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Association of Insulin Resistance with Dyslipidemia in Gestational Diabetes Mellitus 妊娠期糖尿病胰岛素抵抗与血脂异常的关系
Pub Date : 2022-06-30 DOI: 10.3329/jcmcta.v33i1.67167
Hafsa Hasina, Md. Hafizul Islam, M. Haque, Razaul Karim, Shammi Akter, Ummey Salma
Background: Gestational Diabetes Mellitus is the most common metabolic condition during pregnancy. Insulin resistance is a known risk factor for development of GDM. Women with Gestational Diabetes Mellitus are at increased risk for developing dyslipidemia. The aim of this study was to evaluate the occurrence of Dyslipidemia among women with GDM.  Materials and methods: This cross-sectional comparative study was conducted in Obstetrics and Gynecology Department, Chittagong Medical College Hospital. 100 patients were taken by non-probability convenience sampling where 70 women with GDM were taken as cases and 30 normal pregnant women as controls.Results: GDM cases presented significantly higher mean HOMA-IR values and increased serum TC, TG, LDL-C and decreased HDL than those of controls. So from this point of view GDM cases had both insulin resistance and dyslipidemia. GDM patients with Insulin resistance had significantly higher Triglyceride level and decreased serum HDL-C level when compared to non-insulin resistance state of the same. This study revealed significant association of insulin resistance with dyslipidemia (Increased TG and decreased HDL-C, p<0.01) in GDM.Conclusion: Insulin resistance was significantly associated with dyslipidemia in GDM. Soestimation of fasting lipid profile and fasting insulin in women with GDM may provide baseline information in course of planning and management of GDM patients.JCMCTA 2022 ; 33 (1) : 40-45
背景:妊娠期糖尿病是妊娠期最常见的代谢疾病。胰岛素抵抗是GDM发展的已知危险因素。患有妊娠期糖尿病的妇女发生血脂异常的风险增加。本研究的目的是评估GDM女性中血脂异常的发生情况。材料与方法:横断面比较研究在吉大港医学院附属附属医院妇产科进行,采用非概率方便抽样法选取100例患者,其中70例为GDM患者,30例为正常孕妇。结果:GDM组HOMA-IR平均值显著高于对照组,血清TC、TG、LDL-C均升高,HDL均降低。因此,从这个角度来看,GDM患者同时具有胰岛素抵抗和血脂异常。与非胰岛素抵抗状态相比,胰岛素抵抗的GDM患者甘油三酯水平明显升高,血清HDL-C水平明显降低。本研究显示胰岛素抵抗与GDM患者血脂异常(TG升高,HDL-C降低,p<0.01)有显著相关性。结论:胰岛素抵抗与糖尿病患者血脂异常密切相关。因此,评估GDM女性的空腹血脂和空腹胰岛素水平可以为GDM患者的计划和管理过程提供基线信息。Jcmcta 2022;33 (1): 40-45
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引用次数: 0
A Six Months Analysis of COVID-19 Death : Experience From a Tertiary Hospital, Chattogram 某三级医院6个月COVID-19死亡病例分析
Pub Date : 2022-06-30 DOI: 10.3329/jcmcta.v33i1.67183
Rajat Sanker Roy Biswas, J. Nath, Fatema Emrose Nisha, P. Sarker
Background : COVID 19 pandemic had taken away lots of human life prematurely worldwide and death laid its icy hands also on Bangladesh. So, objectives of this study were to explore the monthly distributions, age, sex, comorbidities, localities and duration of hospital stay among the COVID 19 death cases.   Materials and methods: In this observational study six months hospital death registries were collected and explored for monthly distributions, age, sex, comorbidities, localities and hospital stay.  RT-PCR positive confirmed 113 COVID deaths were enrolled and suspected COVID deaths were excluded. Ethical clearance from the hospital authority was taken before hand. Data was compiled and analyzed by SPSS-20. Results: There was a low frequency of death in the months May-2021 and October-2021(7.1% and 2.7% respectively) but more during June -2021 to September 2021 (12.4%, 16.8%, 42.5% and 18.6% respectively). Female deaths were   more than male deaths (53.1% vs 46.9%, p<0.05). Age more than 51 years were the most vulnerable where 26(23%) deaths were at age group 51- 60 years, 39(34.5%) deaths were at 61-70 years and 22(19.4%) deaths were more than 71 years.  Mean age of death was found 60.66 years and mean duration of hospital stay was found 9.45 days.  Maximum duration of hospital stay was 45 days for one patient.  Co-morbidities of death cases revealed 52(46.00%) patients had DM and HTN both, 17(15.0%) patients had HTN, 16(14.1%) had DM, 3(2.6%) had BA and COPD, 4(3.5%) had CKD, 2(1.7%) had cancer, 3(2.6%) had CVD, 19(16.8%) had IHD and 16(14.1%) patients had no co-morbidities. Locality of the death cases revealed 44(38.9%) patients came from rural areas and 69(61.1%) came from urban areas.   Conclusion: Higher age group and multiple comorbidities specially DM, HTN and IHD were related with COVID deaths mostly found in our study. JCMCTA 2022 ; 33 (1) : 46-49
