Community Based Medical Journal

Chronic Kidney Disease of Unknown Etiology (CKDu)

Mahmud Javed Hasan — Wed, 24 Jan 2024 00:00:00 +0000

Abstract not available

CBMJ 2024 January: Vol. 13 No. 01 P: 1-2

Characterization of Axillary Lymph Nodes Using Conventional Ultrasonography Compared with Histopathological Findings

Irin Farhana, Sayed Zoherul Alam, Md Nurul Islam Raisul, Zahirul Islam — Wed, 24 Jan 2024 00:00:00 +0000

A cross-sectional, observational study was carried out the Department of Radiology and Imaging, Combined Military Hospital (CMH) at Dhaka Cantonment, Bangladesh, between March and August of 2021. A total of 75 female patients were included presenting with or without axillary swelling referred for ultrasound of breasts and axilla from various surgical and medical departments of the same hospital. B-mode ultrasonography was used as method of choice because of its noninvasiveness and availability in evaluating the axillary lymph nodes. Histopathological diagnosis was considered the gold standard for the diagnosis. The average age was 42.62±8.76 years. In conventional ultrasonography results, 33.3% were benign lymph node, 14.7% were reactive and 52% were metastatic lymph node. Based on the histopathological reports, lymph node involvement was detected in 18(24%) patients with benign, 13(17.3%) patients reactive and 44(58.7%) metastatic. The overall results revealed 79.5% sensitivity, 87.1% specificity, 89.7% PPV and 75% NPV. To summarize, conventional ultrasonography was moderately sensitive with good specificity for diagnosis of axillary lymph node. Further studies with a larger population and intra-operative axillary lymph node are recommended.

CBMJ 2024 January: vol. 13 no. 01 P: 3-8

Cognitive Performance of the Elderly People in an Urban Area of Bangladesh: A Sociodemographic Study

Wed, 24 Jan 2024 00:00:00 +0000

A cross-sectional, analytical study was conducted to see the sociodemographic characteristics of elderly people and their association with cognitive performance in an urban setting in Dhaka, Bangladesh, between January and December of 2016. A convenient sampling technique was adopted. A total of 189 elderly people (118 male and 71 female) were included in the study. A semi structured questionnaire was first developed in English and then translated into Bangla. The questionnaire contains questions related to sociodemographic characteristics of the respondents and their cognitive functions, as determined by using Mini Mental state Examination (MMSE). Sociodemographic data were analyzed with descriptive statistics. Pearson correlation test was applied to determine the relationship between quantitative variables, while Chi-square test was done to assess association of qualitative data. The age of the respondents ranged from 60 to 90 years. The mean age was 67.8±6.26 years. Higher proportion of male (37.3%) and female respondents (36.6%) were in 60-64 age group, while the lower proportion was in ≥75 years age group (male 12.7% and female 14.1%). Most of the male respondents were graduate and above education group (64.4%), while most female respondents belonged to SSC and below and informal education group (50.7%) group. The rest of them fell into HSC education group: 11% and 32.4% respectively. Most of the elderlies (57.67%) belonged to the extended family and the rest lived in the nuclear family (42.33%). Among the male respondents, 76.3% were retired. Rest of the respondents was service holder (9.3%), businessman (12.7%) and teacher (1.7%). Female respondents were mostly housewives (97.2%) and two were teachers (2.8%). Among 189 respondents, 35.4% had normal cognitive function. Half of the respondents (52.4%) had mild cognitive impairment and the rest had moderate cognitive impairment (12.2%). None had severe cognitive impairment. Significant relationships of the cognitive performance were observed with age, sex, marital status, educational status, and type of family they lived in. However, no significant association was found between occupation and cognitive performance.

