Mymensingh medical journal : MMJ最新文献

This cross-sectional study was conducted in Department of Paediatrics, Mymensingh Medical College Hospital (MMCH), Bangladesh from February 2016 to December 2016 to detect massive proteinuria by spot urinary protein creatinine ratio as an alternative diagnostic test to 24 hrs urinary total protein in nephrotic syndrome. Fifty one (51) children aged 2 to 12 years admitted with 1st episode of nephrotic syndrome in the pediatric department of MMCH were included in this by purposive sampling technique. All the patients were asked to give a 24 hours urine sample. After this collection the next spot urine samples were collected for protein and creatinine estimation. Among 51 patients 33 were male and 18 were female. The mean age was 5.5+2.3 years. The entire patient had normal renal function. The mean 24 hours urinary protein level was 3.8±1.7 gm/m²/24 hours, the mean spot urinary protein-creatinine ratio was 5.4±2.5. Mean serum albumin was 1.8±0.6 gm/dl and the mean serum cholesterol was 357.6±74.7 mg/dl. The spot urinary protein creatinine ratio was increased with the increase in the amount of 24 hours urinary total protein and a strong positive Pearson correlation (r=0.805) was found. In all the cases of nephrotic syndrome spot urinary protein creatinine ratio were found more than 2. Based on this study, it can be concluded that the determination of the spot urinary protein-creatinine ratio can replace the 24 hours urine collection in the quantitation of proteinuria in nephrotic syndrome.

In late 2019, a novel coronavirus emerged in Wuhan, China, causing an atypical pneumonia- like illness. Scientists subsequently isolated the virus, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), in January 2020. This highly contagious virus rapidly spread worldwide, triggering a global public health emergency. The ongoing Covid-19 pandemic necessitates continuous evaluation of the characteristics of infected individuals. This study aimed to investigate the demographic and clinical features of patients diagnosed with Covid-19 at a tertiary care hospital in Bangladesh. This retrospective cross-sectional study was conducted between November 2023 and February 2024 at the Department of Respiratory Medicine, Uttara Adhunik Medical College Hospital (UAMCH), Dhaka, Bangladesh. The study involved collaboration with the departments of Virology and the hospital's Covid Unit. Data were collected from the medical records of 200 confirmed Covid-19-positive cases admitted upon arrival at the hospital. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version 23.0. Of the 200 participants, the most frequent age group was 46-60 years old, representing 42% (84 patients). Males comprised the majority (73.0%, 145 patients), and most participants resided in urban areas of Bangladesh (86.5%, 173 patients). The socioeconomic analysis revealed that the upper-class category had the highest frequency (85.0%, 170 patients). Diabetes Mellitus (DM) emerged as the most prevalent co-morbidity (58.5%, 117 patients). Regarding clinical presentation, fever was the most frequent symptom (76.0%, 152 patients), followed by cough (47.5%, 95 patients), shortness of breath (SOB) (27.5%, 55 patients), and pneumonia (15.0%, 30 patients). Less frequent symptoms included acute respiratory distress syndrome (ARDS), lower respiratory tract infection (LRTI), and chest pain. The mean systolic and diastolic blood pressure readings were 126.61±14.58 mmHg and 77.24±12.44 mmHg respectively. The mean oxygen saturation (SaO2) was 93.39±5.53%. This study investigated that the most frequent age group was (46-60) years. The male dominant in Covid-19-positive cases. Diabetes Mellitus (DM) was observed as the most frequent co-morbidity. The common symptoms of Covid-19-positive cases were fever, cough, SOB, pneumonia acute respiratory distress syndrome, lower respiratory tract infection, chest pain, high blood pressure and low oxygen saturation.

