Medicine Today

Yolk Sac Tumor of Testis Diagnosed 10 years after Orchidopexy in 24-year-old Adult: A Case Report

Ramesh Lamichhane, Saroj Chaudhary — Thu, 13 Apr 2023 00:00:00 +0000

Introduction: Yolk sac are a rare type of germ cell tumors that occurs most commonly in prepubertal age but are rare in adults.

Case report: We present a case of a yolk sac tumor in a 25-year-old man with a history of bilateral cryptorchidism diagnosed at the age of 10 for which bilateral orchidopexy was done at the age of 19.

Discussion: Delayed diagnosis of cryptorchidism are common in developing countries. Most adults with cryptorchidism prefer orchidopexy instead of orchiectomy. Due to a lack of adherence to follow-up, late presentation with complications is common.

Conclusion: Yolk sac tumor can rarely occur in cryptorchid testis after post-pubertal orchidopexy. As lack of adherence to follow-up is common in developing countries, orchidopexy should be avoided.

Medicine Today 2023 Vol.35(1): 67-69

Intraligamentary Pregnancy- A Rare Obstetric Event

Asma Binte Khair, Mahmuda Rahman, Rumana Afroz — Thu, 13 Apr 2023 00:00:00 +0000

Introduction: Intraligamentary pregnancy is a rare form of ectopic pregnancy, where the gestation grows within the leaves of the broad ligament. Clinical presentation, diagnosis and outcome are highly variable.

Case report: Here, we report a case of a 30 years old lady (P2G7), presented at her 13+ weeks of pregnancy with acute abdomen and severe anaemia. USG revealed extrauterine alive pregnancy with huge peritoneal collection. Emergency laparotomy was performed and final diagnosis was made as ruptured intraligamentary pregnancy. Right sided salpingooophorectomy was done. Our main challenge was to control bleeding and to maintain haemostasis at the placental implantation site.

Conclusion: Although, definite preoperative diagnosis based on clinical sign symptoms and sonographic evaluation is elusive, proper resuscitation and surgical expertise can save a mother’s life. Role of MRI and Laparoscopy in selected cases should be in consideration.

Medicine Today 2023 Vol.35(1): 70-72

C-reactive Protein Level in Bangladeshi Preeclamptic Patients and Its Comparison with Trimester-Matched Normal Pregnancy

Thu, 13 Apr 2023 00:00:00 +0000

Introduction with objective: Preeclampsia is a major cause of maternal and fetal morbidity and mortality in Bangladesh. This study aimed to estimate C-reactive protein (CRP) level among patients with preeclampsia and to compare with those of trimester-matched normal pregnancy.

Materials and Methods: : This cross-sectional study was done from January 2005 to December 2006 at the different tertiary care hospital at Dhaka. A total of 33 preeclamptic and 33 normal pregnant women in the third trimester were enrolled in the study. The PE patients were divided into two groups: mild hypertension [diastolic blood pressure (DBP) <110 mm Hg] and severe hypertension (DBP _110 mm Hg). Similarly the patients were divided into two groups on the basis of proteinuria, group I ( 2+>=1gm/l) and group II (3+_3gm/l). Both PE and control groups were matched for their age and parity. Estimation of serum CRP was done by Turbulometry method.

Results: CRP concentration (mg/l) was 4.55±2.83 in control group and 23.52±24.85 in PE group which was significantly higher than in control group. CRP level was significantly higher (p<0.001) in severe PE than in mild PE group. Significant difference was also seen between the groups subdivided on the basis of proteinuria (p<0.05). In the whole population CRP values showed significant positive correlation with systolic and diastolic blood pressure (p<0.001) and significant negative correlation with gestational age at delivery and birth weight (gestational age: p<0.05, birth weight: p<0.001).

Conclusion: Maternal CRP concentration was higher in patients with preeclampsia and was correlated with disease severity.

Medicine Today 2023 Vol.35(1): 1-6

Clinical Characteristics and Pattern of Imaging Change of Pediatric COVID-19

Thu, 13 Apr 2023 00:00:00 +0000

Introduction: COVID-19 infection in children is relatively milder and vary from that in adults. Higher fatality rate of children in Bangladesh from COVID-19 infection does not matched with other country may be due to malnutrition, air pollution, poverty, poor parental education about health hygine, inadequate access to high-quality acute healthcare. Chest X-ray is initial imaging technique which is done in children with mild respiratory infections with or without dyspnea. Few studies have reported the radiological findings of COVID-19 in children.

