KYAMC Journal

Acute Acalculous Cholecystitis in Dengue Fever with Raised Transaminase

2023-11-30T03:34:24+00:00

Background: Dengue fever is a viral fever classically characterized by high-grade temperature, headache, ocular pain, sternal pain, muscle and joint pain, nausea, vomiting and sometimes rash. Apart from above stated clinical features, there may be hepatitis, ascites, cholecystitis, pleural effusion, etc. which are confirmed by investigations.
Objective: To establish the fact that acute acalculous cholecystitis is not uncommon in dengue fever. Raised transaminases are good indicators for further investigation and to find out the prognosis and management of acute acalculous cholecystitis in dengue fever.
Materials and Methods: A total of 100 patients with confirmed dengue fever who were admitted to Khwaja Yunus Ali Medical College Hospital, were selected randomly for one month. Among them, 44 patients had undergone for ultrasound of the whole abdomen because of nausea, vomiting, abdominal pain and raised transaminases.
Results: Acute acalculous cholecystitis was detected in 20 patients (20%) with confirmed dengue fever. These patients with acute acalculous cholecystitis were treated conservatively and they recovered completely without any surgical intervention.
Conclusion: In dengue fever unlike acute pancreatitis or encephalitis, acute acalculous cholecystitis is not uncommon and it is self-limiting and resolved by conservative management.

KYAMC Journal Volume: 14, No: 04, January 2024: 190-193.

Calcium Imbalance and Hypothyroidism: Exploring the Relationship

2023-11-25T04:43:22+00:00

Background: The thyroid gland synthesizes mainly two hormones, triiodothyronine (T3) and thyroxin (T4) which are important to maintain various functions especially metabolic, mineral and thermogenic homeostasis in body. The disorders of thyroid function especially hypothyroidism is important it can cause of disturbance in calcium metabolism by their direct action on bone turnover.
Objective: This study was designed to assess the role of hypothyroidism in serum calcium levels.
Materials and Methods: This case-control study was done in the Laboratory Service Department, Khwaja Yunus Ali Medical College and Hospital, Enayetpur, Sirajganj from February 2023 to June 2023. A total of 45 subjects of hypothyroidism of both sexes were selected for the purpose. Data were collected in and analysis was done by IBM SPSS Statistics for Windows, version 23.0 (IBM Corp., Armonk, N.Y., USA) software. The categorical variables were represented as percentages and measurable variables as mean ± SD. Pearson’s correlation test was used to observe the correlation of calcium level with other variables. P value ≤ 0.05 was considered to be statistically significant.
Results: There is a significant positive correlation of serum T3 & T4 with serum calcium in hypothyroid patients. The r value is +0.73(p value = 0.02). (r value + 0.78and p value < 0.05) respectively. There is strong negative correlation between TSH and serum calcium levels in hypothyroid patients (r value -0.58 and p value0.03).
Conclusion: This study result shows, serum calcium levels significantly decrease in hypothyroid patients. Therefore, it is important to check the level of calcium in thyroid disorders. If necessary, the supplementation of mineral should be given in order to prevent further bone complication.

KYAMC Journal Volume: 14, No: 04, January 2024: 194-197.

Impairment of Renal Function in Perinatal Asphyxia with Hypoxic Ischemic Encephalopathy in Term Neonates

2023-10-28T03:46:01+00:00

Background: Perinatal asphyxia is a major cause of neonatal morbidity and mortality worldwide including in Bangladesh. It causes damage to almost every tissue and organ of the body. In kidneys, renal insufficiency may occur promptly even within 24 hours of asphyxia. So, renal function assessment is essential for accurate management of metabolic derangement in neonates as prolonged hypoxic ischemic episode can lead to irreversible cortical necrosis with onset of acute renal failure.
Objectives: To find out renal impairment and to measure serum creatinine, serum electrolyte and eGFR, Also to compare biochemical parameters level and determine the frequency of AKI among the asphyxiated neonates with HIE.
Materials and Methods: This cross-sectional study was conducted in the neonatal care unit of Sir Salimullah Medical College Mitford Hospital, Dhaka. A total of 70 term neonates suffered from perinatal asphyxia with different stages of Hypoxic ischaemic encephalopathy. A ‘p’ value <0.05 was considered as statistically significant.
Results: Among 70 term neonates having HIE, it was observed that 62.9% neonates had moderate birth asphyxia followed by mild (28.6%) and severe (8.6%). Newborns with SGA (71.4%) had more renal impairment than AGA. Among biochemical variables Blood urea and serum creatinine were high and eGFR was low in stage Π. Among electrolytes, hyponatremia was present in 24.3% of cases and more in stage Π, and hyperkalemia was present in 21.4% of cases and more in stage Ш. AKI was found in 18.6% of cases, Risk (stage 1) was 77%, Injury (stage Π) was 15.3% and Failure (stage 3) was 7.7 %.
Conclusion: Renal impairment was found in 18.5% of term asphyxiated neonates with HIE according to pRIFLE and AKIN criteria and Biochemical parameters showed no significant changes between different stages of HIE.

