KYAMC Journal

Haemolytic Disease of the Newborn

Mohammed Mejbahuddin Mia — 2023-07-16

Background: Immune-mediated haemolytic disease of the newborn refers to a specific category of haemolytic anaemia that results from transplacental passage of IgG antibodies from a pre-sensitized mother to her fetus in utero. This occurs due to blood group incompatibility between the mother and the fetus. The clinical presentation covers a wide spectrum spanning from still births and erythroblastosis fetalis as well as infants born with only mild haemolysis to those having severe anaemia snd severe indirect hyperbilirubinaemia followed by hydrops.
Objective: We describe the journey of a Rh-D negative mother who endured through six pregnancies in order to have a healthy baby.
Conclusion: To highlight the importance of blood grouping and Rh typing during the first antenatal visit and subsequent monitoring of antibody titers, especially in a mother who is Rh-D negative.

KYAMC Journal Vol. 14, No. 01, April 2023: 54-56

Gallbladder Paraganglioma- A Rare Case Report

Halima Khatun Doly — 2023-07-16

A 34-years-old married middle-class housewife without diabetes, hypertension or betel-nut- chewing hailing from Manikganj, Dhaka; came with the outside diagnosis as neuroendocrine tumor of the gallbladder to the Oncology Department of Khwaja Yunus Ali Medical College and Hospital (KYAMCH). She was admitted in the hospital with complaints of upper abdominal pain, abdominal bloating, weakness, anorexia, nausea and heartburn while taking fatty food. According to her Ultrasonography (USG) of the abdomen, a soft tissue mass was found in the gallbladder with unremarkable routine blood examination including tumor markers. She underwent open cholecystectomy with the suspicion of cancer. Grossly, gallbladder was measures 7.0x 5.0 cm with 0.3 cm wall thickness and on opening a polypoid nodule is found. Before treatment on request from the Oncology Department of KYAMCH, all slides were reviewed and a histopathological diagnosis of paraganglioma was made on the basis of organoid, nested or lobules (Zellballen pattern) of tumor cells in the lamina propria surrounded by a prominent fibrovascular stroma. Atypical mitoses, tumor necrosis, lymphovascular or perineural invasion was not found. The IHC reveals diffuse and strong positive reactions to NSE and CD56 for chief cells and strong positive reaction to S-100 protein for sustentacular cells. The epithelial tumor was ruled out by CK negative reaction. Therefore, the diagnosis of paraganglioma of the gallbladder was established. Because of the positive reaction to sustentacular cells, the neuroendocrine tumor has been excluded. To our knowledge, this type of case has not been reported in our country. On clinical follow-up the patient was found healthy.

KYAMC Journal Vol. 14, No. 01, April 2023: 57-61

Vibrio fluvialis: An Emerging Pathogen for Intestinal and Extraintestinal Infections

Quazi Manjurul Haque — 2023-07-16

The genus Vibrio is a ubiquitous group of bacteria belonging in the family Vibrionaceae. More than 100 species have been discovered in the genus Vibrio and about 14 of them have been reported to cause several human infections. Vibrio fluvialis, a member of this group is widely distributed in the aquatic environment, mostly in the seas, brackish waters and coastal zones.1 V. fluvialis is a pathogenic bacterium more commonly found in coastal areas. It causes diarrhea and enterocolitis and a significant number of extra intestinal infections. Due to increasing number of infections, it is considered as an emerging pathogen.1 Though this pathogen can be easily isolated by conventional staining and culture methods along with the biochemical properties, its identification is considered as a challenging problem due to its close phenotypic similarity of this species either with other vibrios and Aeromonas spp. By using automated BD Phoenix M50 techniques, it has become easier to identify V. fluvialis from clinical and different environmental samples. In this system biochemical properties of different 45 substrates are used to observe their fermentation reactions. Automated identification and antimicrobial susceptibility test systems are essential for modern clinical microbiology laboratories for rapid identification and proper selection of effective antibiotics. Several virulence factors of V. fluvialis have been identified.2 The rule and mechanisms of action of these virulent factors causing pathogenesis and infection are yet to be clarified. In this review article, the epidemiology, identification, pathogenicity, intra- and extra-intestinal clinical features and management of V. fluvialis infections have been focused.

