Mymensingh medical journal : MMJ最新文献

Childhood acquisition of Hepatitis B infection significantly increases the risk of chronic liver disease. To prevent this, the World Health Organization (WHO) recommends immunizing infants with three doses of the pentavalent vaccine (DPT + Hib + Hepatitis B) at 6, 10 and 14 weeks of age as part of the Expanded Program on Immunization (EPI). Vaccination schedules may vary based on birth weight and maternal Hepatitis B infection status. Preterm infants, due to their potentially weaker immune status, may require revaccination or booster doses in cases of non-response or poor response. This cross-sectional comparative study was conducted in the Department of Pediatrics, Mymensingh Medical College Hospital, Bangladesh, from October 2017 to September 2019. A total of 118 infants (59 terms and 59 preterm) who had completed the three-dose pentavalent vaccine schedule were included, selected from two EPI centers in Mymensingh city. Anti-HBs antibody levels were assessed six weeks after the third vaccine dose using an ELISA immunoassay kit. The mean anti-HBs levels in preterm and term infants were 143.41±37.81 mIU/mL and 140.96±42.81 mIU/mL, respectively, with no statistically significant difference (p>0.05). A good response (anti-HBs >100 mIU/mL) was observed in 89.8% (53/59) of preterm and 86.4% (52/59) of term infants. Poor responses (anti-HBs 10-100 mIU/mL) were seen in 6.8% (4/59) of preterm and 11.9% (7/59) of term infants. Among infants with a birth weight ≥2500 gm, 87.7% (50/57) showed a good response. Infants weighing 1500-2499 g demonstrated a good response in 88.3% (53/60) of cases. Of the 53 preterm good responders, 86.8% (46) had a gestational age of ≥34 weeks at delivery. In conclusion, the current pentavalent vaccine schedule under EPI produces a good immune response in most infants, with no significant difference between term and preterm infants. Among preterm infants, a better immune response was associated with a gestational age of ≥34 weeks.

A cross sectional study was conducted among 79 children and adolescents in Paediatric Endocrine Outpatient Department (OPD) of Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) General Hospital, a tertiary care centre in Dhaka, Bangladesh. Children and adolescents of 8 to 18 years of age with simple obesity who visited during the period of 1st January 2018 to 30th June 2018 were included in this study. The study was done to determine the percentage of different grades of fatty liver disease and to compare metabolic profiles and anthropometric measurements among obese children and adolescents with different grades of fatty liver disease. Fatty liver disease was identified and it's grading was done by Real-time ultrasonography of hepatobiliary system. Total 24 obese children (30.4%) had fatty liver disease among 79 patients. Majority of them (54.2%) had mild fatty liver disease followed by moderate fatty liver disease (41.6%). Severe fatty liver disease was found in only one child. Fasting blood sugar (p=0.031) and SGPT level (p=0.001) were significantly higher among children and adolescents with fatty liver disease in comparison to children without it. When comparison was done in different grades of fatty liver disease, triglyceride level (p=0.033) and diastolic hypertension (p=0.016) was significantly higher in children having moderate fatty liver disease. There was no significant difference in anthropometric measurements among children having different grades of fatty liver disease.

