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> en-US <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> (Md. Abu Sayeed) (Md Fahmid Uddin Khondoker) Wed, 10 Jun 2020 00:25:47 +0000 OJS 60 Response to short course androgenisation in late reported cases with micropenis <p><strong>Background and objectives</strong>: Micropenis is an abnormally short penis and its treatment should begin in infancy or in very early childhood. The present study investigated the response of short term testosterone therapy in late reported cases of micropenis.</p> <p><strong>Methods</strong>: A total of 17 cases of micropenis between the age of 8 and 15 years were included in the study. Standard criteria for the diagnosis of micropenis were followed. All cases were treated with intramuscular testosterone 50 to 75 mg once every 21 days. Response to testosterone treatment was measured by the absolute and percent increment in stretched penile length (SPL). Response was considered adequate if final SPL crosses the average SPL for age. We also compared the response of treatment of cases reported before and after 11 years of age.</p> <p><strong>Result</strong>: A total of 17 micropenis cases were included in the study. Out of total 17 boys, 10 were between 8 to 11 years (Group 1) and 7 were between 12 to 15 years (Group 2) of age. The mean pre-treatment SPL of 17 micropenis cases was 3.1±0.2 cm (CI: 2.83, 3.43 cm). The mean initial SPL of Gr1 and Gr2 was not significantly different (3.2±0.3 cm vs 3.0±0.1 cm; p&gt;0.248). The mean post treatment SPL of 17 cases increased significantly (p&lt;0.001) compared to their initial SPL. The range of percentage increment in SPL was 100%-400%. Higher testosterone doses were required in Gr2 cases compared to Gr1 (360±20.8 mg vs 260.7±38.5 mg).</p> <p><strong>Conclusion</strong>: Micropenis in boys with palpable gonads responded to short term testosterone treatment in late reported cases and we termed these cases as simple micropenis.</p> <p>Ibrahim Med. Coll. J. 2020; 14(1): 1-4</p> Mahmudul Huque, Tania Tofail, Tofail Ahmed ##submission.copyrightStatement## Fri, 05 Jun 2020 09:52:26 +0000 Association of visceral adiposity index with insulin resistance in adults with diabetes mellitus <p><strong><em>Background and objectives</em></strong>: Visceral adiposity is linked to excess morbidity and mortality and positively correlates with the risk of insulin resistance, type-2 diabetes mellitus, cardiovascular disease and premature death. The study was conducted to find out the relationship between visceral adiposity index (VAI) and homeostatic model assessment insulin resistance (HOMA-IR) in diabetes mellitus (DM).</p> <p><strong><em>Materials and methods</em></strong>: This cross sectional study was carried out on adult population with and without DM. Waist circumference (WC) and body mass index (BMI) were measured. BMI of 25-29.9 kg/m2 and ≥30 kg/m2 was defined as overweight and obese respectively. HOMA-IR method was used to calculate insulin resistance (IR). Standard formula using BMI, WC, triglyceride (TG) and high density lipoprotein cholesterol (HDL-c) was used to calculate VAI. Blood was analyzed for fasting blood glucose (FBS), TG, HDL-c and insulin level.</p> <p><strong><em>Results</em></strong>: A total of 439 individuals were included in the study of which 269 had DM and 170 were healthy volunteers and the mean age was 41.47±6.82 and 36.16±7.44 years respectively. Compared to healthy controls, a greater number of diabetics had high VAI (86.5% vs. 98.9%) and high IR (43.5% vs. 85.1%). We found the highest sensitivity and specificity at a cut-off of 2.23 of VAI while at 3.65 had the highest specificity. Insulin resistance was observed significantly higher in those with diabetes compared to control, both in case of normal and high VAI at all cut-offs of VAI. Among anthropometric parameters (WC, BMI and VAI), VAI had positive (r=0.21, p&lt;0.001) correlation with HOMA-IR than WC (r=0.10, p=0.043). Visceral fat was linearly related with insulin resistance (ß=0.18, p&lt;0.001). Area under the curve (AUC) (0.66) showed that VAI can discriminate HOMA-IR.</p> <p><strong><em>Conclusion</em></strong>: There was a high rate of raised VAI in cases with DM. VAI had positive association with HOMA-IR in diabetes mellitus. Although weak, there was an acceptable discrimination between them.</p> <p>Ibrahim Med. Coll. J. 2020; 14(1): 5-12</p> Sultana Parveen, Tohfa E Ayub, Tahniyah Haq, Nazmun Nahar, Naureen Manbub, Fahmida Islam, Farjana Aktar, Murshida Aziz ##submission.copyrightStatement## Fri, 05 Jun 2020 16:39:32 +0000 Lipid profile in an urban healthy adult Bangladeshi population <p><strong><em>Background and objectives</em></strong>: The prevalence of ischemic heart disease (IHD) has increased in most of the developing countries, including Bangladesh. An important marker of IHD is dyslipidemia which includes high levels of triglyceride (TG), total cholesterol (T-cholesterol), low density lipoprotein cholesterol (LDL-c) and low level of high density lipoprotein cholesterol (HDL-c). So it is very important to know the lipid levels of a particular population for early intervention and prevention of IHD. The present study investigated the lipid levels of healthy urban adult Bangladeshi population.