Coll. 2021; 30(2) : 129-130

A Pictogram of a Male With Status Epilepticus and a History of Ischemic Stroke

Reaz Mahmud — Sun, 29 Jan 2023 00:00:00 +0000

Abstract not available

J Dhaka Med Coll. 2021; 30(2) : 237-238

Prognosis of Traumatic Diaphragmatic Injury in Dhaka Medical College Hospital, Dhaka

Sun, 29 Jan 2023 00:00:00 +0000

Introduction: Diaphragmatic injuries include wounds and diaphragmatic ruptures due to thoracoabdominal blunt or penetrating trauma. Their incidence ranges between 8 and 15%. The diagnosis is often delayed despite several medical imaging techniques. The mortality is mainly related associate Injury.

Aims: The aim of our study was to evaluate the prognosis, after surgery of our patient with diaphragmatic injury.

Patients and methods: We performed a prospective study over a period of two years, between January 2018 December 2019, at the department of thoracic surgery of Dhaka Medical College Hospital, Dhaka, Bangladesh. All patients diagnosed with diaphragmatic injury were included in this study. Each patient operated because traumatic diaphragmatic injury was evaluated in respect of age, sex, nature of injury, preoperative examination findings, laboratory test results, imaging methods, time of diagnosis, operation findings, concomitant injures to other organs, operations performed, length of stay in hospital and development of postoperative morbidity and mortality.

Results: Over the study period, 22 cases of diaphragmatic injuries were included. The female was 4 and 18 was male. The mean age of male patients 29.2±12.1 and female 28±11.6 years. RTA with blunt trauma chest was 12, 6 was fall from height and 5 were stab injuries. The most common injuries concomitant to traumatic diaphragmatic rupture were a haemothorax, rib fracture, stomach, colon, liver and spleen. Three patients developed wound infection and two patients died.

Conclusion: In high energy blunt and penetrating thoracoabdominal trauma, diaphragmatic injures should be suspected. An emergency thoracotomy or laparotomy followed by reposition of abdominal organ and repair of the defect of the diaphragm is the gold standard for the management of these cases.

J Dhaka Med Coll. 2021; 30(2) : 131-135

Role of Crp to Stratify Severity of Covid- 19 Infection: A Comparison With Chest Computed Tomography

Mohammad Shayekh Abdullah, Azmiree Binte Aslam, Mohammad Sayem — Sun, 29 Jan 2023 00:00:00 +0000

Background: COVID-19 is the pandemic disease causes severe acute respiratory infection. Tcell mediated responses are activated and responses are initiated by antigen presentation via DCs and macrophages. Immunologically SARS-CoV showed that virus infected lung epithelial cells produced IL-8 in addition to IL-6. A hyperinflammatory environment has been a hallmark of COVID 19 infection and is thought to be a key mediator of morbidity and mortality. C-reactive protein (CRP), an inflammatory marker, can be used in the diagnosis of COVID pneumonia.

Purpose: To find out the role of CRP in COVID-19 Infection and comparison with Chest Computed Tomography.

Materials and method: This cross sectional prospective study was conducted in Department of Medicine, Dhaka Medical College Hospital, among the 100 patients with symptomatic and positive RT-PCR for SARS-CoV-2. C-reactive protein (CRP) level was compared with HRCT findings. All the information collected in data collection sheet and analyzed using SPSS version-22.

Result: Mean age of the patient was 45.2 ± 8.5 years. Fever and cough was commonest presentation, 79.0% and 36.0% of patients respectively. It showed, 27.0% cases were found to have raised CRP where 73.0% had normal level with mean value 14.1 mg/L. Chest HRCT imaging finding revealed, 44% patients had 26–50% lung involvement and 16 patients had 51–75% involvement. In maximum patients (57.0%), chest CT showed single or multiple GGO. HRCT score was significantly higher in patients with raised CRP, and a significant positive significant correlation (r=0.941; p=0.001) between the HRCT scores and CRP level.

Conclusion: The rising CRP can aid in predicting COVID-19 pneumonia and significantly correlates with percentage of lung involvement on HRCT in COVID-19 pneumonia.