Polycystic ovary syndrome (PCOS) is a polygenic and multifactorial condition, considered as the most common endocrine problem of women in reproductive age. Insulin resistance, hyper-androgenism and obesity significantly influence the pathophysiological process of PCOS. This study was designed to estimate clinical and biochemical parameters in different phenotypes of PCOS. The cross sectional descriptive type of observational study was carried out at Mymensingh Medical College Hospital, Bangladesh from January 2018 to June 2019 among purposively selected 107 patients with PCOS. Data were analyzed by computer software, SPSS, version 22.0. Quantitative variables of this study were summarized using mean and standard deviation and qualitative variables were summarized by percentage. Biochemical parameters in different phenotypes were compared with t-test. Phenotype A was found in highest number (59.8%) followed by phenotype B (14.9%), phenotype D (14.0%) and phenotype C (11.2%). Biochemical hyper-androgenism was observed highest in phenotype A (57.8%) followed by phenotype B (36.4%) and phenotype C (6.1%). Biochemical or clinical hyper-androgenism was not observed among patients of phenotype D. Mean age of phenotype A, B, C and D were 22.92±6.36, 20.81±3.69, 24.82±5.96 and 21.94±4.12 years respectively. All the phenotypic subgroups were found higher in the high and middle class urban family. Body mass index (BMI), waist circumference and waist hip ratio were increased in all phenotypes but more in phenotype A and B. Blood pressure had no significant change. Phenotype A presented with oligo-menorrhea (50.47%), amenorrhea (7.48%) and menorrhagia (1.87%). Majority of phenotype B (13.08%) and D (12.15%) presented with oligo-menorrhea. All the phenotype C (11.2%) had normal menstrual cycle. Hirsutism was more in phenotype A and B. Phenotype A presented with more severe acne (19.6%), acanthosis nigricans (38.3%), weight gain (34.6%) and subfertility (18.7%) than others. Phenotype A and B had high serum total cholesterol and triglyceride but low serum HDL. Phenotypic division helps in better understanding the pathophysiology of PCOS, severity of the disease and also helps in predicting the adverse effects. Moreover, identifying various phenotypes have diagnostic implications and also assist in providing appropriate treatment and prognosticating the patients.

Stroke is a major health burden and a leading cause of morbidity and mortality. Acute stroke is stressful event and patients suffering from an acute stress such as stroke or myocardial infarction may develop hyperglycemia, even in the absence of a preexisting diabetes mellitus. This cross sectional observational study was conducted in the Department of Medicine and Neuromedicine, Mymensingh Medical College Hospital, Bangladesh from 16th August 2020 to 15th February 2021 to evaluate the glycaemic status in first ever ischaemic stroke patient admitted within 24 hours in a tertiary care hospital. Data were collected from the patients or informant and recorded in structured case record form. Thorough clinical examination and relevant investigation were done. SPSS and Microsoft excel were used for data analysis and processing. On assessment of glycaemic status, 71.0% of patients were found to have blood sugar level ≤7.7 mmol/L where 29.0% patients were blood sugar level ≥7.8mmol/L. This study demonstrated that, prevalence of acute stress hyperglycemia in stroke patient is detected 29.0% in tertiary centre hospital of Bangladesh. Evaluation was done on the basis of patient's symptoms, degree of disability or dependence in the daily activities and clinical outcome and it was measured by modified Rankin Scale (MRS). Study shows that 81.0% of the patients recovered (MRS score 0 to 2), among them maximum were normo-glycemics patients (90.1% vs. 51.7%). Fourteen patients developed poor outcome, they were disabled and discharged on request or risk bond (MRS score 3 to 5). In this study 7.0% expired during hospital stay (MRS score 6). In expired case maximum were stress hyper-glycemics patients (2.8% vs. 17.2%). So, in-hospital outcome is very poor in stress hyper-glycemics patients. We investigated association between acute stroke and glycaemic abnormalities, and found that stroke or other vascular event is harbor, or risk factor for prediabetes and diabetes. Proper evaluation, prevention of risk factor, and strict glycemic control is suggested for prevention of complication and reduction of occurrence of such event.

Hepatitis C Virus (HCV) is emerging as one of the major health problems in Bangladesh. Worldwide, there are roughly 71 million people who are chronically infected. Prevalence of HCV infection in Bangladesh is 0.88%. Chronic HCV carriers have the potential of transmitting HCV parenterally in the hospital setting; thus, health care workers (HCWs) are at risk of contracting HCV, with the most likely exposure being via a needle stick injury (NSI). As there is no effective vaccine till today, personal protection, safe transfusion of blood and blood products, safe disposal of Hospital bio-waste and use of disposable or auto-disabled syringes would be the best preventive option for a country like Bangladesh. This study aimed to investigate the knowledge, attitudes and practices regarding hepatitis C virus among health care workers in Mymensingh Medical College Hospital (MMCH). This cross-sectional observational study was conducted among 239 health care workers (79 Doctors, 100 Nurses, 50 Lab technicians and 10 Porters) from July 2019 to December 2019. Data were collected by structured questionnaire. The overall response rate was 85.0%. For knowledge about hepatitis C virus physicians were the most knowledgeable while porters are least knowledgeable group. Males who were over 40 years old and had working history of more than 10 years were most likely to show positive attitude towards hepatitis C. Physicians have more positive attitude than other groups. Those who received training had more positive attitude than others. In this study about half of participant took training about standard precaution. Though about fifty percent participant knows about protective measures but not all of them used it. Measures taken against blood borne viruses specially against hepatitis C virus are not satisfactory among the health care staffs of MMCH, Bangladesh. Therefore, a guideline should be put in place and implemented by the government and private health care authorities.

