IMC Journal of Medical Science The IMC Journal of Medical Science (IMCJMS) is a bi-annual publication of Ibrahim Medical College. IMCJMS was previously known as <a title="IMCJ" href="" target="_blank">Ibrahim Medical College Journal</a>, which was first launched in January 2007. The name of the Ibrahim Medical College Journal was changed to IMC Journal of Medical Science by the Editorial Board effective January 2016. All the previous issues of Ibrahim Medical College Journal are available in the journal's <a title="IMCJ archive" href="" target="_blank">Archive</a>.<p><a href="" rel="license"><img style="border-width: 0;" src="" alt="Creative Commons Licence" /></a><br />Articles in <strong>IMCJMS</strong> are licensed under a <a href="" rel="license">Creative Commons Attribution 4.0 International License</a> CC BY-4.0.This license permits use, distribution and reproduction in any medium, provided the original work is properly cited.</p><p>IMCJMS is included on <a title="DOAJ" href="" target="_blank">DOAJ</a> and <a title="JournalTOCs" href=";subAction=hits&amp;journalID=37926&amp;userQueryID=6734&amp;high=1&amp;ps=30&amp;page=1&amp;items=0&amp;journal_filter=&amp;journalby=" target="_blank">JournalTOCs</a>.</p> Ibrahim Medical College en-US IMC Journal of Medical Science 2519-1721 <p>Authors who publish in <strong>IMCJMS</strong> agree to the following terms that:</p><ol type="1" start="1"><li>Authors retain copyright and grant <strong>IMCJMS</strong> the right of first publication of the work.<br /><br /></li><li><a href="" rel="license"><img style="border-width: 0;" src="" alt="Creative Commons Licence" /></a><br />Articles in <strong>IMCJMS</strong> are licensed under a <a href="" rel="license">Creative Commons Attribution 4.0 International License</a> CC BY-4.0.This license permits use, distribution and reproduction in any medium, provided the original work is properly cited.</li><li>Authors are able to enter into separate, additional contractual arrangements for the distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</li><li>Authors are permitted to post their work online (e.g., in institutional repositories or on their website) as it can lead to productive exchanges, as well as greater citation of published work.</li></ol> Prevalence of helminthic infestations among Bangladeshi rural children and its trend since mid-seventies <p><strong>Background and objectives: </strong>Helminthic infestation is one of the commonest health problems in a developing country like Bangladesh. The objectives of the current study were to determine the prevalence of helminthic infestations, associated risk factors and its effects among the rural children in Bangladesh. The trend of helminthic infestation rate over time was also analyzed.</p> <p><strong>Methodology: </strong>A cross-sectional study was conducted among the rural primary school children of Sreepur Upazilla of Gazipur District. The area is located about 40 km north-east of capital Dhaka. A total of 593 students aged 5-13 years were enrolled from 5 primary schools. Out of 593 children, 204 agreed to provide fecal samples. A semi-structured questionnaire was used to collect data by face to face interview method and several anthropometric measurements along with clinical examinations were also carried out. Helminth ova were detected by direct microscopy of fecal smear and floatation concentration methods. Data were analyzed using the software IBM SPSS (Version 20).</p> <p><strong>Result: </strong>Out of 204, 80 (39.2%) children were infested with at least one species of helminth. Ascaris lumbricoides, Trichuris trichiura and mixed infection was 23%, 12.8% and 3.4% respectively. Overall prevalence of infection was higher among female students compared to male students (p&lt;0.05). Living in mud-floor and thatch walled houses were significantly (p&lt;0.05) associated with increased helminthic infestation. The risk behaviors commonly related to helminthic infestation revealed no difference between infected and non- infected groups of children. Height, weight, mid-upper arm circumference (MUAC), skin fold thickness, and waist and hip circumference of worm infested children were not significantly different from those without worm infestation.</p> <p><strong>Conclusion: </strong>The results reflect that the deworming program of Sreepur Upazilla was not fully successful. Poor socio-economic condition and lack of awareness of personal hygiene played an important role in prevalence of parasite infestation.