Journal of Dhaka Medical College 2018-11-18T10:51:51+00:00 Prof. Khan Abul Kalam Azad Open Journal Systems Official journal of the Dhaka Medical College Teachers' Association. Full text articles available. Bangladesh in the road to Eliminate Viral Hepatitis B 2018-11-18T10:49:07+00:00 Monira Pervin <p>Abstract not available</p><p><em>J Dhaka Medical College, Vol. 26, No.2, October, 2017, Page 86-88</em></p> 2018-11-18T10:49:07+00:00 ##submission.copyrightStatement## Assessment of Initial Stroke Severity by National Institute Health Stroke Scale (NIHSS) Score at Admission 2018-11-18T10:49:10+00:00 Swapon Kumar Ghose Kazi Gias Uddin Ahmed Ahmed Hossian Chowdhury ATM Hasibul Hasan Kanol Saha Reaz Mahmud Nazmul Islam Joy Rama Biswas Md Sadekur Rahman Sarkar Md Mahabubur Rahman Hashmi Sina Md Arifuzzaman Iftikher Alam Mohammad Murad Hossain ASM Rezaul Karim Mansur Habib <p><strong>Background: </strong>The National Institutes of Health Stroke Scale or NIH Stroke Scale (NIHSS) is a widely used tool for assessing stroke severity. We conducted this study to determine the severity of stroke patients admitted in a tertiary care hospital.</p><p><strong>Methods: </strong>This is a cross sectional study conducted in Department of Neurology, Dhaka Medical College Hospital from April 2016 to October 2016 involving 91 acute stroke patients.</p><p><strong>Result: </strong>About half (44%) of the patients were older than 60 years of age and mean age of the patients was 60.34(±16.1) years at onset and there is a slight female predominance (51.6%). Majority had hypertension (75.8%) followed by physical inactivity (67%), diabetes (37.4%), smoking (33%), obesity (23.1%), family H/O stroke (20.9%) and dyslipideamia (15.4%). Many patients were found to have hyperglycemia (14.3%) followed by hyperthermia (13.2%), hypotension (4.4%) and low oxygen saturation (3.3%) at the time of admission. Most of them had ischemic stroke (60%), followed by intracerebral hemorrhage (35%) and subarachnoid hemorrhage (5%). After leveling with NIHSS score more than half of the patients (51%) were found to be moderate grade on admission. Although, there was no association between risk factors of stroke and admission NIHSS score level, significant association was found between hypoxia and admission NIHSS score severity.</p><p><strong>Conclusion: </strong>Acute stroke patients, mostly have moderate grade of NIHSS score on admission. Hypertension, physical inactivity, diabetes, smoking, obesity, family H/O stroke and dyslipideamia are common risk factors observed among the patients which have no significant association with admission stroke severity determined by NIHSS score. There is significant association between hypoxia and admission NIHSS score severity.<em></em></p><p><em>J Dhaka Medical College, Vol. 26, No.2, October, 2017, Page 90-93</em></p> 2018-11-18T10:49:10+00:00 ##submission.copyrightStatement## Lipid Lowering effect of Natural Honey in Comparison to Atorvastatin on Hyperlipidemic Rats 2018-11-18T10:49:23+00:00 Kawsar Jahan Moon Kazi Afzalur Rahman Hasanur Rahman Ruman Afroz Mohammed Ruhul Amin Fauzia Alima Sabrina Yeasmin Kazi Shamim Ahamed Fatema Ahmed <p><strong>Aims: </strong>The present study was performed to investigate the hypolipidaemic effect of natural honey in hyperlipidaemic rats. We also compared the hypolipidaemic effects of natural honey with a standard known hypolipidacmic agent, atorvastatin.</p><p><strong>Methods: </strong>At first the rats (n=42), were randomly divided into six groups. Each group composed of seven rats. Group A control group received normal diet, distilled water for 10 days. Group B hyperlipidemic group received normal diet olive oil (1.5inl) with cholesterol daily for 10 days. Group C received normal diet, distilled water. D, E &amp; F. On the 11th day of experiment the final body weight was measured &amp; blood was collected by cardiac puncture for the study of lipid profile.</p><p><strong>Result</strong>: Only cholesterol fed Group B and C rats gained body weights. Natural honey and atorvastatin treated group of rats. Group D, E, F lost body weights. These changes between the initial and final body weight were statistically significant (p&lt;0.05). Regarding the lipid levels, it was observed that (a) there as statistically significant rise of serum TCI., LDL &amp; TG levels in group B compared to that of group A (p &lt;0.001 in each parameter), b the serum TCL is significantly decreased in group B (p&lt;0.05), and group F (p&lt;0.01) in the comparison to groups; the value also decreased in group D but the decrease was slightly significant (C) the serum LDL level significantly reduced in group D, E &amp; F compared to group C; but the maximum effect comparison to group C; the value also decreased in group D but the decreased was slightly significant. (C) the serum LDL level significantly reduced in group D, E &amp; F compared to group C, but maximum effect was observed in group E &amp; F (p &lt;0.001). (d) No significant change of serum HDL was observed in Group D but slightly significantly increased in group E and group F (p &lt;0.05) compared to group C. (e) The serum TG level reduced significantly (p &lt;0.001) in group D. E and F compared to group C. Thus study showed natural honey reduced TCL, LDL &amp; TG and slightly increase HDL and atorvastatin reduce TCL, LDL &amp; TG. But atorvastatin have some side effect on the other hand natural honey have no side effect.