Objective: In this study, our main goal was to investigate the clinical and imaging features of pediatric COVID-19 patients in child corona unit of Dhaka Medical College Hospital, Bangladesh.

Materials and Methods: This single center observational study was conducted in Child Corona Unit of Dhaka Medical College Hospital between January 2022 to September 2022. A total of 123 COVID-19 positive pediatric patients detected by RT-PCR were purposively included in the study. Patients with comorbidities were excluded from the study.

Results: Among 123 children with COVID-19, 43 had no symptoms, 71 had low grade fever and 9 presented with cough, nasal congestion, diarrhea, headache, or fatigue. Normal X-ray findings present in 50(40.6%), unilateral patchy shadowing in 28 (22.8%), bilateral patchy shadowing in 22(17.9%), ground glass opacity in 11(8.9%), consolidation in 7(5.8%) and Interstitial abnormalities in 5(4.0%).

Conclusion: This study throw light on the cases of COVID-19 in the pediatric population. Children usually have mild or moderate clinical and imaging presentations. Understanding of the clinical and imaging findings helps in reducing misdiagnosis rate for those with concealed and atypical symptoms.

Medicine Today 2023 Vol.35(1): 7-11

Medical Waste Management Practices in Sylhet City among Healthcare Providers

Thu, 13 Apr 2023 00:00:00 +0000

Introduction: In the present world, large amount of wastes are clinical wastes, generated during diagnosis, treatment and research purpose. Most of the clinical wastes are hazardous like infectious, toxic of radioactive compounds. It is challenging to ensure proper waste management for developing countries like Bangladesh.

Materials and Methods: This cross sectional study was conducted among doctors, nurse, nursing assistants, OT technicians, janitors, helper, sanitary worker and security guards at different private hospitals, clinics and diagnostic centers in Sylhet city. 300 healthcare staffs were purposively interviewed to evaluate the extend practices of biological or hospital waste management from January 2021 to December 2021. The study was conducted after taking informed written consent.

Results: The outcomes of the present study indicated that maximum of the study participants were knowledgeable. But majority (71%) still do not use PPE (Personal protective equipment), 53% were not immunized against hepatitis B. They also had less practice to keep the hospital wastes in correct color coded container and less practice of washing the waste container properly.

Conclusion: Most participants valued the significance of waste management practice to prevent health hazards but average practice was observed among them. For proper waste handling and disposal, frequent awareness program should be conducted among the health personnel.

Medicine Today 2023 Vol.35(1): 12-15

Study of the Frequency and Outcome of Acute Respiratory Tract Infection in Exclusively Breastfed Infants

Thu, 13 Apr 2023 00:00:00 +0000

Introduction: Exclusive breast feeding is the fundamental component of child nutrition and survival. Exclusive breast feeding provides nutritional and immunological support for infant normal growth and development. Bangladesh is traditionally a breastfed community. The risks of acute respiratory infection (ARI) is higher in partially breastfed and formula-fed infants during the first 4 months of life.

Objective: To see frequency and outcome of ARI in exclusively breastfed (EBF) infants.

Materials and Methods: This cross sectional study was done at Department of Pediatrics, Rajshahi Medical College Hospital, from January 2013 to June 2013, a period of six months to find out the frequency and outcome of acute respiratory tract (ARI) infection in exclusively breastfed infants. 100 cases of infants suffering from ARI were selected who were exclusively breastfed. Data were analyzed through SPSS software.

Results: Most of the EBF babies (M48+F28=) 76% came to hospital with a history of one or two attacks of ARI. Among 100 EBF babies, 96 babies were cured without complications and 02 babies develop complications and cured. There was 02 unfortunate death. Only 42% of EBF babies presented with moderate or less severe attack, 58% had mild attack. Hospital stays in EBF babies are shorter, only 64% of EBF patients had to stay more than 03 days.

Conclusion: Frequency and severity of ARI attack is less and mild and hospital staying is short found in EBF babies, as well as better outcome with treatment.

