Journal of Comilla Medical College Teachers' Association

Cover & Contents Vol. 27 (2), 2023

2024-02-25T04:06:28+00:00

Abstract not available

J Com Med Col Teachers’ Asso July 2023; 27(2)

New Strain of COVID-19 – Interest or Concern!

2024-02-15T04:48:05+00:00

Abstract not available

J Com Med Col Teachers’ Asso July 2023; 27(2): 44

A Study on Antithromin III Deficiency in Children with Extrahepatic Portal Hypertension Attending a Tertiary Care Hospital in Bangladesh

2024-02-15T05:11:00+00:00

Background: Extrahepatic portal venous obstruction accounts for 80% of cases of portal hypertension. Of all cases of portal hypertension (PHT) in developing countries, 40% are due to portal vein thrombosis. No risk factors were found in most of the cases of extrahepatic portal hypertension. To date, numerous observational studies have reported the prevalence of antithrombin III deficiency in patients with portal vein thrombosis. In Bangladesh, a largely populated country, we see a good number of patients with EHPVO every year. But there is a lack of such studies in our country about the frequency of antithrombin III deficiency.

Objective: To find out the frequency of antithrombin III deficiency in children with extrahepatic portal hypertension.

Methods: Over a period of 18 months, this cross-sectional descriptive study was carried out at the Department of Paediatric Gastroenterology and Nutrition of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Children of either gender diagnosed with cases of extrahepatic portal hypertension were included in this study. Informed written consent was obtained from the parent/caregiver of each child. Data were analyzed by using SPSS 22.0 for Windows 10 (SPSS, Inc, Chicago, IL). In all cases, the significance level of p value was <0.05.

Results: A total of 18 patients diagnosed with extrahepatic portal hypertension were enrolled in this study, out of which 14 (78%) were males. The mean age at presentation was 8.6 ± 4.7 years. The most common (83%) presenting symptom was upper gastrointestinal bleeding manifested as hematemesis and melena. On physical findings, the majority (89%) of patients were pale, splenomegaly was present in 83% of patients. On full blood count, anemia was present in all (100%) patients, leucopenia in 4 (22.2%), and thrombocytopenia in 14 (78%) patients. Cavernous transformation was found in 9 (50%) patients, portal vein thrombosis (PVT) was identified in one (5.6%) patient. All (100%) patients had esophageal varices. Nine (50%) patients had Antithrombin III deficiency.

Conclusion: Antithrombin III deficiency was seen in half (50%) of the studied patients. No significant difference or association was identified between the antithrombin III deficient with the normal group in terms of clinical profile, biochemical parameters, and endoscopic findings.

J Com Med Col Teachers’ Asso July 2023; 27(2): 45-51

Seroprevalence and Co-infection of Hepatitis A and Hepatitis E Viruses in Children – A Hospital Based Study in Bangladesh

2024-02-17T03:13:04+00:00

Background: Viral hepatitis is a serious health problem globally and in endemic countries like Bangladesh. Viral hepatitis may present as mono-infection or co-infection caused by hepatitis A virus (HAV), hepatitis B virus, hepatitis C virus, hepatitis D virus, and hepatitis E virus (HEV). Enterically transmitted viral agents like Hepatitis A virus (HAV) and Hepatitis E virus (HEV) are common causes of viral hepatitis in developing countries. As the routes of entry are similar double infections by both agents are common. Co-infection with two or more viruses may lead to serious complications and increased mortality.

Objective: This study was carried out to learn about the seroprevalence of HAV & HEV (and double infections if any) infections in acute viral hepatitis (AVH) cases attending our hospital.

Methods: This is a retrospective cross-sectional study of a 2 years duration carried out in the Pediatric Gastroenterology and Nutrition department of BSMMU, Dhaka. Total 400 cases, presenting with Acute Viral Hepatitis were included in the study. Cases with suggestive history were tested for IgM anti-HAV and IgM anti-HEV respectively.

Results: Out of 400 samples, 100 samples were positive for HAV and/or HEV infection with an overall prevalence of 24.7%. HAV & HEV seroprevalence in AVH cases were found to be 13.75% (55/400) and 5.75% (23/400), respectively. Dual infection of HAV and HEV was found in 5.25% (21/400) of study subjects. Both year, most of the positive cases are seen in the months of August and September.

