Bangabandhu Sheikh Mujib Medical College Journal

List of Contents January 2024

2023-11-21T04:59:04+00:00

Abstract not available

Bangabandhu Sheikh Mujib Med. Coll. J. 2024;3(1): II

Cover Page January 2024

2023-11-21T04:55:21+00:00

Abstract not available

Bangabandhu Sheikh Mujib Med. Coll. J. 2024;3(1): I

Dysmenorrhea in Adolescents: How to approach: A Review Article

2024-03-19T17:46:40+00:00

Dysmenorrhea refers to recurrent pelvic pain during menstruation in sufficient magnitude, which incapacitates a woman’s day-to-day activities. It is the most common gynecological complaint among adolescents. It negatively impacts their quality of life, attendance at school or work and mental health. Most adolescents experiencing dysmenorrhea have primary dysmenorrhea without having any pelvic pathology. If a girl does not feel clinical improvement within 3-6 months of empiric treatment with nonsteroidal anti-inflammatory drugs, secondary dysmenorrhea should be kept in mind and exploration of the cause of secondary dysmenorrhea should be done. Our objective was to review the current knowledge regarding the pathophysiology of dysmenorrhea and to summarize the approach in the diagnosis and management in specific adolescent groups. We selected adolescents as their psychosomatic factors like anxiety, tension adversely influence their pain threshold. We reviewed the recent article written on dysmenorrhea, which has been published in different medical literature. At the same time, different guidelines and treatment protocols have been reviewed. Adolescents are more vulnerable to dysmenorrhea. They are suffering mostly from primary dysmenorrhea, but pelvic pathology should be kept in mind, especially endometriosis and Mullerian abnormalities. Non-steroidal anti-inflammatory drugs (NSAIDs) and oral contraceptive pills (OCP) are the first-line treatment. Special emphasis should be given to improving their mental strength.

Bangabandhu Sheikh Mujib Med. Coll. J. 2024;3(1):44-48

Battling Dengue Fever in Bangladesh: Urgent Action Needed

2024-03-16T03:07:51+00:00

Abstract not available

Bangabandhu Sheikh Mujib Med. Coll. J. 2024;3(1):05-06

Cryptomenorrhea due to Agenesis of Upper Part of Vagina Treated by Vaginoplasty with Amnion Graft and Cervicovaginal Anastomosis: a Case Report

2024-03-19T18:02:41+00:00

Cryptomenorrhea due to vaginal agenesis is a rare developmental anomaly of Mullerian duct. It may be complicated by retrograde menstruation, endometriosis and acute or chronic pelvic infection. We report a case of a 12-year-old girl who presented with a history of severe cyclical lower abdominal pain for 2 months. Her clinical examination revealed well developed secondary sexual characteristics, slightly bulged lower abdomen with a palpable tender mass and a short blind vagina. Ultrasound imaging showed hematometra, hematocervix and vaginal agenesis. She was treated by vaginoplasty with amnion graft and cervicovaginal anastomosis with serial vaginal dilatation using plastic vaginal mold. The patient was symptom free with regular menstruation on follow up visit at 1, 3 and 9 months. The Uterus was normal in size with empty cavity and well-defined endometrial lining on ultrasound.

Bangabandhu Sheikh Mujib Med. Coll. J. 2024;3(1):49-51

Familial Hypophosphatemic Rickets: A Case Report and Review of the Literature

2024-03-19T18:37:46+00:00

Among the genetic disorders causing rickets because of hypophosphatemia, X- X-linked dominant hypophosphatemic rickets (XLH) is the most common, with a prevalence of 1/20,000. The defective gene is on the X chromosome, but female carriers are affected, so it is an X-linked dominant disorder. XLH associated with short stature during childhood are mostly referred to the hospital & diagnosed as vit-D deficiency rickets & received vit D before adulthood. We presented a 2-year-old boy with the complaint of walking difficulties since his 1 year of age. The patient was assessed for sociodemographic, hematological & biochemical parameters. All imaging, Laboratory parameters and positive family history confirmed the diagnosis of XLH. We treated the patient with Di basic sodium phosphate solution and 1, 25 vit D. XLH needs a good assessment, care and follow-up through a complementary medical team.