Medicine Today 2023 Vol.35(1): 16-19

Causes of Infertility among the Couples Who are Attending the Infertility OPD of BSMMU

Thu, 13 Apr 2023 00:00:00 +0000

Introduction: Infertility may be defined as inability to conceive within one year of unprotected regular coitus. Approximately 85 – 90% of healthy young couples conceive within 1 year, most within 6 months1. Infertility therefore affects approximately 10 – 15% of couples and represents an important part of clinical practice2. A general classification of causes of infertility are male 35 – 40%, female 40 – 50% (tubal 25%, ovulatory 20% and cervical 1 – 2%), sexual 10% and unknown 10%3. More than one factor per couple accounts for the total percentage appearing to exceed 100%.

Objective: To assess the determinants of infertility among the infertile couples both male and female attending the outpatient department of infertility unit of the department of obstetrics and gynaecology of Bangabandhu Sheikh Mujib Medical University , Shahbagh, Dhaka.

Materials & Methods: This prospective observational study was conducted in the Infertility unit, Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, during the period from 01.07.2018 to 31.12.2021. Five hundred infertile couples were recruited from the out-patient department of infertility unit who came to take treatment for their infertility problem. Data were collected from the couples by data collection sheet and the data were plotted in the tables. The data were analyzed by SPSS program, version 28.

Results: The socio-demographic characteristics of the study subjects (n = 500).Husbands age group was 22 -55in years, Mean ± SD (34.0 ± 5.9). Age of the female partners was 18 – 44 years, mean ± SD (27.1 ± 5.2). Majority of the female study subjects had secondary level of education (49.4%), where as in male study subjects secondary level of education was 30.4%, followed by graduates (29.6%). Occupation of female partners was mostly housewife = 395 (79.0%), occupation of male partners was mostly service = 356 (71.2%). Regarding religion, Muslims were 476 (95.2%), others were 24 (4.8%). Majority of them hailed from rural area (62%). According to BMI, majority of female were overweight (56%). Among the respondents, majority of them had primary infertility (59.8%) and the rest (40.2%) had secondary infertility. Regarding hormonal status of infertile women, most of them (94%) had serum FSH below normal (< 3U/L), serum LH below normal (< 2U/L) in 96% patients, Serum TSH above normal (>4.5 mU/L) in 49.0% patients, serum FT4 above normal (>21 pml/L) in (60.8%) patients, serum Prolactin level above normal (>630 mU/L) in 27.8) patients. Diabetes: In male = 28 (5.6%).Mumps: In male = 7 (1.4%). Chicken pox: In male = 18 (3.6%). Hypertension: In male = 10 (2.0%). Orchitis: In male = 6 (1.2%). Personal history of husband: Smoking = 129 (25.8%). In male patients, Testosterone level normal (10 – 30 nmol/L) in 133 (26.6%) patients and above normal (>30 nmol/L) in 367 (73.4%) patients. The semen analyses of the husbands of the infertile female patients shows, quality of semen poor (<4%) in 305 (61%) patients. Regarding semen quality, oligospermia (<15 million/ml) was in 480 (96%) patients and azospermia (0% count) in 20 (4%) patients. In case of motility of sperms, rapid linear below normal (<50%) was in 90 (18%). In case of slow linear (SL), below normal (<15%) in 324 (64.8%) patients. In case of morphology of sperms, below normal (<14million/ml) in 25 (5%) patients. Regarding structural abnormalities of female organs bicornuate uterus was found in 15.2% patients, abnormal uterine cavity in 11.4% patients. In 13.0% patients’ abnormal right ostium were found and in 12.6% patients’ abnormal left ostium were found. Intrauterine adhesion was found in 35.2% patients and submucus fibroid in 17.6% patients. Abnormal right fallopian tube was found in 33.2% patients and abnormal left fallopian tube was found in 34.2% patients. Dye test in 42.4% patients were negative that means the tubes were blocked.

Conclusion: This study shows that a significant percentage of both male and female are suffering from infertility. The major causes of male infertility are partly hormonal, structural abnormalities of male genitalia, infection of genital tract, and partly psychological.Causes of female infertility are mostly hormonal, structural abnormalities of the uterus, fallopian tubes, infection of the genital tract and partly psychological.

