Mymensingh medical journal : MMJ最新文献

Chronic obstructive pulmonary disease (COPD) remains a major public health problem with relatively high prevalence rates worldwide (5.0-13.0%). COPD is a major cause of morbidity and mortality worldwide and results in an economic and social burden that is both substantial and increasing. The purpose of the study was to explore the alteration of serum iron in patients with COPD. This cross-sectional study was carried out in the Department of Biochemistry, Mymensingh Medical College, Bangladesh from January 2021 to December 2021. Data was collected from Medicine Department of Mymensingh Medical College Hospital, Bangladesh. A total number of 120 subjects participated in this study. Out of them, 60 apparently normal healthy individuals were selected as Group I and another 60 diagnosed COPD patients were selected as Group II. Serum iron was measured by CAB method. Statistical package for social science (SPSS), version 21.0 was used for results calculation and analysis. Data were expressed in mean ±SD and statistical significance was done by Student's unpaired 't' test. The mean results of serum iron were 97.60±5.50 μg/dl in Group I and 49.80±5.92 μg/dl in Group II (p<0.001). This study found the relation between COPD and alteration of serum iron was statistically significant. So, by this study we recommended that routine evaluation of serum iron is important for prevention of exacerbations, reduction of morbidity and mortality in patients with COPD.

Lag times for the diagnosis and treatment of urinary bladder cancer are generally longer which reduces the chances of achieving cures. This study was carried out at the Urology Department of Bangabandhu Sheikh Mujib Medical University, Dhaka and a Urology Center in a private hospital in Dhaka, Bangladesh from July 2007 to June 2008 on patients of newly diagnosed muscle invasive bladder carcinoma. This study was intended to assess the delay encountered by the patients and its consequences in the process of diagnosis and treatment of bladder cancer. This cross-sectional study was conducted on 50 patients of newly diagnosed muscle invasive bladder carcinoma. The five types of delays studied were: Delay-1 or Patient Delay; Delay-2 or GP (General Practioners) Delay; Delay-3 or First Treatment Delay; Delay-4 or the lag time from TURBT (Trans Urethral Resection of Bladder Tumor) to obtaining the biopsy report and Delay-5 from the biopsy report to final treatment. These five delays were added together to find the total delay. A 6-month period was used as a cut-off point to divide the patients into shorter (≤180 days) and longer (>180 days) delay groups and all the variables of interest were compared between these two groups to find the causes and consequences of delay in bladder cancer. The total median delay encountered by the patients was 220(45-888) days. The median Delay 1 was the shortest (3.5 days), while the median Delay 2 was the longest (91.5 days) among the 5 delays. The median Delay 3, Delay 4 and Delay 5s were 12.5, 12.5 and 11 days respectively. Older and female patients were predominant among the delayed group (86.7% and 40.0% respectively) than those among the non-delayed group (65.0% and 15.0% respectively) (p=0.134 and p=0.059 respectively). One-third of the delayed presenters was housewife as opposed 10.0% of the early presenters (p=0.048). Illiterate and middle and poor income subjects delayed significantly more than their educated and solvent counterparts (p=0.052 and p=0.012 respectively). Delayed group had a 25.0% increase in the incidence of pT3 - 4 (p=0.083) and 23.0% increase in the non-organ confined disease (N stage positive) than the non-delayed group (p=0.103). Distant or lymph node metastasis was relatively higher in delayed group (p=0.279). A delay in the presentation of muscle-invasive bladder tumors may lead to larger lesions and disease dissemination, resulting in advanced disease. GP delay is the longest to contribute to the total delay.

