KYAMC Journal

Dangers of Xenobiotics To Health and Ecosystem

A B M Moniruddin — 2023-03-30

Abstract not available

KYAMC Journal Vol. 13, No. 04, January 2023: 189-191

Idiopathic Granulomatous Mastitis: A Management Dilemma

ABM Moniruddin — 2023-03-30

Idiopathic Granulomatous Mastitis (IGM), or Granulomatous Lobular Mastitis (GLM) or simply GM (Granulomatous Mastitis) is a benign chronic and sometimes recurrent inflammatory process of unknown etiology, involving one or both breasts, commonly in women of childbearing age. In has no definite diagnostic hallmark or marker. It is to be diagnosed by exclusion of all other diseases. Biopsy is mandatory. A challenge is there to differentiate IGM from other diseases including malignancy, tuberculosis and other granulomatous reactions, It has no specific curative treatment. Breastfeeding from the IGM breast is safe, if not on immunosuppressive or steroid treatment. It has long been classically treated with oral steroids with or without such other immunomodulators as methotrexate, azathioprine etc. Recently, intralesional triamcinolone injection has been shown to improve the symptoms. But local high concentration intralesional triamcinolone, systemic immunosuppressive agents are unsafe for breastfed babies. If a woman chooses systemic treatment, after Shared Decision Making (SDM), she should be cautioned about milk suppression and untoward effects both in mother and baby. Some women prefer no medication during lactation. Complicated cases or failure of conservative treatment calls for surgical treatment in the form of local wide resection or mastectomy etc. The patients may suffer physically, mentally, and economically, significantly lowering the quality of life. There is no consensus on its management strategies. Its management still remains as a challenge. We like to review, discuss, and share about its masked etiology, presentations, diagnostic aids plus the available avant-garde optimum management strategies.

KYAMC Journal Vol. 13, No. 04, January 2023: 250-256

Acute Kidney Injury Is A Predictor Of Mortality In Patients Hospitalized With Covid-19

Md Maqsudur Rasul — 2023-03-30

Background: Common biomarkers used to determine the disease severity and prognosis of corona virus disease -19 (Covid-19) are well determined. Among these biomarkers only few can reliably predict disease outcome but they are not easily available and costly. So organ-specific functional status especially acute kidney injury (AKI) can be use as predictor of prognosis.
Objective: To determine the kidney disease indicator as a marker in predicting the severe disease in COVID-19 patients.
Material & Methods: We studied the health records for all purposively selected hospitalized Covid-19 patients for three months from 1st May to 31st July, 2020, at combined military hospital Dhaka, Bangladesh. Those who were more than 18 years old and hospitalized RT-PCR positive for COVID-19 patients were enrolled. Those having history of renal replacement therapy (RRT) and unwilling to participate were excluded from the study. Kidney disease significance between survivors and deceased were examined using Cox proportional hazard regression analysis. In-hospital death was ascertained by using the Kaplan-Meier method.
Results: Total 470 patients were enrolled in this study. Mean age of study population was 54.7 (± 14.3) years and male to female ratio was about 2:1. Hypertension (51.91%) and diabetes mellitus (43.19%) were the most common co morbidity. During hospital stay 106 (22.55%) patients developed AKI. Total 23 (4.89%) patients were died of the total study population. Among them 19 (82.60%) had AKI. Mortality rate was significantly (P value<.001) higher among patients who developed AKI than those who did not (82.60 % vs 17.40%).
Conclusion: Monitoring functional status of kidney should be given due importance to all Covid-19 patients even with mild disease. Early diagnosis and appropriate treatment of kidney injury and avoidance of nephrotoxic medications may help to reduce mortality and improve prognosis of COVID-19.

KYAMC Journal Vol. 13, No. 04, January 2023: 192-197

Bangla Version of Lymphedema Life Impact Scale Version 2: Reliability and Validity

