Mymensingh medical journal : MMJ最新文献

Maternal diabetes in pregnancy has become an emerging health burden. Among various complications neonatal hypoglycaemia is associated with neurodevelopmental sequelae but it is preventable. It will be very helpful if we can predict neonatal hypoglycaemia from maternal last trimester single HbA1c. The aim of the study was to find out whether maternal last trimester single time HbA1c level can predict neonatal hypoglycemia in case of Infant of Diabetic Mother (IDM). It was a hospital based prospective observational study. The study included 70 inborn IDM with maternal last trimester HbA1c attending in Neonatology Department of Mymensingh Medical College Hospital (MMCH), Bangladesh from November 2019 to September 2022. Those IDM babies who had maternal last trimester HbA1c ≥6.0% were selected as Group A and those who had maternal HbA1c <6.0% were selected as Group B. Their clinical evaluation and capillary blood glucose monitoring at ½, 2, 4, 6, 12, 18, 24 hours was done and venous blood glucose was done at 2 and 4 hours of age. Data were collected in a predesigned case record form and finally analyzed by appropriate statistical methods. There was significant difference of mean blood glucose values between two groups at 4, 6 and 18 hours of age. Good agreement was found between venous blood glucose and capillary blood glucose at 2 hours and at 4 hours of age. A moderate negative correlation was observed between maternal HbA1c and blood glucose level of IDMs at 4 hours of age (r = -0.575) and OR is 6.00. We found area under ROC curve for predicting neonatal hypoglycemia was 0.870 and optimal cut-off value was 6.45%, with sensitivity 75.0% and specificity 83.3%. In this study, maternal last trimester single time HbA1c level was found to be a useful tool for predicting neonatal hypoglycaemia.

Patent Ductus Arteriosus (PDA) is a common acyanotic congenital heart disease in newborn which has a lot of serious consequences if left untreated. By giving proper medication timely, we can limit its complications. Already established drug 'Indomethacin' has demonstrated good effects but with many contraindications and potential adverse effects. Hence, the search for alternative drug for PDA is now a need of time. So, the objective of the study is to compare the clinical response of paracetamol and indomethacin in the medical treatment of PDA in newborn. This randomized controlled trial was carried out in the Department of Neonatology, Mymensingh Medical College Hospital, Bangladesh from October 2016 to February 2019. The study included sixty (60) cases of PDA, which were divided into two groups: the paracetamol group and the indomethacin group. Both drugs were found as equally effective in respect to PDA closure. The paracetamol group's PDA closure rate was 85.7%, whereas the indomethacin group's was 85.2%. More increase of serum creatinine and serum bilirubin and reduction of platelet count were observed in indomethacin group after intervention but these differences were not statistically significant (p>0.05). Paracetamol was found as safer than indomethacin and the frequency of complications including renal impairment, gastrointestinal bleeding, necrotizing enterocolitis were found more in indomethacin group. According to the results of this study, enteral paracetamol is safer than indomethacin yet just as effective in treating PDA closure in neonates.

Congenital hypothyroidism (CH) is the commonest preventable cause of mental retardation in newborn. It is more prevalent in endemic goiter regions like Bangladesh. The clinical manifestations are often subtle or absent at birth. As early clinical diagnosis is difficult without newborn screening, most cases of congenital hypothyroidism remain undetected before three months of age. Before the appearance of clinical manifestation, CH can be identified by a simple knee X-ray. This cross-sectional observational study was conducted in the department of pediatrics, Rajshahi Medical College Hospital, Bangladesh from January 2015 to December 2015, to compare between radiographic appearance of knee epiphysis and biochemical data as a screening tool for congenital hypothyroidism in neonate. Total 100 term neonates aged 7 days to 28 days admitted in the department of pediatrics, Rajshahi Medical College Hospital, Bangladesh were included in this study by purposive sampling method. Digital X-ray of knee joint was performed in all (100) cases. If the epiphysial diameter was between 0-8 mm then serum TSH and T₄ level was measured and compare the both results. Among the 100 X-rays of the knee, size of the epiphysis of 74 neonates was normal (>8 mm). Twenty six (26) neonates had epiphysial size between 0-8mm in diameter. Among these 26 neonates, both epiphysis (distal femoral and proximal tibial) were absent in 20(77.0%) neonates and 6 neonates had epiphysis size <8 mm in diameter. Out of these suspected 26 cases, two had TSH level <10 mIU/L but T₄ level was <6 μgm/dl and 3 other suspected patients had T₄ level more than 6μgm/dl but TSH level of those 3 patients were >10 mIU/L. These 5 cases are diagnosed as suspected hypothyroidism and advised for follow up. Rest of the neonates (21 cases) had both TSH level >10 mIU/L and T₄ level <6 μgm/dl. This study was found when either the individual epiphysial diameter or combined mean epiphysial size in diameter between 0-8 mm, we should strongly suspect congenital hypothyroidism and confirm it with biochemical data.

