Mymensingh medical journal : MMJ最新文献

Evaluation of the in vitro antibacterial activity of Chloroform extracts isolated from Henna (Lawsonia inermis) leaf against two nosocomial infection causing pathogens, gram-positive Staphylococcus aureus and gram-negative Klebsiella pneumoniae. This interventional study was carried out for the period of January 2021 to December 2021 in the Department of Pharmacology and Therapeutics in collaboration with the Department of Microbiology, Mymensingh Medical College, Bangladesh. The antibacterial activity was tested at different concentrations of Chloroform Henna leaf extracts by using disc diffusion and broth dilution method. The extract was prepared by using solvents chloroform and 0.1% Dimethyl sulfoxide (DMSO). The test microorganisms were also tested for their activity against a standard antibiotic Ciprofloxacin by broth dilution method and the result was compared with that of Chloroform extracts. Chloroform Henna Extracts (CHE) were used initially in nine different concentrations (2.5, 5, 10, 20, 50, 100, 200, 500 and 1000 mg/ml). Among different concentrations of the CHE, 100mg/ml and above concentrations showed inhibitory effect against Staphylococcus aureus and Klebsiella pneumoniae. The MIC for Staphylococcus aureus and Klebsiella pneumoniae were 100 and 200mg/ml in CHE respectively. The MIC of Ciprofloxacin was 1μg/ml against Staphylococcus aureus and 1.5μg/ml against Klebsiella pneumoniae. The MIC of Ciprofloxacin was the lowest in comparison to MICs of CHE for the test organisms. This study showed that Chloroform Henna extracts demonstrated antibacterial effects against food borne pathogens. It is clearly observed that there is definite antibacterial effect of the Chloroform extract of Henna leaves (Lawsonia inermis) against Staphylococcus aureus and Klebsiella pneumoniae.

Otomycosis, a fungal infection of external ear, is challenging for both patients and otolaryngologist as it requires long term treatment and follow up. Candida spp. is second common organism causing otomycosis with Aspergillus being first. Among Candida species, C. albicans is considered as most common but in recent years there is increasing incidence of Non albicans Candida (NAC) species with greater resistance and recurrence. This descriptive type of observational study was planned to determine the species distribution and antifungal susceptibility of Candida spp. causing otomycosis. From March 2021 to February 2022, 60 patients clinically suspected of Candida associated otomycosis at Mymensingh Medical College Hospital, Bangladesh were enrolled. Specimens were taken by an otorhinolaryngologist. After culture and microscopic examination, isolated Candida species were identified by phenotypic and genotypic method and antifungal susceptibility was determined at Department of Microbiology, Mymensingh Medical College. From 60 samples 18(30.0%) were positive for Candida on microscopy and culture. Of the isolates, C. albicans were 2(11.11%) and Non albicans Candida (NAC) 16(88.89%). Five different NAC species were identified of which C. parapsilosis was predominant 5(27.77%) followed by C. tropicalis 4(22.22%) and C. famata 3(16.67%). Rare species of C. ciferrii 2(11.11)%, Kodamaea ohmeri 2(11.11%) were isolated. Candida spp. showed highest resistance to Clotrimazole 8(44.0%) followed by Itraconazole 6(33.0%), Nystatin 4(22.0%) and Fluconazole 3(17.0%). C. ciferrii and Kodamaea ohmeri showed resistance to all antifungals except Nystatin. Outcomes from this study showed a different picture of species distribution, with isolation of rare and emerging drug resistant threatening species like C. ciferri and Kodamea ohmeri which necessitates more detailed survey.