Bangabandhu Sheikh Mujib Med. Coll. J. 2024;3(1):52-55

Patterns of Gastrointestinal Symptoms of Covid-19 Patients in a University Hospital of Bangladesh

2024-03-14T08:18:58+00:00

The World has experienced a devastating pandemic of COVID-19 caused by SARS-CoV-2 that started at March, 2020 and ended in May, 2023. Most patients of COVID-19, presented with respiratory symptoms and signs. But the number of COVID-19 patients experiencing gastrointestinal symptoms were also significant. The spectrum of gastrointestinal symptoms in the second wave of COVID-19 was observed in this study from July 2020 to September 2020 with an aim to describe the frequency of occurrence and the possible timing of onset and duration of these symptoms. This cross-sectional study was carried out in the COVID-19 outpatient (triage of fever clinic) and COVID dedicated inpatient department of Bangabandhu Sheikh Mujib Medical University (BSMMU) involving at least 79 consecutive patients who were RT-PCR positive for coronavirus 2 (SARS-CoV-2). Gastrointestinal symptoms including anorexia, nausea, vomiting, altered taste, diarrhoea, haematemesis or melena were recorded precisely by face to face interview maintaining proper infection control protocol. Among the 79 COVID-19 patients, 70.88% patients had at least one gastrointestinal symptom & the rest had no GI symptom. Most patients suffered from anorexia (70.88%), followed by diarrhoea (62.02%), nausea (41.77%), loss of taste (36.70%), vomiting (32.90%) & abdominal pain (7.59%), melena (2.53%). Diarrhoea was mild in most cases. The mean duration of diarrhoea and dysgeusia/loss of taste was 2.83 days and 5.8 days respectively. Mean duration of exposure to COVID 19 patient and onset of diarrhoea and dysgeusia was 7.69 days and 3.8 days respectively. This study did not exhibit any association between GI symptoms and severity of the disease.

Bangabandhu Sheikh Mujib Med. Coll. J. 2024;3(1):07-11

Association of Admission CRP Level with Short Term Outcome in Patients with Acute Ischemic Stroke

2024-03-14T10:16:17+00:00

Acute ischemic stroke is very common in Bangladesh and one of the most common causes of physical disability and death. This study was performed to determine the prognostic value of CRP measured in the very early phase of ischemic stroke for short term functional outcome of patients with acute ischemic stroke. This observational study was carried out in the departments of Medicine and Neurology of Faridpur Medical College Hospital, Faridpur from July 2012 to December 2012. Total 100 patients of acute ischemic stroke were recruited in this study. Blood sample was collected for CRP level during the time of admission. In this study 26% of patients were in low CRP group (CRP <3 mg/L), 34% of patients were in medium CRP group (CRP 3-9.9 mg/L), 40% of patients were in high CRP group (CRP ≥10 mg/L). According to modified Rankin Scale (mRS) scoring system the high CRP group having a 44% risk for a poor outcome (mRS ≥3 ) vs 27% for the low CRP group ( p = 0.01). According to Barthel Index (BI) scoring system the high CRP group having a 45% risk for a poor outcome (BI <95) vs. 25% for the low CRP group (p = 0.002). Z test of proportion revealed significant association between high CRP level and poor short-term outcome of patients with acute ischemic stroke.