</p> <p><strong><em>Methods</em></strong>: The cross sectional study was carried out over a period of one year at the Department of Physiology of Ibrahim Medical College, Dhaka, Bangladesh. A total number of 286 apparently healthy individuals were included in this study. Blood sample following overnight fast was collected for determination of serum TG, T-cholesterol, LDL-c and HDL-c. For all four lipid components, 95th percentile value was calculated and compared with values recommended by World Health Organization (WHO).</p> <p><strong><em>Results</em></strong>: A total number of 286 adult individuals were enrolled of which 130 (45.5%) and 156 (54.5%) were male and female respectively. The mean levels of TG (122±56 mg/dl) and T-cholesterol (178±25 mg/dl) of male participants were significantly (p=0.001, p=0.008) higher than that of females (79.3±35.6 and 170±26 mg/dl). The level of serum HDL-c was significantly (p=0.001) higher in females (46.1±7.8 mg/dl)) compared to the males (39.7±8.6 mg/dl). The 95th percentile values of TG, T-cholesterol and LDL-c were higher than that of values recommended by WHO. Of the total participants, 17.1% to 24.1% had TG, T-cholesterol and LDL-c levels higher than the WHO recommended range.</p> <p><strong><em>Conclusion</em></strong>: It is concluded that a proportion of our urban healthy young adult population had lipid profiles different from that recommended by WHO.</p> <p>Ibrahim Med. Coll. J. 2020; 14(1): 13-17</p> Taslima Akter, Elisha Khandker, Zinat Ara Polly, Fatima Khanam ##submission.copyrightStatement## Fri, 05 Jun 2020 16:41:00 +0000 Comparative evaluation of rapid Salmonella Typhi IgM/IgG and Widal test for the diagnosis of enteric fever <p><strong><em>Background</em></strong>: Accurate and early diagnosis of enteric fever is a diagnostic challenge where facility for blood culture is not available. As a result, Widal test is still used widely in resource limited settings. Recently, user-friendly rapid immunochromatographic tests (ICT) have been introduced for quick diagnosis of enteric fever. So, we evaluated sensitivity and specificity of an immunochromatography based <em>Salmonella </em>Typhi IgM/IgG test kit and Widal test compared to blood culture for the diagnosis of enteric fever.</p> <p><strong><em>Method</em></strong>: The study was conducted in the Department of Microbiology, Ibrahim Medical College (IMC) and Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) from June 2017 to September 2017. Clinically suspected enteric fever cases were included. Blood culture, Widal and <em>Salmonella </em>Typhi IgM/IgG detecting ICT were employed for the diagnosis of enteric fever.</p> <p><strong><em>Results</em></strong>: Out of 71 suspected cases of enteric fever, blood culture was positive in 36 cases (50.7%) while 42 (59.15%) and 35 (49.29%) cases were positive by Widal test and ICT respectively. Widal and ICT had sensitivity and specificity of 100% and 89.9% and 82.9% &amp; 91.4% respectively.</p> <p><strong><em>Conclusion</em></strong>: Findings of the study suggest that both Widal and immunochromatographic tests can be used interchangeably for rapid diagnosis of enteric fever.</p> <p>Ibrahim Med. Coll. J. 2020; 14(1): 18-25</p> Farjana Akter, Mahmuda Yeasmin, Md Zahangir Alam, Md Rokibul Hasan, Fahmida Rahman, Elisha Khandker, Md Monirul Hoque, Lovely Barai, - Md Mohiuddin, Md Shariful Alam Jilani ##submission.copyrightStatement## Tue, 09 Jun 2020 14:36:37 +0000 Knowledge about informed consent among doctors in postgraduate courses in Bangladesh <p><strong><em>Background and objectives</em></strong>: Informed consent is now accepted as the cornerstone of medical practice and research. Concept of consent is an endeavor by which the patient can take part in clinical judgment concerning their treatment and protects patient and doctors against any litigation. However, in research informed consent is not merely a form that is signed, but is a process in which the participant has an understanding of the research and its risks. In view of this, the objective of the study was to assess the knowledge regarding informed consent among the doctors pursuing postgraduate courses in a medical institute in Bangladesh.