KYAMC Journal Volume: 14, No: 04, January 2024: 198-205.

Psychiatric Co-morbidity with Obsessive Compulsive Disorder

2023-10-05T07:16:08+00:00

Background: Obsessive-compulsive disorder is a chronic psychiatric disorder. It is associated with substantial psychiatric comorbidity. Major Depressive disorder & mixed anxiety and depressive disorder are the most common psychiatric co-morbidities.
Objective: To evaluate the psychiatric co-morbidity with obsessive-compulsive disorder.
Materials and Methods: It was a descriptive and cross-sectional clinical study. It was conducted in the Outpatient Department of Psychiatry, Khwaja Yunus Ali Medical College, Sirajganj from January 2021 to December 2022. Total 100 patients were taken. All the selected patients were interviewed in detail by using ICD-10. Analysis was done according to the Statistical Package for Social Science (SPSS) for windows version 25.
Results: This study shows obsessive compulsive disorder is more common in young to middle age (21 to 40 years) and mean age of onset of illness was 28.31±10.21 years. Maximum (57%) were female and 43% were male. Depressive disorder, mixed anxiety and depressive disorder were most common psychiatric comorbidity (63% and 22%) in patient with OCD followed by panic disorder in 7% patients, social phobia in 5% patients, generalized anxiety disorder in 5% patients, substance abuse in 5% patients, schizophrenia in 5% patients, bipolar affective disorder in 2% patients and tic disorder in 1% patients.
Conclusion: This study demonstrates a high prevalence of psychiatric comorbidities in individuals diagnosed with OCD. The most prevalent co-occurring disorders are depressive disorder & mixed anxiety and depressive disorder.

KYAMC Journal Volume: 14, No: 04, January 2024: 206-209.

Socio-Demographic Profile of Suicidal Death at Manikganj District, Bangladesh: A One Year Autopsy Based Study

2023-10-01T05:21:15+00:00

Background: Suicide is one of the leading causes of death in many countries and also a major public health concern. When a person dies by suicide the effects are felt by Family, Friends, and communities. The number of suicidal deaths is increasing worldwide day by day and Bangladesh is also facing this situation alarmingly.
Objective: To evaluate the Socio-demographic profile of suicidal deaths.
Materials and Methods: This cross-sectional study was carried out at Manikganj sadar hospital mortuary, from January 2019 to December 2019.Total 133 suicidal death cases were collected by using a pre-designed format from mortuary register book. The inquest report provided comprehensive information about the deceased. Postmortem examinations documented the method of suspension used and in cases of poisoning, chemical analysis was conducted to determine the type of poison.
Results: During this study majority of the deceased were Female (50.38%). The age distribution of the deceased from 01 year to above 51 years, the highest occurrence observed in the age group 11-20 years (33.08%). Most of the deceased were House wife (40.00%). Majority of deceased were Muslims (88.72%). Total 30.08% cases were reported under Manikganj sadar Thana. The most prevalent technique observed for suicide were by Hanging (65.41%) and common consumption of poison is Organo-phosphorous compound (OPC) (65%).
Conclusion: The collected data has the potential to facilitate the identification of individuals who are at an elevated risk of engaging in suicidal behaviors. Moreover, this information can be effectively used to support individuals through the implementation of a comprehensive nationwide suicide prevention initiative that adopts a collaborative and interdisciplinary approach.