J Dhaka Med Coll. 2021; 30(2) : 136-141

Association of High Sensitivity C-Reactive Protein in Polycystic Ovary Syndrome

Sun, 29 Jan 2023 00:00:00 +0000

Objective: This study is aimed to see the level of high sensitivity C-reactive protein (hs-CRP) and its association with manifestations of polycystic ovary syndrome (PCOS).

Design: This cross-sectional study was conducted over a period of one year (January 2017 to December 2018) in the department of Endocrinology of a University hospital.

Participants: Fifty-five PCOS patients diagnosed on basis of revised Rotterdam diagnostic criteria 2003 and 50 age-matched healthy controls [PCOS vs. Control- BMI (kg/m2): 25.47±4.65 vs. 20.68±3.51, p<0.001].

Main outcome measures: hs-CRP level, manifestations of PCOS

Methods: After relevant history and physical examinations, blood was taken in fasting state during follicular phase of menstrual cycle to measure total testosterone (TT), luteinizing hormone (LH), follicle stimulating hormone (FSH) and hs-CRP. Hormones were measured by chemiluminescent microparticle immuno-assay and hs-CRP by nephelometric technique.

Results: hs-CRP (mg/L) was found significantly higher in PCOS patients [1.67 (0.69, 2.54) vs. 0.94 (0.30, 1.42), p=0.006] even after adjustment for age and BMI [OR (95% CI): 1.585 (1.093, 2.299), p=0.015]. Also hs-CRP status (>5 mg/L) was found significantly higher in them than that of controls; but only in non-obese (BMI <25 kg/m2) participants [7.27% vs. 0.0%, p=0.018]. hs- CRP showed no significant correlation and predictive association with any of the manifestations of PCOS including age, BMI, waist circumference, TT and LH/FSH ratio [p=NS for all]

Conclusions: Patients with PCOS had significantly higher hs-CRP level and high hs-CRP status without any significant association with its manifestations.

J Dhaka Med Coll. 2021; 30(2) : 142-148

Extent of Prescribing Antibiotics And Corticosteroids on COVID-19 Admitted Patients Into a Corona Dedicated Hospital In Khulna

Sun, 29 Jan 2023 00:00:00 +0000

Background: Majority of the patients infected with SARS-CoV-2 receive antibiotics and corticosteroids though its role has not yet been adequately defined. Inappropriate use of antibiotics despite bacterial co-infections may lead to global antibiotic resistance.

Aim and objectives: We aim to assess the using pattern of antibiotics and corticosteroids in different clinical categories of COVID-19 patients admitted to a hospital.

Materials and methods: This is a cross sectional study where 345 clinically diagnosed COVID 19 patients having coexisting diseases of both sexes with different age group received antibiotics and corticosteroids were included. Patients’ demographic profile, treatment plan were obtained using a specially designed form. All data were compiled in Microsoft excel spreadsheet and results expressed in total number and percentage.

Results: Out of total 345 patients, male (53.62%) and female patients (46.37%) of age group between 41 to 60 years (42.89%) of different categories; mild (28.40%), moderate ((39.42%), severe (24.63%), critical (7.53%) cases were enrolled in this study. Moxifloxacin followed by ceftriaxon was most commonly prescribed antibiotic in all clinical groups with higher percentages. Other antibiotic includes meropenem, amoxicillin+ clavulanic acid, piperacillin+tazobactam, linezolid also prescribed in higher rate. Among systemic corticosteroids, dexamethasone followed by methylprednisolone, hydrocortisone was prescribed invariably with higher percentages.

Conclusion: With the rapid increase in the rate of infection, purposeful use of antibiotic and corticosteroid might be considered as a better treatment option to fight against COVID 19 patients.

J Dhaka Med Coll. 2021; 30(2) : 149-155

Hearing Outcomes of Stapedotomy In Patients With Otosclerosis

Sun, 29 Jan 2023 00:00:00 +0000

Objective: This study was focused on the assessment of patient’s improvement in hearing, as measured by pure tone audiometry after stapedotomy for primary otosclerosis.

