Journal of Armed Forces Medical College, Bangladesh

Introduction of CME Credit System amongst Doctors of Bangladesh Armed Forces

Masud Ahmed, A K M Mustafa Kamal Pasha, S M Shameem Waheed — Thu, 14 Mar 2024 00:00:00 +0000

Abstract not available

JAFMC Bangladesh. Vol 19, No 1 (June) 2023: 1-5

Leprosy- Atypical Presentation with Reaction

Mohammad Mofizul Islam Khan — Thu, 14 Mar 2024 00:00:00 +0000

Leprosy is a chronic granulomatous disease affecting mainly the skin and nerves caused by the obligate intracellular pathogen Mycobacterium leprae. Patient not always present with typical skin lesion with loss of sensation or muscle weakness rather may present with atypical skin lesion with swelling of the affected area like cellulites or lymphangitis as reactional state. A 25- years-old male patient presented with linear erythematous verrucous plaque along with multiple nodules and pain and swelling of left upper extremity. Local examination revealed sensory loss on inner aspect of left hand and finger and ulner nerve found enlarged, thickened and tender. Slit skin smear showed numerous lepra bacilli. Skin biopsy for histopathology showed collection of foamy histocytes forming granuloma within the upper dermis and wade fite staining, moderate number of lepra bacilli was seen. Patient was diagnosed as a case of borderline leprosy with type 1 lepra reaction. Patient was getting treatment with MDT (multi drug therapy) and systemic steroid and responded very well. His skin lesions are almost subsided and weakness of hand was recovering gradually.

JAFMC Bangladesh. Vol 19, No 1 (June) 2023: 76-79

Teachers’ Opinion about Pharmacology MCQ Question Papers of MBBS Professional Examinations

Thu, 14 Mar 2024 00:00:00 +0000

Introduction: Multiple choice questions (MCQ) are very effective in assessing the students learning since it is very much objective and time saving. MBBS curriculum introduced MCQ in professional examination from 2002.

Objective: This cross sectional descriptive study was conducted to get the teachers’ opinion about Pharmacology professional examination MCQ papers of different Universities of Bangladesh.

Methods: For this purpose, opinions of total 56 purposively selected teachers of the Department of Pharmacology & Therapeutics of 20 Medical Colleges were collected through self-administered semi-structured questionnaire. Most of the teachers (61%) were in favour of existing distribution of different types of question in curriculum (recall-60%, understanding-30% and problem based-10%) for MCQ paper.

Results: Majority of the teachers (71% and 63%) were satisfied with the present coverage of recall and understanding type questions respectively and 60% teachers were satisfied with the coverage of problem based type questions. Fifty-seven percent teachers were satisfied with content coverage in MCQ papers. About 57% teachers were satisfied with the construction of MCQs and 78% teachers were in favour of introduction of single best answer (SBA) type MCQ. Regarding introduction of negative marking for wrong answer, 61% were agreed with the proposal.

Conclusion: Findings of this study may be used to redefine the distribution of different types question in SAQ papers and to improve the quality of question papers by ensuring their coverage and construction.

JAFMC Bangladesh. Vol 19, No 1 (June) 2023: 6-10

Haematological Profile and its Clinical Implications in Dengue Viral Infections

Suraiya Akhtar, Susane Giti, Md Shahidul Islam, Sharif Mohammad Rezaul Masud — Thu, 14 Mar 2024 00:00:00 +0000

Introduction: Dengue fever is the most common arboviral disease in the world. Transmission to humans of dengue virus initiates a spectrum of illness, from inapparent to severe and sometimes lethal infections. Complete blood count (CBC) is an important part of diagnostic workup of patients. Comparison of various findings in CBC and peripheral blood film can help the physician in diagnosis, management and assessment of prognosis of the patients.

Objectives: To find out the pattern of haematological findings in dengue infection.

