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. en-US 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. (Col Md Ahsan Habib MBBS, M Phil) (Md Fahmid Uddin Khondoker) Tue, 23 Apr 2019 20:21:35 +0000 OJS 60 Health Problems of Elderly People in Bangladesh <p>Abstract not available</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 1-2</p> Md Azizul Islam, Md Fashiur Rahman ##submission.copyrightStatement## Fri, 21 Apr 2017 00:00:00 +0000 Soil Pattern and Breeding of Sandfly in Endemic Areas of Bangladesh <p><strong>Introduction: </strong>Sandfly breeds in soil but is selective to identify soil favourable for their breeding. Soil covered by vegetation, marshy land, orchards and settlements shows high sandfly breeding in an endemic region. Besides,the presence of inorganic constituents of the soil was found to affect sandfly breeding.</p> <p><strong>Objective: </strong>To identify soil pattern in Kala-azar endemic areas suitable for sandfly breeding, and the relationship of soil’s physical and chemical properties with their breeding which may help in taking feasible measure to control the vector of Kala-azar or Visceral Leishmaniasis (VL).</p> <p><strong>Materials and Methods: </strong>The cross-sectional type of descriptive study was conducted in the Kala-azar endemic areas of Trishal and Fulbaria of Mymensingh, Madhupur of Tangail and Chatmohor of Pabna district, Bangladesh during the period of July 2015 to December 2015. From each site, 250 gm soil was collected and packed in a plastic container. All the samples were taken in the laboratory and were kept as it is for one week to configure the moisture and soil temperature maintaining the lab room temp at 28±2ºC and relative humidity at 75.0%±2.0. Soil samples were analysed for physical and chemical properties at the Soil Science Department of Sher-e-Bangla Agricultural University, Dhaka.</p> <p><strong>Results: </strong>Total 48 soil samples were collected from Trishal, Fulbaria, Madhupur, Chatmohor and each sample was analysed for physical property (sand, silt, clay, porosity, water content), chemical constituents (pH, C, N, Ca, Mg, K, P, Fe). The mean from each district’s soil constituents (sand, silt, clay, porosity, water content) ranged from 17.36%-18.83%, 44.10%-45.46%, 35.70%-38.06% 41.98%-47.24% respectively and among the chemical constituents, pH ranged from 7.46-7.98, Carbon 0.92-0.98 Cmolkg-1, Nitrogen 0.174-0.184 Cmolkg-1, Calcium 4.83-6.21 Cmolkg-1, Magnesium 1.97-2.46 Cmolkg-1, Potassium as K2O 1.37-1.79 Cmolkg-1, Phosphorus as P2O5 12.60-13.78 Cmolkg-1, Iron as Fe2O3 9.54-10.06 Cmolkg-1 respectively.</p> <p><strong>Conclusion: </strong>Physical and chemical characteristics of soil by area of endemicity have been postulated to afford suitable environment for sandfly breeding. This information of the breeding sites of phlebotomine sandflies could help to plan environmental intervention measures that would impede the breeding of these insects.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 3-7</p> Md Fashiur Rahman, Selina Banu, Md Jahangir Alam, Md Jalal Uddin, Md Abu Sayeed Sarker, Latifa Rahman, Shyamal Paul, Mohammad Mosharraf Hossain, Md Abdul Alim, Yoshitsugu Matsumoto, Md Bahanur Rahman ##submission.copyrightStatement## Fri, 21 Apr 2017 00:00:00 +0000 Health Problems of Elderly Patients attending Combined Military Hospital, Dhaka <p><strong>Introduction: </strong>Health problems of elderly are an emerging health burden throughout the world. Bangladesh is currently undergoing a demographic transition and the proportion of the population of 60 years and older is increasing rapidly. Health care providers and policymakers are highly concerned with this burning issue.</p> <p><strong>Objective: </strong>To know the disease pattern among the elderly patients in Combined Military Hospital, Dhaka.</p> <p><strong>Materials and Methods: </strong>This cross-sectional study was carried out from July 2015 to June 2016 among 152 elderly patients above 60 years of age admitted in Combined Military Hospital (CMH), Dhaka Cantonment. Data were collected by face-to-face interview with semi-structured questionnaire and checklist following purposive sampling technique. Analysis of data was done by Statistical Package for Social Science (SPSS, version 20.0).</p> <p><strong>Results: </strong>Mean age of the elderly was 72.06±4.56 years with the range of 60-80 years and majority (90.8%) of the elderly was male. Out of total 152 elderly patients, by occupation majority (31.6%) were in the business group followed by 30.3% in the retired group and 9.2 % in the housewife group. Average monthly family income was BDT 17927.63±7360.75 with the range of BDT 6000-35000. With initial complaints elderly patients reported to doctors in private chamber (38.2%), private hospital (25.6%) and Govt hospital (5.9%). Among all of the elderly patients, majority (21.1%) had Diabetes Mellitus followed by Rheumatoid Arthritis (17.6%), Asthma (12.5%), Cataract (11.2%), ENT problem (6.6%), Malignancy (5.9%) and Benign Enlargement of Prostate 8(5.3%).</p> <p><strong>Conclusion: </strong>The number of elderly people is expanding rapidly; it also presents multifaceted health problems and thus creates unique challenges for the national healthcareservices. Early identification of problem and ensuring the availability of health with economic and social support can have a control over the elderly health problems.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 8-12</p> SM Humayun Kabir, Md Ziaul Islam, Masuda Begum, Masud Ahmed, Mohammad Mohsin, Ishrat Jahan, SM Shahidul Haque ##submission.copyrightStatement## Fri, 21 Apr 2017 00:00:00 +0000 Epidemiologic Features of Vulvovaginal Candidiasis in Women of Childbearing Age in a Combined Military Hospital <p><strong>Introduction: </strong>Vulvovaginal Candidiasis is a reproductive tract infection which remains a common cause of morbidity adversely affecting women’s physical and emotional health. Vaginal discharge in the childbearing age group is the most common complaint encountered every day both by gynaecologists and general practitioners. Among the cases of symptomatic vaginal discharge, Bacterial vaginosis is the commonest cause followed by Candidiasis and Trichomoniasis. It is characterized by curd-like vaginal discharge and itching and is associated with considerable health and economic costs.</p> <p><strong>Objective: </strong>To detect the prevalence of Candida species in patients with complaints of vaginal discharge of reproductive age group attending at Child Welfare Centre (CWC), Gynaecology Outpatient Department (GOPD) and Medical Inspection Room (MI Room) of Combined Military Hospital (CMH) Ghatail.</p> <p><strong>Materials and Methods: </strong>A cross-sectional descriptive study was conducted at CMH Ghatail during the period of April 2017 to October 2017. A total of 183 patients of reproductive age group with the complaints of vaginal discharge attending CWC, GOPD and MI Room of CMH Ghatail were included in this study. Two specimens of High Vaginal Swabs (HVS) were collected from each patient, one for direct microscopy and another for culture. For every patient, two wet film preparations and two Gram’s staining were done. Specimens were cultured on Blood Agar Medium and Sabourad’s Dextrose Agar Medium. Identification of Candida species was carried out by Wet film, Gram’s staining and culture examination.</p> <p><strong>Results: </strong>According to the results of this study, the prevalence of Vulvovaginal Candidiasis (VVC) was found in 57(31.15%) of the cases. The maximum number of patients 126(66.66%) were found between 26 years to 35 years of age group. On the other hand, amongst 57 VVC positive cases, 44(77.19%)were identified as Candida albicans and 13(22.81%) were Candida non-albicans.</p> <p><strong>Conclusion: </strong>Candida albicans is the predominant organism amongst candida species identified from VVC in this study. The high prevalence necessitates adequate screening of woman with vaginal discharge in order to give appropriate treatment and to avoid complications associated with it.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 13-16</p> Syed Nurun Nabi, Md Rahimgir, Arif Ahmed Khan, Kaniz Fatema ##submission.copyrightStatement## Fri, 21 Apr 2017 00:00:00 +0000 Sacrococcygeal Teratoma in Children- Experience in a Tertiary Military Hospital <p><strong>Introduction: </strong>Sacrococcygeal teratoma (SCT) is the most common solid tumour found in neonates. Most SCTs are reported in neonates and children, but SCTs are found in adults also. SCTs occur more commonly in females than males. If not detected antenatally, clinical features at birth are prominent in most cases as a palpable or visible mass. Surgery is the principal mode of treatment. The standard treatment for SCT with malignant elements is surgery and chemotherapy.