Journal of Dhaka Medical College <p>Official journal of the Dhaka Medical College Teachers' Association. Full text articles available.</p> en-US (Dr. Md. Zaid Hossain Himel) (Md Fahmid Uddin Khondoker) Tue, 10 Mar 2020 08:28:01 +0000 OJS 60 Obstructive Sleep Apnoea (OSA) <p>Abstract Not Available</p> <p>J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 1-2</p> Salma Rouf ##submission.copyrightStatement## Mon, 02 Mar 2020 08:55:42 +0000 A Study of Risk Factors in Young Patients of Acute Coronary Syndrome <p><strong>Aim: </strong>The study was carried out to see the risk factors of Acute Coronary Syndrome in young patients.</p> <p><strong>Materials and Methods: </strong>This is a prospective study which was carried out in 60 young patients (18-40 years of age) with a diagnosis of Acute Coronary Syndrome admitted to Dhaka medical college Hospital, Dhaka. over a period of 02 years from January 2016 to January 2018. Acute Coronary Syndrome was diagnosed by clinical history, ECG evaluation and Serum Cardiac enzyme Troponin I and CK-MB estimation.</p> <p><strong>Result: </strong>Most of the patients (73%) had a sedentary lifestyle and 50% had dyslipidemia. 40% patients were taking a diet rich in fats, 37% patients were diabetic, 33% were hypertensive, 37% patients consume oral tobacco, 30% were smokers, 13% were obese and 17% were alcoholics. The family history of premature coronary artery disease was present in only 13% of cases. In our study, none of the patients had consumed oral contraceptive pills.</p> <p><strong>Conclusion: </strong>The most important modifiable risk factor is the sedentary lifestyle. The commonest non-modifiable risk factor is Male sex. Smoking, oral tobacco consumption, hypertension, diabetes, dyslipidemia, and diet modification are other important modifiable risk factors in young adults.</p> <p>J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 3-6</p> Prodip Kumar Biswas, Md Hafiz Sardar, Gopal Chandra Saha, Mohammad Zaid Hossain, Mohammed Shahadat Hossain, Tushit Paul, Khan Abul Kalam Azad ##submission.copyrightStatement## Mon, 02 Mar 2020 09:36:50 +0000 Association between hypertension and the severity of new onset ischemic stroke in Diabetic patients <p><strong>Objective: </strong>To evaluate the association between hypertension and the severity of new onset ischemic stroke patient with diabetes mellitus.</p> <p><strong>Method: </strong>This Cross sectional study was carried out in the Department of Neurology, BSMMU, Dhaka, from February 2013 to September 2014 on 50 patients with first attack of ischemic stroke with DM. mRS was measured on 14th day of the stroke. During this period other important relevant investigations were also recorded.</p> <p><strong>Result: </strong>In this study, out of 50 patients, 40.0% were in age group 51-60 years and the mean age of the patients was 58.9 ± 9.6 years with a range from 30 to 75 years. Males were 52.0% and females were 48.0%. Male to female ratio was 1.08:1. It was observed that more than one third (36.0%) patients were current smoker, 9(18.0%) were former smoker and 23(46.0%) were non smoker. More than half of the patients had hypertension (58.0%). Mean systolic BP was 129 ±16 mmHg with a range from 90 to 160 mmHg and the mean diastolic BP was 81±11 mmHg with a range from 60 to 100 mmHg. No association was found between hypertension with severity of new onset ischemic stroke in Diabetic patients.</p> <p><strong>Conclusion: </strong>As per study result it can be concluded that there is no association between hypertension and the severity of new onset ischemic stroke in Diabetic patients.</p> <p>J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 7-10</p> Hashmi Sina, Tamanna Mustary, Kazi Gias Uddin Ahmed, Ahmed Hossain Chowdhury, Kanol Saha, Mohammad Arifuzzaman, Abu Raihan Siddique, lftikher Alam, Sabbir Ahmed Dhali, Sharif Uddin Ahmed ##submission.copyrightStatement## Mon, 02 Mar 2020 00:00:00 +0000 Assessment of Nutritional Status through Body Mass Index (BMI) among First Year Students of MBBS & BSc Nursing Course of Government Medical Education Institutes in Dhaka <p><strong>Context: </strong>Adequate knowledge about nutritional status of a community is necessary to have a comprehensive idea about its development process, as under-nutrition is one of the major health problems in developing countries. As an individual’s height and weight can be readily and inexpensively measured, body mass index (BMI) has become a popular heuristic approximation for body fatness in epidemiology and clinical practice. The BMI is the most common surrogate measure of obesity as well as nutritional assessment for individual. For this reasons an attempt has been taken to assess the nutritional status through the body mass index (BMI) among first year students of MBBS and B sc nursing course of government medical education institutes in Dhaka.