Mymensingh medical journal : MMJ最新文献

Magnesium plays a vast role in the nervous system. In particular, high magnesium in cerebrospinal fluid appears to enhance the neural functions, while low magnesium induces neuronal diseases. The aim of the study was to find out the relation of serum magnesium with idiopathic generalized epilepsy attending in a tertiary care hospital. This cross-sectional comparative study was conducted in the department of Neurology at Mymensingh Medical College and Hospital, Bangladesh from January 2019 to June 2020 following ethical approval. Total 110 purposively selected participants (55 with idiopathic generalized epilepsy and 55 non epileptic apparently healthy individuals) were enrolled in this study. Serum total Mg was measured by EMP-168 Biochemical Analyzer. Average age of epileptic individuals was 33.13±9.5 years and majority was female (60.0%). Mean serum magnesium level was lower in epileptic patients than controls (1.80±0.041 vs. 2.02±0.19 mg/dl; p<0.001). Patients with higher seizure attack (>3 per month) had significantly lower mean serum magnesium level than the patients with seizure attack three or less per month. Serum magnesium levels are reduced in epileptic patients compared to healthy age and gender matched controls. Studies involving larger numbers of patients are needed to confirm these results.

Detection of rickettsia most commonly done by simple, economical Weil-Felix test which detects IgM antibody. This initial investigation provides limited sound guidance to clinical decisions because of its low specificity and sensitivity. An alternative test, enzyme-linked immunosorbent assay (ELISA) is faster, less complicated, can also be automated. Advancements in molecular method like polymerase chain reaction (PCR) are highly specific, sensitive and rapid assays for detection of rickettsiales in many different samples including blood, tissue etc. This study was carried out to diagnose the rickettsial agent in the north-central (Mymensingh division) area of Bangladesh. In laboratory, we performed ELISA and PCR. The agent was diagnosed up to species level by molecular approach. A total of 150 febrile patients were included. All were clinically suspected cases of rickettsial fever attending inpatient and outpatient department of medicine and pediatrics of Mymensingh Medical College Hospital from Octy 2012 to January 2014. The laboratory tests were performed in Microbiology department of Mymensingh Medical College. Following universal safety precautions blood samples were collected, serum separated and both were stored at -20°C. IgM ELISA and Nested PCR were performed. Several genes by PCR were detected for confirmation of the presence of rickettsial agent in the blood. Among 150 clinically suspected cases 76(50.66%) were positive for ELISA, and 69(46.0%) were positive for PCR. The sensitivity and specificity of ELISA were 92.75% and 85.19% respectively taking PCR as gold standard. The prevalence of rickettsial infection found in this study was very much close to other countries of this Sub continent.

Achilles tendon injury has been increasing over recent years due to a variety of causes. The injury of the Achilles tendon is a disabling condition, which is difficult to treat if there is a gap or defect between the two ends of the disrupted tendon. Patients with a rupture of the Achilles tendon should be operated without delay. Most of the people in our country use flat pan in the latrine, which are at a same level of the toilet floor. Surface of the toilet pan breaks down and cause sharp cut. Some of the cases of open tendon injuries occur due to road traffic accident, cut by broken glass and also assault. It is generally accepted that surgical repair of fresh ruptures of the Achilles tendon gives excellent results. Objective of the study was to find out the evaluation of the results of primary repair of Open tendo-achilles injury (OTAI). This prospective study was done in the department of Casualty of Mymensingh Medical College Hospital, Bangladesh in the period of Octy 2021 to June 2022. Patients who came with OTAI in casualty department were selected randomly. All cases were selected as OTAI, without associated injury of other leg muscles, posterior tibial artery and nerve within 12 hours. All patients underwent primary end to end repair by Modified Kessler's method. Evaluation of the results of primary repair of OTAI were carried out and were find out the common causes of injury, age and sex incidence, level of injury and to proposed a protocol for treating such cases in comfortable, cheap and convenient way for the patients. Operations were done at Casualty operation theatre (COT). Then 48 patients were followed up at the Department of Casualty. Among them 43(89.58%) of patients were able to stand on tip toes, 4(08.33%) of patients were not stand on tip toes of affected foot unsupported but able to stand on tip toes supported, 1(02.08%) of patients failed to stand on affected foot unsupported due to severe infection and wound gap. Final result were Excellent - 29(60.0%), Good - 14(30.0%), Fair - 4(8.0%), Poor - 1(2.0%). Repair of OTAI is not difficult but early diagnosis, proper surgical toileting, meticulous repair; adequate post-operative management is the key of success. So, the result of this study, treatment protocol can be followed, which is easy for surgeon and convenient and cheap for the patients.

