Faridpur Medical College Journal https://www.banglajol.info/index.php/FMCJ Official journal of Faridpur Medical College Teachers Association. Full text articles available.<br /> Faridpur Medical College Teachers Association en-US Faridpur Medical College Journal 2079-3553 PET-CT–a Most Advanced Fusion Molecular Imaging Modality of Nuclear Medicine https://www.banglajol.info/index.php/FMCJ/article/view/46156 <p>Abstract not available</p> <p>Faridpur Med. Coll. J. Jan 2019;14(1): 1</p> Hafizur Rahman ##submission.copyrightStatement## 2020-03-26 2020-03-26 14 1 1 1 10.3329/fmcj.v14i1.46156 Clinical and Endoscopic Characteristics of Medication Induced Esophageal Injury https://www.banglajol.info/index.php/FMCJ/article/view/46157 <p>Medications can cause several complications in the esophagus and lead to medication-induced esophageal injury. This study was carried out among patients diagnosed as medication-induced esophageal injury from June 2015 to October, 2018 in the Department of Gastroenterology, Enam Medical College and Hospital, Savar, Dhaka to investigate clinical and endoscopic characteristics of medication-induced esophageal injury as well as outcome of these patients with treatment. Patients diagnosed as malignancy, viral or fungal esophagitis, esophageal varix, corrosive and sclerotherapy induced ulcer and GERD were excluded. Clinical and endoscopic characteristics of patients diagnosed as medication-induced injury were analyzed. After given treatment, clinical improvements as well as mucosal healing of oesophageal injury were noted. Thirty seven patients were diagnosed as medication-induced esophageal injury. Their median age was 40; 17 were males and 20 were females. Common symptoms were chest pain (94.6 %), odynophagia (78.4 %) and dysphagia (62.2 %). Symptoms appeared between 3 hours to 15 hours after ingestion of medication. Predisposing factors for 75.67% of the patients were related to taking the medicine with insufficient water or in recumbent position, or both. The main causative agents were antibiotics, Non-steroidal anti-inflammatory drugs (NSAIDs) and Alendronate sodium. Common diseases that required treatment with these drugs were various urinary system diseases, osteoporosis and migraine. During endoscopy, 25 had only ulcer, 7 had only erosion and 5 had both ulcer and erosion. Most of the ulcers and erosions were located at the middle third of the oesophagus with a rate of 70%, and 58.3% respectively. Appearance of the ulcer was oval, circular, kissing and geographical shaped and their sizes vary between 6 mm to 18 mm and single or multiple in numbers. All the patients were treated with proton pump inhibitors (PPIs) or sucralfate, and the causative drugs were discontinued. Symptoms resolution occurred within 5 to 12 days after treatment and mucosal healing were detected in all patients after 4 weeks who were performed endoscopy. Almost every kind of medication, particularly doxycycline, NSAIDs can cause oesophageal ulcer and erosion. It can be successfully treated with PPIs and discontinuation of the causative medication and prevented by warning patients about drinking water sufficiently and sitting up while taking the pill.</p> <p>Faridpur Med. Coll. J. Jan 2019;14(1): 2-7</p> Mohammad Quamrul Hasan Nelson Taposh Mondal Irin Perveen MM Shahin Ul Islam Md Khalequzzaman Sarker ##submission.copyrightStatement## 2020-03-26 2020-03-26 14 1 2 7 10.3329/fmcj.v14i1.46157 Evaluation of Breast Cancer Subtypes Based on ER/PR and Her2 Expression: A Clinicopathologic Study of Hormone Receptor Status (ER/PR/HER2-neu) in Breast Cancer https://www.banglajol.info/index.php/FMCJ/article/view/46158 <p>Breast cancer stands first in the incidence of malignancy in women. Enormous studies have been conducted worldwide regarding hormone receptor status in breast cancer. The study was done in the department of pathology in Khulna Medical College, Khulna to compare the clinicopathologic features with four breast cancer subtypes defined by immunohistochemistry (IHC) expression of estrogen receptor (ER) or progesterone receptor (PR) and human epidermal growth factor receptor 2 (Her2): ER/PR<sup>+</sup>, Her2<sup>+</sup>; ER/PR<sup>+</sup>, Her2<sup>_</sup>; ER/PR<sup>_</sup>, Her2<sup>+</sup>; and