Neonatal intestinal obstruction (NIO) is a critical surgical emergency with high morbidity and mortality, particularly in resource-limited settings. This study aims to evaluate the predictors, treatment modalities, and outcomes of NIO in neonates admitted to a tertiary care hospital in Bangladesh. This cross-sectional observational study was conducted at the Department of Pediatric Surgery, Mymensingh Medical College Hospital, Bangladesh, from July 2017 to October 2018. Data were collected from 60 neonates diagnosed with NIO through detailed clinical evaluations, laboratory investigations and imaging studies. Treatment modalities included surgical interventions and conservative management, with outcomes analyzed using descriptive and inferential statistics. The majority of neonates (71.67%) were aged between 2-5 days, with a male predominance (66.67%). Anorectal malformation (45%) and Hirschsprung's disease (26.67%) were the most common causes of NIO. Surgical interventions were predominant, with pelvic colostomy (26.67%) and anoplasty (18.33%) being the most frequently performed procedures. Morbidity was observed in 71.67% of cases, while mortality occurred in 23.33%. Low birth weight (p<0.05), delayed presentation (p<0.05), elevated C-reactive protein (CRP) levels (p<0.05), and sepsis (p<0.05) were significantly associated with mortality. Early treatment (within 72 hours) showed a trend toward better survival, though not statistically significant (p>0.05). The study highlights low birth weight, delayed presentation, sepsis and elevated CRP levels as key predictors of adverse outcomes in neonates with NIO. Timely diagnosis, early intervention, and improved perioperative care are essential to reduce morbidity and mortality. Regional healthcare improvements are crucial for optimizing neonatal outcomes in resource-limited settings.

The overall cure rate for childhood acute lymphoblastic leukemia (ALL) has improved from virtually zero to the current event-free survival rate (EFS) of more than 90.0%. Disseminated intravascular coagulation is the commonest hemostatic abnormality in patients with ALL. It might cause serious hemorrhagic complications and warrants proper medical attention in due time. To detect the frequency, identify the risk factors and outcome of disseminated intravascular coagulation in children with acute lymphoblastic leukemia during induction chemotherapy. This prospective observational study was carried out in 55 diagnosed cases of ALL children in the department of pediatric hematology and oncology, BSMMU from November 2020 to October 2021. Patients were on regular follow-up with special attention to bleeding manifestation, fever, diarrhea, respiratory distress. DIC was detected by using the International Society of Thrombosis and Haemostasis scoring system by using Prothrombin time, Platelet count, Serum fibrinogen and D-dimer. Investigation for diagnostic DIC evaluation was done on every patient at baseline, on day 7, day 14 and day 21. Statistical analysis of the results was obtained by using windows computer software with Statistical Packages for Social Sciences (SPSS-version 22.0). Out of 55 patients, DIC was encountered in 12(21.8%) patients. At diagnosis, DIC was found in 8 patients (14.54%), on day 7, DIC was found in 4 patients (8.0%). A total of 8(14.54%) patients have developed DIC at diagnosis, among them 4(50.0%) had persisted DIC after starting chemotherapy, 4 patients resolved. But 4 patients (8.5%) newly developed DIC during hospitalization (p=0.001). The use of Daunorubicin had 6.252 times significantly (p<0.05) increased risk to developed DIC with 95.0% CI (0.107 to 36.048%). Patients with DIC had more bleeding 10(83.3%) than the non-DIC group 20(46.6%). The mortality rate was higher, 3(25.0%) in the DIC group and 6(14.0%) in the non-DIC group. The frequency of DIC was 21.8% during the induction period, use of daunorubicin was identified as the risk factor for the development of DIC. Mortality was higher in patients with DIC.

