Mymensingh medical journal : MMJ最新文献

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease involving both upper and lower motor neurons. Its underlying etiology is not well established. But certain risk factors including genetic predilection and exposure to certain environmental toxins like Organophosphorus Compounds (OPC) have been postulated. Here we describe a young male patient presented with progressive weakness of all four limbs immediately following survival from OPC ingestion as a suicidal attempt. He also had slurred, indistinct speech without swallowing difficulty and sensory findings. Neurological examination findings are having mixed upper and lower motor neuron signs. EMG (Electromyography) shows features of denervation and reinnervation suggestive of ALS. ALS following single exposure to OPC is a relatively rare finding. Supportive treatments including physiotherapy and psychotherapy were given. This case may strengthen the etiological link between OPC and ALS.

Sudden sensorineural hearing loss is a medical emergency. Incidence is very low. Unilateral SSNHL is common and mostly idiopathic. Spontaneous recovery rate is 30-65% within 2 weeks. Bilateral SSNHL is a rare subset, less than 5% of reported SSNHL and higher association with systemic disease. Prognosis is very poor following treatment. Recovery of hearing after 3 months following SSNHL is a very rare entity. Spontaneous hearing gain after a long time is a miracle that happened in the reported case. A 12-year-old female child suddenly recovered serviceable hearing few days prior to the date of cochlear implant surgery following SSNHL. She developed a very rare bilateral sudden sensorineural hearing loss two years back. Bilateral sudden sensorineural hearing loss is a rare subset though unilateral SSHL is little common. Recovery of hearing occurs mostly within two weeks, very rare beyond sixty days. Our case reported sudden hearing gain about two years after insidious SSNHL. Explanations not clear provably reestablishment of vascularity to cochlear or spontaneous elimination of underlying cause. No available data found, further study is needed.

Parkinson's disease (PD) is a common neurodegenerative disorder. The pathogenesis of PD is unknown till now. The high-sensitivity C-reactive protein (CRP) is a non-specific biochemical marker of inflammation. It is used for the screening of organ diseases and the monitoring of responses to treatment in cases of inflammation and infection. This study aimed to evaluate the relationship of high-sensitivity C-reactive protein in early Parkinson disease. A total of seventy-six early Parkinson's disease patients were enrolled in this Cross-sectional observational study which was carried out in the Department of Neurology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from September 2014 to March 2016. We assessed high sensitivity CRP of early Parkinson's disease patients as an inflammatory marker. This study was performed with 76 early Parkinson disease patients. Among them, male and female were 69.7% and 30.3% respectively. The mean ±SD age of patients was 53.25±11.53 years with an age range of 24 to 77 years. The mean ±SD value of high-sensitivity C-reactive protein was estimated 2.76±3.57 mg/L with the range of 0.21 to 20.90mg/L. We also calculate the 95% CI in the range of 1.96 to 3.56mg/L. Also, a positive and highly significant correlation were seen in between duration of tremor and High sensitivity CRP (r=0.430, p<0.001) and between duration of bradykinesia and High sensitivity CRP (r=0.426, p<0.001) which indicate increase duration causes increase level of high-sensitivity C-reactive protein value. In conclusion, above findings suggests that neuro-inflammation plays a significant role in the pathogenesis of early Parkinson's disease progression.

Recurrent respiratory papillomatosis (RRP) is a rare disease which is caused by human papilloma virus (HPV). It is a warty growth in the upper airway may cause significant airway obstruction or voice change. Though it is rare but one with severe morbidity and occasional mortality. It is caused mostly by HPV 6 and 11. Juvenile-onset recurrent respiratory papillomatosis (JoRRP) which is Juvenile form of RRP affects children, most common between the ages of 1 to 4 years.

