Journal of Enam Medical College

College News Vol. 11(2)

Editor in Cheif — 2021-05-31

Abstract Not available

J Enam Med Col 2021; 11(2): 135

Reviewers in this Issue Vol 11(2)

Editor In Cheif — 2021-05-31

Abstract not available

J Enam Med Col 2021; 11(2): 136

Chronic Sinusitis ─ A Rare Initial Presentation of Childhood Granulomatous Polyangiitis

Shaheen Akter — 2021-05-31

Childhood granulomatosis with polyangiitis (cGPA), is a rare, potentially fatal necrotizing vasculitis and its clinical features overlap with infection. Clinical manifestations of cGPA varies widely from involvement of upper and/or lower respiratory tract, necrotizing glomerulonephritis and less commonly skin, central nervous system, heart, salivary gland, eye and orbit. A ten-yearold girl was admitted having chronic sinusitis and fever for three months followed by perforating palate ulcer, persistent middle ear effusion, epistaxis, nasal deformity, rapidly progressing pneumonia and necrotizing skin lesions in limbs. Investigations demonstrated high titer of cANCA and vascular granulomatous lesions that confirmed the diagnosis of cGPA. Diagnosis of cGPA at the early stage is difficult because of the nonspecific symptoms which mimic other disorders. This case highlights the difficulty in diagnosing cGPA and the potentially life-threatening consequences of failing to do so.

J Enam Med Col 2021; 11(2): 128-132

Chylous Fistula Following Mastectomy

Mohammad Israt Faisal — 2021-05-31

Though chyle leakage after axillary dissection is a rare occurrence, sometimes it becomes difficult to manage. All surgeons dealing with breast should be aware with this unusual complication and its management.

J Enam Med Col 2021; 11(2): 133-134

Antihyperglycemic and Glucose Homeostasis Effect of Ethanol and DCM Extract of Gymnema Sylvestre on Type 1 Diabetic Model Rat

Nasreen Chowdhury — 2021-05-31

Bacground: Plants have formed the basis for the treatment of diseases in traditional medicine systems for thousands of years and continue to play a major role in the primary health care of about 80% of the world inhabitants. Gymnema sylvestre is one of the most studied herbs which has been claimed to be active against both type of diabetes mellitus.

Objective: The dried powder leaves of Gymnema extracted with ethanol and dichloromethane (DCM) and then its effect were studied in streptozotocin induced type 1 diabetic model rat at different prandial state.

Materials and Methods: In the present study both of the extracts (GS EthOH and GS DCM) of Gymnema sylvestre produced a significant antihyperglycemic effect in type 1 diabetic model rats when the extract was given 30 minutes before glucose load. The effectiveness of the extracts in type 1 diabetic rats with residual insulin secretion indicates that the hypoglycemic effect of active plant compound(s) is probably mediated either by improving insulin secretion from the existing β cells or by increasing its sensitivity.

Results: The baseline value of fasting serum glucose reflects that the degree of damage of β cells by the toxic effect of streptozotocin was gradual. The findings at one week show some spontaneous recovery in water control group and better recovery in all the treated groups. After two weeks, fasting serum glucose level was improved in all the extract treated groups.

Conclusion: The data suggest that Gymnema sylvestre leaf extracts improve the glycemic status in type 1 diabetic model rat.

J Enam Med Col 2021; 11(2): 72-77

Association of Carpal Tunnel Syndrome with Diabetic Polyneuropathy

Sayeda Shabnam Malik — 2021-05-31

Background: Common thought is that diabetic neuropathy is a predisposing factor to entrapment syndromes. Carpal tunnel syndrome (CTS) is the most frequent entrapment neuropathy.

Objectives: To find out association of carpal tunnel syndrome with diabetic polyneuropathy.

Materials and Methods: During the period of March 2013 to September 2015, this cross-sectional study was carried out in the Department of Neurology, Bangabandhu Sheikh Mujib Medical University, Dhaka. A total of 100 adult patients having symptoms and signs of polyneuropathy were recruited as study population. Of them 50 patients grouped into diabetic polyneuropathy (DPN) and the rest 50 patients in non-diabetic neuropathy due to other causes.

Results: Out of all patients, the mean age was found 49.60 (13.53) years with 42% female in diabetic neuropathy patients and mean age was 44.64 (15.72) years with 46% female in non-diabetic neuropathy patients. The duration of diabetes was found 8.44 (7.79) years. According to development of Carpal tunnel syndrome (CTS), in diabetic neuropathy patients, about 58% patients developed CTS while in non-diabetic neuropathy patients, that of 14% (p=0.0001). We found diabetic neuropathy patients have 8.48 times higher possibility of development of CTS than non-diabetic neuropathy patients. On adjusted model, age as confounding variable, diabetic neuropathy and female sex were found significantly associated with development of CTS with adjusted odd ratio 10.92 and 3.78 respectfully (p<0.0001).

