Mymensingh medical journal : MMJ最新文献

Stroke, usually a focal rather than global neurological deficit resulting from vascular origin with sudden onset, may be with cerebral infarction or intracerebral haemorrhage. It results in brain oedema following vascular injury and electrolyte imbalance. A descriptive cross sectional study was carried out in the Department of Medicine, Mymensingh Medical College Hospital, Mymensingh, Bangladesh during March 2016 to May 2018 to assess the electrolyte levels among 220 purposively selected patients with stroke confirmed by CT scan. Data were collected by the principal investigator himself by using interview schedule and case record form after attaining consent. Blood samples were collected from the patients to carry out biochemical and haematological tests and to assess serum electrolyte levels. Data were cross-checked for completeness, consistency and relevancy, and were analyzed by computer software SPSS 20.0. Age was significantly higher in haemorrhagic stroke (64.88±13.00 years) than ischaemic stroke (60.92±13.96 years). Male (55.91%) were predominant than female (44.09%). One hundred nineteen (54.09%) patients had ischaemic stroke and 101(45.91%) patients had haemorrhagic stroke. The serum concentration of Na+, K+, Cl- and HCO₃- were measured during acute period of stroke. Imbalance in serum Sodium, Chloride, Potassium and Bicarbonate level were observed in 37.27%, 29.55%, 23.18% and 6.36% patients respectively. Hyponatremia, hypokalemia, hypochloremia and acidosis were most common electrolyte imbalance in both ischaemic and haemorrhagic strokes. In ischaemic stroke hyponatremia was 35.29%, hypernatremia was 3.36%, hypokalemia 19.33%, hyperkalemia 0.84%, hypochloraemia 30.25%, hyperchloraemia 3.36%, acidosis was in 6.72% and alkalosdis in 1.68% patients while in haemorrhagic stroke hyponatremia 33.66%, hypernatremia 1.98%, hypokalaemia 22.77% hyperkalemia 3.96%, hypochloremia 19.80%, hyperchloraemia 4.95%, acidosis 2.97% and alkalosis was in 0.99% of patients. Mortality was more in hyponatremic, hypokalemic and in hypochloremic patients.

Diabetic retinopathy (DR) is one of the most important causes of preventable visual impairment among patients of working age and leading cause of blindness. Deficiency of vitamin B12 and folate has been associated with increased serum homocysteine (Hcy) levels. This study was done to find out the role of vitamin B12 and Hyperhomocysteine (HHcy) in Diabetic retinopathy. The present study is a hospital-based case-control study conducted during over a period of 12 months from January 2019 to December 2019 study conducted in the Department of Ophthalmology at BIRDEM General Hospital, Dhaka, Bangladesh consisting of 100 Type 2 DM patients either with or without retinopathy (DR, n=50 and DNR, n=50, respectively). Subjects with Type 2 DM with and without retinopathy were recruited from patients attending in the department of Ophthalmology at BIRDEM General Hospital, Dhaka and were matched for duration of diabetes. Diabetes subjects on nutritional supplements for the last 6 months and those with a history of nephropathy (based standard renal function tests) and complications other than DR were excluded. Homocysteine (Hcy) levels were inversely related (p<0.05) with Diabetes patients with retinopathy. Vitamin B12 also significant correlated with Diabetes patients with retinopathy. A statistically significant negative linear relationship was found between serum homocysteine and vitamin B12 levels (Pearson r = -0.918, p=0.001) Diabetes patients with retinopathy. Vitamin B12 significantly correlated with diabetes retinopathy and homocysteine levels were inversely related with diabetes patients with retinopathy.

Cytomegalovirus infection can cause increased mortality and morbidity in renal transplant recipient. The purpose of the present study was to observe the clinical profiles and outcomes of Cytomegalovirus positive renal transplant patients in early post-transplant period. This prospective cohort study was conducted in the Department of Nephrology at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from September 2016 to August 2017. Adult patients who had undergone renal transplantation were selected as study population. CMV serology (CMV IgM and CMV IgG) of both donor and recipient were detected before renal transplantation. Cytomegalovirus viral DNA was extracted from both serum by using a commercially available DNA extraction kit and PCR was done by the StepOne™ PCR machine using real time PCR kit in all patient during the early post-transplant period. During this period, sign symptoms of patients with cytomegalovirus infection as well as clinical outcomes were also noted. Total number of 32 patients was included in this study with the mean age of 31.15±11.56 years. Cytomegalovirus was found positive in 11(34.4%) patients and negative in 21(65.6%) patients. Anorexia was the most common presentation which was found in 81.8% cases followed by renal impairment, fever, diarrhea, cough and weight loss which were present in 6(54.5%), 3(27.3%), 2(18.2%), 2(18.2%) and 2(18.2%) cases respectively. The outcomes of cytomegalovirus positive patients in first 6 months after renal transplantation revealed 25.0% patients had cytomegalovirus infection; 6.2% patients had cytomegalovirus disease and 6.2% patients were died. However, 9.4% patients had co-infection in the form of UTI and 6.2% patients had re activation of hepatitis C infection associated with cytomegalovirus infection. Cytomegalovirus was found positive in approximately one third of renal transplant recipients in early post-transplant period. Careful clinical evaluation and appropriate laboratory parameters should be looked over for timely diagnosis and management of these cases.