</p> <p><strong>Objective: </strong>To share the experience with sacrococcygeal teratoma, the most common tumour found in newborn in a tertiary military hospital.</p> <p><strong>Materials and Methods: </strong>This observational study was carried out in the Department of Paediatric Surgery, CMH Dhaka during the period of January 2010 to December 2015. During the study period a total of 6 neonates with SCT were admitted in this hospital that were included in the study.</p> <p><strong>Results: </strong>The age of the patients ranged from 3 days to 1 month. Out of them 5(83.33%) were female, 1(16.67%) was male with a female to male ratio of 5:1. Four neonates (66.67%) had type-I and 2(33.33%) had type II SCT. They were not diagnosed antenatally. All presented in neonatal period and were operated as elective cases. Five neonates (83.33%) were born by normal vaginal delivery and one (16.67%) was born by Caesarean section due to cervical dystocia. All patients had elevated alpha fetoprotein (AFP). Posterior sacral approach was sufficient in all the cases and histopathology revealed benign lesion. There was no perioperative death but 1 patient (16.67%) developed malignant recurrence within 1st year and 1 patient (16.67%) developed neurogenic bladder with bilateral hydronephrosis.</p> <p><strong>Conclusion: </strong>SCTs are rare tumours that occur most frequently in neonates. Antenatal diagnosis is possible in many cases in this modern era. Follow up of cases after surgery should not only the look out for tumour recurrence, it includes the management of possible secondary urinary and/or bowel incontinence.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 17-21</p> Shams ud Din Elias Khan, Md Mahbubur Rahman, Zinia Parveen, Meherun Nessa ##submission.copyrightStatement## Fri, 21 Apr 2017 00:00:00 +0000 A Comparative Study on Short-term Clinical Outcome in Acute Coronary Syndrome <p><strong>Introduction: </strong>Coronary artery diseases are currently the major cause of death in developing countries. Acute coronary syndrome (ACS) is defined as any group of clinical symptoms compatible with acute myocardial ischemia and covers the spectrum of clinical conditions ranging from unstable angina (UA) to non-ST elevation myocardial infarction (NSTEMI) to STelevation myocardial infarction (STEMI). Accurate diagnosis and management of ACS has life-saving implications of its outcome.</p> <p><strong>Objective: </strong>To compare the outcomes of STEMI and NSTEMI in a percutaneous coronary intervention (PCI) capable centre.</p> <p><strong>Materials and Methods: </strong>The patients who undergone percutaneous coronary intervention (PCI) in Combined Military Hospital, Dhaka were considered from January 2013 to January 2017. Diagnosis of acute MI was based on the clinical presentation, electrocardiogram (ECG) and raised highly sensitive troponin I. Acute MI patients were classified into 2 groups, STEMI and NSTEMI. Their coronary risk factors, co-morbidity, ECG, echocardiogram, coronary angiographic (CAG) findings and short-term outcomes were collected. All statistical data were analysed by SPSS 22.0 software.</p> <p><strong>Results: </strong>There were 464 patients enrolled for analysis. Among them, 208(44.8%) patients had STEMI and 256(55.2%) had NSTEMI. The ratio of male/female was greater in STEMI as compared to NSTEMI (4.0 vs 1.9; p=0.041). Among NSTEMI patients, 88(34.4%) had ST depression, 168(65.6%) patients had other ECG changes like T wave abnormalities in 66(25.7%) and poor R-wave progression in 16(6.3%). NSTEMI patients had less regional wall motion abnormality on echo cardiogram (p=0.0045). As a complication heart failure (36% vs 9.3%), cardiogenic shock (16.8% vs 15.6%), atrial fibrillation (7.2 vs 0.78 %), ventricular tachycardia (2.8% vs 0.5%), reinfarction (3 % vs 0.78%) and death (2.4% vs 0.40%) were observed more in STEMI patients than NSTEMI respectively. NSTEMI patients had less regional wall motion abnormality on echocardiogram (p=0.0045). As a complication heart failure (36% vs 9.3%), cardiogenic shock (16.8% vs 15.6%), atrial fibrillation (7.2% vs 0.78%), ventricular tachycardia (2.8% vs 0.5%), reinfarction (3% vs 0.78%) and death (2.4% vs 0.40%) were observed more in STEMI patients than NSTEMI respectively. Coronary angiogram shows that left anterior descending artery was the most commonly involved artery in STEMI; however, the left circumflex artery or right coronary artery was involved more commonly in NSTEMI (p&lt;0.001).</p> <p><strong>Conclusion: </strong>The first step in successful treatment of acute MI depends on early diagnosis. Inspite of immediate management, STEMI had relatively worse outcome compared to NSTEMI.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 22-27</p> Syeda Aleya Sultana, Syed Asif Iqbal, Md Abdul Malek, Md Wali ur Rahman, Abu Yusuf Md Shahidul Alam, Md Aminul Haque, Safia Binte Rabbani ##submission.copyrightStatement## Fri, 21 Apr 2017 00:00:00 +0000 A Comparative Study on Indomethacin Suppositories with Physical Therapy and Conventional Treatment Modalities for Lumbago Sciatica <p><strong>Introduction: </strong>Most of the patients with Lumbago sciatica can be managed conservatively in a primary care setting with the expectation of a good outcome. It is one of the most common causes of pain and disability pertinent to lumbar spine. There are many alternative forms of treatment for this condition but the evidence of the efficacy of Indomethacin suppositories is yet to be established from clinical trials. Though several interventions are used in combination with physical therapy but indomethacin suppositories is commonly employed as a first line agent in the management of lumbago sciatica.</p> <p><strong>Objective: </strong>To ascertain whether a comparative effect of Indomethacin suppositories with other conventional treatment modalities produce a significant difference in the outcome.</p> <p><strong>Materials and Methods: </strong>This experimental clinical study was carried out at the Department of Physical Medicine, Combined Military Hospital (CMH), Dhaka and Department of Physical Medicine and Rehabilitation BSMMU, from 01 September 2015 to 28 February 2016. A total of 153 patients were randomly selected for trial and they were divided by lottery into 3 Groups. Group-“A” received Indomethacin suppositories with physical exercise and patients were 54 in number. 'Group-B' received NSAIDs (except indomethacin suppositories), SWD /MWD/IFT/TENS and patients were 47. In 'Group-C' there were 52 patients who received counseling with only physical exercises. Each Group received above-mentioned treatment modalities 5 days in a week for 6 weeks.</p> <p><strong>Results: </strong>The results were observed and noted with the help of visual analogue scale (VAS). The highest significant improvement was observed in 'Group-A' throughout the whole treatment period. The significant difference of improvement was found between groups finally in week 4 (W4) to week 6 (W6). The group received Indomethacin suppositories with physical exercise shows improvement of patients with lumbago sciatica.</p> <p><strong>Conclusion: </strong>The use of Indomethacin suppositories with physical therapy and the conventional modalities of treatment comparison help the physician to provide treatment facilities. The result was found better in groups those who received Indomethacin suppositories (Group-A) rather than those Groups who received other conventional treatment modalities.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 28-32</p> SM Shahidul Haque, Md Abdul Ali Miah, Mohammad Yousuf, Md Fashiur Rahman, Wahida Rahman, SM Humayun Kabir, Md Maksudul Haque ##submission.copyrightStatement## Fri, 21 Apr 2017 00:00:00 +0000 Medico-legal Issues and Socio-demographic Profile of Suicidal Deaths in People of Dhaka City-A Study of 827 Cases <p><strong>Introduction: </strong>There are two manners of death: Naturalwhere death is entirely caused by disease or ageing process, where poison or trauma does not take part to cause it and Unnatural- where death is sudden, suspicious, unexpected, litigious, unexplained and unattended either due to poison or trauma. Accident, homicide and suicide are the three unnatural manners of death. Death due to intentional injuries such as homicide or suicide and unintentional injuries of accidental manner, such as in transportation injury or industrial or machinery mishaps constitute unnatural deaths. Suicidal deaths are the acts or an instance of taking one’s own life voluntarily and intentionally especially by a person of years of discretion and of sound mind.