Bangabandhu Sheikh Mujib Med. Coll. J. 2024;3(1):12-15

Monitoring Oxford-AstraZeneca COVID-19 vaccine Side Effects in Faridpur, Bangladesh: A Prospective Study

2024-03-14T10:28:36+00:00

The Oxford-AstraZeneca COVID-19 vaccine is effective in preventing illness and death from COVID-19. In this study, we aimed to evaluate the safety of the Oxford-AstraZeneca COVID-19 vaccine in a population in Faridpur, Bangladesh. The study population included individuals who received both doses of the vaccine from Bangabandhu Sheikh Mujib Medical College Hospital in Faridpur. We followed up with these individuals via phone interviews one week and one month after each vaccination to gather information about side effects. We found that the overall incidence of systemic and injection site side effects after the first and second doses was 36.5% and 34.7%, and 68.2% and 61.3%, respectively, among the 2256 studies population. The most common systemic side effects were fatigue, fever, and muscle pain, while the most common injection site symptoms were tenderness, pain, and redness. These side effects generally resolve within 24-72 hours after vaccination. Only a small percentage of individuals (1.3% after the first dose and 0.5% after the second dose) sought medical attention for their side effects. We also found that individuals with a history of chronic disease and those who had a history of COVID-19 symptoms had a significantly higher likelihood of experiencing side effects. In conclusion, the Oxford-AstraZeneca COVID-19 vaccine was generally safe in this population, with a low incidence of side effects requiring medical attention.

Bangabandhu Sheikh Mujib Med. Coll. J. 2024;3(1):16-21

Demographic Profile, Respiratory Presentation and Outcome Analysis of Acute Encephalitis Syndrome in a Tertiary Hospital in Bangladesh

2024-03-14T12:58:45+00:00

Acute encephalitis syndrome has been a major health problem worldwide due to its high morbidity and mortality. The aim of this study was to find out the demographic profile of acute encephalitis syndrome and to determine the association of the outcome of the disease with the demographic factors and respiratory symptoms at presentation. This observational analytic cross-sectional study was conducted in the departments of Medicine, Paediatrics, and Neurology in Bangabandhu Sheikh Mujib Medical College Hospital in Bangladesh from September 2013 to August 2014. People of all ages who fulfilled the inclusion criteria of acute encephalitis syndrome were included in the study. In this study, 270 cases were diagnosed with acute encephalitis syndrome. Most cases were clustered around the age groups of 0-5 year (24.1%), 6-17 year (24.8%), and 18 -45 year (28.5%). Death was higher among the 18-45 age groups (33.3%) as well as in males (59.3%). Apart from neurological symptoms, respiratory symptoms on presentation were present in 66.9% cases with 89.6% death and this association was found statistically significant (p value < 0.001, AOR 6.96, COR 5.3 with 95% CI). Influence of socio-demographic factors and delay in seeking hospital admission on adverse outcome was not statistically significant. Most cases occurred in January-February (12.6% and 11.1%) and in July (14.4%). Overall mortality was 17.8%. Encephalitis presenting with respiratory symptoms in association carries higher mortality.

Bangabandhu Sheikh Mujib Med. Coll. J. 2024;3(1):22-26

Prevalence, Pattern and Outcome of Congenital Anomalies in Patients Admitted at a Tertiary Level Hospital in Bangladesh

2024-03-16T07:02:44+00:00

Congenital anomalies are a major public health concern globally, contributing significantly to perinatal and neonatal mortality. Understanding their prevalence, patterns, and outcomes are essential for effective healthcare planning and interventions. This cross-sectional observational study aimed to investigate the distribution and immediate outcomes of congenital anomalies among infants delivered at Bangabandhu Sheikh Mujib Medical College Hospital, Faridpur, Bangladesh. Study population comprised admitted pregnant mothers who delivered infants with congenital anomalies from January to December 2022. Data were collected from medical records, including parity, gestational age at delivery, mode of delivery and outcomes of congenital anomalies. Total 3461 deliveries occurred during this period, of which 88 had congenital anomalies with a prevalence of 2.54%. Among the 88 infants with congenital anomalies, the most prevalent anomalies were Anencephaly and Hydrocephalus, affecting the central nervous system. Anencephaly had a 100% mortality rate, emphasizing its severity and poor prognosis. Anencephaly was more common in infants delivered between 12 to 28 weeks. Early gestational stages play critical role in its pathogenesis. Hydrocephalus showed a relatively higher proportion of live births. Vaginal delivery was the predominant mode of delivery for most congenital anomalies. Public health efforts targeting early detection, appropriate care and support for affected families can potentially reduce the impact of congenital anomalies on maternal and neonatal health.

