Mugda Medical College Journal

Determinants of Type 2 Diabetes Mellitus among Children and Adolescents Attending A Tertiary Specialized Hospital in Bangladesh

Samin Tayyeb, Bedowra Zabeen, Farzana Naz, Kishwar Azad — Tue, 06 Feb 2024 00:00:00 +0000

Background: Type 2 diabetes in children and adolescents has increased in frequency around the world over the past two decades. The worldwide epidemic of childhood obesity has been accompanied by an increase in the incidence of type 2 diabetes in children and adolescents.

Objective: To observe the determinants of type 2 diabetes mellitus among children and adolescents attending a tertiary specialized hospital in Bangladesh.

Methods: This cross-sectional, descriptive study was done on a total of 151 children and adolescents attending the pediatric diabetic outpatient department (OPD) of Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine, and Metabolic Disorders (BIRDEM) Hospital, Dhaka, Bangladesh. The sampling technique was purposive. All patients who came to the hospital between July to December 2017 were included. Data was collected through a structured questionnaire.

Results: Among 151 respondents, 98 were in the age group of 10-14 years (64.9%), female to male ratio of 1.22:1. The majority belonged to a high used to lead socio-economic class. Regarding food habits, 55.6% had a history of eating fast food regularly and used to lead a sedentary lifestyle with a lack of exercise. 43.7% of children and adolescents were obese 76.8% had high cholesterol and 84.1% had high triglyceride levels. Most of the children had a positive family history of type 2 diabetes mellitus (74.8%).

Conclusion: Our study reflects that determinants like obesity, physical inactivity, eating habits, and family history are important factors in the development of type 2 diabetes mellitus in children and adolescents.

Mugda Med Coll J. 2023; 6(2): 51-56

Association between Serum Ferritin and Insulin Resistance Markers with Distinct Glycemic Profiles in an Adult Bangladeshi Population

Tue, 06 Feb 2024 00:00:00 +0000

Background: Type 2 diabetes mellitus (T2DM) is a global health concern. Around 56% of subjects in Bangladesh go undiagnosed, increasing the risk of stroke and cardiovascular issues. Iron stores' impact on diabetes is gaining attention, with ferritin as a key biomarker. Hyperferritinemia probably contributes to insulin resistance and subsequently to decreased insulin secretion, causing the development of insulin resistance. The link between ferritin and insulin resistance (IR) varies based on ethnicity, gender, and glycemic state.

Objectives: This study investigates serum ferritin levels in different glycemic stages and explores potential correlations between ferritin and insulin resistance markers (blood glucose, serum insulin, and HOMA-IR)

Methods: The study was conducted at the Department of Biochemistry, Sir Salimullah Medical College, Dhaka, Bangladesh, from March 2018 to February 2019. A total of 140 subjects were included to conduct this study. Participants were categorized into three groups: those with normal fasting glucose (NFG group), impaired fasting glucose (IFG group), and newly diagnosed type 2 diabetes mellitus (Diabetic group) according to WHO (2006) criteria. A purposive convenient sampling method was used, focusing on adults aged 25 to 55 years. Exclusion criteria were applied to eliminate individuals with inflammatory diseases, chronic conditions, major cardiovascular events, anemia, or specific medications that could affect ferritin levels.

Results: The study found that serum ferritin levels significantly differed among three glycemic groups (NFG, IFG, and T2DM) with higher levels in T2DM. IFG and T2DM groups also had elevated serum insulin and HOMA-IR. Serum ferritin correlated strongly with fasting blood glucose, serum insulin, HOMA-IR, and BMI. The highest tertile of ferritin levels were associated with the IFG & diabetic group.

Conclusion. Elevated serum ferritin levels in IFG and type 2 diabetes may significantly impact glucose regulation. Compared to NFG, there are high insulin resistance markers (fasting insulin, glucose, HOMA-IR) in T2DM and IFG. They have crucial implications for both therapy and prognosis in these conditions.