</p> <p><strong>Objective: </strong>To ascertain the medico-legal issues and sociodemographic profile of suicidal death cases occuerd in Dhaka City.</p> <p><strong>Materials and Methods: </strong>A record based cross sectional study of postmortems was performed at the mortuary of the Forensic Medicine Department of Dhaka Medical College (DMC) from August 2009 to July 2010. A total of 3,337 cases brought to DMC mortuary from the south-eastern part of Dhaka district during this period were included in this study and thereafter 827 suicidal deaths were considered for this study.</p> <p><strong>Results: </strong>A total of 3,337 unnatural deaths (accidents, suicide and homicide) were reported at the mortuary of the Forensic Medicine Department of Dhaka Medical College (DMC) during the period of August 2009 to July 2010. This study revealed that 827(24.78%) individual committed suicide out of 3337 cases. There was a predominance of Muslims 779(94.19%), males 481(58.16%) over females 346(41.84%) in committing suicide. Majority of the victims belonged to the age group of 21-30 years in both sexes. Out of these suicidal cases, 318(38.45%) victims committed suicide by hanging. The other methods used for suicide were Organophosphorus compound poisoning (OPC) by 238(28.79%) victims, poisoning from other substances like Opiates, Ethanol, Methanol, Rodenticide, Barbiturate etc by 267 (32.28%); 3(0.36%) cases were identified as burn and 1 (0.12%) by firearm.</p> <p><strong>Conclusion: </strong>Suicide is the second most common manner of unnatural death flanked by accident and homicide. Suicide is one of the most multifaceted and media-sensitive phenomena. Suicide by hanging is an increasingly common method. All stakeholders such as government along with private agencies, non-government organizations, public health departments, social workers, community, religious leaders and media can take a leading step to prevent suicide</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 33-36</p> Md Abdus Samad Al Azad, Md Saidur Rahman, Mushtaq Ahmad, Taniza Tabassum, Zubaidur Rahman ##submission.copyrightStatement## Fri, 21 Apr 2017 00:00:00 +0000 Occupational Stress in Health Professionals of Combined Military Hospitals <p><strong>Introduction: </strong>Stress is a term that is widely used in everyday life. Work-related stress is recognized globally as a major challenge to workers’ health and the health of an organization. Stress at work has become a serious problem affecting many people of different professions, life situation and age groups. The healthcare profession has been depicted as one of the most stressful occupations across the globe.</p> <p><strong>Objective: </strong>To assess the extent of occupational stress among health professionals of Combined Military Hospitals and to explore its association with work-related factors and family-work interference.</p> <p><strong>Materials and Methods: </strong>A total of 574 respondents were selected from five Combined Military Hospitals using simple random sampling considering doctors, nurses, paramedic medical assistants and technologists as the study population. Occupational stress was determined by Health Professions Stress Inventory (HPSI).</p> <p><strong>Results: </strong>Stress of health professionals was reassessed through HPSI and 1.0%, 77.6%, 20.7% and 0.8% were found to be mild, moderate, very and extremely stressful respectively. About one fifth (21.4%) were found to be in high stress. High stress was more prevalent among Paramedic Medical Assistants (PMAs) (24.5%), Paramedic Medical Technologists (PMTs) (23.2%) and nurses (21.9%) on contrary to doctors (11.7%). Their mean stress scores were 55.70±13.75, 55.44±13.53, 56.18±10.55 and 50.92±10.93 respectively (p&lt;0.05) out of 124. Highest stress was in CMH Dhaka (56.50±14.27) followed by CMH, Rangpur (53.43±11.65) (p&lt;0.05). The mean work hour per week for doctors, nurses, PMAs and PMTs were 63.25(±18.95), 55.70(±9.72), 89.58 (±17.44) and 80.58 (±16.12) hours respectively (p&lt;0.05). Working for long/unsociable or unpredictable hours, financial and job insecurity were found to be related to the greater prevalence of high stress (p&lt;0.05). The parameters of pressures at work, job satisfaction and support from colleagues/superior were found to be associated with high stress (p&lt;0.05). Higher prevalence of family-work interference was found to be a predictor of high stress (p&lt;0.05).</p> <p><strong>Conclusion: </strong>A large proportion health professional of Combined Military Hospitals were in high stress due to the prime stressors. Measures like workload-management, job-redesign, employee motivation and training should be taken to alleviate these stressors.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 37-41</p> Umar Rashed Munir, Md Fashiur Rahman, Mohammad Ahmed Ahsan ##submission.copyrightStatement## Fri, 21 Apr 2017 00:00:00 +0000 Pylorus-Preserving Pancreaticoduodenectomy: Evaluation of 50 Cases <p><strong>Introduction: </strong>Pancreaticoduodenectomy is the procedure of choice for periampullary neoplasms. It is considered as a major surgical procedure. It is associated with relatively higher postoperative mortality and morbidity rate, however, with development of technology, proper patient selection, meticulous operative technique, appropriate postoperative care, morbidity and mortality rate has decreased subsequently. Up to the 1970s, the operative mortality rate after pancreaticoduodenectomy approached 20% but it has been reduced to less than 5% in recent reports. This study is designed to evaluate the postoperative outcomes of pylorus-preserving pancreaticoduodenectomy procedure in our set up.</p> <p><strong>Objective: </strong>To evaluate the outcome of the pylorus-preserving pancreaticoduodenectomy procedure with the intention to measure operation time and per-operative bleeding, observing postoperative anastomotic leakage and gastric emptying time. To find out postoperative wound infection and complications to detect the dumping syndrome.</p> <p><strong>Materials and Methods: </strong>A prospective observational study was carried out in the Department of Hepatobiliary Surgery, Combined Military Hospital, Dhaka from July 2013 to January 2017. Fifty patients who underwent pylorus-preserving pancreaticodudenectomy procedure were included in this study.</p> <p><strong>Results: </strong>Out of 50 postoperative patients, 12(24%) patients developed complications. Of these patients, 3(6%) developed wound infection, 2(4%) developed bile leakage and 2(4%) developed postoperative haemorrhage. Pancreatic fistula, vomiting, delayed gastric emptying and abdominal collection all were 1(2%) each. Postoperative mortality was 3(6%).</p> <p><strong>Conclusion: </strong>The present study demonstrated the development of postoperative complications after pylorus-preserving pancreaticoduodenectomy is as similar as published in different studies. Better outcome can be achieved with meticulous pre-operative evaluation of risk factors and per-operative skill maneuvering.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 42-45</p> SM Shakhwat Hossain, Ferdous Rahman ##submission.copyrightStatement## Fri, 21 Apr 2017 00:00:00 +0000 Pattern of Children Presenting with Inguinal Hernia and Hydrocele- Experience in a Tertiary Level Hospital <p><strong>Introduction: </strong>Inguinal hernias and hydroceles are among the common surgical problems in children. Both the hernia and hydrocele share a similar aetiology. Inguinal hernia in a child is usually an indirect inguinal hernia due to patent processus vaginalis. Likewise a fluid filled sac typically found in the scrotum may result from patent processus vaginalis or due to an imbalance between the secretion and absorption within the tunica vaginalis. Very little study was done in Bangladesh on inguinal hernia and hydrocele though these are very common in children.</p> <p><strong>Objective: </strong>To observe the pattern of inguinal hernia and hydrocele amongst the children reported to a tertiary level hospital.</p> <p><strong>Materials and Methods: </strong>This observational study was carried out in the Department of Paediatric Surgery, Combined Military Hospital, Dhaka during the period of January 2014 to December 2017. During the study period, a total of 258 children with inguinal hernia and hydrocele admitted in this hospital for operative treatment were included in this study.