Mymensingh medical journal : MMJ最新文献

The standard values of lung function parameters obtained from Western populations do not agree with that of the people of Bangladesh. The study aimed to establish valid and up-to-date spirometry predictive values for the general population in Bangladesh. This cross-sectional observational study was conducted over six months from February 2020 to July 2020 in the Department of Respiratory medicine of Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh. Data was obtained from 627 participants after inclusion and exclusion criteria. An Easy One Air Type A 2500-2A Spirometer, USA was used for measurement of forced expiratory volume in the first second (FEV₁), forced vital capacity (FVC), FEV₁ and FVC ratio (FEV₁/FVC) and forced mid-expiratory flow (FEF 25.0% - 75.0%). All spirometric measurements were performed with the subjects seated and according to standard protocol provided by the American Thoracic Society (ATS) guidelines. Most people were (39.7%) in the normal-weight (BMI: 18.5-24.9) range. FEV₁ was more in females than males among the lung function parameter, but FEF was higher in males. In linear regression, forced vital capacity, forced expiratory volume in the first second, and forced vital capacity ratio, forced mid-expiratory flow negatively correlates with age and forced vital capacity has a negative correlation with body mass index. Lung function variables were significantly different between males and females in Bangladesh. Females have a higher lung volume than males. In regression analysis, lung functions variables were determined for males and females considering age as an independent variable but there was no correlation with body mass index except forced vital capacity.

The autonomic nervous system governs rhythmic fluctuations in blood pressure and heart rate, which are influenced by breathing patterns. This study aims to explore how different breathing techniques, specifically Kapalbhati (fast-paced breathing) and Slow Deep Breathing (SDB), affect heart rate variability (HRV). This study was conducted in the Department of Physiology and AYUSH at AIIMS Bhopal, India and duration was 2 (Two) months from May 2021 to June 2021 This quasi-experimental study involved 60 participants divided into two groups: Kapalbhati and SDB. Results showed significant differences in HRV, with Kapalbhati inducing sympathetic dominance and SDB promoting parasympathetic activity. These findings suggest that SDB may enhance relaxation and longevity, while Kapalbhati could aid in weight loss by boosting metabolism.

Subtrochanteric femoral fractures are one of the common fractures encountered in today's Orthopaedic practice. This area consists of mostly cortical bone with high stress generation thus heal slowly which leads implant failure. The inherent instability of this fracture and forces of the muscles with comminuted medial calcar is giving the fracture a tendency to varus collapse. Intramedullary nails are not suitable for short proximal segment and wide medullary canal while extramedullary implants are associated with higher rate of implant failure. Recently proximal femoral locking compression plate (PF-LCP) has been applied in treatment of proximal femur including subtrochanteric fractures. It has an excellent functional outcome in respect of Weight bearing, Knee ROM, Pain status, Walking, Squatting and Return to pre-injury state. The aim of this study was to assess functional outcome of subtrochanteric femoral fractures fixation by PF-LCP. This prospective study was conducted from March 2019 to September 2020 at Mymensingh Medical College Hospital through non randomized purposive sampling. Total 25 patients aged above 18 years irrespective of sex with closed subtrochanteric fracture were included but pathological fractures, multiple injuries were excluded from the study. They were evaluated by Modified Harris Hip Score (MHHS). Age was ranged from 22 to 70 years and mean age 42.04±14.97 years. Maximum patients (56.0%) were in workable age (21-40 years) and Seinsheimer type III (48.0%) was most common fracture type. Minimum follow up was at least 24 weeks and mean 41.12±7.11 weeks. Functionally most of patient started early partial (88.0%) and full (64.0%) weight bearing with 64.0% have full knee ROM, 52.0% found pain free and 76.0% without limb shortening. Maximum patients regained walking (76.0%) and squatting (68.0%) and return to pre-injury state (72.0%) of activities. Evaluation of functional outcome by Modified Harris Hip Score showed 56.0% excellent, 32.0% good, 8.0% fair and 4.0% poor functional outcome. Excellent and good outcome were considered as satisfactory, thus satisfactory outcome were 88.0%. This study concludes proximal femoral locking compression plate (PF-LCP) is a safe and reliable implant for the treatment of subtrochanteric fractures with excellent functional outcome.