A prostate gland biopsy is a test to remove small sample of prostate tissue to be examined under a microscope. A biopsy may be done when a blood test shows a high level of prostate-specific antigen (PSA) or after a digital rectal examination finds an abnormal prostate or a lump. Transrectal ultrasound (TRUS) guided biopsy is a commonly performed procedure for the detection of prostate cancer. It is associated with serious complication like urosepsis. Although the incidence of post-TRUS urosepsis is low, when it occurs it is typically serious and leads to hospitalization. Antibiotics are used prior, during and after the procedure to prevent infections as a result of TRUS biopsy. Ciprofloxacin is being used as antibiotic of choice for a long time. Antibiotic prophylaxis may prevent such complications. This cross-sectional descriptive type of observational study was taken place in Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2010 to December 2011 among purposively selected 70 patients with an aim to determine the urosepsis and bacteriuria after TRUS guided prostate biopsy. Patients attending the Urology OPD in DMCH having of LUTS and other non-specific symptoms were evaluated by history, physical examination including digital rectal examination (DRE) and necessary investigations like serum PSA to identify the potential candidates. Patients with abnormal DRE findings and increased PSA level were included in this study and those who had any painful anal and rectal condition, bleeding diathesis, anticoagulant therapy and any known allergy to lidocaine, previously undergone prostrate biopsy and those who refused to give the informed consent were excluded from this study. Data were collected on variables of interest using a structured case record form. Data were processed and analyzed using Statistical package for social science (SPSS), version 17.0. Frequency of bacteriuria and urosepsis was measured according to urine and blood culture report. Sensitivity pattern was also seen. According to this study, the frequency of bacteriuria and urosepsis was 17.1% and 5.7% respectively. Most common uropathogen was E coli both in urine and blood culture. Organisms (100.0%) were found resistant to ciprofloxacin and amoxicillin. Most of the pathogens were sensitive to tobramycin, gentamycin and cefipime. A potentially dangerous ciprofloxacin resistant organism (ESBL producing E. coli) was found positive in 25.0% of culture positive patients.

Trichomonas vaginalis (T vaginalis) is the most prevalent non-viral sexually transmitted infection of the reproductive age group, which may lead to various complications, if left untreated. This study aimed to diagnose Trichomonas vaginalis infection by different diagnostic procedures and to evaluate the efficacy of different diagnostic procedures. This cross-sectional descriptive study was conducted among 102 women with vaginal discharge at the Department of Obstetrics & Gynecology at Mymensingh Medical College Hospital (MMCH) from July 2019 to December 2020. Three ectocervical swabs were collected from each patient. Saline wet mount microscopy, giemsa staining and PCR were performed for each patient. Data were collected using a structured questionnaire and analyzed using Excel 2007, statistical package for social sciences (SPSS) version 26.0. The PCR assay detected Trichomonas vaginalis positivity in 6(5.9%) of 102 patients, followed by Giemsa staining 4.9% and Wet mount examination 2.9%. Wet mount microscopy showed less sensitivity 33.33%, but high specificity 98.95%, 66.67% positive predictive value, 95.96% negative predictive value and accuracy 95.09%. The sensitivity, specificity, PPV, NPV and accuracy of Giemsa staining were 66.67%, 98.96%, 80.0%, 97.94% and 97.06% respectively. Statistical significance was observed when both WMM and Giemsa staining were compared to gold standard test PCR. In resource limited settings, a wet mount is a good option for diagnosis of T vaginalis infection as giemsa staining requires heavy T vaginalis infection to be positive. But wherever facilities are available, PCR should be performed.

