Journal of Shaheed Suhrawardy Medical College

Comprehensive Analysis of Gallstone Composition and Association with Risk Factors in Bangladesh: Insights into the burden and outlook for prevention and management.

2024-05-13T06:10:58+00:00

Gallstone is as ancient as human civilization. It has been found in the gallbladders of Egyptian mummies, dating back to 1000 BC. Gallstone is one of the diseases prevalent in developed nations but it is less prevalent in the developing populations that still consume traditional diets. Gallstones are formed in the gallbladder, from the constituents of bile cholesterol and calcium bilirubinate are the main chemical compounds present in gallstones and their precipitation in bile is induced by multiple aetiological factors. The prevalence and the chemical composition of gallstones vary from population to population. This indicates the involvement of multiple risk factors in the pathogenesis of gallstones. Therefore investigation of the chemical composition of gallstones is primarily important to recognize the correlation with the risk factors for gallstones disease in a community.

J Shaheed Suhrawardy Med Coll 2022; 14(2): 3-10

Risk Factors, Clinical Profile and Association of Clinical Grading With Radiological Grading of Adenoid Hypertrophy in Children

2024-05-13T06:28:02+00:00

BACKGROUND: Adenoid hypertrophy producing obstructive airway symptoms is the most commonly encountered pediatric ENT problem. Clinical symptoms in combination with lateral nasopharyngeal x ray is a reliable technique for selection of children requiring surgical intervention.

METHODOLOGY: The current cross sectional prospective study was conducted among 250 children aged 3-12 years with clinical symptoms and radiological evidence suggestive of enlarged adenoids, at Pediatric outpatient department of a tertiary care center, Dhaka, during 1-year period.

RESULT: In our current study, majority children (74%) with adenoid hypertrophy were 3-6 years old followed by 26% between 7-12 years. 66% children were male and 34% were female with a male to female ratio of 1.9:1. 44% children were from lower class family and history of atopy was present among 54% children. Clinical grading of adenoid hypertrophy was done on the basis of presenting symptoms (mouth breathing, snoring, sleep disturbances and adenoid facies) and radiological grading was done from calculating adenoid nasopharyngeal ratio. Correlation between clinical scoring and radiological grading of adenoid hypertrophy among study population was observed. Clinical score of 0-4, 5-8, 9-12 and 13-16 was graded clinically into Grade I, II, III and IV respectively. Highly significant p value (.000) was observed in Grade II clinical and radiological grade of enlarged adenoid. The remaining clinical and radiological grade of enlarged adenoids showed significant p value .031, .024 and .019 among grade I, III and IV respectively.

CONCLUSION: Though various diagnostic modalities for detection of degree of obstruction caused by enlarged adenoids are available, clinical scoring in combination with radiological grading can be effectively used to select patients requiring surgical intervention for pediatric adenoid hypertrophy.

J Shaheed Suhrawardy Med Coll 2022; 14(2): 11-17

Anthropometric parameter that best predict metabolic syndrome in postmenopausal women.

2024-05-13T06:44:17+00:00

Background: The use of anthropometric parameter is one of the new and low-cost diagnostic methods of detection of metabolic syndrome.

Aims and objectives: The objective of the present study was to examine the predictive power of many anthropometric parameters as an accurate predictor for MS in postmenopausal women.

Material and Methods: This cross sectional study involved 199 postmenopausal women. Six anthropometric parameters : Waist circumference (WC), body mass index (BMI), waist-to-height ratio (WHtR), waist to hip ratio (WHR), lipid accumulation product (LAP) and visceral adiposity index (VAI) were measured and calculated. Metabolic syndrome (MS) was defined according to the criteria of NCEP-ATP III. The women were devided into two groups based on presence or absence of metabolic syndrome. Comparisons of clinical and metabolic characteristics were performed between the groups. To analyze the correlation of anthropometric parameters with MS Spearmann test was used. The cut-off points, area under the curve (AUC), sensitivity and specificity of parameters were determined using Receiver Operating Characteristic Curve (ROC).

Results: The prevalence of MS in postmenopausal women was 74.4%. Visceral adiposity index (VAI), Lipid accumulation product (LAP), waist circumference (WC), Body mass index (BMI) and waist to height ratio (WHtR) were significantly higher in women with MS. Among the anthropometric parameters assessed mainly VAI and LAP showed a significant correlation with the majority of MS criteria. Through ROC curves VAI, LAP and WC presented higher AUC being the cut- off points followed :0.85, 0.83 and 0.75 respectively. This study has shown the postmenopausal women had a high prevalence of MS and VAI and LAP regarded as most sensitive and specific predictors for MS in post menopausal women.