背景:COVID - 19大流行在全球范围内过早地夺走了许多人的生命,死亡也在孟加拉国展开了冰冷的手。因此,本研究的目的是探讨COVID - 19死亡病例的月分布、年龄、性别、合并症、地区和住院时间。材料和方法:在这项观察性研究中,收集了六个月的医院死亡登记,并探讨了每月分布、年龄、性别、合并症、地点和住院时间。纳入了RT-PCR阳性的113例COVID死亡病例,排除了疑似COVID死亡病例。事先获得了医院管理局的道德许可。采用SPSS-20对数据进行整理和分析。结果:2021年5 -2021年10月和2021年5 -2021年10月死亡率较低(分别为7.1%和2.7%),2021年6 -2021年9月死亡率较高(分别为12.4%、16.8%、42.5%和18.6%)。女性死亡率高于男性(53.1% vs 46.9%, p<0.05)。51岁以上是最脆弱的年龄组,其中26例(23%)死亡发生在51- 60岁年龄组,39例(34.5%)死亡发生在61-70岁年龄组,22例(19.4%)死亡发生在71岁以上年龄组。平均死亡年龄为60.66岁,平均住院时间为9.45天。一名患者的最长住院时间为45天。死亡病例合并症:糖尿病合并HTN 52例(46.00%),HTN 17例(15.0%),DM 16例(14.1%),BA合并COPD 3例(2.6%),CKD 4例(3.5%),癌症2例(1.7%),CVD 3例(2.6%),IHD 19例(16.8%),无合并症16例(14.1%)。农村44例(38.9%),城市69例(61.1%)。结论:高年龄组和多种合并症与新冠肺炎死亡相关,特别是DM、HTN和IHD在本研究中多见。Jcmcta 2022;33 (1): 46-49
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引用次数: 0
Malnutrition in Children with Uncomplicated Versus Complicated Appendicitis 非并发症阑尾炎与并发症阑尾炎儿童营养不良的比较
Pub Date : 2022-06-30 DOI: 10.3329/jcmcta.v33i1.67195
Md Tameem Shafayat Chowdhury, Rajib Khastagir, T. A. Chowdhury, Md. Abdullah Al Farooq, Md Khurshid Alam Sarwar, T. Chowdhury
Background : Acute appendicitis is one of the commonest surgical emergencies in children and malnutrition is prevalent in the country. This study was designed to compare if complicated appendicitis occurs more in malnourished children. Materials and methods: This cross-sectional study was conducted in Department of Paediatric Surgery, Chittagong Medical College Hospital from March 2017 to December 2019 with 155 children. Anthropometric measurements (Height, weight, Mid Upper Arm Circumference (MUAC) Triceps Skin Fold Thickness (TSFT) were recorded and biochemical assessment (Haemoglobin, albumin and total lymphocyte count) were done before surgery. Patients were grouped into two groups: Group A (Acute uncomplicated appendicitis; n=65) and Group B (Acute complicated appendicitis, n=90). Anthropometric and biochemical indices were compared between these two groups.   Results: Age ranged from 2 -12 years (Mean 9.2 ±2.5 years) (Male: female- 1.35:1). Among the five anthropometric indices abnormal measurements in Group A vs Group B were respectively. Abnormal TSFT (73.8% vs 80%, p=0.4) wasting (38.5% vs 44.4%, p=0.4) low MUAC for age (13.8% vs 17.8%, p=0.8) low weight for age (30.8% vs 36.7%, p=0.5) and low height for age (21.5% vs 24.4%, p=0.7) low albumin (52.3% vs 83.3%, p<0,001); low haemoglobin (61.5% vs 60.0%, p=0.6)) and low total lymphocyte count (39.5% vs 44.8%, p=0.7). Conclusions: Malnutrition was widely prevalent in both groups. Although the proportion of malnutrition was more with acute complicated appendicitis, it was not statistically significant. The lower serum albumin level in these patients might be due to the consequence of the disease rather than prevailing malnutrition. JCMCTA 2022 ; 33 (1) : 66-70
背景:急性阑尾炎是儿童最常见的外科急诊之一,营养不良在该国很普遍。本研究旨在比较营养不良儿童是否更容易发生复杂的阑尾炎。材料与方法:本横断面研究于2017年3月至2019年12月在吉大港医学院附属医院儿科外科进行,共有155名儿童。术前进行人体测量(身高、体重、中上臂围(MUAC))、肱三头肌皮褶厚度(TSFT)和生化评估(血红蛋白、白蛋白和总淋巴细胞计数)。将患者分为两组:A组(急性无并发症阑尾炎;B组(急性并发症阑尾炎,n=90)。比较两组的人体测量和生化指标。结果:年龄范围2 ~ 12岁(平均9.2±2.5岁)(男:女:1.35:1)。在五项人体测量指标中,A组与B组的异常测量值分别为。异常TSFT (73.8% vs 80%, p=0.4)、消瘦(38.5% vs 44.4%, p=0.4)、低MUAC (13.8% vs 17.8%, p=0.8)、低体重(30.8% vs 36.7%, p=0.5)、低身高(21.5% vs 24.4%, p=0.7)、低白蛋白(52.3% vs 83.3%, p< 0.001);低血红蛋白(61.5% vs 60.0%, p=0.6)和低总淋巴细胞计数(39.5% vs 44.8%, p=0.7)。结论:营养不良在两组患者中普遍存在。急性并发阑尾炎患者营养不良比例较高,但差异无统计学意义。这些患者血清白蛋白水平较低可能是由于疾病的后果,而不是普遍的营养不良。Jcmcta 2022;33 (1): 66-70
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引用次数: 0
Risk Factor Evaluation of Non Alcoholic Fatty Liver Disease in Lean Individual 瘦人非酒精性脂肪肝的危险因素评价
