Mymensingh medical journal : MMJ最新文献

Percutaneous nephrolithotomy (PCNL) is the gold standard treatment for large kidney stones. Recent advancements in endoscopic technology and operative techniques have significantly increased the success rate of PCNL while reducing associated complications and morbidity. A key development contributing to this progress is the introduction of various new lithotripter techniques, which facilitate rapid stone fragmentation and clearance. The objective of the study was to compare the outcome of PCNL using pneumatic lithotripsy alone and combined lithotripsy (pneumatic and ultrasonic). This quasi-experimental study was conducted in the Urology Department of the National Institute of Kidney Diseases and Urology (NIKDU) in Dhaka, Bangladesh from April 2019 to March 2020. Thirty patients in Group A underwent PCNL using pneumatic lithotripsy, while another thirty patients in Group B underwent PCNL using combined lithotripsy. The two groups were compared in terms of stone size, operative time, hospital stay, hemoglobin loss, ancillary procedures, and initial and overall stone clearance rates. The mean age was 34.33±9.72 years (range 22-65 years) in Group A and 36.83±12.61 years (range 19-62 years) in Group B, with homogeneous distribution. There are 45 males and 15 females in two groups, resulting in a male-to-female ratio of 3:1. The mean stone size was 3.36±1.07 cm (range 2-6 cm) in Group A and 3.67±0.88 cm (range 2.4-6.0 cm) in Group B, with no significant differences between the groups. The mean operation time was significantly different: 67.50±13.2 minutes (range 40-86 minutes) for PCNL with pneumatic lithotripsy compared to 57.30±10.9 minutes (range 45-95 minutes) for combined lithotripsy (p<0.05). The mean postoperative hemoglobin drop was 1.37±0.50 g/dL in the pneumatic lithotripsy group, significantly higher than the 1.12±0.46 g/dL drop in the combined lithotripsy group (p<0.05). Other variables, including stone-free rate, postoperative hospital stay, and postoperative complications, showed no significant differences between the groups. The combined lithotriptripsy (pneumatic and ultrasonic) signify superior efficacy in PCNL compared to the pneumatic lithotriptripsy alone, as it remarkably reduces both the total operative time and blood loss.

Fluroquinolone resistance among the Enterobacteriaceae including Proteus spp. is a serious public health problem as it is used for treating many clinical infections including UTI and intra-abdominal infections. Now-a-days, plasmid- mediated quinolone resistance (PMQR) has presented with considerable attention that can spread from one bacterium to another. So, the aim of this study was to detect the presence of qnr type (qnr A, B, D and S) and aac(6́)-Ib-cr genes among clinical isolates of ciprofloxacin resistance Proteus species .This cross-sectional study was carried out in the Department of Microbiology, Mymensingh Medical College, Mymensingh, Bangladesh from March 2020 to February 2021. Antimicrobial susceptibility test of 60 Proteus spp. isolates were done by disc diffusion technique. Among them, 48(80.0%) ciprofloxacin resistant isolates were detected during disk-diffusion technique and MIC of ciprofloxacin was performed among ciprofloxacin resistant Proteus isolates using agar dilution method. Amplification with uniplex specific primers of quinolone resistance genes (qnrA, qnrB, qnrD, qnrS and aac(6́)-Ib-cr) were performed out of quinolone resistant Proteus spp. isolates. Out of 48 Proteus species, Quinolone resistance genes were found positive 22(45.83%) for aac(6́)-Ib-cr, 9(18.75%) for qnrD, 6(12.5%) for qnrA and 3(6.25%) for qnrS. None of the strain was positive for qnrB gene. In total, 64.58% ciprofloxacin resistant Proteus isolates were positive for at least one PMQR gene. In this study, presence of high rate (64.5%) of PMQR genes as well as co-existence (30.0%) of the multiple genes among Proteus spp. is highly alarming, because fast dissemination could occur due to the increased prescription of fluoroquinolones and conjugative plasmid mediated horizontal transfer.

Hemoglobin is a common hematological parameter assessed in laboratory and also an important tool for clinical management of patients. Reference values being used in most laboratories in our country, have been provided from the established reference values of developed countries. Hemoglobin concentration varies usually due to age, sex, attitude, ethnic origin, dietary habits, socioeconomic status and environmental factor. Therefore, there is a need to establish reference value of hemoglobin for healthy Bangladeshi population. This study was carried out to establish the reference value of hemoglobin of healthy adult population of Dhaka, Bangladesh. This cross sectional study was conducted in the department of Physiology, Dhaka Medical College, Dhaka, Bangladesh from July 2017 to June 2018. A total number of 500 healthy subjects from different areas of Dhaka city were selected on the basis of inclusion and exclusion criteria. The subject was interviewed and detailed history was taken and recorded in a prefixed questionnaire. Hemoglobin concentration was estimated in the Department of Laboratory Medicine, Dhaka Medical College hospital, Dhaka. For statistical analysis, Unpaired Student's 't' test was performed by using SPSS windows version 19.0. The reference values (2.5th percentile- 95th percentile) of hemoglobin concentration for male and female were 10.9-15.9 and 9.4-14.7gm/dl respectively. The hemoglobin concentration was significantly higher in male than female (p<0.05). There was no statistically significant correlation of hemoglobin concentration with age of study subjects. The reference value of hemoglobin obtained from this study is lower than practiced reference value and supports the need for nationwide study to establish our population specific hematological parameters.