CBMJ 2024 January: vol. 13 no. 01 P: 9-16

Prevalence and Association of Hypertension among the Government Civil Employees of Bangladesh Armed Forces Attending BNS Patenga (Navy Hospital), Chattogram

Wed, 24 Jan 2024 00:00:00 +0000

Hypertension is a major risk factor for several cardiovascular diseases (CVD). A descriptive, cross-sectional study was conducted to estimate the prevalence of hypertension and its risk factors among the government civil employees of Bangladesh Armed Forces reported to BNS Patenga (Navy Hospital), Chattogram, Bangladesh, between January and June 2023. The study involved participants aged 25-60 years who are government civil employees working in Bangladesh Armed Forces in Chattogram area. This study was done using multi-stage random sampling. Data on age, gender, smoking habits, sedentary lifestyle, obesity, diabetes, dyslipidemia, physical activity, diet, extra salt use, family history of hypertension, cardiovascular disease and cerebrovascular disease, anthropometric measurements and blood pressure were collected using modified WHO-STEPS protocol. Hypertension was defined according to JNC-8 guidelines. Multiple logistic regressions models were used to identify risk factors associated with hypertension. Data were collected with semi-structured questionnaire and checklist by face-to-face interview and reviewing medical records respectively. Data were analyzed by SPSS version 19.0. A total of 150 participated (128 male and 22 female). Among the study population, 17% had hyperlipidemia, 32% consume high caloric diet, 15% were overweight, 20% had smoking habit, 17% were working in stressful environment, 57% were sedentary worker, 19% having family history of hypertension. The overall age-adjusted prevalence hypertension among 150 participants was 27%, which was higher among males compared to females (25% in contrast to 2%). Bivariate analysis showed significant relationship of hypertension with age, BMI, no physical activity, tobacco use, extra salt intake, dyslipidaemia, stressful life, high calorie diet, diabetes, and family history of stroke/cardiovascular disease, hypertension, diabetes and dyslipidaemia. In the multivariate model, factors significantly associated with hypertension were older age (33%), smoking (26%), extra salt intake (35%), and high waist circumference (36%). The prevalence of hypertension was high among our study participants. Population-based intervention programs and policies for increased awareness about the risk factors, and life-style modification are essential for prevention of hypertension.

CBMJ 2024 January: vol. 13 no. 01 P: 17-21

Role of Computed Tomography in Differentiating between Benign and Malignant Gallbladder Masses with Histopathological Correlation

Mukthadira, Salma Yasmin, MN Farzana, Mahzabeen Islam, Netay Kumar Sharma — Wed, 24 Jan 2024 00:00:00 +0000

A cross-sectional study was done to evaluate computed tomography (CT) scans as a diagnostic tool for distinguishing between benign and malignant gallbladder masses corroborated by histopathological findings. The study was conducted in the Department of Radiology & Imaging of Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh, between January and December of 2013. The study included a total of 45 patients who were ultrasonographically diagnosed with gallbladder masses. Later, those patients underwent CT scans using a 16-slice helical CT scan machine. All CT scan findings were interpreted by the specialist radiologists, focusing on lesion involvement, contrast enhancement characteristics, and invasion into adjacent structures. Postoperative tissues were examined histopathologically, and these findings were correlated with the CT scan results. The study revealed a higher prevalence of GBC in females (73.33%) and in the age group of 40-60 years. CT scans indicated malignancy in 84.44% of cases, which was confirmed as adenocarcinoma in 88.89% of cases through histopathology. The sensitivity, specificity, and accuracy of CT scans for detecting malignant gallbladder masses were 90.24%, 75.00%, and 88.89%, respectively. For benign masses, the corresponding values were 75.00%, 90.24%, and 88.89%. The positive predictive value was notably high at 97.37% for malignant masses but lower at 42.86% for benign masses. CT scans demonstrated high sensitivity and specificity in the diagnosis of malignant gallbladder masses, corroborated by histopathological findings. The study underscores the utility of CT scans as an effective, non-invasive diagnostic tool for early detection and management of gallbladder masses, although caution is advised in interpreting benign results due to a lower positive predictive value.