</p><p><strong>Conclusion: </strong>The result and observation of the present study provide a rationale for use of natural honey in the development of a new herbal medicine much needed for the reduction of serum lipid levels (TCL, TO, LDL). Atorvastatin also lower TCL, LDL &amp; TO. Thus it could he useful in hyperlipidaemic conditions. But before establishing natural honey as a therapeutically effective hypolipideamic agent, further studies should be carried out to determine the active principles responsible for hypolipidaemic effect and its cellular mechanism of action.<em></em></p><p><em>J Dhaka Medical College, Vol. 26, No.2, October, 2017, Page 94-102</em></p> 2018-11-18T10:49:23+00:00 ##submission.copyrightStatement## A Study on Prevalence of Anaemia in Pregnancy among the Women Reporting for Antenatal Care in Combined Military Hospital, Dhaka Cantonment 2018-11-18T10:49:36+00:00 Md Lutfur Rahman Zebun Nessa Sabrina Yesmin Md Hafizur Rahman Choudhury Faisal Md Manzurur Rahman <p><strong>Background: </strong>Anemia is regarded as a major risk factor for unfavorable outcome of pregnancy both for the mother and the fetus. Maternal anaemia is a common problem in pregnancy, particularly in developing countries.</p><p><strong>Aims: </strong>To determine the prevalence of anaemia in pregnancy and to find out the haemoglobin level of pregnant women reporting for antenatal checkup among the women reporting for antenatal care in Combined Military Hospital Dhaka.</p><p><strong>Method: </strong>This is a descriptive cross sectional study was done in the antenatal clinic at CMH Dhaka. One eighty four (184) pregnant women attending antenatal clinic at CMH Dhaka including CWC under CMH Dhaka were included for the study. The data were collected from 1<sup>st </sup>May 2001 to 31<sup>st</sup> May 2001 at the antenatal clinic, combined Military Hospital. Dhaka where pregnant women reported for antenatal check up. The data were collected by interviewing respondents in different dates &amp; day of the week at different CWC and CMI-I Dhaka. Prior to the interview the respondents were explained clearly the objective of the study and sought their co-operation. The authority of CMH Dhaka was given prior information through issuing letter from AFMI. The respondent was assured on ethical point of view that strict secrecy would be maintained. Data were collected by the following methods: Interview Method; Laboratory Investigation for Hb estimation and Scrutinization of antenatal check up card.</p><p><strong>Results: </strong>A total of 184 pregnant women of them 70 were primi gravida and 114 were multigravida. The prevalence of anaemia as per WHO cutoff points was 56.52% (&lt;11.0 g/dl). The mean age was 24.96 <strong>± </strong>4.49 years. The age groups 20-24 was the maximum. Out of 184 women 104 women was ariaemic. 15-24 age group was more anaemic (57.42%) than the 25-39 age group (55.42%) but the difference was not statistically significant, P&gt;0.05. The prevalence of anaemia was higher in Illiterate (100%), lowest in degree and above level education group (48.48%). The maximum women (64.13%) belong to lowest income group. (Tk 2500-5000) Anaemia was the most common in the lowest income group (60.50%). The prevalence of anaemia was the highest among the family size 6 and above group (75%) and lowest in 2-3 family size group. Anaemia was more prevalent among high parity group (75%) and lowest in ‘0’ parity group (52.28%) but the difference was not statistically significant (P <strong>&gt; </strong>0.05). Multigravida were found more anaemic (62.28%) contrast to prirnigravida (47.14%) which was statistically significant (P&lt;0.05). The prevalence of anaemia was less in higher birth interval group but the difference was not statistically significant (P&gt;0.05). About the cultural belief only 33 women were found having cultural belief of avoiding food during pregnancy (17.93%) and anaemia was more prevalent among them (57.57%) but the difference was statistically significant (P&gt;.05). In this study 14.13% women had concomitant illness during pregnancy. In this study 15 women had caesarian section of which 10 were anaemic (75%) and there was one Forcep delivery (non-anaemic).