Journal of Armed Forces Medical College, Bangladesh https://www.banglajol.info/index.php/JAFMC <p>The aim of JAFMC is to publish quality papers from all corners and any branches of medical science.</p> Armed Forces Medical College Bangladesh en-US Journal of Armed Forces Medical College, Bangladesh 1992-5743 Submission of a manuscript for publication implies the transfer of the copyright from the author to the publisher upon acceptance. Accepted manuscripts become the permanent property of the Journal of Armed Forces Medical College and may not be reproduced by any means in whole or in part without the written consent of the publisher. Co-existence of Systemic Lupus Erythematosus and Autoimmune Hypothyroidism https://www.banglajol.info/index.php/JAFMC/article/view/48629 <p>Abstract not Available</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 1-2</p> Md Habibur Rahman AKM Musa Khan ##submission.copyrightStatement## 2020-08-20 2020-08-20 15 1 1 2 10.3329/jafmc.v15i1.48629 Pattern of Intervention in Congenital Heart Disease: Single Centre Analysis of Cases over Five Years in Bangladesh https://www.banglajol.info/index.php/JAFMC/article/view/48630 <p><strong>Introduction</strong>: In Bangladesh, 25/1000 cases of neonates are born with mild to severe type of congenital heart disease. Significant numbers of cases from new born to adult age group are reporting to OPD clinics with broad spectrum of congenital and grown up untreated heart diseases. This study will cover pattern of diseases among cases selected for cardiac catheterization and intervention in study group in a cardiac hospital with limited facility for children.</p> <p><strong>Objectives</strong>: To analyze all the cases who had cardiac catheterization and intervention in said period and to see the outcome.</p> <p><strong>Materials and Methods</strong>: It is a retrospective study conducted in a cardiac hospital from December 2014 to December 2019. All cases of cardiac catheterization and interventions were included in the study. Pattern of diseases, interventions, management and outcomes were analyzed.</p> <p><strong>Results</strong>: Out of 1179 cases, 44.87% were male and 55.13% were female. Two hundred fifty four cases(21.54%) were in 0-1 year age group, 44.02% were in &gt;01-05 year age group, 18.66% cases were in &gt; 5 to 10 year , 8.48% cases were in &gt;10 to 20 years, 4.83% cases were in&gt; 20 to 30 years and 2.46% cases were in more than 30 year age group. Among trans-catheter closure patent ductus arteriosus (PDA) was the commonest type of intervention (44.68%), followed by atrial septal defect (ASD) (25.20%), ventricular septal defect (VSD) (11.83%) and balloon valvoplasty (BVP) for pulmonary stenosis (11.63%). Neonatal interventions were minimum as the coronary care unit used as post cathward had limited facility for neonatal care. PDA stenting was performed in 0.81% cases and BAS in 0.91% cases. Many patients underwent more than one intervention at a time; most common was ASD device closure and pulmonary valvoplasty. Cardiac Catheterization studies were minimum in this series and most of the cath study cases were VSD or/with other combinations (4.48%). Among infants (254), PDA device closure was the commonest intervention (64.56%) followed balloon valvoplasty for PS (15.35%) and balloon dilation of Coarctation on aorta (7.87%). Among implants, most commonly used were 8/6 mm (14.59%) Amplatzer Duct occluder (ADO), 6/4 ADOII, MF-Konar (9.79%) device and most common balloon used for valve or vessel dilation was 10x3 mm Tyshak II (3.26%). Only one mortality was noticed in a case of double intervention of critical Aortic and pulmonary valve stenosis.</p> <p><strong>Conclusion</strong>: Commonest and established interventions were performed in this study other than few life saving interventions in neonates and outcome was excellent. Skilled team of pediatric cardiologist and technician in catheterization laboratory can bring success at the end of the day in spite of challenges.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 3-9</p> Nurun Nahar Fatema Begum Nazmul Islam Bhuiyan Md Ashfaque Ahemmed Khan Md Jahangir Alam ##submission.copyrightStatement## 2020-08-20 2020-08-20 15 1 3 9 10.3329/jafmc.v15i1.48630 Association of Systemic Lupus Erythematosus with Autoimmune Hypothyroidism https://www.banglajol.info/index.php/JAFMC/article/view/48631 <p><strong>Introduction</strong>: Autoimmune disease has got tendency to co-exist with another autoimmune disease. SLE and hypothyroidism are common autoimmune diseases. They may be associated with each other. Objectives: To find the association of SLE and Autoimmune Hypothyroidism.</p> <p><strong>Materials and Methods</strong>: This prospective case control study was conducted in the department of Rheumatology, CMH Dhaka from January 2017 to June 2019. Total 100 cases of SLE (Group A) were included in the study to see the presence of co-existing autoimmune hypothyroidism. Another 100 age and sex matched healthy controls without SLE (Group B) were screened for hypothyroidism. Verbal consent was taken and ethical issue was addressed. Data were collected in a pre-planned and pre-designed form after face to face interview, clinical history, physical examination and relevant laboratory investigations and plotted in tables and charts. Data were analyzed in computer SPSS Version 16. Chi-square test was done to see the level of significance.</p> <p><strong>Results</strong>: Total 100 SLE patients were enrolled in this study (Group A). Age range was from 14-65. Amongst them 96 were females and only 4 were males. Majority of them belonged to 20-30 and 31-40 years age group and frequency were 40 (40%) and 35 (35%) respectively. Out of 100 SLE cases 8 patients had coexisting autoimmune hypothyroidism, 6 patients had subclinical hypothyroidism and another 4 had thyroid autoantibody with biochemically euthyroid state. Amongst the control group only 1 had hypothyroidism, 2 had subclinical hypothyroidism and 1 had thyroid autoantibody with biochemically euthyroid state. The differences in two groups were statistically significant.</p> <p><strong>Conclusion</strong>: There is a strong positive association between SLE and autoimmune hypothyroidism. There are also overlapping clinical manifestations in these conditions. Therefore, thyroid screening test may be done in every case of SLE for early detection of autoimmune hypothyroidism to effectively manage both diseases.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 10-12</p> Md Abdur Razzak Quazi Audry Arafat Rahman Md Abdul Wahab ##submission.copyrightStatement## 2020-08-20 2020-08-20 15 1 10 12 10.3329/jafmc.v15i1.48631 Patients’ Satisfaction on Services of Border Guard Hospital, Guimara, Bangladesh https://www.banglajol.info/index.php/JAFMC/article/view/48632 <p><strong>Introduction</strong>: Patients’ satisfaction is one of the established yard sticks to measure success of the hospitals. To improve the quality of services, health organizations use patient satisfaction survey to evaluate their processes delivered. A satisfied patient is more likely to develop a deeper and longer lasting relationship with their medical service providers, leading to improved compliance, continuity of care, and ultimately better outcomes.</p> <p><strong>Objectives</strong>: To assess the patients satisfaction with services provided and the infrastructure facilities of Border Guard Hospital, Guimara (BGHG), of Khagrachari district Bangladesh.</p> <p><strong>Materials and Methods</strong>: This descriptive cross sectional study was conducted among the patients who attended the outpatient department of BGHG from January to December 2017. Total 1340 patients aged more than 18 years, irrespective of sex, having no serious complications and willing to participate were selected by convenient sampling. Data were collected by semi-structured questionnaire by face to face interview and analyzed by SPSS 21.0.</p> <p><strong>Results</strong>: Out of 1340 respondents 53.7% were serving BGB members, 18.3% were BGB families and 28.0% respondents were local residents. Majority of the patients stated that the general basic facilities at the hospital were adequate. Regarding cleanliness 94.7%, waiting room sitting facilities 91.9%, drinking water availability 88.4%, lighting arrangement 96.7%, ventilation arrangement 88.1% and toilet facilities 91.1% respondents reported that the hospital facilities were adequate. Most of the respondents were satisfied with the quality of professional services by all type of staffs of the hospital. Highest 84.9% of the respondents were satisfied with doctors’ attitude, behavior and cooperation. About other staffs; 72.9% respondents were satisfied with attitude, behavior and cooperation of nurses, 71.9% with pharmacists, 71.1% with registration clerk, 75.3%, with information desk, 70.2% with guards and 73.8% with supporting staffs.