Bangabandhu Sheikh Mujib Med. Coll. J. 2024;3(1):27-31

Association of Serum Homocysteine with Gestational Diabetes Mellitus (GDM): A Case-Control Study

2024-03-17T04:11:39+00:00

Gestational diabetes mellitus (GDM) is associated with an increased risk of maternal and fetal mortality and morbidity. There is an increasing trend in the prevalence of GDM in Bangladesh. The role of homocysteine (Hcy) as an independent risk factor of GDM has not been extensively studied. The aim of this study was to evaluate the association of serum homocysteine levels in gestationaldiabetes mellitus. It was a case-control study among pregnant women attending the inpatient and outpatient departments of Obstetrics and Gynecology,BSMMU, Shahbag Dhaka, from April 2020 to March 2021. A total of 80 singleton pregnant women between 18-35 years of age were included in this study in their 24-40 weeks of gestation. Among them, 40 diagnosed women with GDM were considered as the cases and the rest of the 40 matched healthy pregnant women were selected as controls matching for age and gestational age.The overall average Hcy levels in the cases and controls were 5.48±1.3 μmol/L and 4.06±0.98 μmol/L, respectively. Both in the late second trimester and the third-trimester serum Hcy levels were significantly higher in the GDM cases than non-GDM healthy pregnant women (p<0.05). Considering Hcy level of 6.38 μmol/L as the cut-off value, GDM was 4.75 times more likely in pregnant women with elevated serum Hcy level (≥6.38) than those with < 6.38 μmol/L (OR=4.75; 95% CI = 0.941-23.985). There was a significant positive correlation of serum Hcy level with both fasting blood sugar level (r = +0.600, p<0.001) and 2 hrs after 75g glucose level (r = +0.438, p<0.001). Elevated level of serum homocysteine was found associated with GDM.

Bangabandhu Sheikh Mujib Med. Coll. J. 2024;3(1):32-37

Trends and Rates of Stillbirths: An Observational Study in a Tertiary Level Hospital, Faridpur, Bangladesh

2024-03-19T15:37:10+00:00

Fetal death at any time during pregnancy is a very tragic situation for the parents and treating obstetricians. Pregnancy loss is a distressing problem and retention of dead fetus in utero has its own ill effects on physical, psychological, and social aspects. Mifepristone is commonly used for induction of labour when a fetus dies in the utero. This cross-sectional survey aimed to determine the incidence and trend of intrauterine fetal death and socio-demographic characteristics, maternal obstetric history, health seeking behavior among the women who experience a stillbirth delivery. It will also aim to evaluate the efficacy and safety of using Mifepristone in case of induction of labour. This study was done at the Obstetric & Gynecology department of Bangabandhu Sheikh Mujib Medical College and a total of 219 stillbirth deliveries were recorded out of 4275 total deliveries from January to December 2022, resulting in a stillbirth rate of 51 per thousand live births. The majority of stillbirths were preterm between 28-38 weeks, and more than half were delivered via normal vaginal deliveries. The study revealed poor distribution of prenatal care, with only 9.59% of mothers having had the recommended 4 ante natal care visits, while 29.22% were primiparous. The results underscore the need for effective prenatal care to reduce the incidence of stillbirth and highlight the importance of careful management of intrauterine fetal death cases to mitigate physical, psychological, and social effects. The findings of this study provide valuable information for clinicians, policy makers, and researchers working in the field of obstetrics and gynecology.

Bangabandhu Sheikh Mujib Med. Coll. J. 2024;3(1):38-43