We performed this study to investigate the socio-demographic factors of breast cancer patients of Bangladesh. This cross-sectional study was conducted in the Department of General Surgery at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2018 to September 2019 for a period of one (1) year. All consecutive cases of breast carcinoma admitted in hospital and attended at outpatient department during the study period were selected as study population. Total 50 patients were selected. The mean age of the study patients was 51.1. Maximum number (70.0% cases) of breast cancer was belonged in 4th to 5th decade aged group. 70.0% breast cancer patients were housewives. The most of the breast carcinoma was reported in the urban people which were 78.0% cases. The percentage of educated study population was 80.0%. On religious background, 86.0% cases of breast cancer patients were Muslim. Most of breast cancer patients were sporadic in origin 94.0% cases, had no family history of breast cancer. Breast cancer was mostly distributed in pre-menopausal aged group with 82.0% cases. Ninety percent (90.0%) of the study population was come from middle class socio-economic group. In western countries, incidence of breast cancer is more in elderly aged menopause women with high socio-economic class. In this study the breast carcinoma was most prevalent among educated urban Muslim pre-menopausal housewives of age group 4th to 5th decade and most of them belonged to middle socio-economic class. The socio-demographic factors of breast cancer patients in Bangladesh are disparate from western countries in age standard, social class group and menstrual status.

Following the COVID-19 pandemic, a growing percentage of COVID-19 survivors exhibit post-COVID symptoms. This cross-sectional study aimed to assess radiological findings in individuals having post-COVID respiratory problems. This study was conducted in the Departments of Radiology and Imaging and Internal Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from November 2021 to June 2022 and included 30 COVID survivors aged 40 to 65 years. We employed a pre-tested semi-structured questionnaire including socio-demographic information, clinical data and CT chest imaging parameters. Pearson's correlation coefficient was calculated, as well as multiple linear regressions. Among 30 participants, 56.0% were male. The mean age of the respondents was 51.20 years (standard deviation of 7.09), ranging from 40 to 65 years. Approximately one-third of the participants had at least one co-morbid condition where hypertension (26.67%), diabetes (26.67%), chronic interstitial lung disease (16.67%) and obesity (16.67%) were most commonly recorded. Approximately 20.0% of participants were smokers. The incident of at least one post-COVID symptom was 100.0%. Approximately 73.0% presented with post-COVID lethargy, 16.67% with SoB (Shortness of Breath), and 90.0% of participants complaint of self-reported anxiety. We have found a positive correlation between age and overall lung involvement. The most common lung tomographic findings were fibrosis (93.0%) and diffuse ground glass opacity (70.0%). Interstitial lung thickening was found in 50.0% of cases and bronchiectasis accounted for 16.67%. In 6.6% of cases, there was no pulmonary lesion. It was notifiable that, with time, the feature of DGGO (diffuse ground glass opacity) became subtle and the total lung involvement decreased from 75.0% to about 25.0% during the post-COVID period. Timely assessment for post-COVID pulmonary sequelae by high-resolution CT chest scan might play an important role in modulating a treatment plan for patients suffering from the post-COVID syndrome.

Despite recent advances in neonatal care, early detection of neonatal sepsis still remains challenging. Positive blood culture is the gold standard for definitive diagnosis of neonatal sepsis but is time consuming and demands a well equipped laboratory setting. Therefore, it becomes imperative to evaluate usefulness of white blood cell count, Immature to total (IT) ratio and C-reactive protein as potential markers in the early diagnosis of neonatal sepsis. The objective of the study was to evaluate role of white blood cell count, IT ratio and C-reactive protein in early detection of clinically suspected neonatal sepsis. This cross-sectional descriptive study was conducted from January 2017 to December 2018 at Special Care Newborn Unit (SCANU) of Rangpur Medical College Hospital, Rangpur, Bangladesh. After parental permission and ethical clearance, a total of 70 eligible neonates were included into the study. Estimation of total white blood cell count, IT ratio and C-reactive protein as well as blood culture were done for each case. Significance for Chi-Square test and Pearson's correlation coefficient test was predetermined as p<0.05. Of the total 70 neonates studied, 19(27.14%) were blood culture positive and most common organism was Escherichia coli (7/14, 37.0%). Among individual and combination tests, CRP was highly sensitive (100%) followed by WBC count (74.94%). Highly specific tests in diagnosing sepsis were combination test of IT ratio and CRP (88.23%) followed by combination test of WBC count and CRP (82.35%). Positive predictive value (PPV) was high for combination test of WBC count and CRP (90.90%) followed by combination test of IT ratio and CRP (90.47%). Negative predictive value (NPV) was high in CRP (100.0%) followed by WBC count (89.19%). IT ratio positively correlated with CRP (p=0.002) and there was significant association between raised CRP and WBC count (p=0.005) in neonatal sepsis. Diagnostic role of both individual and combination tests were significant in early detection of clinically suspected neonatal sepsis while awaiting results of blood culture. However, none of the combination tests were able to achieve 100.0% sensitivity.