</p> <p><strong>Conclusion</strong>: Patients attended at BGHG was highly satisfied about the infrastructure and the services provided the hospital. But few percentages of patients expressed their dissatisfaction. BGHG authority should keep it up and try to improve further.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 13-15</p> Md Abdul Wahab Farzana Zafreen Mohsen Uddin Ahmed Md Habibur Rahman Md Abdur Razzak ##submission.copyrightStatement## 2020-08-20 2020-08-20 15 1 13 15 10.3329/jafmc.v15i1.48632 Outcome of Sorafenib Therapy in Advanced Hepatocellular Carcinoma https://www.banglajol.info/index.php/JAFMC/article/view/48633 <p><strong>Introduction</strong>: Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer. It occurs most often in people with chronic liver diseases, such as cirrhosis caused by hepatitis B or hepatitis C infection. It is the fifth most common liver cancer globally and also a common cancer in Bangladesh. Treatment is difficult; however newer oral drug Sorafenib is available in our country which is promising.</p> <p><strong>Objectives</strong>: To evaluate the efficacy of TKI Sorafenib on advanced and non-resect able primary HCC in Bangladeshi patients.</p> <p><strong>Materials and Methods</strong>: This clinical trial was conducted on 38 diagnosed patients of advanced hepatocellular carcinoma (stage-3 and Child-Pugh Class-C) over a period of 3 years from May 2014 to July 2017 in the department of Oncology, CMH Dhaka. The patients receive Sorafenib 200-400 mg twice daily till disease progression ceases or increases and there are no unacceptable toxicities. Efficacy was observed in terms of overall survival, progressive free survival (PFS), drug compliance and common toxicities.</p> <p><strong>Results</strong>: In 24 months of follow –up period from the date of Sorafenib taken, median overall survival was 7.73 months. The median overall survival was 8 months (range 8.13-27.43 months) in 42.4% patients. The median PFS is 3.5 months (range 1.2-5.8 months). Common toxicities found were anorexia, weakness, yellow colouration of skin and mucosa, HTN, rash and diarrhoea.</p> <p><strong>Conclusion</strong>: In Sorafenib treated Bangladeshi advanced HCC patients, the median overall survival was found to be significant and compatible with some of the international publication.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 16-18</p> Md Niamul Gani Chowdhury Md Azizul Islam ##submission.copyrightStatement## 2020-08-20 2020-08-20 15 1 16 18 10.3329/jafmc.v15i1.48633 Cognitive Function in Patients with Type 2 Diabetes Mellitus https://www.banglajol.info/index.php/JAFMC/article/view/48634 <p><strong>Introduction</strong>: The increasing prevalence of diabetes over the world has become an important public health issue. It is considered as an independent risk factor for cognitive impairment. The cognitive function of patients with type 2 diabetes mellitus is usually not assessed in routine checkup.</p> <p><strong>Objectives</strong>: To evaluate the cognitive status and associated factors of type 2 diabetes mellitus patients.</p> <p><strong>Materials and Methods</strong>: This cross-sectional study conducted in Combined Military Hospital, Dhaka from July 2014 to June 2015. A total of 191 type 2 diabetes mellitus patients were studied to find out the association between glycemic status and cognitive capacity among the patients. Cognitive capacity was assessed by using MMSE scale. Data were collected by face to face interview with a semi-structured questionnaire and checklist following systematic random sampling technique.</p> <p><strong>Results</strong>: Out of 191 patients 85.3% of the patients had uncontrolled DM but 88% of the patients had normal level of cognitive capacity and only 12% having border line cognitive capacity. More male (16.0%) than female (7.1%) patients had border line cognitive capacity. Statistically significant (p&lt;0.05) association was found with age group and glycemic status, aged group has more uncontrolled diabetes mellitus. Majority (39.4%) of elderly patients (61-80 years) had border line cognitive capacity while most (96.4%) of the younger patients (41-50 years) had normal cognitive capacity.</p> <p><strong>Conclusion</strong>: In this study type 2 DM patients found with decline in cognitive capacity. So, patients with type 2 DM should be regularly assessed for their cognitive function.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 19-21</p> Abdullah Al Mamun Sheikh Shahidul Islam Maj Ariful Haque AKM Shafiqur Rahman ##submission.copyrightStatement## 2020-08-20 2020-08-20 15 1 19 21 10.3329/jafmc.v15i1.48634 Continuous versus Intermittent Tamsulosin Therapy in Men with Lower Urinary Tract Symptoms due to Benign Prostatic Hyperplasia: A Randomized Control Trial https://www.banglajol.info/index.php/JAFMC/article/view/48635 <p><strong>Introduction</strong>: Benign prostatic hyperplasia (BPH) is the most common benign tumour in men. About 50% of men at the age of 50 years develop BPH and about half of them report to the doctors with some form of lower urinary tract symptoms (LUTS).</p> <p><strong>Objectives</strong>: To see the therapeutic effect of Tamsulosin on alternate day administration in comparison to daily dose for men who had been suffering from LUTS due to BPH.</p> <p><strong>Materials and Methods</strong>: This clinical trial was carried out at Combined Military Hospital, Dhaka in a consecutive fashion for about 18 months. A total of 152 patients were selected from outpatient department and after assessing them through inclusion and exclusion criteria and grouped randomly in three groups Group-A (50 patients), Group-B (50 patients) and Group C (52 patients); all the patients were treated with Tablet Tamsulosin (0.4mg) daily for first three months. Then next 15 months they were treated as; Group-A received Tablet Tamsulosin (0.4mg) daily, Group-B received Tablet Tamsulosin (0.4mg) every alternate day and Group C received placebo Tablet (Folic acid 5 mg) daily. Data were collected at the beginning and end of 3rd month, 4th month, 7th month and 18th month of study, in the form of international prostate symptom score (IPSS), maximum urinary flow per second (Qmax) and post-voidal residue (PVR).</p> <p><strong>Results</strong>: This study showed that at the initial three month, IPSS score declined in all three groups, Qmax improved and PVR reduced in all groups. In next phase of study; in Group-A patient there was progressive and significant improvement of all parameters (IPSS, Qmax and PVR) at the end of study. In Group-B patient also showed similar result at the end of study. In Group-C patient showed statistically significant difference in outcome in relation to Group-A and Group-B i.e. more in IPSS, less in Qmax and increase in PVR.</p> <p><strong>Conclusion</strong>: With this study it is clearly evident that tamsulosin (0.4mg) therapy significantly improves symptoms of men suffering for LUTS due to BPH. And alternate day therapy having similar therapeutic outcome in relation to every day therapy.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 22-26</p> SM Shameem Waheed Mohammad Abdur Rakib Md Shahidul Islam Mohammad Abdur Rakib Md Ashif Chowdhury Md Shafiul Alam ##submission.copyrightStatement## 2020-08-20 2020-08-20 15 1 22 26 10.3329/jafmc.v15i1.48635 Post-Traumatic Stress Disorder among Burn Patients in a Tertiary Hospital https://www.banglajol.info/index.php/JAFMC/article/view/48636 <p><strong>Introduction</strong>: Imbalance in multi-factorial components of human ecology plays a role in developing post-traumatic stress disorder hampering economical productivity and normal social life.</p> <p><strong>Objectives</strong>: To find out the interplay of issues that are conducive to the outcome of the disorder among hospital admitted burn patients.</p> <p><strong>Materials and Methods</strong>: This unobtrusive qualitative behavioral health research by in-depth interview was conducted among conveniently selected 35 burn patients in Dhaka Medical College Hospital of Bangladesh from July 2013 to June 2014. The data were analyzed to draw conclusion through etic and/or emic interpretation. All ethical issues were taken care of.</p> <p><strong>Results</strong>: The highest 80% burn patients were married, 71% were male, and 80% were Muslim. Majority 37.14% were day laborer, 28.57% had completed primary education, 34.29% belonged to the age group 21-30 years, and 43% had monthly family income up to Tk. 10000. Of 41% burn occurring at home, majority 27% occurred during rice cooking, affecting the upper limb in 29% cases. Social dislocation was the major phenomena leading to burn injury in 22.86% of the patients. Lack of harmonious relationship and in-laws poking in conjugal life sometime led to deliberate infliction of burn.</p> <p><strong>Conclusion</strong>: The study concluded with the suggestions for prevention of neoteric entry in the domain of post-traumatic stress disorder through social movement and psychotherapy of burn patients. Study also hinted for further probing of the phenomenon of the disorder.