ER/PR<sup>_</sup>, Her2<sup>_</sup> and to evaluate hormone receptor status in breast cancer to estimate a patient's response to endocrine therapy and their prognosis for better clinical outcomes. It is a retrospective observational study from 1st January, 2015 to 31st December, 2017. A total 378 invasive breast cancer subjects who underwent diagnostic tests for hormone receptors status were included in this study. Clinical and pathologic features and survival of the four subtypes were compared. Data of oestrogen, progesterone and human epidermal growth factor receptor 2 expression statuses was analyzed. Overall record of 378 patients was studied of whom 43% were identified to have positive hormone receptor status. The age of the patients ranged from 24 to 86 years with 65% in 25-50 years, 30.8% in 51-75 years and 4.08% in 76- 100 years. Fiftyeight percent were diagnosed as Stage III, 37% Stage II and 5.3% Stage IV. Those diagnosed with oestrogen receptor (positive status) were 10.7%, human epidermal growth factor receptor 2 over-expression 8.7%, oestrogen/progesterone hormone receptor positivity 51% and 23.4% patients were positive for all the three receptors. The triple negative subtype has the worst overall and disease free survival.</p> <p>Faridpur Med. Coll. J. Jan 2019;14(1): 8-12</p> Md Mahabubur Roshed SM Kamal Syed Mozammel Hossain Shamima Akhtar ##submission.copyrightStatement## 2020-03-26 2020-03-26 14 1 8 12 10.3329/fmcj.v14i1.46158 Prevention of Succinylcholine Induced Postoperative Myalgia by Pretreatment with Lignocaine: A Randomized Controlled Study https://www.banglajol.info/index.php/FMCJ/article/view/46159 <p>Succinylcholine, a depolarizing muscle relaxant possesses a unique property of rapid onset and short duration of action, but is accompanied by side effects such as fasciculation and myalgia. The aim of this study was to investigate the prophylactic effect of intravenous lignocaine on the incidence and severity of succinylcholine-induced postoperative myalgia. This was a randomized controlled double blind study conducted at National Institute of ENT Dhaka, during September to December 2017. Eighty adult patients of American Society of Anesthesiologists status I and II of both sexes for elective surgery under general anesthesia were randomly allocated into two equal groups, lignocaine group and normal saline group. The patients of lignocaine group were pretreated with lignocaine 1.5 mg/kg body weight in 5 ml volume, while patients of normal saline group were given isotonic saline 0.9% in the same volume (5 ml) intravenously. Thereafter, anesthesia was induced in all patients, by injecting 1.5 mg/kg of fentanyl and 2 mg/kg of propofol intravenously. Following the loss of eyelid reflex, 1.5 mg/kg of succinylcholine was injected intravenously as a muscle relaxant and then the patients were intubated. The incidence and severity of myalgia were assessed by a blinded observer 24 hours after surgery. In terms of demographic data, the results of this study showed that there is no significant difference between patients in both groups (P&gt;0.05). Overall, the incidence and severity of succinylcholine-induced myalgia in lignocaine group was significantly less, when compared with normal saline group (P&lt;0.05). Pretreatment with intravenous lignocaine is effective in prevention of postoperative succinylcholine induced myalgia.</p> <p>Faridpur Med. Coll. J. Jan 2019;14(1): 13-15</p> Muhammad Sazzad Hossain Lipika Sanjowal Mohammad Mamunur Rashid Md Anisur Rahman Babu Devashis Saha ##submission.copyrightStatement## 2020-03-26 2020-03-26 14 1 13 15 10.3329/fmcj.v14i1.46159 Study of Efficacy and Safety of Acitretin as Monotherapy in the Treatment of Moderate to Severe Plaque Type Psoriasis https://www.banglajol.info/index.php/FMCJ/article/view/46160 <p>Psoriasis is a chronic papulosquamous disorder with remissions and exacerbations. Varied estimates of the population prevalence of the disease in different parts of the world range from 0.1 - 3%. It is not uncommon in our country. Although there are no treatment options offering a complete cure, a number of options exist for providing symptomatic relief, inducing as well