Conclusion: In conclusion, we revealed the higher frequency of CTS in diabetics with DPN. As well we also found DPN and female sex were strongly associated with development of CTS. As DPN is a risk factor for CTS, priority should also be given to the treatment of DPN.

J Enam Med Col 2021; 11(2): 78-85

Serum Prolactin Status in Primary Sub-Fertile Males with Azoospermia and Oligozoospermia

Lubna Naznin — 2021-05-31

Background: Fertility is adversely affected by negative feedback of prolactin on hypothalamic secretion of gonadotropin-releasing hormone (GnRH). Hyperprolactinemia inhibits the pulsatility of GnRH secretion and may cause secondary hypogonadism and results in spermatogenic arrest and impaired sperm motility. Besides, prolactin is also directly related to spermatogenesis and steroidogenesis.

Objective: This study was designed to assess the serum prolactin status in primary sub-fertile males with azoospermia and oligozoospermia.

Materials and Methods: This study was carried out at Armed Forces Institute of Pathology (AFIP), Dhaka Cantonment from January 2019 to December 2019 on 150 males. The study population included primary infertile males, 50 azoospermic and 50 oligozoospermic as cases and 50 age-matched normozoospermic males with proven fertility as control. Serum prolactin levels were estimated in fasting sera by electrochemiluminescence immunoassay in all the three groups. The reference value for serum prolactin was 4−18 ng/mL.

Results: Mean age for normozoospermic fertile males, oligozoospermic and azoospermic infertile males were 30.73 ± 4.13 years, 31.46 ± 4.59 years and 32.34 ± 5.04 years respectively. Mean serum prolactin level in normozoospermic fertile males, oligozoospermic sub-fertile males and azoospermic sub-fertile males were 9.44 ± 3.46 ng/mL, 12.02 ± 11.78 ng/ mL, and 10.48 ± 4.55 ng/mL respectively with no significant variation (p>0.05). Serum prolactin was within the normal range (4−18 ng/mL) in all (100%) normozoospermic fertile males, 84% oligozoospermic males and 90% azoospermic males. Eight (16%) oligozoospermic cases and five (10%) azoospermic cases had hyperprolactinemia. Among the oligozoospermic cases with hyperprolactinemia, four (50%) had elevated prolactin with hypergonadotrophic state and four (50%) cases showed isolated prolactin elevation. All five (100%) azoospermic hyperprolactinemia cases were associated with hypergonadotrophic state.

Conclusion: Serum prolactin estimation should be evaluated in primary sub-fertile males with azoospermia and oligozoospermia. Cases of hyperprolactinemia should also be evaluated for gonadotroph status.

J Enam Med Col 2021; 11(2): 86-91

Hemodynamic Effects of Oxytocin when Given as Bolus or Slow Intravenous Infusion During Cesarean Section

Nasima Begum — 2021-05-31

Background: Oxytocin is a uterotonic drug with profound haemodynamic effects. The effects of oxytocin on women undergoing cesarean section include tachycardia, hypotension and decreased cardiac output. These can be sufficient to cause significant compromise in high risk patients.

Objective: This study aims to find out a simple way to decrease these risks without compromising the therapeutic benefits such as decreasing bleeding after delivery and uterine contraction.

Materials and Methods: We recruited 60 women undergoing cesarean section. The subjects were randomly divided into two groups, 30 subjects per group, randomly selected by blind envelope method. Group A: parturient received 5 IU bolus (approximately over 2 seconds). Group B: parturient received 5 IU oxytocin IV slow infusion (diluted with 10 mL distilled water) over 2 minutes.

Results: A significant increase in heart rate and fall in blood pressure in the group where oxytocin was given IV bolus compared to the slow IV infusion group. There were no differences in the estimated blood loss and uterine contraction between the two groups.

Conclusion: The haemodynamic changes are more marked in the IV bolus than the slow IV infusion of oxytocin. Slower injection of oxytocin can effectively minimize the cardiovascular side effects without compromising the therapeutic benefits.