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 27-31</p> Md Iqbal Hasan Md Shafiqur Rahman Rukhsana Shaheen ##submission.copyrightStatement## 2020-08-20 2020-08-20 15 1 27 31 10.3329/jafmc.v15i1.48636 Demography of Lung Cancer Patients: A Retrospective Study in Military Hospital, Dhaka https://www.banglajol.info/index.php/JAFMC/article/view/48637 <p><strong>Introduction</strong>: The habit of smoking bidis and cigarettes is of long standing and widely prevalent in the southern part of Asia and largely in Bangladesh. Currently there are limited data on the lung cancer patients of Bangladesh.</p> <p><strong>Objectives</strong>: To determine the correlation of smoking and lung cancer patients of CMH, Dhaka and to review their demographic profile.</p> <p><strong>Materials and Methods</strong>: This retrospective hospital based study was conducted at Cancer Center, CMH, Dhaka. A total of 128 patients of lung cancer were enrolled those who were admitted to CMH Dhaka from January 2011 to December 2014. Data were collected in a predesigned format from old documents.</p> <p><strong>Results</strong>: Age range of 128 lung cancer patients were from 28 to 80 years. Most of the patients 114(89.06%) belonged to &gt;50 years age group, male 105(82.03%), 106(82.8%) smoker, 14(10.94%) were non-smoker and in 8 (6.25%) cases the smoking habit was not mentioned in documents. Most of the patients 60(47.24%) were from Dhaka district and belonged to lower middle class background 110(85.93%). Common coexisting diseases were COPD 30(23.43%), HTN 32(25%) and DM 25(19.53%). Maximum lung cancer cases were squamous cell subtype 38(29.69%) and adenocarcinoma 35(27.43%). TNM stage group IIIA were 25(19.53%), IIIB 40(31.25%) and IV were 35(27.34%). Large majority of patients were treated with chemotherapy alone 89(66.42%) and concurrent chemotherapy and radiotherapy 31(24.13%). Most of the patients of lung cancer 123(96%) died within 2 years of diagnosis.</p> <p><strong>Conclusion</strong>: In this study, there was a strong correlation between smoking and lung cancer. Majority were diagnosed late in advanced stage and treated with chemotherapy alone or chemotherapy and radiotherapy combined. Prognosis was poor in this series and 96% died within 2 years of diagnosis.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 32-34</p> Md Quadrat E Elahi Md Abdur Razzak Md Azizul Islam Md Ashraful Alam ##submission.copyrightStatement## 2020-08-20 2020-08-20 15 1 32 34 10.3329/jafmc.v15i1.48637 Awareness about Normal Vaginal Delivery among Pregnant Women Attending at an Upazilla Health Complex https://www.banglajol.info/index.php/JAFMC/article/view/48638 <p><strong>Introduction</strong>: Childbirth is a personal and individual journey that is different for every woman. Perception of the birth experience is thought to be influenced by many factors, the most significant of which may be the type of delivery. Normal vaginal delivery (NVD) is a natural process and cesarean section (CS) an operative process for child birth. Awareness regarding mode of delivery have a very important role for the future wellbeing of mother and child both.</p> <p><strong>Objectives</strong>: To assess the awareness regarding normal vaginal delivery among pregnant women attending the out patients department (OPD) of an Upazilla Health Complex.</p> <p><strong>Materials and Methods</strong>: This descriptive cross-sectional study was conducted at Kaliganj Upazilla Health Complex, Gazipur from January to March 2018 among 300 pregnant women. Age range of the patients was 15-40 years and selected purposively who were willing to attend and having no major complications. Data were collected by face to face interview with structured questionnaire and analyzed by SPSS version 20.0</p> <p><strong>Results</strong>: Out of 300 respondents 103(34.3%) was within 21-25 years, 87(29%) was within 26-30 years and 61(20.3%) was below 20 years of age. Respondents’ age at marriage found 113(37.7%) was within 21-25 years and 107(35.7%) below 20 years. About 178(59.3%) was regular and 122(40.7%) was irregular about their antenatal care visit. Common health problem was weakness 185(61.7%), GDM 67(22.3%) and swelling feet 21(7%). Among 211 respondents 133(63%) was satisfied, 40(19%) was dissatisfied and 38(18%) having mixed feelings about their previous delivery. Regarding awareness about mode of delivery 207(69.3) opted NVD better, 56(18.7%) opted CS better and 30(10%) was confused. Regarding preferred mode of delivery 191(63.7%) opined for NVD, 52(17.3%) opined for CS and 57(19%) was not clear about their opinion.</p> <p><strong>Conclusion</strong>: Study found that majority of respondent was aware about the NVD but still good number of participant opted CS as their choice. Proper health education and creating awareness by mass media and healthcare worker and community leader may improve the situation.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 35-38</p> Farzana Zafreen Md Abdul Wahab Mohsen Uddin Ahmed Md Habibur Rahman Md Abdur Razzak ##submission.copyrightStatement## 2020-08-20 2020-08-20 15 1 35 38 10.3329/jafmc.v15i1.48638 Socio-demographic and Economic Factors Associated with Adherence to Anti-Tuberculosis Treatment https://www.banglajol.info/index.php/JAFMC/article/view/48639 <p><strong>Introduction</strong>: Tuberculosis is one of the most significant health problems in Bangladesh. Adherence to TB treatment is crucial to achieving cure while avoiding the emergenceofdrug resistance. Non-adherence to anti-tuberculosis treatment may result in persistent infectiousness and a higher rate of treatment failure, relapse and drug resistance and therefore, it’sa significant barrier to the success in tuberculosis control.</p> <p><strong>Objectives</strong>: To determine the socio-demographic and economic factors influencing adherence to anti-tuberculosis treatment among tuberculosis patients.</p> <p><strong>Materials and Methods</strong>: This case control study was carried out among purposively selected 47 cases and 94 controls in selected DOTS centres of Dhaka city from January 2010 to July 2010. Data were collected by face to face interview using a semi-structured questionnaire.</p> <p><strong>Results</strong>: Males were 2.5 times more likely to be non-adherent and among them day-labourer and main earning member were more commonly non-adherent (p&lt;0.05). Low per capita income and irregularity of monthly income were significantly (p&lt;0.01) associated with non-adherence.</p> <p><strong>Conclusion</strong>: Non-adherence is associated with the risk factors that are modifiable by the correction of socio-demographic and economic characteristics as a whole. So the highest priority in fighting against non-adherence therefore must be to reduce poverty for its prevention especially targeting the patients of low economic status.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 39-41</p> Md Motahar Hossain Meerjady Sabrina Flora - Md Shahidullah Md Nurul Amin Murshida Mosharref Md Abdul Wahab ##submission.copyrightStatement## 2020-08-20 2020-08-20 15 1 39 41 10.3329/jafmc.v15i1.48639 Effect of Losartan and Amlodipine on Lung Function Status in Hypertensive Patients: A Randomized Control Trial https://www.banglajol.info/index.php/JAFMC/article/view/48640 <p><strong>Introduction</strong>: Essential hypertension is associated with altered pulmonary function. Antihypertensive medication and lung function are also associated. Losartan (angiotensin II receptor blocker) and amlodipine (calcium channel blocker) are commonly used antihypertensive drugs.</p> <p><strong>Objectives</strong>: To evaluate the effects of antihypertensive drugs on lung function status in patients with essential hypertension.</p> <p><strong>Materials and Methods</strong>: This prospective observational study was carried out in the Department of Physiology of Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka, from July 2012 to June 2013 on 100 newly diagnosed hypertensive patients without any antihypertensive medication (group B, age 30-55 years). They were selected from the Out Patient Department (OPD) of Cardiology, BSMMU, Dhaka. Age, sex and BMI matched 50 apparently healthy normotensive subjects were also studied as control (group A). Based on treatment, these study subjects were divided into two groups (B1 and B2). Group B1 included 50 patients received losartan 50 mg daily and B2 included 50 patients received amlodipine 5 mg daily. They were observed once before the treatment (B1a and B2a), after 3 months of medication (B1b and B2b) and after 6 months of medication (B1c and B2c). For assessing lung function status, Forced Vital Capacity (FVC), Forced Expiratory Volume in 1st second (FEV1) and Peak Expiratory Flow Rate (PEFR) were measured with a RMS computer based Spirometer.</p> <p><strong>Results</strong>: Mean FVC, FEV1 and PEFR were significantly lower in newly diagnosed hypertensive patients in comparison with that of healthy normotensive. Mean FVC, FEV1 and PEFR were found significantly higher in the group taking losartan and amlodipine for 6 months when compared to newly diagnosed but lower than those of controls.