Methods: This cross sectional study was carried out on 62 dengue cases in CMH Savar from May to October 2019. Diagnosis of dengue was based on clinical features, haematological and biochemical findings and confirmed by serological tests. Haematological parameters analyzed include haemoglobin (Hb), haematocrit, total leucocyte count (TLC), differential leucocyte count (DLC), platelet count and peripheral blood film.

Results: Important findings in haematological profile were haemoconcentration, raised haematocrit, low WBC count, early neutrophilia and late lymphocytosis, reactive lymphocytes in peripheral blood and thrombocytopenia. Haemoglobin ranged from 10.0-18.5gm/dl. Haematocrit was raised in 13(20.96%) cases. Thrombocytopenia (platelet count <1.5 Lac/mm3) was observed in 59(95.16%) cases. Platelet count 1-1.5 Lac was seen in 4(6.45%) cases, 50,000-1 Lac in 25(40.32%) cases, 20,000-50,000 in 26(41.93%) cases and < 20,000 in 4(6.45%) cases. Leucopenia (TLC<4000/mm3) was seen in 46(74.19%) cases and >11000mm3 in 2(3.22%) cases. On peripheral blood smear reactive lymphocytes including plasmacytoid lymphocytes were seen in almost all the cases.

Conclusion: CBC examination gives enough clue for early diagnosis of dengue infection which can be confirmed by dengue serology. Serial CBC examination is also important in disease monitoring, treatment of the patient and prediction of prognosis.

JAFMC Bangladesh. Vol 19, No 1 (June) 2023:11-14

Stress in First Year Medical Cadets of Armed Forces Medical College, Bangladesh

Md Azizur Rahman, Jebunnessa Begum — Thu, 14 Mar 2024 00:00:00 +0000

Introduction: The journey of medical life specially in the military environment is a very stressful for medical cadets.

Objectives: To determine stress in 1st year medical cadets of Armed Forces Medical College.

Methods: Out of 124 medical cadets, 117 were conducted based on a well established questionnaire that included different established factors of stress. The methodology and purpose of study was well explained to all the cadets and consent was obtained. In this study, the Medical student Stressor Questionnaire with small cadetship related factor 24(MSSQ) was used to identify sources of stress. Each of the questions in this questionnaire can be a potential source of stress in cadet in his academic life. Data were analyzed with SPSS v.12. Relation between variables was assessed with chi-square test with a significance level of 0.05%

Results: Of the 124 total cadets, present 117 received questionnaires and completed them returned them. Out of 117 cadets, 82(70%) were female and 117(100%) were unmarried. Moderate stress (1.87) experienced in academic factors as well social factors. Bangla medium students facing relatively more stress than English version background students.

Conclusion: This finding suggests, the very medical education is full of multi varieties stressors. More so cadetship accentuates the stress further in medical life. Now the time has come to think the policy maker involved in medical education. Their realistic thinking to reorganized the curriculum according to time limit to ensure a stress free environment as much as possible in the 1st year of MBBS.

JAFMC Bangladesh. Vol 19, No 1 (June) 2023:15-17

Pattern of Lightning Related Injuries to Human in Bangladesh

Thu, 14 Mar 2024 00:00:00 +0000

Introduction: In recent past, the incident of lightning strikes and related injuries has increased significantly which is the detrimental consequence of climate change. Therefore, it is recognized as one of the cause of weather related death in Bangladesh.

Objective: To present the pattern of lightning related injuries in Bangladesh.

Materials and Methods: A cross sectional study carried out on September 2021 among 40 people who were victim of lightning on the way to attend a wedding reception in Shibganj upazila of Chapainawabganj on 4 August 2021. Detail information was received from one relative of each 16 deceased family and 24 survivors. Further, data were collected from the doctors and nurses of Chapainawabganj Government Hospital

Results: In addition to the two fatalities on the route to the hospital, 14 individuals died on the spot. Further, among 24 survivors, 16 people survived with moderate and rest 8 survivors had mild injuries. 45% lightning victims were dead and 35% were survived with major injuries by lightning and 20% victims survived with minor injuries. Majority (35%) of death were due to direct strike which is followed by ground strike (30%). Injury to nervous and cardiovascular system is the usual site of injury for human organ where percentage of injury is 35% and 30% respectively. The victims remain admitted to hospital in varying range and survivors had multiple symptoms of minor injuries. Among them, majority victims (9 people) 40.91% left hospital after initial observation.