Arsenicosis, a problem with chronic ingestion of arsenic in drinking water was first detected in 1993 in Bangladesh. Currently, 61 districts have been identified as having an arsenic concentration exceeding the maximum permissible limit of 0.05 mg/L. More than 40,000 people developed signs and symptoms of arsenicosis, manifested as skin hyperpigmentation often with hypopigmentation and later painful Keratosis on the palm and sole with fissures, cracks and warty lesions that reduce the working ability of patients. Keratosis is difficult to cure for its longer duration treatment and standard treatment is still lacking. Neem (Azadirachta Indica), a valuable source of unique natural products, has been used in various conditions, including skin care. Topical use of ethanol extract of neem has also been found to be effective. A cost-effective topical drug, in lower concentration with shorter duration and less adverse effect, is necessary. The purpose of this study was to observe the effect of the combination of neem, propylene glycol and salicylic acid for the treatment of palmar arsenical keratosis. Thirty patients of moderate palmar arsenical keratosis from an arsenic-affected area at Cumilla in Bangladesh were recruited randomly based on inclusion and exclusion criteria. One group of patients was given salicylic acid (10.0%) lotion in ethanol and another group of patients was given a combination of ethanol extract of neem (10.0%), propylene glycol (40.0%) and salicylic acid (10.0%). Clinical improvement was assessed by measurement of the palmar arsenical nodular size of both hands by slide calipers before and after the completion of treatment and perceptions of the patients about their improvement was scaled. The score (mean±SD) of the nodule of patients using neem (10.0%) plus propylene glycol (40.0%) plus salicylic acid (10.0%) before the study was 19.6±10.2 which was decreased to 8.1±6.6 after treatment. After 12 weeks of treatment, the mean perception score of improvement in neem (10%) plus propylene glycol (40.0%) plus salicylic acid (10.0%) was 4.8±0.6, improved from 2.2±1.1 in salicylic acid (10.0%) alone group. None of the patients reported any side effects rather topical use of a combination of ethanol extract of neem plus propylene glycol plus salicylic acid showed a significant effect in improving the keratotic lesion.

Disseminated Intravascular Coagulation (DIC) is a complex syndrome causing generalized micro thrombi formation, which causes consumption of coagulation factors resulting in secondary fibrinolysis. It is not uncommon in children. Due to its highly complex and variable pathophysiology and interrelationship with hemostatic system, DIC does not show any uniformity in presentation. Although, there are many forms of DIC, clinical picture of DIC is dominant with bleeding. Besides, there is no gold standard investigation to diagnose DIC. Many therapeutic approaches are not validated and controversial. Prompt diagnosis and correct treatment depends on understanding of underlying pathology. Treatment should be individualized depending on the nature of DIC to correct the underlying pathology, as complexity and variation of presentation suggests.

Open appendicectomy remains a common surgical procedure for managing uncomplicated acute appendicitis. Traditionally, peritoneal closure has been performed to restore anatomical layers, but this practice has been questioned due to its potential impact on surgical duration, postoperative pain and recovery outcomes. This study aims to compare early postoperative outcomes between peritoneal closure and non-closure techniques in patients undergoing open appendicectomy. This prospective comparative study was conducted at Mymensingh Medical College Hospital, Bangladesh, from July 2021 to June 2022, including 80 patients undergoing open appendicectomy for uncomplicated acute appendicitis. Patients were divided into Group I (peritoneal closure) and Group II (peritoneal non-closure).Data were processed and analyzed using the computer software SPSS (Statistical Package for Social Sciences, version 26.0 for Windows). The probability value, p<0.05 was considered statistically significant. There was no significant difference in age, sex, BMI, or comorbidities between the groups. Most procedures used a Grid Iron incision (67.5%). Wound infection (22.5%, 17.5% respectively) and wound dehiscence (7.5%, 2.5% respectively) rates were almost similar, with no significant differences (p=0.576 and p=0.305, respectively). However, Group II had significantly lower postoperative wound pain (p<0.001), reduced analgesic requirements (p<0.001) and shorter surgery duration (p<0.001) compared to Group I, demonstrating the potential benefits of omitting peritoneal closure in appendicectomy. It is concluded that non-closure of the peritoneum at open appendicectomy for uncomplicated appendicitis appears to have no adverse effect on post-operative recovery and outcome. Leaving the peritoneum open seems to reduce the operating time and shorter hospital stays. It also decreases post-operative pain with less analgesic requirement. Hence, the practice of non-closure of peritoneum in open appendicectomy for uncomplicated appendicitis can be done safely.

Leiomyoma is the most common benign mesenchymal tumor of the uterus and it can develop in any location containing smooth muscle cells. While the broad ligament is the most frequent extrauterine site, the ovary is among the rarest, representing only 0.5-1.0% of all benign ovarian tumors. Primary ovarian leiomyoma is a benign ovarian tumor that typically occurs in women aged 20 to 65. It is often discovered incidentally during pelvic examinations, ultrasound imaging, or through pathological analysis following surgery. We are reporting a case of a 38-years-old woman who presented with a history of lower abdominal pain in left side. Ultrasonography of whole abdomen revealed a left adnexal mass. Unilateral salpingo-oophorectomy was performed. Ovarian leiomyoma was diagnosed after surgery followed by histopathologic examination and confirmed by immunohistochemistry.