Medicine Today 2023 Vol.35(1): 20-26

A Comparative Study between Metal Clip Application and Suture Ligation of Cystic Duct in Laparoscopic Cholecystectomy

Thu, 13 Apr 2023 00:00:00 +0000

Introduction: Laparoscopic cholecystectomy has been performed for decades and is a fairly standardized procedure throughout the world. Occlusion of the cystic duct is popularly done with the help of metal clips. There are many other techniques described in the literature to deal with occlusion of the Cystic Duct. Suture ligation of the duct is one such way.To evaluate the effectiveness in term of cost, safety, and complication in occlusion of cystic duct with suture ligation compared to clip application.

Materials and Methods: A prospective cross sectional comparative study was carried out From June 2020 to November 2020. Data were collected from 80 patients undergone laparoscopic cholecystectomy for Gall stone diseases. 40 patients were enrolled in each group by consecutive purposive sampling. Complete history was taken. Thorough clinical examination was done. Relevant investigations report was collected.

Results: Female patients were predominant in both groups and most of the patients were underweight. Mean time for ligation was more in occlusion of cystic duct with clip application. Bile leakage was found and duration of drain in situ was more in occlusion with clip application. Cost was high in occlusion with clip application.

Conclusion: : Time for ligation, Bile leakage, mean duration of drain in situ (days), and cost of Cystic Duct occlusion and port closure were significantly higher in Laparoscopic Cholecystectomy with conventional Clip application of Cystic Duct group in comparison to Laparoscopic Cholecystectomy with ligation of the Cystic duct with no-1vicryl by extra corporeal knotting group.

Medicine Today 2023 Vol.35(1): 27-30

Management Pattern of Chronic venous Disease in Bangladesh

Md Shamim Reza, Md Anwar Hossain, Mst Tanzila Yasmin — Thu, 13 Apr 2023 00:00:00 +0000

Introduction: Chronic venous disease (CVD) is mostly underdiagnosed diseasewhich may progress to chronic venous insufficiency and venous ulcer thus extensive treatment. CVD may affect negatively into patient’sgood well-beingwhich can create burdens on their life and also healthcare resources. Bangladesh has very minimum awareness on CVD.

Materials and Methods: This was a cross-sectional study was carried out in department of vascular surgery of National Institute of Cardiovascular disease. we randomly choose 60 patients with chonic venous disease (CVD) and evaluate their characteristics and prevalence of several types along with the management pattern. Data collection started from May 2021 for next 6 months.

Results: The patients of this survey were aged between 24 to 70 years and the Mean±SD age was 43.6±12.2. 78.3% of total study population were male, 33.3% were businessman and 10% were housewife. 66.6% patients were having low socio-economic condition. C2 varicose veins were highly prevalent among the study population ( 35%) & lowest prevalence of C4b lipodermatosclerosis or atrophie blanche (11.7%). Male were predominantly more prevalent to having CVD, 78.33% (n47), (p <0.001). Among all the patient 68.3% patient were exposed to smoking. All the patient were managed predominantly by compression therapy mainly are of moderate pressure (66.7%,) 80% of total patients got treated by oral MPFF therapy.

Conclusion: : Patients having CVD, invariably presented with the complains of heaviness of leg and unexplained leg swelling and Varicose vein were highly prevalent irrespective of sex. Compression therapy has been remained the mainstay of treatment in tertiary level hospital NICVD along with oral MPFF therapy.

Medicine Today 2023 Vol.35(1): 31-33

Intraventricular Hemorrhage Extension is a Strong Predictor of Mortality in Hemorrhagic Stroke

Thu, 13 Apr 2023 00:00:00 +0000

Introduction: Spontaneous intracerebral hemorrhage (sICH) accounts for 10–15% of all strokes and is characterized by a 30–50% 3-month mortality rate. Intraventricular hemorrhage (IVH) extension can be seen in up to 54% of spontaneous intracerebral hemorrhage and is an independent predictor of worse outcome and neurological deterioration. Objective: To predict outcome and prognosis in spontaneous intracerebral hemorrhage patient in relation with intraventricular hemorrhage extension.

Materials and Methods: Hospital based prospective study carried out in two hundred hemorrhagic stroke patients. The severity of intraventricular hemorrhage extension was calculated using the Graeb scale and volume of hemorrhage was measured by ABC/2 formula using CT scan.