as prolonging remission. Various systemic therapies such as methotrexate, acitretin, cyclosporine, and biologic agents can be used. A review of pharmacokinetics, safety and a discussion of relapse rate establish acitretin, an aromatic retinoid as an efficacious, convenient, oral monotherapy for initial and maintenance of severe psoriasis. A prospective clinical trial was conducted to find out the efficacy and safety of acitretin as monotherapy in the treatment of moderate to severe plaque type psoriasis (PASI range 10-42). Thirty two clinically diagnosed cases of moderate to severe plaque type psoriasis attending the Skin and VD out patient department of Faridpur Medical College Hospital, Faridpur were selected randomly. Majority (46.9%) were between 61 to 80 years of age and only 3.1% patients were in the &lt;20 years age group. The average age was 57.3 years and range was 19-90 years. Majority (68.8%) of the patients were male and 31.2% patients were female. The male female ratio was 2.2:1. After 8 weeks of treatment with acitretin PASI 50 and PASI 75 response rates were 55% and 24% respectively and after 12 weeks of treatment, PASI 50 and PASI 75 response rates were 75% and 50% respectively. As side effects of the treatment, 4(12.5%) patients developed alopecia, each of xerophthalmia and cheilitis was seen in 3(9.37%) patients, each of fatigue and pruritus was seen in 2(6.25%) patients and only 1(3.12%) patient developed myalgia. This study demonstrates that acitretin as monotherapy is effective and safe in the treatment of moderate to severe plaque type psoriasis.</p> <p>Faridpur Med. Coll. J. Jan 2019;14(1): 16-19</p> Sumitendra Kumar Sarkar Krishna Gopal Sen Md Kamal Mostofa Md Habibur Rahman ##submission.copyrightStatement## 2020-03-26 2020-03-26 14 1 16 19 10.3329/fmcj.v14i1.46160 Desarda Versus Lichtenstein Repair for Primary Inguinal Hernia in Men: Results of A Randomized Control Trial https://www.banglajol.info/index.php/FMCJ/article/view/46161 <p>Inguinal hernia is a very common surgical problem for which mesh based technique particularly Lichtenstein repair is considered as standard. However, it is not free from some major and bothersome complications. Desarda technique of non-mesh hernia repair invented by the Indian surgeon is claimed as low cost tension free procedure with promising results. The objective of the study is to evaluate the feasibility of Desarda procedure in country like Bangladesh as a treatment of primary inguinal hernia in men by comparing with Lichtenstein repair in terms of various parameters. One hundred and sixty male patients between ages of 18-70 years with uncomplicated primary inguinal hernia were initially randomized to perform the one of the two procedures in every alternate patient. Outcome were measured and analyzed. A total of 100 patients were finally studied with a follow up of 2 years. Operative time and immediate postoperative pain were significantly less in Desarda arm. Cost and foreign body sensation were also in favour of Desarda group. There was no recurrence in either group. Desarda repair is easy to perform and takes less time. It is cost effective with a comparable clinical outcome to standard Lichtenstein repair at least in short term.</p> <p>Faridpur Med. Coll. J. Jan 2019;14(1): 20-26</p> ASM Tanjilur Rahman Swapan Kumar Biswas Ratan Kumar Saha ASM Zahidur Rahman Tanvir Ahmed Md Mahfuzur Rahman ##submission.copyrightStatement## 2020-03-26 2020-03-26 14 1 20 26 10.3329/fmcj.v14i1.46161 Apheresis-Adverse Events in Man and Machine Individualities https://www.banglajol.info/index.php/FMCJ/article/view/46162 <p>Adverse events due to platelet pheresis are not unheard of citrate related reactions being the most common. Most of these events are mild and self limiting. The current study describes adverse events in platelet pheresis using modern apheresis systems. This prospective study included 1455 platelet pheresis procedures done from July 2016 to December 2017. Procedures were performed on Hemonetics MCS+, Trima Accel and Cobe spectra cell separators. The endpoint of each procedure was a yield of 3 × 1011 platelets (PLTs) per unit. Donor adverse reaction if any was managed, reported, and documented. The