Treatment of relapsed or refractory diffuse large B-cell lymphoma is difficult. The de novo diffuse large B-cell lymphoma has better prognosis than the transformed diffuse large B-cell lymphoma. The response of CHOP or a similar regimen has an important role in determining response to salvage therapy, in relapse or refractory diffuse large B-cell lymphoma patients. Patients who are non-responder to initial treatment have a very poor chance of responding to therapy for relapse. This was a small scale observational study and was conducted from January 2017 to December 2020 in National Institute of Cancer Research and Hospital, Bangladesh. A total of 34 patients with relapsed or refractory diffuse large B-cell lymphoma were identified at hematology department in National Institute of Cancer Research and Hospital, 28 of them were treated with ICE chemotherapy and 6 with R-ICE chemotherapy as second line regimen. Overall response rate to 2nd line chemotherapy was 64.8%, with 32.4% (11 patients) complete remission and 32.4% (11 patients) partial remission. Median overall survival to second line regimen was 10 months, corresponding to a 4 year overall survival of 32.4% and a 4 year progression free survival was 17.6%. Patient with stable disease/progressive disease median overall survival was 7 months compared with 15 months for complete remission and 9 months for partial remission (p<0.001). Median overall survival was significantly better in patients with international prognostic index 0-2 compared in those with international prognostic index >2 (p=0.010). However improvement of salvage efficacy is an urgent need with new drugs. Further studies are necessary to determine whether this regimen will improve outcomes of relapsed or refractory diffuse large B-cell lymphoma patients.

Breast cancer is the most common type of cancer among women. The molecular subtypes of breast cancer, depending on the Estrogen Receptor (ER), Progesterone Receptor (PR) and Human Epidermal Growth Factor Receptor (HER-2) status, usually play a vital role for the adjuvant treatment. Interestingly, there is a good possibility of change of receptor status in the recurrence of same primary tumor. The study is designed April 2018 to March 2019 to see the concordance in triple-receptor expression (ER, PR, and HER-2) between the primary and the locally recurrent breast cancer patient and the results can be able to influence the management and prognosis of the breast cancer patients. This observational study was carried out in the department of surgical oncology, NICRH where total 48 patients were studied who were subjected to core biopsy of recurrent lesion for ER, PR and HER-2 status. A structured case record form was used to interview and collect data. Data analysis was done using SPSS version 26.0 to see concordance and discordance in triple-receptor expression between the primary and the locally recurrent breast cancer patient. Among 48 cases, 12(25.0%), 10(20.83%) and 2(4.16%) patients showed Estrogen Receptor (ER), Progesterone Receptor (PR) and Human Epidermal Growth Factor Receptor (Her-2) discordance that are statistically significant in every receptor status. Majority discordance of ER, PR and Her-2 were associated with invasive duct cell carcinoma (IDC); ER & Her-2 discordance was equally associated with histological grade 2 and 3 whereas PR discordance had significant association with grade 3. Staging of disease showed that all ER, PR and Her-2 discordance were associated with stage (p<0.05). Besides, majority discordance was mostly associated with lumpectomy except Her-2 discordance. Besides, among the adjuvant treatment regimen chemotherapy along with radiotherapy was mostly associated with discordance of all receptors (p<0.05). Estrogen Receptor (ER), Progesterone Receptor (PR) and Human Epidermal Growth Factor Receptor (HER-2) status of primary breast cancer showed 25.0%, 20.83% and 4.16% discordant in recurrent episodes in this study. Invasive duct cell carcinoma, histological grade 2 and 3, stage II, stage III, MRM and CT along with RT are major attributable factors in this study.

Cardiorespiratory health is one of the critical parameters for improving endurance. Breathing exercises in the form of various Pranayama have a significant effect on cardiorespiratory health. To assess the effect of breathing exercises in the form of various pranayamas on cardiorespiratory parameters in people living with sedentary lifestyles. This longitudinal study was done on 30 subjects aged 25 to 35 years. Participants performed Bhastrika, Kapalbhati, Anulomvilom and Bhamri Pranayama with prayers and warm-up for 10 to 40 minutes, progressively increasing over one year. The average daily duration in the initial 3 months was 15 minutes; in the next three months, it was 23 minutes. The average daily duration in the last 6 months was 34 minutes. Cardiorespiratory functions were assessed using Spiro Excel machine spirometer and Mercury sphygmomanometer (Diamond) at the time of enrolment and the end of 1 year of the study. A paired t-test, using statistical software, was used to analyze parameters. In males and females, significant change is observed in pulse rate, systolic blood pressure and diastolic blood pressure. In pulmonary function test parameters, non-significant change was observed in forced expiratory volume in 1 sec (FEV₁) and forced vital capacity (FVC); other parameters, i.e., FEV₁ as percentage of FVC in % [FEV₁ (%)], peak expiratory flow rate in L/s (PEFR) and Minute Ventilation Volume (MVV) L/min showed significant change in males and females. Breathing exercises in the form of various Pranayama positively affect cardiorespiratory health, and further studies are recommended in the diseased population.