Coronavirus disease-2019 (Covid-19) caused by the virus SARS-CoV 2 is a major health problem across the globe currently. Bangladesh is also defying this highly infectious disease with an exponentially rising number of cases across the country. This study was designed to observe the socio-demographic characteristics, clinical presentation and treatment outcome of Covid-19 cases in Bangladesh. In this cross-sectional observational study, a total of 334 Covid-19 positive patients were enrolled following selection criteria who were tested RT-PCR for Covid-19 infection in the Department of Microbiology, Mymensingh Medical College, Bangladesh from January 2021 to December 2021. A telephonic interview with a pre-tested semi-structured questionnaire was used to collect data. Among 334 Covid-19 positive patients, males (72.46%) were more affected than females (27.54%). The mean age was 36.32±12.369 years. Most of the cases resided in urban areas (83.53%). Approximately 13.77% were asymptomatic and 86.23% were symptomatic. Out of 334 patients, 98 (29.34%) patients had comorbidities, among which 76(22.75%) patients had a single co-morbid condition and 22(6.59%) patients had multiple comorbidities. Fever (83.53%), cough (52.99%) and altered smell and taste (40.71%) were the most common presenting symptoms. Antibiotics (91.32%) and paracetamol (83.53%) were the most commonly used drugs. Approximately 80.24% were isolated in their homes, while 5.39% were treated at Covid-19-dedicated hospitals. Finally, 13.77% were discharged without complications and 2.69% died. This investigation revealed that males became more infected than females. The majority of the cases resided in urban areas. Most of the infected patients were isolated at homes, whereas one-fifth of them were treated at different types of hospitals. Clinically, antibiotics were the most commonly used medication. However, the majority of the cases were discharged from the hospital without complications.

To assess and compare the sensory component of the saphenous nerve in Coronary artery disease (CAD) patients undergoing Coronary artery bypass graft (CABG) with great saphenous vein graft pre and post-CABG. An observational longitudinal study evaluating the effect of surgery on the saphenous nerve involved 32 CAD patients undergoing CABG. This study was carried out jointly by the Department of Physiology and the Department of Cardiothoracic Vascular Surgery (CTVS) at All India Institute of Medical Sciences, Bhopal, India from November 2022 to January 2024. We performed pre- and post-operative sensory saphenous nerve conduction investigations and then examined their results to look for any alterations in the saphenous nerve following surgery. The average nerve latency of the Saphenous Nerve (Sensory) showed an increase from a minimum of 3.77 milliseconds to a maximum of 5.15 milliseconds, amplitude increased from a minimum of 12.04 microvolt at the pre-operative time point to a maximum of 12.15 microvolt, and conduction velocity of the nerve of harvested side limb decreased from a maximum of 54.28m/s from the the pre-operative value to a minimum of 35.61m/s. These results indicate that the saphenous nerve has sensory changes following CABG surgery. The increased Latency and decreased conduction velocity suggest a temporary or potentially longer-term impairment in nerve function. Despite the minor increase in amplitude, the overall decline in conduction velocity underscores the need for further research into the long-term impact of CABG with GSV grafts on saphenous nerve function and potential strategies for mitigating these effects.

Type 2 diabetes, formerly known as adult-onset diabetes, is a form of diabetes mellitus that is characterized by high blood sugar, insulin resistance and relative lack of insulin. This cross sectional study was carried out in the Department of Biochemistry, Mymensingh Medical College and in collaboration with the Department of Endocrinology, Mymensingh Medical College Hospital, Mymensingh from July 2021 to June 2022. A total of 100 subjects were included in this study. Among them 50 were diagnosed type 2 diabetes mellitus patients denoted as case group and 50 were apparently healthy individuals denoted as control group selected on the basis of inclusion and exclusion criteria. Serum vitamin D was estimated by chemiluminescence immunoassay from the subjects. Data were then processed and analyzed. Statistical analysis was done by using SPSS (Statistical Package for Social Science) version 26 windows package. The study revealed that, mean±SD values of vitamin-D were 25.50±3.63 ng/ml and 27.72±5.25 ng/ml in Group I and Group II respectively. Student's unpaired 't' test was done to measure the level of significance. Serum vitamin-D was significantly lower in Group I than that of Group II. This result has an association with type 2 diabetes mellitus progression and also may has important role in the etiology of type 2 diabetes mellitus and its complications.