Conclusion: Lightning kills few hundred and injures several thousand people in our country every year. However, lightning survivors should be taken to hospital for further investigation and treatment. Field management is very important for a patient to survive. For this, lightning education will immensely help not only to minimize the death cases but also help them to manage the lightning victims on the spot.

JAFMC Bangladesh. Vol 19, No 1 (June) 2023:18-21

Clinical Presentation, Echocardiographic Findings, Treatment Options Available for Ventricular Septal Defect in Children: A Study in a Tertiary Care Military Hospital

Thu, 14 Mar 2024 00:00:00 +0000

Introduction: Ventricular Septal Defect (VSD) is the most common congenital heart defects. Early diagnosis, appropriate treatment and transcatheter VSD closure with newer devices in favorable cases, decrease the need for surgical interventions and mortality.

Objectives: To determine the clinical presentation, echocardiographic findings and the treatment options available for VSD in Paediatric Cardiology Department, Combined Military Hospital (CMH) Dhaka.

Methods: It was a cross sectional observational study carried out in the department of Paediatric Cardiology, CMH Dhaka. Forty six isolated ventricular septal defect cases were diagnosed by echocardiography. Clinical features, echocardiographic findings and treatment options of all 46 cases were observed and recorded in pre formed data sheet and statistical analysis was done in statistical software SPSS version 25.

Results: Among the 46 patients of VSD, majority 20(43.48%) were in age group 0-6 months. Most of them were male 24(52%). Common presenting features were dyspnea on exertion 23(50%), cough 30(65.20%), head sweating 23(50%), and feeding problem in 34(73.91%). VSD in 27(58.6%) patients were <5mm, 15(32.6%) were 5-10mm and 4(8.7%) had size >10mm. Most of the VSDs were perimembranous 31(67.39%). Among the 46 cases medical management was given to 20(43.5%), device closure was done in 10(21.7%) patients and surgical interventions done in 16(34.8 %) patients.

Conclusion: Most of the VSD patients presented at an earlier age some of them were undergone device closure and some require surgical interventions that were not suitable for device closure. Patients those presented lately developed pulmonary hypertension.

JAFMC Bangladesh. Vol 19, No 1 (June) 2023: 22-26

Clinicopathological Study of Patients with Non-inflammatory Benign Breast Disease at Combined Military Hospital (CMH) Chattogram

Md Ataur Rahman Siddiqui, Md Shahinur Rahman, Abdullah Al Baki — Thu, 14 Mar 2024 00:00:00 +0000

Introduction: Breast lump is a very common problem among females attending surgical outpatient department. Its development and growth are under the control of various hormones and various physiological statuses like menstruation, pregnancy, lactation and menopause.

Objectives: To evaluate the clinicopathological status of patients with non-inflammatory benign breast disease (NIBBD).

Methods: This clinical study was conducted at the department of surgery, CMH Chattogram, this study was done during January 2018 to May 2019. Patient presented with breast lump, nipple discharge, sinus and mastalgia in whom histopathology revealed any type of non-malignant BBD were included in the study. Patient treated on outdoor patient basis were excluded and patient with malignant breast lesions or acute breast abscess requiring incision and drainage were excluded from the study.

Results: Majority of the patients, 41(74.5%) had breast lump followed by 10(18.2%) had breast pain, 6(10.9%) had nipple discharge and 3(5.5%) had enlargement of breast. Most of the site was found unilaterally 54(98.2%). Majority of the patients, 27(49.1%) had fibroadenoma, 14(25.5%) had fibrocystic diseases, 10(18.2%) had fibroadenosis, 2(3.6%) had duct ectasia, 1(1.8%) had cystosarcoma Phyllodes and 1(1.8%) had Lipoma.

