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> Listerial contamination of raw beef and chevon in north-central Nigeria <p><strong>Background and objective</strong>: Listeria sp. is a ubiquitous and frequently isolated foodborne pathogen. The prevalence of Listeria sp in raw beef and chevon sold in Lafia Nigeria, as well as their antibiotic susceptibility profile was evaluated.</p> <p><strong>Methods</strong>: A total 104 samples comprising of 52 raw beef and 52 chevon were obtained from street vendors (hawkers), Shinge abattoir, Lafia old market and Lafia Modern Market. Isolation of Listeria sp. was performed on Listeria Selective Agar, following enrichment in supplemented Listeria Selective Broth. Identification of Listeria sp. was carried out by cultural and biochemical methods. Antimicrobial susceptibility of isolated L. monocytogenes was performed by standard disk diffusion method. Chi-square test was used to determine association between contamination levels at p=0.05.</p> <p><strong>Results</strong>: Seven types of Listeria sp. were isolated. L. monocytogenes and L. ivanovii were the most frequently isolated contaminants in all meat types and from all sample sources. L. monocytogenes was isolated with a frequency of 64.4% (67/104) in the meat samples. Beef samples had the highest listerial contamination with a frequency of 58.2% (78/134) compared to chevon which had a listerial frequency of 41.8% (56/134). Resistance of L. monocytogenes to streptomycin and sparfloxacin was 58.2% and 55.2% respectively. Resistance to ampicillin (34.3%) and gentamicin (20.9%) was also observed. Resistances to multiple antimicrobials were detected in 11 L. monocytogenes isolates.</p> <p><strong>Conclusion</strong>: The study demonstrated that the raw meat sold in Lafia was contaminated with several Listeria sp. L. monocytogenes showed high rate of resistance to several antimicrobial agents used for the treatment of listerial infection. Appropriate regulation and monitoring of livestock rearing and meat retailing practices are advocated to safeguard the health of consumers.</p> <p>Ibrahim Med. Coll. J. 2019; 13(2): 1-8</p> Aleruchi Chuku Godwin Attah Obande Sani Bashir Eya ##submission.copyrightStatement## 2020-02-03 2020-02-03 13 2 1 8 10.3329/imcjms.v13i2.45274 Prevalence of hypothyroidism in different occupational groups of Bangladeshi population <p><strong>Background and aims</strong>: Hypothyroidism is a common global endocrine disorder. The magnitude of hypothyroidism at community level in Bangladesh is unknown except some clinic-based studies. The present study was undertaken to determine the prevalence of hypothyroidism in different occupational groups of Bangladeshi population and to assess the risks related to it.</p> <p><strong>Study design</strong>: Three occupational groups (house-wives, college students, rickshaw-pullers) of native Bangladeshi population were purposively selected. Investigations included socio-demography, anthropometry, blood pressure and biochemistry [fasting blood glucose, lipids, thyroid stimulating hormone (TSH) and free thyroxin (FT4)]. Laboratory tests were done only on a randomized sample of participants.</p> <p><strong>Results</strong>: Overall, 626 (M/F=123 / 503) participants with a mean age of 35.9 (34.75 – 37.02) years volunteered. The mean values of all participant for TSH and FT4 were 2.08 (95%CI: 1.72 – 2.45) μiu/ml and 13.04 (95CI:12.86 – 13.22) pmol/L respectively. The third percentile of TSH ranged from 0.42 to 0.46 μiu/ml and 97th percentile ranged from 5.16 to 5.24 μiu/ml. For FT4, the 3rd and the 97th percentile were 10.3 and 16.41 pmol/L, respectively. The prevalence of hypothyroidism in both sexes was 7.0% (M/F=4.1/8.3%). Occupational groups, sex and increasing age, obesity, blood pressure, and lipids showed no association with hypothyroidism. Hyperglycemia was proved to be a significant risk for hypothyroidism (prevalence in diabetic vs. non-diabetic was12.9% vs. 5.5%, p = 0.04; FBG was correlated with TSH, r = 0.138, p &lt;0.001).</p> <p><strong>Conclusions: </strong>It is concluded that the prevalence of hypothyroidism was almost equal to other studies. Hypothyroidism was not related to increasing age, obesity, blood pressure and lipids. It was found to affect all sexes, all social classes and all occupational groups. Hyperglycemia was evidently found as significant risk for hypothyroidism.