CBMJ 2024 January: vol. 13 no. 01 P: 22-27

Infant and Young Child Feeding Practice among Mothers in Rural Areas of Gazipur District, Bangladesh

Wed, 24 Jan 2024 00:00:00 +0000

A cross-sectional, descriptive study was conducted among 599 mothers who had at least one child aged 0–23-month to determine infant and young child feeding practice (IYCF) in rural areas of Bangladesh. The study was conducted between November 2019 and March 2020 in rural areas of Gazipur district. A pre-tested semi-structured questionnaire was used to collect data. Out of 599 respondents, the majority (62.93%) were in the 21-30 years age-group. Only 6.67% were illiterate and the rest of the respondents were literate with different levels of education. About one third (33.38%) of the respondents had monthly income between BDT 5001- 15000. 27% of the mothers could not give colostrum to the babies; half of them (50%) mentioned that baby could not suck well, while 43.83% mentioned being advised by the elders (not to give colostrum) and 6.17% mentioned their own illness. Pre-lacteal feeding practice was observed among 27% mothers and common pre-lacteal food was honey (61.25%), sugar water (35.63%) and animal milk (4.32%). Breastfeeding was initiated within the first hour of birth among 73.29% of mothers. 53.26% percent of mothers practice exclusive breastfeeding (EBF). Difficulties faced by mothers for EBF are insufficient secretion of breast milk (46.42%), not having knowledge about EBF (42.51%), and mother’s illness (11.07%). Most of the mothers (81.63%) gave complementary feeding in the correct time (6 months) and predominant complementary food was Khichuri (51.91%); however, most of them (60.77%) gave complementary food ≤3 times in a day. Our data suggests that the practice of IYCF was not optimum among the rural mothers. To improve this condition, it is necessary to motivate mothers through proper health education about the positive impacts of IYCF on child health.

CBMJ 2024 January: vol. 13 no. 01 P: 28-34

Effect of Topical Cyclosporine A (0.05%) in Treatment of Corneal Subepithelial Infiltrates after Adenoviral Keratoconjunctivitis

Md Emdad Hussain, Mohammad Abdul Quader — Wed, 24 Jan 2024 00:00:00 +0000

A retrospective study was done in Bangladesh Naval Ship Patenga Hospital at Chattogram, Bangladesh, from July 2021 to December 2022, to evaluate the clinical benefit and effectiveness of 0.05% cyclosporine A (CsA) eye drop in the treatment of symptomatic corneal sub-epithelial infiltrates (SEIs) related with adenoviral keratoconjunctivitis that are resistant to tapering of corticosteroid eye drops. We reviewed 15 patients (20 eyes) who had symptomatic corneal SEIs after adenoviral keratoconjunctivitis that were resistant to tapering of corticosteroids eye drops and later, who were subsequently treated with cyclosporine A (0.05%) eye drops. Data was collected and recorded including best corrected visual acuity (BCVA), intra ocular pressure (IOP), evaluation of severity of corneal SEIs, i.e., corneal subepithelial infiltrate scoring (CSIS) prior to beginning of treatment and at the last follow-up visit. Ten males (66.6%) and Five females (33.3%), mean age of 34.2±15.4 years were included in this study. The patients average topical CsA 0.05% use duration was 4.5 months (3-6 months). The mean BCVA (logarithm of minimum angle of resolution) before and after the treatment were 0.17±0.16 and 0.06±0.06 respectively, CSIS 1.072±0.69 and 0.33±0.23 respectively, IOP 20.06±2.82 and 14.73±2.60 mm of Hg respectively. There were statistically significant improvements in BCVA (P=0.003), reduction of CSIS (p=0.002) and reduction of IOP (p=0.001) at the last follow-up visit. 17 eyes (85%) showed clinical improvement and 3 eyes (15%) showed decreased SEI which did not fully disappear within 3-6 months. The no of eyes which had clinical improvement with CSIS score 0 were decided to discontinue of CsA treatment in the last follow-up visit. Patients reported a reduction in the severity of symptoms after the treatment. The patients reported foreign body sensation, glare or other side effects with topical CsA treatment, but overall patients noted improvement of vision and satisfaction with topical CsA treatment. Topical CsA (0.05%) is a safe and effective corticosteroid sparing alternative drug for the treatment of corneal SEIs after adenoviral keratoconjunctivitis, especially in patients who did not respond to other treatment modalities and have undesired side effects from using long term topical steroid.