</p> <p><strong>Results: </strong>During the study period 258 children with inguinal hernia and hydrocele were operated. Among them 246 (95.35%) had inguinal hernia and 12(4.65%) had hydrocele. Out of the children with inguinal hernia 206 (83.74%) were male and 40(16.26%) were female with male female ratio of 5.15:1. All had indirect inguinal hernia. Right side was involved in 140(56.91%) children. Out of 246 children with inguinal hernia, 161(65.44%) reported between 6 months to 5 years. Thirteen (5.28%) presented before 6 months and 72 (29.27%) presented after 5 years of age. All children were operated by traditional open method as admitted case. Among 12 children with hydrocele 10(83.33%) had right sided hydrocele and 2(16.67%) had hydrocele on the left side.</p> <p><strong>Conclusion: </strong>Inguinal hernia and hydrocele occur most frequently in premature neonates. Inguinal hernia does not resolve spontaneously and there is high risk of incarceration requiring operative treatment as early as possible.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 46-50</p> Zinia Parveen, Shams ud Din Elias Khan, Sharmeen Sultana, Sangita Mithun, Mst Nasrin Nahar, Meherun Nessa ##submission.copyrightStatement## Fri, 21 Apr 2017 00:00:00 +0000 Urinary Neutrophil Gelatinase-Associated Lipocalin and Its Association with the Histological Pattern in Idiopathic Nephrotic Syndrome <p><strong>Introduction: </strong>Idiopathic nephrotic syndrome (INS) is the most common glomerular disorder of childhood. Clinical outcome of children with nephrotic syndrome depends on underlying histopathlogy and responsiveness to steroid treatment. Minimal change disease (MCD) has a favorable long-term prognosis whereas, other than minimal change nephrotic syndrome is often resistant to steroid and is more likely to progress to end-stage renal disease (ESRD). Neutrophil gelatinase-associated lipocalin (NGAL) which is a small protein belonging to the lipocalin superfamily has been demonstrated to be a powerful risk marker of chronic kidney disease progression. This study was undertaken to determine whether urinary NGAL could be used as a biomarker in differentiating minimal change disease from other glomerular histologic lesions in idiopathic nephrotic syndrome in children.</p> <p><strong>Objectives: </strong>To evaluate the association between urinary NGAL and histological pattern in idiopathic nephrotic syndrome.</p> <p><strong>Materials and Methods: </strong>This cross-sectional, multicenter study was conducted in the Department of Paediatric Nephrology, Dhaka Shishu Hospital and Department of Paediatric Nephrology, Bangabandhu Sheikh Mujib Medical University from June 2014 to May 2015. Fifty-one children with idiopathic nephrotic syndrome comprising 12 children with minimal change disease (MCD) and 39 with other than minimal change nephrotic syndrome were included. Urinary NGAL was measured using a commercially available HUMAN NGAL/ LIPOCALIN 2 ELISA kit which employed the quantitative sandwich enzyme immunoassay technique. Median urinary NGAL level were compared between MCD and other than MCD. Median urinary NGAL and urinary creatinine ratio also compared between two groups. The prognostic accuracy of urinary NGAL was assessed by receiver operating characteristic (ROC) curve analysis.</p> <p><strong>Results: </strong>Median urinary NGAL (uNGAL) level of MCD group was 44.5 [IQR: 32-109.5] (ng/ml) and that of the other than MCD group was 130 [IQR:85-172] (ng/ml). This difference was statistically significant (p=0.004). Median urine NGAL and urine creatinine ratio was significant between two groups (MCD=105.5 ng/mg and other than MCD=288 ng/mg, p-value was&lt;0.001). The area under the curve (AUC) for the uNGAL as a biomarker to differentiate MCD from other than MCD was 0.78 [95% CI: 0.64-0.92] (p=0.004) and showed an optimized sensitivity of 0.82 and specificity of 0.75 with an optimal trade-off value of 72 ng/ml.</p> <p><strong>Conclusion: </strong>Urinary NGAL was found to be a reliable biomarker to differentiate the histological pattern in idiopathic nephrotic syndrome.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 51-55</p> Farhana Jalil, Mohammed Hanif, Golam Muin Uddin, Shireen Afroz ##submission.copyrightStatement## Fri, 21 Apr 2017 00:00:00 +0000 Socio-demographic Characteristics and Related Factors Affecting Children with Autism Spectrum Disorder <p><strong>Introduction: </strong>Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by social deficits, communicative difficulties and repetitive behaviors, with evidence of cognitive dysfunction. Approximately 1% of the world’s population or 67 million are affected by autism. ASD is an emerging public health issue globally which is associated with a huge burden on the family, community and the nation.</p> <p><strong>Objective: </strong>To determine the socio-demographic characteristics and related factors affecting children with ASD to help the government and relevant organizations to take necessary steps to reduce burden of the families.</p> <p><strong>Materials and Methods: </strong>This cross-sectional study was carried out from July 2015 to June 2016 among 154 children with ASD. Data were collected by face-to-face interview with semi-structured questionnaire following systematic random sampling technique.</p> <p><strong>Results: </strong>Majority (73.4%) of the children were male and mean (±SD) age was 6.66±2.97 years. Most (88.8%) of the children were from urban areas with average monthly family income Tk. 41785.71±23936.45. Majority of the fathers (45.5%) and mothers (31.8%) had 'masters level'of education. Maximum (68.2%) children were from nuclear family and a few (9.1%) parents had a history of consanguineous marriage. Most (96.8%) of the children were initially treated by specialist doctors whereas, the majority (74.0%) were diagnosed in government hospitals. Most (89.6%) of the children were treated withspeech therapy.</p> <p><strong>Conclusion: </strong>Since ASD is a growing public health problem in Bangladesh, countrywide proper early diagnostic facilities, especially in peri-urban and rural areas, should be available to measure its actual burden in the country.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 56-61</p> Mahbubur Rahman Bhuiyan, Md Ziaul Islam, Ahmed Rafi, Abdullah Al Kawsar, Khursheda Akhtar ##submission.copyrightStatement## Fri, 21 Apr 2017 00:00:00 +0000 Outcome of Thyroid Surgery without Drainage Tube- A Study of 60 Cases <p><strong>Introduction: </strong>The use of a negative suction drainage tube in the neck in thyroid surgery is a common practice in order to avoid hematoma or seroma or other complication. It is associated with neck discomfort, post operative neck pain, delayed ambulation, longer hospital stay and ugly scar formation.</p> <p><strong>Objective: </strong>To determine the advantages and safety of thyroid surgery without negative suction drainage tube.</p> <p><strong>Materials and Methods: </strong>A cross-sectional observational study was carried out from September 2015 to May 2017 in the Department of Otolaryngology and Head-Neck Surgery, Kurmitola General Hospital, Dhaka Cantonment and Azmol and Life Aid General Hospital, Mirpur, Dhaka. A total of 60 patients who had undergone total thyroidectomy or hemithyroidectomy for thyroid disorders without drainage tube were included in this study. Patients with previous thyroid surgery, retrosternal goiter or malignant diseases of thyroid requiring neck dissection, undifferentiated thyroid cancer patients and those undergoing anticoagulant therapy were excluded from this study. Data were collected and recorded in a structured case report form. Data were processed and analyzed by the Statistical Package for Social Science (SPSS) version 20.</p> <p><strong>Results: </strong>Hospital staying was shorter for 50 patients out of 60 and 83.34% patients were discharged on the 2nd postoperative day. The time of mobility of patient was shorter and 66.66% patients became ambulated from bed after 11-14 hours. Complication was less and only 11 patients developed different type of complications.</p> <p><strong>Conclusion: </strong>Thyroid surgery can be done safely and perfectly without negative suction drainage tube in the neck with a shorter period of hospital stay, early ambulation, fewer complications and morbidities. However, the drain should be used in the presence of large dead space, particularly when there is a huge multinodular goiter or intrathoracic extension or when the patient is on anticoagulant or anti-platelet treatment.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 62-65</p> Mohammad Kamal Hossain, AKM Asaduzzaman, Md Tauhidul Islam, Ahsanuzzaman Khan, Md Shamim Bin Shaid, Md Rokan Uddin Bhuiyan, Mohammad Gloam Rabbani ##submission.copyrightStatement## Fri, 21 Apr 2017 00:00:00 +0000 Clinical Presentation of Cholesteatoma- A Study of 50 Cases <p><strong>Introduction: </strong>Cholesteatoma is an abnormal accumulation of keratin-producing squamous epithelium in the middle ear, epitympanum, mastoid or petrous apex. It is a threedimensional epidermoid structure exhibiting independent growth, replacing middle ear mucosa, resorbing and replacing underlying bone. Although it is not a neoplastic lesion, it can be insidious and potentially dangerous to the patient.