</p> <p>Ibrahim Med. Coll. J. 2019; 13(2): 9-17</p> MA Sayeed Masuda Mohsena Tahniyah Haq AHG Morshed Sadya Afroz Nehlin Tomalika Hasina Momtaz M Mostafizur Rahaman ##submission.copyrightStatement## 2020-02-03 2020-02-03 13 2 9 17 10.3329/imcjms.v13i2.45275 Detection of Candida auris and its antifungal susceptibility: first report from Bangladesh <p><strong>Background and objectives: </strong>Candida auris is an emerging multidrug-resistant fungal pathogen that has been associated with nosocomial infections with a high mortality. The organism has been reported from several countries of the world except Bangladesh. The present study describes the presence of C. auris in clinical samples obtained from a large hospital of Dhaka city, Bangladesh.</p> <p><strong>Materials and methods: </strong>The A total of 100 Candida species isolated from different clinical samples were purposively included in the present study. Samples were obtained from patients attending a 750 bed hospital of Dhaka city. C. auris was identified by growth characteristics, biochemical and carbohydrate assimilation test and further confirmed by polymerase chain reaction and sequencing using ITS1 and ITS2 targeting the conserved regions of 5.8S rRNA. Antifungal susceptibility of identified C. auris was performed by disk diffusion and minimum inhibitory concentration (MIC) methods.</p> <p><strong>Results: </strong>Out of 100 Candida sp. tested, 21 isolates were identified as C. auris. Of the 21 C. auris, 14 (66.7%) were isolated from blood samples and the remaining 7 (33.4%) were from urine. Most of the C. auris isolated were from patients admitted in intensive care units. Out of 21 C. auris, 17 (81.0%), 7 (33.3%) and 3 (14.3%) were sensitive to amphotericin B, fluconazole and voriconazole respectively by disk diffusion method. Out of 14 fluconazole resistant isolates, 5 were susceptible dose-dependent (SS-D) by MIC method.</p> <p><strong>Conclusion: </strong>The present study is the first report demonstrating the presence of C. auris in clinical samples obtained from a large hospital of Bangladesh. Majority of isolates showed resistance to fluconazole and variable susceptibility to other antifungal agents. Further study is suggested to find its true magnitude and its susceptibility pattern to a range of antifungal agents.</p> <p>Ibrahim Med. Coll. J. 2019; 13(2): 18-22</p> Subarna Dutta Md Hasibur Rahman Kazi Shakhawath Hossain Jalaluddin Ashraful Haq ##submission.copyrightStatement## 2020-02-03 2020-02-03 13 2 18 22 10.3329/imcjms.v13i2.45276 Effect of metformin on blood lipids in patients with diabetes mellitus <p><strong>Background and objectives</strong>: Metformin improves macrovascular complications in people with diabetes mellitus (DM). Although the exact mechanism is not known, metformin has beneficial effects on dyslipidaemia. The aim of the study was to find out if there was an effect of metformin on blood lipids in people with diabetes mellitus.</p> <p><strong>Method</strong>: This was a cross-sectional study which included 80 patients with diabetes mellitus. They were divided into 2 groups – (a) Group 1: on metformin and (b) Group 2: without metformin medication. None of the patients were on any other anti-diabetic medication. All data were obtained from patients’ medical records. Individual blood lipids and lipid ratios were compared between two groups.</p> <p><strong>Result</strong>: Group 1 included 42 patients with a mean HbA1c of 7.58 ± 0.24% taking an average dose of 820.83 ± 60.40 mg/day of metformin. Group 2 consisted of 38 patients with mean HbA1c of 7.58 ± 0.29%. There was no significant difference in individual plasma lipid levels, lipoprotein ratio or frequency of dyslipidaemia between patients taking and not taking metformin (p&gt;0.05). Also, different doses of metformin had no significant effect on the plasma lipid levels.</p> <p><strong>Conclusion</strong>: Metformin did not affect the lipid profile of patients with diabetes mellitus.</p> <p>Ibrahim Med. Coll. J. 2019; 13(2): 23-27</p> Tahniyah Haq Sabah Haq ##submission.copyrightStatement## 2020-02-03 2020-02-03 13 2 23 27 10.3329/imcjms.v13i2.45277 Polymorphonuclear neutrophil response to Burkholderia pseudomallei in patients with diabetes mellitus <p><strong>Background and objectives</strong>: Burkholderia pseudomallei is the causative agent of melioidosis, a potentially fatal disease endemic in Bangladesh. Diabetes mellitus (DM) is a risk factor for increased susceptibility to B. pseudomallei infection. A few studies have been conducted to identify the underlying immunological mechanism responsible for increased susceptibility of individuals with diabetes mellitus to B. pseudomallei infection. The present study investigated the polymorphonuclear neutrophil (PMN) response to B. pseudomallei in terms of phagocytosis and early respiratory burst in individuals with diabetes mellitus.