median age of donors was 31 years with male to female ratio of 13:1. The median body surface area and body mass index were 1.64 m<sup>2</sup> and 22.4 kg/m<sup>2</sup>, respectively. The mean PLT count of donors was 199.8 × 103/uL with a mean hemoglobin value of 13.6 g/dl. ACD infusion was significantly more in the Hemonetics MCS+, (P&lt; 0.01). Donation time was least with the Trima compared to Hemonetics MCS+ (P&lt; 0.01) and Cobe (P&lt; 0.001). Total whole blood volume processed was higher in Hemonetics MCS+, (P&lt; 0.01). Paresthesia due to citrate toxicity was the most common adverse reaction (65.3%), and vascular injury was observed in only five donors. The overall incidence of adverse reaction was 3.4%. Serious adverse events were not observed. The modern generation apheresis machines are more donors friendly and cause less adverse reactions compared to the older versions. Good donor screening, optimized donor physiognomic and hematological values and skilled operators are the key factors in reaction reduction by apheresis.</p> <p>Faridpur Med. Coll. J. Jan 2019;14(1): 27-30</p> Md Ashraful Hoque Kashfia Islam Selina Akter ##submission.copyrightStatement## 2020-03-26 2020-03-26 14 1 27 30 10.3329/fmcj.v14i1.46162 Association of Serum Electrolyte Abnormalities in Preterm Low Birth Weight Neonates https://www.banglajol.info/index.php/FMCJ/article/view/46164 <p>Despite decline in under five mortality in the last few decades, neonatal mortality rate has not changed substantially. A large number of these newborn are premature or low birth weight. Premature infants are at increased risk of developing dehydration or overhydration. Therefore, high index of suspicion, prompt recognition and thorough understanding of common electrolyte abnormalities are necessary to improve neonatal outcome. It seems to be essential for immediate management for planning appropriate fluid and electrolyte therapy and thereby for improved outcome. To study the electrolytes abnormalities in preterm low birth weight neonates information were collected who gave consent and participated in the study willingly. Duration of data collection was approximately 6 (Six) months. Patients admitted to the Dhaka Medical College Hospital and after meeting the inclusion and exclusion criteria a simple random sampling technique was applied for selecting the sample patients. Total 50 preterm LBW neonates fulfilling the inclusion criteria were studied during this study period. Abnormal electrolytes were documented in 20(40%) preterm LBW neonates of which hyperkalemia was the predominant electrolyte abnormality found in 8(16.0%) neonates, hyponatremia was found in 7 (14.0%), hypokalemia in 3 (6.0%) and hypernatremia in 2 (4.0%). It was observed that electrolyte abnormalities are common in preterm LBW neonates. So, identification of associated electrolyte abnormalities and proper management of fluid and electrolytes and close monitoring are important.</p> <p>Faridpur Med. Coll. J. Jan 2019;14(1): 31-33</p> Abu Sayeed Chowdhury Md Ekhlasur Rahman Farhana Hossain Abu Faisal Md Parvez Md Kamrul Hassan Farzana Munmun Poly Begum ##submission.copyrightStatement## 2020-03-26 2020-03-26 14 1 31 33 10.3329/fmcj.v14i1.46164 Impact of Antenatal Care (ANC) on Perinatal Asphyxia. https://www.banglajol.info/index.php/FMCJ/article/view/46165 <p>Antenatal care (ANC) is very important for all women for their own health and their neonates. This study was done to observe the impact of antenatal care on perinatal asphyxia. This case-control study was conducted at Neonatology Department of Dhaka Medical College Hospital, Dhaka from July 2014 to December 2014. Fifty neonates with perinatal asphyxia (Group I) and fifty neonates without perinatal asphyxia (Group II) were selected as study subjects. After selection, informed written consent was taken. Then data were collected by face to face interview of the mother. The mean age of neonates was 49.0±72.1 hours in group I and 55.8±63.9 hours in group II. Majority (80.0%) of the neonates had birth weight 2.5- 4.0 kg in group I and only 22(44.0%) neonates had birth weight 2.5-4.0 kg in group II. Almost half (48.7%) of the mothers received antenatal check-up at UHC/FWC/MCWC in group I and 20(41.7%) in group II. It was observed that 19(38.0%) mothers received antenatal care from untrained Dai in group I and 42(84.0%) in group II. Only 30.0% of the mothers received adequate antenatal check-up in group I and 68.0% in group II. Mothers having baby with perinatal asphyxia received significantly less number of ANC.