Mohammed Emran — 2023-03-30

Background: The use of disease-specific scales would be more valuable for the evaluation of the effects of lymphedema. To manage accordingly, and maintain the optimum quality of life of lymphedema patient, a validated outcome measure is helpful.
Objective: To investigate the reliability and validity of Bangla Version of Lymphedema Life Impact Scale Version 2 (B-LLIS V2).
Materials and Methods: A structured process that included translation, verification, compromise assessment, reverse translation, feedback, and final correction. B-LLIS V2 reliability and validity were conducted on 52 lymphedema patients. The reliability was evaluated by performing internal consistency and test–retest analyses. Its validity was assessed by comparing the B-LLIS V2 with other scales implying Pearson’s correlation.
Results: Internal consistency with Cronbach’s alpha was 0.92 for total score and 0.79, 0.82, 0.80 and 0.78 for physical, psychosocial, functional, and infection respectively. The calculated overall tool score in Intra-class correlation co-efficient (ICC) for test-retest reliability was 0.94 and among subscales, the scores were 0.92, 0.95, 0.91 and 0.93 for physical, Psychosocial, functional, and infection respectively, which signified substantial reliability. The overall values of Pearson’s correlation coefficient for the construct validity were 0.91, 0.78 and 0.86 against reference standard Bengali SF-36 Health Survey, Bangla version of the Boston Carpal Tunnel Questionnaire and Bangla Start Back Screening Tool, and they all were statistically significant.
Conclusions: B-LLIS V2 is a valid and reliable tool for the assessment of impairment due to lymphedema.

KYAMC Journal Vol. 13, No. 04, January 2023: 198-203

Impact of Pregnancy Induced Hypertension on Babies

Sirajum Monira — 2023-03-30

Background: Pregnancy-induced hypertension (PIH) is a relatively common pregnancy disorder that causes variable maternal and fetal problems. This may increase the number of perinatal asphyxia, sepsis, still birth etc. It also has a significant affect on birth weight which is also related to gestational age.
Objectives: To observe the impact of pregnancy induced hypertension on their newborn babies and compare the findings with the babies of normotensive mother.
Materias and Methods: This case control study was conducted from July 2016 to December 2016. The study group was selected from the babies of pregnancy induced hypertension (PIH) mothers and control group selected from babies of a normotensive mother attending in Obstetrics department of Dhaka Medical College Hospital, Dhaka having the inclusion and exclusion criteria. The total number of 100 neonates were included consecutively in this study. 50 neonates born to mothers with pregnancy-induced hypertension were grouped as cases and 50 neonates born to normotensive mothers were grouped as control.
Results: The study revealed that, the highest frequency of neonatal morbidities were perinatal asphyxia (22%) among the babies of PIH mother. Stillbirth it was found 12 % . The duration of pregnancy were also affected by PIH where most of the babies were preterm (88%) and complete-term pregnancy found only (12%). It should be mentioned that those mother having history of preeclampsia delivered more premature babies (p <0.001). Another important outcome birth weight related to gestational age was also very important which were measured as the highest for SGA 92% and AGA 8%. The weight of the baby were significantly (p<0.001) reduced in those who had a history of PIH and the mean weight was 1592.78 ± 470.06.
Conclusion: Prematurity, Small for gestational-age babies and perinatal asphyxia are more common in Pregnancy induced hypertension group than in the normotensive group.

KYAMC Journal Vol. 13, No. 04, January 2023: 204-207

Spirulina platensis Attenuates Cold Allodynia and Chemical Allodynia in Streptozotocin induced Diabetic Rats

Munmun Ghosh — 2023-03-30

Background: Diabetic neuropathic pain exerts strong as well as negative influence on both survival and quality of life of the patient. This pain is difficult to treat with conventional analgesics. Now a days, different medicinal herbs are highlighted due to their wide range of beneficial application with less side effects. In this regards Spirulina platensis is well known for its wide range of biological activities.
Objective: To assess the effects of oral administration of Spirulina platensis on cold allodynia and chemical allodynia in diabetic neuropathic pain in Long Evans rats.
Materials and Methods: This study was conducted in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka from March 2017 to February 2019. Twenty four (24) Long Evans rats, having 150 to 200 grams body weight (on the basis of treatments), the rats were divided into Group I (normal saline 5 ml/kg body weight) and Group II (Spirulina platensis 400 mg/kg body weight). All the supplementations were given once daily for consecutive 21 days orally and last doses were given one hour before the pain evaluation tests. Further on the basis of experiments, previously grouped rats were divided into subgroup ‘a’(cold tail immersion test), and ‘b’ (formalin test). Data were expressed as mean±SEM and were statistically analyzed by SPSS (Version 16) using independent sample ‘t’ test to compare mean value between two groups. (p 0.05 was considered as the level of significance).
Results: Spirulina platensis showed significantly higher tail flick latency (p 0.001) in cold tail immersion test. S. platensis demonstrated significantly lowered jerking frequency (p 0.001,p 0.01,p 0.001, respectively); the duration of licking (p 0.001,p 0.05,p 0.001, respectively) and the duration of flexing (p 0.001, non-significant 0.01, respectively) in early, inter and late phases of formalin test in compared to those of control.
Conclusion: S. platensis attenuates cold allodynia and chemical allodynia diabetic neuropathic pain in rat model.

