Journal of Armed Forces Medical College, Bangladesh The aim of JAFMC is to publish quality papers from all corners and any branches of medical science. 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. Awareness about Antibiotic Uses <p>Abstract not available</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.12(1) 2016: 1-2</p> Dipak Kumer Paul Chowdhury Md Fashiur Rahman ##submission.copyrightStatement## 2016-01-23 2016-01-23 12 1 1 2 10.3329/jafmc.v12i1.39947 Road Traffic Injury among Pedestrians in Dhaka City <p><strong>Introduction</strong>: Road traffic accident (RTA) is a growing public health problem worldwide. It is responsible for greatest number of injuries and fatalities by killing around 1.2 million people each year and injuring 50 million who occupy 30-70% of orthopedic beds in developing countries hospitals. Pedestrians are the most common victims of RTAs.</p> <p><strong>Objective</strong>: To find out the epidemiological factors and pattern of road traffic injury among pedestrians admitted at selected tertiary level referral hospitals in Dhaka City for getting necessary treatment.</p> <p><strong>Materials and Methods</strong>: This descriptive type of cross sectional study was done during December 2015 to June 2016 at four tertiary level referral hospitals in Dhaka. A total of 197 pedestrian patients were selected by purposive and convenient method of sampling. The primary data was collected from the patients after their discharge from hospital by face to face Exit interview using a pre tested semistructured questionnaire.</p> <p><strong>Results</strong>: Among 197 pedestrian victims interviewed; 129(65.48%) were male and 68(34.52%) female. Maximum accidents took place on city main roads 93(47.21%), followed by internal roads 93(47.21%), maximum accidents occurred at day time 87(44.16%), followed by evening 49(24.87%). Regarding vehicles, highest number of accidents were caused by buses 63(31.97%), followed by mini bus 42(21.32%). Highest incidence of injuries was observed among the age group 21 to 30 yrs 81(41.12%), 168( 85.27%) reported that they had been knocked down by the vehicles while crossing the roads (hit and run injury), 24(12.18%) were injured by motor cycles moving at a speed illegally on the footpath, 56(28.42%) people fall on ground due to faulty roads and potholes, open manhole cover followed by vehicle’s accident. Majority of victims 136(69.03%) were from earning group below 15,000 taka per month, most of the victims 155(78.68%) never used foot over bridge,168(85.27%) person faced difficulty while walking through footpath due to piling of construction materials, selling items of neighboring shops etc, 127(64.47)% were using mobile phone while crossing the road or walking through it. All the research samples had multiple abrasion and bruise all over the body, 164(83.25%) had lacerations in different body area, 85(43.14%)%) had fracture of upper limb bones, 69(35.03%)had fracture of lower limb bones .</p> <p><strong>Conclusion</strong>: The incidence and severity of injury of road accident can be prevented by motivation of public, strict application of traffic rules and proper training of drivers. More scientific research on road traffic injury are needed in future.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.12(1) 2016: 3-7</p> Mushtaq Ahmad Farial Naima Rahman Mohammad Ali Md Abdus Samad Al Azad ##submission.copyrightStatement## 2016-01-23 2016-01-23 12 1 3 7 10.3329/jafmc.v12i1.39948 Result of Combined Mifepriston and Misoprostol in Termination of Early Pregnancy at Different Gestational Age <p><strong>Introduction: </strong>An estimated 56 million induced abortion occured each year worldwide. Indirect estimates suggest more than 1.2 million annual menstrual regulations (MRs) and induce abortions each year in Bangladesh. Maternal mortality in Bangladesh is 1.76 /1000 live birth, one fourth of these deaths are due to complication of induced abortion. The safety of procedure is therefore of global public health importance. Now medical abortion option have made more available to women in a variety of health care setting and home administration of medical abortion is acceptable.</p> <p><strong>Objective: </strong>To know the outcome and safe use of mifepristone and misoprostol combination up to 9 weeks (&lt;63 days) of missed period to reduce the maternal morbidity, mortality related to complications of menstrual regulation (MR) and induced abortion in Bangladesh.</p> <p><strong>Materials and Methods: </strong>This was a prospective cross sectional study of outdoor patients (100 cases) of Marie Stopes Premium Maternity Hospital, Mirpur-10 who came for menstrual regulation within 9 weeks (63 days) of missed period by MRM (Menstrual Regulation by Medication), using 200mg of oral Mifepristone followed by buccal Misoprostol 800μg. Study period was from July 2014 to December 2014.</p> <p><strong>Results: </strong>Success rates of regimen used in this study that are higher (98%) in case of women &lt;6wks amenorrhoea than that group who have had amenorrhea up to 9 weeks (94%). There were 4 failures (4%), among them 1(2%) from women &lt;6 weeks and 3 (6%) from women &gt;6 weeks who needed surgical evacuation later on.</p> <p><strong>Conclusion: </strong>MRM with Mifepristone 200mg followed by buccal Misoprostol 800μg is highly effective and safe.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.12(1) 2016: 8-11</p> Marlina Roy Rokeya Khan Nasrin Hasan Rehnuma Karim Alifa Nasrin Nahida Rahman ##submission.copyrightStatement## 2016-01-23 2016-01-23 12 1 8 11 10.3329/jafmc.v12i1.39949 Basic Knowledge of Army Troops and their Relatives in Rangpur towards Antibiotic <p><strong>Introduction</strong>: Inappropriate use of antibiotic may create several problems including emergence of drug resistant microorganisms, the rising costs of health-care services and the development of side effects. Misconceptions regarding antibiotic can lead to misuse of antibiotics. So, consumers’ knowledge towards antibiotic may play a vital role in the success of treatment process.</p> <p><strong>Objectives</strong>: To investigate the level of basic knowledge towards antibiotics among troops of Bangladesh Army and their relatives in Rangpur, Bangladesh.