Hypertension is the leading risk factor for death and disability globally, particularly in Bangladesh. Serum calcium is supposed to be linked with the pathophysiology of hypertension, though various studies have shown contradictory results. Hence, this study was conducted to evaluate the role of serum calcium level in essential hypertensive patients. This cross-sectional study was conducted in Shaheed Monsur Ali Medical College and Hospital, Bangladesh following ethical clearance. Total 107 essential hypertensive patient who fulfilled inclusion and exclusion criteria, were included in this study following informed written consent. Blood pressure was measured according to the protocol of American Heart Association (AHA). Serum calcium, albumin and creatinine were measured by HITACHI analyzer. Data was collected using questionnaire with closed ended questions which has been pretested. Collected data were analyzed by the SPSS 24.0. Mean age of study participants was 45.44±7.13 years (range: 21-63). Most of the patients were middle-aged (78.5%), male (54.2%), hailed from urban residence (95.3%), were overweight or obese (97.2%). Among comorbidities, 17.76% had DM, 7.48% had stroke and only 2.80% had cardiovascular diseases. Mean±SD SBP and DBP was 161.21±12.91 and 98.26±6.31 mmHg, respectively. Overall of the assessment showed, 23.36% patients were hypocalcemic, only 4.67% were hypercalcemic and rest of them were within physiological limit. Mean serum calcium was 9.04±0.84 mg/dL (7.36-11.72 mg/Dl). Systolic BP was significantly higher among patients with corrected calcium >8.5 mg/dL compared to ≤8.5 mg/dL (163.05±12.48 versus 155.87±13.04 mmHg, p<0.05). There was a positive linear relation between serum calcium and SBP (Beta=0.201, p=0.024). This study result revealed a significant association of corrected calcium with systolic BP. However, further larger multicenter study is recommended.

Chronic kidney disease (CKD) is one of the largest public health issues and the major cause of death worldwide. Due to an increase in the incidence of systemic diseases like diabetes and hypertension, which are the two main causes of CKD and kidney damage, the prevalence of CKD is rising globally. Chronic Kidney Disease results in mineral disorders as well as profound lipid disorders due to improper balancing of the mineral & hormone levels in the body. This cross-sectional study was completed in the Department of Biochemistry, Mymensingh Medical College, in collaboration with the Department of Nephrology, Mymensingh Medical College Hospital, during the period of July 2022 to June 2023. The subjects were selected based on inclusion and exclusion criteria by purposive non-random sampling. Total 120 subjects were included in this study. Out of them, 60 were selected chronic kidney disease patient (Group II) and another 60 apparently normal healthy persons were selected as control (Group I). In this study, serum magnesium levels were measured for analytical study. All the values were demonstrated as mean±SD and values of serum magnesium were in Group I (1.99±0.50 mg/dl) and in Group II (2.24±0.19 mg/dl). Statistical analysis was performed using by statistical package for social science (SPSS) version 26.0. The statistical significance of the difference between the case and control was evaluated using Student's unpaired 't'-test (p<0.001). After careful evaluation, this study was found that mean serum magnesium levels was significantly increased in CKD patients.

Transfusion dependent thalassemia (TDT) patients require a regular blood transfusion to survive. Without adequate transfusion support, they suffer many complications, and have a short life span. Near about 200 milligrams of iron remains within a single Red cell concentrate (RCC) unit. So, blood transfusion acts as a double-edged sword, prolonging life while eventually leading to iron overload. For patients who are receiving transfusions for several years, iron accumulation causes different types of morbidity including thyroid failure. Though serum ferritin is a simple tool for measuring the iron load of the body, it is often misleading. Because, in first 100 unit of blood transfusion serum ferritin levels increase steadily. After that, this relation is not simple. Serum ferritin may increase in chronic inflammation or decrease in vitamin C deficiency, which may be misleading. The study aimed to identify a simple predictor of hypothyroidism in TDT patients. This cross-sectional study conducted from April 2018 to September 2019 includes 64 TDT patients according to selection criteria. Among them 43 were male and 21 were female TDT patients, with a mean age of 25.5 years. Body iron load was estimated by serum ferritin level. Pearson correlation test was done to measure the correlation of serum TSH level with serum ferritin, unit of blood transfused so far and duration of receiving transfusion therapy. All of these three variables had positive correlation with serum TSH level (r value 0.241, 0.319 and 0.332 respectively). Level of correlation of serum TSH was statistically significant with unit of blood transfused (p=0.010) and with duration of transfusion therapy taken (p=0.007) but not with serum ferritin level (p=0.055). Meticulous transfusion history taking is more important than investigation reports like serum ferritin level to predict hypothyroidism in TDT patients.

Urinary tract infection (UTI) is one of the important causes of morbidity and mortality in Systemic lupus erythematosus (SLE). To calculate the frequency, organism and risk factors for UTI in SLE. This observational study was conducted in the lupus clinic in the department of Rheumatology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from September 2012 to January 2014. Total 169 diagnosed SLE patients were enrolled consecutively. Urinary symptoms positive patients were considered as case and symptoms negative were considered as controlled. The patients having DM, Recurrent UTI and unable to participant were excluded. Urinary symptoms including demographic variable, disease activity index- Systemic Lupus Erythematosus Disease activity index (SLEDAI), organ damage index Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) were evaluated. Dose, duration and cumulative dose of steroid, HCQ, MMF, azathioprine and cyclophosphamide were evaluated for risk factor of UTI. Serum C3, C4, CRP, ANA, anti-ds DNA, CBC, urine routine examination with culture and sensitivity were done. Out of 169 patients 19 patients excluded in this series. Forty patients had UTI and rate of UTI was 28.57%. The most common organism was E coli and it was 52.5%. High disease activity index (SLEDAI), severe organ damage index (SLICC score), Lupus nephritis and cyclophosphamide were found risk factor for UTI by Bi-variate analyses. Use of cyclophosphamide in SLE patient was found as significant risk factor in multivariate analyses. Frequency of UTI in SLE was quiet high. Past suffering from Lupus nephritis and use of Cyclophosphamide were notable risk factor for UTI.