Conclusion: Seroprevalence of HAV was 13.75%, HEV 5.75% and dual infection of HAV & HEV 5.25% in the current study.

J Com Med Col Teachers’ Asso July 2023; 27(2): 52-56

Factors Predicting Relapse in Children with First Attack Idiopathic Nephrotic Syndrome- A Hospital Based Retrospective Study

2024-02-17T03:53:15+00:00

Background: Nephrotic Syndrome is a disease of relapse. So, it is very important to find out such children who are prone to develop frequent relapse and the predictors responsible for relapse. This retrospective study was conducted in the department of Pediatric Nephrology, Bangabandhu Sheikh Mujib Medical University, from September 2016 to August 2017.

Methods: A total of 75 patients of idiopathic nephrotic syndrome (INS) with the initial attack, aged 1–18 years, were enrolled in this study. All patients were treated with prednisolone 60 mg/m2/day, single morning dose for 6 weeks, followed by 40 mg/m2 every alternate day for another 6 weeks and were analyzed and followed upfor a minimum period of six months to identify the risk factors related to relapses.

Results: Among them, 50 (66.7%) were males, 25 (33.3%) were females, with a male: female ratio of 2:1. Ten (13.3%) children had no relapse, 18 (24.0%) had infrequent relapse, and 40 (53.3%) had frequent relapse. Children responding between 2 and 4 weeks after the start of treatment had a more chance of relapse (P = 0.002) than those who responded less than 1 week. Only urinary tract infection and respiratory tract infection are independent risk factors for subsequent relapse. Children with INS whohave UTI atonset had 1.55 times more chance for further relapse and RTI caused 1.42 times more chance for relapse. Patient with low serum albumin have 1.91 times more chance for relapse than with high albumin with in significant association.

Conclusion: Young age at diagnosis of INS, male gender, low serum albumin and infections were predictive risk factors of multiple relapses. So, physicians should be vigilant to monitor these patients closely and counsel the families of nephrotic children regarding the prediction of subsequent relapses and ultimate outcome.

J Com Med Col Teachers’ Asso July 2023; 27(2): 57-61

Admission Pattern and Outcome of Patients Admitted to Pediatric Intensive Care Unit, CMH, DHAKA: 2-Years Study

2024-02-17T04:51:09+00:00

Background: The care of critically ill children remains one of the most demanding and challenging aspects in the field of pediatrics. The main purpose of the pediatric intensive care unit (PICU) is to prevent mortality of these children by intensive monitoring, early intervention and quality care with an objective to achieve better prognosis than the patients admitted in other parts of the hospital. Pediatric intensive care is an emerging concept in Bangladesh with only a few PICUs mostly in the capital city, Dhaka. This study was conducted to find out the pattern of diseases and outcome at our centre which would help in better understanding, modifying practices if necessary, leading to better management and outcome and necessary resource allocation by the planners.

Methods: It was a descriptive study conducted over 2 years, from October 2018 to September 2020, including all patients admitted to PICU of Combined Military Hospital, Dhaka. Bangladesh. Total 730 patients were admitted during the study period. Data were extracted from the patient’s files including demographic and clinical characteristics, previously diagnosed chronic conditions and outcome including length of stay (LOS) or death were noted.

Results: Total 730 patients were admitted during the study period. Mean age of the patient was 4 months and 4.68 days and mean hospital stay was 4.37±0.5 days. Preschool children (1–5 years of age) were the largest age group (n = 313). November and December were the most common months of admission (n = 58 and 57, respectively). Total 658 (90.1%) patient were improved and discharged, 32 (4.4%) patients were referred to surgical department, 3 (0.4%) patients was discharged against medical advice (DAMA) whereas, unfortunately 37 (5%) patients died. Central nervous system was involved in 198 (27.1%) and skin was the least involved system. A higher portion of patient of Preschool (1-5yrs) 15 (4.8%) died compared to <1 yr and > 5 years but the relationship was not significant statistically (p = 0.101). A higher proportion of males, 23 (5.2%), died compared to females, 14 (5%). This relationship was not statistically significant (p = 0.706). A higher proportion of death also observed in LOS< 24 hours, but the relationship was not significant (p=0.168).