</p> <p><strong>Materials and Methods</strong>: This cross-sectional study was conducted from January to March 2015 for 12 weeks using the structured questionnaire involving 389 respondents attending outdoor of various departments of Combined Military Hospital (CMH), Rangpur. A random knowledge score system was used to assess basic knowledge based on the answers provided.</p> <p><strong>Results</strong>: The mean age of the respondents was 30.434 years (SD=6.5365) with male (53.47%) predominance. Out of 389 respondents, 219(56.30%) respondents had a moderate level of knowledge. Most of the respondents (89.72%) could correctly identify that antibiotics are indicated for the treatment of bacterial infections. However, 348(89.46%) respondents incorrectly thought that antibiotics are also used to treat viral infections. Most of the respondents wrongly believed that antibiotics are indicated to relieve pain (68.69%) and reduce fever (77.38%). About 270(69.41%) respondents were aware of antibiotic resistance phenomena in relation to overuse of antibiotics. Age, sex and educational level were significantly associated with knowledge towards antibiotic.</p> <p><strong>Conclusion</strong>: Educational intervention is needed to promote prudent use of antibiotic.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.12(1) 2016: 12-16</p> Sayeda Nazrina Dipak Kumar Paul Chowdhury Abdullah Al Maruf Wahida Rahman ##submission.copyrightStatement## 2016-01-23 2016-01-23 12 1 12 16 10.3329/jafmc.v12i1.39950 Comparison of 27 G Quincke and 25 G Quincke Needles for Post Dural Puncture Headache in Caesarean Section <p><strong>Introduction: </strong>Although modern anaesthesiology has made great progress in the last decades and spinal anaesthesia is popular for its effectiveness, Post Dural Puncture Headache (PDPH) is a significant and well known complication of spinal anaesthesia that may be incapacitating for patients. A few decades ago less refined and thicker spinal needles were being used and the incidence of PDPH was high. But within the last 15 years more refined and thinner needles have been used and the incidence of PDPH is grossly reduced.</p> <p><strong>Objective: </strong>To compare the incidence and severity of post dural puncture headache using 25 G Quincke and 27 G Quincke needle during spinal anaesthesia in case of caesarean section.</p> <p><strong>Materials and Methods: </strong>This randomized prospective study was carried out in the Border Guard Hospital, Dhaka, during the period of January to July, 2015. Patients were selected randomly from the age group of 20-35 years having a pregnancy of at least 34 weeks gestation with a single uncompromised fetus and uncomplicated pregnancy. Patients with a history of migraine, convulsion, cerebrovascular accident, Pre-eclampsia, eclampsia, spinal deformity, coagulopathy or previous neurological disease were excluded. They were randomly allocated into two groups. Each group consisting of 50 patients. Data was collected by interviewing and observation results. Data were processed and analyzed by using statistical test.</p> <p><strong>Results: </strong>There was no statistically significant difference found in age, height, weight and ASA status between two groups. 27G Quincke needle had significantly higher failure rate of successful lumber puncture in first attempt than the 25G Quincke needle (20% vs 6%, P&lt;0.05). There was no difference difference regarding the incidence of intraoperative complications between two groups. The overall incidence of PDPH was 2(4%) in group A and 12 (24%) in group B (P&lt;0.05). Decreased severity of headache was noted in the 27G group Quincke needle. There was no difference regarding the duration of headache in between two groups.</p> <p><strong>Conclusion: </strong>This study suggests that the risk of PDPH was much lower in 27G Quincke needle as compared to 25G Quincke needle though it had a higher failure rate of successful lumber puncture in first attempt. For spinal anaesthesia 27G Quincke needle should be used.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.12(1) 2016: 17-21</p> Md Anisul Islam Amena Begum SM Shahida ##submission.copyrightStatement## 2016-01-23 2016-01-23 12 1 17 21 10.3329/jafmc.v12i1.39951 Effects of Smoking on Pilots of Bangladesh Air Force in Dhaka Area <p><strong>Introduction: </strong>Smokers have a high morbidity and mortality rate and the causes of excess morbidity and mortality include lung cancer, COPD (Chronic Obstructive Pulmonary Disease) and cor pulmonale. An estimated 100 million people died in the 20th century from tobacco-associated diseases. Smoking also affects the performance and cause physical deterioration of pilots.</p> <p><strong>Objectives: </strong>To evaluate the effects of smoking on pilots of Bangladesh Air Force (BAF), Dhaka area.</p> <p><strong>Materials and Methods: </strong>This cross sectional study was conducted during the period of January to June 2014 among the available pilots of different age and ranks of 6 flying squadrons of BAF Dhaka area. Data were collected by using a pre-tested semistructured questionnaire distributed among the pilots. Information were also collected from Central Medical Board (CMB), BAF about total number of pilots placed in low medical category and nature of their sickness. Finally chest X-ray and ECG of the pilots were done to find out any respiratory and cardiovascular abnormalities. Data obtained were entered into SPSS version 21.0 for analysis.</p> <p><strong>Results: </strong>Total 190 pilots were interviewed and among them, 80(42%) were smokers and 110(58%) were non-smokers. Most of the pilots were within the age group of 26-30 years (30%). Out of 80 smoker, 37(46%) smoked for more than 10 years, rest smoked for 10 years and less. Stress was the most common cause of starting smoking (96.3%). Fifty eight (72.5%) pilots agreed that their stamina and physical efficiency decreased due to smoking, 21 (26.3%) experienced breathlessness at high altitude, 26(32.5%) experienced visual disturbance during night flying. Fifty three (66.3%) pilots complained of occasional episode of palpitation along with increase in pulse rate. Thirty one (39%) experienced occasional headache during high altitude flight, 58(72.5%) had heart burn related to smoking. Thirty eight (47.5%) had occasional bouts of cough with sputum and 40(50%) complained of occasional gum bleeding. These pilots also informed that they reported sick several times for headache, heart burn, cough and URTI (Upper Respiratory Tract Infection) and were unfit for flying duties. During January-June 2014, a total of 10 pilots of BAF Dhaka area were placed in low medical category out of them 6 (60%) pilots had smoking habits and suffered from IHD-4 (Ischemic Heart Disease) and HTN-2 (Hypertension). There was statistically significant association between number of the cigarette smoked, period of smoking and physical deterioration of smoker pilots (P&lt;0.05). Those who smoked more than 10 sticks/day and more than 10 years had moderate to severe physical deterioration.