</p> <p>IMC J Med Sci 2019; 13(1): 004</p> Sadya Afroz Smita Debsarma Subarna Dutta Mir Masudur Rhaman Masuda Mohsena ##submission.copyrightStatement## 2019-06-29 2019-06-29 13 1 004 004 10.3329/imcjms.v13i1.42038 Safety and feasibility of subarachnoid block in laparoscopic cholecystectomy <p><strong>Background and objectives</strong>: Laparoscopic surgery is normally performed under general anesthesia (GA), but regional techniques like epidural or subarachnoid block (SAB) have been found beneficial in patients having associated major medical problems. In selected cases, it can be a safe alternative to GA. Hence, the present study was conducted to explore the safety and feasibility of SAB in otherwise healthy individuals undergoing laparoscopic cholecystectomy.</p> <p><strong>Methods</strong>: Forty patients undergoing elective laparoscopic cholecystectomy and fulfilling specific inclusion criteria were included in the study. All patients received a segmental (L2-L3 injection) SAB with 3 ml (0.5%) of bupivacaine and 25 microgram of fentanyl. Laparoscopic cholecystectomy was done by standard 4 port technique. Intra-abdominal pressure was kept low at 9-10 mm Hg using CO<sub>2</sub> pneumoperitoneum. Patients were followed up at 30 minutes, 4 hours, at the time of discharge and on day 7 after operation. Any unwanted voluntary or involuntary movement or exaggerated diaphragmatic excursion during the operation was monitored. Operation time, operating room (OR) occupancy time, hospital stay, post-operative pain, analgesic requirement, nausea, vomiting, headache, right shoulder pain, wound-related complications and patient satisfaction were recorded.</p> <p><strong>Results</strong>: SAB was effective for surgery in all 40 patients. Two patients required conversion to general anesthesia for persisting low oxygen saturation. Hypotension was recorded in 23.7% patients while 10.5% experienced right shoulder pain. Average operating time was 37.3 minutes (21 - 77 minutes). Awkward movement and exaggerated respiratory excursion was noted in 23.7% and 18.4% cases respectively. Only two cases had to undergo (conversion to) GA. Mean period of hospital stay was 29.3 hours. No incidence of any major complication occurred.</p> <p><strong>Conclusion</strong>: This study showed that SAB could be used successfully and effectively for laparoscopic cholecystectomy in healthy patients and may be a safe alternative to GA.</p> <p>IMC J Med Sci 2019; 13(1): 006</p> Mahmud Ekram Ullah Md Mushfiqur Rahman Rajibul Haque Talukder Refat Uddin Tareq Md Noor A Alam ##submission.copyrightStatement## 2019-06-29 2019-06-29 13 1 006 006 10.3329/imcjms.v13i1.42039 Respiratory and other illnesses among the jute-mill workers in an industrial unit of Bangladesh <p><strong>Background and aims: </strong>Bangladesh produces 33% of the world’s jute and about 40 million people in Bangladesh are directly or indirectly involved in the jute sector. The jute (organic) dust inhalation causes byssinosis and other respiratory illnesses. However, no study has yet addressed the health status of the jute handlers/workers in Bangladesh. This study aimed to determine the prevalence of respiratory illnesses among the Jute Mill Workers (JMWs). Additionally, this study tried to find out the overall health status of the JMWs which included presence of non-communicable diseases (NCD) and its related risk, which are usually ignored.</p> <p><strong>Study design: </strong>A cross-sectional study conducted in a purposively selected jute mill - 40km off from Dhaka City. Of the 5500 workers, a list of 600 workers was provided by the mill authority for enrollment in the study. The investigations included – a) interviewing on socio-demography and clinical history; b) anthropometry (height, weight, waist- and hip-circumference); c) blood pressure measurement; d) estimation of fasting blood glucose and lipids; e) peak flow meter test; f) spirometry; g) high resolution computerized tomography (HRCT) and electrocardiography.