KYAMC Journal Vol. 13, No. 04, January 2023: 208-213

Assessment of Foot Ulcer and Peripheral Neuropathy in Diabetic Patients

Saiful Islam khan — 2023-03-30

Background: One of the most common complications of diabetes mellitus in lower extremity is the diabetic foot ulcer. There are numerous risk factors, among those peripheral neuropathy is the most important risk factor for diabetic foot ulceration.
Objectives: To assess the diabetic foot ulcer, probable risk factors and the relationship of diabetic foot ulcer with peripheral Neuropathy.
Materials and methods: This cross sectional study was done in the department of General Surgery, Rangpur Medical College Hospital, Rangpur, Bangladesh between May, 2015 to November 2015. 50 patients with diabetic foot ulcer were selected by purposive sampling method.
Results: In this study, 60% of patients were above 60 years of age. 82% of patients were male and 18% were female. All patients were with uncontrolled diabetes mellitus and 80% of patients had blood glucose level between 11-20 mmol/L. HbA1c level found >7 in 68% of patients. 72% patients had history of trauma. 66% of the patients were smoker. None of the patients was alcoholic. Peripheral arterial disease was present in 24% patients. 72% patients had peripheral neuropathy.
Conclusion: This study may help to raise the awareness among patients and professionals, ultimately which will help to take initiatives for early diagnosis and treatment of high risk patients.

KYAMC Journal Vol. 13, No. 04, January 2023: 214-217

Compare the Effect of Zinc–Probiotic versus Zinc Therapy in Acute Watery Diarrhea in Children

Rumy Tabrez Hyder — 2023-03-30

Background: Acute watery diarrhea still remains a major health problem among under 5 children worldwide. Apart from oral rehydration solution, continued feeding and oral zinc therapy the administration of adequate amounts of probiotics seems beneficial for acute diarrheal episodes in children in the developing world.
Objective: To compare the efficacy of zinc-probiotic combination therapy versus zinc-only therapy in children with acute watery diarrhea.
Materials and Methods: This was a hospital based randomized controlled clinical trial (RCT) conducted from July 2019 to June 2021 in the Department of Pediatrics, Khwaja Yunus Ali Medical College & Hospital. Total 70 children aged 6 months to 5 years admitted in hospital with acute watery diarrhea (AWD) with severe dehydration or some dehydration with intractable vomiting were included in this study. Patients were equally divided into 2 groups. Group A received oral zinc sulfate 20 mg/day for 10 days combined with oral Bacillus clausii probiotic 4million spores/day for 5 days. Group B received only oral zinc sulfate at the same dosage as group A. We also studied the relationship between mother`s education, knowledge of ORS preparation and child’s feeding practices and nutritional status with the occurrence of diarrhea in children.
Results: Frequency of diarrhoea was significantly higher in group B (Zinc only) in comparison to group A (Zinc and probiotic). Mean frequency of diarrhea, Mean duration of diarrhea and Mean length of hospital stay was significantly higher in group B (Zinc) than group A (Zinc+Probiotic).
Conclusion: Compared to oral Zinc therapy only; the combination of oral zinc and probiotic therapy is clinically more effective in reducing the frequency of acute watery diarrhea in under 5 years children.

KYAMC Journal Vol. 13, No. 04, January 2023: 218-222

Sleep Quality among Undergraduate Public Medical and University Students: A Comparative Study

Md Golam Abbas — 2023-03-30

Background: Sleeping is the body's natural means of recharging, which aids in repair, healing, and learning from all interactions and activities during the day. To maintain their focus, concentration, and academic performance, students need to get enough sleep at night.
Objective: To determine and compare the sleep quality of 278 undergraduate medical and university students.
Materials and Methods: This online-based cross-sectional study was conducted by using a pre-tested semi-structured questionnaire with Pittsburgh Sleep Quality Index (PSQI) scale.
Results: The mean age of medical students were 22.6±1.5 years and university students were 22.0±1.2 years. The mean study hours in a day, spending time on digital media and BMI were almost similar in both settings students. The mean PSQI scores were 7.2±3.3 in medical students and 6.4±3.3 in university students respectively. Majorities of the students (71.2% and 58.3%) had poor sleep quality, but subjective sleep quality was good in both settings of students (60.4% and 51.8%). Educational backgrounds were significantly associated with level of sleep quality, level of subjective sleep quality and mean of PSQI scores (p<0.05).
Conclusion: This study demonstrates that sleep quality is poor among public medical college students compared to university students.