Now-a-days, all over the world, skin disease are the fourth most common cause of disability. A significant amount of patient attending the dermatology outdoor of any major hospital in a daily basis. Irrational drug prescribing is a common contemplation in clinical practice. The present research work was commenced to study the drug use pattern and rationality of prescriptions of the patients be at Dermatology Out-Patient Department (OPD) of a tertiary care hospital. It was an observational, single center study, conducted among 600 patients attending the Dermatology OPD of Enam Medical College and Hospital (EMCH), Bangladesh for a period of six months by interviewing the patients and detailed were filled in predesigned form. Overall 600 drug instructions were collected and surveyed for demographic as well as dermatological profile. Antihistamine (16.95%), antibacterial (14.69%), antifungal (10.73%) and corticosteroids (8.47%) were the most recurrent class of drugs ordered. Combination form (oral + topical) was mostly instructed (61.80%). Polypharmacy was seen (3.54 drugs per prescription) in our study, very few drugs (1.97%) name were written by generic name. antihistamine were most frequently advised drug groups. Least amount of drugs was prescribed from Essential Drug List (EDL) of Bangladesh. Interim auditing is necessary to promote standard prescription.

Low free Tri-iodothyronine (FT₃) levels are generally associated with poor prognosis in patients with various critical illnesses. Acute ST-segment Elevation Myocardial Infarction (STEMI) represents the most lethal form of Acute Coronary Syndrome (ACS) with substantial short- and long-term mortality. This study was done to assess the association between FT₃ levels and in-hospital outcome of the STEMI patients treated with streptokinase therapy. This was an observational study of 140 patients of STEMI treated with streptokinase therapy in the department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh from October 2018 to September 2019. The patients were divided into the low FT₃ (FT₃ <3.5 pmol/L; n=70) and the normal FT₃ (FT₃ ≥3.5 pmol/L; n=70) groups according to FT₃ levels measured within 24 hours after admission. During the index hospitalization period, 13 patients died (9.0%) and the overall mortality rates were 18.6% in the low FT₃ group and 5.7% in the normal FT₃ group (p=0.01). The rates of Major cardiac events (MACE) were 45.7% in the low FT₃ group and 18.6% in the normal FT3 group (p=0.001). Multivariate logistic regression analysis showed FT₃ level is an important predictor for in-hospital major cardiac events in patients with ST-elevation Myocardial Infarction (p=0.01). Low FT₃ levels were strongly associated with poor in-hospital outcome in patients with STEMI. The FT₃ level screening may be a simple and valuable way in identifying high-risk STEMI patients.

Multiple myeloma (MM) is a haematological neoplasm of mature B-cell lineage origin. It is characterized by abnormal clonal proliferation of plasma cells and presence of monoclonal protein in serum and / or urine. This study was conducted to observe the International Staging System (ISS) status and trends of relapse. This descriptive cross-sectional study was performed in the department of Haematology, Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2019 to July 2020 among 81 purposively selected Multiple myeloma patients. Principal investigator collected data using Case Record Form (CRF) after obtaining informed consent. Relevant ethical issues and data quality assurance were taken into consideration. Data were analyzed with Statistical Package for Social Sciences (SPSS), Version 25.0. Chi square test, Fisher's exact test and Chi square test with Yate's correction were carried out as appropriate with five percent level of significance for assessing statistical association. Mean age of patients with Multiple myeloma was 58.9±12.0 years. Male female ratio was nearly 2:1. ISS stage III was in 59.4 percent cases, lytic lesions were present in 75.0% and mean Bone Marrow Plasma Cell (BMPC) percentage was 62.1±24.9 percent. Immuno-Fixation Electrophoresis (IFE) revealed IgG Kappa (47.3%), IgG Lambda (25.5%) IgA Lambda (10.9%), IgA Kappa (7.2%) and Free Light Chain (9.1%). Kappa lambda ratio was 60.7:39.3. Free Light Chain (FLC) ratio ≥100 was in 29.0 percent cases. Four-fifths 65(80.2%) cases were de novo, while nearly one-fifth 16(19.8%) were the relapsed cases. Mean duration to become relapsed or refractory was 37.6±19.4 months. Significant association was observed among advanced ISS staging with refractory or relapse. Erythrocyte sedimentation rate in 1st hour (ESR), FLC ratio, FISH cytogenetics, Immunofixation electrophoresis (IFE) and treatment protocol was not found to have statistical association with relapse or refractoriness (p>0.05). A significant number of cases are de novo; while nearly one in five are relapsed one. Mean duration for refractoriness is 37.6±19.4 months. Patients are treated with established chemotherapeutic protocols. About one-fifth of patients developed refractoriness with progression of time.

