Journal of Dhaka Medical College

A Case of C-ANCA Associated Vasculitis Presenting With Localised Skin Thickening

Wed, 03 May 2023 00:00:00 +0000

ANCA vasculitis, caused by antibodies named ANCA (anti-neutrophilic cytoplasmic autoantibodies), is an autoimmune disorder affecting small blood vessels of the body. Among p-ANCA and c- ANCA, c-ANCA (cytoplasmic ANCA) usually targets proteinase three inside neutrophils, causing inflammation of blood vessels. Herein, we report a case of a 56-year-old female patient with c- ANCA-associated vasculitis. The patient presented with a localized skin thickening on the medial aspect of the left thigh and an oral ulcer. Skin biopsy shows erythema induratum (nodular vasculitis). After several investigations, we found c-ANCA positive and concluded the diagnosis as c-ANCA-associated vasculitis. We treat the patient with injectable methylprednisolone, injectable cyclophosphamide, and Mesna. Then we gave oral mycophenolate mofetil and prednisolone.

J Dhaka Med Coll. 2022; 31(1) : 158-162

A Case of Multiple Gastrointestinal Ulcer: A Rare Presentation of Strongyloidiasis

Wed, 03 May 2023 00:00:00 +0000

Strongyloides stercolaris is a common intestinal nematode in tropical and subtropical countries like Bangladesh. The presentation of this infection is nonspecific. Mostly it remains asymptomatic with peripheral eosinophilia. Immunocompromised individuals are at high risk of hyper infection to disseminated disease. We present a case of Strongyloides in an immunocompetent patient with features of gastric outlet obstruction. Laboratory findings revealed hypereosinophilia with multiple gastrointestinal ulcers on endoscopy. Biopsy was taken from a gastric ulcer which revealed ulceration and dense infiltration of acute and chronic inflammatory cells along with extensive intestinal metaplasia. There were tiny helminthic bodies within the mucosal glands and on the surface consistent with Strongyloides stercoralis. Routine examination of stool also revealed larvae of Strongyloides stercolaris.

J Dhaka Med Coll. 2022; 31(1) : 163-166

Antimicrobial Resistance Pattern Among Diabetic Patients With Urinary Tract Infection at Bangladesh

Wed, 03 May 2023 00:00:00 +0000

Introduction: Diabetes Mellitus (DM) is a worldwide health problem. Patients with type 2 diabetes mellitus are at increased risk of infections, with urinary tract being the most common site. UTI may be asymptomatic in DM patient. Worldwide there is a high frequency of antibiotic resistance. This study is designed to determine the causative organism of UTI in diabetic patient as well as their resistance pattern.

Methods: This cross sectional descriptive study was conducted in semiurban multispeciality hospital of Feni for a period of nine month from January 2020 to September 2020. One hundred consecutive culture positive UTI in diabetic patient were enrolled in this study. UTI with negative urine culture were excluded from the study. The organism isolated in culture and antibiotic sensitivity was noted.

Results: Age of this study population ranges from 20 to 80 years. Out of 100 patients with 39%were male and 61% were female. Twenty percent of the UTI were asymptomatic. E. coli was the commonest causative organism found in 64% cases, followed by Klebsiella 11% & Proteus 7%. Overall 84% organism were resistant to amoxicillin & 72% were resistant to quinolones. Most organism were sensitive to meropenem with only 11% resistance. Sixty percent of the isolates were resistant to 3 or more antibiotics.

Conclusion: E. coli being the commonest causative organism with very high frequency of antibiotic resistance & multidrug resistance.

J Dhaka Med Coll. 2022; 31(1) : 5-8

Barriers of Good Glycemic Control Of Known Diabetic Patients in a Tertiary Care Hospital

Wed, 03 May 2023 00:00:00 +0000

Introduction: uncontrolled Diabetes mellitus is a growing cause of disability and premature death. HbA1C is an indicator of glycemic control status over the previous three months. Therefore, to minimize the morbidity and mortality of diabetic patients, it would be necessary to identify the factors associated with poor glycemic control, which may not be similar to developed countries.

Objective: To identify factors acting as a barrier to reasonable glycemic control of known diabetic patients in Bangladesh

Materials and methods: This is a hospital-based descriptive cross-sectional study among diabetic patients with poor glycemic control in the indoor and outdoor Medicine and Endocrinology departments of Dhaka medical college hospital, Dhaka, from July 2019 to December 2019 (6 months). For at least three months, patients who had uncontrolled Diabetes were selected by purposive and convenient sampling method.

Results: One hundred and six patients with poor glycemic status were included in the analysis. Aged persons were at risk for poor glycemic control, especially age range of 50-69 years (65.0%) P-value was .004. Duration of Diabetes and educational status were significantly associated with poor glycemic control. P values were 0.001 and .003, respectively.

Conclusion: Patient education plays a pivotal role in controlling glycemic control, favoring treatment success, reducing adverse drug events, and preventing further complications of Diabetes.

J Dhaka Med Coll. 2022; 31(1) : 9-14

Patient’s and Caregiver’s Awareness On Secondary Prevention Strategy Of Ischemic Stroke

Wed, 03 May 2023 00:00:00 +0000

Background: Stroke is a big problem in Bangladesh. Though the incidence of ischemic stroke is stable or increasing, mortality is gradually decreasing. As a result, questions about disability and stroke recurrence are coming forward. A successful prevention strategy for ischemic stroke depends on the patient’s and caregiver’s awareness regarding ischemic stroke.

Objectives: The objective of the study was to assess the awareness of the patients and caregivers regarding the secondary prevention strategy of ischemic stroke.

