Mymensingh medical journal : MMJ最新文献

Stress-induced hyperglycemia (SIH), reflected by an elevated glycemic gap, has been associated with poor outcomes in acute coronary syndromes. This study aimed to evaluate the association between glycemic gap and in-hospital adverse outcomes in patients experiencing their first attack of acute ST-elevation myocardial infarction (STEMI) who were managed with thrombolytic therapy. This cross-sectional comparative study was conducted at Mymensingh Medical College Hospital, Mymensingh, Bangladesh from October 2019 to March 2021. In this study 287 first-time STEMI patients were included who underwent thrombolysis. Total patients were divided into two groups based on glycemic gap: Group I (>40mg/dL) and Group II (≤40mg/dL). The mean age in Group I and Group II was 55.36±13.28 and 53.06±11.64 years respectively. Males predominated in both groups. Hypertension, diabetes mellitus and sedentary lifestyle were significantly more prevalent in Group I. Admission blood glucose and glycemic gap were significantly higher in Group I (p<0.001). In-hospital complications were significantly more common in Group I, including heart failure (60.2% vs. 28.3%, p<0.001), cardiogenic shock (35.16% vs. 17.75%, p<0.01) and mortality (13.28% vs. 5.66%, p<0.05). Multivariate analysis identified elevated glycemic gap as an independent predictor of heart failure (OR=2.746; 95% CI: 1.060-2.657; p=0.007). This study found that a high glycemic gap is significantly associated with adverse in-hospital outcomes in first-time STEMI patients treated with thrombolysis, suggesting it's potential as a useful prognostic marker for identifying high-risk individuals who require closer care.

Symptoms persisting for more than three weeks after the diagnosis of Covid-19 are known as Post-Covid syndrome. The leading symptoms during Covid-19 are acute and the most of patients recover fully but a significant portion of patients are suffering from long-term health consequences. This study aimed to find out the variation and severity of Post-Covid syndrome. This cross-sectional descriptive study was conducted among adult population (age more than 18 years) from October 2022 to December 2022 residing in some selected villages in Chandina, Upazila of Cumilla, Bangladesh. Sample size was 335. Data were collected using a semi-structured questionnaire by face to face interview. The most common symptoms among the study population in post Covid-19 condition were fatigue 205(61.2%), followed by palpitation 161(48.1%), headache 149(44.5%), mental problem 142(42.4%), sleep disturbances 128(38.2%), anosmia 109(32.5%), abdominal pain 106(31.6%), respiratory distress 92(27.5%) and weight gain or loss 76(22.7%). A wide variety of clinical manifestations including fatigue, palpitation, dyspnea, headache, mental problem, sleep disturbances, anosmia and respiratory distress were the frequent post-covid-19 syndrome.

Type 2 diabetes mellitus (T2DM) poses an important worldwide health challenge, impacting over 400 million individuals globally. It ranks as the seventh most common reason for mortality. Among its forms, T2DM is the most widespread, accounting for close to 90.0% of all identified cases. Recognized as a critical chronic health issue, Type 2 diabetes contributes to early morbidity, heart-related conditions and various other health complications. Over the last two decades, advancements in medical science have introduced novel medications to manage high levels of blood sugar in T2DM. Alongside these developments, updated clinical guidelines now emphasize strict glucose management in the initial phases of the condition. This has complicated the selection of appropriate medications, leading to significant shifts in prescription trends, with notable differences observed across nations based on available treatment options. The study aimed to judge the various categories of oral diabetes medications used at the start of therapy, the prevalence of single-drug versus multi-drug approaches and the average count of medications suggested per patient visit. This cross-sectional study was conducted in the Department of Pharmacology in collaboration with the Department of Endocrinology Outpatients' Department in Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh. The mostfrequently used single drug is metformin (38.92%) and the most generally used combination therapy is Sulfonylurea + Biguanides + DPP4 inhibitor (44.77%). It is concluded that in T2DM cases, metformin was the most usually used drug both in initial drug treatment and as a single drug treatment. Sulfonylurea + Biguanides + DPP4 inhibitor was the most common blend therapy for T2DM.

