Mymensingh medical journal : MMJ最新文献

To find out the otological disease pattern of the patients attended at the Otolaryngology-Head & Neck Surgery outpatient department (OPD) of a tertiary level hospital, Dhaka, Bangladesh and to aware the people about the consequences of Ear diseases, necessity of prevention and early management. This study was done in the Otolaryngology-Head & Neck Surgery OPD of Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh from July 2014 to December 2014. Data were collected retrospectively from hospital record which were recorded by Resident Surgeon during his consultation of referral patients. Total 3686 patients were included in the study and data were analyzed. Out of 3686 OPD patients male were 1947(52.82%) and female 1739(47.17%), ratio 1.12:1. In age groups 11 to 40-year age group patients were more, among them 11-20 (17.25%), 21-30 (21.51%) and 31-40 (21.62%). 47.97% of the patients were presented with Ear diseases. Among the ear conditions CSOM (Chronic suppurative otitis media) were 19.96%, ASOM (Acute Suppurative Otitis Media) 2.54%, OME (Otitis media with effusion) 5.31%, Otomycosis 9.25%, Furunculosis 1.81%, Otosclerosis 0.57%, Foreign body ear 1.68%, Rupture TM (Tympanic membrane) 1.27% and Wax 4.74%. Prevalence of Ear diseases are more in Bangladesh like other developing countries. Most of the ear diseases can be managed in the local hospitals. For the proper management physicians working in those hospitals need training and adequate instruments. District hospitals and medical college hospitals should be well equipped with proper instruments and trained ENT surgeons.

Among other valvular heart disease Aortic stenosis (AS) is the most common in the developed world. Transcatheter Aortic Valve Replacement (TAVR) is most acceptable treatment option for patient with severely calcified aortic stenosis with high and intermediate risk group. Among several challenges, one of the main challenges is to deal with bicuspid aortic valve (BAV). Non-circular annulus, bulky leaflets leading to perivalvular leaks and risk for rupture and often very severe calcification may contribute to periprocedural strokes leading to poor clinical outcome. This case, a 68-year-old woman with a history of type 2 diabetes mellitus (DM), hypothyroidism, bicuspid aortic valve and severe aortic stenosis, bronchial asthma, who had repeatedly refused any suggestion for open heart surgery, was our volunteer candidate for TAVR. After successful TAVR the peak pressure gradient decreased from 100mmHg to 17mmHg. So, TAVR could be a viable option for highly selected patients with severe aortic stenosis and bicuspid aortic valve who have favourable anatomy.

A hospital-acquired infection (HAI) is acquired in a hospital or other health care facilities. This is an extra burden in every unit of hospital as it increases the morbidity, mortality, cost of treatment and also duration of the hospital stays for the patients. This study aimed to find out the causative bacterial agents of HAI from different clinical samples and their antimicrobial susceptibility patterns. This was a cross-sectional descriptive study conducted in the Department of Microbiology and Virology, Sylhet MAG Osmani Medical College, in collaboration with in-patient departments of Sylhet MAG Osmani Medical College Hospital from January 2019 to December 2019. A total of 123 patients of different ages, sex were enrolled in this study. Samples were collected from postoperative wounds, post catheterized urinary tract infections, diabetic wounds and intravenous cannula from Surgery ward, Medicine ward and Obstetrics & Gynecology ward. Standard laboratory procedures were applied to isolate and identify the bacteria. The identified organisms were then tested for anti biogram. Among 123 patients 46 (37.4%) were affected by hospital acquired infections. Higher prevalence (n=28, 60.87%) of HAI was found in Surgery ward and the lower prevalence (n=9, 19.56%) was found in Medicine ward and Obstetrics & Gynecology ward. The most common type of infection was surgical wound infection (20, 43.48%). Out of all the HAIs irrespective of source and site, highest number were done by Staphylococcus aureus (15, 30.61%) followed by Pseudomonas aeruginosa (08, 16.33%), Escherichia coli (07, 14.29%), Serratia spp. (05, 6.12%), Aeromonas spp. (05, 6.12%), Acinetobacter spp. (02, 4.08%), Proteus spp. (02, 4.08%), Citrobacter spp. (02, 4.08%), Klebsiella spp. (02, 4.08%), CoNS (02, 4.08%), Enterobacter spp. (01, 2.04%) and Morganella morganii (01, 2.04%). The antimicrobial susceptibility data suggested that Gram positive bacteria are more susceptible to doxycycline, vancomycin and linezolid; while Gram negative bacteria were more susceptible to imipenem, levofloxacin and meropenem.