Results: Mean age of patients of hemorrhagic stroke was 61.64 ± 12.76 years. 66% of patients were male. Mortality rate of hemorrhagic stroke after the age of 60 years was 47.92% in 1st month. 79.80% of patients were died with GCS score less than 8. In our study 96.08% of patient died with >50 ml Hemorrhage group, on the other hand mortality rate was 48% in 30-50ml hemorrhage group and 11.12% in <30ml hemorrhage group. Mortality rate was 61.17% in hemorrhagic stroke with ventricular extension group on the other hand mortality was 21.65% in hemorrhagic stroke without ventricular extension. Those patients with GRAEB score >5 their mortality rate was 75.00% on the other hand mortality was 49.10% in GRAEB score 1-4.

Conclusion: Intraventricular hemorrhage extension increased mortality in spontaneous intracerebral hemorrhage. Increased IVH extension severity, defined by a GRAEB score _5, is an independent predictor of poor outcome of Spontaneous intracerebral hemorrhage alone with age, GCS and hemorrhage volume.

Medicine Today 2023 Vol.35(1): 34-39

Outcome and Evaluation of the Patient Thyroidectomy with Hyperthyroidism: A Case-Control Study

Thu, 13 Apr 2023 00:00:00 +0000

Introduction: According to reports, pediatric patients with hypothyroidism have a higher risk of complications following surgery than adults. Specifically, this Study's aimed to evaluate how complete thyroidectomy is in youth (18 years) and adults.

Materials and Methods: A retrospective case-control study of all (n=100) complete thyroidectomies was performed on 32 pediatric and 68 adult patients who were consecutive from were compared at the Department of ENT, Head & Neck Surgery, Islami Bank Medical College and multicentral base hospital, Rajshahi, Bangladesh, from July 2018 to June 2021.

Results: The average patient age in children was 9.7 years (range 3.4-17.9 years) against 44.9 years (range 18.4-84.2 years) in adults. Compared to adults, surgical procedures on children took an average of (2.18 ± 0.08 hrs.) longer to complete in adults (1.66 ± 0.03 hrs) (p = 0.003). The average weight of a thyroid specimen was 48.0 ± 6.4 grams in adults and 38.6.0 ± 8.9 grams in children (range, 6.6-203 grams; p = 0.34). Children had a higher ratio of thyroid weight to body weight (0.94 ± 0.11 gm/kg) than adults (0.67 ± 0.8 gm/kg; p = 0.05). After surgery, the hyperthyroid condition improved in every patient. There were no operational deaths, recurrences, or long-term hypoparathyroidism.

Conclusion: It is clear that the technical difficulties associated with treating Graves' disease surgically in children and adults result in longer operational periods. There was no difference in the chances of long-term consequences, including recurrent laryngeal nerve damage or neck hematoma.

Medicine Today 2023 Vol.35(1): 40-43

Efficacy of Rifaximin in Diarrhoea Predominant Irritable Bowel Syndrome: A Placebo Controlled Clinical Trial

Mohammad Sabidur Rahman, Md Rezaul Karim, Md Anamul Haque — Thu, 13 Apr 2023 00:00:00 +0000

Introduction: Irritable bowel syndrome is a common chronic functional gastrointestinal disorder characterized by abdominal pain associated with altered bowel habit of either diarrhoea, constipation or both. Its pathogenesis is multifactorial and incompletely understood.The role of gut microbiota in the pathophysiology of IBS is supported by various evidences.These are differences in mucosal and faecal microbiota between patients with IBS and healthy individuals,development of post-infectious IBS and the efficacy of some probiotics and nonsystemic antibiotics such as Rifaximin. Previous study showed resetting microbial diversity via Rifaximin use may lead to a decrease in bacterial fermentation and a reduction in the clinical symptoms of IBS. This study is designed to assess efficacy of Rifaximin in diarrhoea predominant irritable bowel syndrome.

Objective: This study was conducted to assess the effectiveness of Rifaximin in diarrhoea predominant irritable bowel syndrome patient.

Materials and Methods: This quasi experimental study was conducted on patients aged 18-55 years with IBS-D in department of Gastroenterology, BSMMU during the period of September, 2020 to August, 2021.