</p> <p><strong>Conclusion</strong>: Reduced lung function occurs in newly diagnosed hypertensive patients which was improved by treatment with losartan and amlodipine.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 42-44</p> Mst Nasrin Nahar Shelina Begum Sultana Ferdousi Tamanna Habib ##submission.copyrightStatement## 2020-08-20 2020-08-20 15 1 42 44 10.3329/jafmc.v15i1.48640 Common Health Problems of Retired Armed Forces Personnel Admitted In Combined Military Hospital https://www.banglajol.info/index.php/JAFMC/article/view/48641 <p><strong>Introduction</strong>: In Bangladesh there has been steady increase in aged (&gt;60years) from 5.6% in the year 1981 to more than 7% in the year 2006 and 12% by the year 2025. In Armed Forces we have about 30 to 35% are of aged 60 years and above.Many of them are engaged in life struggle and nation-building activities. They deserve the healthy life access to all health facilities.</p> <p><strong>Objectives</strong>: To assess the common health problems of the retired Armed Forces Personnel and to find out necessary steps or quantify measures.</p> <p><strong>Materials and Methods</strong>: This was a descriptive type of cross sectional study conducted among the 112 retired Armed Forces Personnel who were admitted in Combined Military Hospital, Dhaka with a view to assess their health problems. The sample was selected purposively and data was collected by face to face interview.</p> <p><strong>Results</strong>: The mean age of the respondents was 59.20±7.22 years. The most prevalent diseases among the respondents were hypertension (32.1%), diabetes mellitus (17.0%), bronchial asthma (13.4%), ischemic heart disease (10.7%), and cataract (8.9%). Majority of respondents (57.1%) were unemployed, 28.6% were engaged in business and 14.3% had a job in private company. The association between their health problems and present occupational status was found statistically highly significant (p&lt;0.05).</p> <p><strong>Conclusion</strong>: The most common health problems were hypertension, diabetes mellitus, bronchial asthma and ischemic heart disease among the retired Armed Forces personnel. Prevalence almost all the diseases were significantly (p&lt;0.05) associated with employment status.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 45-47</p> Md Mazharul Islam Khan Maj Ariful Haque Rehnuma Rashid Farzana Zafreen ##submission.copyrightStatement## 2020-08-20 2020-08-20 15 1 45 47 10.3329/jafmc.v15i1.48641 Parenting Stress and Coping Capacity Linked with Quality of Life among Parents of Children with Autism Spectrum Disorder https://www.banglajol.info/index.php/JAFMC/article/view/48642 <p><strong>Introduction</strong>: Autism spectrum disorder (ASD) is prevalent globally. Fundamental impairment of communication and social interactions are common features of ASD children. Parents of autistic children experience parenting differently with severe physical and psychological problems involved and suffer from higher parenting stress which ultimately influence their quality of life. Empowering parents of children with autism for use of available social support, to get assistance of coping strategies and to promote self confidence of odd feelings are essential for enabling the parents to improve their quality of life by reducing theirstress.</p> <p><strong>Objectives</strong>: To assess the link of parenting stress and coping capacity with quality of life among the parents whose children suffer from autism spectrum disorder (ASD) and to help the government and relevant organizations take the required steps to improve the living conditions of the parents of children having ASD.</p> <p><strong>Materials and Methods</strong>: This cross-sectional study was executed from July 2016 to June 2017 among 175 parents whose children have autism spectrum disorder. Data were collected by in-person interview method with systematic random sampling followed by semi-structured questionnaire.</p> <p><strong>Results</strong>: Majority (48.6%) of the parents were between 31 to 40 years of age and mean (±SD) age of the parents was 37.75 ±8.04 with the range of 21-64 years. Most (53.7%) of the parents were female. Majority of the parents (42.9%) were educated up to graduation level and (72.0%) were service holders. Most (93.1%) parents were from urban areas and (92.6%) parents were represents from nuclear family. Majority parents (55.4%) had 2 children and most (70.9%) children have noticed their first symptom at the age of 2 and maximum (47.4%) children were identified with ASD at three years of age. Maximum (62.9%) family had monthly income of Tk. 20001-50000 and majority children (77.1%) were diagnosed in different government hospitals.</p> <p><strong>Conclusion</strong>: Considering the fact that ASD is a mushrooming public health problem in Bangladesh, widespread prior diagnostic facilities are needed to be made available all over the country especially in peri-urban and urban areas, to measure the parenting stress and identify ways of coping capacity for improving lives of parents whose children have ASD.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 48-54</p> Md Shakhawat Hossain Chowdhury Md Ziaul Islam Mhabubur Rahman Bhuiyan Ahmed Rafi Abdullah Al Kawsar ##submission.copyrightStatement## 2020-08-20 2020-08-20 15 1 48 54 10.3329/jafmc.v15i1.48642 Outcome of Oligonodular Hepatocellular Carcinoma after Hepatectomy https://www.banglajol.info/index.php/JAFMC/article/view/48643 <p><strong>Introduction</strong>: Hepatocellular carcinoma (HCC) is a common cancer and is the third most common cause of cancer-related death worldwide. Frequent recurrence of HCC after resection is a major surgical limitation. Early recurrence is the most disappointing outcome after surgery for multinodular HCC. Several studies found good results after hepatectomy for oligonodular (2 or 3 nodules) HCC.</p> <p><strong>Objectives</strong>: To observe the recurrence rate three months after hepatectomy for oligonodular HCC and study the possible risk factors.</p> <p><strong>Materials and Methods</strong>: The study population consisted of 102 patients with oligonodular HCC and received hepatectomy in Combined Military Hospital (CMH) between July 2011 and July 2017 according to the following criteria: (1) numbers of tumour nodules determined by preoperative imaging (computed tomography or magnetic resonance imaging) and intraoperative exploration; (2) diagnosis of HCC confirmed by postoperative histopathology; (3) incision margins negative; (4) complete clinicopathologic data; (5) adjuvant chemotherapy advised one month after operation. Multicentric occurrence (MO) and intrahepatic metastasis (IM) were determined in each patient according to the histopathologic examination.</p> <p><strong>Results</strong>: Among 102 patients, 43(42.2%) had small tumor stain three months after surgery, 22(21.6%) and 21(20.6%) were definded as single and multiple recurrence respectively. The recurrence rate of patients with microvascular involvement was higher (64.3%) than those without (33.8%), (p&lt;0.05). IM or MO, complete tumor capsule or not, number of tumors (2 versus 3), liver condition (cirrhosis versus chronic hepatitis) showed no significant difference.</p> <p><strong>Conclusion</strong>: There was a high rate of very early recurrence for patients with oligonodular HCC three months ater hepatectomy, and the hepatic resection seems no-account for these patients regardless of very early recurrence or not a curative resection. Microvascular involvement was a risk factor while IM or MO is not.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 55-57</p> SM Shakhwat Hossain Md Mahboob Hasan Md Mahbubur Rahman ##submission.copyrightStatement## 2020-08-20 2020-08-20 15 1 55 57 10.3329/jafmc.v15i1.48643 Treatment Response on Positive Symptoms of Schizophrenia with Olanzapine and Risperidone https://www.banglajol.info/index.php/JAFMC/article/view/48644 <p><strong>Introduction</strong>: Positive symptoms become perceptible in patients as schizophrenia progresses. If schizophrenia goes untreated catatonic motor behaviors are develops. Now a day’s catatonia which is a type of disturbed behavior is observed, with less frequency than in past years due to advances in treating schizophrenia. Treatment of schizophrenia by olanzapine and risperidone shows diverse outcomes.</p> <p><strong>Objectives</strong>: To assess the response on positive symptoms of schizophrenia by olanzapine and risperidone.</p> <p><strong>Materials and Methods</strong>: This study was conducted in Department of Pharmacology and Department of Psychiatry of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka during the period from September 2013 to January 2015. A total of 179 schizophrenia patients fulfilling the inclusion criteria were enrolled and of them 75 patients completed the study, where 40 were in olanzapine treated group and 35 were in risperidone treated group in a 12-weeks assessment where Scale for Assessment of Positive Symptoms (SAPS) was applied. After statistical analysis of scores between intergroup and intra group p&lt;0.05 was considered significant.