Type 2 diabetes mellitus (T2DM) is developed through the coexistence of β-cell dysfunction and insulin resistance. T2DM causes multiple complications, increase mortality and morbidity that make huge social and economic burden. Bangladesh is experiencing a rising prevalence of the disease, posing major challenges for health policy planners. Circulating ferritin concentrations may be related with the advanced risk of T2DM, regardless of iron status. Dysregulation of ferritin and glucose level may exert reciprocal effects. The goal of this study was conducted to evaluate and compare serum ferritin between type 2 diabetic patients and non diabetic apparently healthy groups. This cross-sectional analytical type of study was completed in the Biochemistry department of Mymensingh Medical College and samples were collected from the Endocrinology department of Mymensingh Medical College Hospital, Mymensingh, from July 2023 to June 2024. Through the purposive non-random sampling approach, total 132 study subjects were selected according to inclusion and exclusion criteria. Among them, 66 patients with type 2 diabetes mellitus, diagnosed according to ADA criteria, aged from 30 to 65 years of both male and female, were selected as Group I (Case). Another 66 non diabetic apparently healthy individuals of the same age and sex matched, were selected as Group II (Control). Informed written consents were taken. Baseline parameters were accumulated and recorded in pre-designed data collection sheets. Fasting serum glucose and serum ferritin levels were analysed, Mean±SD was used to express all values. Statistical analysis was done by using SPSS (statistical product and service solutions) version 26.0 windows package. By using Student's unpaired 't' test, quantitative continuous variables were compared between groups of study subjects and qualitative variables by Chi-square test. By using Pearson's correlation coefficient test correlations were done. Following comprehensive analysis, it was revealed that highly significant (p<0.001) raised of serum ferritin level in patient with T2DM (185.83±57.19μg/L) case group when compared with non diabetic (102.59±40.56μg/L) control group. Also showed that, highly significant positive correlations of fasting serum glucose with serum ferritin level in patients with T2DM (r=0.542, p<0.001). This study will provide fruitful information to the clinicians to advance their knowledge to overall management of T2DM. So, it is suggested timely evaluation and regular monitoring of serum ferritin in T2DM.

Fibroids are the most common pelvic tumors in women; serious complications are very rare but can be life threatening also. This case report highlights the atypical presentation of spontaneous hemorrhage and gangrene from a uterine myoma that clinicians should consider as a differentials diagnosis of haemoperitonium. It adds to the existing literature in discussing the investigations and management of these rare fibroid complications. We present a case of an atypical presentation of spontaneous hemorrhage from a uterine fibroid with gangrene with no precipitating factors. A 36-year-old lady who was diagnosed as a case of sub serous pedunculated fibroids presented to us with acute abdominal pain and high fever in an unstable condition who required 2 units of blood transfusion. Her ultrasound examination revealed abdominopelvic ascites, two solid pelvic mass most likely right adnexal origin, her vital signs revealed tachycardia with raised temperature, her abdomen was soft but tender with mild distension. Her tumor marker was raised CA-125 (137μ/ml), there was neutrophilic leucocytosis, negative urine pregnancy test-all together made a diagnostic dilemma, so plan for exploratory laparotomy was done with frozen section biopsy facility. After laparotomy a huge hemoperitonium was found. Hemorrhagic fluid was sent for cytology. Two large twisted gangrenous fiboids were found, there was bleeding from surface vein overlying uterine myoma. Gangrenous myoma was sent for frozen section biopsy. After frozen section biopsy report definitive surgery was done with preservation of one ovary. Patient was discharged on 4th post-operative day with no complaints. Haemorrhage and gangrene secondary to a uterine fibroid are a rare complication of uterine fibroids that clinicians must consider. Initial rapid imaging can be used to narrow down the diagnosis. Prompt resuscitation, definitive surgical management in a multidisciplinary team approach will aid in management and improve outcomes.