Results: There was significant improvement on abdominal pain(p <0.001), abdominal bloating(p =0.001) and satisfaction with bowel movement( p<0.001) in Rifaximin group at 4th week from baseline and most of which sustained upto 12th week of study. The total IBS-SSS at baseline (328.7 ±13.7) decreased to (231.5±14.2) at 12th week of study in Rifaximin group which was significant (p <o.oo1). In placebo group IBS-SSS also gradually decreased from baseline (323.4±17.29) to 12th week (269.3±16.2) but statistically not significant. IBS-QOL score at baseline in Rifaximin group was 64±5.2 and in placebo group was 63.4±5.1. Total IBS-QOL score was increased with time in both Rifaximin and placebo group but none was significant.

Conclusion: Rifaximin was more effective than placebo in controlling abdominal pain, abdominal bloating and dissatisfaction with bowel movement after 12th week of study. IBS QOL score was also increased in both groups.

Medicine Today 2023 Vol.35(1): 44-48

Physical and Psychological Health Problems Associated with Migration

Tanzila Rawnuck, Md Selim Reza, Rumana Hasan Sharmi — Thu, 13 Apr 2023 00:00:00 +0000

Introduction: Migration is a process of social change where an individual, alone or accompanied by others, because they may have different purposes especially for study, leaves one geographical area for a prolonged stay. Prolonged detention is seen to have impacted adversely on physical and mental health. The aim of this study was to evaluate the physical and psychological problems associated with the migration of foreign students compared to local ones.

Materials and Methods: TA case-control study was conducted from March 2017 to August 2022 on the students of five different countries. A total of 280 students were enrolled in this study from Dhaka Dental College in Dhaka city. They were divided into case and control groups. To determine the physical and mental health of them, different parameters were used.

Results: Total female-migrants were 3.24 times higher than male-migrants. Kashmir-migrants (47.14%) were higher whereas Bhutan-migrants (0.71%) were lowest in number. Psychological factors like depression, Insomnia, loneliness, and stress were more common in all migrants, particularly in the female. Physical health issues like diarrhea, food poisoning were common in males, however, urinary tract infection and skin problems were of insignificant magnitude in female-migrants.

Conclusion: Migrant students’ physical and mental health is heavily affected by the adopted country’s environment, culture, tradition, language, food habits, and so on. The intensity of the psychological problem has been found to be higher among some migrant groups. Similarly, physical problems such as allergic reactions, respiratory diseases were the most common problems experienced by them.

Medicine Today 2023 Vol.35(1): 49-51

Correlation of Body Mass Index with Vitamin D and Parathormone (PTH) in Obese and Overweight Children, Study from a Tertiary Care Hospital of Bangladesh

Thu, 13 Apr 2023 00:00:00 +0000

Introduction with aim and objectives: Childhood obesity and vitamin D deficiency both are emerging health issues. Vitamin D is essential for normal growth and development and frequently found low in obese and overweight children. The aim of this study was to assess serum vitamin D level, calcium, inorganic phosphate, alkaline phosphatase and parathormone (PTH) in obese and overweight children and to see the correlation between BMI, vitamin D and parathormone.

Materials and Methods: This study was conducted at Pediatric Endocrinology clinic of department of Paediatrics of Bangabandhu Sheikh Mujib Medical University from the period of November 2016 to October 2018. We assessed 50 obese and overweight children for serum vitamin D, calcium, inorganic phosphate, alkaline phosphatase, and parathormone and we also tried to find out the correlations among the parameters in this cross sectional study.

Results: Endocrine society clinical practice guideline was used to define vitamin D status. Result found that all of the obese/overweight children had low vitamin D (82% had deficiency and 18% had insufficiency). There was a statistically significant negative correlation between BMI and serum vitamin D level and positive correlation between BMI and the parathormone level (p value < 0.05). In this study significant negative association was found between vitamin D level and the PTH level p value <0.05.

Conclusion: All the studied obese and overweight had vitamin D deficiency or insufficiency. There was negative correlation between BMI and serum vitamin D level and positive correlation between BMI and the parathormone level (PTH).