</p> <p><strong>Results</strong>: Treatment with both the olanzapine and risperidone were remarkably effective for progress of positive symptoms of schizophrenia patients but in olanzapine treated group the score was reduced more than that of risperidone treated group and the difference was significant (p&lt;0.05).</p> <p><strong>Conclusion</strong>: Olanzapine has responded better on positive symptoms of schizophrenia patients than that of risperidone.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 58-60</p> Fatema Zerin Khan Nafisa Rashid Syeda Papia Sultana Wahida Rahman Sayeda Nazrina Hosnea Ara ##submission.copyrightStatement## 2020-08-20 2020-08-20 15 1 58 60 10.3329/jafmc.v15i1.48644 Patients Satisfaction about Magnetic Resonance Imaging Services at Combined Military Hospital, Dhaka https://www.banglajol.info/index.php/JAFMC/article/view/48645 <p><strong>Introduction</strong>: MRI investigation indicates sensitivity as well as specificity. The increasing clinical utility, coupled with the greater availability and capacity to per¬form, has resulted in a dramatic increase in their use over the past de¬cades. The expectation of the care seekers has also increased and it is a major concern whether this increase in MRI result has improved patient outcomes or not.</p> <p><strong>Objective</strong>: The study was carried out with the aim to evaluate various aspects of satisfaction among the MRI performing patients at Combined Military Hospital, Dhaka.</p> <p><strong>Materials and Methods</strong>: This descriptive cross sectional study was carried out on patient satisfaction of MRI services at CMH, Dhaka. A total of 186 patients performing investigation at MRI Department of CMH Dhaka since 01st May 2011 to 15th May 2011 were interviewed. Data were collected and analysed by face-to-face interview and reviewing medical record with the help of a questionnaire and checklist.</p> <p><strong>Results</strong>: The waiting time of 8-12 weeks for MRI was maximum among 24.7% patients; followed by 17.7% for 2-4 weeks and 16.1% for 1-2 weeks. It also revealed that waiting time was higher (8-12 weeks) in Neurosurgery referred cases (33.3%), Orthopaedic (28.2%) followed by Neurology (14.3%) (p&lt;0.05). The outdoor patients experienced more waiting time in comparison to indoor patients. Orthopaedic referred cases had the highest (53.8%) positive finding followed by Neurosurgery (15.1%) and Medicine (7.5%). A significant majority of the patients are satisfied (68.81%) or very satisfied (25.80%) with the MRI service.</p> <p><strong>Conclusion</strong>: This study finding will help the hospital administrator not only in monitoring the investigation but also to take measures to improve the facilities of MRI department.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 61-63</p> Md Rezaur Rahman Umar Rashed Munir Farzana Zafreen Md Abdul Wahab ##submission.copyrightStatement## 2020-08-20 2020-08-20 15 1 61 63 10.3329/jafmc.v15i1.48645 Pattern of Common Inherited Coagulation Disorders: Evaluation of 100 Cases https://www.banglajol.info/index.php/JAFMC/article/view/48646 <p><strong>Introduction</strong>: The bleeding disorders having inherited abnormality of haemostasis may present with significant difficulties in diagnosis and management. The overall frequency of these disorders in the general population is low.</p> <p><strong>Objectives</strong>: To study the frequency of inherited coagulation disorders and their prevalent clinical manifestations.</p> <p><strong>Materials and Methods</strong>: A prospective cross sectional study of one hundred patients of all age group and both sexes was organized as both in-patient and out-patient based in the Department of haematology, Armed Forces Institute of Pathology (AFIP) from July 2012 to June 2013.</p> <p><strong>Results</strong>: In this study, out of 100 patients, haemophilia A, diagnosed in 75% patients, was the most common disorder. Age group ranging from 5-15 years constituted 48% of total patients. Male to female ratio of patients having hereditary coagulation defect was 73:2 in haemophilia A whereas 2:3 in vWD. Consanguinity was documented in 60% of vWD and 24% of haemophilia A. The most common clinical symptom in hereditary coagulation defect (HCD) was echymosis (60%). The most common presenting feature of haemophilia was haematoma (57.95%) whereas menorrhagia was the most common presentation of female patients with vWD. Among 97 patients of haemophilia and vWD, 59(60.82%) cases were in mild form and 04(4.12%) cases were found to have severe coagulation defect. Fresh frozen plasma (FFP) is the most common modality of treatment in HCD.</p> <p><strong>Conclusion</strong>: It has become the need of the time to find out such a cost effective diagnostic parameter to make an early diagnosis of inherited coagulation disorders.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 64-66</p> Mohammed Nuruzzaman Bhuiyan Maj Gen Susane Giti Mohammed Mosleh Uddin Monwar Tarek Lutfunnahar Khan ##submission.copyrightStatement## 2020-08-20 2020-08-20 15 1 64 66 10.3329/jafmc.v15i1.48646 Trans-Umbilical Open Port Placement During Laparoscopic Access: A Safe Technique https://www.banglajol.info/index.php/JAFMC/article/view/48647 <p><strong>Introduction</strong>: Intra-peritoneal access and creation of pneumoperitoneum through a quick, safe and reliable technique is important for Laparoscopic Surgery. Specially in an resource constrained setting where there is paucity of needed equipment and cost is prohibitive, utilization of the fewer instruments available and accompanid by excellent functional and cosmetic outcomes should be the aim of a laparoscopic surgeon.</p> <p><strong>Objectives</strong>: To describe a modified method of primary trocar introduction that utelizes fewer available instruments.</p> <p><strong>Materials and Methods</strong>: A vertical incision is made in the trans-umblical region at the base of to an everted umblicul scar. The linea alba is incised and the resultant opening bluntly developed after which the 1st port is inserted using tocar as an guide. The trocar is withdrawn while the canula is pushed in.</p> <p><strong>Results</strong>: We included total 124 patient (Male-44, Female-80) in the study period, from Jan 2017 to December 2018. In one single surgical unit, with the age limit 18-75 years, With no significant complications.</p> <p><strong>Conclusion</strong>: This modified open trans-umblical approach is a simple, quick, and reliable way to primary port insertion. Access is gained easily in different age groups and umblicus types, through a small congenital umblical defect that is almost universally present. It is associated with minimum morbidity and has excellent outcome.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 67-70</p> Md Atiqul Haque Sarder Quazi Sabran Uddin Ahmed ##submission.copyrightStatement## 2020-08-20 2020-08-20 15 1 67 70 10.3329/jafmc.v15i1.48647 Sero-prevalence of Blood Borne Agents among Voluntary Blood Donors https://www.banglajol.info/index.php/JAFMC/article/view/48648 <p><strong>Introduction</strong>: Blood transfusion is a significant life-saving intervention in the present era of patient management system. As the blood and blood products are a potential source of infections and the necessity of transfusion is increasing day by day, transfusion transmissible infections have become a major threat to the system of ensuring safe transfusion.</p> <p><strong>Objectives</strong>: To find out the sero-prevalence of Hepatitis B, Hepatitis C, HIV, Syphilis and Malaria parasite among the blood donors and to ascertain risk behaviour of the blood donors.</p> <p><strong>Materials and Methods</strong>: This descriptive cross-sectional study was conducted on purposively selected 115 blood donors at Armed Forces Institute of Pathology (AFIP) during the period of 1st September to 31st December 2011.</p> <p><strong>Results</strong>: The study revealed among 115 blood donors 7.8% were HBsAg positive. More than half of the HBsAg positive cases 66.67% were from civilian. None of the respondents was found positive for anti-HCV, VDRL, Malaria and anti-HIV. All of the donors in this study were voluntary donors. The sample studied had a mean age of 28.03 ± 6.79 years and 90.5% of donors were belongs to age group 18-37 years and female was only 6.1%. Most of the donors (49.5%) were military personnel,86%above SSC educated and 22.6% had visited abroad. Regarding risk behaviour 38.3% had the history of undertaking dental procedure, 0.9% were found undertaking blood transfusion, 2.6% had the history of illicit sex and 29.6% had the history of suffering from jaundice and among them only 1.7% were found HBsAg positive.</p> <p><strong>Conclusion</strong>: The study finding demands motivation against unnecessary blood transfusion. It also emphasize health education programme among peoples having risk behaviour.