Materials and methods: This was a pilot study using a questionnaire developed by a literature review. This observational study was done in the department of neurology, Dhaka Medical College, Dhaka, from March 2015 to February 2018. The study subjects were interviewed face to face with a questionnaire.

Results: More than half of the respondents (54.3%) thought that ongoing drugs would cure the stroke, and they were found to be unaware of reducing or controlling their risk factors. Among risk factors, only smoking (86.4%), hypertension (84.3%), lack of regular exercise (84.3%), and being overweight (81.4%) were well-known to the respondents.

Conclusion: More than half of the subjects knew the drugs should be taken to cure the disease. There was no significant difference in knowledge between rural and urban people, or males and females, regarding ischemic stroke risk factors. A system of group teaching and group discussion can change the situation.

J Dhaka Med Coll. 2022; 31(1) : 15-22

Antimicrobials Resistance Trend Of Bacterial Uropathogens in Patients Attending in Tertiary Care Hospitals In Bangladesh

Wed, 03 May 2023 00:00:00 +0000

Background: Urinary tract infection (UTI) has now become the most common infectious disease, mostly in developing regions, indicating healthcare and economic constraints. Antimicrobial resistance (AMR) is a condition in which microorganisms use varied resistance mechanisms, including horizontal gene transfer (for example, plasmids and bacteriophages), genetic recombination, and mutations.

Methods: This study is a retrospective cross-sectional study that was conducted at Mitford Hospital and Dhaka Medical College Hospital. The study was conducted from January 2021 to January 2022. The total sample size for this study was 500.

Result: The proportion of uropathogenic species of isolates (from total UTI patients; 250) showed E. coli 94(37.6%) and followed by K. pneumoniae 28(11.2%), CONS 11(4.4%), S.aureus 23(9.2%), Proteus spp. 4(1.6%), Citrobacter Spp. 18(7.2%), Salmonella Spp. 1(0.4%), GNR 27(10.8%), Enterobacter Spp. 9(3.6%), Streptococcus spp. 6(2.4%), Klebsiella Spp. 8(3.2%), Pseudomonas Spp. 1(0.4%), Providencia spp. 1(0.4%), K.ozaenae 10(4%), Shigella Spp. 2(0.8%), Enterococcus Spp. 5(2%), Serratia spp. 1(0.4%) and M.morgani 1(0.4%). Gram-positive isolates presented a high resistance to tetracycline 14(93.3%) and penicillin 13(86.7%). Antimicrobial agents most effective against Gram-positive uropathogens were vancomycin and nitrofurantoin. Staphylococcus aureus was the most common isolate of Gram-positive isolates. It was highly resistant to tetracycline 32(100%) and trimethoprim-sulfamethoxazole 26(81.3%). In addition, 9(28.1%) of S. aureus were resistant to cefoxitin.

Conclusion: UTI is the most spreading bacterial infection globally. The increase in antimicrobial resistance is associated with UTI, which is a serious threat and has become a global health emergency.

J Dhaka Med Coll. 2022; 31(1) : 23-28

Preoperative Elective Bowel Preparation In Children With Polyethylene Glycol Versus Polyethylene Glycol and Mannitol - A Comparative Study

Wed, 03 May 2023 00:00:00 +0000

Background: Oral mechanical bowel preparation is a routine practice prior to colorectal surgery in many centers. Virtually all colorectal surgeons consider a mechanically cleansed and empty bowel as one of the prerequisites for a safe colonic resection and anastomosis. Various agents had been used in different centers in mechanical bowel preparation.

Methods: A comparative prospective interventional analysis of preoperative elective bowel preparation in children with polyethylene glycol versus polyethylene glycol and mannitol was conducted on 60 children underwent elective GIT surgery between July 2014 and June 2016. The patients were allocated into 2 groups by simple random sampling, 30 in each group. Children of 6 months to 14 years were selected as study population. In group I, PEG was given per orally or through nasogastric tube at the rate of 1.5 gm powder/kg/dose, in group II, PEG & Mannitol were given orally or via nasogastric tube. PEG was administered as same dose of group I and mannitol 20% at a dose of 10 ml/kg/dose. All patients received prophylactic intravenous antibiotics (ceftriaxone + metronidazole) preoperatively as well as in postoperative period. All children were investigated preoperatively and post operative follow up was recorded. Structured questionnaire was used to collect information regarding preoperative status and post operative follow up. Statistical assessments were done by SPSS version 21. An Ethical clearance had been sought.

Results: Sixty children underwent mechanical bowel preparation prior to GIT surgery. 30 with PEG (group I) and 30 with PEG and Mannitol (group II). Our outcome variables were wound infection, anastomotic leakage, and Electrolyte balance. Demographic pattern also evaluated. The age range of both groups was 6-68 months, p value 0.987. In both group male and female were same in number, 16 male and 14 female each in both groups. Wound infection occurred 3 cases (10%) in PEG group and 2 cases in PEG and Mannitol group, p value 0.64. No anastomotic leakage in PEG and Mannitol group and only 1 leakage in PEG group. No Electrolyte imbalance was found in both groups. No mortality was recorded in this study.

Conclusions: No significant difference was found between the two study groups in respect of wound infection, anastomotic leakage and electrolyte balance. Ingestion of two drugs did not have any better outcome. So, mannitol can be omitted in MBP in children.

J Dhaka Med Coll. 2022; 31(1) : 29-36

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

Nahid Ahmed Khan , Nuzaira Nahid, Melia Choudhury — Wed, 03 May 2023 00:00:00 +0000

Pre–Eclampsia is a disorder in 2nd half of pregnancy, characterized by a combination of hypertension, proteinuria, and edema, secondary to decreased placental perfusion. Clinical studies suggest histo-morphological changes in the placenta of pre-eclamptic women compared to normotensive pregnant women. This study aimed to compare the histo- morphological changes of the placenta in selected pre-eclamptic and normotensive pregnant women.