Legg-Calve-Perthes disease (LCPD) that starts after 8 years (late onset) usually follow more aggressive course and the long-term outcome is also poor. Treatment method of LCPD that will produce best results is controversial particularly if the patients are with late-onset presentation. This prospective study was conducted from January 2015 to January 2019 at Dhaka Medical College Hospital and Health N Hope Hospital, Dhaka, Bangladesh. We evaluated the radiographic outcomes for patients who had varus derotation femoral osteotomy (VDRO). We followed up 16 patients who had femoral varus osteotomy. All patients were above 8 years of age at clinical onset. The involvement of femoral epiphysis was in either in B or B/C in lateral pillar classification. All patients had MRI done to confirm radiological diagnosis and classification. The mean age was 9.5 years (range, 8 to 12 years). Final outcome was evaluated by using the Stulberg classification which was radiological. Important exclusion criteria were patient with bilateral involvement and requirement of femoral varus >30 degree. We had 81.25% of our patient with satisfactory outcomes. Among them there were Stulberg grade I, 0 cases; Stulberg grade II, 13 cases (81.25%); Stulberg III, 3 cases (18.75%), Stulberg IV and V both 0 case each. The surgical outcomes for varus derotation femoral osteotomy in late onset LCPD patients over 8 years old were showing the good results than other modalities of non surgical and surgical methods.

Non-alcoholic fatty liver disease (NAFLD)/ non-alcoholic steatohepatitis (NASH) is a rising epidemic with a potential for life threatening complications, especially in individuals with diabetes mellitus (DM) and metabolic syndrome. Though liver biopsy remains the recommended gold standard for diagnosing liver fibrosis, due to its technical feasibility and requirement of trained personnel, methods to develop non-invasive diagnostic tools for liver fibrosis have recently been underway. One such non-invasive method to diagnose liver fibrosis, point shear wave elastography using Acoustic Radiation Force Impulse (ARFI)-Imaging has gained remarkable results. This research was carried out to assess non-alcoholic steatohepatitis by acoustic radiation force impulse in individuals with diabetes and metabolic syndrome. Between March 2020 and October 2021, 140 patients with DM and metabolic syndrome, were identified. Demographic profile as well as reports of complete blood count, liver function tests, renal function tests, serum lipid profile, fasting blood sugar and postprandial blood sugar of the study participants were collected and recorded. Point shear wave liver elastography using ARFI imaging was performed for each of the study participant. NAFLD fibrosis score was determined in all of the study participants using appropriate software. Continuous and categorical variables were expressed as mean ± standard deviation and percentages respectively. Two-sided p values were considered as statistically significant at p value <0.05. Chi square test was done to see the association of clinical symptoms with fibrosis or non fibrosis. Independent t test was done to compare test variables and lab parameters between fibrosis and no fibrosis. Among the 140 study participants, 83 were males (59.29%) and 57 were (40.71%) females. On analysing the mean velocities measured by using ARFI elastography,30 participants (21.43%) had mean velocities >2.2m/s suggesting the presence of liver fibrosis and 110(78.57%) participants had mean velocities <2.2m/s did not have fibrosis. Among 83 males, 20(24.1%) had fibrosis and among 57 females, 10(17.5%) had fibrosis (p>0.05). Mean age of the 'Fibrosis' group was 54.53 (SD12.42) and that of the 'No fibrosis' group was 56.20(SD 11.76). Majority of the participants were between 56 and 65 years of age (50 participants). The mean height, weight and BMI of the 'Fibrosis' group was 152.84(±41.29), 73.33(±8.41), and 27.37(±2.73) respectively and that of the 'No fibrosis' group was 157.31(26.47), 70.89(12.46) and, 27.10(4.22) respectively (p>0.05). In the 'Fibrosis' group, majority (60%) were in the Obese 1 group and in the 'No fibrosis' group as well, majority were in the Obese 1 group (47.3%) (p=0.286). The mean (±SD) NAFLD- fibrosis Score was -1.54±1.06 in the 'No fibrosis' group and -0.61±1.81 in the 'Fibrosis' group (p value=0.012). There was no significant difference between fasting blood sugar, postprandial blood sugar, triglyce