Conclusion: Maximum age group was 3rd to 4th decade. Most of the patients clinically presented with lumps in the breast followed by pain, enlargement of breast, fever and nipple discharge. Mostly encountered breast lesion was fibroadenoma other common lesion were found fibrocystic diseases, fibroadenosis, duct ectasia, cystosarcomaphyllodes and Lipoma.

JAFMC Bangladesh. Vol 19, No 1 (June) 2023: 27-30

Outcome of External Dacryocystorhinostomy Operation with and without Posterior Nasal Mucosal Flap Suturing Technique in Combined Military Hospitals of Bangladesh

Amina Akhter — Thu, 14 Mar 2024 00:00:00 +0000

Introduction: External Dacryocystorhinostomy is an anastomosing operation which creates a fistula between the medial wall of lacrimal sac and lateral wall of nasal cavity.

Objectives: To compare the success rate by suturing both the anterior and posterior nasal mucosal flaps and without suturing the posterior nasal mucosal flap in External DCR surgery of 50 cases in different Combined Military Hospitals (CMH) of Bangladesh.

Methods: The study included 50 cases of Chronic Dacryocystitis patients with symptoms of epiphora and blocked Sac Patency Test (SPT). External Dacryocysto- rhinostomy (DCR) surgery was done by same surgeon in different CMH over the period of 02 years extending from January 2016 to December 2017. Total 50 patients were divided into equal 02 groups. Group A underwent External DCR with silicone tube intubation and both anterior and posterior nasal mucosal flaps were sutured. Group B underwent similar DCR surgery where only anterior nasal mucosal flaps were sutured with lacrimal sac flap and posterior mucosal flap was excised completely.

Results: External DCR surgery success rate was evaluated by a patent SPT at 03 months, 06 months and 12 months post operatively in both groups. SPT was successful in 92% cases in group A and 96% in group B at 3 months follow up after silicone tube removal. At 6 months reduction of epiphora occurred in 90% cases in Group A and 96% cases in Group B with unchanged SPT percentage. At 12 months follow up result remained unchanged as found at 6 months. There was significant difference in success rate of two different surgical technique. Quality of surgery improved with less intraoperative complications with shorter surgical time when only anterior nasal mucosal flap was sutured with excision of posterior nasal flap.

Conclusion: This study suggested that comparing both the techniques of with and without suturing anterior and posterior nasal mucosal flaps in external DCR surgery, the later one makes considerable improvement in success rate of DCR. Excising the posterior nasal mucosal flaps can reduce operation time, improve operation technique and reduced epiphora post surgically.

JAFMC Bangladesh. Vol 19, No 1 (June) 2023: 31-33

Side Effects of COVID-19 Vaccination among the Pregnant Women: A Cross-Sectional Study in a Tertiary Hospital of Bangladesh

Hasina Akhter, Nasrin Ara Zaman, Kamrun Nahar — Thu, 14 Mar 2024 00:00:00 +0000

Introduction: Pregnancy is a very special time for a woman and her family, although being pregnant is a stressful condition for every woman. The COVID-19 pandemic has made that condition more stressful. Clinical trials prove that COVID-19 vaccines are safe for pregnant women and also for lactating mothers. So WHO has approved vaccines for both above-mentioned groups. Hence, Bangladesh Government has taken the decision to vaccinate every pregnant woman against COVID-19 infection.

Objectives: To assess the side effects of COVID-19 vaccination on pregnant women in a tertiary care hospital in Bangladesh Army.

Methods: This cross sectional single-centered observational study was conducted in Combined Military Hospital (CMH) Dhaka from August 2021 to November 2021. Total 50 pregnant nullipara and multipara women with double dose vaccination were included. Relevant data were recorded in a preformed data collection sheet and analyzed by SPSS version 20.

Results: Mean age of the participants was 19.2±10.8 years. The most commonly observed symptoms were pain in injection site, fatigue, swelling in injection site and myalgia. The most prevalent affected age group were 25-35 years. Among 48 participants, 20(41.6%) had co-morbidites. Two participants were found to have COVID-19 infection (4%) after vaccination.