</p> <p><strong>Objective: </strong>To find out the socio-demographic pattern, clinical presentation and complication of cholesteatoma.</p> <p><strong>Materials and Methods: </strong>This prospective study of 50 cases was done in the Department of Otolaryngology and Head-Neck surgery, CMH, Dhaka adopting simple random sampling technique from July 2008 to Dec 2009. Data were collected by personal interview and clinical examination in a pre-designed data sheet and were analyzed by SPSS 20.</p> <p><strong>Results: </strong>In this study, the highest number of patients (44%) was in the age group 11-20 years with a mean age of 17.2 years. Male were more affected (70%) and the male to female ratio was 2.33:1. Commonest symptom was otorrhoea (100%), followed by hearing impairment (80%), otalgia (16%), postauricular painful swelling (12%) and postauricular discharging sinus (10%). Extracranial complications were in 26% and intracranial complications in 12% of patients in this series. Abscess (temporal lobe + extra dural) were found in 02 cases (10%) by CT scan. A maximum number of patients had moderate conductive deafness (74.47%) followed by mild conductive deafness (19.15%) and only a few with severely mixed deafness (6.38%).</p> <p><strong>Conclusion: </strong>Clinical presentation of cholesteatoma in this study was discharge and deafness. The discharge was thick purulent foul smelling, scanty, occasionally blood-stained. Grave intracranial complications in children developed because of illiteracy, poverty, lack of awareness and medical facilities mostly in the rural areas. So early diagnosis and prompt treatment was a necessity.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 66-70</p> Md Ahsanuzzaman Khan, AKM Asaduzzaman, Md Tauhidul Islam, Bashir Ahmed, Mohammad Kamal Hossain, Mohammad Misbah Al Kabir Sumon, Sarder Mohammad Golam Rabbani ##submission.copyrightStatement## Fri, 21 Apr 2017 00:00:00 +0000 Management of Zygomatico-Maxillary Complex Fracture in Military Dental Centre, Dhaka: A Study of 40 Cases <p><strong>Introduction: </strong>Zygomatic bone is closely associated with the maxilla, frontal, temporal bones which are usually involved when a zygomatic bone fracture occurs. The most common causes of these fractures are from the assaults, road traffic accidents and falls. Aesthetic beauties and functions are greatly hampered with the displacement of the fractured fragments.</p> <p><strong>Objective: </strong>To analyze the aetiology, clinical presentations, surgical intervention and complications associated with zygomatic complex (ZC) fractures in a tertiary level healthcare facility.</p> <p><strong>Materials and Methods: </strong>This descriptive observational study was carried out in the Oral and Maxillofacial Department, Military Dental Centre, Dhaka during the period of January 2016 to December 2016. Data were obtained from clinical notes and surgical records of the patients using standardized data collection form specifically designed to examine the variables and features of zygomatic complex fractures.</p> <p><strong>Results: </strong>Road traffic accidents were the leading cause (75%) of zygomatic fractures. The mean operation time was found 99.5±31.2 minutes with a range from 60 to 125 minutes. Open reduction and two-point internal fixation were employed in more than two-third (67.5%) of the cases. Four (10.0%) patients developed postoperative complications; among them 2(5.0%) cases suffered paresis of temporal branch of facial nerve and trismus. Other complications included paraesthesia, ectropion, scar and palpability of plate. Twenty-five (62.5%) patients were found having limited mouth opening preoperatively and postoperative improvement occurred in 21(52.5%). Thirty three (82.5%) patients had facial asymmetry preoperatively and postoperative improvement occurred in 29(72.5%).</p> <p><strong>Conclusion: </strong>More than two-third of the patients received two point fixations. Only four patients out of forty in this study were found having post operative complications. The functional and Aesthetic outcome was found to be fair in terms of improvement in limitation of mouth opening and correction of facial asymmetry.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 71-74</p> Quazi Sindhi, Golam Mohiuddin Chowdhury, Md Abdur Rab, Md Emdadul Haque, Manjur E Mahmud, Mohammad Tofazzal Hossain ##submission.copyrightStatement## Fri, 21 Apr 2017 00:00:00 +0000 Assessment of Complications Associated with Tooth Supported Fixed Dental Prosthesis amongst Armed Forces Personnel <p><strong>Introduction: </strong>Fixed dental prosthesis is becoming more popular for preservation of badly damaged crowns and endodontically treated teeth and also for replacing lost teeth around the world. Complications of fixed dental prosthesis are also becoming very common. Fixed dental prosthesis assures greater retention and stability in addition to comfort. Fixed dental prosthesis is more acceptable to patients when correctly planned and designed which provide predictable function are also enhances the esthetics and psychological well being of the patients.</p> <p><strong>Objective: </strong>To assess the complications associated with tooth supported fixed dental prosthesis amongst armed forces personnel reporting to Combined Military Hospital (CMH) Cumilla and Combined Military Hospital (CMH) Dhaka.</p> <p><strong>Materials and Methods: </strong>An interview based questionnaire was used for 220 patients followed by clinical oral examination of every individual in this cross sectional study conducted during September 2016 to August 2017 in Combined Military Hospital, Dhaka. Patients soft tissues were checked but the main emphasis was given on recording the information regarding the type of prosthesis being used, material of the prosthesis, location of the prosthesis and the complication present including dental caries, coronal or radicular abutment fracture, root canal treatment failure, periapical lesions, periodontal problems and mechanical failures including occlusal interference, no occlusal contact, decementation of the prosthesis, esthetic problems, porcelain and metal fractures. Periapical radiograph was made to assess mentioned complaints; more so periodontal probing was applied to measure the gingival attachment loss.</p> <p><strong>Results: </strong>Approximately 183(83%) patients were using porcelain fused to metal prosthesis with 133(60%) of prosthesis being used in posterior segments of mouth. Complications like dental caries, coronal abutment fracture, radicular abutment fracture, occlusal interferences, root canal failures and decementations were more significantly associated with crowns than bridges (p=0.001). On the other hand esthetic issues, periapical lesions, periodontal problems, porcelain fractures and metal damage were more commonly associated with bridges (p=0.001). All cases of dental caries reported were associated with acrylic crown and bridges, whereas all coronal abutment fractures were associated with metal prosthesis. A significantly higher number of patients who got their fixed dental prosthesis from other sources i.e. paramedics, technicians, dental assistants or unqualified dentists had periapical lesions, decementations, esthetic issues and periodontal diseases.</p> <p><strong>Conclusion: </strong>Complications associated with fixed dental prosthesis like root canal failures, decementations, periapical lesions and periodontal disease were more significantly associated with prosthesis fabricated by other sources rather than those acquired from CMHs and private dental care and also in patients using prosthesis for 5 to 10 years.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 75-80</p> Md Tariquzzaman, Golam Mohiuddin Chowdhury, Md Liakat Ali Hyder ##submission.copyrightStatement## Fri, 21 Apr 2017 00:00:00 +0000 Operative versus Conservative Treatment for the Management of Displaced Midshaft Clavicle Fractures in Adults <p><strong>Introduction: </strong>Displaced fractures of mid third clavicle are common in young athletic population and choice of management is still controversial. Recent studies have shown that these fractures do not have favourable outcomes with non-operative management and nonunion rates could be as high as 20%, in addition, there is symptomatic malunion with shortening.</p> <p><strong>Objective: </strong>To compare the results of the operative versus that of conservative treatment for the management of displaced midshaft clavicular fractures.