Pub Date : 2022-06-30 DOI: 10.3329/jcmcta.v33i1.67194
M. N. Mohsin, Salahuddin Mohammed Ali Haider, F. Akter, E. Ahmed, B. Paul
Background : Non-Alcoholic Fatty Liver Disease (NAFLD) is epidemic around the world. Bangladesh is also experiencing an increasing trend of NAFLD. Obesity is a common clinical phenotype associated with NAFLD, which is linked to metabolic syndrome and related comorbidities, including type II diabetes, hypertension and dyslipidemia. Clearly, not all obese subjects develop NAFLD and NAFLD also can be found in non-obese patients. This subset of individuals, known to have ‘lean NAFLD’ or ‘non-obese NAFLD’, is growing increasingly prevalent. NAFLD in lean patients appears to be more common among Asians. So it is important to look for risk factors for NAFLD in lean patients for prevention of advanced liver disease. The objective of our study was to find out the risk factors of NAFLD in lean (Nonobese) individual. Materials and methods: It was prospective observational study done on 100 patients attending in the Gastroenterology Department and OPD of Chittagong Medical College Hospital after approval of Ethical and Review Committee of CMC and grant from DGHS. Total 100 patients having 18 to 65 years of age, were taken as study subjects who met inclusion criteria. Informed written consent was obtained from the patients or attendant after full explanation of the purpose of the study. Fasting Blood Glucose (FBS) Fasting lipid profile, SGPT, SGOT, Ultrasonography of hepatobiliary system and Fibrosan were done. All necessary data was included in the data collection sheet and was analyzed by Microsoft excel and SPSS-23. Results: 100 patients were included in this study. Mean age of this study with age was in between 18 years to 65 years.Male to female ratio was 3:1 in the studied population.The majority of the lean patient with NAFLD (31%) was in the age group 40-49 years. The majority of the lean patient with NAFLD (83%) was in normal BMI range 18.5-22.99 kg/m2 and 13% had BMI <18.50 kg/m. Out of 100patients diabetes and hypertension were found 22% and 17% of patients respectively. 22% and 17% patients. 65% and 37% patients had raised SGPT and SGOT respectively. Out of 100 subjects, 50% had raised triglyceride level (50%) and 18% had raised LDL cholesterol (18%) level.According to Ultrasonography findings 68% were in Grade I, 11% in Grade II and only 1 patient was in Grade III fatty liver. Fibroscan of 100 subjects, Significant fibrosis ( ³2 F) was observed in 9%,  while advanced fibrosis (F4) was seen in 4% of patients.  As per steatosis score 36% was in S2 and 34% were in S3 grade. Median fibrosis score and steatosis score was significantly higher in patients with high SGPT compared to patients with normal SGPT (p <0.005) whereas median fibrosis score and steatosis score was higher in patients with high SGOT compared to patients with normal SGOT, but only the difference in steatosis score reached statistical significance (p<.042). AUC of SGPT for discriminating fibrosis grade F0-F1 from Grade F2-F4 was 0.565 (95% CI: 0.404-0.726, p=0.519). AUC of SGOT for
背景:非酒精性脂肪性肝病(NAFLD)在世界范围内流行。孟加拉国也正在经历NAFLD的增加趋势。肥胖是与NAFLD相关的常见临床表型,它与代谢综合征和相关合并症有关,包括2型糖尿病、高血压和血脂异常。显然,并非所有肥胖患者都会发生NAFLD,非肥胖患者也会发生NAFLD。这类个体,被称为“瘦型NAFLD”或“非肥胖型NAFLD”,正变得越来越普遍。瘦弱患者的NAFLD似乎在亚洲人中更为常见。因此,寻找瘦患者NAFLD的危险因素对于预防晚期肝病非常重要。本研究的目的是找出瘦(非肥胖)个体NAFLD的危险因素。材料与方法:经中华医学会伦理审查委员会批准,DGHS资助,对吉大港医学院附属医院消化内科和门诊就诊的100例患者进行前瞻性观察性研究。选取100例年龄在18 ~ 65岁的患者作为研究对象,符合纳入标准。在充分解释研究目的后,获得患者或护理人员的知情书面同意。测定空腹血糖(FBS)、空腹血脂、SGPT、SGOT、肝胆系统超声及纤维蛋白。所有需要的数据都包含在数据收集表中,并通过Microsoft excel和SPSS-23进行分析。结果:100例患者纳入本研究。这项研究的平均年龄在18岁到65岁之间。研究人群中男女比例为3:1。大多数瘦的NAFLD患者(31%)年龄在40-49岁之间。大多数消瘦NAFLD患者(83%)BMI在18.5 ~ 22.99 kg/m2的正常范围内,13% BMI <18.50 kg/m。在100名患者中,糖尿病和高血压分别占22%和17%。22%和17%的患者。分别有65%和37%的患者提高了SGPT和SGOT。100名受试者中,50%的人甘油三酯水平升高(50%),18%的人低密度脂蛋白胆固醇水平升高(18%)。超声检查显示,ⅰ级占68%,ⅱ级占11%,ⅲ级脂肪肝仅1例。在100例受试者的纤维扫描中,9%的患者观察到明显纤维化(2 F),而4%的患者观察到晚期纤维化(F4)。按脂肪变性评分,36%为S2级,34%为S3级。