</p> <p><strong>Conclusion: </strong>Smoking adversely affects all systems of human body. It impairs altitude tolerance, early induction of hypoxia, impairment of night vision. It affects autonomic systems and thus impairs all compensatory mechanism needed at higher altitudes. Morbidity and mortality related to smoking have linear relation. Pilots must be indoctrinated not to smoke for the sake of their safety flight, own life, their families and the nation.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.12(1) 2016: 22-27</p> Mohammad Ahmed Ahsan Umar Rashed Munir Mushtaq Ahmad Md Shahidullah ##submission.copyrightStatement## 2016-01-24 2016-01-24 12 1 22 27 10.3329/jafmc.v12i1.39962 Variations of Lung Function Status in Hypertension and Antihypertensive Medication <p><strong>Introduction: </strong>Essential hypertension is associated with altered pulmonary function. Antihypertensive medication and lung function are also associated. Amlodipine (calcium channel blocker) and Atenolol (beta blocker) are commonly used antihypertensive drugs.</p> <p><strong>Objective: </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 essential hypertensive patients. Based on prescribed treatment, these study subjects were divided into two groups - B1 and B2. B1 included 50 patients who received amlodipine 5mg daily and B2 included 50 patients who received atenolol 50mg daily. Lung function tests were done in both B1 and B2 groups before taking medication, after 3 months of medication and after 6 months of medication. 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 computer based Spirometer. Age, sex and BMI matched 50 apparently healthy normotensive subjects were also studied as control (group A). Data were compared among subjects of different groups. For statistical analysis independent sample‘t’ test and paired sample‘t’ test were performed.</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 subjects. Mean FVC, FEV1 and PEFR were found significantly higher in the group taking amlodipine for 6 months when compared to newly diagnosed hypertensive patients but lower than those of controls. In addition mean FVC and FEV1 were found significantly lower in the group taking atenolol for 6 months when compared to newly diagnosed hypertensive patients and those of controls.</p> <p><strong>Conclusion: </strong>Reduced lung function occurs in newly diagnosed essential hypertensive patients which improve by treatment with amlodipine but decreases after treatment with atenolol.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.12(1) 2016: 28-32</p> Mst Nasrin Nahar Shelina Begum Sultana Ferdousi Sharmeen Sultana Zinia Parveen Tunergina Akhter Tamanna Habib ##submission.copyrightStatement## 2016-01-24 2016-01-24 12 1 28 32 10.3329/jafmc.v12i1.39963 Accuracy of Ultrasonogram in Diagnosis of Acute Appendicitis <p><strong>Introduction</strong>: Acute appendicitis is one of the most common causes of abdominal pain of adult patients referred to the emergency department. Despite its prevalence, the diagnosis of appendicitis can be elusive and fraught with pitfalls because of the absence of a pathognomonic sign or symptom and the poor predictive value of laboratory testing. So following the significant advances in accuracy, ultrasonography has become an important part of the modern work-up of acute appendicitis.</p> <p><strong>Objective</strong>: To evaluate the role and accuracy of ultrasonography in the diagnosis of acute appendicitis. Materials and Methods: A total number of 110 cases (65 men and 45 women), with clinical suspicion of appendicitis, were subjected to abdominal ultrasonographic examination. All ultrasonographic positive cases and a few of ultrasonographic negative cases were subjected to operative intervention.The accuracy of ultrasonography in the diagnosis of appendicitis was compared with the clinical diagnosis, operative findings and histopathological examination reports. The statistical analysis was done by using SPSS10.</p> <p><strong>Results</strong>: Among 110 cases, 77 cases were sonographically positive for appendicitis and 5 cases were appendicular masses. The cardinal signs were right lower abdominal tenderness, rebound tenderness and positive Rovsing’s sign. The specificity of Ultrasound was 74.28%, sensitivity 90.66%, positive predictive value 88.31%, negative predictive value 78.79% and accuracy was 85.45% in the diagnosis of acute appendicitis.</p> <p><strong>Conclusion</strong> So far the cost reduction of treatment and negative laparotomies are concerned, the ultrasonography is still an useful tool in the diagnosis of appendicitis in spite of more recent investigations like CT abdomen and Laparoscopy.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.12(1) 2016: 33-37</p> Rosy Perveen AFMS Islam Habibur Rahman Ruksana P Khan ##submission.copyrightStatement## 2016-01-24 2016-01-24 12 1 33 37 10.3329/jafmc.v12i1.39964 Evaluation of Sympathetic Nerve Function Status in Hypertensive Patients <p><strong>Introduction: </strong>Hypertension is independent and the most powerful predictor of cardiovascular morbidity and mortality. Sympathetic overdrive may be related to essential hypertension. Heart Rate Variability (HRV) analysis is one of the most quantitative markers of autonomic activity in hypertensive patients.</p> <p><strong>Objective: </strong>To assess the cardiac autonomic nerve function status by heart rate variability in essential hypertension.