Conclusion: Side effects profile obtained from pregnant women in this study were non-life threatening. A recognized vaccine programme can be a relieving factor for pregnant women from increased stress and anxiety caused by COVID-19.

JAFMC Bangladesh. Vol 19, No 1 (June) 2023: 34-37

Clinical and Biochemical Characteristics of Acute Pancreatitis Patients Attended in a Tertiary Hospital of Bangladesh

Syed Mohammad Shaifuddin, Jaida Jalal Sarker — Thu, 14 Mar 2024 00:00:00 +0000

Introduction: Acute pancreatitis is a complex, life- threatening disease resulting from acute inflammation of the pancreas which causes considerable morbidity and mortality among the patients.

Objectives: To find out the clinical and biochemical characteristics of acute pancreatitis patient attended at the Combined Military Hospital (CMH) Dhaka.

Methods: This observational study was conducted at CMH Dhaka among 40 patients of acute pancreatitis admitted from 1st January 2013 to 30th June 2013. Data were collected through face-to-face interview using a pre-tested semi- structured questionnaire and review of the hospital records.

Results: Highest number of the respondents (42.5%) belongs to the age group of 20-39 years. The mean age was 44.90 years (±13.46) years and 60.0% of them were male. More than half (57.5%) of the respondents had monthly income in the 20001 to 50000 Taka with average of 31,650(±15,255.60) Taka. All the patients presented with pain in the abdomen which was followed by nausea/ vomiting (82.5%), abdominal distention (72.5%). On examination, it was revealed that all the respondents had abdominal tenderness which was followed by muscle guard (10.0%), ascites (7.5%) and jaundice (5.0%). Almost half (47.50%) of the respondents developed acute pancreatitis due to stone in the gall bladder which was followed by idiopathic origin (30.0%). Eighty five percent of the patients had severe symptoms and rest (15%) had mild symptoms. All the respondents had elevated serum amylase level and 82.5% had elevated serum lipase level.

Conclusion: Acute pancreatitis mostly affect young adult male. Most common clinical presentations are upper abdominal pain, nausea/vomiting and abdominal tenderness. Gallstone is the commonest cause of the condition. Serum amylase is the most important biochemical abnormality found in acute pancreatitis.

JAFMC Bangladesh. Vol 19, No 1 (June) 2023: 38-41

Role of Parents in Meeting the Educational Needs of Children with Autism Spectrum Disorders

A K M Johirul Hossain Khan, Abdul Hamid, Sheikh Sujaur Rahman — Thu, 14 Mar 2024 00:00:00 +0000

Introduction: Autism Spectrum Disorders (ASD) are increasing alarmingly in recent times making it an important emerging public health problem. The role of parents is of paramount importance in meeting the educational needs of their special children with ASD.

Objectives: To find out the role of parents in meeting the educational needs for their children with ASD.

Methods: This descriptive type of cross sectional study was carried out among the 61 purposively selected respondents who were attended to Center for Neurodevelopment and Autism in Children, BSMMU, Dhaka and Proyash School, Dhaka cantonment, Dhaka. The data were collected through face to face interview by semi structure questionnaire.

Results: This study revealed that the mean age of the children was 6.65 years with SD±2.763 years, 72.1% children with autism were male and 27.9% of them were female. In this study, maximum 39.3% of mothers were HSC qualified and 50.8% of fathers were graduated, 80% mothers were housewife and 20% were in service. It was found that among the children about 52.5% were detected abnormality within first 18 months of age and about 47.5% were detected after 18 months of age. The association between age of first abnormality detection and mother’s educational level was statistically significant (p=.025). The present study also reveals that 82% of mother had knowledge about autism, 88.5% of them feels that their children need special education for taking care. It was found in the study about 70.5% mother spent more than 4 hours time/day for taking care of their children at home whereas 29.5% of them spent 1-4 hours of time/day and detection of abnormality of the children was delayed among less educated mothers in comparison to educated mothers.