KYAMC Journal Vol. 14, No. 01, April 2023: 48-53

Human Health Benefits From Probiotics

A B M Moniruddin — 2023-07-16

Abstract not available
KYAMC Journal Vol. 14, No. 01, April 2023: 01-03

Frequency of Helicobacter Pylori Infection in Children presented with Recurrent Abdominal Pain in Northern part of Bangladesh

Uzzal Kumar Ghosh — 2023-07-16

Background: Abdominal pain is one of the common symptoms in hospital attended children. Recurrent abdominal pain also is a challenge to diagnosis. Although the most common etiology of recurrent abdominal pain is functional, organic treatable cause exclusion is justified. Peptic ulcer disease is one of the causes of recurrent abdominal pain; whereas association of Helicobacter Pylori is not so uncommon.
Objective: To find out the frequency of H Pylori infection in children presented with recurrent abdominal pain.
Materials and methods: A cross sectional was study done in Khwaja Yunus Ali Medical College located in northern part of Bangladesh. One hundred eight recurrent abdominal pain (RAP) cases were included in our study. Along with the other investigations ICT for H Pylori was sent to find out the etiology of recurrent abdominal pain in children attending in outpatient and inpatient department of pediatrics. RAP were our study population (N). H Pylori positive & H Pylori negative test results were included in data sheet. Demographic characteristics were noted among the H pylori positive cases (n) including age, sex and socioeconomic condition. Data were analyzed in Microsoft Excel.
Results: Among the 108 RAP cases H Pylori infection were found 37(34.25%) by diagnostic test ICT for H. pylori. Out of 37(34.26%) H pylori positive children 21(56.76%) were male 16(43.24%) were female. Children aged 7 to 9 year constituted 6(16.21%), 10 to12 year 12(32.43%), 13 to 15 year 19(51.36%). Twenty six (70.27%) belonged to rural area and 11 (29.73%) belonged to urban area. Low income family 28(75.68%), medium income family 5(13.51%) and high income family were found 4(10.81%).
Conclusion: About thirty five percent H Pylori infection are found in children presented with recurrent abdominal pain in northern part of Bangladesh among the seven to fifteen year child.

KYAMC Journal Vol. 14, No. 01, April 2023: 04-06

Outcome of Febrile Neutropenia in Children with Cancer: Experience from a Tertiary Health Care Center

Md Imrul Kaes — 2023-07-16

Background: Febrile neutropenia (FN) is a serious event in children with cancer; associated with various complications and mentionable adverse outcome.
Objective: To identify the outcome of febrile neutropenia in children with cancer.
Materials and methods: This prospective observational study was conducted from October 2017 to November 2018 in the Department of Pediatric Hematology and Oncology, BSMMU. Children (age<18years) with malignancy who were admitted with febrile neutropenia or admitted patients who had developed febrile neutropenia onward were enrolled in this study. Finally, the outcome of each episode of FN was analyzed.
Results: Total of 61 patients with 68 febrile neutropenic episodes were studied. Male patients were 62.29% and female patients were 37.70% with a mean age of 7 years. Majority were ALL (50.8%) followed by AML (29.5%), NHL (11.4 %) and solid tumor (8.1%). Bacterial infection was confirmed by culture in 14.7% episodes, 11.7% episodes had positive blood culture. Most of the isolated organisms were gram-negative (90%). Cough (39.7%), bleeding (19%) and diarrhea (17.64%) were the common clinical manifestations in those febrile neutropenic episodes. The mean duration of neutropenia was 9 days, 55.88% of episodes had prolonged neutropenia. Profound neutropenia was recorded in 47 % episodes and significantly associated with adverse outcome. Age ≥10 years also significantly associated with adverse outcome. The treatment success rate was achieved in76.4 % of episodes. A composite adverse event was observed in 23.52% of episodes; with mortality in 11.76%.
Conclusion: Febrile neutropenia was a common complication in hematological malignancy. Although 76.4% episodes of febrile neutropenia had been treated successfully, mortality was significantly higher 11.76%. Profound neutropenia and age ≥10 were significant risk factors for dreadful outcome.