Obesity is a risk factor for vitamin D deficiency (VDD) with limited data on their association with Bangladeshi children. The aim of this study was to compare vitamin D levels and the status among obese, overweight and normal-weight children. This cross-sectional study was performed in the Obesity Clinic, Department of Endocrinology, Bangladesh Medical University hospital, Bangladesh from May 2020 to August 2021 and included 100 children of 10-17 years [age-matched 50 children with normal BMI, 22 with overweight and 28 with obesity: 14.0 (12.0-17.0) vs. 12.50 (10.0-16.25) vs. 12.50 (11.0-14.0), years, median (IQR), p=0.114] of both sexes (boys/girls: 49/51). Height and weight were measured to calculate body mass index (BMI) and plotted in the Centre for Disease Control chart to classify normal, overweight and obese with cut-offs of 85th and 95th BMI-percentile. Serum 25-hydroxy vitamin D[25(OH)D] was measured by chemiluminescent microparticle immunoassay. VDD (<20 ng/mL) and insufficiency (20-29.9ng/mL) were found in 92 and eight patients respectively with none having sufficiency (≥30 ng/ml). Among 92 patients with VDD, 61 (66.30%) had mild VDD (10-19.9 ng/mL) and 31 (33.70%) had moderate to severe VDD (<10 ng/mL). Vitamin D level and status were statistically similar across BMI-spectrum (NS for all). Vitamin D level did not significantly correlate with BMI (r=-0.026, p=0.798). Children with moderate to severe VDD had significantly higher percent of girls (67.7% vs. 44.3%, p=0.047), living in urban area (100.0% vs. 85.2%, p=0.026) with higher socio-economic status (61.3% vs. 32.8%, p=0.023) than those with mild VDD. In conclusion, despite high percentages of VDD, vitamin D had no association with BMI in children.

Comorbid depressive symptoms in diabetic patients may be associated with metabolic deterioration. The objective of this facility-based cross-sectional study was to determine the prevalence of depressive symptoms and their association with glycemic control and diabetic complications among patients with type 2 diabetes mellitus (T2DM) in Bangladesh. This study was conducted among 350 patients with type 2 diabetes mellitus attending the outpatient department of the Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka Bangladesh, from July 1, 2021 to July 31, 2021. The prevalence of depressive symptoms was 31.0% (mild 10.0%, moderate 12.0%, moderately severe 5.1% and severe 4.0%). In the logistic regression model, age (aOR 1.11, 95% CI 1.01-1.22), female sex (aOR 2.47, 95% CI 1.22-5.00), rural residence (aOR 3.42, 95% CI 1.82-6.45), single living (aOR 7.34, 95% CI 5.51-9.63), poor glycemic control (aOR 2.59, 95% CI 1.31-5.12) and cardiovascular complications (aOR 4.17, 95% CI 1.36-12.78) were independent predictors of depressive symptoms among T2DM patients. The findings observed from this study support an association between depressive symptoms and poor glycemic control as well as cardiovascular complications of diabetes.

Febrile neutropenia (FN) is a common clinical consequence of chemotherapy in patients with hematological malignancies which make them vulnerable to bloodstream infection (BSI) due to profound immunosuppression. The objective of the present study was to explore the etiology and antibiotic sensitivity pattern of causative organisms of BSI in these patients. This cross-sectional study was conducted in Hematology department of Dhaka Medical College Hospital, Dhaka, Bangladesh from July 2020 to June 2021; including 99 adult patients with hematological malignancies who developed febrile neutropenia after receiving chemotherapy. Blood culture and antibiogram were done for isolation and investigation of antibiotic sensitivity pattern of the causative organisms. Total of 33.0% blood sample yielded a positive culture. Escherichia coli was the most common Gram negative bacteria (22.0%) followed by Klebsilella (15.6%) and Enterococci and Staphylococcus was the most common Gram-positive bacteria. Almost 33.0% of the isolated bacteria were multi-drug resistant (Gram-positive 38.0% and Gram-negative 22.0%). Among the antibiotics, carbapenem group of antibiotics like meropenem and imipenem, along with gentamycin and ticoplanin, linezolid and nitrofurantoin were found as sensitive in a substantial number of gran-positive and gram-negative bacteria. Bloodstream infection is common in patients with chemotherapy induced FN for hematological malignancies and widespread resistance to common antibiotics has made its treatment challenging. Appropriate antibiotic therapy based on local evidence and culture and sensitivity test is crucial for optimum management of these patients.