Materials and Methods: This prospective clinical study was performed in a total of 156 patients diagnosed with Primary Otosclerosis, who underwent Stapedotomy at the Department of ENT & Head-Neck Surgery, Combined Military Hospital Dhaka between January 2013 to January 2019. All patients were evaluated as per the candidacy criteria for stapedotomy and selected patients underwent surgery during the study period and were followed up for a period of 12 months in the Otology clinic. Pre and Post-operative audiometric evaluation was done using conventional pure tone audiometry with standard calibrations. Post-operative audiometry was performed at 03 month, 06 months and 12 months. The bone-conduction & air conduction thresholds and the Air-Bone gap (ABG), were documented and analyzed at 0.5 KHz, 1 KHz, 2 KHz and 4 KHz frequencies respectively. The subjective outcomes in hearing were also recorded with a patient satisfaction questionnaire to assess improvement in quality of hearing after stapedotomy.

Results: Overall, the frequency specific pre-operative mean averaged Air Conduction thresholds were 63.3dB at 500Hz, 57.5dB at 1 KHz, 55.1dB at 2 KHz and 45.7dB at 4 KHz. The frequency specific post-operative mean averaged Air conduction thresolds were 34.6 dB at 500Hz, 28.9 dB at 1Kz, 30.5dB at 2Kz and 33.3dB at 4Kz.The frequency specific mean average post operative Air Bone Gap (ABG) closure was achieved by 28.7dB at 500Hz, 27.6 dB at 1KHz, 24.6 dB at 2KHz and 12.4 dB at 4KHz by the time of completion of the study at 01 year. A successful closure of AB gap to less than 10dB was achieved in the speech frequencies of 2 KHz and 4 KHz in 83.97% of cases. Overall, the frequency specific bone-conduction thresholds were unchanged postoperatively in all cases except 03, showing that no significant sensori-neural impairment had occured due to the stapedotomy procedure. 04 patients developed post-op severe vertigo which was self-limiting after six weeks. 01 patient developed transient facial weakness which was subsided over a time period of 03 months. Patients included in our study had significant subjective audiological improvement and responded satisfactorily to the questionnaire formulated to assess their hearing quality after stapedotomy.

Conclusions: Our case study confirms that stapedotomy is a safe and successful procedure providing long-term hearing improvement in primary otosclerosis. Our study shows that meticulous selection of cases for stapedotomy will result in highly successful audiological outcomes.

J Dhaka Med Coll. 2021; 30(2) : 156-160

Electro-Physiological Pattern And Severity Grading of Carpal Tunnel Syndrome

Sun, 29 Jan 2023 00:00:00 +0000

Background: Carpal Tunnel Syndrome (CTS) is a constellation of symptoms and signs caused by entrapment of the median nerve at the wrist. Nerve Conduction Study (NCS) serve as an objective supplementary modality in the diagnosis of CTS and is used for severity assessment with high degree of sensitivity and specificity. Severity assessment is a crucial step for defining prognosis of CTS.

Methodology: The study was a hospital based observational cross sectional study and was conducted in the department of Neurology, DMCH on 50 patients with clinical diagnosis of CTS with electro-physiological confirmation from July, 2017 to June, 2019. Equal number of age and sex matched healthy people were included in the study. All the cases had clinical evaluation and standardized electrophysiological studies of upper limbs using the same protocol.

Result: The mean age of CTS patients was 43.06 (±10.54) years and majority of the them were female (74%). In patients with CTS, electrophysiological study of median nerve revealed the following mean value MDL=5.98± 1.63 ms, SDL=4.24± 0.59 ms, CMAP = 6.16± 3.22mv, MNCV = 54.46± 6.76 m/s, SNAP = 11.65± 13.42 ìV, In Comparison to mild to moderate CTS other than CMAP, all other parameters have significant changes. In case of moderate to severe grade of CTS, all the parameters have significant changes. Amongst the 50 CTS patients, there was bilateral involvement in 21 (42%) and unilateral involvement in 29 (58%) patient. According to electrophysiological grading, 15 (21%) were in mild group; 35 (49%) were in moderate group and 21 (30%) were in severe group. According to the clinical grading, 31 (44%) were in mild group, 25 (35%) in moderate and 15 (21%) were in severe group.