高SGOT患者的中位纤维化评分和脂肪变性评分明显高于正常SGOT患者(p< 0.005),高SGOT患者的中位纤维化评分和脂肪变性评分明显高于正常SGOT患者(p< 0.042),但只有脂肪变性评分差异有统计学意义。SGPT鉴别F0-F1级和F2-F4级纤维化的AUC为0.565 (95% CI: 0.404-0.726, p=0.519)。SGOT区分F0-F1级和F2-F4级的AUC为0.573 (95% CI: 0.342-0.803, p=0.474)。这表明SGPT或SGOT值在预测显著纤维化方面没有显著作用(³2F)。SGPT区分S0-S2级和S3-S4级脂肪变性的AUC为0.565 (95% CI: 0.404-0.726;p = 0.519)。SGOT区分S0-S2级和S3-S4级脂肪变性的AUC为0.573 (95% CI: 0.342-0.803, p=0.474)。这表明SGPT和SGOT在预测显著脂肪变性(³3S)方面具有重要作用。多因素logistic回归分析显示,年龄较大(p< 0.028)和女性(p<0.013)是非肥胖NAFLD患者显著纤维化(³F2)的独立预测因素。结论精益型NAFLD已在临床实践中得到广泛认识,但其流行病学、危险因素、生理病理、组织学特征、自然病史及治疗等方面的资料尚少。从生物学角度来看,瘦型NAFLD与肥胖型NAFLD非常相似。我们的研究可能有助于发现非肥胖NAFLD的危险因素,这可能有助于通过早期干预预防肝脏疾病的进展。Jcmcta 2022;33 (1): 56-65
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引用次数: 0
Association of Serum C-Peptide with the Components of Metabolic Syndrome among Non Diabetic Obese 非糖尿病性肥胖患者血清c肽与代谢综合征成分的关系
Pub Date : 2022-06-30 DOI: 10.3329/jcmcta.v33i1.67411
Shammi Akter, Md. Hafizul Islam, M. Haque, N. Tasnim, Hafsa Hasina, Mosammat Tanjina Akther
Background: Obesity is a major health concern and is associated with metabolic syndrome that increases the risk for cardiovascular disease and diabetes mellitus. C-peptide or connecting peptide, is a short polypeptide that connects A-chain of insulin to its B-chain in the proinsulin molecule.  In different studies it was found that C-peptide level are associated with Metabolic Syndrome and its complication. C-peptide is also reported to be more reliable than insulin as a measure of endogenous insulin secretion, insulin resistance and pancreatic beta cell function. The aim of the study is to observe the association of C-peptide levels with the components of metabolic syndrome in non diabetic obese subjects. Materials and methods: This was a hospital based cross- sectional study comprising hundred non diabetic apparently healthy obese subjects age between 30-70 years. This study was carried out at the Department of Biochemistry and Outpatient Department of endocrinology, Chittagong Medical College Hospital. Samples were collected by non-probability convenient sampling.   Results: Serum C-peptide was significantly higher in Metabolic Syndrome positive subjects (4.29 ±0.28 ng/ml) than non-Metabolic Syndrome (1.72 ± 0.12ng/ml). There was significant association between Metabolic Syndrome and increased serum C-peptide concentration. Serum Cpeptide levels were significantly associated and positively correlated with serum triglyceride, blood pressure, fasting plasma glucose and negatively correlated with HDL-C in the cases. Conclusion: However, this study did not find any significant association between WC (Waist Circumference) or HDL and Serum C-peptide concentration. Higher Cpeptide level was associated with the components of Metabolic Syndrome and BMI (obesity) was the most important factor affecting the C-peptide concentration to develop Metabolic Syndrome. JCMCTA 2022 ; 33 (1) : 148-153
背景:肥胖是一个主要的健康问题,与代谢综合征相关,代谢综合征可增加心血管疾病和糖尿病的风险。c肽或连接肽,是一种短多肽,在胰岛素原分子中连接胰岛素的a链和b链。不同的研究发现c肽水平与代谢综合征及其并发症相关。据报道,c肽作为内源性胰岛素分泌、胰岛素抵抗和胰腺细胞功能的测量指标比胰岛素更可靠。本研究的目的是观察c肽水平与非糖尿病性肥胖受试者代谢综合征组成的关系。材料和方法:这是一项以医院为基础的横断面研究,包括100名年龄在30-70岁之间的非糖尿病、明显健康的肥胖受试者。本研究在吉大港医学院附属医院生化科和内分泌科门诊进行。样本采集采用非概率方便抽样。结果:代谢综合征阳性组血清c肽含量(4.29±0.28 ng/ml)明显高于非代谢综合征组(1.72±0.12ng/ml)。代谢综合征与血清c肽浓度升高有显著相关性。血清肽水平与血清甘油三酯、血压、空腹血糖呈显著正相关,与HDL-C呈负相关。结论:本研究未发现腰围和HDL与血清c肽浓度有显著相关性。c肽水平升高与代谢综合征各组成部分相关,BMI(肥胖)是影响代谢综合征发生的最重要因素。Jcmcta 2022;33 (1): 148-153
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引用次数: 0
Study of Sociodemographic Characteristics, Clinical Profile and Pattern of Pathogens of Meningitis in Children Admitted in A Tertiary Level Medical College Hospital 某三级医学院附属医院住院儿童脑膜炎的社会人口学特征、临床特征及病原菌类型研究
Pub Date : 2022-06-30 DOI: 10.3329/jcmcta.v33i1.67225
K. Nahar, Md. Shah Alam, M. Chowdhury, N. Nahar