KYAMC Journal Vol. 14, No. 01, April 2023: 07-10

Musculoskeletal Disorders among Traditional Bangladeshi Fishermen

Mohammed Emran — 2023-07-16

Background: Fishing is one of the most important economic activities in riverine Bangladesh. We studied musculoskeletal disorders (MSDs) among Bangladeshi fishermen which is generally high.
Objective: To study patterns and extend of MSDs among Bangladeshi fishermen.
Materials and Methods: A total 150 fishermen enrolled with at least six months employment history attended at out-patient department of Physical Medicine and Rehabilitation of Khwaja Yunus Ali Medical College and Hospital of Sirajganj district, Bangladesh, in this cross-sectional study using a random sampling procedure. The Nordic Questionnaire was used to assess work-related musculoskeletal disorders. To determine the significance of age, BMI and working experience with pain and discomfort in different regions of the body, Pearson Correlation test was done.
Results: Musculoskeletal disorder among fishermen due to extreme physical demand during the hauling of fishing nets on the raft in Jamuna River and its tributaries with the prevalence significantly higher. All body region were affected by musculoskeletal problems, among them the highest prevalence found in lower back and lowest in upper back (37.3%) region. There were significant associations of age with wrist pain (P=0.039), lower back pain (0.025) and knee pain (0.021). There was no significant association of BMI with any pain or discomfort. Total working experience of fishermen had significant association with pain or discomfort within last 12 months in shoulder (p=0.008), wrist (0.023), lower back (0.022) and knee (0.001).
Conclusion: Long hours of fishing in a traditional fishing boat with age-old equipments adopting inconvenient ergonomic posture can lead high prevalence of musculoskeletal problems among fishermen.

KYAMC Journal Vol. 14, No. 01, April 2023: 11-15

Clinical Patterns of Oral Squamous Cell Carcinoma Patients Attending the Department of Oral and Maxillofacial Surgery of Rajshahi Medical College Hospital

Md Abdul Hakim — 2023-07-16

Background: Oral cancer is one of the most prevalent cancers and a significant public health issue. Squamous cell carcinoma of
the mouth is thought to account for more than 90% of all cases of oral cancer.
Objectives: This study set out to gather baseline information on the prevalence of squamous cell carcinoma of the mouth (SCC) in
Bangladesh.
Materials and Methods: This study was cross-sectional in nature. The Rajshahi Medical College Hospital's Department of Oral and Maxillofacial Surgery assessed patients with oral squamous cell carcinoma from January 2019 to December 2021. The required information on age, sex, and residency ware retrieved from all registries when they had all been gathered. Clinical evaluation and pre-diagnosis were performed on each patient. Tissues were preserved in 10% buffered formalin after being removed from lesions and submitted for histological confirmation.
Results: Squamous cell carcinoma was found in 52.17 % of men and 47.83 % of women. The 41–50 age range has the highest percentage, which is 39.13%. Oral, buccal mucosa (39.13%) was the initial location of oral squamous cell carcinoma incidence.
Conclusion: Most cases of SCC, which account for the bulk of oral malignancies, occur in older people. It is important to take prevention and early detection seriously.

KYAMC Journal Vol. 14, No. 01, April 2023: 16-18

Risk Factors for the Musculoskeletal Pain Based on the Computer Ergonomics Related Practices among Medical Professionals

Abu Saleh Mohammad Mainul Hasan — 2023-07-16

Background: With The fast growing world, in Bangladesh also getting increased usage of digital connectivity has led to a rise in online activities and also rise in the musculoskeletal (MSK) pain among the professionals.
Objective: We investigating the relationship between MSK pain and discomfort among resident doctors because of computer ergonomics related issues.
Materials and Methods: The study collected computer ergonomics related information from 227 resident doctors who had used computer for at least one year. Along with descriptive statistical tools, this study addressed essential test of hypothesis and administered a binary logistic regression model to identify the risk factors of MSK pain among resident doctors.
Results: The prevalence of neck pain and lower back pain was estimated over 50% whereas more than one-third faced pain in one or both eyes as well as in their upper back. The different sorts of ergonomics significantly associated with different types of MSK pain. The faculty type- taking break, awkward posture, the shoulder placement had significant impact on the pain in one or both eyes. Besides, having gap between leg and seat as well as monitor placement were the significant predictor of neck pain. In addition, wrist not straightening was not the only risk factor for lower back pain and faculty type, device type, gap between legs and seat, Not having an armrest were the risk factors for upper back pain.
Conclusion: The computer ergonomics related practices are the fundamental codes for the medical professionals to avoid MSK pain and hence specific practice safeguards for specific pains.

