Mymensingh medical journal : MMJ最新文献

Wernicke's encephalopathy is a potentially lethal complication of thiamine deficiency which mainly occurs in chronic alcoholic patients. It may occur in other conditions like hyperemesis gravidarum too. Pregnancy may also be complicated with other neurological and cardiac complications. Here we present a rare case of hyperemesis gravidarum in a primigravida patient with twin pregnancy having Wernicke's encephalopathy, central pontine myelinolysis and recurrent supraventricular tachycardia. This 20-year-old lady had all the classic features of Wernicke's encephalopathy like confusion, nystagmus, ophthalmoplegia and ataxia. Empirical treatment was given with parenteral thiamine. MRI of the brain was suggestive of Wernicke's encephalopathy. She had transient dysphagia. MRI of the brain also revealed central pontine myelinolysis, which was the most likely cause of this dysphagia. With treatment, her condition improved significantly, supraventricular tachycardia was also corrected. This case warrants careful monitoring and treatment of hyperemesis gravidarum patients to prevent such complications.

This anthropometric study was designed to construct data of 5 to 10 years aged Bangladeshi children regarding tibial length and an attempt has been made out to grow interest among the researchers for future study of different country. This study will be helpful to compare the data with the data of the people of other races. This cross sectional descriptive type study was conducted among Bangladeshi children (5-10 years aged) at different areas of Mymensingh district. This study was performed on 109 Bangladeshi children among them 70 was male and 39 was female children and conducted in the Department of Anatomy, Mymensingh Medical College, Mymensingh. Nonrandom purposive sampling technique was taken for sample collection of this study. Any kind of leg and foot deformity due to either from congenital anomaly or physical injury was excluded. Tibial length was measured using handmade sliding scale. The mean length of both tibia of 5, 6, 7, 8, 9 and 10 years aged male children were 19.66±1.59 cm, 21.56±1.88 cm, 23.94±3.28 cm, 24.73±1.64 cm, 26.50±2.34 cm and 27.02±2.12 cm respectively and those of female children were 21.54±1.94 cm, 22.62±.80 cm, 24.31±.97 cm, 23.16±2.17 cm, 25.92±3.55 cm and 26.65±1.91 cm respectively. Comparison of tibial length between male and female children was done by unpaired Students 't' test. Comparison of differences of mean tibial length between male and female children was statistically non- significant except in case of 5 years old age group, it was significant. Data were statistically analyzed using Microsoft excel and SPSS software. The results of this study will be useful in anatomy, orthopedics, forensic science, plastic surgery, radiology, podiatry, archeology, anthropology.

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The regional variation of the femur bone is influenced by sex, stature geographical area and heredity, as the environment plays an important role in the developmental process. This cross-sectional descriptive purposive study was done on 150 (64 right and 86 left) fully ossified dry human femur of Bangladeshi people to find out the variation of neck length on anterior and posterior aspect. Sample was collected in the Department of Anatomy, Mymensingh Medical College, Bangladesh from January 2019 to December 2019. Fractured, damaged and remodeled bones were excluded from the study. Neck length was measured with the help of digital Vernier slide calipers. The mean±SD neck length on anterior aspect of femur on right and left side was, 30.81±3.74 mm and 29.99±3.91 mm respectively. The mean±SD neck length on posterior aspect of femur on right and left side was 35.90±4.07 mm and 35.97±4.17 mm respectively. The knowledge of variations in the parameters of dry femora will help the orthopedicians and also assist prosthetists to design a suitable prosthesis. These data also provide information about neck length of femur of Bangladeshi people and to compare these data to those from various other races thus it could contribute to demographic studies of fracture neck femur, osteoarthritis, hip joint ailments probability and management in Bangladeshi population.

A 58-year-old hypertensive man was admitted with severe central chest pain and palpitation. His electrocardiogram (ECG) showed fast atrial fibrillation with features suggestive of left main coronary artery occlusion. He was taken to the Cath-lab but surprisingly, coronary angiogram (CAG) showed no stenosis. Meanwhile, other labs showed high D-dimer and lactate. Hence, bedside Transthoracic echocardiography (TTE) was carried out and showed dissecting flap in the ascending aorta. Immediately, a CT (Computed Tomography) was arranged and it revealed Stanford Type-A Aortic Dissection (AD). Then urgently, he was taken for surgery but unfortunately, he died after long surgical procedure. Here, the misleading factors were that his presentation and ECG changes were so typical of acute coronary syndrome (ACS) that heading us to think about coronary artery disease (CAD). Therefore, the intriguing question: is a bedside echocardiography before shifting to Cath-lab could have given the clue for early detection of AD.