</p> <p><strong>Materials and Methods: </strong>This cross sectional study was carried out to observe the HRV in 60 hypertensive male patients with age ranging from 40-60 years (group B) in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University (BSMMU) from 1st July 2008 to 30th June 2009. Based on treatment, hypertensive patients were divided into B1 (untreated patients on their 1st day of diagnosis) and B2 (patients with antihypertensive therapy for less than 5 years). For comparison, 30 apparently healthy normotensive subjects (group A) matched by age sex were also studied. The study group was selected from the Out Patient Department of Cardiology, BSMMU, Dhaka and the control group was selected by personal contact. Heart Rate Variability parameters were assessed by Polygraph (RMS Polyrite D, version2.2) and for statistical analysis Independent sample t-test, One-way ANOVA test, Chi-square test and Pearson’s correlation coefficient tests were done as applicable.</p> <p><strong>Results: </strong>LF/HF(Low Frequency/High Frequency) ratio and LF norm (normalized unit) were significantly (p&lt;0.001) higher and HF norm was significantly (p&lt;0.001) lower in untreated hypertensive patients in comparison to those of healthy normotensive subjects. parameters were observed between treated hypertensive and healthy control subjects. The LF/HF ratio and LF norm showed positive correlations and HF norm showed negative correlations with SBP (systolic blood pressure) and DBP (diastolic blood pressure) in both the hypertensive groups. However, all these findings were more marked in untreated hypertensive patients than those of treated group.</p> <p><strong>Conclusion: </strong>Hypertensive patients may have sympathovagal imbalance and is usually characterized by higher sympathetic as well as lower vagal modulation of the heart rate.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.12(1) 2016: 38-43</p> Rehnuma Tabassum Sangita Mithun SM Nurul Irfan ##submission.copyrightStatement## 2016-01-24 2016-01-24 12 1 38 43 10.3329/jafmc.v12i1.39965 Morbidity and Mortality Outcome in Late Preterm Neonates at a Tertiary Care Hospital <p><strong>Introduction: </strong>The morbidity and mortality in late preterm neonates is higher than term neonates. The main reason is the relative physical and neurologic immaturity, though there is no significant difference in the weight or the size of the two groups.</p> <p><strong>Objective: </strong>The study was conducted to compare the early neonatal morbidity and mortality (within first 7 days of life) in late preterm infants (34–36 6/7 weeks) with those in term neonates (37–41 6/7 weeks).</p> <p><strong>Materials and Methods: </strong>This was a prospective study conducted from 01 January 2015 to 30 June 2015 in the department of Neonatology at a tertiary hospital.</p> <p><strong>Results: </strong>Total 100 neonates were included in the study; fifty neonates in each group. Late preterm infants had significantly higher morbidity due to any cause, e.g. respiratory morbidity (p&lt;0.05), jaundice (p&lt;0.05), hypoglycemia (p&lt;0.05), sepsis (p&lt;0.05) and perinatal asphyxia (p&lt;0.05). Early neonatal mortality in late preterm neonates was significantly higher than term neonates (p&lt;0.05).</p> <p><strong>Conclusion: </strong>Late preterm neonates are at high risk for morbidity and mortality as compared to term neonates.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.12(1) 2016: 44-47</p> Tahsinul Amin Ayesha Najma Nur ##submission.copyrightStatement## 2016-01-24 2016-01-24 12 1 44 47 10.3329/jafmc.v12i1.39966 Stress Fractures in Female Cadets in Bangladesh Naval Academy during Training <p><strong>Introduction</strong>: Stress fractures occur due to repetitive cumulative micro trauma on the bone over a period of time. These are common overuse injuries in military cadets and sports personnel during training. Stress fracture in female cadets is a rising cause of concern for its high prevalence. It increases morbidity, long term absence from training and significant economic loss.</p> <p><strong>Objective</strong>: To find out the prevalence, time of occurrence and sites involved among the fresh female cadets during their basic training.</p> <p><strong>Materials and Methods:</strong> A descriptive cross-sectional study was conducted during January 2011 to April 2017 in female cadets undergoing basic training at Bangladesh Naval Academy, Chittagong. A detailed history and physical assessment was performed of those presenting with pain, swelling or limping. Radiographic imagings were done to evaluate the symptoms. All cases of stress fractures were finally diagnosed on the basis of findings and were appropriately managed and followed up every two weeks till the time of union.</p> <p><strong>Results</strong>: Eighteen cases out of 82 had clinical and radiological signs of stress fractures with an overall prevalence of 21.95%. Average age was 19 years (range 18-20). Highest prevalence was around 12 weeks of training. Common sites were tibia (40.90%), pelvis (40.90%) and fibula (9.09%). There was one metatarsal and one femoral neck fracture. All the fractures were treated conservatively and were healed in an average period of 7 weeks. All cadets returned to their full activity in an average period of ten weeks.</p> <p><strong>Conclusion:</strong> Prevalence among the female naval cadets is high and probably underrated in this setting. For prevention, modifiable causes and risks factors must be evaluated and identified. A protractive approach for early detection and immediate management is indispensible to reduce the morbidity and early return to full activity.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.12(1) 2016: 48-52</p> Md Borhan Uddin Md Anisur Rahman ##submission.copyrightStatement## 2016-01-24 2016-01-24 12 1 48 52 10.3329/jafmc.v12i1.39967 Effects of Preoperative Mean Platelet Volume on Early Outcomes of Patients after Conventional Coronary Artery Bypass Graft Surgery <p><strong>Introduction: </strong>The Mean Platelet Volume (MPV) is a marker of platelet size with increased platelet activation. An elevated MPV is associated with major cardiac adverse events after Coronary Artery Bypass Graft (CABG) surgery. Effect of preoperative MPV on outcome of in-hospital patients after coronary artery bypass graft surgery was investigated in this study.</p> <p><strong>Objective: </strong>To investigate the association of preoperative MPV with in-hospital outcome of patients after CABG surgery.</p> <p><strong>Materials and Methods: </strong>An observational prospective study was carried out in the Department of Cardiovascular Surgery, National Institute of Cardiovascular Diseases (NICVD), Dhaka during the period from July 2012 to June 2014. Preoperative mean platelet volume was obtained prospectively in 81 consecutive patients undergoing conventional coronary artery bypass surgery. The patients were divided into two groups according to normal and elevated MPV at 10.60 femtolitre (fL) cut off level. Postoperative mortality and major adverse events were recorded in the early postoperative period.