Methods: Two hundred twenty pregnant women were selected with inclusion and exclusion criteria from 3 different medical colleges and divided into two groups. A study group comprised 110 pre-eclamptic women, and a control group comprised 110 normotensive pregnant women. After delivery, tissue samples were collected from the placenta and prepared for histopathological studies by hematoxylin and eosin stain. The mean number of areas of syncytial knot formation, the mean number of areas of cytotrophoblast cell proliferation, the mean number of areas of fibrinoid necrosis, and the mean number of areas of hyalinized villi of pre-eclamptic and normal pregnant women were evaluated. We evaluated the morphology by weight, diameters, number of cotyledons, and placental infarcts.

Results: The mean number of areas of syncytial knot formation, cytotrophoblastic cell proliferation, fibrinoid necrosis, and hyalinised villi were significantly higher in the study group compared to the control group. The mean weights, diameters, and the number of cotyledons were considerably lower in the study group compared to the control group. Moreover, the number of infarcted areas was significantly higher in the placentas of pre-eclamptic women.

Conclusion: There are histomorphologic changes in the placenta of pre-eclamptic women.

J Dhaka Med Coll. 2022; 31(1) : 37-45

Hearing Status Among the Traffic Polices Of Dhaka Metrpolitan City

Wed, 03 May 2023 00:00:00 +0000

Background: Noise induced hearing loss is a common and avoidable occupational hazards in urban environments. People in high noise area suffer from hearing impairment. They are considered as social burden in their late life. Identifying risk groups and providing them a safe occupational environment is the responsibility of welfare state.

Aims and Objectives: To compare hearing between noise exposed traffic police with polices not exposed to high noise.

Methods: A cross sectional study was conducted in Rajarbagh police line hospital from July 2015 to November 2016 where 180 police personnel were enrolled and divided into two groups for comparison with mean duration of work in police force 11.06 years in group-I and 10.48 years in group-II. Work hours of traffic police was 8 hours per day.

Result: 37.7% of traffic police found to suffer from mild and 41.75% suffer from moderate degree of hearing loss that need attention of appropriate authority.

Conclusion: Environmental pollution in Dhaka city is very high .High noise is a risk factors for occupational hazards that must be looked after by civil society and law enforcing agency to implement sound pollution act.

J Dhaka Med Coll. 2022; 31(1) : 46-50

Role of Incentive Spirometry On Management of Postoperative Pulmonary Complications in Elderly Urology Patients

Wed, 03 May 2023 00:00:00 +0000

Background: Incentive spirometry (IS) is a device used to improve pulmonary function. It is a device that provides patients with visual feedback when they inhale at a predetermined flow rate/volume, sustain the inflation for a minimum of 3 seconds, and then expire. It is postulated that incentive spirometry (IS) might play a significant role in preventing and treating postoperative pulmonary complications. However, we need more research-based information on this issue.

Objective: The aim of the study was to assess the effectiveness of incentive spirometry in improving pulmonary function following urologic surgery in elderly patients.

Methods: This comparative study was conducted in the department of Urology, Dhaka medical college hospital (DMCH), Dhaka, Bangladesh, from January 2021 to December 2021. In total, 150 elderly people were included as the study subjects. The total subjects were divided into two groups. In group A, there were 75 patients who received incentive spirometry in addition to deep breathing, coughing and early ambulation. In Group B, there were also 75 patients, denoted as control group patients, who received standard care of treatment including deep breathing, coughing and early ambulation without incentive spirometry. All data were collected, processed, and analyzed by using MS Office and SPSS-18 programs as per need.

Results: In this study in incentive spirometry, postoperative VAS, FVC, FEV1, and FEV1/FVC scores were 5.29±1.73, 1.25±0.61, 1.21±0.45 and 88.61±18.44 respectively. On the other hand, in Group B (Non incentive spirometry), postoperative VAS, FVC, FEV1, and FEV1/FVC scores were 5.71±1.57, 1.14±0.56, 1.09±0.22 and 91.57±19.91 respectively. We found a significant correlation in comparing FEV1 (Forced Expiratory Volume) between both groups, with a P value of 0.040. In this study, in Group A (IS), only 8% of elderly patients of urological surgery were found with postoperative pulmonary complications. On the other hand, in patients without using Incentive spirometry, one-fifth (20%) were with postoperative pulmonary complications.

Conclusion: As per the findings of this study, both treatment methods are effective. But patients’ compliance may be better in applying Incentive spirometry (IS) in urological surgery in elderly patients. Physicians can minimize the possibilities of postoperative pulmonary complications by using Incentive spirometry.

J Dhaka Med Coll. 2022; 31(1) : 51-55

Maternal and Neonatal Outcome of Patients Having Placenta Previa Lying Over The Uterine Scar

Anuradha Karmaker, Farzana Khan Eusufzai, Fahmida Sultana — Wed, 03 May 2023 00:00:00 +0000

Background: Placenta previa (PP) is defined as placenta implantation in the lower uterine segment with or without overlying the endocervical os. It is a significant cause of severe fetal and maternal morbidity and mortality.

Objective: To evaluate the maternal and neonatal outcome of placenta previa lying over the uterine scar due to previous one or two caesarean sections.

Material and Methods: This descriptive type of observational study was done in the Department of Obstetrics & Gynaecology, Enam Medical College & Hospital, Savar, Dhaka, from December 2020 to June 2021. All relevant data were collected prospectively in a prescribed form (questionnaire). Data were processed and analysed with the help of the computer program SPSS (Statistical Package for Social Sciences) windows version 25.