Heparin is an anticoagulant used invariably in all cardiac surgery. Heparin dosing and its reversal were determined by monitoring activated clotting time (ACT). Intermittent heparin dosing after initial bolus dose is widely practiced to maintain ACT level 200-300 seconds in Off-pump coronary artery bypass surgery (OPCAB). Fluctuation of ACT level from this range may cause adverse postoperative outcome. This study was aimed to compare early postoperative outcome between intermittent heparin dose and continuous heparin infusion after initial bolus dose during OPCAB. This comparative cross-sectional study was carried out in National Institute of Cardiovascular Diseases (NICVD), Bangladesh from January 2019 to December 2020. Total 110 patients were enrolled by purposive sampling and divided into 2 groups: Group A where 55 patients received intermittent heparin after initial bolus dose and Group B where 55 patients received continuous heparin infusion after initial bolus dose. Data were analyzed by statistical package for social science (SPSS) version 26.0 and p value <0.05 was considered significant. Baseline ACT level of Group A and Group B was not significant (p=0.800). After bolus dose of Heparin, ACT level of Group A and Group B was not significant (p=0.068). Mean maintenance ACT was 326.34±22.774 seconds in Group A and 258.67±12.285 seconds in Group B patient, which was significant (p<0.001). Peroperatively 29.0% from Group A and 11.0% from Group B developed arrhythmia. Platelet count significantly reduced in Group A (p<0.001). Postoperative mean Troponin I level in Group A was 5.78±1.15 and Group B was 5.32±1.05ng/dl, which is significant (p=0.030). Postoperative blood loss was significantly higher in Group A than Group B (986.36±398.31 vs. 852.73±241.22, p=0.036). There was significantly better reduction of arrhythmia and ischemia in postoperative and on discharge ECG finding in Group B patients (p=0.002). On discharge echocardiography 31.0% from Group A and 13.0% from Group B had regional wall motion abnormality, which is significant (p=0.018). But there was no significant difference in LVEF% (52.65±5.99 vs. 53.85±5.77, p=0.287). Early postoperative outcome of continuous heparin infusion is better than intermittent intravenous heparin after initial bolus dose during Off-pump coronary artery bypass surgery. So, during OPCAB use of continuous heparin infusion after bolus dose is eminent time worthy.

One of the most prevalent congenital defects in boys is undescended testes. Ultrasound is commonly employed to locate the testis in cases of impalpable testes, which frequently yields false-negative results. Laparoscopy has gained widespread acceptance recently for managing impalpable testes. Objective of the study was to evaluate the efficacy, safety and diagnostic accuracy of laparoscopy in the management of impalpable undescended testes (UDT) in a tertiary care setting. To Assess, analyze the outcome of laparoscopic orchiopexy and orchiectomy and highlight the advantages of laparoscopy over traditional diagnostic and surgical methods. This was a prospective type of observational study of all children with impalpable testes presenting for laparoscopy from January 2022 to July 2024 in the department of Pediatric Surgery, Mymensingh Medical College Hospital, Mymensingh, Bangladesh who had undergone ultrasound examinations without localizing the testes was conducted and the role of laparoscopy in diagnose with managing impalpable testes. Those patient are included in this study who are clinically impalpable and on ultrasound near deep ring or abdominal and excluded those who are clinically palpable and ultrasound can locate the testis within inguinal canal and ambiguous geneitalia by karyotyping. Total 56 patients were included among them 67 were impalpable testes. The age ranges from 1 to 12 years. Initially site and size of testes were identified by abdominopelvic USG in all 56 patients. Single stage laparoscopic orchidopexy was done in 40 testes, stage procedure underwent 18 testes, laparoscopic orchiectomy was done in 9 testes. Follow-up by clinical examination Doppler ultrasound in selected patient for 6 months. Atrophy of testis occurred in 2 patients during this follow-up period. Laparoscopy has revolutionized the management of impalpable UDT, providing a reliable, safe, and effective method to diagnose and treat this condition. Its advantages make it the preferred approach for pediatric surgeons when dealing with non-palpable testicles.