</p> <p><strong>Materials and Methods: </strong>This prospective cross-sectional study was carried out in Orthopaedic and Trauma center, CMH, Dhaka, from the period of January 2014 to December 2016 to compare results of open reduction and internal fixation by plating with that of conservative management. Total 60 patients (30 in each group) were analyzed in terms of fracture union and functional outcome. Patients in the non-operative group were managed by triangular sling with or without strapping whereas in the operative group fractures were reduced and fixed with a contoured reconstruction plate. Patients were actively followed up for 12 months and functional outcome was measured by Rowe and Oxford shoulder scoring system. Complications were monitored clinically and radiologically.</p> <p><strong>Results: </strong>All fractures in the operated group united compared with thirteen cases of symptomatic malunion (43.33%) in the non-operated group which is statistically significant. Rowe and Oxford scores was significantly higher in the operated group than the non-operated group in every occasion of follow-up. There was no major complication of surgery. In one patient (3.33%) plate had to be removed for hardware irritation and prominence.</p> <p><strong>Conclusion: </strong>Open reduction and internal plate fixation in acute displaced midshaft clavicular fractures resulted in improved outcome decreased rate of non-union and symptomatic mal-union compared with non-operative treatment</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 81-85</p> Md Maksudul Haque, Masud Ahmed, Md Zakir Hossain, Md Ali Faisal, Mohammad Saiful Islam, SM Shahidul Haque, Md Monowar Tarik, Mohammad Russel ##submission.copyrightStatement## Fri, 21 Apr 2017 00:00:00 +0000 Efficacy of Narrow-Band Ultra Violet B versus Narrow-Band Ultra Violet B with Topical Tacrolimus Ointment (0.1%) in the Treatment of Vitiligo <p><strong>Introduction: </strong>Several treatment options e.g. topical corticosteroids, phototherapy like narrow-band ultra violet B (NB-UVB) and psoralen+ultra violet A (PUVA) etc are available for vitiligo. But none is so effective in single but combined one is more effective and superior.</p> <p><strong>Objective: </strong>To compare the efficacy of NB-UVB vs NB-UVB with topical Tacrolimus ointment (0.1%) in the treatment of Vitiligo.</p> <p><strong>Materials and Methods: </strong>This descriptive cross-sectional study was conducted in Combined Military Hospital, Dhaka from October 2015 to April 2016. Total 100 patients with vitiligo were divided into 2 groups of 50 patients. NB-UVB was given for 04 weeks to Group-A. In Group-B patients, topical Tacrolimus ointment (0.1%) twice daily was advised with simultaneous NB-UVB. The patients were followed-up at the baseline of the 4th, 8th and 16th week.</p> <p><strong>Results: </strong>Majority (46%) of the patients were from 25-34 years of age with a mean age of 27.4±12.6 years. Among all risk factors, Family history of Vitiligo was the most common risk factor and common skin type (Fitzpatrick) was Type IV (40%). At the end of 4th week, maximum cases of Group-B showed good response (score 3) with a mean score of 1.74. Whereas, maximum cases of Group-A showed poor response (score 1) with a mean score of 0.86. End of the 16th week, maximum cases of Group-B improved successfully. In the end, 20% patients of Group-A showed an excellent result; but it was 42% from Group-B.</p> <p><strong>Conclusion: </strong>It is revealed from this study that patients treated with a combination of NB-UVB with topical Tacrolimus ointment (0.1%) showed better treatment outcome, more effective and becomes a new mode of treatment.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 86-89</p> Jweena Bintey Jamal, Muhammed Ashraful Alam Bhuiyan, Md Abdul Latif Khan ##submission.copyrightStatement## Fri, 21 Apr 2017 00:00:00 +0000 Quality of Life among Patients with Coronary Heart Disease Admitted in a Selected Tertiary Level Hospital <p>&nbsp;</p> <p><strong>Introduction: </strong>Coronary heart disease and cerebrovascular disease are the two main contributors of global morbidly and mortality. Coronary Heart Disease deaths in Bangladesh reached 1,63,769 or 17.11% of total deaths and reaches 25th in world. Importantly quality of life among them can modify the coronary heart disease. The opportunity for improved quality of life should be a factor in the health care provider's decision to recommend the treatment procedure.</p> <p><strong>Objective: </strong>To ascertain the physical and mental health component of Quality of Life with sociodemographic characteristics and health-related morbidity status among admitted coronary heart disease patients.</p> <p><strong>Materials and Methods: </strong>This cross-sectional study was conducted from January 2013 to December 2013 among coronary heart disease patients admitted in Cardiology department of Combined Military Hospital, Dhaka. The data were collected purposively by using Medical Outcomes short form SF-36 invented by RAND corporation, UK for measuring health-related quality of life among Bangladeshi patients where data were expressed as a score on a 0-100 scale. Data analysis was done by using software SPSS version 19.</p> <p><strong>Results: </strong>A total of 105 cases were selected purposively amongst which majority were in the age group of 50-60 years with mean age of 55.27 years. Among the respondents 97.1% were males and 98.1% were Muslims. Majority (41%) of them were retired personnel. The mean monthly income was Tk. 16,393.56. Regarding education level 73% of the study population were SSC pass and below. Among the study group, 27(25.7%) patient had undergone coronary artery bypass graft operation. The study group possessed a total quality of life obtaining 63.4% score in their interviews as per SF-36. Among the whole study group, mental components score (63.61%) was found slightly higher than physical components score (63.2%). CABG operated patients mental component score (69.43%) was found relatively higher than Non CABG patients mental component score (60.01%). Patients having better monthly income as well as better educational level possess better mental component and total quality of life than others.</p> <p><strong>Conclusion: </strong>It is of paramount importance to maintain the quality of life among coronary heart disease patients. Mental assurance and surgical intervention can improve quality of life among coronary heart disease patients.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 90-94</p> Molla Muntasir Hossain, Md Abdul Wahab, Md Abdus Samad Al Azad, Rubaiya Reza Tumpa ##submission.copyrightStatement## Sun, 23 Apr 2017 00:00:00 +0000 Magnetic Resonance Imaging Evaluation of Menisci and Cruciate Ligamentous Injuries of the Knee with Arthroscopic Correlation <p><strong>Introduction: </strong>Now a days Magnetic Resonance Imaging (MRI) has become the primary investigation for the assessment of knee injuries. Non-invasive MRI has the ability of high resolution and accuracy to diagnose the knee injuries and it can be the alternative to diagnostic arthroscopy.</p> <p><strong>Objective: </strong>To validate MRI evaluation in the assessment of cruciate ligamentous and meniscal injuries of the knee joint and compare with arthroscopic findings.</p> <p><strong>Materials and Methods: </strong>This cross sectional study was conducted at Combined Military Hospital, Dhaka from 01 January 2013 to 30 June 2013 where sixty patients who had the history of twisting injuries to the knee were selected in this study. Along with injury history they were strongly suspected to have meniscal and/or cruciate ligamentous tears. Then they were examined by open MRI machine 0.4 tesla, Hitachi, made in Japan. A Quadrature (QD) extremity coil was used in this study. Spin echo T1, fast spin echo T2 and Short Tau Inversion Recovery (STIR) sequences were taken in direct coronal, sagittal and axial planes with 4mm slice thickness. Data were recorded and statistical analysis was done by SPSS version 20.</p> <p><strong>Results: </strong>Total 60 patients underwent MRI and Arthroscopic examination. The final diagnosis was established by direct findings at Arthroscopic examination. The Sensitivity, Specificity and Accuracy of Magnetic Resonance Imaging in the diagnosis of cruciate ligamentous and meniscal injuries as compared to arthroscopy were Anterior Cruciate Ligament (ACL): 96.88% sensitivity, 96.43% specificity, 96.66% accuracy, 96.87% Positive predictive value (PPV) and 96.42% Negative predictive value (NPV); Medial Meniscus (MM): 96.43% sensitivity, 98.87% specificity,96.66% accuracy, 96.42% PPV and 98.88% NPV; for Lateral Meniscus (LM): 80.00% sensitivity, 97.77% specificity, 93.33% accuracy, 92.30% PPV and 93.62% NPV.