Thalassemia is one of the most common haemoglobinopathies in the world. Transfusion dependent thalassemia patients need regular blood transfusion. Repeated blood transfusions lead to iron overloads which can affect various organs in the body including eyes. The present study aims to evaluate the ocular involvements in transfusion dependent thalassemia children and their relationship with duration of the disease and serum ferritin level. This cross-sectional observational study included 46 multi-transfused thalassemia children aged 3-18 years. Detailed ophthalmological examination including visual acuity, slit lamp bio microscopy, direct and indirect ophthalmoscopy was done. Statistical analysis was done using SPSS version (IBM) 23.0. Student's t-test and chi-square (χ²) test was done and p value of <0.05 was considered significant. Out of 46 thalassemia children male were 25(54.3%) and female were 21(45.7%). Mean age of the children was 8.94±5.04 years, mean duration of disease was 7.02±3.5 years and mean serum ferritin level 1543.68±914.43ng/dl. Ocular involvements were detected in 19(41.3%) children. Among them 8(17.39%) children had more than one ocular involvements. The ocular manifestations were decreased visual acuity in 17(36.95%), corneal dryness in 7(15.21%), lens opacity in 6(13.04%), optic disc atrophy in 7(15.21%), peripheral retinal pigmentation in 5(10.86%) and retinal vessels tortuosity in 3(6.52%) children. Higher serum ferritin level and increased duration of the disease were significantly (p<0.001) related with ocular involvement. Various ocular involvements were found in transfusion dependent thalassemia children. Therefore, transfusion dependent thalassemia children should be screened periodically for early detection and proper management of ocular changes.

Coronary heart disease (CHD) imposes a significant burden on health care systems because of high morbidity and mortality. There is documented evidence that South Asian people develop CHD at a higher rate and at an early age. If the affected individual is 40 years old or below, the tragic consequences are catastrophic. Identifying risk factors could be important for health promotion. The objectives of this study were to determine the frequency of risk factors in young patients with acute myocardial infarction and thus with ischemic heart disease (IHD) aged 40 years and below in our population. It was a descriptive observational study which was carried out at Coronary Care Unit of Rajshahi Medical college Hospital, Rajshahi, Bangladesh in 61 patients from January 2011 to June 2011. All patients who fulfilled the inclusion criteria admitted to coronary care unit (CCU) with a diagnosis of Acute MI were included. Their detailed history was then taken including symptoms at presentation and their risk factors were assessed according to the Framingham Risk Scoring System with the help of history and laboratory investigations. Mean age ±SD of the patients was 36±3.7 year. Most of the patients were male. Smoking was the major risk factor (73.8%) followed by family history of IHD (44.3%). Other risk factors were dyslipidaemia (39.35%), hypertension (37.7%), obesity (11.5%) and diabetes mellitus (8.2%). Majority of the patients were adopted in sedentary lifestyle. 91.8% patient presented with chest pain. Other symptoms were dyspnoea (37.7%), palpitation (59.0%), sweating (77.0%), nausea, vomiting (50.8%) and impaired consciousness (19.7%) etc. Most frequent risk factor for acute myocardial infarction (MI) at young age is smoking followed by family history of MI and dyslipidaemia. Majority of the patients had two or more than two identifiable antecedent risk factors.

Now-a-days Laparoscopic cholecystectomy is regarded as the gold standard treatment for benign gallbladder disease but in certain situations conversion to open cholecystectomy is extremely important for the safety of the patient. The objective of this study was to evaluate the reason for conversion of this operation to open surgery. This prospective study was carried out on 392 patients in a single unit of Department of Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh and in a private hospital from July 2013 to December 2018. Maximum (28.3%) patients were 31-40 years age group. Majority (75.3%) was female and 24.7% were male. It was observed that only 2.1% were converted due to dense adhesion (n=3), severe inflammation (n=2), difficult to define anatomy of Calot's triangle (n=2) and Mirizzi syndrome (n=1). Meticulous dissection and proper case selection can reduce the rate of conversion to open surgery.

Topical application of honey results in disinfecting the wound infection promptly and also expedites healing. Being cheap and widely available, honey can be an excellent alternative to be used as a topical antimicrobial agent. This study observes the in vitro growth inhibitory activity of different concentration of honey for different bacterial strains. This experimental study had been carried out in the Department of Pharmacology and Therapeutics of Sir Salimullah Medical College and Mitford Hospital (SSMC), Dhaka, Bangladesh in collaboration with Microbiology, Department of Sir Salimullah Medical College and Mitford Hospital (SSMC), Dhaka, Bangldesh over a period of one year from July 2018 to June 2019. Using the Agar dilution method to detect the antimicrobial activity of honey on 18 bacterial isolates belong to enterobacteriaceae family namely, 8 bacterial isolates of Salmonella Enterica Serovar Typhi, Five (5) bacterial isolates of Escherichia coli and 5 bacterial isolates of Pseudomonas aeruginosa. The mean of the minimum inhibitory concentration (MIC) of honey for the isolates of Salmonella enterica serovar typhi was 15.35±12.39mg/ml, ranged between 3.56 and 41.6mg/ml (0.25% - 3.0% v/v). In case of the isolates of Escherichia coli the mean MIC of honey recorded at 28.53±16.18mg/ml and the growth was ranged between 7.10 and 48.3mg/ml (0.5% - 3.50% v/v). And the mean of the MIC of honey for the isolates of Pseudomonas aeruginosa was 20.31±13.20mg/ml, ranged between 10.63 and 41.6mg/ml (0.75% - 3.0% v/v). The brilliant antibacterial activity of honey against clinical bacterial isolates indicates the usefulness of honey in clinical practice against bacterial infection.