</p><p><strong>Conclusion: </strong>In this study anaemia is more prevalent among younger age group women (15-24), with less educated group low income group, large family size group, high parity and high gravida, less birth spacing and also in women having concomitant illness. Anaemia is more prevalent among women having cultural belief on avoiding food during pregnancy. The findings of this study may not reflect the overall picture of the country. It does not differ much from the results of similar studies at national level. However, this study can be a base for further studies in a broader perspective.<em></em></p><p><em>J Dhaka Medical College, Vol. 26, No.2, October, 2017, Page 103-110</em></p> 2018-11-18T10:49:36+00:00 ##submission.copyrightStatement## Sera-epidemiology of Dengue Virus Infection in Clinically Suspected Patients Attended in Dhaka Medical College Hospital During January to December 2016 2018-11-18T10:49:48+00:00 Monira Pervin Afroza Akbar Sweety Mohammad Zaid Hossain Rabeya Sharmin Nusrat Fatema Md Anisur Rahman Naznin Nehar Marufa Yasmin Mohammad Mehfuz E Khoda Kazi Monisur Rahman Khan Abul Kalam Azad <p><strong>Introduction: </strong>Dengue is now established as one of the most important Arboviral infection in tropical countries. As the epidemic continues worldwide, this Aedes mosquito-transmitted pathogen is considered a major re-emerging tropical disease and significant public health concern. The study was conducted to determine the sero-epidemiology and clinical picture of dengue virus infection among the clinically suspected patients attended in Dhaka Medical College Hospital during January to December 2016.</p><p><strong>Materials and Methods: </strong>The study was carried out on 145 clinically suspected Dengue patients attended in Dhaka Medical College Hospital from January to December 2016 who had fever with temperature &gt;39°C. Blood sample was collected during acute febrile phase of patients and separated sera were tested for NS1 dengue antigen and IgM antibodies using commercial test kits (NS1 by OMC Healthcare (Pvt.) Ltd &amp; IgM antibody by Omega Diagnostics Ltd.).</p><p><strong>Results: </strong>Of the total 145 patients 40 (27.6%) were positive for Dengue NS1 antigen and or IgM antibody test. Of the positive 40 patients, 18 (45%) were positive for NS1, 19 (47.5%) were positive for IgM and 3 (7.5%) were positive for both NS1 and IgM antibody. Major clinical manifestations were fever with arthralgia (79.5%) and retro-orbital pain (50%).</p><p><strong>Conclusion: </strong>Outbreak of Dengue fever is continuing every year and typical presentation of Dengue fever has changed. Arthralgia and retro orbital pain was the most common clinical feature in the present study instead of headache and rash with fever. A large number of suspected dengue cases were negative by Dengue tests for antigen NS1 and IgM antibody which suggests other organisms of similar clinical manifestations are becoming prevalent in Dhaka city.<em></em></p><p><em>J Dhaka Medical College, Vol. 26, No.2, October, 2017, Page 111-116</em></p> 2018-11-18T10:49:48+00:00 ##submission.copyrightStatement## Clinicopathological Profile of Cervical Cancer Patients Attending in a Specialized Hospital 2018-11-18T10:49:59+00:00 Sultana Afroj Mahbuba Akhter Banu Sufia Sultana Raunak Jahan Shamima Rahman Nazneen Begum <p><strong>Background: </strong>Cervical cancer is one of the leading causes of death among women in our country. .It is a preventable disease and early carcinoma cervix can be cured by proper treatment. Lack of countrywide well accepted screening program of cervical cancer may be a cause of this hidden advancement of disease.</p><p><strong>Objectives: </strong>To assess the clinical and pathological profile of patients with cervical cancer.</p><p><strong>Method: </strong>This cross sectional descriptive study was conducted in the Department of Gynaeoncology of National Institute of Cancer Research &amp; Hospital (NICRH) from January, 2011 to December, 2011. Initially 76 patients were enrolled in the study by purposive sampling. Thereafter they were scrutinized by eligibility criteria and ultimately 67 patients were finalized. A case record form was prepared which was pre-structured, interview and observation based and peer reviewed. Data regarding socio-demographic, clinical and pathological profiles were collected in standard data sheet. Data were recorded, compiled, edited and analyzed. P-value was determined as significant at &lt;0.05.</p><p><strong>Results: </strong>The mean age of 67 patients were 44.9±12.01 years (age range: 20-75 years). 