Results: This study shows the most familiar age group was 26-30 years, which included 46%, and 38% belonged to the 31-35 age group. The average age was 29.93 years. Maximum (54%) number of cases were admitted during the gestational period of 35-38 weeks. It was observed that maternal outcome was profuse intraoperative blood loss (100%), post-partum haemorrhage (26%), transfusion requirement (100%), and post-partum anaemia (28%). In addition, the outcome was fetal distress (36%) and lower Apgar scores at 1 min (24%).

Conclusion: This study shows women with placenta previa lying over the uterine scar were more likely to have poorer maternal and neonatal outcomes. To counsel their patients appropriately, healthcare providers should be aware of possible complications of placenta previa lying over the uterine scar.

J Dhaka Med Coll. 2022; 31(1) : 56-60

Mean Platelet Volume in Patients With Subclinical Hypothyroidism Attending at A Tertiary Care Hospital of Bangladesh

Wed, 03 May 2023 00:00:00 +0000

Background: Subclinical hypothyroidism (SCH) is a common endocrine disorder affecting about 3-8% of the general population. On the other hand, mean platelet volume (MPV) is an indicator of platelet activity, and elevated MPV is associated with adverse cardio-metabolic complications. This study was conducted to observe MPV in SCH and to correlate it with thyroid-stimulating hormone (TSH) and free thyroxine (FT4) levels.

Materials and Methods: This cross-sectional observational study was conducted in Medicine and Endocrinology OPD of US- Bangla Medical College & Hospital over twelve (12) months from September 2020 to August 2021. This study included forty (40) cases of newly detected SCH and twenty (20) age & body mass index (BMI) matched euthyroid control subjects as per inclusion and exclusion criteria.

Results: SCH group had higher TSH and MPV than controls (P value <0.001 and <0.05 respectively) where age, BMI, and FT4 level were comparable (P value>0.05). MPV shows a positive correlation with BMI in SCH & controls (P values <0.05). MPV shows a significant positive correlation with TSH and a negative correlation with FT4 only in SCH (P<0.05) but not in controls (P value>0.05).

Conclusion: Patients with SCH have elevated MPV, so they are at increased risk of developing an adverse cardiovascular outcome.

J Dhaka Med Coll. 2022; 31(1) : 61-65

Serum Testosterone Level and Its Association With BMI: A Cross-Sectional Comparative Study Among Male Ckd Patients and Healthy Individuals

Wed, 03 May 2023 00:00:00 +0000

Introduction: Chronic kidney disease (CKD) is a significant problem that affects all other vital organs and systems. Endocrine dysfunction is not uncommon as well. Early identification of patients with chronic kidney disease (CKD) may help implement interventions to decrease progression and eventual morbidity and mortality.

Aim of the study: This study aimed to evaluate the serum testosterone level of adult males with different stages of CKD and its association with body mass index and comparison with agematched healthy individuals.

Methods: This cross-sectional study was conducted in the Department of Nephrology, Dhaka Medical College Hospital, Dhaka, Bangladesh. All CKD patients were designated as group ‘A’ with 90 cases; the healthy control group were grouped as group ‘B’ with 88 cases.

Result: In this study, the majority 40(44.4%) of patients had glomerulonephritis, 24(26.8%) had DM and 11(12.2%) had HTN. The mean BMI was found to be 20.85±2.7 kg/m2. More than two-thirds (66.7%) of patients had normal (3.2-14.6 ng/ml) Serum testosterone, and their mean Serum testosterone was found at 4.29±1.9 ng/ml. Negative Spearman’s rank correlation (r=- 0.893; p=0.001) was observed between different stages of CKD and S. Testosterone of CKD patients. A positive Pearson correlation existed (r=0.517; p=0.001) between BMI and S. Testosterone of CKD patients.

Conclusion: A significant positive correlation existed between BMI and serum testosterone of CKD patients.

J Dhaka Med Coll. 2022; 31(1) : 66-70

Expression of P16 in Surface Epithelial Ovarian Neoplasm

Wed, 03 May 2023 00:00:00 +0000

Background: Epithelial ovarian carcinoma is the major subtype of ovarian cancer, one of the most lethal gynaecological malignancies. Due to some difficulties in early detection, patients are usually diagnosed at advanced stages, and overall survival is poor. P16 is a tumour suppressor gene that regulates the cell cycle by inhibiting S phase. Studying experssion of this immunohistochemical marker will help to diagnose and predictrognosis of ovarian epithelial tumours. The study’s objective was to evaluate the expression of p16 in surface epithelial ovarian neoplasm and its association with histo-pathological grading.

Methodology: This cross-sectional study was carried out at the Department of Pathology, Sir Salimullah Medical College, Dhaka. A total of 46 patients diagnosed histo-pathologically as surface epithelial ovarian neoplasm were included in the study. In addition, P16 immuno-staining, as well as some demographic and clinical data, were also evaluated.

Result: The mean age of the patient was 48.04 ± 12.182SD years. The most common histologic subtype was serious, followed by the mucinous type. P16 was positive in 40 (86.96%) cases. A statistically significant difference in p16 expression was observed between tumour types and between tumour grades. Up-regulation of p16 expression was observed in malignant tumours more than in benign tumours. P16 expression was increased with increased grading of the malignant tumours.

Conclusion: P16 expression is associated with histo-pathological grading in ovarian epithelial carcinoma.