Conclusion: All this findings suggests that parent’s educational needs for taking care of their children with ASD. In this aspect in-depth study on broader perspective is needed for more accurate description of the problem.

JAFMC Bangladesh. Vol 19, No 1 (June) 2023: 42-46

Treatment with Wound Edges Marsupialization of Simple Anal Fistula: A Randomized Controlled Trial

Thu, 14 Mar 2024 00:00:00 +0000

Introduction: Simple anal fistula can be treated with fistulectomy or fistulotomy. Wound edges marsupialization is a part of treatment.

Objectives: To find out the outcomes of the treatment with marsupialization.

Methods: Sixty consecutive patients with simple anal ﬁstula were included in this prospective randomized controlled trial study where 30 patients treated with fistulotomy were included group A & 30 patients treated with fistulotomy and marsupialization were included in group B. The primary outcome variable was wound healing time while secondary outcome variables were operating time, postoperative wound size, postoperative pain using visual analogue scale (VAS), post-operative bleeding, wound infection, anal incontinence, recurrence and patient satisfaction.

Results: Thirty patients were randomized to group A and 30 to group B. The operating times were significantly different between two groups (21.00±6.35 minutes vs. 28.20±6.57 minutes, P=0.0001) and Postoperative wounds were larger in group A than group B (2.07±0.90 cm2 vs 1.03±0.87 cm2). Bleeding occurred less frequently in group B than group A (10% vs 53.33%, P=0.0003) and wound discharge was observed for a significantly longer duration in group A than group B (4.10±1.8 weeks vs. 2.05±1.71 weeks, P<0.0001). Postoperative wounds in group B healed earlier than group A wounds (3.85±1.19 weeks vs 6.55±1.3 weeks, P<0.0001). VAS scores for postoperative pain on the first postoperative day was (4.05±1.47 vs. 5.15±1.32, P=0.0035) for the two groups.

Conclusion: Marsupialization after ﬁstulectomy signiﬁcantly reduces the healing time, the risk of post-operative bleeding and size of the wound without increasing postoperative anal incontinence, recurrence and sepsis.

JAFMC Bangladesh. Vol 19, No 1 (June) 2023: 47-49

Evaluation of the Effects of Microwave Diathermy in Patients with Chronic Low Back Pain

Thu, 14 Mar 2024 00:00:00 +0000

Introduction: Low back pain is very common in every community. About 60-80% of people suffer from back pain in their whole life. It is tagged as one of the most common causes for absence from work. Microwave diathermy (MWD) is an important treatment modality which is used as an adjunct to other treatment options. In our country, very few studies were carried out in this regard.

Objectives: To find out the efficacy of MWD chronic LBP when given with other usual treatment options like various medications and back muscle strengthening exercise.

Methods: We evaluated 60 patients suffering from chronic LBP. Those who attended Orthopaedic department, CMH Barishal were divided randomly into two groups and treated with all conventional back pain modalities with or without microwave diathermy. Study design was case control study. It was conducted in CMH Barishal from January 2021 to December 2022. Patients were examined weekly for six weeks. After six weeks, the results were observed and compared. Data were collected by questionnaire and compared by Lattinen test score.

Results: Pre-treatment overall score with Lattinen test score system in MWD group was 9.75±4.45 and in non MWD group was 9.5±4.5. After 6 weeks, Group MWD score was 3.20±4.25 whereas Group non MWD score was 5.5±5.6. We found significant improvement of Lattinen test score with application of microwave diathermy after 6 weeks (P<0.05). There was significant improvement in MWD group (P<0.05).

Conclusion: This study reveals that MWD can be an effective adjunct to usual treatment modalities.