CBMJ 2024 January: vol. 13 no. 01 P: 35-40

Study on Outcome of Phacoemulsification Cataract Surgery with Clear Corneal Steep Axis Incision

Wed, 24 Jan 2024 00:00:00 +0000

A prospective, observational study was conducted in the Department of Ophthalmology, Combined Military Hospital (CMH), Dhaka, Bangladesh, from April to October of 2019, to observe the outcome and determine the amount of surgically induced astigmatism in phacoemulsification cataract surgery done with clear corneal incision. A total of 60 patients were included in this study. Cataract extraction was done in all the patients by phacoemulsification through clear corneal incision with foldable intraocular lens implantation. All the surgeries were done with INTREPID Micro-Coaxial system using the INFINITI Vision system by the same surgeon under local anaesthesia. The patients were followed up on 1st, 7th, and 30th POD. The parameters recorded were uncorrected visual acuity, best-corrected visual acuity, slit lamp examination, and keratometry. Due to clear corneal incision on steep axis, the steep meridian became flat, from 44.329±1.473D (diopter) (as found in pre-operative keratometry) to 43.971±1.431D (on the 30th post-operative day). On the other hand, the flat meridian became steeper from 43.225±1.471D (pre-operative) to 43.225±1.501D (on the 30th day). At preoperative examination and 30th day follow-up visit, astigmatism was determined as 1.10±0.319 and 0.583±0.413 respectively. The change of astigmatism was statistically significant (P<0.05).

CBMJ 2024 January: vol. 13 no. 01 P: 41-45

Diagnostic and Prognostic Roles of C-Reactive Protein in Childhood Pneumonia

Wed, 24 Jan 2024 00:00:00 +0000

A hospital-based, case-control study was conducted in the Department of Pediatrics in Community Based Medical College, Bangladesh (CBMC,B) Hospital, Mymensingh, Bangladesh, between February and September of 2013, to determine the role of CRP for the diagnosis of pneumonia as well as treatment response of pneumonia. A total of 180 children with pneumonia were enrolled – 90 as case (group A) and another 90 having ARI other than pneumonia as control (group B), based on specific inclusion and exclusion criteria. Necessary information was collected by detailed history taking, clinical examination and close follow-up in the hospital, by using a pre-designed data sheet. The mean±SD age of the participants as case (group A) and control (group B) were 8.53±10.24 and 6.68±3.59 respectively (P>0.05). Male children were 66(73.3%) and 68(75.6%), while female children were 24(26.7%) and 22(24.4%) in group A and group B respectively (P>0.05). In two groups, the mean CRP before treatment were 48.80±32.4 and 3.60±1.30 respectively; the difference was statistically significant (P<0.001), which signifies that those who were suffering from pneumonia had an initial CRP response much higher than those who were suffering from other forms of respiratory diseases. Among antibiotic responders, symptoms and signs resolved in approximately 2-4 days; however, among non-responders, symptoms even persisted >7 days. Among the responders, CRP was significantly reduced after treatment (P<0.001); in contrast, among non-responders, even after treatment, no or little reduction in CRP was observed (P>0.05). Hence, we suggest that measuring CRP to see the antibiotic response in childhood pneumonia is helpful.

CBMJ 2024 January: vol. 13 no. 01 P: 46-52

Early Diagnosis of Chronic Obstructive Pulmonary Disease in Smokers Using Spirometry

Rifat Sharmin, Md Mahbubur Rahman, Shamima Akter — Wed, 24 Jan 2024 00:00:00 +0000

A cross-sectional, observational study was done in the Pulmonology Department of Combined Military Hospital (CMH) Dhaka Cantonment, Bangladesh, from September 2016 to February 2017, to explore the role of spirometry in the early detection of Chronic Obstructive Pulmonary Disease (COPD) among smokers. A total of 70 participants were selected. After taking the detail history, spirometry and chest x-ray were done. The correlation between smoking and COPD was determined. Among the total respondents 44%, 40% and 15.7% had 10-15, 15-20 and >20 pack-year smoking history respectively. Forced expiratory volume in one second/Forced vital capacity (FEV1/FVC) among these three groups of smokers were found 90%/91%, 77%/89%, and 58.4%/88% respectively. Among the participants, 20% had a change in chest X-ray and 23 (32.85%) of respondents had COPD. Among those 23 participants, 13 (18.57%) suffered from mild, 6 (8.57%) suffered from moderate, 3 (4.28%) suffered from severe, and 1 (1.43%) suffered from a very severe level of airway obstruction. Our results suggest that spirometry can be a valuable tool for the early diagnosis of COPD among smokers. Though it was found as a promising option in a small-scale study, further evaluation is necessary through a population screening to confirm its effectiveness.