J Shaheed Suhrawardy Med Coll 2022; 14(2): 18-24

Serum IL-23, IL-17 and TNF-α level as Psoriasis severity markers: A hospital based cross sectional study.

2024-05-13T06:55:02+00:00

Background: Psoriasis is an autoimmune chronic inflammatory disease where serum cytokines are marked as prime drivers of disease progression and severity. Objectives: To investigate serum TNF-α, IL-17 and IL-23 level according to disease severity of psoriasis.

Methods: A total of 35 psoriasis patients and 35 healthy controls were enrolled. Disease severity of psoriatic patients was assessed by Psoriasis Area and Severity Index (PASI) scoring. Serum TNF-α, IL-17 and IL-23 of study subjects were measured by ELISA.

Results: Serum level of is significantly increased in psoriasis patients than healthy controls. Among 35 patient 56.7% were suffering from moderate to severe psoriasis. Serum TNF-α level was more in mild group (P =0.70) and serum IL-23 level increased in moderate to severe psoriasis (P=0.42). Whereas serum IL-17 level significantly increased along with disease severity (P=0.03).

Conclusion: Our study underscores the role of TNF-α, IL-17 and IL-23 in disease severity of psoriasis.

J Shaheed Suhrawardy Med Coll 2022; 14(2): 25-29

Awareness of sexual violence, status of temptation and consent among children experiencing sexual violence

2024-05-13T09:40:22+00:00

Background: Worldwide sexual violence in children is a common burning problem irrespective of culture and geographical location. Awareness and temptation status among the victims may signify and influence the establishment of sexual violence. This study was conducted to explore awareness of sexual violence, status of temptation and consent among children experiencing sexual violence with their clinical profile.

Methods: This cross-sectional study included 106 victimized children attending the Department of Forensic Medicine and Toxicology and One-stop Crisis Center of Dhaka Medical College, Dhaka Bangladesh between June 2019 and March 2020. Sexual violence, status of awareness and temptation were assessed depending on operational definition. Physical examination was also done. Results for numerical data was expressed as mean ± SD, while categorical was expressed as frequency (number) and percentage (%).

Results: Age of the victims was 13.55±4.03 years who were mostly students (68.9%) and resided in urban areas (74.5%). Only 67% female children had awareness of sexual violence. Among the affected victims, 48.1% had given consent and 51.9% were tempted. Most of the sexual violence was carried out by lover (43%) and neighbour (39%). More than three-fourth (78.3%) of the sexual violence occurred at house and during day time (62.3%). Almost one-third victims (34%) had previous sexual experience. Time elapsed between occurrence of violence and physical examination ranged from 2-60 days. Among the female victims, more than 70% had developed breast, while pubic hair was grown in 77.5%. None of the male victim either developed moustache or pubic hair.

Conclusion: Lack of awareness is an important factor for occurrence of sexual violence. Temptation also plays a major role in affirming consent to establish a sexual violence. Awareness development in children is essential to prevent sexual violence.

J Shaheed Suhrawardy Med Coll 2022; 14(2): 30-34

Association between lymphovascular invasion (LVI) and prognostic factors in breast cancer.

2024-05-13T07:49:18+00:00

Background: The presence of tumor cells within lymphatic or blood vessels in the surrounding tissue of a malignant tumor indicates the possibility of cancer spreading (metastasis) to other parts of the body. Lymphovascular invasion (LVI) is a significant pathogenic feature in invasive breast cancer that can provide valuable information about the tumor's aggressiveness and influence therapy options.

Objective: To the association of LVI with prognostic factors in breast cancer.

Methods: This cross-sectional study was conducted in the Department of Surgery, Sir Salimullah Medical College and Mitford Hospital, on 52 adult breast cancer patients who received Breast Conserving Surgery (BCS) or mastectomy. No patients with neoadjuvant therapy (recurring, breast cancer, metastases, or advanced breast cancer were excluded). Patients' demographic data, clinical data, and lab diagnoses were obtained. Histopathology and immunohistochemistry were performed on all samples. ER, PR, and Ki-67 were correlated with histological results. Pathologists diagnosed LVI in surgical resection tissue. All data were validated for consistency after collection. Data were analyzed using SPSS 12.0. A p value < 0.05 was considered statistically significant.

Results: The presence of ER and PR was significantly higher in cases where LVI was negative. On the other hand, the presence of Ki-67 was significantly higher in cases where LVI was positive. It was observed that cases with LVI positive had higher stages of lymph nodes metastasis and tumor grading. It was also found that the Ductal type of breast cancer was significantly higher in cases where LVI was negative. Additionally, LVI positive case was found to be significantly higher among aged people.