</p> <p><strong>Materials and Methods</strong>: A total of 5 cases of DM and 5 age and sex matched non-diabetic healthy individuals were enrolled in the study to determine the early respiratory burst and phagocytic ability of PMN to B. pseudomallei. The effect of B. pseudomallei on phagocytic ability and early respiratory burst of PMN was determined by phagocytic assay and nitroblue tetrazolium (NBT) test respectively. The response of PMN treated with B. pseudomallei was compared with that of Escherichia coli.</p> <p><strong>Results</strong>: There was no significant (p&gt;0.05) difference in phagocytosis of B. pseudomallei by PMN between diabetic and non-diabetic cases (21.8±4.64 percent vs 29.25±5.5 percent). But in both diabetic and non-diabetic cases, significantly (p˂0.05 and p˂0.01) reduced rate of phagocytosis of B. pseudomallei by PMN was observed compared to E. coli (21.8±4.64 vs 65±5.36; 29.25±5.5 vs 71.25±5.59). Similar results were obtained in terms of phagocytic index. Mean percentage of formazan positive PMN from diabetic cases was not significantly different (p&gt;0.05) from non-diabetic healthy cases when cells were treated with B. pseudomallei or E. coli. In both diabetic and healthy individuals, mean percentage of formazan positive PMN treated by B. pseudomallei was not significantly different from that by E. coli.</p> <p><strong>Conclusion</strong>: The observations revealed that B. pseudomallei was equally capable of inhibiting the phagocytic ability of PMN from both diabetic and non-diabetic individuals. This anti-phagocytic property might play an important role in the pathogenesis of melioidosis.</p> <p>Ibrahim Med. Coll. J. 2019; 13(2): 28-34</p> Sraboni Mazumder Lovely Barai Md Shariful Alam Jilani KM Shahidul Islam Jalaluddin Ashraful Haq ##submission.copyrightStatement## 2020-02-03 2020-02-03 13 2 28 34 10.3329/imcjms.v13i2.45278 Vitamin D status of healthy coastal fishermen of Bangladesh <p><strong>Background and objectives</strong>: Vitamin D deficiency is now a global concern. Industrialization, urbanization and the decreasing participation in outdoor activities, with consequent sunlight deprivation, are thought to be the key factors in the increasing prevalence of vitamin D deficiency among general population of many countries. It is presumed that healthy, adequately sun-exposed people should maintain adequate vitamin D levels. However, studies within this population are scarce. Hence, this study was conducted to find out the actual vitamin D status in healthy, adequately sun-exposed population living in coastal district of Bangladesh.</p> <p><strong>Material and Methods</strong>: One hundred and forty healthy fishermen living in costal district of Cox’s Bazar (210 25' North, 910 59' East) of Bangladesh were enrolled in this study. Relevant data and blood samples were collected during August 2018, one of the months with lower zenith angle and higher UV index. Chemiluminescent micro-particle immunoassay (CMIA) was used to measure 25-hydroxy vitamin D3. Other relevant biochemical parameters measured were random blood glucose (RBG), serum creatinine, albumin, calcium, phosphate, alkaline phosphatase and intact parathyroid hormone (iPTH).</p> <p><strong>Results</strong>: Mean vitamin D level of the study population was 27.04±7.20 ng/ml. Based on the cut off value of Endocrine Society, 70.7% of the study population had low vitamin D levels of which 26 (18.6%) and 73 (52.1%) were in vitamin D deficient (&lt;20ng/ml) and insufficient (20 – 29.99 ng/ml) categories respectively. Vitamin D level was normal in 41 (29.3%) subjects. There was no significant difference in iPTH level between groups with low and normal vitamin D levels (p&gt;.05, 95%CI= -5.68226, 1.21086).</p> <p><strong>Conclusion</strong>: The unexpectedly high prevalence of vitamin D deficiency in this healthy and adequately sun-exposed population raises the question regarding the validity of the current cutoff value being used to assess the vitamin D status of Bangladeshi population. Future studies should be carried out to determine nation-specific, local cutoff values for vitamin D sufficiency.