</p> <p>Faridpur Med. Coll. J. Jan 2019;14(1): 34-36</p> Anita Sarker Iffat Ara Shamsad Najnin Umme Zakia Khyrun Nahar Sabiha Shimul ##submission.copyrightStatement## 2020-03-26 2020-03-26 14 1 34 36 10.3329/fmcj.v14i1.46165 Delayed Primary Closure of Wound Prevents Wound Infection after Surgery in Patients with Obstructive Jaundice https://www.banglajol.info/index.php/FMCJ/article/view/46166 <p>Surgery in jaundiced patients is associated with a higher risk of postoperative complications compared with surgery in non jaundiced patients. These complications primarily consists of septic complications, hemorrhage, superficial surgical site infection (SSSI), wound dehiscence and renal disorders. Of them Surgical Site Infection (SSI) is found more commonly than other. This study was done to evaluate the effect of delayed primary closure on preventing wound infection than that of primary closure of wound after surgery in patients with obstructive jaundice. This randomized clinical trial was carried out at the Hepatobiliary and Pancreatic division of Department of Surgery in Bangabandhu Sheikh Mujib Medical University, Dhaka from July 2012 to June 2013. A total of 88 patients were included in this study who underwent surgical intervention for obstructive jaundice. These patients were divided into two groups randomly; control group (n=44) who underwent primary closure of the wound and experimental group (n=44) who underwent delayed primary closure of the wound. Patients demography, clinical presentation, comorbidities, pre, per and post operative variables and outcome were compared between two groups. Mean age of the patients of experimental and control group was 47.91± 14.63 and 42.25±12.13 years respectively. Duration of jaundice was significantly higher in experimental group 4.91±2.87 months than in control group 3.10±1.62 months. Postoperative wound infection was found significantly higher in control group (43.2%) than that of experimental group (11.4%). Postoperative hospital stay was significantly longer in control group (18.77± 6.24 days) than in experimental group (13.52±3.61 days). Delayed primary closure of wound reduces wound infection significantly than primary closure of wound in patients with obstructive jaundice.</p> <p>Faridpur Med. Coll. J. Jan 2019;14(1): 37-40</p> Md Aslam Hossain Md Julfiqur Rahman Khan SM Rokonuzzaman Md Maniruzzaman Khan Md Mobaraque Hossain Khan Bidhan C Das ##submission.copyrightStatement## 2020-03-26 2020-03-26 14 1 37 40 10.3329/fmcj.v14i1.46166 Use of Oral Valacyclovir Instead of IV Acyclovir in Treatment of Herpes Simplex Encephalitis (Hse) in Resources- Poor Country: A Review Article https://www.banglajol.info/index.php/FMCJ/article/view/46167 <p>Viral encephalitis remains a significant public health problem worldwide including Bangladesh. The recommended treatment for herpes simplex encephalitis (HSE) remains intravenous acyclovir. In resource-poor countries, however, intravenous formulations are usually unavailable or unaffordable. Efficacy of treatment depends upon cerebrospinal fluid (CSF) level of acyclovir. Main concern of use of valacyclovir is central nervous system penetration of drugs. This study reports the comparison of penetration of acyclovir into the cerebrospinal fluid (CSF) in patients with HSE, treated with the oral pro drug valacyclovir at a dose of 1,000 mg three times daily. The oral therapy achieved adequate acyclovir concentrations in the CSF and may be an acceptable early treatment for suspected HSE in resource-limited settings. In our country treatment of HSE by IV acyclovir is costly and needs about 45000 BDT per person to complete treatment and is not available in rural areas, on the other hand it is 10 times cost effective in treatment with oral Valacyclovir.