Conclusion: The presence of lymphovascular invasion has a negative association with ER, PR, and ductal type breast cancer and is positively associated with ki67, high grade, and greater lymph node metastasis.

J Shaheed Suhrawardy Med Coll 2022; 14(2): 35-38

Assesment of pain management in chronic pancreatitis after lateral pancreatico-jejunostomy: A comparative analysis of pre and post operative outcomes

2024-05-13T08:15:36+00:00

Background: Chronic pancreatitis is a fairly common condition with pain being the major symptom and lateral pancreaticojejunostomy (LPJ) is performed for symptomatic relief. It is done for patients with severe pain, obstructed and dilated pancreatic duct. Surgical decompression of the duct and ductal drainage can achieve best pain relieve and slow the progression of the disease.

Aim: The aim of the study was to assess relief of pain pre and post-LPJ for chronic pancreatitis.

Methods: This prospective observational study was conducted at the Department of Surgery in Shaheed Suhrawardy Medical College Hospital, for One year period. Patients with chronic pancreatitis admitted in the department of surgery were approached for inclusion in the study. Total 17 patients were selected according to inclusion and exclusion criteria. Informed written consent was taken from each patient. All patients underwent lateral Pancreaticojejunostomy. Detail clinical and demographic history was taken along with thorough physical examination relevant investigations. All patients were evaluated preoperatively and post operatively at discharge, 1 month and 3 months. Pain was assessed preoperatively and post operatively using Visual analogue scale (VAS). Collected data were checked and analysed in SPSS 23.

Results: Among 17 patients, average age was 33.4 (±9.6) years with majority in age group 20-35 years. Male patients were more than female (67% vs 33%). Major clinical presentations upper abdominal pain (100%), nausea/vomiting (73.3%), history of weight loss (60%), fatigue (53.3%), fever (40%), steatorrhoea (40%), diarrhoea (33.3%) and shortness of breathe (26.7%). Among 73.3% patients, outcome was good and among 26.7% patients, outcome was poor. Of all, 40% had VAS score 0 at discharge but increased at 1 months (53.3%) and 3 months (73.3%) follow up and 26.7% had higher VAS score at discharged reached but to a VAS score of 0 or 2 at 1 month (6.7%) and 3 months (6.7%) follow up. Mean pain score before and after the lateral pancreaticojejunostomy surgery was 8.26±1.27 and 1.7±1.66 with statistically significance (p <0.001).

Conclusion: Seventy Three percent of patients had good outcome regarding pain after LPJ. Significant relief in symptoms of pain were noted after LPJ. Further larger study is recommended to validate this findings.

J Shaheed Suhrawardy Med Coll 2022; 14(2): 39-46

Effectiveness of Segmental Thoracic Spinal Anaesthesia in Breast Surgery: An Observational Study

2024-05-13T08:21:42+00:00

Background: General anaesthesia is usually performed for breast surgery but the risks and complications of general anaesthesia outweigh its benefits. For this, segmental thoracic spinal anesthesia might be an alternative to general anesthesia.

Objectives: The objective of this study was to evaluate the effectiveness segmental thoracic spinal anaesthesia in breast surgery.

Methods: This prospective observational study was conducted at surgery operation theatre in the Shaheed Suhrawardy Medical College and Hospital, Dhaka, Bangladesh from January 2023 to December 2023. Patients of ASA (American Society of Anesthesiologist) class I and II, ageing above 18 years, and BMI < 35 kg/m2 scheduled for breast surgery (modified radical mastectomy for carcinoma breast, lumpectomy for breast lump/gynaecomastia, and wide local excision for phylloids tumor) were included in this study. Segmental thoracic spinal anaesthesia was performed at T5-T6 space with injection 0.5% hyperbaric bupivacaine 1 ml (5mg) and fentanyl 0.5 ml (25 microgram). Perioperative hemodynamic changes, unwanted effects, time of first rescue analgesic, total opioid consumption in first 24 h, patient and surgeon satisfaction score were recorded in a data sheet.

Results: Sixty patients were eligible for the study but 55 patients completed the study successfully. Modified radical mastectomy, Lumpectomy and Wide local excision were done in 42 (76%), 8 (15%) and 5 (9%) patients, respectively. The mean age of the patients was 50.78±8.98 years. There were no significant changes in haemodynamic parameters during the intraoperative period. The frequency of adverse effects were minimal. Mean time for 1st dose of analgesic was 5.8±1.8 hours and total opioid consumption was 76.77±15.7 mg in first 24 hours. Both patient (91%) and surgeon (95%) were highly satisfied with this technique.