CBMJ 2024 January: vol. 13 no. 01 P: 53-59

Correlation between the Maximum Length and the Weight of the Human Humerus Bone

Wed, 24 Jan 2024 00:00:00 +0000

The humerus bone of the humans is frequently used in anatomical science, forensic medicine and anthropological studies. This cross-sectional, descriptive study was done on 100 (43 right and 57 left) fully ossified dry human humerus in the Department of Anatomy, Mymensingh Medical College, Bangladesh, between July 2021 to June 2022. A non-random, purposive sampling technique was adopted. The maximum length was determined by measuring the distance between the most superior point on the head of the humerus and the most distal point of the trochlea of the humerus. The length was measured with a metallic scale, while the weight of the humerus was measured using a digital weighing machine. The mean (±SD) maximum length of the right humerus was 304.139 (±17.652) mm, while the left humerus was 300.42 (±20.779) mm. The mean (±SD) weight of the right humerus was 91.069 (±26.944) gm and the left humerus was 93.965 (±32.227) gm. A positive correlation was observed between the maximum length and the weight of the human humerus through regression analysis (r=0.653 and r=0.824 on right and life side respectively). The differences were statistically significant on both sides (P<0.001).

CBMJ 2024 January: vol. 13 no. 01 P: 60-65

Pelvic Stress Fracture among Naval Cadets in Bangladesh

Mohammad Abdul Quader, Irin Farhana — Wed, 24 Jan 2024 00:00:00 +0000

Stress fractures are often found in military recruits. Most involved bones are tibia, metatarsals, calcaneus and fibula. Pelvic stress fracture especially at pubic ramus is relatively rare; however, it is found more in females in comparison to its male counterpart. A prospective study was carried out to investigate demographic features of pelvic stress fractures among the Naval cadets in Bangladesh. A total of 18 patients with pelvic stress fractures reported at the Department of Orthopedics of Bangladesh Naval Ship (BNS) Patenga Hospital at Chattogram, Bangladesh, between January 2021 and December 2022. Naval trainee officers both male and female undergo physical and military training during their courses. Most of the cadets reported with pain in their groin. Routine investigation was done. Plain radiograph of pelvis revealed fracture lines sometimes periosteal elevation and sclerosis. The mean age of the patients was 18.94 years (ranging between 18 and 20 years). Out of 18 patients, 17 were female and 1 was male. All the cadets were treated conservatively. Post trauma pain developed in 3(16.67%) cases, while the rest 15(83.33%) recovered completely.

CBMJ 2024 January: vol. 13 no. 01 P: 66-70

Social Awareness and Use of Face Masks among Medical Students in Association with the COVID-19 Pandemic

Md Serajul Islam, Mir Moyeedul Islam, Nazia Nazneen, Tamrin Zaman — Wed, 24 Jan 2024 00:00:00 +0000

A cross-sectional, descriptive study was conducted to assess the level of social awareness and use of face mask in association with the COVID-19 pandemic among the medical students of Ad-din Sakina Women’s Medical College, Jashore, Bangladesh, between January and February of 2022. The study was carried out in the Department of Community Medicine. A total of 354 students of the same medical college participated in the survey. Data was collected by structured questionnaire and data processing and statistical analysis were done by using SPSS version 25.0. The age of the respondents was between 18 and 26 years. The mean age was 21.73 years. 82.8% of respondents were Muslims and 15.3% were Hindu. The average monthly family income of respondents was about 53,000 BDT. 83% of the respondents used face masks for the protection against COVID-19. 70.3% of the respondents relied more on the surgical type of mask. According to the survey the main mode of transmission of virus was found to be through respiratory droplets by 87.3% of the respondents. However, 13% failed to recognize droplet inhalation as a source of transmission. 92.1% of the respondents believed that the route of transmission includes eyes, nose, and mouth. Among the respondents 96% sanitize hand and face properly and 87.3% maintain social distance. It was found out that 7.1 percent of the respondents were affected by COVID-19 and 100% respondents were vaccinated against COVID-19. These findings clearly showed a satisfactory level of awareness and attitudes among the medical students towards COVID-19. Promoting the use of facemasks and educating the public about mask-wearing as an effective tool in disease prevention may also help to increase the public’s perceived benefits, which may then also contribute to increasing mask-wearing compliance. Facemasks play a pivotal role in the prevention and control of infectious respiratory disease transmission.