</p> <p><strong><em>Methodology</em></strong>: A descriptive cross sectional study was carried out among 160 postgraduate medical students in Dhaka city. A self-administered structured questionnaire consisting of 36 questions was used to assess their knowledge regarding informed consent. The response format was based on a 3-point Likert scale. Frequency distribution was used for statistical analysis.</p> <p><strong><em>Results</em></strong>: The age range of the participants was from 25-40 years. Of the total participants, 48% were males and 42% were females. Majority of the respondents acknowledged the importance of an informed consent and 86.3% of the doctors agreed that only verbal consent was not adequate. Only 66.2% agreed that consent for participation in research should always be voluntary and informed. Majority (76.9%) agreed not to recruit individuals with mental or behavioral disorders not capable of giving adequately informed consent. Only 27.5% were aware that assent should be taken from children participating in a research. Out of total participants, 71.2% and 81.2% agreed that the participants should be informed about the laboratory test results. Management/referral must be ensured in case of abnormal test results respectively. For genetic research, 88.1% and 81.3% agreed for pre- and post-counseling respectively.</p> <p><strong><em>Conclusion</em></strong>: There is need to initiate further educational programs to aware the doctors of the importance of informed consent in research, clinical practice and patient care.</p> <p>Ibrahim Med. Coll. J. 2020; 14(1): 26-35</p> Kazi Taib Mamun, Nabeela Mahboob, Mohammad Abdullah Al Mahmud, K Zaman ##submission.copyrightStatement## Tue, 09 Jun 2020 14:37:39 +0000 Helicobacter pylori CagA seropositivity in adult Bangladeshi patients with peptic ulcer and erosion <p><strong><em>Background</em></strong><strong>: </strong>CagA IgG antibody in sera might indicate presence of virulent <em>Helicobacter pylori </em>in patients with peptic ulcer disease. Present study was performed to find out the prevalence of CagA IgG antibody in patients with peptic ulcer/erosion.</p> <p><strong><em>Methods</em></strong><strong>: </strong>Any case that had peptic ulcer/erosion, plus positive for rapid urease test (RUT) or <em>H. pylori </em>stool antigen (HpSAg) or serum anti-<em>H. pylori </em>IgG/IgA were included in the study and named as <em>H. pylori </em>positive case. <em>H. pylori </em>positive cases were tested for CagA IgG antibody. Anti-<em>H. pylori </em>IgG, IgA and CagA IgG antibodies were determined by enzyme-linked immunosorbent assay (ELISA) and stool antigen by rapid immunochromatographic test (ICT). Urease production in biopsy sample was detected by RUT.</p> <p><strong><em>Results</em></strong><strong>: </strong>Total 86 <em>H. pylori </em>positive patients were included in the study. Out of 86 patients, CagA IgG was positive in 34 (39.5%; 95% CI: 0.30,0.50) cases. CagA seropositivity rate in ulcer and erosion cases were 58.8% (95% CI: 0.36,0.78) and 34.8% (95% CI: 0.25,0.47) respectively. <em>H. pylori </em>stool antigen and IgA antibodies were positive in all (100%) CagA antibody positive ulcer cases while the rates were significantly less among the CagA antibody negative cases (42.8% and 28.6%; p&lt;0.05). However, in CagA antibody positive erosion cases, the rates were not significantly different from CagA antibody negative cases.</p> <p><strong><em>Conclusion</em></strong><strong>: </strong>The study has demonstrated that the CagA positive strain is less prevalent in erosion than ulcer cases.</p> <p>Ibrahim Med. Coll. J. 2020; 14(1): 36-40</p> Fahmida Rahman, Khandaker Shadia, Salma Khatun, Mafruha Mahmud, Indrajit Kumar Dutta, Jalaluddin Ashraful Haq ##submission.copyrightStatement## Tue, 09 Jun 2020 15:08:58 +0000 Hypothyroidism and hyperprolactinemia in women with primary and secondary infertility <p><strong><em>Background and objectives</em></strong><em>: </em>Infertility is a global health problem including Bangladesh. Altered thyroid and prolactin levels have been implicated as a cause of infertility. The study was undertaken to find out the serum thyroid hormones and prolactin status in women with primary and secondary infertility.</p> <p><strong><em>Methods</em></strong><em>: </em>Women with primary and secondary infertility were enrolled. Fertile age-matched women were included as control. The anthropometric details (age, height and weight) were recorded. Overnight fasting blood sample was collected on 2nd day of menstrual cycle of the follicular phase. Serum thyroid stimulating hormone (TSH), free tri-iodothyronine (FT3) and free thyroxine (FT4) were measured by enzyme-linked immunosorbent assay (ELISA). Serum prolactin (PRL) was estimated by radioimmunoassay.