World population is experiencing huge death toll due to Covid-19 pandemic with panic and uncertainty. Students used the electronic media called e-learning, became the budging word in these days. This study was aimed to determine the experiences of the medical students regarding e-learning during Covid-19 pandemic. This cross-sectional study was carried with conveniently selected 207 medical students of Kumudini Women's Medical College and Hospital, Bangladesh. Data were collected by structured questionnaire through face-to-face interview. Then data were analyzed using a computer program SPSS (Statistical Package for Social Science) version 26.0. Among 207 respondents 67.1% had good experience, and 32.9% had bad experience during e-learning. Among all of them 54.6% were within 21-23 age with mean age 21.82±1.705 years. Among all 69.0% of respondents lived in urban and they had good experience of e-learning. Among them most of the students 22.7% were in 2nd year and they had good experience of e-learning. Among all 87.4% used mobile devices, 35.3% used computer device. Of all of them 46.4% used mobile network and 21.3% used broadband network. All respondents were found to be used zoom application as the media of e-learning, whereas 86.5% respondents used WhatsApp. Among all 99.0% respondents were able to provide the feedback of e-learning session through item examination. Of all the respondents 98.0% had knowledge of e-learning and among them had good experience of e-learning. Among all, 74.4% were found that e-learning session was helpful to prevent their learning gaps during this pandemic situation of them 87.0% respondents were actively interact with their facilitator by raising their hands during the e-learning sessions. Regarding practical session 99.0% found it difficult to perform their practical classes through e-learning sessions. Of all of them 57.5% expressed their internet speed was average during the e-learning session. Most of the respondents in this study had a good experience of e-learning. However, there are many challenges including difficulty in practical classes, speed of the internet services, electricity interruption and physical problems considered as roadblock for proper utilization of the benefit of the e-learning.

Laparoscopy is a minimally invasive technique for visualization of the peritoneal cavity without creating large abdominal incisions. It has changed the treatment of abdominal pain in both emergency and elective settings. Many patients undergo exploration according to the conventional investigation; many are treated conservatively and discharged. However, in most cases, patients return with a recurrence or more definitive symptoms of pathology. Laparoscopy is now a well-known and accurate way to make a final diagnosis and avoid delays in making a diagnosis. Objective of the study was to evaluate the role of laparoscopy in diagnosis and treatment of abdominal pain where clinical symptoms and routine investigations are inconclusive. It was a prospective, cross-sectional study and the duration of the study was 6 months, from March 2016 to August 2016. All the patients who underwent laparoscopy for the diagnosis of abdominal pain were chosen using the purposive sampling technique. They were then investigated in accordance with the eligibility criteria, and 30 patients with abdominal pain that couldn't be diagnosed by clinical examination, routine investigations, and who consented to laparoscopy were included in this study. All data for the study were collected using a predesigned pro forma. After collecting the data, it is compiled, edited, and analyzed. After laparoscopy, 93.0% (28) of cases had a definitive diagnosis, while 6.67% (2) of cases had no obvious pathology. At the time of diagnosis, 66.67% (20) of patients underwent laparoscopic surgery and in 3.33% (1) of cases, they required conversion to laparotomy to treat the condition. Laparoscopic biopsy was taken in 16.67% (4) cases. In 3.33% (1) of the cases, a complication was observed related to laparoscopic port infection. The average hospital stay was 3.73 days and the average operation time was 65 minutes. Abdominal pain can be accurately, quickly and efficiently managed with laparoscopy. This procedure decreases the number of avoidable laparotomies while also improving diagnostic accuracy. Thus, physicians should consider diagnostic laparoscopy as the first invasive test for people with the unknown abdominal pain.