</p> <p><strong>Material and Methods: </strong>This descriptive type of analytic study was conducted in the Anatomy Department of Dhaka Medical College, Dhaka. The study sample was 177 individuals of first year students of MBBS and B.Sc nursing course admitted in the session of 2017-2018 in the Dhaka Medical College &amp; Dhaka Nursing College, Dhaka. Body Mass Index (BMI) was calculated as student’s weight in kilograms divided by the square of the student’s height in meters (kg/m2). The warning sign of poor nutritional health was calculated according to the checklist adapted by the Nutrition Screening Initiative, American Academy of Family Physicians July 2001. With the help of statistical software SPSS-20 comparisons between the two groups were done.</p> <p><strong>Result: </strong>The mean (±SD) height (meter), weight (kg) and BMI of groups MBBS and B Sc nursing were 1.63±0.09, 61.65±11.22, 23.11±3.53 and 1.56±0.07, 49.05±9.42, 20.15±3.47 respectively. Good nutritional health status was found 61.80% in MBBS and 53.30% in B Sc nursing groups.</p> <p><strong>Conclusion: </strong>The present study showed that the BMI of first year students of MBBS course is higher than first year students of B Sc nursing course.</p> <p>J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 11-16</p> AHM Mostafa Kamal, Khadeza Khatun, Shakil Shams, Begum Dilruba Kazi, Kazi Afzalur Rahman, Tasmin Shahnaz, Muhammad Mahbub Hossain, Munira Afroz Siddika ##submission.copyrightStatement## Mon, 02 Mar 2020 00:00:00 +0000 Clinical Pattern of Intra-cranial space occupying lesion in Tertiary Level Hospital <p><strong>Background : </strong>The term “Intra-cranial space occupying lesion” (ICSOL) is defined as any neoplasm, benign or malignant, primary or secondary, as well as any inflammatory or parasitic mass lying within the cranial cavity. Advances in intracranial imaging have made the detection of intracranial lesions relatively accurate and enabling us to focus on the etiology of these space-occupying lesions. Many reports suggested that both incidence and pattern of intracranial space occupying lesions are subject to considerable geographic and racial variations. Knowledge of the regional peculiarities of these lesions will help in identifications of possible risk factors.</p> <p><strong>Materials and Methods</strong>: This observational study was done in the department of medicine of Mymensingh medical college hospital, Bangladesh from November, 2011 to April, 2012 to evaluate the clinical pattern of ICSOL among the 75 adult admitted patients. Patient aged more than 15 years of either sex with symptoms and signs of ICSOL and at least one CT or MRI evidence in favour of diagnosis were included.</p> <p><strong>Results: </strong>The highest participation (22.7%) was observed from 55-64 years age group. Mean age of the participants was 54.35±18.68 years. Neoplastic tumor was (25.8%) in 15-24 years age group and non neoplastic lesion was (31.8%) in 55-64 years age group, among participants (76.0%) came from rural areas and 24% from urban. Population regarding the occupation 30.7% were housewives, 21.3% were service holders and 20.0% are farmers. Headache was the most common symptom noted in 93.33% of patients. Nausea/ vomiting, difficulty in limb movement and imbalance were the other most common three symptoms. In this series intracerebral hemorrhage was found in 53.3% of patients, Astrocytoma was the second most common (20.0%). Meningioma was found in 8% of the participants and another 8% had metastatic lesions in their brain. There were two cases of schwanoma while tuberculoma was diagnosed in another two participants (2.7%).</p> <p><strong>Conclusion: </strong>Patients with symptoms and signs of ICSOL should be dealt with great care and CT or MRI helps to evaluate them for early diagnosis and proper management.</p> <p>J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 17-22</p> Ponkaj Kanti Datta, Satya Ranjan Sutradhar, Md Nur a alam khan, Mohammad Zaid Hossain, Sultan Mahamud Sumon, Imrul Hasan, Raj Datta, ASM Tanim Anwar, Rezaul Islam, Md Monjur E Elahi ##submission.copyrightStatement## Tue, 03 Mar 2020 04:10:37 +0000 Cardiopulmonary Exercise Test in evaluation of Functional Capacity in patients with Chronic Obstructive Pulmonary Disease <p><strong>Background: </strong>Assessment of severity in patients with Chronic Obstructive Pulmonary Disease(COPD) is usually done at rest by spirometry test. But cardiopulmonary exercise test can be a measure to assess the functional capacity more accurately in patients with COPD.</p> <p><strong>Method: </strong>Fifty eight patients with stable COPD were included in this study period of one and half years from January 15 to June 2016 and categorise into four groups based on spirometric data following the GOLD guidelines 2018; GOLD 1 mild COPD, GOLD 2 moderate COPD, GOLD 3 severe COPD and GOLD 4 very severe COPD. Symptom limited CPET on treadmill using Bruce protocol using cardiopulmonary exercise machine was done in all fifty eight patient.</p> <p><strong>Results: </strong>twenty one patients (36.20%) had moderate COPD; twenty six(44.82%) had severe COPD; eleven(18.96%) had very severe COPD and none found to be categorised as mild COPD. All fifty eight patients attained anaerobic threshold. Majority(34, 58.62%) of patients stopped exercise due to shortness of breath; decreased oxygen saturation was the cause of stopping exercise in eight(13.7%) patients; other causes of exercise limitation were increased heart rate, vertigo, leg fatigue, increased blood pressure, ventricular ectopic and chest tightness. Four patients were found to limit exercise due to combined shortness of breath and leg fatigue. A significant correlation between forced expiratory volume in first second (FEV1, percent predicted) and maximum oxygen uptake(ml/kg/min) was observe. Twenty(46.55%) patients with low(&lt;40%) AT were identified who could be benefited from pulmonary rehabilitation program.