</p> <p><strong>Conclusion: </strong>As a non-invasive diagnostic modality Magnetic Resonance Imaging is very useful and having high sensitivity, specificity and accuracy in the detection of meniscal and cruciate ligament injuries. To prevent unwanted arthroscopies MRI should be done in every patient of suspected cruciate ligamentous and meniscal injury before doing arthroscopy.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 95-98</p> Mohammed Mominul Hoque Sarker, Md Taharul Alam, Syed Zoherul Alam, Mohammad Shafiqul Alam, AKM Sharifur Rahman, Farzana Rahman ##submission.copyrightStatement## Sun, 23 Apr 2017 00:00:00 +0000 Effect of Arsenic on Breastfed Baby of Arsenic Affected Lactating Mother <p><strong>Introduction: </strong>In the endemic areas of chronic arsenic poisoning of Bangladesh (Cumilla, Noakhali, Laksham, Matlab) drinking water is heavily contaminated with arsenic. An estimated of about 70 million people are at risk from drinking water contaminated with arsenic. There are numerous data on effects of arsenic in adults but a few reports are available on the adverse effect of arsenic on infants and arsenic concentration in human milk, as human milk is the primary source of nutrition during first 6 months of life. Arsenic level found in the urine of infants reflects the intake of arsenic through breast milk.</p> <p><strong>Objective: </strong>To find out the effect of arsenic among the breastfed babies of arsenic affected mothers.</p> <p><strong>Materials and Methods: </strong>This cross sectional study was conducted in the arsenic exposed area of Bangladesh from January 2007 to July 2008. Thirty exclusively breastfed babies of arsenic affected mothers were enrolled as cases and 30 exclusively breastfed babies from non affected mothers were taken as control. Urinary arsenic concentration was considered for measurement of arsenic status. Mothers with their babies were thoroughly examined for length, weight, occipitofrontal circumference (OFC) and gross motor skills.</p> <p><strong>Results: </strong>Arsenic affected mothers excreted high concentration of arsenic (334.68μgm/L±108.02) in their urine than control group (19.17μgm/L±7.92) but the urinary arsenic concentrations from both groups of breast fed babies were found to be low. Growth and development parameters like length, weight, OFC and gross motor skills were also found to be normal in both groups of babies.</p> <p><strong>Conclusion: </strong>Exclusive breast feeding should be practiced in arsenic affected area to protect the babies from exposure to arsenic from water sources.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 99-102</p> Ferdousi Hasnat, Selina Khatun, Farhana Noman, Mohammad Ibrahim Khalil, Nusrat Nahar, Sharmistha Ghosal ##submission.copyrightStatement## Sun, 23 Apr 2017 00:00:00 +0000 Correlation of HPV-DNA Test with Cytology and Histology for the Diagnosis of Cervical Cancer and Precancerous Lesions in a Tertiary Care Hospital in Bangladesh <p><strong>Introduction: </strong>Cervical cancer is the second most prevalent cancer among women worldwide. High-Risk Human Papilloma virus (hr-HPV) is an established cause of cervical cancer and precancerous lesion. Studies have shown the relationship between the HPV-DNA test with cervical precancerous and cancerous lesion in diagnosing cervical cancer. This study aimed to correlate HPV-DNA test with both cytology and histology.</p> <p><strong>Objective: </strong>To find out the correlation of HPV-DNA test with cytology and histology for the diagnosis of cervical precancerous and cancerous lesion.</p> <p><strong>Materials and Methods: </strong>Cervical smears and DNA samples were collected from the selected patients attending the colposcopy clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU) from July 2011 to April 2013. Biopsy was done on colposcopically positive cases and histopathology reports were obtained. Thus 99 histologically proven patients of cervical cancer and precancerous lesion were selected. Pap smear was carried out on these 99 patients. HPV-DNA test (Hybrid Capture-2 assay) was carried out on the same samples and viral loads were estimated.</p> <p><strong>Results: </strong>Among the 99 cases, 28(28.28%) cases were positive with Hybrid Capture-2(HC-2) assay. Out of 60 cases of CIN-I (Cervical Intraepithelial Neoplasia-1), 7(11.7%) cases were positive with HC-2. Among others, 3(15.0%) cases of CIN-II were positive with HC-2. The viral load was very high in invasive SCC (squamous cell carcinoma) cases in contrast to other categories of histological and cytological diagnosis. A significant relationship was observed between HC-2 and histological diagnosis (P&lt;0.005); and between HC-2 and Pap smear (P&lt;0.005).</p> <p><strong>Conclusion: </strong>Introduction of HC-2 where possible along with Pap smear would be highly effective in primary screening and subsequent follow up of cervical precancerous and cancerous lesion.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 103-105</p> Shamina Islam, Md Nizam Uddin, Nasima Akter, Tarana Tabashum, Maznun Us Sadakin, Shahanaz Jahan, Kamrul Hasan Khan ##submission.copyrightStatement## Sun, 23 Apr 2017 00:00:00 +0000 Incidence and Complications of Emergency Peripartum Hysterectomy: A Retrospective Study at Maternal and Child Health Training Institute, Dhaka <p><strong>Introduction: </strong>Emergency peripartum hysterectomy (EPH) is a major surgical venture performed in the setting of life threatening hemorrhage during or immediately after abdominal and vaginal deliveries. In developing countries, 8-10% of maternal mortality directly occurs due to massive obstetrical hemorrhage. Most common indication for emergency peripartum hysterectomy has been uterine atony and uterine rupture. The decision to perform an emergency hysterectomy on a young woman especially one with low parity poses a dilemma for the obstetrician particularly in our society.</p> <p><strong>Objective: </strong>To estimate incidence, indications and postoperative complications associated with emergency hysterectomy at Maternal and Child Health Training Institute (MCHTI), Azimpur, Dhaka.</p> <p><strong>Materials and Methods: </strong>This is a retrospective study and registration numbers of all women who underwent emergency peripartum hysterectomy were indentified. With the numbers, the case notes were retrieved from the medical records department for in-depth study. Information abstracted included the socio-demographic characteristics of the patients, indications for the hysterectomy, type of hysterectomy performed, booking status of patients, mode of delivery, gestational age at delivery and maternal outcome were recorded in a pre-designed data form. The data were analyzed using simple proportion, rates and tables.</p> <p><strong>Results: </strong>There were 18 cases of emergency peripartum hysterectomies performed during the study period of January 2011 to December 2013 (incidence 1.26/1000 deliveries). Commonest age of the middle group was 29-34 years. Ruptured uterus was the commonest indication (9 cases, 50%) and other indications were uterine atony/ PPH (8 cases, 44.44%), placenta praevia (1 case, 5.56%). Subtotal abdominal hysterectomy was done in 17(94.44%) cases whereas total abdominal hysterectomy in 01(5.56%) cases. This emergency procedure was associated with significant number of intraoperative and postoperative complications, However maternal and perinatal outcome was satisfactory.</p> <p><strong>Conclusion: </strong>EPH remains an essential life saving procedure and its incidence continues to remain high in our community when compared with developed countries. Effective antenatal care, identification of patients at risk, enhancement of blood transfusion facilities together with improvement of surgical skills are important to reduce the incidence of peripartum hysterectomy as well as morbidity and mortality.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 106-110</p> Rowshan Hosne Jahan ##submission.copyrightStatement## Sun, 23 Apr 2017 00:00:00 +0000 Acquaintance on HIV/AIDS among the Higher Secondary Level Students of Manikgonj District, Bangladesh <p><strong>Introduction: </strong>HIV (Human Immunodeficiency Virus) is a transmissible retrovirus that causes AIDS (Acquired Immune Deficiency Syndrome) in human, HIV infection gradually affects the immune system of human body and consecutively damages the cell. The result of HIV infection is relentless destruction of the immune system leading to the onset of Acquired Immunodeficiency Syndrome (AIDS). As young adults are one of the vulnerable groups for infection of HIV and studies regarding the awareness on HIV/AIDS among the young adults out of Dhaka are very few in numbers so this study was conducted outside of the capital among the higher secondary level students.