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 71-74</p> AKM Shafiqur Rahman - Md Arifuzzaman Md Mehedhi Hasan Shourov Farzana Zafreen ##submission.copyrightStatement## 2020-08-20 2020-08-20 15 1 71 74 10.3329/jafmc.v15i1.48648 Patterns and Outcome of Traumatic Brain Injury Patients: A Study in a Tertiary Level Military Hospital https://www.banglajol.info/index.php/JAFMC/article/view/48649 <p><strong>Introduction</strong>: A traumatic brain injury (TBI) is an injury to the brain caused by an impact to the head. TBI represents a huge global medical and public health problem across all ages and in both civilian and military populations. TBI is characterized by great heterogeneity in terms of etiology, mechanism, pathology, severity and treatment with widely varying outcomes.</p> <p><strong>Objective</strong>: To determine the pattern and outcome of traumatic brain injuries in victims reported to emergency and casualty (E&amp;C) department following intensive care with or without surgical intervention.</p> <p><strong>Materials and Methods</strong>: This prospective type of observational study was conducted at Neurosurgery department of Combined Military Hospital, Dhaka from October 2013 to March 2017. A total of 675 head injury patients with TBI were assessed with gender, age, cause and type of trauma, GCS on admission, associated other injuries, time lapsed from trauma to hospitalization and care given. The outcome was measured after 72 hours using Glasgow Outcome Scale (GOS).</p> <p><strong>Results</strong>: The incidence of TBI was 47.03% among the head injury patients. Common age group was 21-30 years (43.7%) and male victims (66.55%). RTA was the most frequent cause (50.05%) of TBI and the most common pathophysiological cause of TBI was subdural haemorrhage (SDH)(35%) followed by extradural haemorrhage (EDH)(27%). Most patients (45%) had mild TBI. Surgical intervention was required in 45% patients of TBI mainly for the SDH, EDH which had significant positive effect on the TBI patient’s outcome. The majority of patients (77%) had good outcome which included recovery (51.85%) and moderate disability (25.48%). The poor outcome was observed in 23% patients which included death (7.40%), persistent vegetative state (3.11%), severe disability (12.14%) and it was associated with older age, severe TBI (GCS&lt;8 on admission), associated other injuries and delayed resuscitative care and interventions.</p> <p><strong>Conclusion</strong>: TBI was common among the young adults male. The RTA was the leading cause of TBI. The factors that influence the outcome of TBI include patient’s age, severity of TBI, associated injuries and delayed resuscitative care.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 75-78</p> Md Shohidul Islam Md Fashiur Rahman Md Aminul Islam ##submission.copyrightStatement## 2020-08-20 2020-08-20 15 1 75 78 10.3329/jafmc.v15i1.48649 Workplace Hygiene Practice among Saloon Workers in Bangladesh Army https://www.banglajol.info/index.php/JAFMC/article/view/48650 <p><strong>Introduction</strong>: In Bangladesh like any other developing country, saloon is the unique place for transmission of some communicable diseases.</p> <p><strong>Objectives</strong>: To explore the level of knowledge, attitude and practices regarding hygienic and cleanliness among saloon workers of Bangladesh Army.</p> <p><strong>Materials and Methods</strong>: This descriptive cross-sectional study was carried out in different barber shops of army units in Dhaka cantonment during the month of May 2011. Data were collected from 115 saloon worker by structured questionnaire through face to face interview.</p> <p><strong>Results</strong>: Mean age of 115 respondents’ was 22.65±5.8 years whereas 76% of the respondents have less than 5 years of service. Their monthly income was less than 8000 taka and 70.4% had only primary education. About 77% washed linen used for wrapping twice a week and 16.5% did it in alternate day. About 89.5% had awareness and knowledge of transmission of skin diseases through unclean comb, but only 2.6% did not have any knowledge regarding this matter. In case of disease spread through unclean handle of blade/khur majority 60% respondents were aware about skin disease but only 12% were aware about AIDS and 16.5% were aware about jaundice. Majority (90%) found using antiseptic solution to clean used shaving brush /handle of razors. No respondent clean their hand before providing service to each customer and none used fresh linen for each customer rather 1 linen for every 10-12 customer on average.</p> <p><strong>Conclusion</strong>: The study revealed that majority of the saloon workers were either illiterate or had only primary plus level education with poor socio economic background. Despite the knowledge and practice of workplace hygiene among the saloon workers are quite satisfactory levels even though there are areas for further improvement.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 79-80</p> - Md Mohsin AKM Mashiul Munir ##submission.copyrightStatement## 2020-08-20 2020-08-20 15 1 79 80 10.3329/jafmc.v15i1.48650 Aetiology of Ludwig’s Angina: A Hospital Based Study https://www.banglajol.info/index.php/JAFMC/article/view/48651 <p><strong>Introduction</strong>: Ludwig’s angina is potentially life-threatening spreading cellulites of neck with high level of morbidity and mortality. Dental caries and diabetes mellitus are most common aetiological factor for Ludwig’s angina. Bad oral hygiene and poor socioeconomic condition are also responsible for this grave disease. This disease was frequently fatal; mortality rates for Ludwig’s angina exceeded 50% in the pre antibiotic era; however, antibiotics and aggressive surgical intervention have significantly reduced mortality recent series quote mortalities of 0-10%. &nbsp;Objectives: To find out the aetiology of patient’s of Ludwig’s angina.</p> <p><strong>Materials and Methods</strong>: This cross sectional descriptive study was conducted among 89 patients admitted in the Department of ENT and Head-Neck Surgery in Dhaka Medical College Hospital from 01.07.2010 to 30.06.2012. Patients were selected by specified inclusion and exclusion criteria. Data were collected in a structured questionnaire and analysed by SPSS 16.0 for Windows.</p> <p><strong>Results</strong>: Among 89 patients about 69% were from rural area and55% from poor socio-economic class. Sixty-four patients (74.2%) suffered from dental caries and 15.7% were diabetic.</p> <p><strong>Conclusion</strong>: Study shows some factors like dental caries, bad oral hygiene, oral mucosal infections, diabetes mellitus were associated with Ludwig’s angina, which may be preventable and curable by early diagnosis and intervention. The public awareness regarding aetiology of Ludwig’s angina may contribute great role in reduction of this disease prevalence.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 81-83</p> Mohd Shamim Bin Shaid Khan Syed Muhammed Tipu Sultan Mohammad Kamal Hossain Mahmudur Rahman Md Monsur Alam Md Zahidul Islsm ##submission.copyrightStatement## 2020-08-20 2020-08-20 15 1 81 83 10.3329/jafmc.v15i1.48651 Detection and Quantification of HCV-RNA by RT-PCR among Anti-HCV Positive Patients https://www.banglajol.info/index.php/JAFMC/article/view/48652 <p><strong>Introduction</strong>: The most common contemporary strategy to diagnose chronic hepatitis C virus (HCV) infection consists of initial screening with an HCV enzyme immunoassay (EIA) antibody test followed by supplemental testing of positive screening tests with a quantitative HCV RNA assay to confirm the positive EIA and to determine whether they have active or resolved hepatitis C infection.</p> <p><strong>Objectives</strong>: To detect and quantify HCV-RNA by real-time polymerase chain reaction (real-time PCR) among anti-HCV positive patients and to identify the socio demographic factors among these patients.</p> <p><strong>Materials and Methods</strong>: This was a descriptive type of cross-sectional study which was conducted in Combined Military Hospital and Armed Forces Institute of Pathology, Dhaka cantonment. A total of 108 anti-HCV positive patients by enzyme-linked immunosorbent assay (ELISA), who were clinically suspected and advised for anti-HCV test, were selected randomly for the study and subjected to do HCV-RNA analysis during the period of October 2016 to September 2017.</p> <p><strong>Results</strong>: Out of 108 anti-HCV positive patients by ELISA, HCV-RNA was detected in 72 (66.7%) cases with mean value of HCV RNA quantification was 2013323.95±2695207.41 (IU/ ml). Majority of anti-HCV positive patients (29.6%) belonged to 51-60 years age group with male predominance (58.33%). It was observed that 43.52% patients came from middle income group family, 31.48% came from poor and 25.0% came from high income group family. Risk factor for HCV infected population was found maximum in dialysis patients (47.37%), followed by blood transfusion (13.89%), Injecting drug User (IDUs) (12.04%), surgery &amp; intervention (9.26%) and sexual transmission (1.85%). Mean alanine aminotransferase (ALT) was found 67.30±44.99 U/L among HCV-RNA detected patients (p&lt; 0.05).