KYAMC Journal Vol. 13, No. 04, January 2023: 223-228

Surgical Outcome after Downstaging in Locally Advanced Breast Carcinoma-A Clinical Study of 50 Cases

Shaikh Adnan Rakib — 2023-03-30

Background: The number of deaths related to breast cancer is increasing at an alarming pace worldwide. In Bangladesh, the incidence rate of breast cancer was about 22.5 per 100000 females. Almost everyone has a palpable lump, and 40% of them have locally advanced breast cancer. The typical treatment for patients with LABC is neoadjuvant chemotherapy followed by surgery.

Materials and Methods: From January 2018 to December 2022, 50 newly diagnosed locally advanced breast cancer (LABC) patients were enrolled in this prospective study at the Bangladesh Medical College Hospital, Dhaka; to assess the clinical and pathological response of the disease after chemotherapy and surgery. The size of the primary tumor and the size of the axillary nodes were measured and compared to the previous record. The patients had a surgery and axillary excision after three to six weeks of neoadjuvant treatment. The pathological response of the primary tumor and axillary node was examined using histopathology. Other biological markers were tested, including the estrogen receptor (ER), progesterone receptor (PR) and Human epidermal growth factor receptor (Her-2).

Results: 44 patients (88.0%) responded clinically after four cycles of neoadjuvant chemotherapy, with 7 patients (14.0%) showing complete clinical response (cCR) and 41 patients (82.0%) showing partial response (pCR). In 22 individuals, surgical specimens revealed complete pathological response (cPR) (10 percent).

Conclusions: The neoadjuvant chemotherapy schedule for locally advanced breast cancer has good surgical outcome.

KYAMC Journal Vol. 13, No. 04, January 2023: 229-233

Comparison between Effects of Fentanyl and Fenofol as Sedative in Elective Caesarean Section under Subarachnoid Anaesthesia

Md Enayet Karim — 2023-03-30

Background: Regional anaesthesia has become an important anaesthetic technique now a days. Pharmacologically induced tranquility improves acceptance of regional technique.
Objective: To compare Fentanyl and Fenofol (Fentanyl+Propofol) in terms of onset and recovery of sedation, haemodynamic effects, respiratory effects and adverse effects of both the drugs during elective Caesarian section under spinal(subarachnoid) anaesthesia.
Materials and Methods: This randomized clinical trial included 60 ASA (American Society of Anaesthesiologists) grade I or II patients between age 20-40 years undergoing elective Caesarean sections under Subarachnoid anaesthesia during the period January 2022 to June 2022. Patients were randomly allocated to one of two groups: Fentanyl group (Group F, n=30), who received Fentanyl in a single dose of 0.5mcg/kg and Fenofol group (Group FP, n=30), who received Fenofol in a single dose of Fentanyl-0.5mcg/kg+Propofol-0.5mg/kg. Spinal anaesthesia was conducted by injecting a hyperbaric solution of 0.5% bupivacaine 3ml through a 25G spinal needle at L3-4 level. All parameters were documented at 5 min intervals until arousal of the patient. The onset of sedation i.e. time from iv (intravenous) injection of Fentanyl or Fenofol to closure of eye lids (OAA/S score of 3) and the arousal time from sedation i.e. time from closing of the eye lids to OAA/S score of 5 ( patient is awake clinically) were noted. Any complication during operation was documented. The patient’s satisfaction with the sedation was assessed by the 5 point ‘Likert verbal rating scale.’
Results: There was no significant difference of mean blood pressure and mean heart rate between the two groups in different time intervals (P>0.05). Time of onset of sedation and the arousal time i.e. duration of sedation was comparable between the two groups (P>0.05). Significant percentage of patients required O2 supplementation in Fenofol group due to hypoventilation (66.66% vs 10%, P<0.001). Pain in arm during drug administration was significantly more with Fenofol (46.66% vs 6.66%, P<0.001).
Conclusion: As a significantly higher percentage of patients required O2 supplementation during sedation with Fenofol and pain in arm during drug administration was significantly more in Fenofol group, it is recommended that Fentanyl is a better choice than Fenofol for sedation in single dose technique during subarachnoid block for Caesarean section.