KYAMC Journal Volume: 14, No: 04, January 2024: 210-214.

The Partograph: A Practical Guide for Preventing Prolonged Labour

2024-05-11T05:56:56+00:00

Background: The partograph, a graphic recording of labour and features in the mother and foetus has been used since 1970 to detect labour that is not progressing normally. The partograph serves early warning system and assist in early decision of transfer, augmentation and termination of labour. It also increases the quality and regularity of observing mother and foetus in labour.
Objectives: The study aimed to evaluate effect of using partograph on the management and outcome of labour.
Materials and Methods: It was a prospective cross-sectional observational study conducted in the Department of Obstetrics and Gynaecology at Sher-E-Bangla Medical College Hospital, Barishal; Bangladesh over one (1) year from January 2017 to December 2017. A total 280 patients were enrolled in this study. Plotting on the partograph was started at cervical dilation of 4 cm on alert line.
Results: The mean age of the participants was 23.4 ±4 years and mean gestational age was 38.3 ±1.74 weeks and 45% were primigravida. The mean Apgar score of the newborn after 5 minutes was 9.3 ±0.7. The mean duration for delivery on active labour was 4.3 ±2.5 hours in primigravida and 3.4 ±2.3 hours in multipara.
Conclusion: The proper use of partographs and the application of the right decision at the right time can be achieved the best for maternal and neonatal outcomes.

KYAMC Journal Volume: 14, No: 04, January 2024: 215-219.

Clinical Profile and Treatment Outcome of Endogenous Endophthalmitis

2024-04-23T06:04:31+00:00

Background: Endogenous Endophthalmitis is a sight threatening intraocular infection resulting from hematogenous spread of pathogens from distant foci.
Objective: To find out the source, risk factors, microbiological profile, visual and anatomical outcome of management of Endogenous endophthalmitis.
Materials and Methods: A retrospective study was done from medical records of diagnosed case of Endogenous Endophthalmitis at Vision Eye Hospital, Dhaka. Data collection was done on demographic factors, medical and surgical history, infectious data, BCVA throughout the clinical course and complications. Visual outcome and anatomical outcome were measured and compared.
Results: 20 Eyes of 18 patients were diagnosed as Endogenous Endophthalmitis where 88.9% were unilateral and 11.1% were bilateral. Known foci of infection were found in 27.8% of cases and infective foci were not found on 33.3%. 44.4% were culture positive where the commonest organism was Pseudomonas followed by Klebsiella. 70% patients were treated by PPV and 30% were treated conservatively. Among 18 patients 6 had normal eyeball, 7 had formed eyeball, 3 developed phthisis bulbi and 1 needed enucleation. Finally, VA improved at 44.4% patients, remain unchanged at 22.2% patients and deteriorated at 33.3% patients.
Conclusion: The prognosis of endogenous endophthalmitis is often poor despite treatment. A high index of suspicion, early diagnosis and prompt treatment are crucial to salvage vision and eye.

KYAMC Journal Volume: 14, No: 04, January 2024: 220-225.

Endoscopic Sinus Surgery in the Management of Inflammatory Sinonasal Disease

2023-07-22T01:57:18+00:00

Background: Inflammation of the nose and paranasal sinus is a clinical problem frequently encountered in the practice of otolaryngology in our country. Endoscopic sinus surgery is a minimally invasive technique for the evaluation and treatment of inflammatory sinonasal disease. Endoscopic sinus surgery is used to restore sinus ventilation and normal function of sinuses.
Objectives: To see the outcome of endoscopic sinus surgery associated with inflammatory sinonasal diseases.
Materials and Methods: It is a prospective observational study carried out in ENT &Head Neck Surgery of Shaheed Suhrawardy Medical College Hospital Dhaka from April 2016 to September 2016.Fifty(50) patients were enrolled in this study. Data was collected by Structural Questionnaire.
Result: The majority of patients were 21-30years age group. The mean age group was 35.32 years, Male: male-to-female ratio was 1.3:1. The Majority of cases were antrochoanal polyps followed by an ethmoidal polyp, chronic maxillary sinusitis, and fungal rhinosinusitis. The majority of patients came with nasal obstruction and nasal discharge. Polyp was found in the majority of cases. A major complication was found in hemorrhage. Symptomatic improvement was found following endoscopic sinus surgery.