CBMJ 2024 January: vol. 13 no. 01 P: 71-76

Effect of Beta Thalassemia Trait in Pregnancy

Marlina Roy, Md Golam Robbani, Rahnuma Karim, Nasrin Hasan — Wed, 24 Jan 2024 00:00:00 +0000

A cross-sectional, observational study was conducted to determine the effects of beta thalassemia trait in pregnancy. A total of 150 pregnant women diagnosed with beta thalassemia trait in Bangladesh Navy Ship (BNS) Patenga Hospital, at Chattogram, Bangladesh, having regular antenatal care and delivery, between January and December of 2022, were included in the study. Thalassemia status was diagnosed by Hb-electrophoresis. Most of the patients belonged to the age group 19-35 years. 30.46% of women had normal hematocrit level. During pregnancy women suffered from severe anemia (14%) and mild anemia (55.33%) (P<0.001). Blood transfusion needed during 1st trimester (1.3%), 2nd trimester (4.6%), 3rd trimester (8%) and at postpartum period (9.3%) (P>0.05). Most of the women (76.66%) delivered babies at her 36-39 weeks of gestational age,18.67% delivered at or after 40 weeks of gestation and 4.67% delivered baby before 36 weeks (P<0.05). 66.67% had normal vaginal delivery, while 33.33% underwent Caesarean section operation due to several complications. Observed obstetric complications were: pregnancy induced hypertension (6.6%), gestational diabetes (4%), oligohydramnios (11.33%, premature rupture membrane (3.3%), preterm labor (8.66%), and placental abruption (1.33%). Adverse fetal outcomes observed were: prematurity (4.6%), intrauterine growth retardation (5.33%), still birth (0.6%), and fetal asphyxia (3.33%). Neonatal admission at NICU was needed in 2(1.33%) cases.

CBMJ 2024 January: vol. 13 no. 01 P: 77-82

Functional Outcome of Primary Repair of Long Flexors of Finger at Zone V with Early Mobilization

Wed, 24 Jan 2024 00:00:00 +0000

A prospective, observational study was conducted in National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh, between September 2019 and March 2021, to observe the functional outcome of primary repair of long flexors of finger at zone V with early mobilization. Our study included 51 patients, who had follow-up visits up to 12 months after operation. Tendon functionality was assessed by Buck-Gramcko score, while grip strength was assessed by modified sphygmomanometer. The mean age was 30.08±13.38 years. Middle and index fingers were most involved with both flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) injury. In this study, most of the patients had excellent or good outcomes. The average return to work time was 32.82 weeks. 9.8% of the patients developed post-operative complications like infections, adhesion, and rupture. Most of the patients obtained good to excellent results (90%), while 3.92% had fair and only 2% had poor outcome. Early motion of the fingers seems to improve outcome in these patients. However, worse outcomes were seen in patients with a greater number of damaged structures, especially in concomitant nerve injury.