Mugda Med Coll J. 2023; 6(2): 57-63

Comparison of the Effects of Nitroglycerin, Labetalol and Lidocaine in Hypertensive Patients in Attenuation of the Endotracheal Intubation Reflex

Tue, 06 Feb 2024 00:00:00 +0000

Background: Laryngoscopy and tracheal intubation integral parts of general anesthesia which may cause acute haemodynamic instability. Hypertensive patients are more prone of developing cardiovascular complications such as pulmonary oedema, cardiac failure and cerebrovascular haemorrhage. To attenuate such intubation reflex, some drugs are used, e.g., opioids. lidocaine sodium nitroprusside, nitroglycerin, beta blockers, calcium channel blockers etc.

Objective: The purpose of the study is to see the effectiveness of nitroglycerin, labetalol and lidocaine in attenuation of intubation reflex and their anesthetic outcome in hypertensive patients.

Methods: This randomized controlled study was carried out in the Department of Anesthesia, Pain, Palliative and Intensive care Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, between March and September of 2021. A total of 90 patients were included: 30 in each group as per inclusion and exclusion criteria. Group A patients received inj. nitroglycerin 2 minutes before intubation, while group B patients received inj. labetalol 0.25mg/kg 5 minutes before intubation, and group C was given 2% lidocaine 1.5mg/kg 2 minutes before intubation. Haemodynamic status of all patients was checked before and after intubation.

Results: Mean age of the patients was 44.4±10.9 years in group A, 47.6±9.4 years in group B and 46.4±10.6 years in group C. Heart rate after intubation was low and statistically significant in groups-B after 1.2 and 5 minutes. Regarding mean arterial pressure (MAP), group A patients had significantly low blood pressure. Rate pressure product (RRP) of the patients was significantly low in group B at 1 minute, 2 minutes and 5 minutes. Regarding ECG changes sinus tachycardia was observed in 26.6%, 86.6% and 20% in group A, group B and group C immediately after intubation. Groups B patients showed lower incidence of sinus tachycardia than that of two other groups and showed no premature ventricular contractions, whereas group A (6.7%) and group C (3.3%) showed premature ventricular contractions.

Conclusion: Labetalol showed better rhythm control, mean arterial pressure and less incidence of tachycardia. To summarize, labetalol is safer and more effective than nitroglycerin and lidocaine to attenuate the endotracheal intubation reflex in hypertensive patients.

Mugda Med Coll J. 2023; 6(2): 64-70

Bacteriological Study and Antibacterial Susceptibility in Ludwig’s Angina in a Tertiary Level Hospital in Dhaka, Bangladesh

Tue, 06 Feb 2024 00:00:00 +0000

Background: The knowledge of the local pattern of infection and antibacterial sensitivity in Ludwig’s angina is essential to enable efficacious treatment for it.

Objective: To find out the pattern of bacteria responsible for developing Ludwig’s angina and their antibacterial susceptibility.

Methods: It is a prospective, observational type of study carried out in the Department of Otolaryngology & Head-Neck Surgery, Dhaka Medical College Hospital, Dhaka, and the Department of Clinical Microbiology, ICDDR, B, Dhaka, Bangladesh, between April and September of 2016. A total of 100 patients were included in this study.

Results: This study was done among 100 patients. In this study, 42 cases (42%) were in the 31-45 years age group. The male patients were 60 (60%) and females were 40 (40%). Majority of patients 70(70%) came from poor class family with educational level up to HSC (75%), maximum 35(35%) patients use meswak to clean teeth, 70 (70%) patients came from rural area, 70 (70%) patients had dental infection, 25 (25%) patients had diabetes mellitus, all the cases (100%) presented with swelling in the floor of the mouth and neck, pain and tenderness and fever. The major complication was necrotizing fasciitis 8 (8%), 36 (36%) patients were discharged within 1-2 weeks after treatment, Streptococcus 40 (40%) was the most common organism and the most effective antibiotic was Ceftriaxone (65%).

Conclusion: The most frequently isolated organism in Ludwig’s angina is Streptococcus and sensitivity results showed a majority of isolates are susceptible to Ceftriaxone.

Mugda Med Coll J. 2023; 6(2): 71-76

Demographic Characteristics and Clinical Factors of the Patients Suffering from Osteoarthritis of Hand – A Study Done in A Tertiary Specialized Hospital in Bangladesh

Md Zobayed Sultan, Saida Sharmin, Razia Sultana, Merina Tanzil — Tue, 06 Feb 2024 00:00:00 +0000

Background: Osteoarthritis (OA) is one of the most common forms of arthritis. Hand OA is a heterogeneous, age and gender-dependent disorder, occurring more frequently in postmenopausal women over 50 years of age.