KYAMC Journal Vol. 14, No. 01, April 2023: 19-24

Effects of Physical Exercise on Urinary Albumin-Creatinine Ratio and Blood Pressure in Type 2 Diabetic Male with Microalbuminuria

Mahaboba Rahman — 2023-07-16

Background: Microalbuminuria is a microvascular complication of diabetes mellitus. Physical exercise has effects on urinary
albumin-creatinine ratio and blood pressure in type 2 diabetic male with microalbuminuria.
Objective: To assess the effects of physical exercise on urinary albumin-creatinine ratio and blood pressure in type 2 diabetic male with microalbuminuria.
Materials and Methods: This prospective interventional study was carried out in the Department of Physiology, Sir Salimullah Medical College (SSMC), Dhaka between 1st July 2015 and 30th June 2016. Total thirty (30) type 2 diabetic male with newly diagnosed microalbuminuria (urinary albumin-creatinine ratio 30-299 mg/g), age ranged from 45 to 60 years were selected by purposive consecutive sampling from Out Patient Department of Endocrinology, Sir Salimullah Medical College and Mitford Hospital, Dhaka. Previously prescribed oral hypoglycemic and antihypertensive drugs were maintained, and the participants were instructed not to change their diet habits during the study period. All the participants were asked to perform moderate aerobic physical exercise, consisting of 30-40 minutes walking/day, 5 days/week, at an intensity of 50-70% of maximum heart rate (HRmax) for a total duration of 90 days. All the subjects were studied two times: before performing physical exercise i.e. on day-1 (Phase A) and after performing physical exercise for 90 days i.e. on day-91 (Phase B). Urinary creatinine level was estimated by fix time kinetic method and urinary albumin level was estimated by immunometric assay method. Urinary albumin-creatinine ratio was measured by calculation. Moreover, blood pressure was also measured. For statistical analysis, paired sample “t” test was performed.
Results: In this study, urinary albumin-creatinine ratio, systolic and diastolic blood pressure were significantly (p<0.001) decreased in type 2 diabetic male with microalbuminuria after performing physical exercise for 90 days in comparison to those of their pre exercise values.
Conclusion: From this study it may be concluded that, physical exercise significantly decreased urinary albumin-creatinine ratio, systolic and diastolic blood pressure in type 2 diabetic male with microalbuminuria.

KYAMC Journal Vol. 14, No. 01, April 2023: 25-29

The Pregnancy Outcome in Women with Polycystic Ovary Syndrome

Most Nasrin Nigger — 2023-07-16

Background: In women of reproductive age, polycystic ovarian syndrome (PCOS) is a prevalent endocrine condition. Menstrual irregularities (oligomenorrhea or amenorrhea), hirsutism, persistent acne, androgen-dependent alopecia, abdominal obesity, hypertension, and infertility are all clinical signs of PCOS.
Objective: To assess the success of pregnancy in patients with polycystic ovary syndrome.
Materials and Methods: This observational cross-sectional study was carried out in the Department of Obstetrics and Gynaecology at Khwaja Yunus Ali Medical College and Hospital, Enayetpur, Sirajganj, Bangladesh from June 2020 to May 2022 for a period of two years. Women diagnosed with PCOS were willing to participate in our study were recruited from obstetrics Out patient Department (OPD) and antenatal ward of Department of Obstetrics and Gynaecology at Khwaja Yunus Ali Medical College and Hospital. After obtaining an informed consent from them, a detailed interview schedule containing socio- demographic details, menstrual/marital/ obstetric/past/personal/ family history was taken.
Results: Concerning complications Preeclampsia was found in 5 (9.1%) of the PCOS patients but not in the non-PCOS patients. The differences in gestational age and mode of birth between the two groups were not statistically significant (p>0.05). Perinatal outcome: 21 (39.6%) PCOS patients were admitted to the Neonatal Intensive Care Unit (NICU), compared to 11 (20.0%) non-PCOS patients. Which of the two groups was statistically significant (p<0.05).
Conclusion: The present study suggested that preeclampsia is a relatively common condition, and complications such gestational hyperglycemia, gestational hypertension, and preeclampsia were frequent in the PCOS group. In comparison to the non-PCOS group, the PCOS group had considerably greater rates of low birth weight and NICU admission.