</p> <p>Ibrahim Med. Coll. J. 2019; 13(2): 35-39</p> Wasim Md Mohosin Ul Haque Md Faruque Pathan MA Sayeed ##submission.copyrightStatement## 2020-02-03 2020-02-03 13 2 35 39 10.3329/imcjms.v13i2.45279 Risk factors for peripheral neuropathy in patients with diabetes mellitus <p><strong>Background and Objectives</strong>: Peripheral neuropathy is a complication of diabetes mellitus (DM). Several risk factors may accelerate the development of peripheral neuropathy in DM. The objective of the current study was to determine the risk factors for development of peripheral neuropathy in patients with DM.</p> <p><strong>Methods</strong>: The study was conducted from July 2014 to June 2015 in a large hospital of Dhaka city. A total of 150 diabetic patients of both sexes with and without peripheral neuropathy were enrolled. The investigations included interviewing on clinical history, anthropometry (height, weight, waist- and hip-circumference), blood pressure measurement, estimation of HbA1c, fasting blood glucose and lipids.</p> <p><strong>Results</strong>: Duration of diabetes for more than 5 years was significantly (χ2=124.39, p &lt;0.001) associated with peripheral neuropathy. Sequential logistic regression analysis revealed high BMI (&gt; 25 Kg/m2; OR=8.8, p &lt;0.001), HbA1c (&gt;6.5%; OR=5.25, p&lt;0.05) and higher total cholesterol level (&gt; 200 mg/dl; OR=4.74, p &lt;0.05) as the significant risk factors for peripheral neuropathy.</p> <p><strong>Conclusion</strong>: Obesity, hyperglycemia and high total cholesterol were possible risk factors for development of diabetic peripheral neuropathy. Proper glycemic control and prevention of obesity and dyslipidemia could be helpful to avert progression to peripheral neuropathy in diabetic population.</p> <p>Ibrahim Med. Coll. J. 2019; 13(2): 40-44</p> Taslima Akter Qazi Shamima Akhter Zinat Ara Polly Smita Debsarma ##submission.copyrightStatement## 2020-02-03 2020-02-03 13 2 40 44 10.3329/imcjms.v13i2.45285 Levocarnitine in the management of fatigue in levothyroxine treated hypothyroid patients <p><strong>Background and objectives: </strong>Hypothyroid patients often complain of fatigue even after effective treatment. Thyroid hormone plays an important role in carnitine-dependent long chain fatty acid transport for oxidation and ultimate formation of ATP. Deficiency of L-carnitine has been presumed to disrupt ATP formation leading to fatigue. Present study was designed to assess the role of L-carnitine as a supplement to manage the fatigue state of hypothyroid patients.</p> <p><strong>Methods: </strong>Hypothyroid patients receiving levothyroxine (L-T4) and suffering from fatigue symptoms were enrolled. Patients were randomly divided into Group A (Control group, n=35) and Group B (Experimental group, n=36). Patients of Group A were treated with L-T4 only and Group B patients received L-carnitine 2 g/day in addition to L-T4 therapy for 8 weeks. Fatigue was assessed by fatigue severity scale (FSS), physical fatigue (PF) and mental fatigue (MF) scores. Data regarding fatigue status, serum thyroid stimulating hormone (TSH) and free thyroxine (FT4) were collected at the beginning and after 8 weeks of intervention.</p> <p><strong>Result: </strong>The mean age of Group A and Group B patients was 33.5±8.1 and 35.4±7.5 years respectively (p&gt;0.05); and the mean body weight was 61.5±9.6 kg and 62.5±8.2 kg respectively (p&gt;0.05). The mean baseline values of different fatigue scores and the serum TSH and FT4 levels of patients of two groups were identical and not significantly different (p&gt;0.05). In Group-A patients, the mean MF score improved significantly (5.2±1.5 vs 4.6±1.4; p=0.01) from baseline score after 8 weeks while the FSS and PF scores did not improve significantly (p&gt;0.05). In Group-B patients, the mean FSS, PF and MF scores improved significantly (p&lt;0.01) from baseline score after 8 weeks of treatment with L-carnitine along with L-LT4 treatment. FSS, PF and MF scores of Group-B patients reduced significantly (p&lt;0.01) compared to Group-A patients after 8 weeks of treatment. FSS, PF and MF scores improved in 88.9%, 77.8% and 47.2% cases respectively in Group-B compared to 20%, 14.3% and 5.7% cases in Group-A. L-carnitine was well tolerated and no severe adverse event was recorded.</p> <p><strong>Conclusion: </strong>The results suggest that, administration of L-carnitine along with L-T4 in hypothyroid patients significantly reduced physical and mental fatigue.</p> <p>Ibrahim Med. Coll. J. 2019; 13(2): 45-52</p> Farjana Akhter Zesmin Fauzia Dewan MA Hasnat Selina Akhter ##submission.copyrightStatement## 2020-02-03 2020-02-03 13 2 45 52 10.3329/imcjms.v13i2.45286 Postnatal care services and factors affecting its utilization in slum areas of Dhaka city <p><strong>Background and objectives</strong>: Maternal as well as infant mortality is high in Bangladesh. Utilization of post natal care (PNC) services is important to reduce maternal and infant mortality. Considering this matter, this study attempted to find out the level of PNC utilization by women living in slum areas of Dhaka city as well as to identify the factors associated with the utilization of PNC services.