Damage of fallopian tube, endometriosis, fibroid uterus, adenomysis and polycystic ovary syndrome are the major pelvic pathology that causes subfertility. Although there are many diagnostic tests available, the clinical presentation of each patient can usually be linked to specific and efficient testing strategies. Transvaginal sonographic (TVS) imaging is an effective, easy to use, safe and readily available noninvasive means to evaluate fertility potential. But in some cases laparoscopic evaluation is mandatory. The study was conducted with an aim to investigate prospectively the role of transvaginal sonography in evaluation of subfertile women. Sixty two patients' transvaginal sonographic and laparoscopic findings were compared to explore the role of TVS as diagnostic tool in infertile women. This descriptive cross sectional type of observational study was done in the Reproductive Endocrinology and Infertility unit, Dhaka Medical College Hospital, Bangladesh from January 2020 to December 2020. Sixty two samples were selected for laparoscopy was taken as purposive sampling. Out of 62 patients 58.0% presented with primary sub-fertility and 42.0% presented with secondary subfertility. Using laparoscopy as the gold standard, TVS showed 100.0% sensitivity and specificity in detection of polycystic ovary and congenital anomaly of the uterus. TVS showed 100.0% sensitivity and 98.3% specificity in the detection of adenomyosis in comparison to laparoscopy. As a test for the detection of fibroid TVS had 87.5% sensitivity, 95.7% specificity and accuracy of 93.6% in comparison to laparoscopy. In detection of chocolate cyst TVS showed good specificity (98.1%) and sensitivity (77.8%) but in cases of hydrosalpinx TVS showed sensitivity only 40.0% in comparison to laparoscopy. The sensitivity of transvaginal sonographic characterization of pelvic adhesion was 6.7% while specificity and positive predictive value were 97.9% and 50.0% respectively. Tubal occlusion was found in 45.0% cases by laparoscopy but TVS failed to evidence this. TVS can be used for the initial investigation of infertile women in cases of congenital anomaly of the uterus, adenomyosis, fibroid uterus and polycystic ovarian syndrome.

Hypospadias is the absence of external urethral meatus in the tip of the glans but present in the ventral surface of the penis. Hypospadias surgery is challenging and changing. Many modifications have been done to reduce the complications. Currently urethroplasty with flap coverage is widely used but flap itself induces some complications. Aim of this study was to evaluate the outcome of double layer urethroplasty in mid and distal penile hypospadias without flap. This was a prospective type of observational study conducted in the department of pediatric surgery Mymensingh Medical College Hospital (MMCH) and several other private hospitals from January 2021 to December 2023. Total 61 patients were enrolled among them 7 patients failed the follow up schedule; finally 54 patients were included in this study. Age ranges from 2-12 years with mean age 5.8±2.55 years. Maximum 26 (48.14%) patients had distal penile hypospadias followed by coronal hypospadias 11 (20.37%). Mean operative time was 65.0±10.0 minutes for all types. Among the 54 patients, 48(88.88%) were recovered uneventfully and 6(11.11%) patients developed one or more complications. Urethro-cutaneous (U-C) fistula 5(9.25%) were the most common complications followed by meatal stenosis 3(5.5%) and residual chordee 1(1.8%). This study shows double layer urethroplasty without flap in mid and distal penile hypospadias surgery is safe and feasible as other procedures with flap.

Historically multi-nodular goiters have been thought of as a benign disease with a low risk of associated malignancy. Recent studies suggested that the incidence of malignancy in patients with MNG is not uncommon. With the aim of determining frequency of malignancy in multi-nodular goiter this cross sectional observational study was done at Mymensingh Medical College Hospital, Mymensingh, Bangladesh from June 2021 to March 2022. One hundred (100) cases were selected by purposive sampling. Data were collected by preformed questionnaire, clinical examination and laboratory investigations which included only patients with Multi-nodular Goiter (MNG). Analysis was performed using the SPSS software version 23.0. Malignant neoplasm accounted 12 in 100 cases of multi-nodular goiter. Among them 7.0% were Papillary thyroid carcinoma (PTC) and 5.0% were Follicular thyroid carcinoma (FTC). Others (88.0%) cases were non- neoplastic or benign lesion. Age of the patients and duration of multi-nodularity found statistically significant for development of malignancy. As an indicator of probable benign disease multi-nodularity of goiter should no longer be considered. So, multi-nodularity of the goiter should not be considered as low risk of malignancy and delay for surgical intervention.