Sepsis is a leading cause of neonatal morbidity and mortality worldwide, especially in low- and middle- income countries (LMIC). It is estimated to cause almost 1 million deaths that accounts for more than 25.0% of neonatal deaths worldwide. In Bangladesh the incidence of neonatal sepsis is 13.4% and sepsis contributes to almost 19.9% of all neonatal death. Vitamin D deficiency in mothers and neonates is being recognized increasingly as a leading cause of many adverse health effects in the newborn infant, including sepsis. Vitamin D plays an important role in calcium and phosphorus homeostasis as well as immunomodulatory actions on immune system. The aim of the study was to determine the association of serum 25(OH) vitamin D deficiency with late onset neonatal sepsis in term and late preterm neonates. This cross-sectional analytic study was conducted in the department of Neonatology, Mymensingh Medical College Hospital, Bangladesh from November 2021 to October 2022. Neonates who were admitted with suspected late onset neonatal sepsis were the study population. Neonates who visited during the same period due to physiological hyper-bilirubinemia (without sepsis) were enrolled as control group. Vitamin D deficiency was found in both sepsis group and control group. But in comparison the sepsis group had significantly lower mean±SD serum vitamin D levels 13.99±6.07 ng/ml than the control group 20.56±5.93 ng/ml (p=0.001). Similarly, vitamin deficiency was also found in mothers of both groups. But mothers of septic neonates also had significantly lower mean±SD vitamin D levels 16.36±6.25 ng/ml than the mothers of non-septic neonates 23.06±5.85 ng/ml (p=0.001). There was strong positive correlation of neonatal 25(OH) D with maternal 25(OH) D in both case (r =0.983; p<0.001) and control (r = 0.970; p<0.001).

Globally the incidence and prevalence of chronic kidney disease (CKD) is increasing day by day. Various biochemical and hematological abnormalities are associated with CKD that leads to morbidity and mortality. The aim of this observational study was to evaluate the socio-demographic profile, biochemical and hematological parameters of chronic kidney disease patients in Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2020 to December 2020. This study also showed variation of biochemical parameters with lower calcium and hemoglobin level which was due to improper renal function. A total of 179 End Stage Renal Disease (ESRD) patients were enrolled in this study. Male and female ratio was 2.086:1. This study had more male patients than female. The Mean±SD age of the patient was 46.14±14.25 years and maximum of the CKD patients belonged to the age group of 41-60 years. This study depicted Glomerulonephritis was the leading cause of CKD. Second common cause was Diabetes mellitus. A portion of CKD was unknown etiology (CKDu) which was found 17.31%. Routine biochemical parameters were also seen in this study. This study showed that the majority of the patients were living below the level of poverty and came from rural area. This study aimed to evaluate the derangements of serum biochemical parameter and the association of risk factors with CKD. These demographic character, biochemical profile and etiology have association with CKD progression. So, early evaluation of these parameters may reduce the incidence of CKD.

Wilson's disease is an autosomal recessive disorder that affects copper transport due to deficiency of ceruloplasmin and causes deposition of copper mainly in the liver, brain and cornea. It causes hepatic and/or neuropsychiatric manifestations. This copper deposition causes cirrhosis of the liver, encephalopathy and liver failure. It also causes disorders of the menstrual cycle and subfertility. During pregnancy, there is an increased risk of the development of preeclampsia, fetal growth restriction, and neurologic damages to the fetus. Pregnancy with decompensated liver cirrhosis developed more complications like bleeding from esophageal varices, liver failure, encephalopathy, and rupture of the splenic artery. A successful decopperizing agent may lead to restoration of the ovulatory cycle and enable pregnancy. We are reporting four cases of successful pregnancy outcomes of known case of Wilson's disease with pregnancy which was taken from Fetomaternal Medicine Department of Bangabandhu Sheikh Mujib Medical University (BSMMU), and discussing the management of pregnant women with this disorder.