74.6% patients were married, 79.1% were housewife and 50.7% were illiterate/only can sign. The household income was &lt;10,000 BDT/month in case of 58.2% cases whereas 10,000-25,000 in 38.8% cases. Among study population 47.8% and 31.3%adenoc patients were staged as stage- II and stage-III, on the contrary 19.4% and 1.5% were staged as stage I and IV. Majority of patients 86.57% are suffering from aqueous cell carcinoma and only 13.43% had carcinoma. Most of the patient in advanced stage 32.75% in stage IIIB, 29.3% stage IIB. In this study all patients had excessive P/V discharge, among them 67.16% foul smelling and 19.4% blood stained, 764.1% irregular P/V bleeding and 86.56% postcoital bleeding. Regarding identifiable risk factors grand mutipara 79.1%,low socioeconomic group 58.2% and early marriage 49.25%</p><p><strong>Conclusion: </strong>There are several risk factors available among our cervical cancer patients like early marriage, multipariy ,low socioeconomic coditioand, ,multiple sex partner. Most of them are suffering from squamous cell carcinoma. The alarming clinical presentation such as blood stained or foul smelling PV discharge, irregular PV bleeding and postcoital bleeding should be considered seriously for seeking medical attention.<em></em></p><p><em>J Dhaka Medical College, Vol. 26, No.2, October, 2017, Page 117-121</em></p> 2018-11-18T10:49:59+00:00 ##submission.copyrightStatement## Outcome of Primigravida with high foetal head at term or onset of labour 2018-11-18T10:50:10+00:00 Mukti Rani Saha Nahid Yasmin Afzalunnessa Chowdhury Shahrin Ahmed Kamrunnahar Sweety Madhurma Saha <p><strong>Objective: </strong>To determine the causes of high foetal head and their relative frequencies in primigravidae presenting at term and to determine the proportion of these patients undergoing lower segment caesarean section or vaginal delivery. Design: A descriptive study.</p><p><strong>Place and duration of study: </strong>The study was carried out at Mugda Medical College Hospital from March 2017 to June 2017.</p><p><strong>Materials and Methods: </strong>A total of 50 primigravidae patients presenting at term and having a single pregnancy were randomly selected. On the basis of history, Physical examination and abdominal ultrasonography, patients having a high foetal head were recognized and their causes documented.</p><p><strong>Results: </strong>Out of 50 primigravidae, with high foetal head there was foetal malpresentation 17(34%), Cephalopelvic disproportion 13(26%) , Foetal distress 12(24%). Lower segment caesarian section was the management of choice in more than half of the patients with high foetal head.</p><p><strong>Conclusions: </strong>Foetal malpresentation &amp; Cephalopelvic disproportion were the major cause of high foetal head in this study and lower segment Caesarean section was the mode of delivery in more than half of the patients with high foetal head.<em></em></p><p><em>J Dhaka Medical College, Vol. 26, No.2, October, 2017, Page 122-125</em></p> 2018-11-18T10:50:10+00:00 ##submission.copyrightStatement## The Gastro Protective Effect of Trigonella Foenum Graecum Seed (Methi) and Omeprazole in Experimentally Induced Gastric illcer in Rats 2018-11-18T10:50:18+00:00 Rumana Afroz Kazi Afzalur Rahman AHM Mostafa Kamal Mahbuba Jahan Lotus Sultana Yesmin Nahid Yeasmin Kazi Monisur Rahman <p><strong>Context : </strong>The gastric ulcer is a common gastrointestinal problem in Bangladesh. Gastric epithelium is under constant assault by a series of endogenous noxious factors, including HCl, pepsinogen / pepsin, and bile salts. In addition, a steady flow of exogenous substances such as medications, alcohol, and bacteria encounter the gastric mucosa. A highly intricate biologic system is in place to provide defense from mucosal injury and to repair any injury that may occur. From the ancient time, various plants were used in traditional medicine with reputation as efficacious remedies. The incidence of duodenal ulcer disease has been declining dramatically for the past 30 years, but the incidence of gastric ulcers appears to be increasing as a result of the widespread use of NSAIDs and low-dose aspirin. The list of plant derived modern medicine is very long now. About 33% of the drugs produced in the developed countries are derived from plants. Trigonella foenumgraecum (Fenugreek, Methi) is a herbal medicine used in many parts of world. Preliminary study on animal showed that Trigonella foenum-graecum seed has significant gastro-protective effect. A study was carried out to see the gastro-protective effect of Trigonella foenum-graecum (Fenugreek, Methi) and omeprazole in ethanol induced gastric ulcer in an experimental rats.</p><p><strong>Material and Methods: </strong>The present study was performed on 24 (twenty four) rats which were divided randomly into 4 groups each having 6 rats in the Pharmacology Department of Dhaka Medical college, Dhaka. The rats were aged between 8-10 weeks of both sexes and weighing between 180-200 gm. The study was carried out to demonstrate the gastro-protective effect of aqueous extract and ethanolic extract of Trigonella foenum-graecum seed and omeprazole on ethanol induced gastric ulcer in experimental rats.