Conclusion: This study revealed that neurological, genetic defect and respiratory diseases were the major causes of admission into the PICU with survival rate of 95%. A PICU is an essential part of hospital caring for the critically ill child by reducing morbidity and mortality. An effective and wellequipped PICU with modern facilitates can bring out the desirable outcome.

J Com Med Col Teachers’ Asso July 2023; 27(2): 62-66

Aetiology and Clinical Profile of Acute Pancreatitis in a Tertiary Care Hospital

2024-02-17T05:07:58+00:00

Background: Acute Pancreatitis is a potentially serious condition with an overall mortality of 10%. Early diagnosis is important for its management. So clinician must carefully evaluate the patient with history, physical examination, laboratory tests and imaging studies before arriving a correct diagnosis. Death is more likely in certain subgroups of patients including elderly, co-morbidity, severe coexisting hospital acquired infection and organ dysfunction.

Objectives: To assess aetiology and clinical profile of acute pancreatitis in a tertiary care hospital.

Methods: A six-month Cross sectional study carried out at the department of Medicine, Comilla Medical College. Ethical approval from the institutional review board was obtained to ensure patient privacy and confidentiality.

Results: The majority of patients are within the age group of 21-60 years (88.4%), with a higher proportion of males (71.2%) than females (28.8%). The most common clinical presentations were abdominal pain (95.6%) and nausea/vomiting (89.6%). Idiopathic (38%) and gallstone-related (38.4%) causes were the most common etiologies, while necrotizing pancreatitis (9.6%) and pancreatic pseudocysts (4.8%) were the most frequent complications. Regarding outcomes, a majority of patients experienced a favorable prognosis, with 64.4% recovering and being discharged. However, the complexity and severity of some cases were evident, as 17.6% of patients required referral to higher levels of care for further management. Additionally, a small percentage of patients left against medical advice (14.8%), and mortality was observed in 3.2% of cases. Laboratory investigations played a crucial role in diagnosing acute pancreatitis, and elevated levels of serum amylase (64.4%) and lipase (95.2%) were prominent diagnostic markers. Other abnormal laboratory parameters, such as elevated transaminase (90.8%) and C-reactive protein (86.4%), provided valuable insights for diagnosis and management.

Conclusion: The study found acute pancreatitis with a wide range of clinical presentations and aetiologies. Abdominal pain is the most common symptom and gallstones are the most common causes. The study has evaluated the outcomes and complications of acute pancreatitis indicating that a significant proportion of cases had a favorable prognosis. A notable proportion required referral to higher levels of care, suggesting the complexity and severity of some instances of acute pancreatitis. A smaller percentage left against medical advice, and a few cases resulted in mortality.

J Com Med Col Teachers’ Asso July 2023; 27(2): 67-74

Speech Language Disorder in Children: An Overview

2024-02-17T05:24:30+00:00

The speech and language development of a child reflects his or her overall growth and cognitive abilities. Children frequently experience speech and language disorders, which may have long-term effects. Depending on its intensity, it could impair daily functioning, communication, learning, and social interaction. The purpose of this review is to address common speech and language disorders, their etiologies, and interventional strategy. With the rising incidence of speech language problem in children, it is important to early identification of the problem that may help us to take appropriate measures. Children's speech and language abilities can be significantly improved with early detection and timely intervention.

J Com Med Col Teachers’ Asso July 2023; 27(2): 75-82

Rhinosporidiosis of Male Urethra - Case Report of a Rare Disease

2024-02-17T05:42:38+00:00

Rhinosporidiosis is a chronic granulomatous disease caused by the fungus commonly affecting anterior nares and nasopharynx. Other sites of involvement included the larynx, hard palate, vagina, vulva, and anus. It may occur very rarely at urethra. This disease generally acquired by bathing in ponds contaminated by animal feces. It is a benign condition where the organisms are limited to the lesion and regional lymph nodes. Adjacent tissues are not usually involved. The infection is very slow to develop with little discomfort; it is often difficult to ascribe age at onset. Males account for 70% to 90% of cases mostly from the rural environment. The lesion causes pressure and obstructive symptoms when they enlarge. Diagnosis usually confirmed by histopathology of excised mass.

J Com Med Col Teachers’ Asso July 2023; 27(2): 83-84