Background: CNS Infection are likely to arouse tremendous anxiety in both the physician and the patients. It is one of the most potentially serious infections occurring in children and important cause of mortality and morbidity in worldwide. Laboratory surveillance of pathogen is crucial in formulating the empirical treatment guidelines. To evaluate sociodemographic characteristics, clinical profile and pattern of pathogens of meningitis in children. Materials and methods: A descriptive study was carried out in paediatric Inpatient Department of Pediatric CMCH (Chittagong Medical College Hospital) Chattogram during the period of May 2013 to April 2014 where History, clinical examination and CSF sample were obtained from 40 patients of suspected meningitis. Diagnosis was based on the clinical presentation and CSF analysis.   Results: In this study, out of 40 patient, 25 patients were diagnosed as bacterial meningitis and 15 patient were diagnosed as aseptic meningitis based on clinical features and CSF analysis. 20% Culture positive bacterial menigitis was found, S pneumonae was found the leading pathogen. Overall, mortality rate was 2.5 %. Conclusion: Bacterial meningitis is a medical emergency. Making an early diagnosis and prompt treatment are lifesaving. For Starting early empirical treatment of meningitis, knowledge about the local pathogen is necessary. JCMCTA 2022 ; 33 (1) :77-81
背景:中枢神经系统感染可能引起医生和患者极大的焦虑。它是发生在儿童中的最严重的潜在感染之一,也是世界范围内死亡率和发病率的重要原因。病原体的实验室监测对于制定经验性治疗指南至关重要。评估儿童脑膜炎的社会人口学特征、临床特征和病原体类型。材料与方法:对2013年5月至2014年4月在吉大港医学院附属儿科医院儿科住院部进行描述性研究,收集40例疑似脑膜炎患者的病史、临床检查及脑脊液样本。诊断依据临床表现和脑脊液分析。结果:本研究40例患者中,根据临床特征及脑脊液分析,25例诊断为细菌性脑膜炎,15例诊断为无菌性脑膜炎。培养阳性细菌性脑膜炎占20%,主要病原体为肺炎链球菌。总体死亡率为2.5%。结论:细菌性脑膜炎是一种急症。早期诊断和及时治疗可以挽救生命。对于脑膜炎的早期经验性治疗,了解当地病原体是必要的。Jcmcta 2022;33 (1):77-81
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引用次数: 0
Diagnostic Value of Urinary Neutrophil Gelatinase-Associated Lipocalin in Detecting Acute Kidney Injury in Asphyxiated Term Neonates 尿中性粒细胞明胶酶相关脂钙蛋白检测窒息足月新生儿急性肾损伤的诊断价值
Pub Date : 2022-06-30 DOI: 10.3329/jcmcta.v33i1.67419
M. Hossain, S. Biswas, M. Islam, Md. Akram Ullah, N. Sultana, Fuad Md Abdul Hadi, Muhammad Jabed Bin Amin Chowdhury, J. C. Das
Background: Neonates with Perinatal Asphyxia (PNA) are at higher risk for developing Acute Kidney Injury (AKI). Conventionally, Serum Creatinine (SCr) is used to diagnose AKI but lacks specificity during the first few days of life. Neutrophil Gelatinase-Associated Lipocalin (NGAL) has emerged as a novel biomarker of AKI in such situations, while its value in our setting is yet to be validated. The study aimed to evaluate the role of urinary NGAL (uNGAL) level as a predictive biomarker of AKI in term newborn infants with PNA. Materials and methods: This prospective observational study included 55 full-term neonates with PNA from the Special Care Neonatal Unit of Chittagong Medical College Hospital.The uNGAL was measured by an enzyme-linked immunosorbent assay. Urinary samples were obtained for uNGAL on postnatal day 1(after 6 hours), and on day 3, blood samples for sCr were obtained on postnatal day1, 3 and 6. Results: Among 55 neonates with PNA, 20 (36.4%) had AKI. The mean ±SD uNGAL level was 97.77±17.13 ng/ml in neonates with AKI compared to 25.76±2.19 ng/ml in those without AKI in the first postnatal day. An uNGAL cutoff value of 28.86 ng/ml had 90.0% sensitivity and 82.9% specificity in predicting AKI the same day. The mean value of uNGAL was observed at a lower level, 54.53±14.72 ng/ml vs 15.17±2.18 ng/ml in AKI and no AKI neonates on third postnatal days. The cutoff value for detecting AKI was seen to be 26.43 ng/ml with high validity on this day. Significant differences in sCr were observed between AKI and no AKI measuring on days one and three, whereas the difference was not significant on day six. Conclusion: The study showed that uNGAL might be a valuable biomarker for predicting AKI among neonates with PNA. JCMCTA 2022 ; 33 (1) : 173-177