Cases of asphyxial death are frequently come across and the numbers are remarkable now-a-days. The study was aimed to estimate the frequency and to determine the socio-demographic pattern of the victims of asphyxial death. It was a cross-sectional variety of descriptive study and carried out in the Department of Forensic Medicine, Dhaka Medical College, Bangladesh from 1st January 2018 to 31st December 2019. A predesigned proforma was made first, and then various data were assembled, tabulated and analyzed there. In the midst of 2199 medicolegal autopsies, there were 224 cases of asphyxial death. Male victims (62.05%) were mostly found and the most affected age group was 30-39 years (35.26%). Victims were predominantly married (53.57%) and were mainly from urban areas (38.39%). The Muslims (76.78%) were the major victims followed by the Hindus (17.41%), Christians (2.67%) and the Buddhists (1.78%). Maximum victims were unemployed (31.69%) followed by students, day laborers & cultivators. Hangings (54.01%) were mostly encountered followed by drowning (23.21%) and throttling (7.14%). Majority of the cases were suicidal (58.48%) followed by homicidal (24.55%) and accidental (16.96%). The main provoking factors in suicidal cases were unemployment (22.13%) followed by failure in examination (20.61%) and domestic violence (12.97%). Hangings were proven to be suicidal. In cases of drowning manner of death could not be given and throttling were homicidal by autopsy.

Among the different complications of chronic kidney diseases, peripheral arterial disease is not uncommon. Though it is an indicator of widespread atherosclerosis, sometimes it is neglected in CKD patients. Our study was done to evaluate the frequency and pattern of PAD in chronic kidney disease patients admitted in a tertiary care hospital of Bangladesh. One hundred (100) admitted patients of CKD were taken by nonrandom purposive sampling considering inclusion and exclusion criteria. After clinical evaluation and Ankle brachial index (ABI) measurement 5 cc venous blood was collected and sent to Clinical Pathology and Biochemistry department of CMCH. Data was collected in a structured proforma and analyzed. Among the 100 patients, 2.0% patient belonged to stage 3, 28.0% were in stage 4 and remaining 70.0% were in stage 5. We found the proportion of PAD in CKD were 18.0%. Among 18 PAD patients, 66.67% were in stage 5, 22.22% in stage 4 and 11.11% in stage 3. Regarding right lower limb 12 patients had some PAD, 3 patients had moderate PAD, 2 patients had borderline and 1 patient had calcified PAD. For left lower limb, 10 patients had some PAD, 4 patients had moderate PAD, 4 patients had borderline PAD. The mean AB) of the PAD patients for right limb was 0.87 and for left limb 0.84. 50.0-55.0% patients were asymptomatic. Among the PAD patients 38.9% had DM, 72.2% had HTN, 33.3% had both DM and HTN, 44.4% had other vascular events, 55.6% were smokers, 33.3% had dyslipidemia and 22.2% had family history of PAD. Renal diseases seem to have a strong association with vascular disease and PAD is not uncommon.

Most of the thalassemic children of Bangladesh are receiving repeated blood transfusion. But they do not receive chelation therapy due to financial constraints. As a result, iron overload occurs in various organs of these children. Extra iron that is loaded in thyroid gland causes thyroid dysfunction. This study was undertaken to evaluate thyroid status in children with transfusion dependent Thalassemia patient. This cross-sectional analytical study was conducted in the Department of Pediatrics, Mymensingh Medical College Hospital, Bangladesh from September 2016 to April 2018. Children having thalassemia diagnosed by Hb electrophoresis, aged 3-12 years of both sexes were included as study group. Children of same age and sex admitted in indoor of Mymensingh Medical College Hospital with minor illness and without thalassemia were taken as comparison group. Purposive Sampling technique was applied. Serum FT₄, TSH and ferritin level were estimated in all children. Data analysis was done with Statistical Package for Social Science (SPSS) version 21.0. A total of 60 patients were enrolled as study group and another 60 patients were compared as comparison group. Mean ages of study group was 7.88±2.55 years and comparison group were 7.22±2.48 years. The mean pre-transfusion hemoglobin, serum ferritin, serum FT₄ and serum TSH level were found 6.23±0.60 gm/dl, 2658.33±879.39 ng/ml, 15.14±4.40 fmol/mL, 4.29±4.60 μIU/mL respectively in study group. The mean serum FT₄ was found significantly lower and mean serum TSH was significantly higher in thalassemic children in comparison to non-thalassemic children (p= <0.05). Frequency of subclinical hypothyroidism was found significantly higher in study group (25.0%) compared to comparison group (3.3%) (p=0.001). Mean serum ferritin level was found significantly higher in hypothyroid cases. Mean FT₄ level was significantly lower and mean TSH level was significantly higher in hypothyroid thalassemic patients (p= <0.001). Significant positive correlation between serum ferritin level and serum TSH level was found. Higher serum ferritin level was found significantly associated with the development of hypothyroidism in thalassemic patients.