Macular hole is a full thickness defect at the centre of macula. Pars plana vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade helps to close the hole and improves visual function. Aim of this study was to assess the anatomical and functional outcome following surgery of idiopathic macular hole. This interventional study was conducted in the Department of Vitreo retina, National institute of ophthalmology and hospital, Dhaka from December 2020 to August 2022. A total, 50 patients having idiopathic macular hole were included during the study period according to selection criteria. Preoperative logarithm of minimal angle of resolution (logMAR) visual acuity was measured and Optical Coherence Tomography (OCT) was done for further staging of hole. Pars plana vitrectomy, ILM peeling assisted with Brilliant blue G dye and perfluoropropane gas tamponade was done under local anesthesia. Patients were instructed to maintain a facedown position for two weeks. Postoperatively, patients were examined on day one, day seven, after one and three months. At each follow up visual acuity, ocular examination and measurement of intraocular pressure was done. OCT was done to assess anatomical closure of hole and final visual outcome was measured as best corrected visual acuity (BCVA) at three months after surgery. After data collection data were coded, entered and analyzed in a computer. Statistical test was done by windows software using statistical package for social science (SPSS) statistics for Windows, Version 26.0. Male female ratio was 1:2.3. Among 50 patients, majority (29; 58.0%) were in stage II macular hole. Duration of symptoms was more than five months before surgery in 35(70.0%) patients. Majority of study patients (82.0%) were phakic. Preoperative BCVA was found as 1.48-1.00 logMAR in 33(66.0%) patients. BCVA (0.94±0.13 vs. 0.62±0.26 in logMAR) was significantly (p<0.001) improved after macular hole surgery. Macular hole was closed in majority (45; 90%) of the study patients. Preoperative BCVA and stage of macular hole were significant factors for visual improvement. This study revealed that the overall closure rate of macular hole was satisfactory and BCVA was significantly improved during the last follow up.

Congenital Anomalies of the Kidney and Urinary Tract (CAKUT) often results in renal failure. Alhough the pathophysiology of CAKUT is still not completely understood, several maternal risk factors have been identified associated with children with CAKUT so far. Therefore, the aim of this study was to assess the proportion of risk factors of mothers gave birth to the infants with CAKUT. This cross-sectional study was conducted over a six-month period in the Departments of Pediatrics, Pediatric Nephrology, Neonatology and Pediatric Urology in Dhaka Shishu Hospital, Bangladesh from May 2018 to November 2018. A total of 200 infants aged ≤60 days and with a confirmed diagnosis of CAKUT were included in this study. Informed ascend was taken from the parents of the child. A semi-structured questionnaire was used for data collection, and statistical analysis was performed using SPSS version 21.0. This research was undertaken in conjunction with the ethical principles of Declaration of Helsinki. The mean age of the infants with CAKUT was 22.25±15.08 (SD) days with a male to female ratio of 1:1. The presenting anomalies were primary vesico-ureteral reflux (38.0%), pelvi-ureteric junction obstruction (20.0%), agenesis of the kidney (16.0%), posterior urethral valve (12.0%), dysplasia of the kidney (10.0%) and multicystic dysplastic kidney (3.5%). The most common pregestational risk factors were overweight (76.0%), diabetes mellitus (32.5%) and hypertension (29.5%) among the mothers. On the other hand, oligohydramnios (87.5%), gestational diabetes mellitus (67.0%) and gestational hypertension (45.5%) were the most frequently identified gestational risk factors. Pregestational overweight in women, maternal diabetes and oligohydramnios were most commonly identified risk factors among the mothers of CAKUT infant.

Rheumatoid vasculitis (RV) is an uncommon extra-articular manifestation of Rheumatoid Arthritis (RA) that typically affects patients with a more aggressive form of the disease. The diagnosis of rheumatoid vasculitis is suggested based on clinical presentation, laboratory findings, and confirmed through biopsy. We describe the case of a 28-year-old man who initially presented with myalgia and weakness in all four limbs. Subsequently, he developed hypertension and testicular tenderness. Neurological examination revealed painful sensory-motor neuropathy involving the bilateral median and ulnar nerves, as well as the right tibial and left common peroneal nerves- findings consistent with mononeuritis multiplex. Laboratory investigations showed a high titer of rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies. He was treated with intravenous methylprednisolone (1 gm daily for 3 days), followed by oral prednisolone (1 mg/kg body weight) and six pulses of intravenous cyclophosphamide. This was later transitioned to maintenance therapy with azathioprine. The patient showed dramatic clinical improvement, and at one-and-a-half-year follow-up, he remained reasonably well. This case highlights that mononeuritis multiplex due to rheumatoid vasculitis can be the initial presentation of Rheumatoid Arthritis. Clinicians should consider this diagnosis in similar clinical scenarios, and prompt immunosuppressive treatment should be initiated to prevent further complications.