</p> <p><strong>Results: </strong>Of the enlisted 600 jute mill workers, 514 (men / women = 478 / 36) took part in the study. The response rate was 85%. For overall estimate of bio-physical characteristics (n = 514), the means (95% confidence interval) of age, body mass index (BMI), waist-hip ratio (WHR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 44.19 (43.34 – 45.04) years, 24.44 (24.16 – 24.73), 0.90 (0.90 – 0.91), 118.9 (117.4 – 120.4), 79.69 (78.81 – 8/0.54), respectively. Regarding social class and education, 84.4% were from non-affluent (poor) class and 50% were illiterate. About 88% of the JMWs had been working for ≥42 hours a week and 91.6% were exposed to moderate or heavy work (equivalent to ≥60 min walk). The prevalence of breathlessness, tightness of chest and chronic cough were 16.5%, 25.7% and 16.3%, respectively. The restrictive and obstructive pulmonary functions were detected in 7.0% and 0.8% of study population respectively. The prevalence of systolic hypertension was 16.5%, diastolic hypertension was 7.2% and diabetes (IFG+DM) was 13.3%. They had increased cardiovascular risks – hypertriglyceridemia (23.9%) and hypercholesterolemia (24.3%).</p> <p><strong>Conclusions: </strong>JMWs have been suffering mostly from respiratory illnesses and a substantial number of them suffer from undiagnosed hypertension, diabetes and other non-communicable diseases. Dyslipidemia was also prevalent as a potential risk factor. The study could not assess ocular, auditory, musculoskeletal and mental health and it suggests that a well designed study should address these health related problems of JMWs.</p> <p>IMC J Med Sci 2019; 13(1): 007</p> Mir Masudur Rhaman M Abu Hana Golam Morshed M Abu Sayeed ##submission.copyrightStatement## 2019-06-29 2019-06-29 13 1 007 007 10.3329/imcjms.v13i1.42040 Management of non-absorbable mesh infection after hernia repair by negative pressure wound therapy <p><strong>Background and objectives: </strong>Mesh infection following hernia repair has previously often resulted in removal of mesh. The aim of this study was to evaluate if negative pressure wound therapy (NPWT) can be used to treat such complications and preserve the mesh.</p> <p><strong>Materials and method: </strong>A prospective study was carried in the Department of Surgery, BIRDEM General Hospital from January 2017 to January 2019. Patients with deep wound infection and exposed infected mesh after hernioplasty were included in the study. Patients’ demographics, existing comorbidities and outcome were recorded. All patients were treated with NPWT till the wound was covered with healthy granulation tissue and closed.</p> <p><strong>Results: </strong>NPWT was used to treat 7 patients with mesh infection following hernia repair. There was 2 male and 5 female cases and age ranged from 38-58 years. With NPWT the mesh in 6 patients (86%) out of 7 could be completely salvaged and wound closed with secondary suturing. However, in 1 patient although the mesh covered with granulation tissue by NPWT and wound was closed; but it had to be partly removed later on due to development of chronic discharging sinus 20 days after stitch removal.</p> <p><strong>Conclusion: </strong>The study demonstrated that NPWT was a useful technique for the treatment and preservation of infected mesh after hernia repair.</p> <p>IMC J Med Sci 2019; 13(1): 008</p> Amreen Faruq HM Sabbir Raihan Muhtarima Haque ##submission.copyrightStatement## 2019-06-29 2019-06-29 13 1 008 008 10.3329/imcjms.v13i1.42041 A rare case of isolated tuberculous epididymitis in a young man <p>Genitourinary tuberculosis is the second most common extrapulmonary tuberculosis (ETB), after lymph nodes. Isolated tuberculous epididymitis (ITE) is a rare entity among genitourinary tuberculosis and is defined as epididymitis without clinical evidence of either renal or prostate involvement. We present a case of epididymal tuberculosis in a 26 year old male which presented as a right scrotal mass. We discussed this case to emphasize that tuberculous etiology should also be considered in the differential diagnosis of scrotal mass besides malignancy, and an image guided fine needle aspiration cytology (FNAC) and stain for acid fast bacilli (AFB) play crucial role in diagnosis and treatment.