CBMJ 2024 January: vol. 13 no. 01 P: 83-88

Bacterial Isolates from Diabetic Foot Ulcer with Antibiotic Sensitivity Pattern

Suttam Kumar Biswas, Shilpi Rani Roy, Arup Roton Paul — Wed, 24 Jan 2024 00:00:00 +0000

A cross-sectional, descriptive study was carried out in the Department of Surgery, Mymensingh Medical College Hospital, Mymensingh, Bangladesh, between October 2014 and September 2015, to determine the microbiological profile and antibiotic susceptibility patterns of organisms isolated from diabetic foot ulcer. A total of 130 patients of diabetic foot ulcer were included in the study according to inclusion and exclusion criteria. Samples of pus were collected from those patients and sent for culture and sensitivity tests. Out of 130 cases, the highest number of patients 55(42.4%) were in 50-59 years age group. The mean age was 60.1±9.8 years. Most of the patients (70%) were male. 90(69.2%) samples yielded growth, while 40(30.8%) did not show any bacterial growth. Out of those 90 samples with growths, 112 bacteria were isolated. Of them, 59(52.7%) organisms were gram-positive, while 28(25%) were gram-negative and 25(22.3%) organisms were both gram-positive and gram-negative. Out of 59 gram-positive isolates, 35(59.3%) were S. aureus, 18(30.5%) were Enterococci, and 6(10.2%) were Streptococci. In 28 gram-negative isolates, 15(53.7%) were E. coli, 6(21.4%) were Pseudomonas, 4(14.2%) were klebsiella, and 3(10.7%) were proteus. Regarding antibiotic sensitivity, all gram-positive bacteria (100%) were sensitive to vancomycin. S. aureus was 80% sensitive to ceftriaxone, 71.4% to flucloxacillin, 65.7% to clavulanic acid, 54.2% to ampicillin, 48.5% to amoxicillin, and 28.5% to cotrimoxazole. Enterococci spp. was 61.1% sensitive to ceftriaxone, 33.3% to clavulanic acid, (27.7%) to ampicillin, and 16.6% to both amoxicillin and cotrimoxazole. Streptococcus spp. showed 83.3% sensitivity to ceftriaxone, 66.6% to flucloxacillin, 33.3% to clavulanic acid, and 16.6% to cotrimoxazole. Among gram-negative bacteria, E. coli was found to be sensitive to imipenem (100%), ceftriaxone (86%), amikacin (100%), cefuroxime (73.3%), ampicillin (33.3%), ciprofloxacin (60%), and gentamycin (60%). Pseudomonas was found to be sensitive to imipenem (50%), ceftriaxone (66.6%), amikacin (83.3%), and cefuroxime (66.6%). Klebsiella was found to be sensitive to imipenem (100%), ceftriaxone (75%), amikacin (75%), cefuroxime (50%), and ciprofloxacin (25%). Proteus was found to be sensitive to imipenem (100%), ceftriaxone (66.6%), amikacin (66.6%), cefuroxime (33.3%), ciprofloxacin (66.6%), and gentamycin (66.6%).

CBMJ 2024 January: vol. 13 no. 01 P: 89-94

A Rare Case of Virilizing Ovarian Fibrothecoma in A Teenage Girl

Wed, 24 Jan 2024 00:00:00 +0000

Ovarian fibrothecomas comprise tumors in the spectrum of ovarian sex cord / stromal tumors where there are components of both an ovarian fibroma and an ovarian thecoma. They account for 3-4% of all ovarian tumors. Most occur in adult women, with 65% in postmenopausal women. However, it represents only 2% of pediatric ovarian tumors. They are the most common benign solid ovarian tumor. The tumors are usually hormonally inactive but can be estrogenic or sometimes androgenic. Here we are reporting a rare case of a 15-year-old girl presenting with primary amenorrhea, severe hirsutism and finally diagnosed with ovarian fibrothecoma. After surgical removal of the tumor, a dramatic response was observed as the patient developed menarche. She was relieved of her hirsutism by laser therapy later, but her deep voice remained the same.

CBMJ 2024 January: vol. 13 no. 01 P: 95-97

Oral Bullous Lichen Planus – A Case Report

Md Shahidul Islam, Nahida Islam, Atia Sharmeen — Wed, 24 Jan 2024 00:00:00 +0000

Oral bullous lichen planus (BLP) is a rare and challenging variant of lichen planus affecting the oral mucosa. A 40-year-old female patient was diagnosed with Bullous lichen planus and treated with hydroxychloroquin, triamcinolone acetonide, levamisole, prednisolone and benzydamine oral rinse. Her main complaint was a burning feeling in her mouth that was linked to generalised pruritis, and skin lesions. The patient has not had any lesions during their year-long follow-up. The incidence of oral bullous lichen planus and its treatment are still poorly understood in Bangladesh. With regard to our local context, this report seeks to advance knowledge of this condition.