The treatments of subtrochanteric femoral fractures are a challenge. It accounts about 10.0% to 34.0% of all hip fractures with a high complication rate. This area consists of mostly cortical bone with high stress generation thus heal slowly. The fracture is too proximal to adequately control with implants for femoral shaft and too distal to control with implants for intertrochanteric fractures. The intrinsic insecurity of this fracture and forces of the muscles with comminuted medial calcar is giving the fracture a tendency to varus crumple. Extramedullary implants are associated with higher rate of implant failure while intramedullary nails are not suitable for short proximal segment and wide medullary canal. Recently proximal femoral locking compression plate (PF-LCP) has been applied in treatment of proximal femur including subtrochanteric fractures. It has an excellent result in respect of union, fewer complications and early rehabilitation. The aim of this study was to assess the rate and time taken for union of fractures by PF-LCP and determine perioperative parameters. 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. Union status evaluated by Radiographic Union Score for Tibial (RUST) fracture of Whelan; where antero-posterior and lateral radiographs (X-ray) based assessment of healing of the four cortices done. The entity cortical scores were added to give an entire score; 4 being the least amount demonstrating fracture are positively not healed and 12 being the highest score representing that the fracture is positively healed. The mean age of the patients was 42.04±14.97 years with range 22-70 years. Majority of patients were male (60.0%) and most of injury (64.0%) due to road traffic accident with most fractures was Seinsheimer type III (48.0%). Average operative time was 121.92 minutes, follow up period was 41.12 weeks (24-48 weeks) and time taken for union was 14.16 weeks (11-28 weeks). According to RUST scores; fracture union rate 88.0% with delayed union 12.0% and no nonunion. There were two patients with superficial wound infection and no implant failure. This study concludes that PF-LCP is a safe and reliable implant for the treatment of subtrochanteric femoral fractures.

Although comprehensive epidemiological data related to long term use and abuse of benzodiazepine (BZD) in our country is scarce, undocumented clinical observation suggests that the prevalence is quite high and constitutes a significant public health problem. This cross-sectional study was carried out in the Department of Medicine, Shaheed Ziaur Rahman Medical College hospital, Bogra, from 1st October 2015 to 31st March 2016. The objectives of the study were to evaluate the indication, dosage, duration and untoward effects of use of benzodiazepine for one month or longer among the patients attending the inpatient and outpatient departments of medicine. A total of 100 cases of long term benzodiazepine users aged between 18 to 72 years with mean age of 44.0±15.02 years were taken for the study. Male to female ratio of the cases was 1.08:1.00, 97.0% were Muslims, 96.0% were married; 77.0% were rural dwellers. Fifty four (54.0%) cases were from middle class society and 39.0% were housewives by occupation. The benzodiazepine dosage ranged from <5mg to 10mg equivalent to diazepam, with mean dose of 7.5±1.71 and the duration ranged from 1-60 months. Benzodiazepine tolerance was found in 21.0% and dependence in 18.0%. The common reason for taking was benzodiazepine for long duration was the different anxiety disorders in 63.0% followed sleep disturbance in 33.0%. Common cause of long term continuation reported by the respondents was rapid relief of symptoms (51.0%) and lack of awareness (21.0%). In 56.0% cases, the drugs were prescribed by providers other than registered physicians. Only 23.0% of patients were counseled beforehand regarding the probable hazards of long term use of the drugs and the counseling were provided only by registered physicians. In conclusion, it can be said that, large scale epidemiologic studies are warranted to evaluate the weight of burden of benzodiazepines abuse in our community and the needs for changes in clinical approach.

Assessing children's pain using patient-based pain scales can be challenging. Hence, there is a need of new version Artificial Intelligence Child Dental Anxiety Scale (AI-CDAS) to scale and test its psychometric properties (validity and reliability). This study was conducted to evaluate the validity and reliability of Artificial Intelligence version of the Child Dental Anxiety Scale (AI-CDAS) for anxiety detection scale in children using face as a response set from October 2022 to December 2023. Aim of this study was to examine the reliability and validity of Artificial Intelligence based Child Dental Anxiety Scale (AI-CDAS) using a wide range of age samples in dental clinics. A total of 100 outpatients (Age 03-09 years) from Bharati Vidyapeeth Deemed to be University Dental College and Hospital, Pune, India participated in this study. Dental anxiety was assessed using the Artificial Intelligence Child Dental Anxiety Scale (AI-CDAS) and comparing with a valid and reliable scale of Colored Version of Modified Facial Affective Scale. Reliability and validity was good and significant correlations were found between the AI-CDAS and the Colored Version of Modified Facial Affective Scale. This study suggests that the Artificial Intelligence based Child Dental Anxiety Scale (AI-CDAS) is a valid and reliable measure for assessing children's dental anxiety and may help encourage dentists to formally assess dental anxiety scale in day to day practice. Self-report measures are commonly employed in dental anxiety assessments. One advantage of self report measures is the ease of administration, taking relatively short period of time to complete. They can also assess the reaction to different aspects of the dental experience.