Medicine Today 2023 Vol.35(1): 52-55

Risk Factors in Post Operative Wound Infections Following Elective Abdominal Operations

S M Akramuzzaman, Md Sherajul Islam, Asadullahil Galib — Thu, 13 Apr 2023 00:00:00 +0000

Introduction: Surgical site infections are common post operative complication and cause significant post operative morbidity and mortality, and have serious consequences for outcomes and costs. Different risk factors are involved, including age, sex, smoking, nutrition, diabetes, pre existing illness, pre operative hospital stay time, pre operative shaving, level of surgeon, length of incision, duration of operation, per operative blood transfusion, wound drainage and nature of wound. The objective of this study was to determine the risk factors affecting abdominal surgical site infections and their rate at Dhaka Medical College & Hospital, a major referral teaching hospital in Bangladesh.

Objectives: were to identify risk factors in post operative wound infections following elective abdominal surgery.

Materials and Methods: A Cross sectional type of observation study was carried out among 153 patients in Department of Surgery, Dhaka Medical College Hospital, Dhaka from January 2008 to December 2009.

Results: Patients (n = 153) who had undergone elective surgery were studied and the relationships among variables were analyzed by Student's t and Chi-square tests. To test the independence of the risk factors, the significant variables (p _.05) in the univariate analyses were entered into a stepwise logistic regression equation. Data were collected through pre and postoperative examinations. The subjects were followed till discharge. Of the 153 patients, 13 suffered from SSI (8.5%). Among the infections superficial SSI was in 8 cases (61.54%), deep SSI in 3 cases (23.08%), and organ/space SSI in 2 (15.38%) cases. There were 14 different variables in study to determine the risk factors. In univariate analysis ten risk factors were identified: age, underweight, diabetes, ASA score, pre operative hospital stay, per operative blood transfusion, length of incision, duration of operation, wound drain and contaminated wound. And in multivariate analysis duration of operation, diabetes mellitus and ASA score appeared to be independent risk factors for wound infection.

Conclusion: The total elimination of wound infection is not possible, a reduction in the infection rate to a minimal level could have significant benefits in terms of both patient comfort and medical resources used. The SSI may be reduced to a more acceptable level by reducing the average operation time to less than 2 hours, pre operative hospital stay, and by reducing contamination during operation and wound drainage. Furthermore post operative study in large scale is recommended.

Medicine Today 2023 Vol.35(1): 56-62

Pattern and Frequency of Microalbunuria with Different Types of Stroke

Thu, 13 Apr 2023 00:00:00 +0000

Introduction with aim and objectives: Cerebrovascular diseases have recently emerged as a major health problem affecting the elderly population. The spectrum includes some of the most common and devastating disorders like ischemic stroke, hemorrhagic stroke and anomalies in vascular system. Microalbuminuria is an early finding in urine in the patients of diabetes and hypertension and it is associated with macrovascular complications like cerebrovascular accident and myocardial infarction. The aim of this study was to find out the pattern and frequency of microalbunuria with different types of stroke.

Materials and Methods: Fifty cases of stroke Patients admitted in CMCH medicine and neurology department from 1 January 2019 to 31 June 2019 were analyzed and urine for microalbumin was done. Univariate statistical analyses were performed to see the outcome in relation with blood volume by SPSS-19.

Results: Regarding analysis of gender distribution of 50 study patients, 27(60%) were found male and 23(40%) were found female. Male to female ratio was 1:0.4. Among the 50 patients, different types of occupation were found. House wife was common occupation. Among the total patients, most of them were from lower middle class 24(61.4%). Others were from low 16(32.0%) and upper middle class 10(5.75%) group. Most of the patients were from rural residence 41(80%). In our study, 13(71.42%) patients had hypertension. Diabetes mellitus was found among 13(8.57%). Different examination findings were analyzed where mean GCS of ischaemic stroke was 14.5 and mean GCS of hemorrhagic stroke was 10.6, 12 patients had abnormal fundoscopic findings. Regarding analysis of serum LDL and serum Creatinine, mean LDL level was 123.95 and mean serum Creatinine level was 1.19. After analysis, mean of urine for Microalbumin of 30 Ischaemic stroke patients was 71.96mg/L and mean of urine for Microalbumin of 20 Hemorrhagic stroke patients was 80.70mg/L.

Conclusions: We found high frequency of microalbuminuria in patients with stroke Therefore; microalbuminuria could be is a useful modifiable factor, in addition to conventional risk factors, in identifying those at increased risk of stroke.

Medicine Today 2023 Vol.35(1): 63-66