Weight management is central to the treatment of infertile women with polycystic ovary syndrome. Both body mass index and waist circumference are measures of obesity. The objective of the study was to examine the clinical importance of waist circumference and body mass index in predicting insulin resistance. The cross-sectional study involved a total of 126 consecutive infertile women with polycystic ovary syndrome attending the Infertility unit of the Department of Obstetrics and Gynaecology of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2017 to December 2017. The anthropometric measurements like weight, height and waist circumference were made and body mass index and waist hip ratio were calculated. Fasting insulin and fasting plasma glucose were estimated in early follicular phase of menstrual cycle. Insulin resistance was calculated with HOMA-IR. Body mass index and waist circumference were examined for clinical prediction of insulin resistance by ROC curve analysis. The mean age was 25.56±3.90 years. Mean body mass index was 26.79±3.25, mean waist circumference was 90.9±9.4cm. By body mass index thresholds, 47.9% of the women were overweight, 39.7% of the women were obese. By waist circumference threshold, 80.2% of the women were centrally obese. Body mass index and waist circumference, both had significant correlation with hyperinsuliaemia. When body mass index and waist circumference were examined for predicting insulin resistance by sensitivity, specificity, positive likelihood ratio and negative likelihood ratio, waist circumference appeared to have moderate clinical importance compared to the negligible role of body mass index. Waist circumference may be a better predictor of insulin resistance than body mass index in infertile women with polycystic ovary syndrome.

Vulvovaginal Candidiasis (VVC), a frequent and cumbersome reproductive tract infection affects women's physical and mental health. Although Candida albicans was reported as the most common agent of VVC yet, recently there are significant changes in the pattern of Candida species causing VVC with varying antifungal susceptibility pattern. Therefore this cross-sectional, descriptive type of observational study conducted to identify the spectrum of Candida species associated with VVC and assesses their antifungal susceptibility pattern from March 2021 to February 2022. High vaginal swabs from 175 patients clinically suspected of VVC were collected and cultured on Sabouraud dextrose agar with Chloramphenicol. Species were identified by phenotypic methods like- germ tube test, sub-culture in chromogenic agar media and genotypic methods like- Polymerase chain reaction (PCR), Restriction fragment length polymorphism (RFLP). Antifungal susceptibility was done by disk diffusion method. Out of 175 patients, 52(29.7%) were positive for Candida species. Of the isolates- C. albicans 34(65.0%), Non albicans Candida (NAC) 18(35.0%). Among NAC, C. glabrata 5(9.6%), C. tropicalis 5(9.6%), C. parapsilosis 4(7.7%) and each of C. krusei, C. kefyr, C. ciferrii, C. dubliniensis were 1(1.9%). On susceptibility testing highest resistance was to Clotrimazole 31.0% followed by Nystatin 13.0%, Itraconazole 12.0% and Fluconazole 10.0%. Resistance to azole was higher in NAC than in albicans. Of these patients, 16(31.0%) had history of recurrent VVC (RVVC) of which 12(75.0%) were by NAC, predominantly C. glabrata 5(32.0%). The results showed the increasing incidence of NAC associated vaginitis with higher resistance and recurrence that should be considered in gynecology clinics.

Metabolic dysfunctions are common in polycystic ovary syndrome (PCOS). Alongside its utility in PCOS diagnosis, anti-Mullerian Hormone (AMH) is emerging as a metabolic risk marker in PCOS. Data relating to the metabolic importance of AMH in Bangladeshi women with PCOS are lacking. This study aimed to evaluate serum AMH in newly diagnosed women with PCOS and correlate the AMH levels with their clinical, hormonal, and metabolic parameters. This cross-sectional study evaluated 150 newly diagnosed women with PCOS attending a tertiary hospital in Bangladesh from January 2020 to December 2020. Alongside clinical assessment, blood glucose, lipids, total testosterone (TT), thyroid-stimulating hormone (TSH), prolactin and AMH were measured. The median age of the study subjects was 21.5 years (interquartile range 18.0-26.0 years); the median AMH level was 5.09ng/dL (interquartile range 3.64-7.73ng/dL) and 52.0% had metabolic syndrome. Age, body mass index, waist circumference, systolic and diastolic blood pressure, fasting plasma glucose, plasma glucose 2 hours after oral glucose tolerance test, triglyceride, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, TT, TSH, and prolactin levels and the frequencies of hirsutism and metabolic syndrome were similar across the quartiles of AMH. AMH correlated with none of the variables except TT, with which a strong positive correlation was found. Participants with PCOS phenotype A had the highest AMH levels, and the difference in AMH across the phenotypes was statistically significant.