</p> <p><strong>Objective: </strong>To assess the level of awareness on HIV/AIDS among the higher secondary level students of Manikgonj District, Bangladesh.</p> <p><strong>Materials and Methods: </strong>This observational study was carried out to observe the awareness of HIV/AIDS among the higher secondary level students of randomly selected urban and rural areas of Manikgonj District, Bangladesh. The total number of respondents was 246 and ages ranged from 16 to 25 years.</p> <p><strong>Results: </strong>A total of 246 respondents were interviewed and among them the majority of students were male and awareness was high among the male respondents. Majority of the respondents (98%) heard about HIV/ AIDS. It also revealed 88.62% participants believed that it is a preventable disease and 78.50% of the respondents had knowledge about the unavailability of the vaccine. About the transmission, 93.90% respondents opined that it was due to infected blood transfusion; followed by 92.82% believed due to unprotected sex and 67.1% stated contaminated instruments cause transmission of HIV. In case of prevention of the disease, 88.21% believed health education as one of the preventive methods followed by using condom 86.59%, safe blood transfusion 80.49% and avoiding contaminated instrument 74.80%.</p> <p><strong>Conclusion: </strong>The level of awareness among the higher secondary level students in study area Manikgonj, Bangladesh was satisfactory. To maintain this adequate focus should be given on the need for the further information, education and communication programs to identify the barriers and to seek the ways to enlighten the population about HIV/AIDS knowledge.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 111-116</p> Mehnaz Quddus, Md Fashiur Rahman ##submission.copyrightStatement## Sun, 23 Apr 2017 00:00:00 +0000 Large for Gestational Age Babies Born To Diabetic and Non-Diabetic Mothers <p><strong>Introduction: </strong>Foetal growth and development is a complex process that involves the interrelationship among the mother, placenta and fetus. Both high and low birth weight infants are associated with the highest prevalence of diabetes. Women with diabetes are at greater risks, because of their pregnancy related complications.</p> <p><strong>Objective: </strong>To compare the characteristics of groups of LGA (large for gestational age) babies born to prediabetic mothers (DM) and gestational diabetic mothers (GDM) with control infants born to apparently healthy non-diabetic mothers (NDM).</p> <p><strong>Materials and Methods: </strong>This was a prospective cohort study of 251 newborn-mother pairs (n: DM=86; GDM=86 and NDM=79) recruited from the Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka. Detailed anthropometric measurements of infants were taken at birth in the hospital. LGA babies had birth weights greater than the 90th percentile for their gestational age for sex and SGA (small for gestational age) babies usually had birth weights below the 10th percentile for babies of the same gestational age for sex.</p> <p><strong>Results: </strong>Only 10(11.6%) babies were found LGA in the GDM group as opposed to 3 each for DM and NDM group. There was a significant group difference in the incidences of SGA babies. Around 16% to 18% were there in the DM and GDM groups, as opposed to much higher rate (30.4%) in the NDM group.</p> <p><strong>Conclusion: </strong>Newborns from both DM and GDM groups showed greater values compared to that of the NDM group in all anthropometric measures except length and head circumference suggesting intrauterine growth acceleration in them.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 117-123</p> AKM Yunus Halim, Syed Nazmul Huda, Luthfor Ahmed, Shireen Begum, Laila Arjumand Banu ##submission.copyrightStatement## Sun, 23 Apr 2017 00:00:00 +0000 Short Course versus Standard Course Antibiotic Treatment for Neonatal Sepsis <p><strong>Introduction</strong>: Neonatal sepsis remains an important cause of morbidity and mortality and often requires prompt empiric treatment. However, only a minority of babies who receive antibiotics for suspected sepsis have an infection. Antimicrobial exposure in infancy has important short-term and long-term consequences. There is no consensus regarding empirical antimicrobial regimens.</p> <p><strong>Objective</strong>: To compare efficacy and benefits of short course (5 days) over the standard course (7 days) antibiotic treatment for neonatal sepsis.</p> <p><strong>Materials and Methods</strong>: The study was a randomized controlled trial done in the neonatal ward in a tertiary level hospital comprising total 100 term neonates equally divided in to two groups by randomization where Group-I (5 days antibiotic therapy) was compared against Group-II (7 days antibiotic therapy) in clinical recovery, hospital stay, morbidity such as seizure, developmental delay etc and mortality.</p> <p><strong>Results:</strong> The study results showed that both the Group-I and Group-II were comparable in baseline clinical data and predisposing factors; however, there was no significant difference between the two groups in clinical features e.g. hypotonia (24% vs 26%, p&gt;0.05), poor primitive reflexes (46% vs 52%, p&gt;0.05), temperature instability (34% vs 28%, p&gt;0.05), feeding intolerance (16% vs 14%, p&gt;0.05), apnea / respiratory distress (28% vs 34%, p&gt;0.05) and in clinical outcome e.g. hospital stay (5.24±0.78 vs 7.86±0.42, p&gt;0.05), recovery (86% vs 90%, p&gt;0.05), death (14% vs 10%, p&gt;0.05), seizure disorder (8% vs 6%, p&gt;0.05) and developmental delay (6% vs 4%, p&gt;0.05).</p> <p><strong>Conclusion</strong>: This study showed that there was no significant difference between the study groups in clinical outcome, however, short course antibiotic (5 days) is equally effective but economically more beneficial to standard course antibiotic (7 days) therapy for neonatal sepsis.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 124-127</p> Tahsinul Amin, Ayesha Najma Nur ##submission.copyrightStatement## Sun, 23 Apr 2017 00:00:00 +0000 Left Ventricular Noncompaction Cardiomyopathy (LVNC) with Left Ventricular Apical Thrombus– A Case Study <p>Left ventricular non-compaction (LVNC) is a rare congenital cardiomyopathy, with or without LV dysfunction, characterized by prominent trabeculations and associated deep recesses which communicate with the ventricular cavity rather than the coronary circulation. LVNC affects all age groups and can occur in isolation or association with other cardiac and systemic anomalies, especially with neuromuscular disorders. Patient may be asymptomatic or present with ventricular arrhythmias, thromboembolism, heart failure and sudden cardiac death. Echocardiography is the most common tool for diagnosis of LVNC. Contrast ventriculography, computed tomography (CT) and magnetic resonance imaging (MRI) are other useful diagnostic tools. Due to increasing awareness and improvement in imaging methods, LVNC is being diagnosed frequently in patients now a day.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 128-130</p> Mohammad Abul Hasnat, Md Israrul Hossain, Md Abdullahel Kafee, Md Borhan Uddin ##submission.copyrightStatement## Sun, 23 Apr 2017 00:00:00 +0000 Dilated Cardiomyopathy due To Coxsackie-B Virus Myocarditis: A Case Report <p>Dilated cardiomyopathy (DCM) is a rare disorder which may be caused by diverse reasons. Many of them are idiopathic also. The article reports a case of DCM resulting from acute Coxsackie virus myocarditis. Antibody to Coxsackie-B virus was positive from a lab of United States of America. This is first case report of Coxsackie-B virus myocarditis (proven) led to cardiomyopathy in Bangladesh.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 131-133</p> Nurun Nahar Fatema Begum, Md Rabiul Hossain, Md Ferdousur Rahman Sarker ##submission.copyrightStatement## Sun, 23 Apr 2017 00:00:00 +0000 Successful Outcome of Pregnancy with Addison’s Disease & Hypothyroidism <p>Hypocortisolism or hypoadrenalism is well known as Addison’s disease which is a long term endocrine disorder. In pregnancy it requires much awareness and attention of treating physicians. Early diagnosis, adequate supplement of glucocorticoid and mineralocorticoid and fetal surveillance through regular antenatal checkup is essential for pregnant ladies with Addison’s disease. Patients should be counselled appropriately regarding medication, life-style and precautions to be taken in case of infection, operational exposure or any other stress.</p> <p>Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 134-137</p> Nargis Nahar, Iffat Ara ##submission.copyrightStatement## Sun, 23 Apr 2017 00:00:00 +0000