</p> <p><strong>Conclusion</strong>: The quantification of HCV RNA by RT-PCR will be helpful to rationalize the treatment, enhance antiviral responses and mitigate mortalities of HCV infected patients.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 84-86</p> Wasila Rahman - Md Rahimgir Arif Ahmed Khan Maj Suman Khisa Rahima Akter Maj Imana Shahreen ##submission.copyrightStatement## 2020-08-20 2020-08-20 15 1 84 86 10.3329/jafmc.v15i1.48652 Role of Ultrasonography in Evaluation of Pelvic Mass in Female https://www.banglajol.info/index.php/JAFMC/article/view/48653 <p><strong>Introduction</strong>: Ultrasonography is one of the best non-iinvasive diagnostic tool to evaluate the size, consistency and gross structure of a pelvic mass. In very difficult situation when the pelvic examination cannot reach any specific diagnosis, ultrasonography can help by both functional and morphological information reliability of ultrasonography in various pelvic masses in female. &nbsp;Objectives: To observe the role of ultrasonography (USG) in evaluation of pelvic mass.</p> <p><strong>Materials and Methods</strong>: This observational study was carried out on 110 patients over a period of 2 years from January 2014 to January 2016 who reported to surgical and Gynae out patient department (OPD) in Medical College for Women and Hospital (MCWH), Dhakaand Catharsis Hospital, Pubail, Dhaka.All patients underwent pelvic ultrasonography and findings were compared with actual status of the patients and finally confirmed by hystopathology after operation.</p> <p><strong>Results</strong>: Total 110 patients of pelvic masses were evaluated out of which 88 patients were found to be ultrasonographically positive and the remaining 22 were negative and out of these 88 patients 84 were hystopathologically confirmed. Out of 22 ultrasonographically negative patients, 08 cases were found to be hystologically confirmed.</p> <p><strong>Conclusion</strong>: Pelvic masses is one of the common complaints in gynaecological cases. Proper clinical assessment is the mainstay of diagnosis and addition of routine abdominal ultrasound by graded compression technique can improve the diagnostic accuracy and adverse outcome.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 87-89</p> Rosy Perveen AFMS Islam Habibur Rahman Ruksana P Khan ##submission.copyrightStatement## 2020-08-20 2020-08-20 15 1 87 89 10.3329/jafmc.v15i1.48653 Knowledge about Non-Communicable Diseases among Selected Urban School Students https://www.banglajol.info/index.php/JAFMC/article/view/48654 <p><strong>Introduction</strong>: The rise in the prevalence and significance of non-communicable diseases (NCDs) is the result of complex interaction between health, economic growth and development. Knowledge about NCDs and appropriate practices related to NCDs are keys to its proper management.</p> <p><strong>Objectives</strong>: To determine the level of knowledge about NCDs among the selected urban school students.</p> <p><strong>Materials and Methods</strong>: A cross-sectional study was conducted among the students of Adamjee Cantonment Public School &amp; Shaheed Bir Bikram Ramiz Uddin Cantonment School of Dhaka Cantonment during 01 January 2017 to 31 December 2017. A total of 183 participants were selected by purposive sampling technique. Data were collected using a pretested interviewer administered semi-structure questionnaires and SPSS version 22 used for data analysis. Simple descriptive statistics were used to describe the study variables. Inferential statistics were include, chi-square test, to find out any significant relationship between two qualitative variables.</p> <p><strong>Results</strong>: Participants (n = 183) included 129 (70.49%) were male and 54 (29.51%) were female, aged between 13–19 years. Among 183 respondents, 106(57.9%) participants have good knowledge, 76(41.5%) participants had average knowledge and 1(0.5%) participant had poor knowledge. Level of knowledge had significant association with gender, age, education, father’s &amp; mother’s occupational status, family income, physical activity, smoking &amp; habit of taking hard drink.</p> <p><strong>Conclusion</strong>: The knowledge and practices related to NCDs among the participants were good in certain aspects but poor in others, suggesting the need for programs on NCDs awareness. Comprehensive community based health education program about NCDs is necessary to improve this situation.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 90-93</p> Md Zahirul Islam Md Mahbubur Rahman Maj Azmery Hossain Moly ##submission.copyrightStatement## 2020-08-20 2020-08-20 15 1 90 93 10.3329/jafmc.v15i1.48654 Efficacy of Burst Mode Torsional Phacoemulsification in Age-Related Cataract https://www.banglajol.info/index.php/JAFMC/article/view/48655 <p><strong>Introduction</strong>: Torsional ultrasound energy and burst mode interrupted energy delivery system are recent advancementsin the technique of phacoemulsification surgery. It has been reported that both these advancementshelpto reduce corneal wound burn and thermal induced endothelial cell loss and thereby helps to achieve excellent early postoperative visual outcome</p> <p><strong>Objectives</strong>: To evaluate the efficacy of burst mode torsional phacoemulsification surgery in age-related cataract.</p> <p><strong>Materials and Methods</strong>: Prospective observational study of 120 cases that underwent phacoemulsificationcataract surgery in which torsional energy was used in burst mode. Phacoemulsification was performed by “vertical –chop” technique. Intraoperatively corneal wound burn, Descemet’s membrane detachment, posterior capsule ruptureetc.were evaluated. Postoperatively corneal oedema, best corrected visual acuity, cystoid macular oedema were evaluated. Postoperatively eyes were examined at day 1, 1 week, 6 weeks and 3 months.</p> <p><strong>Results</strong>: Mean age of the patients was 57.28± 8.20 years. Most of the patients 81(67.5%) had nuclear sclerosis grade-II cataract.Intraoperatively, moderate wound burn occurred in 02(1.6%) eyes, localized Descemet’s membrane detachmentin 03(2.5%) eyes and posterior capsule rupture occurred in 03(2.5%) cases. Postoperatively, moderate and severe corneal edema was found in 06(5.0%) and 04(3.3%) eyes respectively at day 1. At the end of 3 months follow-up, 114(95%) eyes maintained a best corrected visual acuity of ≥ 6/18, of which 109(90.8%) eyes achieved ≥ 6/9.</p> <p><strong>Conclusion</strong>: Burst mode torsional phacoemulsfication is a very effective and advanced technique of cataract surgery. Intraoperative complications are very less and visual outcome is excellent.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 94-97</p> Md Abdullah Al Masum Md Kamrul Hasan Khan Zulfikar Hasan Natasha Kajmina ##submission.copyrightStatement## 2020-08-20 2020-08-20 15 1 94 97 10.3329/jafmc.v15i1.48655 Pattern of Knee Injury Cases Attending Combined Military Hospital, Dhaka https://www.banglajol.info/index.php/JAFMC/article/view/48656 <p><strong>Introduction</strong>: Knee injury one of the most common injuries among soldiers accounts for losses in efficient combat power as well as increase burden of disability placed to the different units of Armed Forces.</p> <p><strong>Objectives</strong>: To find out the pattern of knee injury of patients attending at a tertiary military hospital.</p> <p><strong>Materials and Methods</strong>: This descriptive cross-sectional study carried out during January 2017 to December 2017 at Orthopedic Center of CMH, Dhaka. A total of 153 knee injuries patients were selected purposively as per selection criteria and data were collected by face to face interview and record review.</p> <p><strong>Results</strong>: Total 153 respondents’ mean age was 31.03±10.19 years, most of them (41.8%) were from age group 25-34 years and were male (90.8%). Anterior Cruciate Ligament (ACL) injury was predominant (37.9%) and main precipitating physical event was football (20.3%) followed by jumping 9 feet ditch (16.3%). Right knee was more involved (49.7%) than left knee (46.4%). Most of injuries occurred in the exercise ground (40.5%) then sports ground (35.3%). ACL injuries (19%) were common in the age group 25-34 years and 9.8% were in 15-24 years. Morbidity duration of knee injuries was &lt;1 year for 49% and 1-5 years for 36.6% of the respondents.</p> <p><strong>Conclusion</strong>: Training-related injuries negatively impact the capabilities of any Armed Forces. Low fitness levels among soldiers are associated with increased risk for injury and attrition. Knee injury may be considered as one of the major occupational health problems of Armed Forces.