Hypertension 'The sustained elevation of systemic arterial pressure' is a significant risk factor for heart disease, stroke and other cardiovascular diseases and an estimated 970 million people worldwide suffer from the disease resulting in significant morbidity, mortality and financial burden globally. It is the leading modifiable risk factor for morbidity and mortality worldwide. Worldwide an estimated 1.28 billion adults aged 30-79 years have hypertension, the majority (two-thirds) living with low and middle income countries. One of the global targets for non-communicable diseases is to reduce the prevalence of hypertension by 33% between 2010 and 2030.Sodium plays an important role in blood pressure regulation with a reduced sodium intake being associated with a reduction in systolic and diastolic blood pressure. This study was done to evaluate the differences in body mass index (BMI) and serum sodium in hypertensive and normotensive subjects. This analytical type of cross sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh between the periods from January 2022 to December 2022. A total number of 140 male subjects, age ranged from (30-59) years were included in this study. Among them, seventy (70) hypertensive subjects were taken as study group (Group II) and seventy (70) age matched normotensive subjects were taken as control group (Group I). The results were calculated and analyzed by using Statistical Package for Social Science (SPSS) version 26.0. Anthropometric measurements like height and weight taken in meter and kilogram respectively. Systolic and diastolic blood pressure was performed by aneroid sphygmomanometer (ALPK2, Japan), laboratory analysis of serum sodium by colorimetric method. In this study we found that body mass index in control group 23.59±1.29 kg/m² and study group 26.81±2.31kg/m²; blood pressure (systolic pressure in control group 113.21±6.76 mm Hg and in study group 149.14±5.03 mm Hg, diastolic pressure in control group 75.57±4.55 mm Hg and in study group 100.21±5.28 mm Hg) and serum sodium in control group 138.84±2.12 & in study group was 147.94±1.41 which were significant in study group in comparison with control group. In study group parameters were significantly increased in comparison to control male group. Therefore, by this study we recommended that routine estimation of these parameters is important for prevention of complication related to hypertension for leading a healthy life.

Brachial plexus injury is not uncommon in our country like Bangladesh and it causes functional damage and physical disability of the upper limbs. Most of the cases were caused by motor vehicle accident. We have conducted a prospective study for the operative treatment of 105 adult traumatic brachial plexus injury cases in Hand unit in the department of Orthopaedics, Bangabandhu Sheikh Mujib Medial University (BSMMU) during January 2012 to July 2019. The main surgical options for brachial plexus injury include primary reconstructive surgery such as neurolysis, direct repair, nerve graft, nerve transfer (neurotization) and possibly free functioning (gracilis) muscle transfer and secondary reconstructive procedure such as tendon transfer, arthrodesis, FFMT and bony procedure. Each of these procedures is used either alone or in combination for particular clinical scenarios. Aims and objectives of this study was to restoration of shoulder abduction and external rotation, elbow flexion and hand function are goal of treatment of adult traumatic brachial plexus injury. Age range was from 14 years to 55 years (mean age 26 years). Male were 95 and female were 10 cases. Time from trauma to surgery was valid 3 months to 9 months. Motor cycle accident was most common mechanism of injury. Upper plexus (C5, C6) injury was 52 cases, extended upper plexus (C5, C6 & C7) injury was 19 cases and global brachial plexus injury was 34 cases. When there is high suspicion of root avulsions, early exploration and reconstruction is indicated. Operate these patients 2-3 months after their injury. In other patients without high suspicion of root avulsion, we routinely perform exploration between 3 to 6 months after injury when no adequate sign of recovery are present. Common reconstructive options are any injury with neuroma in continuity with conductive nerve action potential (NAP): only neurolysis or any injury with nerve rupture or postganglionic neuroma not conducting nerve Action potential (NAP) and good proximal nerve: Direct repair or repair with nerve graft or nerve transfer if possible. Follow up period from 6 months to 6 years. The best results were obtained in C5, C6 and C5, C6 & C7 brachial plexus injury cases. SAN to SSN, Oberlin II and long head triceps motor branch to anterior division of axillary nerve transfer for C5 & C6 injury or upper plexus injury and in addition intercostals nerve to anterior division of axillary nerve and AIN branch of median nerve to ECRB for C5, C6 & C7 (extended upper plexus injury). Extra-plexus and intra-plexus neurotization was done in global brachial plexus injury cases and 5 cases by contra-lateral C7 to median nerve by vascularised ulnar nerve graft and only 2 cases contra-lateral C7 to lower trunk through pre spinal or pre tracheal route were done and only one case by FFMT. Few cases gain shoulder abduction and elbow flexion but no improvement of hand function and most cases even by FFMT still in follow up. Results of s