</p><p><strong>Result : </strong>Pretreatment with aqueous extract and ethanolic of Trigonella foenum-graecum seed (500mg/kg/body wt) showed very significant prevention in ethanol induced gastric ulcer in number of lesion, lesion length, lesion breadth, lesion area and lesion index. This prevention was statistically very significant (P&lt;0.001). In this study there was no statistical significant difference was observed between aqueous and ethanolic extracts of Trigonella foenumgraecum seed in gastro-protective effects.</p><p><strong>Conclusion: </strong>The aqueous and ethanol extracts of Trigonella foenum-graecum seed and omeprazole possess gastro protective properties.<em></em></p><p><em>J Dhaka Medical College, Vol. 26, No.2, October, 2017, Page 126-131</em></p> 2018-11-18T10:50:18+00:00 ##submission.copyrightStatement## Aggravating Factors of Migraine among the Patients Attending Neuro-Medicine Outpatient Department at Two Selected Tertiary Level Hospital 2018-11-18T10:50:29+00:00 Syeda Rumana Hoque Md Nazmul Hasan Md Abdullahhel Kafee Nahiduzzaman Shazzad Sanjoy Kumar Saha Md Abdur Rahman Mohammed Masudul Hassan Khan Sadia Islam Fatema Ahmed <p>A descriptive cross-sectional type of study was conducted among the migraine patients attending the Neuromedicine department of Dhaka Medical College Hospital and Bangabandhu Sheikh Mujib Medical University to find out the aggravating factors of migraine in the year of 2006. Total number of respondents was 160. Among them 70% were female. Majority of the patients (46.25%) were aged between 21-30 years. Significant number of respondents (38.12%) was housewives; followed by 28.75% were student. The main aggravating factors so far identified in this study were sleep disturbance, bright light, noise and mental or physical stress. Other aggravating factors were various types of food, oral pill, relation with menstrual cycle. Respondents also stated more than one factor. Among the female respondents 39.8% practiced different types of contraceptive methods of which majority (82.05%) used OCP<strong>.</strong><em></em></p><p><em>J Dhaka Medical College, Vol. 26, No.2, October, 2017, Page 132-134</em></p> 2018-11-18T10:50:29+00:00 ##submission.copyrightStatement## Perinatal Outcome of Premature Rupture Membrane in Pregnancy 2018-11-18T10:50:36+00:00 Housneara Begum Marlina Roy Nahid Reaz Shapla <p><strong>Objective: </strong>To find out the effect of PROM on neonatal outcome so that we can pay more attention for the correct diagnosis and management of PROM in pregnancy which can reduce the perinatal mortality and morbidity caused by PROM.</p><p><strong>Methods: </strong>One hundred PROM cases were selected maintaining appropriate inclusion &amp; exclusion criteria from the department of obstetrics &amp; Gynaecology of BSMMU &amp; DMCH and one hundred controlled cases were taken from the same during the period of January 2010 to December 2010. Data were analyzed with SPSS statistical program to determine the effect of PROM on neonatal health.</p><p><strong>Results: </strong>In this study, 44% babies of PROM patients had various type of morbidity compare to 24% of patients with intact membrane. In PROM patients, perinatal mortality was 7% in this study compare to 5% with intact membrane. Causes of perinatal death in PROM was severe asphyxia (4%), RDS (5%) &amp; neonatal sepsis (6%) mainly.</p><p><strong>Conclusion: </strong>All fetal complications were significantly higher in PROM patients who received treatment after prolonged rupture of membrane. Appropriate antibiotic coverage in appropriate time will reduce fetal morbidity.<em></em></p><p><em>J Dhaka Medical College, Vol. 26, No.2, October, 2017, Page 135-139</em></p> 2018-11-18T10:50:36+00:00 ##submission.copyrightStatement## Correlation of Serum Low Density Lipoprotein Cholesterol and High Density Lipoprotein Cholesterol with Type 2 Diabetes Mellitus 2018-11-18T10:50:43+00:00 Nahid Yeasmin Qazi Shamima Akhter Sayeeda Mahmuda Sultana Yeasmin Rumana Afroz Mahmudul Hasan Rukhshana Rabbani Shamima Akhter Md Ashif Mashud Chowdhury Uma Dhar <p><strong>Background</strong>: Diabetes mellitus is one of the most widespread endocrine disorders in female and its complications are increasing all over the world, leading to life threatening medical problems like cardiovascular diseases, stroke and end stage renal diseases. A correlation between hyperlipidemia and type 2 diabetes mellitus has been identified. The study was carried out to observe the correlation of serum low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) level with type 2 diabetes mellitus in adult female subjects.</p><p><strong>Method</strong>: This cross sectional study was conducted in the Department of Physiology, Dhaka Medical College, Dhaka, during the period of January 2011 to December 2011. Total sixty female subjects were selected with age ranging from 30 to 50 years. Among them 30 female subjects with diabetes mellitus were included from out-patient department of Endocrinology, Dhaka Medical College Hospital, Dhaka as study group (B) and 30 apparently healthy females were taken as control group (A) for comparison. Estimation of serum fasting serum LDL-C and HDL-C levels was done by enzymatic method in the department of Physiology, Dhaka Medical College Dhaka in both groups. Fasting serum insulin level was measured by ELISA method in the laboratory of National Institute of ENT, Dhaka and fasting blood glucose was estimated by glucose oxidase method in the department of Physiology, Dhaka Medical College in both groups. Data were analyzed by Unpaired Student’s- test and Pearson’s correlation co-efficient (r) test as applicable.