Conclusions: Segmental thoracic spinal anaesthesia provides better satisfaction and fewer complications in patients undergoing breast surgery. This regional anaesthesia technique can be used effectively for breast surgeries.

J Shaheed Suhrawardy Med Coll 2022; 14(2): 47-52

Relation between Preoperative vitamin D level and Post operative Infection in Patient undergoing Pancreaticoduodenectomy (Whipple’s) procedure

2024-05-13T08:50:59+00:00

The patient who underwent pancreaticoduodenectomy operation suffers from obstructive jaundice sometimes. Due to lack of bile in intestine these patients have difficulty in absorption of fat soluble vitamin A, D, E and K. Vitamin D has an important role in maintenance of our immune system. So patients who have low serum vitamin D level suffer from infection more than those with normal level in postoperative period. This study aims to identify vitamin D deficiency among patients suffering from obstructive jaundice and see whether they suffers more postoperative infection and hospital stay. In this observational study 13 patients were enrolled after considering the exclusion and inclusion criteria who underwent pancreaticoduodenectomy operation but have low vitamin D level in the department of Hepatobiliary, Pancreatic and Liver transplant Surgery for one year period. Another 13 patients were selected who has normal vitamin D level. They were leveled into two groups. Group one had normal vitamin D level and group two have low vitamin D level. After operation superficial surgical site infection, deep surgical site infection, pneumonia, bile leak, pancreatic fistula, hospital stay were recorded. CRP level were measured on 3rd, 5th and 7th POD. Data analysis to calculate the significance between two groups were done by using SPSS version 23. P value was regarded significant if <0.05. Postoperative infection is significantly lower in normal vitamin D level group. Postoperative CRP level was same on early postoperative period in all patients but in vitamin D normal group CRP level decreases faster. Postoperative hospital stay was shorter in normal vitamin D level group due to less postoperative infection. In conclusion we can say that obstructive jaundiced patient with below normal Vitamin D level prior to pancreaticoduodenectomy surgery have more postoperative infective complications and thus have more hospital stay.

J Shaheed Suhrawardy Med Coll 2022; 14(2): 53-57

Sparsentan: Sparsentan- A novel, non- immunosuppressive, dual action angiotensin II and endothelin A receptor antagonist -A new hope for glomerular disease

2024-05-13T09:40:15+00:00

Abstract not available

J Shaheed Suhrawardy Med Coll 2022; 14(2): 58-62

Posterior Reversible Leukoencephalopathy Syndrome (PRES) in a patient with post eclampsia with status epilepticus

2024-05-13T09:40:18+00:00

Despite the limited number of instances and relatively low knowledge of Posterior Reversible Leukoencephalopathy Syndrome (PRES) among the population of Bangladesh, it is imperative to recognize the gravity of this health issue. The crucial aspect in achieving favorable results is the early detection of the condition, as it allows for the prompt elimination of the precipitating cause and the effective management of blood pressure. The present case study elucidates the significant discoveries pertaining to a patient with posterior reversible encephalopathy syndrome (PRES), as well as the diagnostic and therapeutic strategies used. A female individual who had just undergone a surgical operation known as a cesarean section exhibited symptoms including headache, recurrent convulsions, and loss of consciousness. Subsequent medical evaluation led to the diagnosis of posterior reversible encephalopathy syndrome (PRES). This section presents an examination of the diagnostic process using clinical and radiological characteristics, as well as an overview of the therapy plan. The fast diagnosis and timely beginning of therapy procedures have been identified as crucial factors for achieving early recovery and favorable functional outcomes.

J Shaheed Suhrawardy Med Coll 2022; 14(2): 63-65

Cervical Spinal Chondrosarcoma: A Rare Case Report

2024-05-13T09:40:19+00:00

Cervical spinal chondrosarcoma is an exclusively uncommon disease. A 35-year-old man presented with a history of swelling on the right side of the back of the neck for 1 year and night pain with numbness of the right upper limb for 6 months. Magnetic Resonance Imaging of the cervical spine showed a 7.8×4.5 cm extendible mass lesion involving the spinous process and lamina of the C5-C7 vertebrae. The tumor was excised without stabilization of the cervical spine. After one year of follow-up, the patient is disease-free, and the cervical spine is stabilized with normal movements. A good prognosis is seen when wide excision is done in the case of low-grade chondrosarcoma, even though it is deep-seated.

J Shaheed Suhrawardy Med Coll 2022; 14(2): 66-68