</p> <p><strong>Results: </strong>Combined adverse events including post operative Myocardial Infarction (MI), arrhythmia, bleeding and death occurred in 27 patients (33.3%) during the early follow-up. The preoperative mean platelet volume levels were found to be associated with postoperative adverse events (p&lt;0.05). In multivariate logistic regression models, the preoperative mean platelet volume levels was found strong independent predictor of combined adverse events after surgery (OR 1.968, p=0.008).</p> <p><strong>Conclusion: </strong>Mean platelet volume is simple, readily available and cost effective tool and useful in predicting the postoperative adverse events in patients undergoing coronary artery bypass graft surgery.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.12(1) 2016: 53-56</p> Md Amirul Hasan Md Abul Quashem Sharmin Jahan ##submission.copyrightStatement## 2016-01-24 2016-01-24 12 1 53 56 10.3329/jafmc.v12i1.39968 Microscopic Colitis- Its Prevalence and Characteristics in Diarrhoea Predominant Irritable Bowel Syndrome- A Study of 100 Cases <p><strong>Introduction</strong>: Irritable bowel Syndrome (IBS) is a functional disorder of abdominal pain or discomfort associated with altered bowel habit. Microscopic colitis is a chronic inflammatory condition associated with non bloody diarrhoea and characteristic histological finding. The subset of diarrhoea predominant IBS is having similarity in presentation with microscopic colitis.</p> <p><strong>Objective</strong>: To assess the prevalence and characteristics of microscopic colitis in Diarrhoea predominant Irritable Bowel Syndrome (IBS-D).</p> <p><strong>Materials and Methods</strong>: This observational study was conducted at the department of Gastroenterology, Combined Military Hospital, Dhaka during the period of January 2011 to June 2011. Initially 100 cases of diarrhoea predominant IBS who met Rome III criteria were included. Among those 100 cases, 57 were male and 43 were female. Mean age was 46 years ±2.8 SD(range 18-72). Six patients were subsequently excluded because of some macroscopic abnormalities at colonoscopy. Finally 94 patients of clinical IBS-D whose colonoscopy were normal, biopsy specimens were taken from caecum, transverse colon, descending colon, sigmoid and rectum. Microscopic colitis was diagnosed on the basis of evidence of increased intraepithelial lymphocytes of ≥20/100 inter cryptal epithelial cells and infiltration of lamina propria by mixed inflammatory cells. Overlap of other symptoms between Microscopic Colitis (MC) and IBS-D were also evaluated. Results: Among the 94 patients of clinical IBS-D, 23(24%) patients were histologically proved to have microscopic colitis. Besides Rome III criteria, there was significant overlap of other symptoms. Occasional fever and infrequent arthralgia 7% and 26% vs 4% respectively) but tenesmus, passage of excessive mucus and heart- burn were more prevalent in IBS-D than MC (35% vs 13%, 32% vs 4% and 32 vs 9% respectively). Among the 23 cases of MC, 13(57%) patients were female and 10(43%) patients were male. Mean age of microscopic colitis was 56 years ±2.6 SD (range 25-72). Regarding subtypes of microscopic colitis, 21(91%) patients had lymphocytic colitis (LC) and 2 (9%) patients had collagenous colitis (CC). Of the lymphocytic colitis 11 were female and 10 were male and of the 02 cases of collagenous colitis all were female. MC affected mostly the transverse colonie 11(48%) cases and the next common site was caecum ie 8(35%) cases.</p> <p><strong>Conclusion</strong>: A good percentage of diarrhoea predominant IBS are actually having microscopic colitis. MC is more common in female and elderly persons. In all elderly patients of IBS-D full colonoscopy should be done and biopsy should be taken from multiple sites to exclude microscopic colitis.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.12(1) 2016: 57-62</p> SM Mizanur Rahman SM Motahar Hossain Niamul Gani Chowdhury Md Delwar Hossain Jakeya Rashid ##submission.copyrightStatement## 2016-01-24 2016-01-24 12 1 57 62 10.3329/jafmc.v12i1.39969 Haematological Changes of Critically ill Patients Admitted in CMH, Dhaka <p><strong>Introduction: </strong>Haematological status is an important parameter for the management of critically ill patients.</p> <p><strong>Objective: </strong>To see the status of the haematological changes of critically ill patients admitted in CMH, Dhaka.</p> <p><strong>Materials and Methods: </strong>This cross sectional study was conducted in the Department of Haematology of Armed Forces Institute of Pathology and Intensive Care Unit of Combined Military Hospital, Dhaka from March 2014 to September 2014 for a period of 6 months. All the patients who were admitted in the Intensive Care Unit of Combined Military Hospital, Dhaka at any age with either sex were included in this study. The complete blood count and coagulation parameters were considered and data sheet was prepared.</p> <p><strong>Results: </strong>A total number of 862 samples were analyzed. Male female ratio was 1.8:1. Anaemia was found in 43.2% patients and 22.3% patients had Erythrocytosis. Normocytic Normochromic Anaemia was the most common morphological subtype of Anaemia. 13.8% patients had Leukopenia and 55.1% patients had Leukocytosis; 7.3% patients had Neutropenia and 49.0% patients had Neutrophilia. 10.0% patients had Eosinophilia. 26.3% patients had Lymphopenia and 14.7% patients had Lymphocytosis. 39.1% patients had Thombocytopenia and 20.3% patients had Thrombocytosis. MCV (Mean Corpuscular Volume) was below normal in 36.5% patients and was above normal in 16.8% patients. MCH (Mean Corpuscular Hemoglobin) was below normal among 49.7% patients and 11.1% patients above normal. MCHC (Mean Corpuscular Haemoglobin Content) was below normal level in 61.8% patients and 3.7% patients had above normal. Abnormal coagulation parameters that is prolonged PT, APTT and raised FDP was found in 36.3%, 18.6% and 35.8% patients.</p> <p><strong>Conclusion: </strong>Critically ill patients were suffering from anaemia and thrombocytopenia with significant changes in other blood cells counts and coagulation parameters.