</p> <p><strong>Methods</strong>: This study was conducted in Khilgaon and Rampura slums of Dhaka city. In each slum, women aged between 15-49 years who had given birth to at least one child were enrolled in the study by random sampling technique. Participants were interviewed with a semi-structured questionnaire which included information on socio-economic, demographic, cultural status as well as information on PNC service utilization.</p> <p><strong>Results</strong>: Out of total 360 enrolled women in both slums, 58.6% utilized PNC services. The rate of utilization of PNC services was 55% and 62.2% in Khilgaon and Rampura slum respectively. Compared to 40-49 years age group, significantly (p&lt;0.01) higher percentage of women aged &lt;20, 20-29 and 30-39 years utilized PNC services (69.6%, 67.0% and 56.4% respectively). The significant associates of receiver of PNC were respondent’s education, number of antenatal care (ANC) received, level of tetanus vaccination, place of delivery, distance between home and clinic, mass media exposure, male participation and autonomy.</p> <p><strong>Conclusion</strong>: Local socioeconomic and cultural aspects should be considered while planning intervention program to improve the utilization of PNC service.</p> <p>Ibrahim Med. Coll. J. 2019; 13(2): 53-58</p> Nilufar Yeasmin Nili ##submission.copyrightStatement## 2020-02-03 2020-02-03 13 2 53 58 10.3329/imcjms.v13i2.45287 Radiographic evaluation of the quality of root canal treatment in a Bangladeshi population <p><strong>Background and objective</strong>: Root canal treatment (RCT) has a high rate of success, when performed by properly trained dental surgeons. However, the failure rate is inappreciably high when the same procedure is done by less experienced dental graduates having no specialization on endodontics. This study was conducted to evaluate the technical quality of RCT performed by practicing dental graduates on Bangladeshi patient.</p> <p><strong>Methods</strong>: This cross-sectional study was conducted in the Department of Dentistry of BIRDEM General Hospital Dhaka over a period of 6 months from January to June 2019. Radiographs of patients who had undergone RCT in last 6 months were included in the study. Parameters used to evaluate the obturation of the root canal were presence of root-filled, posts and voids. The RCT was assessed for filling at the end of the root with radiographic apex, the density of the filling material and taper from the orifice to apex. The quality of RCT was evaluated as totally unacceptable (score: 0-2), poorly acceptable (score: 3-4), acceptable (score: 5) and perfect (score: 6) based on the treatment score. Post-treatment complications were determined by furcation and cavity wall perforation, transportation, root perforation, instrument breakage, ledge formation, voids and missed canal.</p> <p><strong>Result</strong>: A total of 180 postoperative readable radiographs with post root-canal treatment were evaluated. Evaluation of the technical quality of RCT revealed that 56% of the RCTs were of standard quality (41.7% were of perfect quality and 14.4% were of acceptable quality). The rest 23.3% were poorly acceptable and 20.6% were totally unacceptable. Majority (92.8%) of the obturation of the root canal revealed that roots were filled with sealing materials; however, 8.9% exhibited posts and 36.7% demonstrated voids. A sizable portion of the root canal obturation was unacceptable in terms of its length (12.2%), density (20%) and tapering (16.7%). Total 132 (73.3%) teeth developed at least one complication. Under filling and voids were predominant complications (42.8% and 41.1% respectively) followed by root perforation (12.2%), transportation (11.7%), ledge formation (5%), instrument breakage (2.8%) and missed canal (3.3%).</p> <p><strong>Conclusion</strong>: The study concluded that over forty percent of the RCTs performed by dental graduates having no specialization on endodontics are of substandard quality and hence not acceptable.</p> <p>Ibrahim Med. Coll. J. 2019; 13(2): 59-64</p> Rafia Nazneen Rajesh Karmaker Gulnar Begum Nurul Amin ##submission.copyrightStatement## 2020-02-03 2020-02-03 13 2 59 64 10.3329/imcjms.v13i2.45288