KYAMC Journal Volume: 14, No: 04, January 2024: 226-233.

Assessment of Factors and Level of Patient Satisfaction in Out-patient Department of a Private Hospital

2023-12-26T05:05:04+00:00

Background: Measurement of patient satisfaction in the outpatient department (OPD) of a hospital can be used to evaluate and redesign the process of caregiving and to improve the quality of services. Sometimes study findings depend on the setting.
Objectives: a) To identify the factors associated with the patient's experience, and satisfaction about health care services of Out-patient department(OPD) of Khwaja Yunus Ali Medical College Hospital receives multidisciplinary health services. b) To measure the satisfaction level regarding doctors, health assistance, and other auxiliary staff working in OPD to help patients.
Materials and Methods: A cross-sectional study was conducted among 914 patients of age ranging from 1 to 80 years selected randomly from OPD between January 2021 and May 2021. A self-designed semi-structured questionnaire was developed to assess patients' satisfaction with health care services. Statistical analysis was done by online computer software.
Results: Overall 92.23 % of the patients were satisfied with the behaviour of the doctors and 75.93 % were satisfied with the services of other staff, and the remaining 7.77% were unsatisfied with doctors' behaviour and 24 % with other staff services respectively.
Conclusions: The percentages of unsatisfied patients were deficient. Various deficiencies should always be covered by the hospital administration that will turn into a good result of improvement in the hospital services for more satisfaction of the patients.

KYAMC Journal Volume: 14, No: 04, January 2024: 234-239.

Colorectal and Anorectal Foreign Bodies

2024-05-09T05:36:08+00:00

Foreign bodies (FBs) in the colon, rectum and anal canal are not unusual. Colorectal Foreign Bodies (CRFBs), whether administered per-anally or swallowed orally, intentionally or unintentionally, bring management challenges to the attending physicians and surgeons. CRFBs are usually seen in the adult patients with perverted sexual or erotic or psychosis, or mental retardation, or in drug smugglers or prisoners, and anorectal FBs (ARFBs) are sometimes seen on accidental or careless swallowing with or without food, or per-anal administration in all age groups. Careless elderly patients with or without visual problems, with or without using artificial dentures are also not unusual victims. Self-administration per-anally to attempt relief from constipation has also been described, especially in adults and elderly people. Many of these FBs can pass with intestinal contents and may be thus removed with stool without complications. The sharp FBs can penetrate the bowel wall leading to serious consequences, and a relatively large FB can get impacted causing bowel obstruction. The presentation may be straightforward and sometimes may be exquisitely concealing. The objective of this review article is to understand and share the management strategies which would be very much helpful to all concerned.

KYAMC Journal Volume: 14, No: 04, January 2024: 240-245.

Artificial Intelligence Used in Medical Education and Service

2024-04-16T07:45:35+00:00

Abstract not available

KYAMC Journal Volume: 14, No: 04, January 2024: 188-189.

A Case Report on Heart Failure in Dengue Patients with Concurrent Capillary Leakage Syndrome: Unveiling a “Leakage-Failure” Co-existence

2023-12-19T02:18:36+00:00

This case report describes a rare and compelling presentation of Massive Tubercular Pericardial Effusion (MTPE) concomitant with Heart Failure (HF) and Diabetes Mellitus (DM). Tuberculosis, once thought to be a disease of the past, continues to manifest in diverse clinical scenarios, emphasizing the importance of maintaining a high index of suspicion, particularly in endemic regions. The patient, a 60 year old male with a known history of DM and HF, presented with symptoms of worsening dyspnea, fatigue, and peripheral edema. Diagnostic workup revealed a massive pericardial effusion with characteristics suggestive of tubercular etiology, subsequently confirmed by pericardial fluid analysis. The challenges in managing this triad of conditions: MTPE, HF, and DM were addressed through a multidisciplinary approach involving cardiology, infectious disease, and endocrinology specialists. This case underscores the significance of a comprehensive diagnostic evaluation and collaborative management in optimizing outcomes for patients with complex cardiovascular and infectious comorbidities.

KYAMC Journal Volume: 14, No: 04, January 2024: 246-248.