J Enam Med Col 2021; 11(2): 92-98

Diagnostic Accuracy of Strain Elastography Ultrasound in Differentiation of Benign and Malignant Breast Lesions with Histopathological Correlation

Tarana Yasmin — 2021-05-31

Background: Palpable breast masses are common and usually benign, but efficient evaluation and prompt diagnosis are necessary to rule out malignancy. High frequency high resolution ultrasonogram helps in its evaluation. With major advances in ultrasonographic technology, ultrasound elastography can improve differentiation between benign and malignant breast lumps. Knowledge of the specific ultrasonogram elastographic characteristics of breast lumps can be offered as a viable alteration to biopsy and imperative for optimal patient management.

Objective: To determine the validity of ultrasound elastography strain ratio in differentiation of benign and malignant breast lesions by detecting the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of ultrasound elastography in diagnosis of benign and malignant breast lesions.

Materials and Methods: This cross-sectional analytical study was done in the department of Radiology & Imaging of Enam Medical College & Hospital during July 2016 to June 2017. A total number of 104 patients were included in this study. Data on clinical presentation, ultrasonographic, sonoelastographic findings including histopathological report were collected and documented in structured forms. Analysis was done using SPSS 20.0 version.

Results: The study was done on 104 women of 19−60 years of age with the mean age of 34.65±5.5 years. Out of sonographically diagnosed 80 benign lesions also having lower elastography strain ratio (2.73±0.87), 75 (94%) were proved benign histopathalogically. With these criteria for diagnosis of benign lesion, sensitivity was 94.9%, specificity 80%, positive predictive value 93.7%, negative predictive value 83.3% and accuracy 91.3%. Sonographically 24 lesions were diagnosed as malignant also having higher elastography strain ratio (8.1±1.38), out of these 20 (83%) cases were proven malignant histopathalogically with sensitivity of 80%, specificity 94.9%, positive predictive value 83.3%, negative predictive value 93.7% and accuracy 91.3%.

Conclusion: Ultrasound elastographic findings of benign and malignant breast lesions correlated well in most of the cases with the histopathological results. So combined use of ultrasound and ultrasound elastography provide better diagnostic yield and thus allowed sparing of cumbersome invasive diagnostic procedures.

J Enam Med Col 2021; 11(2): 99-107

Efficacy and Safety of Tofacitinib vs Methotrexate in Patients with Moderate to Severe Plaque Psoriasis

Lubna Khondker — 2021-05-31

Background: Janus kinase (JAK) pathways are key mediators in the immune-pathogenesis of psoriasis. JAK inhibitors have been studied in early phase trials for psoriasis patients, and the data are promising for these agents as potential treatment options.

Objective: Efficacy and safety of tofacitinib in patients with moderate to severe plaque psoriasis.

Materials and Methods: A prospective, clinical trial was conducted at the department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka for duration of January 2019 to December 2019 with plaque-type psoriasis patients and the group A patient received tofacitinib 5 mg 12 hourly daily for 8 weeks and the group B patient received oral methotrexate 15 mg/week in a three 12-hourly divided doses for same duration.

Results: The psoriasis Area and Severity Index (PASI) score was decreased significantly from base line to 4th week follow up and also to the 8 week follow up in both groups of patients (p<0.05). The mean percentage of decrease of PASI score was found to be high among the group B patients (84.9±10.4, i.e. 85%) than the group A patients (77.6±14.0, i.e 78%), but the mean difference was not statistically significant (p>0.05). Analysis revealed that a statistically significant improvement of psoriasis was observed based on PASI score eight weeks of treatment in both treatment group (p=0.001) and in both groups of patients the adverse effects were few and mild in nature.

Conclusion: Tofacitinib is an effective and safe drug in the treatment of psoriasis and almost similar to methotrexate and so tofacitinib can be alternative drug to methotrexate in the treatment of moderate to severe psoriasis.

J Enam Med Col 2021; 11(2): 108-119

From the Desk of Editor-in-Chief Vol.11(2)

Md Aminul Haque Khan — 2021-05-31

Abstract not available

J Enam Med Col 2021; 11(2): 63

SARS-CoV-2 Variants and Vaccines: What We Learn and What We Can Forecast?

Iftikhar Ahmed — 2021-05-31

Abstract not available

J Enam Med Col 2021; 11(2): 64-67

Chronic Diarrhea in Children

Fahmida Begum — 2021-05-31

Chronic diarrhea (CD) is a common but challenging clinical scenario in pediatric medicine. It has several hundred disorders in the differential diagnosis and can create a complex situation for practitioners and families. Some of the disorders cause failure to thrive but some are not. This article focuses on important aetiologies of CD, their clinical features, diagnostic approach as well as treatment approaches.

J Enam Med Col 2021; 11(2): 120-127