Thyroidectomy is one of the commonest operative procedures performed in the neck and injury to recurrent laryngeal nerve (RLN) is not uncommon. It results in hoarseness to serious respiratory distress depending on the extent of the injury. The incidence of RLN injury varies widely and is multifactorial depending on the extent of surgical procedures, experience and expertise of the surgeons, nature of the thyroid diseases and a wide range of anatomical variations. Peroperative routine identification of the nerve during thyroidectomy can be a way to prevent injury. Despite recommendation for identification of the RLN peroperatively in thyroid surgery, a debate still exists whether the nerve to be identified peroperatively or not, to avoid its inadvertent injury. The aim of this study was to compare the incidence of RLN injury between two groups where RLN was identified peroperatively in one group and the nerve was not attempted for identification in the other group in thyroid surgery. A comparative cross-sectional study was carried out in the department of surgery and otolaryngology at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from June 2018 to November 2019, on patients who underwent elective thyroid surgery. Patients were included in RLN identified group and in RLN not identified group, by individual surgeons' preference to identify or not to identify the RLN peroperatively. Peroperative identification of the nerve was done by direct visualization. All cases were evaluated for vocal cord palsy preoperatively, during extubation and postoperatively. Patient's particulars, other parameters and perioperative data were recorded. A total of 80 cases were included in this study, 40 cases (50.0%) in the peroperative RLN identified group and 40 cases (50.0%) in the RLN not identified group. Unilateral RLN palsy was encountered in 2.5% (2 cases) in the RLN identified group and 6.3% (5 cases) in the nerve not identified group (p value 0.192). Transient unilateral RLN palsy was seen in 7.5% (6 cases) of patients; 2.5% (2 cases) in the RLN identified group and 5.0% (4 cases) in the RLN not identified group. And 1.3% (1 case) of permanent unilateral RLN palsy was encountered in this study, which was in the RLN not identified group; there was no permanent palsy in the RLN identified group. We did not encounter any bilateral RLN palsy. There was no statistically significant difference in the incidence of RLN injury between the peroperatively RLN identified group and no attempt to identify the nerve group despite recommendation for peroperative RLN identification in thyroid surgery to avoid its inadvertent injury. However, from this study, we recommend peroperative RLN identification in thyroid surgery to enhance surgical skill.