</p><p><strong>Results: </strong>The value of fasting serum LDL-C level was significantly higher in study subjects than those of control. Again, fasting serum HDL-C level was significantly lower in study subjects in comparison to controls. In study subjects fasting serum LDL showed positive correlation and fasting serum HDL-C levels showed negative correlation with fasting blood glucose and serum insulin level.</p><p><strong>Conclusion: </strong>Present study reveals that serum insulin and blood glucose level have positive relationship with low density lipoprotein cholesterol (LDL-C) and negative relationship with high density lipoprotein cholesterol (HDL-C) levels.<em></em></p><p><em>J Dhaka Medical College, Vol. 26, No.2, October, 2017, Page 140-147</em></p> 2018-11-18T10:50:42+00:00 ##submission.copyrightStatement## Serum Magnesium and Calcium Status among Term Asphyxiated Newborns with Moderate to Severe Hypoxic-ischemic Encephalopathy (HIE) 2018-11-18T10:50:57+00:00 Rifat Zaman Md Abid Hossain Mollah Mohammad Mahfuzur Rahman Chowdhury Shamima Yeasmin Abu Sayeed Chowdhury Dipa Saha <p><strong>Background &amp; objective: </strong>Perinatal asphyxia affects all organs of the body and brain is the most affected organ. The study was undertaken to find out the status of serum magnesium and calcium level and their significant association among asphyxiated term newborns with moderate to severe HIE.</p><p><strong>Material &amp; methods: </strong>The Cross sectional study was done in the Department of Neonatology, Dhaka Medical College Hospital during January 2012 to July 2012. A total of 102 asphyxiated term neonates were enrolled , who has H/O perinatal asphyxia and had Apgar score of 6 or &lt;6 at 5 minutes. Clinical grading of HIE into moderate and severe was done according to modified Sarnat and Sarnat scoring system .Under aseptic precautions with standard protocol , estimation of serum magnesium and calcium level in venous blood was done at 48 hours and 7th day of birth . Among the study population , 17 patients had died during follow up and 4 patients were absconded. Finally 81 patients were evaluated by both blood samples though initial 102 cases were evaluated by their first sample. 50 normal healthy infants were also evaluated for serum magnesium and calcium at their 48 hours of birth. Chi-square test was used to assess statistical significance, Pearson correlation coefficient test was done to find out correlation between serum magnesium and calcium status and APGAR score &amp; t test was done to assess the comparison between the values of serum magnesium and calcium found on two occasions.</p><p><strong>Results: </strong>Of 102 cases majority (58%) were male. Most of the cases (65.68%) were moderate HIE. Mean serum magnesium was 1.36(0.9-2.8) mg/dl and 1.16(.88-2.6) mg/dl among HIE II and HIE III respectively (p&lt;0.05). Mean serum calcium of HIE II and HIE III were 7.14(5.1-9.6) mg/dl and 6.58(5.3-9.0) mg/dl respectively (p&lt;0.05). There is positive correlation with individual APGAR score with serum magnesium (r=0.229, p=0.02) and serum calcium (r=0.231, p=0.019) level. Hypocalcaemia was found 35.82% and 57.14% among HIE II And HIE III cases respectively(p&lt;0.01). Hypomagnesaemia was found 28.36% and 45.71% among HIE II and HIE III (p&lt;0.05).</p><p><strong>Conclusion: </strong>Hypomagnesaemia and hypocalcaemia are significantly associated with the degree of severity of HIE.<em></em></p><p><em>J Dhaka Medical College, Vol. 26, No.2, October, 2017, Page 148-152</em></p> 2018-11-18T10:50:54+00:00 ##submission.copyrightStatement## Comparative Efficacy of Nebulized 7% Hypertonic Saline versus 3% Hypertonic Saline in Children with Acute Bronchiolitis 2018-11-18T10:51:06+00:00 Md Saiful Islam Md Abid Hossain Mollah Tafazzal Hossain Khan Chandan Kumar Shaha Md Zahir Uddin Shahana Khanam <p><strong>Background: </strong>Acute bronchiolitis is an acute viral lower respiratory tract infection in early childhood and is the leading cause of hospitalization in infants below 2 years of age. Being a viral disease, there is no effective treatment of this problem other than supportive care. To provide this care, both 3% hypertonic saline and 7% hypertonic saline has been used and found effective. However, which option is more effective to reduce clinical severity and length of hospital stay, still remain unsettled.