Objective: This study aims to identify demographic patterns and factors associated with osteoarthritis of the hand among patients attending a tertiary-level hospital in Bangladesh.

Methods: This cross-sectional study was done in the Department of Orthopedics, Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh, between January and December of 2021. A total of 90 patients with OA of hands were included in this study. All patients were selected conveniently and informed written consent of the patients was taken. Participant data were collected through face-to-face interviews using a semi-structured questionnaire. Statistical analyses were done with Statistical Package for Social Science (SPSS) version 25.0. Quantitative variables were analyzed by mean and standard deviation while qualitative variables were summarized by percentage.

Results: In this study, the age distribution of the patients ranges from e”40 years to d”75 years irrespective of sex. The mean age of the patients of both sexes was 56.6±8.72 years. Among those 90 patients, 35 persons (38.9%) were male and 55 (61.1%) were female. Most of the patients are housewives 38 (42.22%). Most of the women (87.27%) are menopausal among the total 55 female patients. Only 13 (14.45%) persons had a previous history of a hand injury, and 20 (22.22%) persons had a habit of smoking or previously smokers. Most of the subjects 78 (86.67%) were right-hand dominant and a maximum of 67 (74.45%) persons enrolled in this study showed priority affected CMC1 OA to the dominant hand. Most of them (75.55%) took medications for treatment for arthritis.

Conclusion: Our study revealed that osteoarthritis of the hands is predominant in females and affects mostly the right hand. Further high-quality studies examining the risk factors for hand osteoarthritis are needed to replicate these findings and determine modifiable factors in symptomatic patients.

Mugda Med Coll J. 2023; 6(2): 77-82

Bacteriological Trends of Chronic Mucosal Otitis Media in a Tertiary Care Hospital in the Northern Region of Bangladesh

Tue, 06 Feb 2024 00:00:00 +0000

Background: Chronic otitis media (COM) is a disease of multiple etiology caused by bacteria and its importance lies in its chronicity and awful complications. The microbiological study shows the growth of a lot of organisms, frequently multiple and those differ based on geographical variation, patient population, climate, and many other factors.

Objective: To evaluate current bacteriological trends of ear infections in patients with chronic otitis media which will be beneficial for appropriate treatment as well as for reducing complications. The study also focuses on rapid diagnosis by exploring other factors like age and sex-wise distribution, socioeconomic status, distribution of patients according to the type of dwelling, and bathing habits of patients.

Methods: This cross-sectional, observational study was conducted in the Department of ENT and Head-Neck Surgery, Rangpur Medical College Hospital in Rangpur, a northern district of Bangladesh, over 6 months on a total of 80 patients who had attended outpatient and inpatient departments. Aural swab was taken from the discharging ears which were inoculated on blood agar and MacConkey’s agar media. The organism pattern was then tabled based on the culture reports.

Results: The most common bacteria causing COM was Pseudomonas aeruginosa in (45.0%) followed by Staph. aureus (27.5%), mixed isolates in 8.75%, E. coli in 5%, Proteus in 3.75%, S. pneumoniae in 2.5%, and Klebsiella in 1.25%.

Conclusion: The study proved to be useful for clinicians in management of COM and its complications. Early and effective microbiological diagnosis and intervention is the best solution. From this study, it is observed that Pseudomonas aeruginosa is the commonest pathogen for bacterial ear disease followed by S. Aureus.

Mugda Med Coll J. 2023; 6(2): 83-87

Growth Status and Glycemic Control of Diabetic Children in a Tertiary Care Hospital in Dhaka City

Farzana Naz, Samin Tayyeb, Bedowra Zabeen, Adnan Yusuf Choudhury — Tue, 06 Feb 2024 00:00:00 +0000