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.12(1) 2016: 63-67</p> Masuma Ahmed Salsabil Md Manirul Islam Jannatul Ferdous Shameem Montasir Hossain ##submission.copyrightStatement## 2016-01-24 2016-01-24 12 1 63 67 10.3329/jafmc.v12i1.39971 A Comparative Study on Efficacy of 30% Trichloroacetic Acid versus 35% Glycolic Acid Peel in the Treatment of Melasma <p><strong>Introduction: </strong>Melasma is a common hyperpigmented disorder of skin which has severe impact on the quality of life. Many modalities of treatment are available to treat melasma. Among them chemical peeling is one of the most popular and widely used method of treatment for melasma.</p> <p><strong>Objective: </strong>The present study was aimed to assess the efficacy of 30% trichloroacetic acid versus 35% glycolic acid peel in the treatment of melasma.</p> <p><strong>Materials and Methods: </strong>The prospective randomized study included 50 patients of melasma of both sexes, in 20-55 years age group. Patients were randomly divided into two equal groups A and B. Group A was treated with trichloroacetic acid (TCA 30%) peel and group B with glycolic acid (GA 35%) peel. Five peels were done serially at intervals of 21 days. Patients were followed up every 3 weekly for 6 weeks after the last peel. The disease severity was monitored with digital photography and melasma area and severity index (MASI) score which were calculated at baseline, 6 weeks, 12 weeks and 18 weeks. A visual analog scale (VAS) was calculated at baseline, 12 weeks and 18 weeks.</p> <p><strong>Results: </strong>Glycolic acid showed better response compared to trichloroacetic acid at the end of five peels, but this difference was not statistically significant (p&gt;0.05). Chemical peeling with trichloroacetic acid produced significantly more erythema, burning sensation (p&lt;0.05) and higher incidence of post peel inflammatory hyperpigmentation (p&lt; 0.05) compared to glycolic acid.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.12(1) 2016: 68-71</p> Syeda Tania Begum Md Abdul Latif Khan Md Sayeed Hasan Md Shirajul Islam Khan ATM Rezaul Karim ##submission.copyrightStatement## 2016-01-24 2016-01-24 12 1 68 71 10.3329/jafmc.v12i1.39972 Status of Height in Children Aged 4 to 14 Years in Relation to Mid Parental Height- An Observational Study <p><strong>Introduction: </strong>The adult height of a growing child largely depends on the heredity. The present height status of a child can be determined by mid parental height. This study is an initial step to determine the status of height in children between 4 years to 14 years in relation to mid parental height.</p> <p><strong>Objective: </strong>To assess the status of height in relation to parental height in children aged between 4 to 14 years and to assess other factors (birth order, number of younger siblings, gestational age at birth, birth weight, feeding in first six month of age, maternal age at child birth, maternal education, crowding, monthly family income and area of residence) that may influence height, other than parental height.</p> <p><strong>Materials and Methods: </strong>A cross-sectional observational study was conducted on 100 children of age between 4 years to 14 years attending outpatient department and inpatient department of Sher-E-Bangla Medical College Hospital, Barisal from 1st March 2011 to 31st August 2011. Data were collected through interviewing with pre-designed questionnaire and anthropometry.</p> <p><strong>Results: </strong>A total 100 children of 4 to 14 years of age were enrolled during the study period. Among them 46 were male and 54 were female. Among all the cases under study, 60 cases were appropriate in status of their height in relation to their parental height, whereas 20 cases were tall in status and another 20 cases were short in status in relation to their mid-parental height. Apparently, it seems both the tall and short cases were equal in number, but the mean of Z scores of all children under the study was -0.432 and median was -0.55 which indicates the overall loss of height. Higher maternal age, appropriate gestational age, higher birth weight, first birth order and higher maternal educational status came out to be having strong influence on higher height in relation to mid parental height while higher total family income had weaker influence.</p> <p><strong>Conclusion: </strong>Height status of our country is almost static in condition, but there is slight inclination towards being shorter in future. Though very apparent but male children are in slight shorter while female children are apparently taller in status, which may be due to early age of puberty in case of female children.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.12(1) 2016: 72-78</p> Abdullah Al Amin Subrata Roy Syed Zahid Hossain ##submission.copyrightStatement## 2016-01-24 2016-01-24 12 1 72 78 10.3329/jafmc.v12i1.39973 Academic Stress, Anxiety and Depression among the Students of Armed Forces Medical College, Dhaka Cantonment <p><strong>Introduction: </strong>Study in Medical College can act as a contributing factor in developing depression in medical students which may have possible negative academic and professional consequences. Study in any medical course is perceived as being inherently stressful across the globe. Studies on psychological problems such as academic stress, anxiety and depression among medical students have seen that these disorders are under diagnosed and under treated. In this background the present study was carried out with an aim to assess the magnitude of depression and its associated factors in medical students in AFMC.</p> <p><strong>Objective: </strong>To find out the prevalence of depressive symptoms and its associated factors among the students of Armed Forces Medical College (AFMC), Dhaka, Bangladesh.</p> <p><strong>Materials and Methods: </strong>This descriptive type of cross sectional study was carried out in AFMC, Dhaka, Bangladesh for a period from February to April 2014. A total of 211 students studying from 1styear to 4th year MBBS participated in the study. Depression was assessed by Goldberg’s General Health Questionnaire (GHQ-28) and Beck Depression Inventory(BDI) scoring was used to find out the level of depression. BDI scoring 0-10 was considered as normal ups and downs, 11-20 as mild depression, 21-30 as moderate depression, 31-40 as severe depression and more than 40 as extreme depression. Additional questions regarding socio demographic variables were also included. Data analysis was done by software SPSS 19 for windows.