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 98-101</p> Md Mashiur Rahman Md Fashiur Rahman Zulfiquer Ahmed Amin Zakia Hossain Faiza Zahidul Islam Md Zahirul Islam ##submission.copyrightStatement## 2020-08-20 2020-08-20 15 1 98 101 10.3329/jafmc.v15i1.48656 Tobacco Uses: A Great Health Hazard https://www.banglajol.info/index.php/JAFMC/article/view/48657 <p>The continued popularity of tobacco appears to defy rational explanation. Smokers mostly acknowledge the harm they are doing to themselves and many report that they do not enjoy it – yet they continue to smoke. Smoking behavior is maintained primarily by the positive and negative reinforcing properties of nicotine delivered rapidly in a way that is affordable and palatable, with the negative health consequences mostly being sufficiently uncertain and distant in time not to create sufficient immediate concern to deter the behavior. Tobacco smoking increases the risk of contracting a wide range of diseases, many of which are fatal. Despite reductions in prevalence in recent years, tobacco smoking remains one of the main preventable causes of ill-health and premature death worldwide. This paper reviews the source, history and epidemiology of tobacco use, extent and nature of harms caused by tobacco use – both active and passive and the benefits of stopping.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 102-106</p> Quazi Audry Arafat Rahman Md Abdur Razzak Mushfika Haque Mumu Md Abdul Wahab ##submission.copyrightStatement## 2020-08-20 2020-08-20 15 1 102 106 10.3329/jafmc.v15i1.48657 A Rare Disease of Familial Chylomicronemia Syndrome in a 20 Days Infant https://www.banglajol.info/index.php/JAFMC/article/view/48658 <p>Familial chylomicronemia syndrome is a group of very rare genetic disorders. It is inherited as autosomal recessive disorder. Its estimated incidence is 1 in 1000000 populations, characterized by deficient activity of an enzyme lipoprotein lipase (LPL) or apo-protein C-II, resulting into severe fasting hypertriglyceridemia and massive accumulations of chylomicrons in plasma. LPL deficiency typically presents in childhood with failure to thrive, colicky abdominal pain, eruptive xanthomas, lipemiaretinalis, pancreatitis and hepatomegaly. We are reporting a rare case of familial chylomicronemia in a 20 days old child who was presented with pneumonia, his plasma incidentally found like milk during routine collection of his blood sample. As the child was only 20 days old with very high triglyceride level, so breast feeding continued and cocktail therapy with low dose Tablet Fenofibrate, Tablet Niacin, Tablet Atovastatin started after referral to paediatric cardiologist at 3 months of age.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 107-109</p> Nurun Nahar Fatema Begum Mukta Sarker ##submission.copyrightStatement## 2020-08-20 2020-08-20 15 1 107 109 10.3329/jafmc.v15i1.48658 A case of Young Stroke due to Moyamoya Disease https://www.banglajol.info/index.php/JAFMC/article/view/48659 <p>Moyamoya disease is a disease in which certain arteries in the brain are constricted. Blood flow is blocked by the constriction, and also by blood clots (thrombosis). A collateral circulation develops around the blocked vessels to compensate for the blockage, but the collateral vessels are small, weak, and prone to bleeding, aneurysm and thrombosis which may result in TIA, recurrent ischemic or hemorrhagic stroke or seizure. The disease may manifest in pediatric age or young adults. In May 2019 we have diagnosed a young lady with Moyamoya disease who presented with right sided hemiplegia, motor aphasia and dysphagia. She was labeled as hypertensive 6 months prior to this event and used to take anti-hypertensive irregularly and gave past history of occasional headache. Her CT scan and MRI of brain revealed left sided ischemic infarct involving frontotemporoparietal region and cerebral angiogram revealed narrowing of left MCA and non-visualization of distal part. There is extensive fine collaterals (Moyamoya vessels) giving the appearance of puffed smoke. The right ACA and MCA were also narrowed with appearance of early collateral vessels. She was treated with aspirin, PPI, NG feeding, antihypertensive medication, physiotherapy, rehabilitation therapy and other supportive care. His condition gradually improved and discharged on 2.7.19. He was referred to Department of Neurosurgery for cerebral revascularization by STA-MCA (superficial temporal and middle cerebral arteries) bypass surgery after stabilization and MR perfusion study.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 110-113</p> Md Abdur Razzak Ghulam Kawnayn Fateha Naznin Quazi Audry Arafat Rahman ##submission.copyrightStatement## 2020-08-20 2020-08-20 15 1 110 113 10.3329/jafmc.v15i1.48659 Long Term Survivor of Vaginal Primary Malignant Melanoma https://www.banglajol.info/index.php/JAFMC/article/view/48660 <p>Primary malignant melanoma of the vagina is a rare entity which constitutes less than 3% of vaginal cancer and only 0.3-0.8% of all melanomas in women. It has a high risk of local recurrence and distant metastasis. Once a recurrence is noted, survival is extremely poor. This article reports a case of primary vaginal melanoma with longer survival. As long-time survival of stage II vaginal melanoma is a rare phenomenon, this case is a unique one in Bangladesh; emphasizing on both importance of routine gynaecological examination for any suspicious pigmented lesions in the vagina as well as the necessity of further research on validating treatment protocols.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 114-115</p> Farhana Kalam Shahana Pervin ##submission.copyrightStatement## 2020-08-20 2020-08-20 15 1 114 115 10.3329/jafmc.v15i1.48660 Paraneoplastic Polymyositis in a Patient of Myelofibrosis https://www.banglajol.info/index.php/JAFMC/article/view/48661 <p>Polymyositis is a rare rheumatologic disorder. Exact cause is unknown but autoimmunity, genetic and environmental factors like infection and drugs may be responsible. It may be a primary autoimmune disease, associated with other autoimmune diseases or underlying malignancy. There is two-way relationship between polymyositis and malignancy. Patients with polymyositis and dermatomyositis has increased chance of various malignancies. On the other hand polymyositis and dermatomyositis may be a paraneoplastic manifestation of some malignancies like carcinoma lung, ovary, breast, pancreas, colon, lymphoma, MDS and myeloproliferative disorders. We have diagnosed a case of polymyositis in a patient of Myelofibrosis (MF). The patient presented with inflammatory myopathy affecting proximal muscles of the limbs, neck muscles, laryngeal and pharyngeal muscles. Muscle enzymes were markedly elevated, EMG and MRI were in favour of inflammatory myopathy. Muscle biopsy showed inflammatory infiltrates in muscles mostly by T- cells with myonecrosis, degeneration and regeneration without vasculopathy and perivascular change. Primary polymyositis and other autoimmune diseases were excluded by absence of relevant autoantibodies. So he was diagnosed as a case of paraneoplastic polymyositis.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 116-118</p> Md Abdur Razzak Jesmin Khandker Sk Md Jaynul Islam ##submission.copyrightStatement## 2020-08-20 2020-08-20 15 1 116 118 10.3329/jafmc.v15i1.48661 Acute Large Bowel Obstruction Following Late Sequelae of Traumatic Diaphragmatic Hernia https://www.banglajol.info/index.php/JAFMC/article/view/48662 <p>A 33 years old patient was admitted in a Military Hospital with the features of acute large gut obstruction. Exploratory laparotomy was done and peroperatively the obstruction was seen in the transverse colon and obstruction seemed to be carcinoma of transverse colon with involvement of left hemidiaphragm which was not negotiable. Transverse loop colostomy with decompression of bowel was done. Subsequently the patient was transferred to tertiary level hospital in Dhaka. In the tertiary hospital, the patient developed left sided massive pleural effusion. With relevant investigation the condition was diagnosed as left sided diaphragmatic hernia. Thoracotomy was done and herniorrhophy was performed after reduction of the content. Post-operative management was stormy and eventful but the condition improved gradually and the patient was discharged in proper time. The patient had history of chest trauma due to RTA he met 4 years back and he received hospital indoor management for 3½ months. The patient was asymptomatic and leading normal active military life before 2nd time admission for acute intestinal obstruction. The patient had past history of trauma to left chest wall 4 years back, presented with acute large gut obstruction and there was diagnostic dilemma. There were management difficulties and post operative events were stormy. The aim of this reporting is to highlight all of these.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 119-120</p> Md Mahboob Hasan MA Baqui Farzana Rahman Merajul Hasan ##submission.copyrightStatement## 2020-08-20 2020-08-20 15 1 119 120 10.3329/jafmc.v15i1.48662