</p> <p>IMC J Med Sci 2019; 13(1): 003</p> Majed Basit Momin Sandeep Satyanarayana Anamika Aluri ##submission.copyrightStatement## 2019-06-29 2019-06-29 13 1 003 003 10.3329/imcjms.v13i1.42047 Brown Adipose Tissue - role in metabolic disorders <p>Brown adipose tissue, a thermogenic organ, previously thought to be present in only small mammals and children has recently been identified in adult humans. Located primarily in the supraclavicular and cervical area, it produces heat by uncoupling oxidative phosphorylation due to the unique presence of uncoupling protein 1 by a process called nonshivering thermogenesis. BAT activity depends on many factors including age, sex, adiposity and outdoor temperature. Positron-emission tomography using 18F-fluorodeoxyglucose and computed tomography (18F-FDG PET–CT), magnetic resonance imaging (MRI) and thermal imaging (IRT) are among several methods used to detect BAT in humans. The importance of BAT is due to its role in whole body energy expenditure and fuel metabolism. Thus it is postulated that it may be useful in the treatment of metabolic diseases. However, there are still many unanswered questions to the clinical usefulness of this novel tissue.</p> <p>IMC J Med Sci 2019; 13(1): 002</p> Tahniyah Haq Frank Joseph Ong Sarah Kanji ##submission.copyrightStatement## 2019-06-29 2019-06-29 13 1 002 002 10.3329/imcjms.v13i1.42049 A systematic review of implicit bias in health care: A call for intersectionality <p><strong>Background and objectives: </strong>Health disparities are a growing concern in health care. Research provides ample evidence of bias in patient care and mistrust between patient and providers in ways that could perpetuate health care disparities. This study aimed to review existing literature on implicit bias (or unconscious bias) in healthcare settings and determine studies that have considered adverse effects of bias of more than one domain of social identity (e.g., race and gender bias) in health care.</p> <p><strong>Methods: </strong>This is a systematic review of articles using databases such as EBSCO, Embase, CINAHL, COCHRANE, Google Scholar, PsychINFO, Pub Med, and Web of Science. Search terms included implicit bias, unconscious bias, healthcare, and public health. The inclusion criteria included studies that assessed implicit bias in a healthcare setting, written in English, and published from 1997-2018.</p> <p><strong>Results</strong><strong>: </strong>Thirty-five articles met the selection criteria – 15 of which examined race implicit bias, ten examined weight bias, four assessed race and social class, two examined sexual orientation, two focused on mental illness, one measured race and sexual orientation, and another investigated age bias.</p> <p><strong>Conclusions</strong><strong>: </strong>Studies that measured more than one domain of social identity of an individual did so separately without investigating how the domains overlapped. Implicit Association Test (IAT) is a widely used psychological test which is used to determine existence of an implicit bias in an individual. However, this study did not find any use of an instrument that could assess implicit bias toward multiple domains of social identities. Because of possible multiplicative effects of several biases affecting a single entity, this study suggests the importance of developing a tool in measuring intersectionality of biases.</p> <p>IMC J Med Sci 2019; 13(1): 005</p> Oluwabunmi Ogungbe Amal K Mitra Joni K Roberts ##submission.copyrightStatement## 2019-06-29 2019-06-29 13 1 005 005 10.3329/imcjms.v13i1.42050 Spontaneous hypoglycemia: a review <p>Spontaneous hypoglycemia is an important entity that may affect multiple organs. The differential diagnosis is broad in individuals with hypoglycemia in the absence of diabetes mellitus. Multiple etiologies may be present concurrently. Drugs, critical illnesses, hormone deficiencies, and non-islet cell tumors should be considered in those who are ill or taking medications. In apparently healthy individuals, endogenous hyperinsulinism due to insulinoma, functional β-cell disorders, or insulin autoimmune conditions are possible, as are accidental, surreptitious or factitious causes of hypoglycemia. Investigations should be guided by clinical scenario. Irrespective of the exact cause of the spontaneous hypoglycemia, treatment consists of correcting the glycemic state and preventing recurrence by alleviating underlying pathology. This review discusses the causes, diagnosis and management of spontaneous hypoglycemia.</p> <p>IMC J Med Sci 2019; 13(1): 001</p> Sultana Marufa Shefin Nazmul Kabir Qureshi Ahmed Salam Mir Ahasnul Haq Amin Tareen Ahmed Faria Afsana Md Shah Alam Farhana Akter Md Shah Emran Tanjina Hossain Md Shahjamal Khan Marufa Mustari Nusrat Sultana Mohammad Saifuddin Sadiqa Tuqan Shahjada Selim Samir Kumar Talukder Rafiq Uddin Md Feroz Amin ##submission.copyrightStatement## 2019-06-29 2019-06-29 13 1 001 001 10.3329/imcjms.v13i1.42048