</p><p><strong>Objective: </strong>To determined the efficacy of 7% hypertonic saline in children with acute bronchiolitis.</p><p><strong>Methodology: </strong>The study was a randomized controlled trial and carried out in the Department of Paediatrics, Dhaka Medical College Hospital (DMCH), Dhaka between January 2015 to December 2016. A total of 135 children from 1 month to 2 years of age irrespective of sex with clinical presentation of acute bronchiolitis admitted in the paediatrics ward of DMCH were included in the study and were randomly assigned to either 7% nebulized hypertonic saline (Group-I = 45) or to 3% nebulized hypertonic saline (Group-II = 90) in ratio (1:2). The main outcome variables were clinical severity score and length of hospital stay. The outcome was evaluated at 12 hourly and 24 hourly intervals till discharge (up to 120 hours)</p><p><strong>Result: </strong>In this study both groups were almost similar with respect to their demographic characteristics like age and sex and baseline clinical characteristics. The study demonstrated that respiratory rate score, wheezing score, retraction score, general condition score and clinical severity score of both treatment modalities were reduced. Children of group-I(7% HS) 40(88.9%) recovered at the end of 72 hours where as 67(74.4%) of the children of group-II(3% HS) recovered from the disease during the same period. Length of hospital stay was shorter in 7% hypertonic saline group compared to 3% hypertonic saline group (56.36±16.33 hours vs63.07±21.48 hours, p=.067). The patients of 7% hypertonic saline group required a shorter duration of oxygen therapy compared to 3% hypertonic saline group (16.53±3.98) hours vs (20.25± 4.15) hours, (p=0.109) respectively.</p><p><strong>Conclusion: </strong>Nebulized 7% hypertonic saline as well as 3% hypertonic saline both were effective in acute bronchiolitis and found no significant difference in efficacy between these options in terms of reducing clinical severity, length of hospital stay and duration of oxygen therapy. No side effect were observed in either group.<em></em></p><p><em>J Dhaka Medical College, Vol. 26, No.2, October, 2017, Page 153-156</em></p> 2018-11-18T10:51:06+00:00 ##submission.copyrightStatement## The Common Causes Leading to Pancytopenia at Tertiary Care Hospital Hossain 2018-11-18T10:51:17+00:00 Mohammad Zaid Hossain Mohammad Manirul Islam Masuma Ahmed Salsabil Quadrat E Elahi Mazharul Islam Md Abdullah Al Imran Pratyay Hasan Afsana Rahman Nira Ferdous Israt Zerin Eva Khan Abul Kalam Azad <p>Pancytopenia is a triad of simultaneous presence of anemia, leucopenia and thrombocytopenia. It is result from a number of disease processes. Both hematopoietic and nonhematopoietic conditions manifest with features of pancytopenia.</p><p><strong>Methods: </strong>This was a cross-sectional study carried out in the Department of Medicine, Dhaka Medical College Hospital between December 2016 to July 2017. We included adult patients of both sexes having age 16 years and above. Criteria for inclusion were persistent pancytopenia on peripheral blood film of more than one week duration. All patients underwent a detailed medical history and full physical examination followed by blood sampling for the investigations. After taking all the aseptic measures and with standard technique the diagnostic bone marrow aspiration and trephine biopsy were done.</p><p><strong>Results: </strong>There were 36 patients with pancytopenia which were included in this study. There were 20 (56%) males and 16 (44%) females with a 1.25:1 male to female ratio and a mean age 47.30 years ± 15.01 SD. The most common complaints were bleeding manifestation (29/36), followed by generalized weakness (27/36) and fever (25/36). Anaemia was the most common (100%) clinical feature followed by jaundice and splenomegaly (6/36). Aplastic anemia was the commonest cause that was observed in 27.78% (10/36) cases followed by Megaloblastic anemia 16.67% (6/36) and erythroid hyperplasia 13.88% (5/36).</p><p><strong>Conclusion: </strong>Aplastic anaemia is leading cause of pancytopenia in this study followed by megaloblastic anaemia and hypersplenism being second and third common causes respectively. Pancytopenia should be suspected on clinical grounds when a patient presents with unexplained anemia, prolonged fever and tendency to bleed.<em></em></p><p><em>J Dhaka Medical College, Vol. 26, No.2, October, 2017, Page 157-161</em></p> 2018-11-18T10:51:16+00:00 ##submission.copyrightStatement## Magnetic Resonance Imaging Evaluation of Spinal Tumors and Its Comparison with Histopathological Findings 2018-11-18T10:51:27+00:00 Gopal Chandra Saha Prodip Kumar Biswas Md Motlabur Rahman Mohammed Shahadat Hossain Mohammad Zaid Hossain AKM Humayon Kabir Ferdous Alam Tushit Paul <p><strong>Objective: </strong>The objective of the study was to assess the diagnostic usefulness of MRI in evaluation of spinal tumors.