J Dhaka Med Coll. 2022; 31(1) : 71-76

Detection of Complications Associated With Nasogastric Tube Feeding in Patients With Haemorrhagic Stroke in a Tertiary Hospital

Wed, 03 May 2023 00:00:00 +0000

Background: Stroke poses the greatest disease burden in hospital admission among the non communicable diseases (NCD’s). In majority of cases haemorrhagic stroke is the common neurological problem. Many of the patients develop swallowing difficulty and require nasogastric feeding for maintenance of nutrition. But this feeding can be a double-edged sword as it can lead to many complications due to various factors including errors in the feeding method, dislodgement of the tube and many other causes. Our intention was to look into this neglected part of clinical practice as this is mostly handled by internists.

Objectives: To evaluate the complications of nasogastric tube feeding practice on haemorrhagic stroke patients.

Materials and methods: One hundred (100) adult patients aged between 18- 70 years with haemorrhagic strokeas enrolled in the study. Haemorrhagic stroke was diagnosed by the clinical presentation, neuroimaging (CT scan/ MRI). Patients requiring nasogastric tube feeding were included in the study. They were systematically examined for any complications related to use of nasogastric tube. Their caregivers were also thoroughly interviewed using a standard pre formed questionnaire regarding any complications as well. All data were be collected by using a preformed data sheet and results were presented in standard method after statistical analysis.

Results: Of the 100 patients studied, most common age group for stroke was 51-60 years (53%). Male to female ratio was 2.22:1. In this study population, 70% had intracerebral haemorrhage, 24% had Sub arachnoid haemorrhage and 6% had aneurysmal haemorrhage. The most common indication for NG feeding was difficulty in swallowing (39%). Other common indications were semi consciousness (26%), unconsciousness (22%), inability to maintain feed (10%). Around 71 % of the patients had complications from NG tube feeding. Out of them, 53% of the patients had nasal irritation where 63.15%was suffering from intracerebral haemorrhage, 31.57% and 5.26% were suffering from subarachnoid haemorrhagic and aneurysmal haemorrhage respectively. 40 % patients developed aspiration pneumonia, out of them 65.51%wasintracerebral haemorrhage, 31.03% was subarachnoid haemorrhagie ,3.44% was aneurysmal haemorrhage. 38% of the patients were developed diarrhea. Diarrhoea was reported by 66.66%, 29.62%, 3.70% in intracerebral haemorrhage, subarachnoid haemorrhagic and aneurysmal haemorrhage respectively. 53% had tube blockage, out of them intracerebral haemorrhage 71.05%, subarachnoid haemorrhage 23.68%, aneurysmal haemorrhage 2.63%. 43% of the patients had electrolyte imbalance, among them intracerebral haemorrhage 67.74% and subarachnoid haemorrhage 32.25%. Tube displacement was experienced by intracerebral haemorrhage 74.16%, subarachnoid haemorrhage 25.80% and 18% of the patients were malnourished.

Conclusion: NG tube feeding is an integral part of management of stroke patients with feeding difficulties. But often it is associated with various complications which can increase the morbidities in stroke patients.

J Dhaka Med Coll. 2022; 31(1) : 77-85

Family History of Psychiatric Illness Among the Individuals With Schizophrenia Spectrum and Other Psychotic Disorders

Wed, 03 May 2023 00:00:00 +0000

Background: Genetic factors are considered to be more influential than environmental factors in the development of schizophrenia. We aimed to find out the history of psychiatric illnesses among the first and second degree relatives as well as the sociodemographic factors of individuals with schizophrenia spectrum and other psychotic disorders attending in the outpatient department of a tertiary care psychiatric hospital.

Materials and methods: This was a cross-sectional study carried out among the individuals with schizophrenia spectrum and other psychotic disorders attended at the outpatient department of National Institute of Mental Health, Dhaka, during October, 2020 – March, 2021. Convenient sampling technique was applied. After having the consent of the individuals with the disorder or their guardians, sociodemographic and other information were collected by a predetermined semi-structured questionnaire through face-to-face interview. To determine the history of psychiatric illness among the first and second degree relatives, the family history method was followed. Completed data of 153 respondents were analyzed using Statistical Package for Social Sciences (SPSS), version 24. p £.05 was considered statistically significant.

Results: The mean age of the respondents was 29.86±12.784. Most of the respondents were male (52.3%), Muslim (94.8%), unmarried (46.4%), unemployed (31.4%), and living in rural areas (49.7%). Regarding educational status, majority (32.0%) belonged to the secondary level of education (class VI – Secondary School Certificate). About one-third (32.0%) of the respondents had family history of psychiatric illness. The correlation of family history of psychiatric illness with gender (p = .209) and marital status (p = .266) was not statistically significant.

Conclusion: About one-third of the individuals with schizophrenia spectrum and other psychotic disorders had family history of psychiatric illness.

J Dhaka Med Coll. 2022; 31(1) : 86-92

Experience of Breast Clinic in a Tertiary Level Hospital

Wed, 03 May 2023 00:00:00 +0000

Background: Breast cancer is the second leading cancer worldwide (2089 million new cases per year, 11.6%) after lung cancer and 5th most leading cause of death (6.6%). The breast clinic concept is to set up a center of a cohesive group of dedicated breast cancer specialists working together as a multidisciplinary team with access to all the facilities required to deliver highquality care throughout the breast cancer pathway.2 The guidelines note that these professionals do not necessarily have to be based in one location but do need to be in the same geographical area and able to carry out close multidisciplinary work. To provide uniform management of breast diseases, hospital-based breast cancer screening, and properly manage breast cancer patients, we restarted this breast clinic weekly on Thursday in the Outpatient Department of Surgery in Dhaka Medical College Hospital, 2018.