Conclusion: From this study it could be concluded that CTS is more common in female. Sensory symptoms and dominant (right) hand involvement were more common. NCS provides additional and independent objective evidence in the diagnosis and severity assessment of CTS patients. Assessment of severity in CTS patients is a crucial step for defining prognosis and therapeutic measures.

J Dhaka Med Coll. 2021; 30(2) : 161-166

Imaging Study & Surgical Perspective Of Cochlear Implantees

Sun, 29 Jan 2023 00:00:00 +0000

Introduction: A cross-sectional prospective clinical study was done to evaluate the inner ear anomalies in candidates undergoing cochlear implantation.

Materials and Methods: Study was carried out over a period of 07 years (Jan 2013 to Dec 2019) at Cochlear Implant Centre, Combined Military Hospital Dhaka. A total 206 deaf candidates, both pre and post lingual, were included in convenient sampling method.

Result: The sample consisted of 206 candidates, of whom 117 (56.80%) were female and 89 (43.20%) were male. All candidates had severe to profound bilateral deafness. 182 (88.35%) of them were pre and 24 (11.65%) were in post lingual group. All patients diagnosed audiologically as profound deafness underwent HRCT scan of temporal bone with 3D reconstruction of cochlea and MRI of internal auditory canal & brain. Radiological examination revealed that 36 (17.47%) candidates had ear anomalies. Mondini deformity 14 (06.80%), cochlear ossification 11 (5.34%), large vestibular aqueduct 04 (1.94%), high jugular bulb 04 (1.94%) and anteriorly placed sigmoid sinus 03 (1.45%) were noted. During intervention, 42 (20.39%) candidates had anomalous intra operative findings. Among them CSF gusher 19 (9.23%), ossification of basal turn 12 (5.83%), isolated rotated Cochlea 02 (0.97%), high jugular bulb 04 (1.94%), anteriorly placed sigmoid sinus 03 (1.45%), and very high facial nerve 02 (0.97%) were observed. During surgery, electrode insertion difficulty due to high CSF gusher was experienced in19 (9.23%) cases, full length of electrode insertion was not possible due to ossified basal turn 12 (5.83%), difficult to find out round window membrane due to rotated cochlea 02 (0.97%), prevented direct visualization of the round window due to high jugular bulb 04 (1.94%), difficult to approach round window due to very high facial nerve 02 (0.97%). and approach to round window membrane was compromised due to anteriorly placed sigmoid sinus 03 (1.45%). Most of these difficulties were effectively managed during surgery.

Conclusions: This study highlights the importance of preoperative radiological scanning in the assessment of patients undergoing cochlear implantation. It provides vital information on cochlear status and in ruling out non cochlear causes where cochlear implantation is not feasible. Detection of anatomical abnormalities with appropriate evaluation, specially imaging should be mandatory in every patient undergoing cochlear implantation.

J Dhaka Med Coll. 2021; 30(2) : 167-175

Post COVID Mucormycosis Prevention With Oro-Nasal Application of Povidone Iodine (Pvp-I)

Sun, 29 Jan 2023 00:00:00 +0000

In March 2020 WHO declared COVID-19 as pandemic while April 2021 Indian authority concede to declare a significantly increased incidence of “Black Fungus” among the COVID-19 patients. The primary route of infection for Mucormycosis or fungal infection following COVID-19 is inhalation or ingestion resulting accumulation of the agents in nose, para-nasal sinuses and mouth. The spores of black fungus intrude neural and vascular structure, which cause mucosal necrosis due to thrombosis in vasculature. The extension of the disease then increases through further destruction of bones of para-nasal sinus as well as neural and vascular route dissemination. We thought about removing, neutralizing or destroying the culprit fungi from its route of entry zone, i.e. nose and mouth. Povidone Iodine (PVP-I) is a microbicidal agent having effective fungicidal as well as virucidal and bactericidal property. PVP-I can be used in both oral and nasal cavity safely. Efficacy and safety of PVP-I is proved in nose in case of COVID-19. PVP-I is proved effective against different fungi at different concentration at different site. So, we recommend Povidone Iodine nasal spray or irrigation and mouthwash for gargling for these vulnerable group of patients in large scale to prevent post-COVID mucormycosis or fungal infection.