Traditionally, percutaneous nephrolithotomy (PCNL) includes placing a nephrostomy tube and a Double J (DJ) stent to drain the kidney and operative tract following the procedure. However, more recent techniques, such as tubeless or totally tubeless PCNL, eliminate these drainage methods. The objective was to assess the feasibility, safety and effectiveness of performing tubeless or totally tubeless PCNL in comparison to standard PCNL a retrospective analysis was performed on 156 patients who underwent PCNL treatment From September 2022 to September 2023. Of these, 78 patients received traditional nephrostomy PCNL, while 46 patients underwent the tubeless procedure and the remaining 32 received the totally tubeless procedure. The three groups showed no significant differences in preoperative patient characteristics. The operation time, analgesic requirements and hospital stay were lower in the tubeless and totally tubeless PCNL group than in the standard PCNL group (p<0.05). No significant differences were found in the mean stone size, stone-free status or the occurrence of major complications. The overall complications (Grade-1, 2 and 3) rate was 14.2% in the standard PCNL group, 8.7% in the tubeless PCNL and 9.4% in the totally tubeless PCNL group. The tubeless and totally tubeless PCNL techniques have proven to be safe and effective, even for patients with incomplete staghorn stones and a moderate pelvic stone burden. These approaches are associated with reduced pain, lower analgesic needs, shorter operative times, and decreased hospital stays, making them more cost- effective and less likely to result in complications, while also improving patient satisfaction. Further research is essential to validate the safety of these techniques, encouraging urologists to adopt them in clinical practice.

Antibiotic resistance (AMR) represents a serious threat to public health and poses challenges in disease prevention and treatment despite various efforts to combat it. Evaluation of the in vitro antibacterial activity of aqueous extracts of black pepper seeds (Piper nigrum L.) against two infectious pathogens: Gram-positive Staphylococcus aureus and Gram-negative Escherichia coli. The Department of Pharmacology and Therapeutics and the Department of Microbiology of Mymensingh Medical College conducted the study from Octy 2022 to June 2023. The antibacterial activity of Aqueous black pepper seed extract (ABPE) was evaluated at different doses using disk diffusion and broth dilution methods. The extract was prepared using 10.0% dimethyl sulfoxide (DMSO) and water as solvent. The commonly used antibiotic ciprofloxacin was used in the broth dilution method and the results were compared with those for aqueous extracts. To confirm a more precise range of antimicrobial susceptibility of the extracts, ABPE was used at seven different concentrations (100, 80, 60, 40, 20, 10 and 5 mg/mL). Selected concentrations were then used as needed. ABPE showed an inhibitory effect on the above bacteria at doses of 90 mg/ml and higher. The Minimum inhibitory concentration (MIC) values for Escherichia coli and Staphylococcus aureus were 85 and 90 mg/ml ABPE, respectively. The MIC of ciprofloxacin against Staphylococcus aureus and Escherichia coli was currently 1μg/ml. The MIC of ciprofloxacin was lowest for the organisms tested compared to the MIC of ABPE. This work clearly demonstrates the antibacterial sensitivity of Staphylococcus aureus and Escherichia coli to an aqueous extract of black pepper seeds.

This is important to note that altered mental status is not a disease in itself, but rather a symptom with a wide range of potential diagnoses. But a structured approach to assessing the patients with this symptom frequently leads to helpful information and can rule out worst-case scenarios. In cases where fever is followed by changes in consciousness, quick assessment of the patient's level of consciousness and potential causes is decisive. A focused history and physical assessment can help differentiate between structural or medical causes. Asymmetrical neurological findings, such as a dilated and fixed pupil, dysconjugated extraocular movements and asymmetrical motor findings, suggest brainstem dysfunction due to a structural lesion, while symmetrical neurological findings usually indicate a medical disorder. A recent study aimed to identify features of different etiologies, demographic patterns, and common causes of both acute and prolonged febrile illness in patients. This cross-sectional type of observational study was conducted in the Department of Medicine, Mymensingh Medical College Hospital, Bangladesh from April 2014 to October 2015. Over the study period patients admitted with satisfying the inclusion and exclusion criteria of study and purposively selected (non-probability) from the hospitalized patients. Total 100 cases with febrile illness and altered consciousness meeting the exclusion and inclusion criteria were examined and investigated to find out the actual etiology. Out of 100 patients, it was observed that 26(26.0%) of patients were suffering from pneumonia, 22(22.0%) urinary tract infection, 18(18.0%) meningitis, 14(14.0%) typhoid fever, 8(8.0%) meningo-encephalitis, 6(6.0%) cerebral malaria, 4(4.0%) tuberculosis and 2(2.0%) from tuberculoma. The result revealed that large number of patients with febrile illness and altered consciousness were suffering from pneumonia and urinary tract infection.