Method and Materials: A 1year observational study was done from 1st August 2018 to 31st July 2019. All female patients having breast problems are included in this study by purposive sampling technique. The total number of patients was 620. A database kept using a registrar book, Microsoft Excel, and documents.

Results: Out of 620 patients, 26% presented with mastalgia, 50% with a breast lump, 15% with Fibrocystic changes, 4% with nipple discharge, 2 cases with duct papilloma, 2% duct ectasia, and 4% with others. Among the breast lumps, 42% presented with different stages of Carcinoma Breast, 32.4% with Fibroadenoma, 4% with galactocele, 8% breast abscess, 2% with breast TB, 9% with Chronic breast abscess including Granulomatous mastitis.

Conclusions: Females are half of the total population, but attention to their problems is not given to that much extent. Therefore, they often presented their symptoms lately. Though mastalgia is a rare symptom of breast cancer, patients are over-conscious regarding breast pain. In contrast, a painless malignant lump grows in its pattern and advances to the T3-4 stage at the presentation time. So providing comprehensive breast care as well as screening with multidisciplinary experts and equipment is a burning need for every tertiary-level hospital.

J Dhaka Med Coll. 2022; 31(1) : 93-97

Correlation of Duplex Scan and Clinical Profile of Peripheral Vascular Diseases In Dmch

Wed, 03 May 2023 00:00:00 +0000

Background: Duplex ultrasound is a non-invasive evaluation of blood flow in the major arteries and veins. It provides a unique spectrum of details, including the anatomical location of the lesion, accompanied by further information about flow velocity and volume. Day by day, this investigation has become popular among physicians and surgeons to evaluate peripheral arterial disease.

Objective: To determine duplex scans’ accuracy in diagnosing peripheral arterial disease and correlate it with clinical diagnosis.

Materials & Methods: The cross-sectional study was conducted in the Department of General Surgery in collaboration with the Department of Radiology & Imaging, Dhaka Medical College Hospital, and Dhaka from January 2011 to December 2011. A total of 100 clinically diagnosed cases of peripheral arterial disease, irrespective of age and sex, were included in the study. However, emergency cases of peripheral arterial disease and patients of peripheral arterial disease with concomitant cerebrovascular disease or venous pathology or arterio-venous malformation were excluded from the study. Based on clinical signs and symptoms, a clinical diagnosis was made, correlated with the diagnosis made by duplex scan findings.

Result: Peripheral arterial disease was mainly confined to the lower limb (85%). The right limb was involved in about two-thirds (64%) of the cases, the left limb in 31%, and both limbs in 5% of cases. More than 90% were a smoker. Pain and intermittent claudication were the universal complaints of the patients, followed by hair changes (85%), colour changes (86%) and wasting of the limb (65%). The most commonly involved arteries in the lower limb were arteria dorsalis pedis (96.6%), followed by the posterior tibial artery (84.2%), popliteal artery (60.6%), and femoral artery (21.3%). In the upper limb, the radial artery was involved in 100% of cases and the brachial artery in 86.7% of cases. Endarteritis obliterans and atherosclerosis were common clinical diagnoses (47% and 48%, respectively). Diagnosis based on duplex scan findings also demonstrated that endarteritis obliterans and atherosclerosis were common (40% and 39%, respectively), bearing consistency with clinical diagnosis. The strength of agreement between the two diagnoses was moderate (k = 0.743).

Conclusion: The study concludes that there was a moderate agreement between Clinical diagnosis and duplex diagnosis, which indicates that a duplex scan can be a valuable tool to support clinical diagnosis, suggest other diagnoses, or detect other associated pathologies.

J Dhaka Med Coll. 2022; 31(1) : 98-106

Clinicopathological Evaluation of Breast Lump in Different Age Groups

Wed, 03 May 2023 00:00:00 +0000

Background: Breast masses have a variety of etiologies, benign and malignant. Fibroadenoma is the most common benign breast mass; invasive ductal carcinoma is the most common malignancy. Most masses are benign, but breast cancer is the most common cancer and the leading cause of cancer deaths in women. Although most breast cancers occur in women older than 50, a significant number of women are diagnosed with breast cancer younger than 50. An efficient and accurate evaluation can maximize cancer detection and minimize unnecessary testing and procedures.

Objectives: Our study aimed to explore the frequency & pattern of different types of breast lumps in various age groups.

Materials & method: This cross-sectional observational study was carried out in the inpatient and outpatient department of surgery at Shaheed Ziaur Rahman Medical College Hospital, Bogra, from July 2008 to Dec 2008. A total of 130 patients with palpable breast lumps were included in the study. The age of the patients was between 11 to 70 years. Fine Needle Aspiration Cytology and biopsy were done for most of the patients with a breast lump. Sometimes ultrasonography, mammography, and other routine investigations were also done.

Result: In this study, the most common age was 11 to 20. The three most common diseases presented with lumps were Fibroadenoma, Carcinoma of the breast, and fibroadenosis. Peak age incidence of fibroadenoma was observed in the 11 to 20 age group (66%), while fibroadenosis was common in the third decade (46%), and peak age incidence was between the late twenties and early thirties. Carcinoma of the breast was common in 31 to 40 years age group (40%). No carcinoma was found below the age of 22 years. Most of the patients with carcinoma presented in an advanced stage. This reflects on illiteracy, poverty, lack of awareness, and medical facilities screening procedure in our population.

Conclusion: The diversity of clinical presentation of breast lumps in different age groups was observed in our hospital practice, and a correlation between clinical manifestations, FNAC findings, and histological diagnosis of breast lumps was made. Fibroadenoma was common in the second and third decades, while breast carcinoma was common in third and fourth decades. Here we attempted to find out the age incidence of the breast lump and its correlation with clinical features, FNAC findings, and histopathological reports to improve the accuracy of diagnosis and management of breast disease.