Iron deficiency is the commonest cause of anemia of postpartum stage which can easily be treated. Antenatal iron therapy results rapid and increased iron storage and ensures better maintenance of Hb concentration with optimum compliance. Objective of the study was to compare whether ferric carboxymaltose are more beneficial than iron sucrose in the treatment of postpartum anemic patients. This randomized clinical trial study was carried out in the Department of Obstetrics and Gynecology of Sir Salimullah Medical College & Mitford Hospital, Dhaka, Bangladesh. A total of 70 postpartum mild to moderately anemic women during July 2021 to June 2022 were enrolled and randomly divided into two groups; Group I: receive ferric carboxymaltose and Group II: receive iron sucrose. Statistical analyze was performed by window based software with Statistical Packages for Social Sciences (SPSS-22.0). Out of 70 women 40(57.1%) had mild anemia and 30(42.9%) had moderate anemia. In mild anemia group, the mean improvement of haemoglobin was 2.51±0.01 mg/dl in Group I and 2.21±0.02 mg/dl in Group II after 4 weeks. Similarly, in moderate anemia group the mean improvement of haemoglobin was 5.15±0.01 mg/dl in Group I and 4.41±0.2 mg/dl in Group II after 4 weeks. Haemoglobin level in ferric carboxymaltose group was significantly (p<0.05) more rises with compared to iron sucrose group. Injection site problem was found 3(8.6%) in Group I and 9(25.7%) in Group II. The injection site problem was statistically significant (p>0.05) between two groups. Regarding the costing, 700Tk. had Ferric carboxymaltose in mild and 1550Tk in moderate, 1300Tk had Iron sucrose in mild and 3000Tk. in moderate. Ferric carboxymaltose is an equally effective, safe and better alternative to iron sucrose for the treatment of iron deficiency anemia in postpartum patients.

Acute kidney injury (AKI) is a common complication of leptospira infection. The changes in renal function during leptospira infection are related to prognosis and mortality of patients. The risk factors for developing AKI after leptospira infection include systemic and renal hemodynamic changes secondary to impaired renal function. Aims of the study were to evaluate the clinical features, biochemical parameters and outcomes of leptospira-associated acute kidney injury (AKI) according to the Acute Kidney Injury Network (AKIN) classification and to identify the predictors of mortality in affected patients. This observational study was conducted in the Department of Nephrology, Mymensingh Medical College Hospital, Bangladesh for one year. A total of 31 patients with acute leptospiral infection were enrolled in the study. Clinical examinations, laboratory investigations, management and outcomes of the patients were recorded in a structured case record form. These patients are divided according to the AKIN classification. After the collection of data, statistical analysis of the results was carried out. Out of 31 patients, the majority (58.1%) was between 31-50 years of age, with a mean age of 46.5±17.2 years (range 17-87). Males predominated (83.9%), with a male-to-female ratio of 5.2:1. Among the patients with AKI, 6(19.4%) required hemodialysis, 3(9.7%) died and 28(90.3%) recovered. Notably, maximum non-survivors were classified as AKIN stage 3. Univariate regression analysis demonstrated that Pulmonary edema (p=0.01), shock (p=0.01) emerged as significant predictors of mortality. Tachycardia (p=0.05) was also associated with higher odds of death were associated with mortality. There was a strong association between AKIN classification and patient outcome, with AKIN stage 3 predicting the highest mortality. Early recognition and timely initiation of dialysis in patients with AKIN stage 3 may improve survival. The early detection of AKI caused by severe leptospira infection is important to reduce associated morbidity and mortality. In first health care settings, the utilize of serum markers such as serum creatinine measurement continues to be very important. The AKIN stages are used to clarify the severity of patients.

Hypertension (HTN) is both a cause and effect of Chronic kidney disease (CKD) and affects the vast majority of CKD patients. HTN control is important for those patients who are suffering from CKD. The risk and progression of CKD may reduce by controlling HTN. Now a days CKD is globally increasingly prevalent condition and is strongly associated with circumstance of cardiovascular disease (CVD). CKD is a rising health problem and one of the major causes of mortality. Control of HTN plays a major role in preventing its progression to end stage kidney disease and death. The objectives of the study were to evaluate the class, dosing schedule of antihypertensive prescribed in CKD and the percentage of monotherapy and combination therapy. This cross-sectional, observational study was conducted in the Department of Pharmacology in collaboration with the Department of Nephrology out patients' Department in Mymensingh Medical College Hospital, Bangladesh from January 2021 to December 2021. Most commonly used single drug is Calcium channel blocker (13.27%) and most commonly used combination therapy is Calcium channel blocker (CCB) and Angiotensin II receptor blockers (ARBs). It is concluded that in CKD with HTN, majority of patients were treated with combination therapy. CCB was found to be the commonest prescribed antihypertensive in monotherapy and in combination therapy. According to JNC8 guideline majority of the BP goals were achieved.