KYAMC Journal Vol. 13, No. 04, January 2023: 234-239

Stress and Coping Status Among the Caregivers of Psychiatrist Patients

Mohammad Sayeed Ahmad — 2023-03-30

Background: Mental disorder account for 13% global burden of disease which has affected more than 970 million people worldwide in 2017. About 1 in 17 suffers from serious mental illness in worldwide. Therefore, the affected person is dependent on caregiver and their wellbeing is directly related to nature and quality of care provided by caregiver. Caregiver are especially vulnerable as they face complex, high burden care situation resulting in higher caregiver stress. The aim of this study is to determine the level of stress and coping of caregivers of Psychiatric patients.
Materials and Methods: This cross sectional study was conducted among 171 caregivers, aged more than 18 years in National Institute of Mental Health (NIMH) Shyamoli, Dhaka. Study period was from 1 January to 31 December 2020. The research participants were selected following the convenient sampling method based on defined selection criteria. A semi-structured questionnaire was developed and the respondents were interviewed face to face individually while maintaining privacy and confidentiality.
Result: Distribution of the socio demographic status of the study participants were females74% and male 26%. Their mean age was 40.09(±13.31) years. In educational level 33.9 % of the participants were illiterate, secondary level education up to 21.1%. In occupation housewife 57.9%, service holder 18.7%. Caregiver having 76.6% moderate stress, low stress 21.6% and 1.8% having high perceived stress. Association between stress and coping average, good coping 74.8% and 88.2% had moderate stress respectively. Their significant P value .009(p<0,05). The person’s correlation present between stress and coping was positive. The correlation co-efficient was .06 (p<0.05). So, there was a weak positive correlation between level of stress and coping status.
Conclusion: Health care personal may screen the stress level of caregivers and if there is any functional impairment is present, they could proper evaluation and therapeutic intervention.

KYAMC Journal Vol. 13, No. 04, January 2023: 240-244

Obesity and Its Co-Morbidities among School Teachers in Dhaka City

Ripon Barua — 2023-03-30

Background: Obesity is an important cause for human morbidity and mortality.
Objective: This study was aimed to determine the prevalence of obesity and its co-morbidities among school teachers in Dhaka city.
Materials and Methods: This cross sectional study was carried out from May 2017 to October of 2017. Total 250 school teachers aged between 25-59 years were enrolled using cluster random sampling technique. Data on socio-demographic profile, co-morbidities, weight, height and blood pressure were recorded.
Results: The prevalence of obesity among school teachers was 15.2%. The mean age of the participants was 46.1±8.2 years. Female teachers were more obese compared to male (20% vs 5.9%), this association was statistically significant (p=0.001). Majority obese participants belonging to the age group of 41-59 years with higher prevalence among female compared to male (25.2% vs 5.8%), this was statistically significant (p=0.030). About 53% obese teachers had hypertension (HTN). On the other hand, Pre-HTN was observed more among obese participants (42.1%) compared to overweight (14.8%). About one third of overweight and obese participants were diabetic (30.6% and 34.2% respectively) and dyslipidaemic (21.5% and 23.7% respectively).
Conclusion: The prevalence of obesity and its co-morbidities such as HTN, diabetes mellitus (DM), dyslipidaemia etc was high among the study participants. By promoting healthy life style and behaviors can reduce the burden of obesity and its co-morbidities.

KYAMC Journal Vol. 13, No. 04, January 2023: 245-249

Renal Primitive Neuroectodermal Tumor or Renal Ewing Sarcoma

Shakila Jannat — 2023-03-30

Renal primitive neuroectodermal tumor (renal PNET) or renal Ewing sarcoma (renal ES) is a rare, rapidly growing malignant small round cell tumor with poor prognosis. A 32-years-old Bangladeshi male patient presented with right loin pain, fever and anemia. On CT imaging a large (18x10.5x10.0 cm) renal mass was discovered. On suspicion of malignancy, a biopsy was taken from the mass. Microscopic evaluation showed features consistent with malignant small round blue cell tumor. Immunohistochemical stains showed diffuse and strong positive reaction to CD-99 and negative for WT-1, CD-3 and CD-20, which confirmed the diagnosis of renal PNET. After 6 cycles of combined chemotherapy, the patient was relatively well and at 6 months follow-up he showed no evidence of metastasis or recurrence.

KYAMC Journal Vol. 13, No. 04, January 2023: 257-260

Undiagnosed Wilson Disease Presented as Liver Failure after Hepatitis A Virus Super infection

Lubana Akram — 2023-03-30

Hepatitis A super infection can cause severe or even fatal illness in patients with chronic liver disease. Here, we describe a ten-year-old boy who was admitted for acute hepatitis A virus infection but later on he was diagnosed with Wilson disease. Wilson disease was diagnosed on the basis of low ceruloplasmin, high urinary copper excretion, and the presence of K-F ring. Hepatitis A was diagnosed by the presence of antibody in the blood. This case report suggests that acute hepatitis A virus infection may play a role in acute decompensation in diagnosed or undiagnosed chronic liver disease.

KYAMC Journal Vol. 13, No. 04, January 2023: 261-263