J Dhaka Med Coll. 2021; 30(2) : 176-179

Susceptibility of Bacterial Isolates From Wound Swabs in Bangladesh: Laboratory – Based Surveillance Study

Sun, 29 Jan 2023 00:00:00 +0000

Background: Wound infection is one of the major health problems that occur frequently. Infections of the wound result from entry of the organisms through breached skin. It plays an important role in the development of chronicity, delaying wound healing. It is evident that wound infection is a challenging situation for the physicians. Multiple bacteria can cause wound infection. Both broad spectrum and narrow spectrum antibiotics are available for the treatment. It is ideal to give proper antibiotic after culture and sensitivity of the wound swab. Improper and irrational use of antibiotics can lead to drug resistance.

Objective: To isolate and identify the bacteria causing wound infection and to determine the antimicrobial susceptibility pattern.

Materials and method: This descriptive cross-sectional study was carried out at the Microbiology Laboratory, Popular Diagnostic Centre Ltd, Dhanmondi, Dhaka, Bangladesh, from November 2019 to January 2020. A total of 62 wound swabs were collected and analyzed for culture and antibiotic sensitivity.

Results: From total wound swab samples, 49 (79%) were culture positive. The most common isolated pathogen was Acinetobacter spp. 20 (40.81%). Other isolates were Staphylococcus aureus 10 (20.41%); Escherichia coli 07 (14.29%); Pseudomonas aeruginosa 07 (14.29%); Klebsiella 04 (08.16%) and Proteus 01 (02.04%). Among the Gram negative isolates, Acinetobacter spp showed 100% sensitivity to colistin, 85% to imipenem, 30% to amikacin and 25% to piperacillin + tazobactum. E. coli showed 100% sensitivity to imipenem and colistin and least sensitivity to third generation cephalosporin. Pseudomonas showed 100% sensitivity to piperacillin+tazobactum, 85.71% to imipenem and aztreonam. Among the Gram positive isolates, Staphylococcus aureus showed 100% sensitivity to linezolid, vancomycin, imipenem, cloxacillin, amikacin and least sensitivity to azithromycin.

Conclusion: Acinetobacter spp. was the most frequently isolated pathogen from wound swab and the antibiotic sensitivity pattern of various isolates will help the clinician in appropriate selection of antibiotics against wound infection.

J Dhaka Med Coll. 2021; 30(2) : 180-188

Histopathological Study of Full-Term Placenta in Selected Normotensive And Pre-eclamptic Women in Bangladesh

Sun, 29 Jan 2023 00:00:00 +0000

Pre-eclampsia is a disorder of 2nd half of pregnancy, which is characterized by a combination of hypertension, proteinuria and edema, secondary to decreased placental perfusion. Clinical studies suggest that there are histopathological changes in the placenta of pre-eclamptic women, compared to normotensive pregnant women. In developing countries, pre-eclampsia causes an estimated 50,000 maternal deaths per year. Only a small number of studies have however, been conducted in Bangladesh.

Objective: To compare the histopathology of placenta in selected pre-eclamptic and normotensive pregnant women.

Methods: 220 pregnant women were selected with inclusion and exclusion criteria from 3 different medical colleges and divided into 2 groups – A study group, consisting of 110 pre-eclamptic women and a control group consisting of 110 normotensive pregnant women. Dietary information was collected by 7 days food frequency questionnaire and food score was determined. Anthropometric and biochemical tests were performed. To evaluate the histopathology of placenta, tissue samples were collected from the placenta after delivery, and were prepared for histopathological studies, by haemotoxylin and eosin stain method. The mean number of areas of syncytial knot formation, the mean number of areas of cytotrophoblastic cell proliferation, the mean number of areas of fibrinoid necrosis, and the mean number of areas of hyalinised villi of pre-eclamptic and normal pregnant women were evaluated.

Results: The mean number of areas of syncytial knot formation, the mean number of areas of cytotrophoblastic cell proliferation, the mean number of areas of fibrinoid necrosis, and the mean number of areas of hyalinised villi were found to be significantly higher in the study group, compared to the control group.