Childhood growth is a critical indicator of the health status of a child which also determines the overall developmental potential in adult life. Along with an increased risk of developing various co-morbidities, diabetic children remain susceptible to growth delay in terms of height and weight. Thus it is necessary to evaluate their growth status about their glycemic control. This cross-sectional study observed 148 sequentially selected diabetic children aged 9 to 15 years, with 5 years of diabetes duration attending a tertiary level hospital. Data regarding their anthropometric measurements including height and weight, HbA1c status, and diabetic history has been collected. HbA1c level is a significant determinant of height, weight, and BMI of the study subjects (p<0.05). The age at diagnosis of diabetes was found to have a significant impact on the height of the girls and weight of both boys and girls and also on their HbA1c level, where, in all groups, the age at diagnosis at 5 to 9 years found to have the highest proportion of children whose growth was less than the reference range. The duration of diabetes in this study was not related to the anthropometric measurement of the children (p>0.05) although it was significantly associated with their HbA1c level (p<0.05). This study's results observed growth alteration among children with diabetes in association with their HbA1c level and age at diagnosis, which suggests that diabetic children should undertake routine monitoring of growth and glycemic control to provide timely and adequate interventions to prevent growth delay among them.

Mugda Med Coll J. 2023; 6(2): 88-92

Hypertensive Disorder of Pregnancy with Vertebral Artery Aneurysm and Vasospasm Led to Vertebral Artery Dissection – A Case Report

Tue, 06 Feb 2024 00:00:00 +0000

Hypertensive disorders of pregnancy (HDP) can lead to various complications affecting maternal and fetal health. In this case report, we present the rare occurrence of vertebral artery aneurysm leading to vasospasm with vertebral artery dissection (VAD) in a woman having pregnancy-induced hypertensive disorder. Her clinical presentation, diagnostic evaluation, and management are discussed, highlighting the importance of early recognition and appropriate intervention. This case highlights the potential link between pregnancy-induced hypertensive disorders and a rare vascular complication like vertebral artery aneurysm which may lead to vertebral artery dissection. The current literature consists of a few incidences documenting adverse outcomes and management. The incidence of recurrence of such events (arterial aneurysms and dissection) in subsequent pregnancies is unknown. Timely recognition, appropriate diagnostic evaluation, and multidisciplinary collaboration are essential for optimal management and patient outcomes.

Mugda Med Coll J. 2023; 6(2): 107-109

Dengue Vaccine: Past, Present and Future

Salma Ahmed — Tue, 06 Feb 2024 00:00:00 +0000

Abstract not available

Mugda Med Coll J. 2023; 6(2): 48-50

Ethical Issues in Rehabilitation Medicine

Tue, 06 Feb 2024 00:00:00 +0000

Within the past few decades, there has been a tremendous increase in the knowledge and awareness of ethical issues and dilemmas within the medical profession. However, until more recently, the problems of chronic illness, and more specifically of rehabilitation-related issues, have received relatively little attention. We reviewed a large amount of literature concerning various ethical dilemmas that occur specifically within the context of chronic care and rehabilitation medicine. The review was done through extensive searching of databases between January and June of 2018. The search was confined to Google Scholar, HINARI, and PubMed published articles. Besides, some institutional guidelines were taken into consideration. Keywords used for searching were ‘rehabilitation’, ‘rehabilitation medicine’, ‘chronic disease’, ‘chronic illness’, ‘disability’, ‘ethics’, ‘ethical issues’, and ‘ethical dilemma’. After meticulous scrutiny, a total of 21 journal articles and 3 guidelines were selected for this review. The goal of this review is to provide a brief overview of the major ethical principles as well as some specific examples of ethical issues that might be encountered on a day-to-day basis by rehabilitation practitioners.

Mugda Med Coll J. 2023; 6(2): 93-98

Understanding Burnout in Surgeons: How to Avoid Burnout?

Mohammed Shadrul Alam — Tue, 06 Feb 2024 00:00:00 +0000

Although surgeons work in more stressful medical fields, surgeons are generally considered to offer some of the best lifestyles among physicians. Burnout among surgeons is increasing at an alarming rate. The goals of this review are to increase awareness of the symptoms, causes, and consequences of surgeons’ burnout and how to avoid burnout? Surgeons’ burnout is largely attributed to work-related factors and personal -related factors. Burnout has many potential adverse consequences including professional consequences and personal consequences. The recovery from surgeon’s burnout can take months or longer, therefore it’s important to try to avoid it in the first place through preventative strategies.

Mugda Med Coll J. 2023; 6(2): 99-106