</p><p><strong>Methodology: </strong>This cross-sectional study was carried out in Dhaka Medical College Hospital, Dhaka. The data was collected from July 2011 to June 2013 and total 51 patients were included in the study. Data was collected from MRI diagnosed spinal tumors who attended at Radiology and Imaging department of DMCH from OPD and indoor patients. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MRI for evaluation of spinal tumors were detected.</p><p><strong>Results: </strong>Out of 51 patients 26 (51%) was intradural extramedullary, 13 (25.5%) was extradural and 12 (23.5%) was intramedullary. Distribution of patients according to MR diagnosis. Among the 51 patients 40 were diagnosed spinal tumor and 11 were not spinal tumor by MRI. Among the 40 spinal tumuor diagnosed 12 (23.5%) were schwannoma, 02 (3.9%) were neuro fibroma, 11(21.6%) were meningioma, 07(13.7%) were ependymoma, 05(9.8%) were astrocytoma, 02(3.9%) were metastasis and 1 (2.0%) was osteoblastoma. Out of all cases 40 were diagnosed as spinal tumour by MRI and among them 39 were confirmed by histopathological evaluation. They were true positive. One case was diagnosed as having spinal tumour by MRI but not confirmed by histopathological findings. That was false positive. Out of 11 cases of non tumour which were confirmed by MRI, 3 were confirmed as spinal tumour and 8 were non-tumour by histopathological findings. They were false negative and true negative respectively. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the MRI in the diagnosis of spinal tumour were 92.86%, 88.89%, 97.50%, 72.73% and 92.15% respectively.</p><p><strong>Conclusion: </strong>The present study conducted to assess the diagnostic usefulness of MRI in evaluation of spinal tumors among the Bangladeshi population. Study revealed high sensitivity, specificity and accuracy of the MRI in the diagnosis of spinal tumour. MRI should be the initial procedure in the evaluation of suspected tumors of the spine.<em></em></p><p><em>J Dhaka Medical College, Vol. 26, No.2, October, 2017, Page 162-166</em></p> 2018-11-18T10:51:27+00:00 ##submission.copyrightStatement## Associations between Adenotonsillar Hypertrophy, Age, and Obesity in Children with Obstructive Sleep Apnea 2018-11-18T10:51:36+00:00 Debesh Chandra Talukder Mani Lal Aich Mohd Rafiul Alam Md Shahriar Islam Sharfuddin Mahmud Dipali Biswas Kanol Saha Farhana Rahman <p><strong>Objective: </strong>To investigate the contributions of adenoid and tonsil size to childhood obstructive sleep apnea (OSA) and the interactions between adenotonsillar hypertrophy, age, and obesity in children with OSA.</p><p><strong>Methods: </strong>In total, 215 symptomatic patients were recruited. The patients were assigned to four groups according to age: toddler (age 1-3), preschool (age 3-6), school (age 6-12), and adolescence (age 12-18). All subjects had tonsil size graded by otolaryngologists, adenoid size determined on lateral radiographs and a full-night polysomnography. The apnea-hypopnea index (AHI), adenoid size, and tonsil size were compared in obese and non-obese children in the four age groups.</p><p><strong>Results: </strong>The AHI was positively related to tonsil grade and adenoid size in all patients. Tonsil grade was positively related to AHI in all four age groups. Adenoid size was positively related to AHI in the toddler, preschool, school groups, but not in the adolescent group. Tonsil grade and adenoid size were both positively related to AHI in obese and non-obese children.</p><p><strong>Conclusions: </strong>Adenotonsillar hypertrophy and obesity are the major determinants of OSA in children. However, the influence of adenoid size decreases in adolescence.<em></em></p><p><em>J Dhaka Medical College, Vol. 26, No.2, October, 2017, Page 167-172</em></p> 2018-11-18T10:51:36+00:00 ##submission.copyrightStatement## An Unusual Cause of Generalized Swelling 2018-11-18T10:51:45+00:00 Sabrina Shahrin Md Aminul Islam Md Ehsan Uddin Khan Parvez Iftekhar Ahmed Md Nazrul Islam Md Nizamuddin Chowdhury <p>Amyloidosis and multiple myeloma are included in the same spectrum of clonal plasma cell disorder. Amyloidosis can present with localized deposits or manifest as systemic disease involving multiple organs such as kidney, heart, intestine. Free Ig subunits ,mostly light chains secreted by a single clone of B cells, are the cause of the most frequent and severe amyloidosis affecting the kidney. The incidence of AL amyloidosis is nine per 1 million populations per year. Amyloid deposists are found in approximately 10% of all patients with myeloma and in 20% of those with pure light chain myeloma[1].Here we are reporting a case who initially presented with generalized swelling and subsequently found to have AL amyloidosis involving multiple organs due to multiple myeloma.</p><p><em>J Dhaka Medical College, Vol. 26, No.2, October, 2017, Page 173-177</em></p> 2018-11-18T10:51:45+00:00 ##submission.copyrightStatement##