Conclusion: Therefore, mean number of areas of syncytial knot formation, the mean number of areas of cytotrophoblastic cell proliferation, the mean number of areas of fibrinoid necrosis is increased in the placenta of pre-eclamptic women, compared to normotensive pregnant women.

J Dhaka Med Coll. 2021; 30(2) : 189-195

Role of Oral Tranexamic Acid in Reducing Peroperative and Postoperative Hemorrhage in External Dcr Surgery

Sun, 29 Jan 2023 00:00:00 +0000

Background: External dacryocystorhinostomy (DCR) is now a well-established, effective approach to relieve nasolacrimal duct obstruction. Per operative hemorrhage obscure the operative field during surgery.so it is difficult to carry on an uncomplicated surgery. Moreover postoperative hemorrhage has become an added problem. The objective of this study is, to evaluate the effect of oral tranexamic acid in reducing both per operative and postoperative hemorrhage in external DCR surgery.

Methods: This hospital based interventional quasi experiment included 60 patients with chronic dacryocystitis at DMCH between January 2014 to June 2014.Oral formulation of tranexamic acid 500mg two capsule and tablet Vit B complex as placebo started 1 hour prior to DCR surgery and continued up to second postoperative day in intervention and control group respectively. In every case, the rate of hemorrhage was evaluated peroperatively and postoperatively.

Findings: In this study, mean duration of operation was 35.98 (range 30 to 51) min in group-A and 54.13(45-75min) minutes in group-B. Perioperative mean blood loss was of 15.03 ml with a maximum blood loss of 25ml in group A and was 33.57ml with maximum blood loss of 39ml in group B. Mean postoperative bleeding was 2.55ml with maximum blood loss 5ml In group A and was 5.53ml with maximum blood loss 13ml in group B. postoperatively no bleeding was found in 24(73.33%) cases in group A and 10(40%) cases in group B.

Conclusion: This study suggests that oral tranaxemic acid significantly reduces peroperative and postoperative hemorrhage and reduces duration of surgery and improves the quality of DCR surgery.

J Dhaka Med Coll. 2021; 30(2) : 196-201

Maternal and Renal Outcome Of Pregnancy Related Acute Kidney Injury Requiring Dialysis in a Tertiary Care Centre

Sun, 29 Jan 2023 00:00:00 +0000

Introduction: Acute kidney injury (AKI) is a rare complication of pregnancy, but may be associated with significant morbidity and mortality in young and often otherwise healthy women. In a developing countries like Bangladesh due to low resource settings intermittent hemodialysis is the usual mode of renal replacement therapy. It opens up a field of investigation to assess the maternal and renal outcome of pregnancy associated acute kidney injury after getting dialysis.

Materials and method: This analytic, descriptive, prospective study was performed over 46 patients with pregnancy associated AKI requiring dialysis during July 2015 to June 2016. Etiology and spectrum of pregnancy related acute kidney injury (PR - AKI) requiring dialysis were assessed and maternal and renal outcome were analyzed.

Result : Puerperal sepsis(25, 54.3%) was the most prevalent cause, followed by preeclampsia/ eclampsia, (7,15.2%), septic abortion ( 5 ,10.9%), PPH/APH (5 ,10.9%), sepsis with PPH (2 ,4.3%), HELLP syndrome (1 ,2.2%) and sepsis with HELLP (1 ,2.2%)36 (73.3%) patients remained alive and 10 (22.8%) patients expired. HELLP syndrome and maternal mortality was more commonly observed in dialysis requiring group. Delivery at term was more commonly observed in dialysis requiring group and preterm delidery was more common in dialysis not requiring group. 26(56.5%) patients had delivery at term , 15(32.6%) had preterm delivery and abortion was found in 5(10.9%). Renal out come was better in dialysis not requiring group when compared with dialysis requiring group.Complete recovery was found in 19(52.8%) patient at 3 months follow up, 10(27.8%) had partial recovery seven patients remained dialysis dependent. According to the RIFLE criteria,19 patients were in the Injury category and 27 patients were in the Failure category.Relative risk of mortality in Injury is 0.94 and in Failure is 1.05. Multivariate logistic regression analysis showed that RIFLE classification did not discriminate the prognosis ( p value 0.788) in pregnancy associated AKI requiring dialysis.