Chronic obstructive pulmonary disease (COPD) is a chronic obstructive disease of the airways. It is one of the most common and important chronic respiratory conditions in terms of years lived with disability. Incidence is increasing in Bangladesh like other developing countries. To evaluate drug prescription pattern for COPD, this cross-sectional, observational study was conducted from January to December in 2020 at the Department of Pharmacology in collaboration with the Department of Medicine in Mymensingh Medical College, Bangladesh. A total of 168 patients were selected for the study by non-random purposive sampling technique. Age distribution indicates that 31.5% of patients were in the 50-59 years age group and males were 93.5%. The majority (82.1%) of the participants were smokers. In this study, majority (34.12%) of the drugs were used as oral form and second most common dosage form was nebulization (26.75%). Bronchodilators were mostly prescribed 652(57.19%), followed by corticosteroids 222(19.47%) and antibiotics 165(14.47%) among drugs used for COPD. Beta sympathomimetics 322(45.49%) were mostly prescribed, followed by anticholinergics 186(28.52%) and methylxanthines 144(22.08%) as bronchodilators. Out of 1140 drugs for COPD, 53.06% and 34.12% were delivered as inhalation and oral forms, respectively. Inhalation route was the most (60.37%) preferred one over oral route (37.63%) for steroid use. The most of the patients [152 (90.48%)] were treated with combination therapy. Mostly (39.6%) used Fixed Dose Combination (FDC) therapy was salbutamol and ipratropium bromide followed by salmeteroal and Fluticasone (30.83%). Both FDC were prescribed in 57.7% of study population. Considering nomenclature, trade name was used in 24.4% of prescription.

This cross-sectional study was carried out in the Department of Radiology and Imaging, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from January 2015 to June 2016 in collaboration with Department of Neurosurgery and Department of Pathology of same hospital, to assess MRI findings of common IMSCTs and to find out the validity of MRI in the diagnosis of spinal ependymoma and astrocytoma, thereby differentiating these two common intramedullary entities. For this purpose, 40 patients aged from 15 to 60 years, who were diagnosed or suspected cases of having intramedullary spinal cord tumours were enrolled. These patients underwent preoperative MRI for evaluation of the spinal cord tumours during the study period in department of Radiology and Imaging. Also, patients were diagnosed by MRI as having IMSCTs incidentally was included. All of them were followed by histopathological examination of the same lesions after surgery. Among these 40 patients after exclusion for valid reason 28 cases were included as study population. MR images were obtained on a 1.5 Tesla (Avanto Magnatom, Siemens) unit with a spine surface coil. MRI findings were compared with histopathology after surgery keeping histopathology as gold standard. Out of 28 clinically and MRI diagnosed IMSCTs cases, 19 cases of ependymoma, 8 cases of astrocytoma and one diagnosed as hemangioblastoma by MRI. The mean age was 34.11±9.55 years, ranging from 15 to 56 years for ependymoma, 26.88±8.08 years ranging from 16 to 44 years for astrocytoma. Highest incidence (47.4%) was in between 31 to 40 years for ependymoma, 50.0% were in between 21-30 for Astrocytoma. On MRI majority 12(63.2%) of the cord ependymomas and majority 5(62.5%) of astrocytomas were in cervical region. While considering axial location ependymomas are mostly 17(89.5%) central and astrocytomas 5(62.5%) are eccentric in location. It was observed that out of 19 cases of ependymoma more than half 10(52.6%) had elongated shape, 12(63.1%) had well defined margin. Associated syringohydromyelia was present in 16(84.2%) cases. On T1WI 11(57.9%) and 8(42.1%) cases were iso and hypo respectively. On T2WI 14(73.7%) cases were hyper intense. After Gd-DTPA in most cases, 13(68.4%) cases showed diffuse enhancement. Noticeable and sizeable solid component observed among 13(68.4%) of the cases. Hemorrhage with cap sign was found in more than one third 7(36.8%) cases. Out of 8 cases of astrocytomas 4(50.0%) had lobulated shape, ill-defined margin 5(62.5%). T1WI: Iso 5(62.5%), hypo 3(37.5%), T2WI: hyper 5(62.5%), After Gd-DTPA: focal and heterogenous enhancement 3(37.5%) and rim enhancement 4(50.0%). Component: mixed 4(50.0%), cystic 3(37.5%) and solid 1(12.5%). Hemorrhage without cap sign 2(25.0%), associated syringohydromyelia 1(12.5%). In the case of evaluation of intramedullary ependymoma sensitivity of MRI in the present series is 94.44%, specificity 80.0%, Positive predictive value (PPV) 89.5%, Negative predic