</p> <p><strong>Results: </strong>A total of 211 students participated in the study. Among them 86(40.8%) students were reported as having mild to moderate depressive symptoms. Depression was very significantly (p&lt;0.001) higher in 1st year 55(83.3%) than 2nd year 25(38.46%), 3rd year 03(5.45%) and 4th year 03(12%) students. Depression was significantly (p&lt;0.05) higher in Non English Medium background 82(38.8%) than English Medium background 04(1.9%).</p> <p><strong>Conclusion: </strong>Depression may be a significant hidden problem for few of the Medical students and mechanisms to identify and help students with mental health problems should be seriously considered. This calls for in-house counseling service and mentorship program at medical colleges for early detection and treatment of these problems that may help in the improvement of academic performance.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.12(1) 2016: 79-82</p> Molla Muntasir Hossain Md Abdul Wahab ##submission.copyrightStatement## 2016-01-24 2016-01-24 12 1 79 82 10.3329/jafmc.v12i1.39974 Infantile Colic: Incidence and Effectiveness of Conventional Therapy <p><strong>Introduction</strong>: Infantile colic is defined as excessive crying for more than three hours a day at least three days a week for one week or more in an otherwise healthy baby. It is most frequently observed in neonates and infants aged two weeks to four months. Objective: To assess the incidence of infantile colic and effectiveness of conventional therapy.</p> <p><strong>Materials and Methods</strong>: This was a prospective cross sectional study of 50 cases carried out in Paediatric out patient department in Combined Military Hospital (CMH) Ghatail during the period of September 2010 to August 2012. Data recorded including demographics, clinical presentations, management and the outcome of therapy.</p> <p><strong>Results</strong>: Out of the total 50 patients, 24(48%) were male and 26(52%) were female. Male:Female=1:1.08. Babies delivered vaginally suffered more 32(64%), full term delevered babies 33 (66%) suffered more than that of gestational age group &lt;37 wk. Non-exclusive Breastfed (Formula fed, combination of breastfed and formula fed) babies having more incidence of colic 31(62%). Maximum patients 26(52%) had history of cry 4-5 hours per day. Motion (Rocking, bouncing, walking etc) 18(36%), change of diet 14(28%) were considerable satisfactory treatments.</p> <p><strong>Conclusion</strong>: Since it is a self limiting condition, conventional therapy should be tried for instant relief.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.12(1) 2016: 83-87</p> Syeda Zeenat Laila Anjuman Ara Beauty Md Mahboob Hasan Md Mizanur Rahman Khan ##submission.copyrightStatement## 2016-01-24 2016-01-24 12 1 83 87 10.3329/jafmc.v12i1.39975 Management of Temporomandibular Joint Disorders by Arthroscopic Lavage <p><strong>Introduction: </strong>Temporomandibular joint disorders (TMDs) are among the most common disorders in the maxillofacial region which usually present with joint pain, decreased jaw mobility, joint clicking, headache, tinnitus, neck pain etc. There are different modalities of treatment used for the TMDs. These include some conservative and surgical procedures. The main aim is to improve the jaw function and reduction of joint pain. Arthroscopy is a modern diagnostic and effective therapeutic procedure for the TMDs.</p> <p><strong>Objective: </strong>To assess the outcome of arthroscopic lavage of Temporomandibular Joint (TMJ) in terms of improvement of jaw function and joint pain in patients suffering from TMDs.</p> <p><strong>Materials and Methods: </strong>This prospective study was carried out at the department of Oral and Maxillofacial Surgery, Military Dental Centre, Combined Military Hospital of Dhaka Cantonment from 01 October 2014 to 31 March 2016. Patients were selected consecutively having TMDs and unresponsive to conservative nonsurgical therapy. Total thirty patients of TMDs were selected for study and all the patients were treated with arthroscopic lavage. Objective data were collected including, inter incisal opening, lateral excursion, deviation on opening, tenderness on palpation. A questionnaire in the form of visual analogue scale relating to pain, joint clicking and Jaw mobility were completed by each patient at 1 week,1 month and 6 months post operatively.</p> <p><strong>Results: </strong>Among thirty patients, 10 patients were male and 20 patients were female. Mean age of the patient was 42.6±5.79 years. Maximum patients were in the age group of 41-45 years. There was statistically significant improvement in maximum incisal opening and pain score. There was also reduction in Joint clicking and tenderness in maximum patients.</p> <p><strong>Conclusion: </strong>The findings of the present study suggested potential utility of arthroscopic lavage in the management of TMDs.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.12(1) 2016: 88-93</p> Md Abdur Rab Golam Mohiuddin Chowdhury Abdullah Al Mehedi Quazi Sindhi Mohammad Iqbal Kabir Shaila Sharmin ##submission.copyrightStatement## 2016-01-24 2016-01-24 12 1 88 93 10.3329/jafmc.v12i1.39976 Nutritional Status and Disease Profile of Under Five Children in a Selected Rural Area <div> <p><strong>Introduction: </strong>Malnutrition is referred to as the greatest single threat to the world’s public health, especially for the developing countries. Childhood malnutrition is linked to slower cognitive development and serious health impairments later in life that reduce the quality of life of individuals. Nutritional status is determined anthropometrically and is a significant determinant of various types of morbidity and is associated with an increased risk of death from acute respiratory infection, diarrhoea, measles and few other infectious diseases.</p> <p><strong>Objective: </strong>To assess nutritional status and disease profile of under five children in a rural area of Bangladesh.</p> <p><strong>Materials and Methods: </strong>This cross-sectional study was conducted among 205 children with age between 1 to 59 months who were selected purposively. Two hundred five data were collected by interviewing the mothers of the children and also by reviewing the documents using a pretested semi-structured questionnaire and checklist. Nutritional status was assessed using WHO recommended Z-score category and Mid Upper Arm Circumference measurement.