背景:围产期窒息(PNA)新生儿发生急性肾损伤(AKI)的风险较高。传统上,血清肌酐(SCr)用于诊断AKI,但在生命的最初几天缺乏特异性。中性粒细胞明胶酶相关脂钙蛋白(NGAL)已成为这种情况下AKI的一种新的生物标志物,但其在我们的环境中的价值尚未得到验证。该研究旨在评估尿NGAL (uNGAL)水平作为PNA足月新生儿AKI的预测性生物标志物的作用。材料和方法:本前瞻性观察研究纳入吉大港医学院附属附属医院特护新生儿病房55例足月PNA新生儿。uNGAL采用酶联免疫吸附法测定。在出生后第1天(6小时后)采集尿液样本检测uNGAL,在第3天,在出生后第1、3和6天采集血液样本检测sCr。结果:55例PNA患儿中,有20例(36.4%)发生AKI。在出生后第一天,AKI新生儿的平均±SD uNGAL水平为97.77±17.13 ng/ml,而非AKI新生儿的平均值为25.76±2.19 ng/ml。uNGAL临界值为28.86 ng/ml,预测当天AKI的敏感性为90.0%,特异性为82.9%。出生后第3天,AKI组和非AKI组uNGAL平均值较低,分别为54.53±14.72 ng/ml和15.17±2.18 ng/ml。当天AKI检测截止值为26.43 ng/ml,具有较高的效度。在第1天和第3天观察到AKI和无AKI之间的sCr有显著差异,而在第6天差异不显著。结论:研究表明uNGAL可能是预测PNA新生儿AKI的有价值的生物标志物。Jcmcta 2022;33 (1): 173-177
{"title":"Diagnostic Value of Urinary Neutrophil Gelatinase-Associated Lipocalin in Detecting Acute Kidney Injury in Asphyxiated Term Neonates","authors":"M. Hossain, S. Biswas, M. Islam, Md. Akram Ullah, N. Sultana, Fuad Md Abdul Hadi, Muhammad Jabed Bin Amin Chowdhury, J. C. Das","doi":"10.3329/jcmcta.v33i1.67419","DOIUrl":"https://doi.org/10.3329/jcmcta.v33i1.67419","url":null,"abstract":"Background: Neonates with Perinatal Asphyxia (PNA) are at higher risk for developing Acute Kidney Injury (AKI). Conventionally, Serum Creatinine (SCr) is used to diagnose AKI but lacks specificity during the first few days of life. Neutrophil Gelatinase-Associated Lipocalin (NGAL) has emerged as a novel biomarker of AKI in such situations, while its value in our setting is yet to be validated. The study aimed to evaluate the role of urinary NGAL (uNGAL) level as a predictive biomarker of AKI in term newborn infants with PNA. \u0000Materials and methods: This prospective observational study included 55 full-term neonates with PNA from the Special Care Neonatal Unit of Chittagong Medical College Hospital.The uNGAL was measured by an enzyme-linked immunosorbent assay. Urinary samples were obtained for uNGAL on postnatal day 1(after 6 hours), and on day 3, blood samples for sCr were obtained on postnatal day1, 3 and 6. \u0000Results: Among 55 neonates with PNA, 20 (36.4%) had AKI. The mean ±SD uNGAL level was 97.77±17.13 ng/ml in neonates with AKI compared to 25.76±2.19 ng/ml in those without AKI in the first postnatal day. An uNGAL cutoff value of 28.86 ng/ml had 90.0% sensitivity and 82.9% specificity in predicting AKI the same day. The mean value of uNGAL was observed at a lower level, 54.53±14.72 ng/ml vs 15.17±2.18 ng/ml in AKI and no AKI neonates on third postnatal days. The cutoff value for detecting AKI was seen to be 26.43 ng/ml with high validity on this day. Significant differences in sCr were observed between AKI and no AKI measuring on days one and three, whereas the difference was not significant on day six. \u0000Conclusion: The study showed that uNGAL might be a valuable biomarker for predicting AKI among neonates with PNA. \u0000JCMCTA 2022 ; 33 (1) : 173-177","PeriodicalId":93458,"journal":{"name":"Journal of Chittagong Medical College Teachers' Association","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79299352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Etiological Spectrum of Diseases Among the Patients Presenting with per Rectal Bleeding Attending at Surgery Outpatient Department in a Tertiary Level Hospital 某三级医院外科门诊直肠出血患者的病因学分析
Pub Date : 2022-06-30 DOI: 10.3329/jcmcta.v33i1.66908
Mayin Uddin Mahmud, M. Hossain, Ajoy Kumer Ghosh, R. Reza
Background: Per rectal bleeding is a problem that is frequently encountered by doctors. There is marked geographical variation in the frequency of different etiologies. This study was conducted to determine the frequency of various causes of per rectal bleeding in patients attending in a tertiary level hospital in Chittagong, Bangladesh. Materials and methods : It was a retrospective study, and non-probability purposive sampling was done. All the patients over ten years of age presenting at the Surgery Outpatient Department with the complain of per rectal bleeding were included. A total of 685 patients were included in this study over a period of 2 years. Results: Mean age of the patients was 36 ± 13 (Mean ± SD) with a range of 10-82 years. Male-female ratio was 1.5:1. Haemorrhoids were the most common cause (34.6%) of per rectal bleeding, followed by chronic anal fissure (26.1%), chronic anal fissure with haemorrhoids (14.9%), colorectal polyps (11.4%) colorectal cancer (8.3%) and Inflammatory Bowel Diseases (IBD) (0.9%). No cause of per rectal bleeding was found in 3.8% of patients. Maximum patients with colorectal cancer presented in their fifth and sixth decades of life.   Conclusion: Haemorrhoids and fissures in ano are the most common causes of per rectal bleeding in our setting. However, the number of colorectal polyps and colorectal cancers are not negligible. JCMCTA 2022 ; 33 (1) : 9-14