JAFMC Bangladesh. Vol 19, No 1 (June) 2023: 50-54

Pattern of Food Cravings in Pregnant Women Receiving Antenatal Care in a Community Setting

Mohammad Abul Bashar, Farida Yesmin, Shaila Sharmin Rafa, Rahnuma Rahman — Thu, 14 Mar 2024 00:00:00 +0000

Introduction: Food cravings are a sudden desire to eat certain types of foods during pregnancy. Worldwide, it is a common phenomenon.

Objectives: To find out the pattern of craving foods and examine to what extent the craving desires were fulfilled.

Methods: This cross-sectional study was conducted among 150 pregnant women in a community setting. Data were collected during January to March 2020 by face-to-face interview with a semi-structured questionnaire. Sample women were selected purposively.

Results: Mean age of the sample women was 23.59 (±4.36) years. 78% (117) of the respondents had cravings for one or more foods. Of them, 29.9% women had craved for sour fruits and 32.5% women had craved for milk-based sweets. Besides, 15.4%, 17.1% and 20.5% women had craved yogurt with misti, rice-milk-banana mixed and pickles respectively. Another 1.7% women had craved for non-food substance burnt clay. 23.9% craving desires was due to inhibiting nausea and 57.3% had no explanation. 70.9% craving desires was fulfilled. The proportion of fulfillment of craving desires was 100% in higher income families (p<.001). In joint families, 78.9% craving desires was fulfilled. It was 56.1% in the nuclear family (p=.009). In the first pregnancy, 81.5% craving desires was fulfilled (p=.003).

Conclusion: Common foods for pregnancy cravings were sweets, sour fruits and pickles. Craving desires was fulfilled more in high income families, joint families and in first pregnancy.

JAFMC Bangladesh. Vol 19, No 1 (June) 2023: 55-58

Analysis of Domain Addressed and Subdivisions of Anatomy Emphasized in Spotting Stations in Anatomy Part of First Professional MBBS Examination

Nasrin Begum, Mahmuda Ayub — Thu, 14 Mar 2024 00:00:00 +0000

Introduction: Assessment of any educational program should implement purpose of the learning objectives. Learning objectives are prepared with the help of several models such as SOLO (Structure of observed learning Outcomes) taxonomy, Bloom’s Taxonomy etc. The most commonly used classification system is “Bloom’s taxonomy to develop learning objectives” which describes the domains of educational objectives and divides the domains into three categories a) cognitive domain b) psychomotor domain c) affective domain.

Objectives: To observe the domains of the questions of soft part-portion of Spotting stations to fulfill the learning objectives set by the curriculum in Anatomy professional examination in the background of Bloom’s Taxonomy. The research also tries to find out the subdivisions of Anatomy preferred more and regions of Gross Anatomy more emphasized in soft part-portion of Spotting stations.

Methods: This cross sectional study held in the Department of Anatomy in Armed Forces Medical College (AFMC) from August 2015 to December 2018. Data (questions of soft part-portion of Spotting stations and ‘answer key’s) are collected from seven different medical colleges affiliated under Dhaka University. A total fifty-two day’s questions with ‘answer key’s are taken for the study from the first professional examination held on May 2013 and May 2014. For the purpose of the study each question is divided into ‘Item’, ‘Part’s and ‘Segment’s. Moreover verbs of the segments are then analyzed in the form of ‘statement’, ‘list’ and ‘single name’ and Anatomy is subdivided into Gross Anatomy, Histology and Developmental Anatomy.

Result: A total 774 items, 1571 parts, 2048 segments are analyzed. The verbs used to address the levels of cognitive domain in the questions reveals that ‘identification’ is mostly (76.62%) used in supplied figure followed by radiology (52.05%) model (41.89%) viscera (38.82%) and dissection (24.95%) stations. ‘Statement’ mostly used as verb by dissection (37.28%) and minimum in supplied figure (11.6%) stations. Similarly ‘list’ is mostly used in viscera (23.14%) and ‘single name’ is mostly used verb in dissection stations. Maximum (89.2%, 92.47%, 90.54% and 81.82%) questions are asked from Gross Anatomy subdivision in viscera, radiology, model and in supplied figure stations respectively. In case of viscera stations about one third (34.62%) and one fourth (25.62%) questions are from the thorax and abdomen proper respectively and around 15% questions cover pelvis, (10.54%) head neck, (12.34%) and brain (16.88%) respectively. Nearly half (46%) of the figure station use supplied figures as a ‘tool’. Maximum (39%) figures are used from brain where supplied figures are used as a ‘tool’ and no figure used from lower limb. When instructed to ‘draw and label’, 50% are from region of brain and less than 20% from other regions.