Stroke is one of the major causes of morbidity and mortality throughout the world. Research is going on to find out the factors which are associated with the severity of acute ischemic stroke. One of the factors which has gained interest in the field of research in recent time is serum ferritin. Serum ferritin is an acute phase reactant. It is recently under research as a marker of severity and prognosis of acute ischemic stroke. The aim of this study was to assess the relation of serum ferritin level with the severity of acute ischemic stroke. This cross-sectional study was conducted in the Department of Medicine in Mymensingh Medical College Hospital, Bangladesh from June 2020 to March 2023. In this study, 323 patients with acute ischemic stroke were enrolled. The severity of neurological disability was evaluated in all participants using National Institute of Health stroke scale (NIHSS) within 48 hours of onset of stroke. Blood was taken for estimation of serum ferritin levels within 48 hours of admission. In this study, mean serum ferritin level was 208.3±161.1 ng/ml in patients with acute ischemic stroke. The study showed most of the participants with high serum ferritin level had severe stroke (n=57, 77.0%; p<0.001). A statistically significant correlation was found between NIHSS and serum ferritin levels in acute ischemic stroke patients (r=0.71). This study revealed that serum ferritin level is associated with severity of neurological disability among patients with acute ischemic stroke. Further studies are required to establish the role of serum ferritin as a prognostic marker of acute ischemic stroke.

The corpus callosum (CC), the largest commissure of the brain, connects the two cerebral hemispheres and lies at the bottom of the longitudinal fissure. The antero-posterior diameter of the CC was larger in males than in females, but this difference was not significant. Again, the length of CC increased with age and there was also a positive significant correlation between the antero-posterior diameters of the CC with the antero-posterior diameter of the brain. This cross sectional descriptive study was performed into four categories: Group A (20-29 years), Group B (30-39 years), Group C (40-49 years) and Group D (50 years and above). The specimens were collected from morgue in the department of Forensic Medicine, Mymensingh Medical College, Bangladesh by purposive sampling technique Octy 2016 to Octy 2017. The antero-posterior diameter of CC was measured by using thread. The mean maximum antero-posterior diameter of corpus callosum was 8.25 cm in group D and minimum was 7.92 cm in Group A. When the diameter was compared between sexes in different age groups, it was significant in Group D and moderately significant in Group C. There was a positive correlation between antero-posterior diameter of corpus callosum and age of individual and it was statistically not significant. For statistical analysis, differences between age and sex groups were analyzed by using students unpaired 't' test. The present study will help to increase the information pool on the antero-posterior diameter of CC of Bangladeshi people and thus will minimize the dependency on foreign standards and also have diagnostic importance for the neurosurgeons and radiologists for clinical investigation and surgery.

The cross-sectional, analytic and descriptive type study was conducted among 5-10 years aged Bangladeshi children at different areas of Mymensingh district (Muktagacha, Fulbaria, Trishal, Haluaghat and Fulpur thana) on 109 Bangladeshi children (39 female and 70 male). The study was conducted in the Department of Anatomy, Mymensingh Medical College, Bangladesh. Nonrandom purposive sampling technique was taken for sample collection. Any kind of leg and foot deformity resulting either from congenital anomaly or physical injury was excluded to construct standard data. The present anthropometric study was designed to construct data of 5-10 years aged Bangladeshi children regarding calf circumference, to measure correlation calf circumference (right) with body weight and comparison of calf circumference (right) between male and female children. The study has been made out to grow interest among the researchers for future study and also to compare the data with the data of the people of other races of different country. Body weight was recorded by weighing machine and calf circumference was measured by measuring tape. Calf circumference (right) showed non-significant positive correlation with weight in 5 years old male, 6 and 7 years old male and female, 8 years old male, 9 years old female and 10 years old male and female children. In case of 5 years old female and 9 years old male children, it showed significant positive correlation with weight but in case of 8 years old female, it showed non-significant negative correlation with weight. Comparison of calf circumference (right) between male and female children was done by Unpaired Students' 't' test which was statistically non-significant.

There is a scarcity of data on congenital adrenal hyperplasia (CAH) in Bangladesh. This study aimed to collect baseline information and identify relevant issues specific to the disease. We analyzed the retrospective analysis of medical records of pediatric patients attending Dhaka Shishu (Children) Hospital, Dhaka, for serum 17-Hydroxyprogesterone (17-OHP) measurement and documented to have CAH from December 2008 to December 2020. The diagnosis was supported by biochemical findings and confirmed by serum 17-OHP assay and karyotyping. The relevant clinical data were descriptively analyzed. A total of sixty (60) patients with the diagnosis of CAH were enrolled. Among them, 40(66.7%), 15(25.0%) and 5(8.3%) patients had salt-wasting (SW), simple virilizing (SV) and non-classical (NC) CAH, respectively. Karyotypically, 45(75.0%) were girls and 15(25.0%) were boys. At presentation, 30(50.0%) were initially assigned as female and 24(40.0%) were male and in 6(10.0%) cases, the sex was not assigned. All six cases of unassigned sex were proven to be female by karyotype, while ninecases assigned as males were proven to be females; overall, 15(25.0%) patients were incorrectly assigned sex at the initial presentation. Patients with SW form of disease presented at an earlier age (median age 1.0 months) than those with SV form (median age 12.0 months). Boys were diagnosed later than girls. CAH should be diagnosed earlier, irrespective of the sex of the child, to prevent death from the salt-losing crisis and proper gender assignment. In a resource-poor country like Bangladesh, we should emphasize building awareness among the general population and caregivers for early clinical identification of the cases and proper referral.