背景:直肠出血是医生经常遇到的问题。不同病因的发病频率有明显的地理差异。本研究旨在确定在孟加拉国吉大港一家三级医院就诊的患者直肠出血的各种原因的频率。材料与方法:本研究为回顾性研究,采用非概率目的抽样。所有在外科门诊就诊的10岁以上以直肠出血为主诉的患者均纳入研究对象。为期2年的研究共纳入685例患者。结果:患者平均年龄36±13岁(Mean±SD),年龄范围10 ~ 82岁。男女比例为1.5:1。直肠出血最常见的原因是痔疮(34.6%),其次是慢性肛裂(26.1%)、慢性肛裂合并痔疮(14.9%)、结肠息肉(11.4%)、结直肠癌(8.3%)和炎症性肠病(0.9%)。3.8%的患者未发现直肠出血的原因。结直肠癌患者最多出现在五、六十岁。结论:痔和肛管裂是本院直肠出血最常见的原因。然而,结直肠息肉和结直肠癌的数量也不容忽视。Jcmcta 2022;33 (1): 9-14
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引用次数: 0
Accuracy of Frozen Section Biopsy in the Diagnosis of Ovarian Malignancy : An Institutional Experience 冷冻切片活检诊断卵巢恶性肿瘤的准确性:一种机构经验
Pub Date : 2022-06-30 DOI: 10.3329/jcmcta.v33i1.67291
Ismat Sultana, Mohammad Azizul Haque, N. Sultana, Nazmin Sultana, B. Nessa
Background: Women with early-stage ovarian cancer need surgical staging, which entails taking samples from areas within the abdominal cavity and retroperitoneal lymph nodes for further treatment. The frozen section is an essential and beneficial adjunct in the intraoperative diagnosis of ovarian tumors. The study aimed to evaluate the diagnostic accuracy of frozen section biopsy in malignant lesions among ovarian masses. Materials and methods: This was a cross sectional study. Thirty cases of ovarian masses from the patients who underwent laparotomy for ovarian massesat the Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from March 2014 to August 2014 were included in the study. Surgical specimens were first processed for frozen section reporting, then processed routinely for final paraffin section histopathology evaluation. Results of frozen and paraffin sections were categorized as benignand malignant, and the accuracy of the frozen section was determined. Results: The mean age was found to be 35.6±12.4 years, with a range from 14 to 70 years. Frozen section biopsy for evaluation of ovarian masses, true positive was in 6 cases and no false, one false negative and true negative in 23 cases identified by histopathology. Frozen section biopsy has a sensitivity of 85.7%, specificity of 100.0%, accuracy of 96.7%, a positive predictive value of 100.0%, and a negative predictive value of 95.8% in the evaluation of malignant ovarian masses. Conclusion: The present study confirms that frozen section diagnosis is a reliable method for the surgical management of patients with ovarian masses. JCMCTA 2022 ; 33 (1) : 144-147
背景:早期卵巢癌妇女需要手术分期,这需要从腹腔和腹膜后淋巴结内取样,以便进一步治疗。在卵巢肿瘤的术中诊断中,冷冻切片是一种必要而有益的辅助手段。本研究旨在评估冷冻切片活检对卵巢肿块中恶性病变的诊断准确性。材料与方法:本研究为横断面研究。2014年3月至2014年8月在孟加拉国达卡班班杜谢赫穆吉布医科大学(BSMMU)妇产科接受剖腹卵巢肿块手术的患者中,30例卵巢肿块被纳入研究。手术标本首先处理冷冻切片报告,然后常规处理最终石蜡切片组织病理学评估。冷冻切片和石蜡切片的结果被分类为良恶性,并确定冷冻切片的准确性。结果:患者平均年龄为35.6±12.4岁,年龄范围14 ~ 70岁。冷冻切片活检评估卵巢肿物,真阳性6例,无假,组织病理学鉴定假阴性1例,真阴性23例。冷冻切片活检评估卵巢恶性肿块的敏感性为85.7%,特异性为100.0%,准确性为96.7%,阳性预测值为100.0%,阴性预测值为95.8%。结论:冷冻切片诊断是卵巢肿物手术治疗的可靠方法。Jcmcta 2022;33 (1): 144-147
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引用次数: 0
Clinical Profile of RT-PCR Positive Paediatric Patients with COVID 19: Overview from Chattogram, Bangladesh RT-PCR阳性儿童COVID - 19患者的临床概况:来自孟加拉国Chattogram的综述
Pub Date : 2022-06-30 DOI: 10.3329/jcmcta.v33i1.67287
Zabeen Choudhury, Salina Haque, Aparup Das, S. Choudhury, H. M. Hira