</p> <p><strong>Results: </strong>Out of 205 children, more than half (57.6%) were girls and the rest of them were boys. About two-third of the children were aged between 25 and 59 months. Maximum (40.5%) mothers of the children had a background of secondary educational status and most of them (90.2%) were housewives. More than one-third (36.1%) of the respondents belong to families haveing monthly income between Tk. 5001 and 10,000 and the average income was Tk.14,544. About onethird (33.5%) of the children were stunted in Height for Age Z score. While 9.7% were moderately wasted and 1.5% were severely wasted in Weight for Height Z score. 3.8% of the children were severely underweight and 70.8% of the children’s weight was within the normal limit for their age. By Mid Upper Arm Circumference (MUAC) measurement, about 20.0% were of moderate acute malnutrition (MAM) and 1.1% were of severe acute malnutrition (SAM). Among the associated morbidities, diarrhoeal disease had highest prevalence (45%) followed by respiratory tract infection (38%) and pneumonia (18%).</p> <p><strong>Conclusion: </strong>Under five children are the vulnerable segment of the population. The result demonstrates a high prevalence of malnutrition (especially stunting) among under five children in the study area. Considering the acute and long-term consequences of malnutrition, interventions aiming at reducing child malnutrition in such a population should focus on all the children of less than 5 years of age.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.12(1) 2016: 94-99</p> </div> <p>&nbsp;</p> Nasrin Sultana Sumon Chandra Debnath Rifat Sultana Shamina Akter Dewan Shahida Banu Mahmuda Khatun ##submission.copyrightStatement## 2016-01-24 2016-01-24 12 1 94 99 10.3329/jafmc.v12i1.39977 Trend of Changing Morphological Pattern of Adult Nephrotic Syndrome, Global and Bangladesh Perspective <p>Nephrotic Syndrome (NS) is a clinical condition characterized by massive proteinuria, hypoalbuminemia, hypercholesterolemia, and generalized oedema. It occurs more commonly in children than in adults, and usually manifests as one of two usually idiopathic diseases: Minimal change NS (MCNS) or focal segmental glomerulosclerosis (FSGS). It has also an incidence of three new cases per 100000 each year in adults. During 70s and 80s membranous nephropathy was considered to be the prime cause of adult NS worldwide. In USA, Brazil, Singapore and South East Asian countries specially in India and Pakistan FSGS has exceeded all other causes of adult NS during last three decades. While in most of the countries of Europe, Australia, Japan, Iran IgA nephropathy has become the main cause of adult NS. Membranoproliferative glomerulonephritis (MPGN) is the predominant cause in certain countries like Russia, South Africa, Singapore etc. In some countries like UAE and Nepal MN is still found to be the main cause of adult NS. In Bangladesh only a few studies are documented which show variable predominant causes of adult NS. It is possibly due to inconsistent renal pathology facilities available in the countries and lack of dedicated renal pathologists.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.12(1) 2016: 100-108</p> Sk Md Jaynul Islam SM Mahbubul Alam Md Monir Ul Islam ##submission.copyrightStatement## 2016-01-24 2016-01-24 12 1 100 108 10.3329/jafmc.v12i1.39979 Strongyloidiasis: The Cause of Hypereosinophillia and Duodenal Ulcer in an Immunocompetent Individual <p>Strongyloidiasis is a common parasitic disease in tropical and sub-tropical regions of the world. Infection with Strongyloides Stercoralis usually remains asymptomatic with peripheral eosinophilia and uncontrolled growth. Consequently, immunocompromised individuals are at a higher risk of complications of this disease. A case of an immunocompetent patient who had complaint of acute abdominal pain and was found to have duodenal ulceration. Laboratory examination revealed significantly elevated absolute eosinophil count at 17000/cmm (normal 0-500/cmm). The stool R/E revealed rhabtidiform larvae suggestive of Strongyloides stercoralis nematode. Endoscopy of upper GIT showed ulcer in duodenum. The patient was treated with weekly dose of Tab Albendazole for two weeks and after that peripheral eosinophilia count became normal. This study found that the elevated eosinophil count played a central role in the pathogenesis.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.12(1) 2016: 109-111</p> Md Monirul Hoque Shuvojit Sen Md Nizam Uddin ##submission.copyrightStatement## 2016-01-24 2016-01-24 12 1 109 111 10.3329/jafmc.v12i1.39980 Pneumatosis Cystoides Intestinalis: A Rare Cause of Pneumoperitoneum in Children <p>Pneumatosis Cystoides Intestinalis (PCI) is a rare disease characterized by presence of air-filled cysts in the gastrointestinal wall. The incidence of PCI is unknown as most of the patients are asymptomatic. Rarely, patients may experience symptoms secondary to the cysts. The pathogenesis of PCI is still unclear and as such many theories are proposed. Usually, no treatment is necessary for 85% of patients who are asymptomatic. Surgery may be required for complications.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.12(1) 2016: 112-115</p> Shams ud Din Elias Khan HR Harun Meherun Nessa Khaled Hasan ##submission.copyrightStatement## 2016-01-24 2016-01-24 12 1 112 115 10.3329/jafmc.v12i1.39981 Colonic Atresia: A Case Report <p>Atresia of the colon is among the rare types of all gastrointestinal atresias. Descending colon is the rarest site of all the colonic atresias. A case report of 3 days old female baby was presented with the features of distal intestinal obstruction. At laparotomy type I atresia of the middle part of asending colon, with proximal dilatation of caecum and ilum. Microcolon was noticed in ascending colon, transverse colon, descending colon and sigmoid colon when newborn underwent exploration. Primary ileostomy and distal mucus stoma of ascending colon was done. After four weeks, closure of ostomy was done.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.12(1) 2016: 116-119</p> Meherun Nessa Shams ud Din Elias Khan Md Shakhawat Hossain ##submission.copyrightStatement## 2016-01-24 2016-01-24 12 1 116 119 10.3329/jafmc.v12i1.39982