Conclusion : PR- AKI requiring dialysis is associated with high maternal mortality and poor renal outcome.

J Dhaka Med Coll. 2021; 30(2) : 202-207

Outcomes of Ultrasound Guided Versus Cystoscopy Guided Obturator Nerve Block (Obn) In Transurethral Resection Of Bladder Tumour (Turbt)

Sun, 29 Jan 2023 00:00:00 +0000

Context: Selective obturator nerve block (ONB) limits obturator reflex, adductor contraction, and leg jerking in transurethral resection of bladder tumour (TURBT), which ultimately prevents complications such as bleeding, bladder perforation, or incomplete tumor resection. The present study aims to compare the effectiveness of two different techniques of obturator nerve block during TURBT.

Methods: A prospective, observational study was conducted in the Department of Anaesthesia, Analgesia, Palliative and Intensive Care Medicine, Dhaka Medical College Hospital, Dhaka, Bangladesh, between September 2018 and August 2019 to evaluate the effectiveness of ultrasound guided ONB versus cystoscopy guided ONB in TURBT operation. A total of 60 selected patients were randomly allocated into two groups: ultrasound guided ONB (group A) and cystoscopy guided ONB (group B) i.e. 30 in each group. Then onset of anesthesia (nerve block), tumour removal and patient outcome were assessed at different point during and after surgery.

Results: Mean age of the patients was 54.7±8.53 years. In total, 34(57%) cases were male and 26(43%) were female. Male to female ratio was 1.3:1. In group A, 19(63.3%) patients had ASA II status and 11(36.7%) had ASA III status, while in group B, the numbers were 18(60%) and 12(40%) respectively. There was no significant difference in demographics and ASA status between two groups (P>0.05). Average onset of obturator nerve block was faster in group A (8.17±1.4 min) than group B (11.3±2.68 min), (P<0.001). Total resectability of tumours were achieved in 28(93.3%) in group A and 23(76.6%) in group B during operation (P<0.001), while 2(22.22%) and 7(77.77%) tumours had incomplete removal respectively (P<0.05). Among complications, adductor jerks were evident in 2(6.7%) and 7(23.3%), bladder perforation in 1(3.3%) and 4(13.3%), and bleeding in 1(3.3%) and 3(10.0%) cases in group A and group B respectively. The differences were statistically significant ((P<0.05).

Conclusion: Although both techniques are safe and easy to perform, ultrasound guided ONB results in faster onset of block and better resectability of tumour with less complication over cystoscopy guided ONB.

J Dhaka Med Coll. 2021; 30(2) : 208-213

Alteration of Coagulation Profile in Preeclampsia And Eclampsia Patients At Tertiary Level Hospital

Sun, 29 Jan 2023 00:00:00 +0000

Background: Preeclampsia and eclampsia is associated with a risk of abnormal hemostasis that occurs most commonly secondary to thrombocytopenia. Automated analyze technique measures whole blood coagulation and has been used to manage coagulation defects in obstetric patients.

Objective: To find out the alteration of coagulation profile beyond physiological level in preeclampsia and eclampsia patients for early detection and planning of management.

Method: It was a observation type of cross sectional study carried out Department of Obs& Gynae, Dhaka Medical College Hospital, Dhaka. Severe pre-eclamptic and eclamptic patients admitted in the department of Obstetrics &Gynaecology, Dhaka Medical College Hospital during the period of July 2018 to December 2018. Data were collected as predesigned data collection sheet and for coagulation profile. Collection of venous sample about 5ml of blood were done without a pressure cuff allowing the blood to enter the syringe by continuous free flow and sending to the laboratory for coagulation assay by automated analyzer Sysmex CA500.

Results: In this study mean age was 26.94 years, majority 56% age group was 26-30 years of age. The mean gestational age was 32.36 weeks. All the coagulation parameters were altered in 6% of the patients, 4 parameters were altered in 10% of the patients, 3 parameters were altered in 16% of the patients 2 and 1 parameters were altered in 24% and 44% patients respectively. Regarding coagulation profile, thrombocytopenia was present in 22% patients, prothombin time was prolonged in 10% of the patients, APTT was prolonged in 20% of the patients, and fibrinogen level was reduced in 40% of the patients and FDP was elevated 32% of the patients. Out of 50 severe preeclamptic and eclamptic patients, 6% of the patients developed DIC in whom all the coagulation parameters were altered.