Background: Coronavirus diseases 2019 (COVID-19) has become global pandemic. During the COVID-19 pandemics, caused by SARS-CoV-2, overall, children younger than 18 years are thought to account for only 1% to 2% of detected cases worldwide. COVID-19 has been found less frequent in children and studies on pediatric COVID-19 have also been less reported, especially from Bangladesh. To evaluate the clinical profile of RT-PCR- positive paediatric patients with COVID 19 in Chattogram region. Materials and methods: This cross-sectional study was conducted in OPD, Department of Paediatrics, Chittagong Medical Colllege Hospital (CMCH) Chattogram. All postCOVID paediatric patients reported as RT-PCR positive by Microbiology department of CMCH were enrolled in the study. The study was carried out from 1/8/21 to 31/01/22. According to inclusion/exclusion criteria 96 RT-PCR positive COVID-19 paediatric patients were taken as sample by convenient sampling for this study. The diagnosis of COVID 19 infection was confirmed by RTPCR report of nasopharyngeal or oro-pharyngeal swab. Patients, guardians were contacted over telephone to attend paediatric OPD of CMCH for clinical information & laboratory findings.   Results: Among them 96 children, 68.8% were in >5 years, 18.8% were in 1-5 years, and 12.4% were in the <1 year age group; 55.2% were female and 48.8% were male. About 66 (80%) patients had history of contact with suspected or confirmed COVID-19 patient. Total 21 patients got hospitalized. Mean ± SD of time from symptom onset to hospital admission was 4.76 ± 1.998 days. Duration of hospital stay was ranged from 4-14 days. Mean ± SD duration of hospital stay was 6.1 ± 2.385 days. Maximum (97.9%) patients had fever, 77.1% patients had cough and 29.2% patients had vomiting.  Majority (82.3%) of the patients had no co-morbidities. Mean ± SD Hb% (g/dl) was 12.04 ± 1.817 g/dl with range: 7-16 g/dl; median (IQR) WBC (/Cumm) was 9500 (720016000) (Range: 3200-26000), median (IQR) Neutrophil (%) was 64 (54-71) (range: 14-90), median (IQR) Lymphocyte (%) was 28 (22-36) (range: 6-74) and median (IQR) Platelet count (/Cumm) was 200000 (172500284000) (Range: 40000-418000). Raised CRP, D-Dimer and S. Ferritin level were found among 43 (75.4%), 8 (14.4%) and 38 (66.7%) patients respectively. Available CXR findings of 47 patients showed that, 21 (45%) had patchy opacity, 19 (40%) had no significant abnormality and 6 (13%) had bilateral consolidation. Paracetamol was the most frequently (83.2%) used drug for this infection. Oral antibiotic was used in 64.2% children, bronchodilator and zinc supplementation were given to 48.4% and 43.2% children respectively. Oxygen therapy was needed for 12.6% children. More than half (57.7%) of the patients reported to feel fatigue after COVID-19 infection. About 40.4% patients had shortness of breath, 38.5% patients had history of weight loss. And 25% patients had lost their taste/smell.   Conclusion: Clinical presentations of COVID-19
背景:2019冠状病毒病(COVID-19)已成为全球大流行。在由SARS-CoV-2引起的COVID-19大流行期间,总体而言,18岁以下的儿童被认为仅占全球发现病例的1%至2%。COVID-19在儿童中的发病率较低,关于儿童COVID-19的研究报告也较少,特别是在孟加拉国。目的:评价Chattogram地区RT-PCR阳性儿童COVID - 19患者的临床特征。材料与方法:横断面研究在吉大港医学院附属医院儿科门诊进行。所有经中华人民共和国医院微生物科报告为RT-PCR阳性的新冠肺炎患儿均纳入研究。研究时间为21年1月8日至22年1月31日。按照纳入/排除标准,采用便捷抽样法抽取96例RT-PCR阳性的COVID-19患儿作为本研究的样本。通过鼻咽拭子或口咽拭子的RTPCR报告确认COVID - 19感染的诊断。通过电话联系患者及其监护人,以获取临床信息和实验室结果。结果:96例患儿中,>5岁占68.8%,1-5岁占18.8%,<1岁占12.4%;女性55.2%,男性48.8%。66例(80%)患者有疑似或确诊患者接触史。住院21例。从症状出现到住院的平均±SD时间为4.76±1.998天。住院时间为4-14天。平均±SD住院时间为6.1±2.385天。发热占97.9%,咳嗽占77.1%,呕吐占29.2%。大多数(82.3%)患者无合并症。平均±SD Hb% (g/dl)为12.04±1.817 g/dl,范围为7 ~ 16 g/dl;中位数(IQR) WBC (/Cumm)为9500(720016000)(范围:3200-26000),中位数(IQR)中性粒细胞(%)为64(54-71)(范围:14-90),中位数(IQR)淋巴细胞(%)为28(22-36)(范围:6-74),中位数(IQR)血小板计数(/Cumm)为200000(172500284000)(范围:40000-418000)。CRP升高43例(75.4%),d -二聚体升高8例(14.4%),S.铁蛋白升高38例(66.7%)。47例患者的现有CXR结果显示,21例(45%)有斑片状混浊,19例(40%)无明显异常,6例(13%)双侧实变。扑热息痛是该感染最常用的药物(83.2%)。口服抗生素占64.2%,支气管扩张剂和补锌分别占48.4%和43.2%。12.6%患儿需要吸氧。超过一半(57.7%)的患者报告在感染COVID-19后感到疲劳。40.4%患者有呼吸短促,38.5%患者有体重减轻史。25%的患者失去了味觉和嗅觉。结论:儿童新冠肺炎临床表现较轻。本研究发现,发烧和咳嗽是COVID-19感染儿童的主要症状。呕吐、鼻塞和气味改变也是典型症状。CRP和S.铁蛋白水平升高是两个重要的实验室发现。Jcmcta 2022;33 (1): 124-131
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