Conclusion: From the findings it can be easily perceived that though Spotting examination is part of practical examination but in our country but it mainly involves in assessing factual knowledge of Anatomy which can hardly meet the demand of the objectives set by the curriculum.

JAFMC Bangladesh. Vol 19, No 1 (June) 2023: 59-65

Semenology of Infertile Men Reported at a Tertiary Level Military Hospital of Bangladesh

Sharmin Hossain, Anup Kumar Biswas — Thu, 14 Mar 2024 00:00:00 +0000

Introduction: A very simple, cheap, easily available and non-invasive approach has made routine semen analysis the most important tool for diagnosis of male fertility.

Objective: To determine I) the percentage of abnormality in semen parameters present in the husbands of infertile couples, II) the effect of occupation on abnormal parameters and iii) the effect of increasing age on semen quality.

Methods: A cross sectional retrospective study was designed in a period of April 2019 to March 2020 on the basic semen analysis reports of the husbands of infertile couples reporting to the fertility clinic of a tertiary level military hospital of Bangladesh.

Results: Out of 851 couples only 372 were excluded from female cause. At least 44% husbands showed at least one abnormality in their semen parameters according to WHO 2010 criteria and out of them 3.8% were azospermic. Almost all abnormalities showed more severity in the patients reporting from non-military background. Significant differences were demonstrated in the mean values in semen parameters like volume, concentration and motility between different occupational groups. Mean values of sperm concentration between different age groups showed significant changes. Values of other parameters also showed gradual decrease with increase of age but differences were not significant.

Conclusions: The present study showed that even 56% normozoospermic husbands can be partners of infertile couples. Occupation and age affect male fertility.

JAFMC Bangladesh. Vol 19, No 1 (June) 2023: 66-71

Neutrophil to Lymphocyte Ratio in Patients with Major Depressive Disorder

Thu, 14 Mar 2024 00:00:00 +0000

Introduction: Depression is common mood disorder that is linked to systemic inflammation. The neutrophil-lymphocyte ratio (NLR) is a non-specific inflammatory marker that is inexpensive and easy to measure. Low-grade inflammation occurs in a subgroup of patients with Major Depressive disorder (MDD).

Objective: To examine the role of inflammation in the etiology of depression based on the NLR in MDD patients who are undergoing no pharmacological therapy.

Methods: This observational study was carried out in the Department of Psychiatry of Jahurul Islam Medical College Hospital (JIMCH), Bajitpur, Kishoregonj between December 2013 and May 2014. Subjects between the ages of 18 and 65 were included in the study that involved 61 subjects with diagnosed MDD, who received no pharmacological therapy of depression within the past 01 month were included in the study, while the control group included 67 healthy subjects with having no psychiatric disease. A sociodemographic information form and a Beck Depression Scale were administered, and the blood was taken for biochemical analysis and complete blood parameters were evaluated in the hematology laboratory of JIMCH. All data were expressed as mean±SD. For statistical analysis, Chi-square test (χ²) was used to compare categorical variables, frequencies, and ratios. An independent sample ‘t’ test was used to compare normally distributed variables between two groups.

Results: In the present study, we found Significance difference in the NLR, neutrophil count, lymphocyte percentage and leukocyte values of the patient group when compared with control group (P<0.05).

Conclusion: The study reveals that NLR tends to be higher in patients with MDD, and a high NLR value supports the view that inflammation is a critical factor in the etiology of MDD.

JAFMC Bangladesh. Vol 19, No 1 (June) 2023: 72-75