Conclusion: In this study, in patients of severe pre-eclampsia and eclampsia 22% patients had thrombocytopenia. 6% of the patients had alteration of all the coagulation parameters. Coagulation indices were altered not only in the patients with reduced platelet count but also in the patients with normal platelet count. Among the patients, 6% of the patients developed DIC, PPH developed in 12% of the patients and maternal death occurred in 4% of the patients.

J Dhaka Med Coll. 2021; 30(2) : 214-219

First Episode Psychosis During COVID-19 Pandemic: Study in a Tertiary Care Psychiatric Hospital

Sun, 29 Jan 2023 00:00:00 +0000

Background: Apart from being suffered from the Coronavirus disease 2019 (COVID-19), the pandemic has been associated with mental health conditions related to the fear of being affected by the virus, relative insufficiency of the healthcare system and the alleviating measures. We aimed to determine the types and associated sociodemographic factors of first episode psychosis (FEP) occurred during COVID-19 pandemic.

Materials and methods: This was a cross-sectional study carried out at the outpatient department of National Institute of Mental Health (NIMH), Bangladesh. Individuals whose psychiatric symptoms were noticed for the first time during the covid outbreak, were included in the study using a convenient sampling technique during September, 2020 - December, 2020. After having informed written consent, data were collected through face-to-face interview of the respondents using a semistructured questionnaire. Psychotic features were elicited and psychiatric diagnoses were assigned by qualified psychiatrists after a thorough assessment according to Diagnostic and Statistical Manual of Mental Disorders, version 5 (DSM-5). Completed data of 288 respondents were analyzed using Statistical Package for Social Sciences (SPSS), version 24. The institutional review board of NIMH approved the research.

Results: About three-fifths (58.3%) of the respondents suffered from first episode psychosis. Around half (47.0%) of the patients with psychosis was suffering from schizophrenia spectrum and other psychotic disorders and 39.3% from bipolar and related disorders. Majority (36.2%) of the respondents with FEP belonged to the age group of 20-29 years, with the mean age of 28.01±12.859 years. There was a significant association between gender and the presence of psychosis (p<.05).

Conclusion: Majority of the FEP were schizophrenia spectrum and other psychotic disorders having a younger age of onset.

J Dhaka Med Coll. 2021; 30(2) : 220-226

Cerebral Venous Sinus Thrombosis With Hereditary Antithrombin Iii Deficiency After COVID-19 Vaccination: A Case Report

Sun, 29 Jan 2023 00:00:00 +0000

Hereditary antithrombin III deficiency is a prothrombotic disorder with an associated 50-90% risk of venous thrombosis. It rarely causes cerebral venous thrombosis in adults. Variable clinical presentations make the diagnosis a challenge. Careful clinical history, extensive clinical examinations, comprehensive investigations, and prompt management are necessary to save lives. COVID-19 vaccine-induced immune thrombotic thrombocytopenia may be a risk factor for cerebral venous thrombosis in these cases. Here, we are reporting an adult female with cerebral venous sinus thrombosis after receiving the COVID-19 vaccine. Subsequently, she was diagnosed with hereditary antithrombin III deficiency.

J Dhaka Med Coll. 2021; 30(2) : 227-231

A Case of Hemorrhagic Dengue Encephalitis: A Rare Presentation of Dengue Expanded Syndrome

Reaz Mahmud, SK Jakaria Been Sayeed, Mohammad Rafiqul Islam — Sun, 29 Jan 2023 00:00:00 +0000

Dengue encephalitis is a rare manifestation of dengue fever. Headache disorientation and or seizure gives the clinical suspicion of encephalitis in the case of dengue. Hemorrhagic encephalitis has been reported very scarce. Here we reported a case of hemorrhagic encephalitis who presented with fever, severe headache, and disorientation. MRI of the brain revealed early subacute in both temporal and frontal lobes.

J Dhaka Med Coll. 2021; 30(2) : 232-236