The global health system faces a substantial burden from the Covid-19 pandemic. To prevent Covid-19 transmission an effective triage system is useful in resource-limited countries like Bangladesh. The purpose of the study was to determine the status of the triage system in a dedicated Covid-19 Hospital. This cross-sectional study was conducted among conveniently selected 150 respondents including 63 doctors, 72 nurses and 15 administrative staff. Data were collected through face-to-face interviews using a pretested semi-structured questionnaire and observation checklist. The collected data were processed and analyzed with the help of SPSS (Version 26.0) and Xcel 2019. The study was conducted at Kurmitola General Hospital, Bangladesh from January 2020 to December 2020. Among study participants, 54.0% of the respondents belonged to the (31-40) age group and 74.0% were female. Half 50.7% of the respondents working duration was (0-4) years. Two-thirds 67.0% of the respondents had training on the triage system. All of the respondents mentioned the presence of a triage system in this hospital but there was no tele-triage. Regarding infrastructure facilities like triage room, sitting facilities with 1-meter distance in waiting area, one-way entrance, and exit, separated ticket counter and washroom, proper hand wash facilities, all were present in this hospital. All of the respondents mentioned the presence of available logistic support for the triage system in this dedicated Covid-19 hospital including a sufficient supply of PPE, thermometer, and pulse oximeter. All doctors and nurses wore PPE. Almost four-fifths 87.30% of the respondents mention that there was no training on donning and doffing procedure of PPE. There was a statistically significant association between training on triage with age group and occupation of the respondents (p<0.05). The ideal working time of healthcare providers was not maintained. There had no facilities of isolated accommodation and health checkups for staff. But RT-PCR for Covid-19 test was done for all staff when he/she returns to normal life after duty. Based on study findings it has been concluded that the infrastructure facilities and logistic supports are sufficient. But staff management has to be improved and the authority should pay special attention to an effective triage system.

Traumatic brain injury (TBI) is a major cause of morbidity and mortality in Bangladesh and also worldwide. Secondary brain injury from progressive intracerebral hematoma, increasing cerebral edema, raised intracranial pressure and subsequent cerebral ischemia is the main cause for morbidity and mortality following TBI. Secondary brain injury is worsened by post-traumatic coagulopathy, which occurs in brain injured patients and is associated with increase in risk of death and morbidity. The antifibrinolytic agent tranexamic acid (TXA) reduces the hematoma expansion and demonstrated improved clinical outcome also reduced the mortality and morbidity. This was a randomized controlled trial (RCT) done in the Department of Neurosurgery, Dhaka Medical College and Hospital. Included patients were randomized to get either the intravenous tranexamic acid (Group A) or placebo (Group B) treatment based on a computer-generated code list (50 patients in each group) along with usual medical management for traumatic brain injury. The extent of contusion expansion (hematoma plus perihematomal oedema) as the primary outcome at 48 hour after admission and was measured by brain CT scan. The contusion and oedema volume were calculated both the times (on admission and after 48 hours). Glasgow coma scale (GCS) after 48 hours and Glasgow outcome scale (GOS) after 7 days were observed. In this study showed increase in hematoma volume in both groups (p<0.05). But the increased hematoma volume in the Group A was significantly less than that in the control group. The mean total hemorrhage expansion was (1.5±1.1) ml and (4.6±1.9) ml in the Group A and Group B, respectively. In Group A- 02(4.0%) patients required operation, whereas in Group B- 11(22.0%) patients required operation. The result was significant (p=0.023) between groups. Therefore use of tranexamic acid is associated with lesser hematoma volume progression. Mean GCS (after 48 hours), mean GOS (after 7 days) result were significantly better in Group A (p<0.001). This study concluded that tranexamic acid has beneficial effect on the patient with significant traumatic brain injury. Tranexamic acid helps in reduction of intracerebral progression of contusion and improvement of clinical outcomes in patients with TBI.