Menopause, in between the age of 45-55 years every woman faces it, that means completely stoppage of menstruation because the decrease level of estrogen from the normal level. In this period the quality life is disturbed due to hormonal imbalance specially estrogen. This study was done to evaluate the changes of body mass index and blood pressure in post-menopausal women in comparison to reproductive women. This cross-sectional analytical type of study was done in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh and the period is from January 2021 to December 2021. Total 140 women subjects age ranged between 25-65 years were involved in this study. Among them 70 post-menopausal women (45-65 years) were involved as study group (Group II) and 70 (seventy) reproductive women (25-45 years) were taken as control group (Group I). By anthropometric measurements, Body Mass Index (BMI) such as height and weight were taken in meter and kilogram respectively and systolic and diastolic blood pressure by aneroid sphygmomanometer (ALPK2, Japan). Findings were expressed as mean±SD and by unpaired student's 't' test, analytical significance of difference among the group was calculated. The mean±SD of BMI of Group I and Group II were 23.05±4.43kg/m² and 29.01±3.12kg/m² respectively. The mean±SD of body mass index is significantly higher in study group in comparison with control group. The average (±SD) of systolic blood pressure of control group I and study group II were 118.29±10.00 mm of Hg & 134.00±11.91 mm of Hg respectively. The mean±SD of systolic blood pressure was significantly higher in study group in comparison with control group. The mean±SD of diastolic blood pressure of control group I and study Group II were 79.21±6.46 mm of Hg and 89.00±6.23 mm of Hg respectively. The mean±SD of diastolic blood pressure was significantly higher in study group in comparison with control group. Post-menopausal women with high systolic and diastolic pressure have a chance of development of cardiovascular diseases, stroke. So assessment of these parameters are important for early detection and prevention of complication related to high BMI and Blood Pressure for leading a healthy life.

Failed Tracheal Intubation with Subsequent inability to maintain an open airway and adequate oxygenation is the most frequent cause of brain damage or death during anesthesia. Recognizing before anesthesia the potential for difficult intubation allows time for optimal preparation. Proper Selection of equipment and techniques is needed to avoid unwanted situation. To find out difficulties associated with endotracheal intubation using Modified Mallampati Test (MMT) combined with Thyromental Height Test (TMHT) and MMT without TMHT. This prospective observational study was conducted at the Department of Anesthesia in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from April 2018 to September 2018. Two hundred two patients with different surgical procedures under general anaesthesia in different operation theaters of BSMMU, Dhaka were selected as study population. After taking written consents from each patient or his/her attendant elaborate history of illness, meticulous clinical examinations were performed and relevant laboratory investigations were done. All information was recorded in a preformed data sheet and statistical analysis was done by SPSS-22.0. Mean age ±SD of the study subjects was 42.49±14.29 years in MMT with TMHT group and 43.40±15.39 years in MMT without TMHT group. Females were enrolled more than males in both the groups. BMI was 28.75±3.59kg/m² in MMT with TMHT group and 29.44±8.64kg/m² in MMT without TMHT group. There were no significant differences in age, gender and BMI between the groups. Sensitivity, specificity, PPV, NPV and accuracy were 100.0%, 96.0%, 96.2%, 100.0% and 98.0% respectively of MMT with TMHT in predicting intubation difficulty. Sensitivity, specificity, PPV, NPV and accuracy were 100.0%, 96.0%, 96.2%, 100.0% and 98.0% respectively of MMT only in predicting intubation difficulty. MMT combined with TMHT is a better predictor of intubation difficulty than MMT alone.

This study was aimed at exploring the causes of relaparotomy following caesarean section. The surgical procedures performed during relaparotomy were also discussed. This was a prospective study conducted in the Department of Obstetrics and Gynaecology, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from November 2020 to May 2021. MMCH is the largest referral Hospital in Mymensingh. During this study period 48 puerpera needed relaparotomy after caesarean section within 6 weeks of caesarean section. The frequency of relaparotomy was 2.6%. Of the 48 cases, 28(58.33%) cases needed relaparotomy due to post partum haemorrhage (PPH). Among them 9(18.75%) had primary PPH, 19(39.58%) patients had secondary PPH. Here 7(14.58%) patients suffered from sub rectus hematoma, 5(10.42%) patients had puerperal sepsis, 3(6.23%) had internal haemorrhage and 4(8.33%) women had wound dehiscence. Foreign body was removed in 1 case (2.08%). Main procedure performed was subtotal (45.83%) and total hysterectomy (25%). Coagulation failure and septicaemia were causes of maternal death. Case fatality rate was 4.17%. Obstetric patients who need relaparotomy face potential death. This study will help us to identify the causes for relaparotomy. Due precautions should be taken as far as possible to avoid this complications following caesarean section and thereby reduce maternal mortality and morbidity.