CBMJ 2024 January: vol. 13 no. 01 P: 98-101

First Ever Organ Transplantation from A Brain-Dead Person in Bangladesh: A Successful Outcome of The Human Organ Transplantation Act

Wed, 24 Jan 2024 00:00:00 +0000

On the 19th of January 2023, a historic event took place in the field of medical practice and country’s healthcare system. A 20-year-old girl named Sarah Islam was pronounced clinically dead on Wednesday (18 January, 2023) while being treated at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, with her terminal illness as she has been suffering from tuberous sclerosis since her childhood. Her final act was termed 'heroic' by her attending physicians as she became the first patient in the country to donate her organs while being brain-dead. The next day in the early morning (19 January, 2023) doctors conducted the country's first-ever cadaveric kidney transplantation as taken from her. The recipients were two females in their 30s who were reportedly recovering well after the surgery. Those two surgeries were performed separately at Bangabandhu Sheikh Mujib Medical University (BSMMU) Hospital and the National Kidney Foundation Hospital in Dhaka. The Human Organ Transplantation Act (HOTA) officially came into force in Bangladesh on April 13, 1999, allowing organ donations from both living and brain-dead donors; after long discussion, some amendments were ratified by the Parliament in 2018. The Act places some legal requirements around the collection and preservation of human organs as well as ensuring their transplantation into a human body. Few years back, religious leaders came forward to issue a fatwa (religious approval) that recognize both living and brain death criteria and permit both living and brain-dead donors to donate organs for transplantation. Based on that fatwa and a long medical discussion the country’s parliament passed this Act. Enacting the HOTA shows an immense influence in our society on cadaveric organ donation and transplantation especially from brain-dead individuals, and we hope that this historic donation will create more awareness and pave a new path for organ donation campaign in the country in near future.

CBMJ 2024 January: vol. 13 no. 01 P: 102-106

Cellular Self-Digestion Unveiled: Autophagy's Impact on Cancer

Ashiqur Rahman Khan Chowdhury, Iftekhar Bin Naser — Wed, 24 Jan 2024 00:00:00 +0000

Autophagy is a strictly controlled process in which cells break down and recycle their own components by transporting them to lysosomes. Multiple studies have shown that autophagy has a diverse range of physiological and pathological functions in cells. Autophagy in cancer has contradictory functions, serving as both a suppressor and a driver of tumor growth. Specifically, it may exhibit several roles in relation to cancer treatment, either leading to cancer resistance or enhancing susceptibility to radiation and chemotherapy. Hence, autophagy has the potential to augment the efficacy of anticancer medications and radiation treatment.

CBMJ 2024 January: vol. 13 no. 01 P: 107-118

Community Based Medical Education: What, Why and How?

Wed, 24 Jan 2024 00:00:00 +0000

Community based medical education has several definitions, but the core definition refers to learning that takes place is need based and in a community setting. Hence, community based medical education refers to medical education in which trainees learn and acquire professional competencies in a community setting based on the need of the community. This concept encourages medical colleges to produce not just highly competent professionals, but professionals who are equipped to respond to the changing challenges of healthcare through re-orientation of their education, research, and service commitments, and be capable of demonstrating a positive effect upon the communities they serve. Such social accountability of a healthcare cum academic institution demonstrates an impact on the communities served and thus, contribute to achieve a just and efficient healthcare service through mutually beneficial partnerships with other stakeholders. Community based medical education can make a difference in the country’s health sector by supporting a community based healthcare delivery system within the concept of National Health Policy and thus, contribute to the overall national efforts in achieving meaningful, self-sustaining quality of life and environment. Besides, it helps bring about change in current educational trait by imposing need-based, flexible academic strategies specific to the rural community and quality of the medical doctors by grooming them as empathetically responsive and active towards patients, professionally competent and ethically sound persons of the society.

CBMJ 2024 January: vol. 13 no. 01 P: 119-129