Care of newborn is traditionally provided by mothers. Maternal knowledge and practice of newborn care can significantly affect neonatal morbidity and mortality. There is convincing concern to explore knowledge and practice of postnatal mothers regarding newborn care. The objective of the study was to evaluate knowledge and practice of postnatal mothers regarding newborn care at hospital setting. This cross-sectional observational study was carried out in Special Care Newborn Unit, Rangpur Medical College Hospital, Bangladesh from July 2018 to January 2019. In this study, mean maternal age was 23.27±3.87 years. Out of 150 respondent mothers 121(81.0%) possessed average knowledge and 144(96.0%) demonstrated average practice on newborn care. Level of knowledge was high in the area of clean cord care by using sterile thread 125(83.3%), p<0.001, duration of exclusive breastfeeding 100(66.7%), p<0.001), colostrum as first food of newborn 122(81.3%), p<0.001) and awareness about immunization 95(63.3%), p<0.001). Postnatal mothers demonstrated poor knowledge regarding cord stump stuff 41(27.3%) p<0.001) and first bath of newborn 38(25.3%), p<0.001. Mothers showed higher level of practice in the area of wash and clean napkins after motion 147(98.0%), p<0.001 and poor practice in correct position and attachment of breastfeeding 00(00.0%), p=0.001. Most postnatal mothers practiced exclusive breastfeeding 139(92.7%), p<0.001. Association between knowledge and practice of newborn care was non significant (p=0.305). Results of the present study demonstrated that majority of the mothers had average knowledge and practice regarding newborn care. Level of knowledge was high in clean cord care using sterile thread, colostrum as first food, duration of exclusive breastfeeding and awareness about immunization. Mothers had poor knowledge about cord stump material and first bath of newborn. Mothers claimed higher level of practice in the area of napkin wash and clean after motion, eye care, exclusive breastfeeding and poor practice in correct position and attachment of breastfeeding.

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Different additives have been used to improve the duration and quality of analgesia of the local anaesthetic used in the single-dose caudal block technique, such as opioids, epinephrine, clonidine, neostigmine, etc. Dexmedetomidine is a potent and a highly selective α2-adrenergic agonist having a sympatholytic, sedative, and analgesic effect and has been described as a safe and effective additive in many anaesthetic and analgesic techniques. Another agent is Fentanyl, a lipophilic opioid, is added frequently to local anaesthetics which least likely to cause respiratory depression when given extradurally, because of its high lipid solubility. It improves and prolongs the analgesia following the addition with bupivacaine for lower abdominal or infraumbilical procedures. The study was aimed to compare the efficacy of bupivacaine with dexmedetomidine versus bupivacaine with fentanyl for caudal block in pediatric infraumbilical surgery. This experimental study was carried out in Mymensingh Medical College Hospital, Bangladesh from 12 May 2019 to 11 November 2019. Total 60 patients, classified by American Society of Anesthesiologists (ASA) physical status category I-II, listed for infraumbilical surgery under caudal block were randomized by card method in two groups of 30 patients each. Anaesthetics were given by using a standardized protocol for induction, maintenance and recovery. Group BD (n=30) patients was given 1 μg/kg dexmedetomidine with 0.5 ml/kg bupivacaine 0.25% and Group BF (n=30) was given 1 μg/kg fentanyl with 0.5 ml/kg bupivacaine 0.25% for caudal epidural analgesia. Mean age of the patients were 6.1±1.7 years and 6.3±1.2 years in BD and BF group respectively. No significant differences were found between groups with respect to age (p=0.721). Male and female ratio was 1.12:1. In group BD 19(63.3%) patients had ASA I and 11(36.7%) ASA II. In group BF 22(73.4%) of patients had ASA I and 8(26.6%) had ASA II. Baseline heart rate was 95.2 and 98.4 beat/min in group BD and BF respectively. After 15 minute heart rate was found 94.4 beat/min in group BD and 90.9 beat/min in group BF. After 30 minute heart rate was 88.7 beat/min in group BD and 85.2 beat/min in group BF. This study showed statistical comparison of postoperative mean RASS scale and CHEOPS at different time interval between three groups. The corresponding mean differences in various groups were comparable and statistically significant (p<0.05). In group BD score was better than BF and the difference of group BD vs. group BF was significant except at base line, 90 min, 120 min (p>0.05). Dexmedetomidine as an adjuvant to bupivacaine is better than fentanyl in infraumbilical surgery has longer sedation and longer postoperative analgesia. Dexmedetomidine potentiates the action of local anaesthetics without increasing the incidence of side-effects compared to fentanyl.