The increasing number of reports from various parts of the world regarding Covid-19 vaccine-related cutaneous events has led to growing concerns about identifying the adverse cutaneous reactions among vaccinated individuals in Bangladesh. The study aimed to characterize the spectrum of cutaneous outcomes following SARS-CoV-2 vaccination and to assess their association with the types and doses of vaccine. From November 2021 to April 2022, a prospective observational study was conducted at the Kuwait Bangladesh Friendship Government Hospital in Dhaka, involving 252 subjects who reported cutaneous reactions within six weeks following Covid-19 vaccination. Data were collected through face-to-face interviews, physical examination and laboratory investigations by using a pre-tested questionnaire. Data were entered in SPSS 26.0. Descriptive analysis and association of variables were seen by frequency distribution and Chi-square analysis with a p-value less than or equal to 0.05. The average age of the study participants was 33.89±14.61 years, 51.2% were male and 48.8% were female. Most cutaneous reactions were observed among those who were vaccinated with Moderna (54.8%). The average gap between vaccination and onset of cutaneous eruption was 10.52±7.67 days. The cutaneous reactions mostly followed the booster dose. The nine cutaneous outcomes were generalized pruritus, urticaria, morbilliform eruption, the flare of dermatophyte infection, palpable purpura, local injection-site reaction, chilblain-like reaction, herpes zoster and diffuse hair loss. Generalized pruritus and urticaria were significantly associated with the booster dose, whereas morbilliform eruption was associated with the first and second doses. Cutaneous reactions found in this study were not severe and cured completely within a few days following symptomatic management.

Paediatric pancreatitis remains a poorly diagnosed clinical entity with widely variable etiology. Children (up to 18 years of age) diagnosed with pancreatitis and treated in the department of Pediatric Gastroenterology of BMU, Dhaka, Bangladesh were included in this study. Over a period of 4 years (from January 2020 to February 2024), total 101 children were enrolled in this single center, prospective cross sectional study. Paediatric Pancreatitis: Acute pancreatitis (AP), acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) was defined by the International Study Group of Pediatric Pancreatitis: In Search for a Cure consortium. During the study period, a total of 101 cases of pancreatitis 42(41.6%) AP, 26(25.7%) ARP and 33(32.7%) CP was managed. The mean age of the study population was 10.38±3.7 (range- 4 to 17) years, with a male to female ratio of 51:50 (1.02:1). The etiology of AP included biliary 9(21.0%): 2 gallstones, 5 choledochal cyst, 2 biliary ascariasis; viral infection 2(4.8%): 1 Mumps, 1 Hepatitis A; drugs 3(7.2%): 2 L-asparaginase, 1 vincristine; trauma 1(2.3%), Hypertriglyceridemia 1(2.3%) and idiopathic 26(61.9%). Local complications of all pancreatitis cases: acute fluid collections in 5(4.95%), pseudocysts in 5(4.95%) and pancreatic ascites in 3(2.97%) cases. Almost half (11/26) of CP had calcific pancreatitis and the etiology of CP was tropical calcific pancreatitis in 11(42.3%), SPINK1/PRSS gene mutation in 2(7.2%), cystic fibrosis in 1(3.8%), trauma in 1(3.8%) and idiopathic in the remaining 11(42.0%) cases. Three (3.5%) patients with CP developed diabetes mellitus and 6(7.0%) patients had steatorrhea. The etiology of ARP was biliary in 6(18.0%) cases; 1 choledochal cyst, 4 gallstones, 1 biliary ascariasis), Hypertriglyceridemia in 2(6.0%), pancreas divisum in 1(3.0%) and idiopathic in 24(72.7%) cases. In this pediatric cohort, causes of acute pancreatitis were mostly idiopathic followed by biliary abnormality. There was no mortality in hospitalized patients of acute pancreatitis in our study. Half of chronic pancreatitis patients were calcific pancreatitis. As there was therapeutic limitation in performing ERCP in small children, proper management could not be given.