</p> <p><strong><em>Results</em></strong><em>: </em>A total of 150 women were enrolled in the study. Out of 150 women, 50 had primary and 50 had secondary infertility while 50 women were age-matched fertile women as control. The mean TSH levels of both infertility groups were significantly higher than that of fertile women. Regarding thyroid function, 24% and 28% of women with primary and secondary infertility had hypothyroidism respectively. The serum prolactin level was high in 42.9% and 50% of hypothyroid cases in primary and secondary infertility groups respectively.</p> <p><strong><em>Conclusion</em></strong>: The study has demonstrated high occurrence of hypothyroidism with raised serum prolactin levels among infertile females emphasizing the importance of estimating both serum TSH and prolactin in infertility.</p> <p>Ibrahim Med. Coll. J. 2020; 14(1): 41-46</p> Shamima Bari, Rokeya Begum, Qazi Shamima Akter ##submission.copyrightStatement## Tue, 09 Jun 2020 15:09:04 +0000 Detection of antibodies to recombinant truncated flagellin and sonicated whole cell antigen of Burkholderia pseudomallei in acute melioidosis and in healthy Bangladeshi individuals <p><strong><em>Background and objectives</em></strong>: Several types of <em>Burkholderia pseudomallei </em>antigens have been used to determine the antibody response in acute and asymptomatic cases. In the present study, we have detected immunoglobulin G (IgG) antibody to recombinant truncated flagellin antigen (RTFA) of <em>B. pseudomallei </em>in the sera of acute melioidosis cases and healthy individuals from melioidosis endemic areas of Bangladesh by indirect enzyme-linked immunosorbent assay (ELISA). In parallel, IgG antibody to sonicated whole cell antigen (SWCA) of <em>B. pseudomallei </em>was determined to compare with anti-RTFA antibody.</p> <p><strong><em>Methodology</em></strong>: Serum samples from culture confirmed melioidosis cases and from healthy individuals aged 21 years and above residing in melioidosis endemic rural areas were included in the study. Serum IgG antibody to RTFA and SWCA of <em>B. pseudomallei </em>was determined by indirect ELISA.</p> <p><strong><em>Results</em></strong>: Out of 8 culture confirmed acute melioidosis cases, 7 (87.5%) and 8 (100%) were positive for anti-<em>B. pseudomallei </em>IgG antibodies by RTFA and SWCA methods respectively. Among 361 healthy individuals, the rate of seropositivity by RTFA-ELISA was significantly less than that of SWCA-ELISA (16.1% versus 26.8%; p = 0.001). The mean optical density (OD) of RTFA-ELISA of positive cases was significantly less than that of SWCA-ELISA in both melioidosis and healthy individuals (0.79±0.11 versus 2.4±0.08, p = 0.0001; 0.67±0.01 versus 1.27±0.02, p = 0.0001). The sensitivity and specificity of RTFA-ELISA were 88.9% and 100% respectively.</p> <p><strong><em>Conclusion</em></strong>: Findings of the study suggest that multiple or combination of antigens should be used to study the seroprevalence of <em>B. pseudomallei </em>infection in a community. Also, prospective study is necessary to find out the duration of persistence of antibodies to different antigenic components of <em>B. pseudomallei </em>after exposure.</p> <p>Ibrahim Med. Coll. J. 2020; 14(1): 47-52</p> Md Shariful Alam Jilani, Tang Thean Hock, Sraboni Mazumder, Fahmida Rahman, - Md Mohiuddin, Chowdhury Rafiqul Ahsan, Jalaluddin Ashraful Haq ##submission.copyrightStatement## Tue, 09 Jun 2020 15:14:35 +0000 Elimination of measles by 2024: achievements and challenges <p>Measles is an infectious agent of viral origin with exceedingly high rate of transmissibility contributing to very high morbidity and mortality rates especially among children. Although measles is extremely infectious, control strategies of this virus used to be recognized as one of the most successful public health interventions ever undertaken. However, despite being vaccine-preventable disease measles has encountered an enormous resurgence as the rate of measles vaccination has declined and in many countries vaccination targets remain unmet and measles continues to claim hundreds of thousands of lives each year. This review discusses the reasons of the re-emergence of measles, the present global and Bangladesh situation and strategies that have been undertaken to combat this killer disease to eliminate measles globally by the year 2024.</p> <p>Ibrahim Med. Coll. J. 2020; 14(1): 53-58</p> Sabrina Afrin, Kazi Taib Mamun, Nabeela Mahboob, Hasina Iqbal, Hasnatul Jannat ##submission.copyrightStatement## Tue, 09 Jun 2020 15:16:51 +0000 Tuberculosis – burden and serodiagnosis <p>Tuberculosis (TB) is one of the leading causes of death worldwide. Clinical features and demonstration of the organism by microscopy/culture are still the mainstay of diagnosis of tuberculosis. The present paper reviews the burden of TB and the role of serology in its diagnosis.</p> <p>Ibrahim Med. Coll. J. 2020; 14(1): 59-69</p> - Md Mohiuddin ##submission.copyrightStatement## Tue, 09 Jun 2020 15:25:57 +0000