Dengue is a mosquito-borne infection that in recent years has become a vital disease of international public health concern. Dengue virus infections and illness when symptomatic, that patients tend to present with a significantly wide variety manifestation. The aim of the study was to gauge liver dysfunction in patients with dengue infections. To judge the impact of dengue virus infection on liver function by measuring various liver function tests in blood samples of serologically diagnosed dengue patients. This study was undertaken as an observational cross-sectional study in the period of June 2019 to October 2020. Records of 120 serologically confirmed cases of dengue infection with available biochemical liver function tests, admitted to Bangladesh Medical College Hospital, were analyzed. Patients were classified as classical dengue fever (DF) - 64.1%, dengue haemorrhagic fever (DHF) - 24.1% and dengue shock syndrome (DSS) - 11.6%. The mean age was 36.61±14.55 years. Normal values of alanine aminotransferase (ALT) had 27.0% of patients and 73.0% had values above normal. With regard to AST 12.0% patients had normal values and 88.0% of patients had values above normal. Deranged alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin and total bilirubin was present in 72.0%, 86.0%, 57.0%, 27.0% patients respectively. The mean±SE of ALT, AST, albumin and total bilirubin were 240.38±892.60 U/L, 364.43±1948.03 U/L, 33.30±4.17 gm/L and 1.26±1.14 mg/dl respectively. The mean value of AST was significantly more than ALT. The degree of rise of ALT and AST was significantly more in DHF and DSS, as compared to DF. Mean serum ALT, AST and bilirubin values were significantly higher in patients with haemorrhage as compared to those without haemorrhage and in non-survivors. Serum albumin concentration was significantly lower in DSS than DHF or DF patients. Hepatic dysfunction was quite common altogether types of dengue infection, with AST rising significantly more than ALT. While preferentially high AST may function an early indicator of dengue infection, high ALT and bilirubin and reduce albumin may act as poor prognostic markers.

Flegel's disease (FD) or hyperkeratosis lenticularis perstans (HLP) is an extremely exceptional skin disease typified by hyper-keratotic papules usually found on the lower extremities. Only the histopathological study is the confirmatory test for diagnosis this disease. The treatment of Flegel's disease is not yet settled as a standard one. Here we report two (2) cases of Flegel's disease in a family one was a 36-year-old woman, a housewife, presented with multiple mildly pruritic hyperkeratotic erythematous plaques and papules on both legs with hyperpigmented border and surrounding skin for 16 years and another one was A 20-year-old woman, daughter of case 1, student of a private university, presented with multiple moderately pruritic, hyperkeratotic, hyperpigmented discrete papules on her both middle part of legs for 6 years that was inherited as autosomal dominant manner were presented in the department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh on 2021. A very few numbers of familial FD were reported globally.

The pandemic Covid-19 not only caused great public health problems but also caused enormous distress, especially for medical staff. The cross-sectional study aimed to investigate the prevalence rate of insomnia and to confirm the social factors among medical support staff in hospitals during the Covid-19 pandemic from 1st July 2020 to December 31st 2020. This study was conducted at Dhaka Medical College and Hospital (DMCH), Kurmitola General Hospital (KGH), Kuwait Bangladesh Friendship Government Hospital and Mugda Medical College and Hospital located at Dhaka and Tungipara UHC from Tungipara, Gopalganj, Bangladesh. Medical support staff in the Dhaka division was recruited. The face-to-face interview was conducted, obtained demographic data and asked self-design questions related to the Covid-19 pandemic and insomnia. Chi-square analysis was done to examine the associations between socio-demographic factors and insomnia symptoms. There were a total of 289 participants in our study. Participants 53(19.4%) had insomnia symptoms according to the Insomnia Severity Index (ISI) (total score ≥8). The chi-square test revealed that insomnia symptoms were associated with uncertainty in effective disease control (p=0.000, OR = 3.377, 95% CI = 1.842 - 6.189), worry about getting infected (p=0.001, OR = 2.748, 95% CI = 1.457 - 5.181). This study found that nearly one-fifth of the medical support staff suffered insomnia symptoms during the Covid-19 pandemic. The related factors included uncertainty in effective disease control and worry about getting infected.