J Dhaka Med Coll. 2022; 31(1) : 107-113

Assessment of Serum Magnesium Levels In Patients With Acute Severe Bronchial Asthma Admitted in a Tertiary Care Hospital

Wed, 03 May 2023 00:00:00 +0000

Background: Hypomagnesaemia has been associated with diminished respiratory muscle power, which maintains the work of breathing. However, the effect of magnesium on asthma has yet to be examined in our country. Therefore, assessing the serum magnesium level in acute severe asthma patients in a tertiary-level hospital was the study’s objective.

Methods: The study was a hospital-based descriptive cross-sectional study conducted at the Department of Medicine and Department of Respiratory Medicine in DMCH. Each patient performed serum magnesium ion (Mg2+) during admission with other necessary investigations.

Results: Fifty-seven percent of participants had hypomagnesemia, and 43% of patients had normal magnesium levels. Mean serum magnesium was 1.57±0.22 mg/dl [range: 1.25-2.23 ng/dl]. Although a higher proportion of patients with severe attacks (64.8%) had hypomagnesemia than those who had moderate-severity attacks (47.8%), the difference is not statistically significant (p >0.05). About 23% of patients stayed at the hospital for >3 days; among them, 73.9% had hypomagnesemia. Hypomagnesaemia patients had higher odds of staying at the hospital for >3 days, but the relation is not statistically significant (OR 2.62, 95% CI 0.93 -7.36, p >0.05).

Conclusion: Hypomagnesaemia is present in half of the patients with acute severe bronchial asthma and is not associated with the severity of the disease and duration of hospital stay.

J Dhaka Med Coll. 2022; 31(1) : 114-119

Role of Serum Ascites Albumin Gradient In The Etiologic Diagnosis of Ascites

Wed, 03 May 2023 00:00:00 +0000

Background: Classification based on ascitic fluid protein has been challenged on several occasions in diverse clinical situations, including cirrhotic patients on extended diuretic treatment, cardiac ascites, 1/3 individuals with malignant ascites, spontaneous bacterial peritonitis, and even normal ascitic fluid.

Objective: The study’s objective was to observe the role of serum ascites albumin gradient (SAAG) in diagnosing Ascites.

Methods: This cross-sectional observational study was conducted at the Department of Medicine, Sylhet M.A.G. Osmani Medical College Hospital, Bangladesh. with a total of 100 participants with ascites following the inclusion and exclusion criteria of the study.

Result: The most prevalent cause of ascites was cirrhosis, observed in 56% of the participants. Among the 56 cirrhosis patients, mean ± S.D. values of AFTP, AFAlb, SAlb, and SAAG were 2.1±1.2, 0.8±0.6, 3.1±0.7, and 2.2±0.7 respective units accordingly. According to ascitic fluid albumin values, a statistically significant relation was observed between cirrhosis and tuberculosis (P<0.01) and cirrhosis vs malignancy (P<0.01) cases. According to serum ascitic albumin gradient values, a similar significant association was also found between cirrhosis vs tuberculosis (P<0.01) and cirrhosis vs malignancy (P<0.01) cases.

Conclusion: SAAG is an essential laboratory tool for the correct aetiological diagnosis of ascites.

J Dhaka Med Coll. 2022; 31(1) : 120-124

Comparison of Safety and Effectiveness of Bivalirudin Between Diabetic and Nondiabetic Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention

Wed, 03 May 2023 00:00:00 +0000

Background: Recurrent thrombotic events remain significantly high in spite of the currently recommended dual antiplatelet (DAPT) and conventional antithrombotic heparin (± GPI/ glycoprotein IIb/IIIa inhibitor) in diabetic ACS patients after PCI compared with non-diabetic even this drug eluting stent (DES) era. Therefore, more potent antithrombotic therapies are warranted for this group of high-risk patients.Comparison of safety and efficacy of newer anticoagulant bivalirudin between diabetic and non-diabetic ACS patients undergoing PCI using bivalirudin versus heparin (± GPI) is less well defined in Bangladeshi population.

Objective: To determine and compare the incidence of 30-day major adverse cardiac events (MACEs), stent thrombosis and hemorrhagic complications between diabetic and non-diabetic ACS patients undergoing PCI. Impact of antithrombotic strategy (bivalirudin vs. heparin ± GPI) on the 30- day post PCI clinical outcome was also evaluated and compared between diabetic and non-diabetic subgroup.

Methods: In this randomized controlled study, 500 ACS patients aged 18-75 years (200diabetic and 300 non-diabetics) who underwent PCI from November 2018 to October 2019 at the department of cardiology, BSMMU, were randomly assigned, in an open-label fashion to treatment with bivalirudin alone, heparin alone, or heparin plus eptifibatide (GPI) in a 1:1:1 ratio. Among them, 200 patients received Bivalirudin with a loading dose of 0.75 mg/kg, followed by an infusion of 1.75 mg/kg/h for up to 4 hours, 153 patients received UFH with a bolus of 70-100 U/kg (targeted ACT: 200-250 s) and 147 patients got heparin plus eptifibatide as 60 IU/kg heparin along with 180 μg/kg eptifibatide i.v. boluses, followed by a 2 μg /kg /min eptifibatide infusion for 18 hr consistent with current guidelines.Other pre- and post-procedural medications got under current guidelines. Both diabetic and non-diabetic subjects were subdivided into bivalirudin and control group (heparin ± GPI). In diabetic cohort, 100 patients were in bivalirudin and 100 patients were in control group. Among non -diabetic patients, 100 were in bivalirudin and 200 were in control group. The outcome measures were 30-day hemorrhagic complications, stent thrombosis, and MACCEs [death, MI, target lesion revascularization (TLR), and stroke] according to diabetic status. The diabetic and non-diabetic subgroup was also analyzed for the same outcome measure according to antithrombotic strategy. Peri and post PCI clinical follow-up comprised checking office visits and telephone contacts.