KYAMC Journal Vol. 14, No. 01, April 2023: 30-34

Antithyroid antibody (TPO-Ab) Status in Type 2 Diabetic Patients

Kamrunnahar Alo — 2023-07-16

Background: Presence of thyroid peroxidase antibody (TPO-Ab) in type 2 diabetic patients is a risk factor for future development of thyroid dysfunction.
Objective: To observe thyroid antibody status in type 2 diabetic patients.
Materials & Methods: This cross sectional study was carried out in the Department of Physiology, Sir Salimullah Medical College, Dhaka from July 2016 to June 2017. Total 60 subjects including male and female, age ranged from 40 to 60 years were included in this study, among them 30 were non-diabetic subjects and 30 were type 2 diabetic patients.
Results: In this study, mean serum TPO-Ab level was significantly (<0.01) higher in diabetic subjects in comparison to that of apparently healthy non-diabetic subjects and mean serum TPO-Ab level was higher in uncontrolled diabetic subjects in comparison to that of controlled diabetic subjects but the difference is not statistically significant. However, On the other hand, among the diabetic patients 6.67% had positive TPO-Ab whereas, among the uncontrolled diabetic patients 11.76% had positive TPO-Ab. There was no correlation between TPO-Ab and HbA_1c.
Conclusion: The present study reveals that TPO-Ab may present in type 2 diabetic patients.

KYAMC Journal Vol. 14, No. 01, April 2023: 35-38

Study of Fetal Outcome in Preeclampsia and Eclampsia Syndrome

Farhana Rahman — 2023-07-16

Background: Preeclampsia and eclampsia syndrome is one of the commonest medical disorders of females. The neonatal outcome is different from the normal pregnancy due to this disorder. It includes- stillbirth, low birth weight, asphyxia, and prematurity.
Objective: The objective of the study was to determine the fetal outcomes in different groups of preeclampsia and eclampsia
syndrome.
Materials and Methods: This cross-sectional observational study was conducted in the Department of Pathology, (BIRDEM) General Hospital, Dhaka, from July 2019 to June 2021. The study comprised 138 clinically diagnosed preeclampsia and eclampsia syndrome cases from the Department of Gynecology & Obstetric of BIRDEM and DMCH. Out of 138 cases, there were 42 cases of mild preeclampsia (mild PE), 62 were of severe preeclampsia (severe PE), and 33 were eclampsia. Relevant data and pregnancy outcome (neonatal birth weight, maturity, Apgar score, and stillbirth), were observed and recorded in a predesigned data collection sheet and statistical analyses were carried out. Ethical practice was ensured in every step of the study.
Results: Among 138 cases, the mean birth weight was (2.12±0.57) kg, which was observed in the mild preeclamptic group, and the mean birth weight was (1.52±0.47) kg found in the eclamptic group. A low Apgar score (score˂7) was mainly observed in the severe PE (77.8%) followed by (84.8%) in eclampsia group. More than half of the cases were revealed stillbirth (54.4%) as the neonatal outcome in eclampsia group. A statistically significant difference was found among three groups regarding pregnancy outcome (neonatal birth weight, maturity, stillbirth, etc.).
Conclusion: Majority of the fetal complications were related to the severity and duration of the preeclampsia and eclampsia syndrome.

KYAMC Journal Vol. 14, No. 01, April 2023: 39-42

Demographic Diseases Pattern in the ENT and Head and Neck Surgery Outpatient Department of A Tertiary Care Hospital

Abdus Salam — 2023-07-16

Background: The distribution of diseases in society varies across communities and geographical places. Diseases of the ear, nose, and throat (ENT) pose severe public health issues in both rural and urban populations.
Objective: To determine the demographic disease pattern in the ENT and Head and Neck Surgery (HNS) Out Patient Department
(OPD).
Materials and Methods: This retrospective study is based on patient’s medical records who attended the Out Patient Department of Otorhinolaryngology, Khwaja Yunus Ali Medical College and Hospital (KYAMCH). The study records covered 2312 patients who visited the Out Patient Department from September 2019 to August 2020 were included in this study.
Results: Study of patients in light of their diagnoses of chronic tonsillitis in 367 (15.87%), followed by chronic pharyngitis affected 347 (15.01%) patients, allergic rhinitis in 135 (5.74%), acute/chronic adenotonsillitis with otitis media with effusion in 133 (5.75%), and otitis externa in 123 (5.32%) individuals. In a broad heading, if the tonsils are mainly affected, it’s called tonsillitis; if the throat is mainly affected, it’s called pharyngitis.
Conclusion: High prevalence of chronic tonsillitis and pharyngitis among ENT illnesses. The most prevalent ENT conditions include chronic suppurative otitis media (CSOM/COM) 11.63%, allergic rhinitis, acute and chronic adenotonsillitis, otitis media with effusion (OME), otitis externa and acute tonsillitis.

KYAMC Journal Vol. 14, No. 01, April 2023: 43-47