Helicobacter pylori (H pylori) infection is known to be associated with dyspepsia for more than three decades. This study was conducted to investigate the frequency of H pylori infection in functional dyspepsia. Helicobacter pylori infection was detected by stool antigen tests were analyzed in 102 patients with functional dyspepsia. The functional dyspepsia was diagnosed according to Rome IV criteria as well as normal upper GI (Gastro-intestinal) endoscopy and abdominal ultrasonography within six months. In this study, H pylori infection rate diagnosed by the stool antigen test was detected to be 26.5% among the people with functional dyspepsia. Sex-based proportion H pylori infection was 21.2% for men and 29.0% for women with functional dyspepsia. The highest prevalent group with Helicobacter pylori infection was 30-39 years. In this study, 25.75% of rural participants and 27.78% of urban participants with functional dyspepsia were positive for H pylori. The stool antigen positive group and the stool antigen negative group were not significantly different in respect to age (p=0.29), sex (p=0.41) and residence (p=0.82). This study showed an increased stool antigen positivity rate for H pylori infection among the patients with functional dyspepsia. Further studies are required to determine the exact prevalence of H pylori among this group of patients.

The upper end of the humerus consists of three necks such as anatomical neck, surgical neck and morphological neck. The anatomical neck of the humerus is the area just below the head of the humerus. The surgical neck of the humerus is the area just below the greater and lesser tubercle of the humerus. The morphological neck is the junction between the diaphysis and upper epiphysis. It is represented by an epiphyseal line in the adult bone. It is a true junction of the head with the shaft. Fracture of the anatomical neck of the humerus rarely occurs. Fracture of the surgical neck of the humerus is more common in the upper-end fracture. The aim of this study was to measure the anatomical neck and surgical neck circumference of the humerus. One hundred (right=43 and left=57) samples were selected through the purposive sampling technique for this cross-sectional descriptive study which was carried out in the Department of Anatomy, Mymensingh Medical College, Mymensingh, Bangladesh during the period of July 2021 to June 2022. Any damaged, unossified bones or fractured bones were excluded. Data were tabulated and statistically analyzed using Microsoft Excel and SPSS software. The mean±SD anatomical neck circumference of the right humerus was 131.418±10.445 mm and the left humerus was 128.982±9.795 mm. The mean±SD surgical neck circumference of the right humerus was 74.883±7.607 mm and the left humerus was 74.298±7.392 mm. The anatomical knowledge of the anatomical and surgical neck of the humerus is beneficial for anthropologists, orthopedic surgeons & radiologists in cases of proximal end fractures of the humerus.

Blood stream infection (BSI) is of the most devastating infection of any hospital which has a high mortality. Staphylococcus aureus, coagulase-negative staphylococci (CONS) and enterococcus species are commonest isolated bacteria. This was a cross-sectional descriptive study conducted at the Sylhet Women's Medical College Hospital from October 2022 to March 2023. Total study period was 6 months. Data were collected from electronic medical record (EMR). Out of a total 1674 blood samples 315 samples were positive for blood culture (18.8%). The mean age of the participants was 15.6 year with a highest frequency in the below 20-year age group. Staphylococcus aureus was commonest isolated bacteria followed by CONS. Imipenem (89.0%), Piperacillin and Tazobactam (88.0%), Doxycycline (81.0%) and Amikacin (79.0%) were most sensitive antibiotics. Precise bacteriological profile and antibiogram is helpful for any institution to have an idea about the current infection pattern. Commonly used empirical antibiotics should be selected according to antibiogram of that particular hospital.