</p> <p>Faridpur Med. Coll. J. Jan 2019;14(1): 41-43</p> MM Bodiuzzaman ##submission.copyrightStatement## 2020-03-26 2020-03-26 14 1 41 43 10.3329/fmcj.v14i1.46167 Hypertrophic Cardiomyopathy: The Molecular Genetics https://www.banglajol.info/index.php/FMCJ/article/view/46168 <p>Hypertrophic Cardiomyopathy (HCM) is the common monogenic form familial pathological cardiac hypertrophy. HCM is an important cause of sudden cardiac death in the young adult and a major cause of morbidity in the elderly. We discuss here the molecular genetics and recent advances in the molecular genetics of HCM. HCM became the first cardiac disease for which a molecular genetic mechanism was identified. More than 100 mutations in nine genes, that encoding sarcomeric proteins have been identified in patients with HCM, which had led to the belief that HCM is a disease of contractile sarcomeric proteins of the cardiac muscle. Approximately two-thirds of all HCM cases are caused by the mutation of the myosin heavy chain (MyHC), cardiac troponin T (cTnT) and myosin binding protein-C (MyBP-C). Genotype-phenotype correlation studies suggest that mutations in the MyHC gene are associated with more extensive hypertrophy and a higher risk of SCD as compared to mutations in genes coding for other sarcomeric proteins, such as MyBP-C and cTnT. However, there is a noteworthy variability and factors, such as modifier genes and probably the environmental factors affect the phenotypic expression of HCM. The results of different functional studies suggest that in spite of the variety of the mutations, the initial defects in HCM is abnormal cardiac myocyte function. In this era of genetics and upcoming future of precision medicine, good knowledge of its molecular basis of any disease is crucial for patient management, and HCM is not different.</p> <p>Faridpur Med. Coll. J. Jan 2019;14(1): 44-49</p> Md Mohiuddin Masum Md Abdullah Al Sayeef Rayhan Shahrear Devjani Banik Gonopati Biswas Zinnat Ara Yesmin ##submission.copyrightStatement## 2020-03-26 2020-03-26 14 1 44 49 10.3329/fmcj.v14i1.46168 Kikuchi-Fujimoto Disease: A Case Report and Review of the Literature https://www.banglajol.info/index.php/FMCJ/article/view/46169 <p>Kikuchi-Fujimoto disease is a rare benign, condition of necrotizing histiocytic lymphadenitis. Presenting complaints of neck masses in association with non-specific systemic signs and symptoms prompt investigation towards the more common diagnoses. However, rarer conditions must still be considered especially when a patient's condition fails to abate. Herein I discuss a case of female patient who presented with a neck mass that was not attributable to the more common causes. A 28 year old lady presented with feverish feeling, weight loss and tender cervical lymph nodes. Initially tuberculous lymphadenitis was suspected but Kikuchi-Fujimoto disease was diagnosed after cervical lymph node biopsy. Symptomatic treatment was provided and an eventful full recovery was made.</p> <p>Faridpur Med. Coll. J. Jan 2019;14(1): 50-53</p> MM Bodiuzzaman ##submission.copyrightStatement## 2020-03-26 2020-03-26 14 1 50 53 10.3329/fmcj.v14i1.46169 OHVIRA Syndrome: A Case Report https://www.banglajol.info/index.php/FMCJ/article/view/46170 <p>OHVIRA syndrome or Herlyn-Werner-Wunderlich syndrome is a rare congenital anomaly of female urogenital tract which is represented by the triad of uterine didelphys, obstructed hemivagina and ipsilateral renal agenesis. This rare variant of Müllerian duct anomalies represent failure of vertical and the lateral fusion of Müllerian ducts around 9 weeks of gestation. OHVIRA syndrome comprises about 2-3% of Müllerian abnormalities. A 13 years old girl got admission in FMCH on 15.3.2018 with lower abdominal pain and acute retention of urine. Her menarche was established 6 months back with regular cycle and associated with dysmenorrhoea. Imaging studies revealed uterine didelphys, highly dilated cervix with hematocolpos and absence of right kidney. The vaginal septum was excised. The patient recovered fully and was under follow up for 6 months. There was no evidence of further outflow tract obstruction.</p> <p>Faridpur Med. Coll. J. Jan 2019;14(1): 54-56</p> Dilruba Zeba Fahmida Zesmin Rajib Roy ##submission.copyrightStatement## 2020-03-26 2020-03-26 14 1 54 56 10.3329/fmcj.v14i1.46170