Results: According to diabetic status, net adverse clinical events (NACEs) were significantly higher in diabetic in comparison to non-diabetic (diabetic vs. non-diabetic, 15% vs. 7.6 %, P=0.008) and was associated with higher incidence of MACCEs (10.5% vs. 4.0%, P=0.004), cardiac death (4 % vs. 1 %, P=0.02) and BARC 2,3,5 grade bleeding events (9% vs. 4 %, P=0.02). In diabetic cohort, incidence of 30-day NACEs was significantly lower in bivalirudin than control group(bivalirudin vs. UFH ± GPI, 6 % vs. 24 %, P=0.004) and was associated with lower incidence of MACCEs (2% vs. 8.5%, P=0.03) and bleeding events (3 % vs. 15 %, P=0.003) whereas incidence of stent thrombosis (2 % vs. 3%, P =0.651) was comparable between the bivalirudin and control groups. There was a significant advantage in favor of bivalirudin treatment among insulin-treated patients with regard to cardiac death at 30-day (bivalirudin vs. control group, 0% vs. 16.6%, p = 0.03) compared with non-insulin treat diabetic patients. However, subgroup analysis of the nondiabetic patients showed that there was no significant difference in the incidence of 30-Day NACEs (4% vs. 9.5%, P=0.09) according anticoagulant status.

Multivariate analysis showed that bivalirudin (HR: 0. 202, 95% CI: 0.078 – 0.519, P=0.009) was independent protective factor of 30-day NACEs for diabetic patients.

Conclusion: Bivalirudin monotherapy is safer and more efficacious for diabetic ACS patients compared with non-diabetic ACS patients undergoing PCI.

J Dhaka Med Coll. 2022; 31(1) : 126-136

Presentation and Outcomes of the Covid- 19 Among the Vaccinated and Nonvaccinated Patients

Wed, 03 May 2023 00:00:00 +0000

Background: Previous infection or vaccination boosts up the body’s immune system. It may have a protective effect or an exaggerated immune response. Knowledge about the impact of vaccination or previous infection on the presentation and outcome of the new variant of COVID- 19 is scarce.

Objectives: In this study, vaccine effectiveness, reinfection rate and severity prediction among vaccinated and non-vaccinated COVID-19 infected patients were assessed.

Methods: This observational study was conducted in the COVID-19 unit of Dhaka Medical College Hospital. Three hundred forty-four patients who presented in the triage and were admitted to DMCH were enrolled as per inclusion criteria and were followed up for three months for outcome variables. Patients were divided into four groups by vaccination and previous infection. Results: Mortality was 18(14.6%), 10(14.3%), 14(22.6%), and 40(44.9%) in new COVID-19 in vaccinated, reinfection in vaccinated, new COVID-19 infection in unvaccinated, and reinfection in unvaccinated patients respectively. 5 (4.1%) of the newly infected vaccinated and 4 (6.5%) freshly infected unvaccinated, 14 (15.7%) reinfected unvaccinated patients were transferred to ICU for mechanical ventilation. The mean duration of the hospital stay was significantly (p<0.05) lower among the vaccinated group than in non-vaccinated patients.

Conclusion: This study suggests that vaccination of previously infected people may be associated with reducing the adverse outcome of COVID-19 infection.

J Dhaka Med Coll. 2022; 31(1) : 137-147

Dengue Outbreaks in Bangladesh

Iffat Ara Shamsad — Wed, 03 May 2023 00:00:00 +0000

Abstract not available

J Dhaka Med Coll. 2022; 31(1) : 1-3

Refractory Gastroesophageal Reflux Disease: Scopes Beyond PPI

Wed, 03 May 2023 00:00:00 +0000

Gastroesophageal reflux disease (GERD) is a very common GI disorder where the reflux of gastric contents into the esophagus causes symptom generation. PPI is the principal weapon to fight against GERD. An empiric course of PPI therapy is a cost-effective strategy for managing GERD. But sometimes, PPI can only do so much if taken correctly. As PPI does not reduce the number of reflux, other measures, including lifestyle modification, are required to get relief of GERD symptoms. Most patients respond to 8 weeks of PPI therapy, but 20-40% do not respond or respond partially. While these patients are labeled as having refractory heartburn, many do not have GERD or have not been treated adequately. So, alternative etiology must be considered when patients are refractory to PPI. Endoscopy of upper GIT should be done initially in case of the presence of alarm symptoms and when considered refractory to exclude other conditions. If endoscopy reveals no abnormality, then esophageal function tests like esophageal manometry, 24 hrs ambulatory pH monitoring, and mucosal impedance test can be considered to exclude other related conditions. Endoscopic and surgical treatment options can also be considered in particular cases.

J Dhaka Med Coll. 2022; 31(1) : 148-157

Letter to the Editor vol. 31(1)

Mohiuddin Matubber — Wed, 03 May 2023 00:00:00 +0000

Abstract not available

J Dhaka Med Coll. 2022; 31(1) : 4

99MTC RBC Scintigraphy in the Diagnosis of Hepatic Haemangioma

Wed, 03 May 2023 00:00:00 +0000

Abstract not available

J Dhaka Med Coll. 2022; 31(1) : 167-169