</p> <p><strong>Conclusion: </strong>CPET can be useful to identifying the COPD patients with functional capacity impairment for pulmonary rehabilitation by assessing exercising capacity and the cause of exercise limitation.</p> <p>J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 23-27</p> Hena Khatun, Mohammad Mostafizur Rahman, Hasina Akhter Chowdhury, Mohammad Aminul Islam, Mohammad Touhiduzzaman, Mohammad Mohiuddin Ahmad, Md Rashidul Hassan, - Md Ashrafuzzaman, Md Ashraf Uddin Ahmed, Md Zakir Hossain ##submission.copyrightStatement## Tue, 03 Mar 2020 04:11:51 +0000 Disk diffusion Method in Enriched Mueller Hinton agar for determining susceptibility of Candida isolates from various clinical specimens <p><strong>Background: </strong>Candida species are responsible for various clinical infections ranging from mucocutaneous infection to life threatening invasive diseases. Recently there is a serious concern with increased resistance of antifungal drugs and its consequences. Thus, identification of Candida and its antifungal susceptibility testing has a paramount significance in the management of Candidal infections. The aim of the study was to determine antifungal susceptibility pattern of Candida by Mueller-Hinton agar media supplemented with glucose and methylene blue for disk diffusion testing of fluconazole, miconazole, clotrimazole, amphotericin B and nystatin.</p> <p><strong>Methods: </strong>A total of 35 Candida species was isolated from 2000 clinical specimens over 6 month’s period from July 2016 to December 2016. Growths on Blood agar and chromogenic agar were evaluated for colony appearance and microscopic examination. Antifungal susceptibility testing was performed by disk diffusion using Mueller-Hinton agar supplemented with glucose and methylene blue.</p> <p><strong>Results: </strong>Candida species were more sensitive to clotrimazole (88.58%) and amphotericin B (88.58%) followed by nystatin ((77.14%), miconazole (74.29%) whereas fluconazole showed the highest level of resistance (60%).</p> <p><strong>Conclusions: </strong>The increase in resistance to fluconazole is of serious concern as it is the most commonly used azole for candidiasis. The sensitivity profile of Candida isolates will be helpful to choose appropriate antifungal agents, thus decreasing patient’s morbidity and mortality.</p> <p>J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 28-33</p> Nabeela Mahboob, Hasina Iqbal, Mushtaque Ahmed, Md Mehedi Hasan Magnet, Kazi Zulfiquer Mamun ##submission.copyrightStatement## Tue, 03 Mar 2020 04:18:23 +0000 Efficacy of Bortezomib plus dexamethasone as a first line treatment in newly diagnosed cases of Multiple Myeloma: A Single Centre Study in a Tertiary Care Hospital <p><strong>Background: </strong>Multiple Myeloma (MM) accounts for 1% of malignant tumors and 10%–15% of hematopoietic neoplasms. Bortezomib, a first in class proteasome inhibitor, induces apoptosis and growth arrest and reverse chemoresistence in Myeloma cell and has demonstrated no irreversible adverse effect on haemopoietic stem cell. Dexamethasone increases the response rate. Thus, Bortezomib plus dexamethasone represent highly effective regimen for previously untreated Multiple Myeloma cases and significantly higher response rates approximately 70%– 90% have been observed.This combination thus may serve the basis of future strands of care in Multiple Myeloma patients.</p> <p><strong>Objective: </strong>The aim of the study was to assess the efficacy , safety and tolerability of Bortezomib in newly diagnosed cases of Multiple Myeloma patients in Bangladesh.</p> <p><strong>Materials &amp; Methods: </strong>This prospective observational study was carried out in the Haematology department of BSMMU from June 2017 to December 2018. Patients received inj. Bortezomib (1.3mg/m2 ) 4 cycles as an intravenous bolus on days 1,4,8,11 in a three week cycle (twice weekly administration) in indoor and same patients as day care basis in outpatients department. Dexamethasone at 40 mg was given intravenously or orally on the day of and day after inj Bortezomib.A self administered questionnaire containing different set of questions regarding Multiple Myeloma were used for data collection.</p> <p><strong>Results: </strong>Among the study population, 93% of patients had anaemia followed by bone pain (86%) and renal impairment (39%). Out of 25 patients,complete response achieved in 13 patients (52%), where 4 patients(16%) showed partial response,6 (24%) showed very good partial response and 2 (8%) patients showed no response. The overall response rate was 92% belonged to partial,very goofd partial and no respone respectively. Death occurred in 3 cases (12%). 5 patients (20%) developed Bortezomib induced peripheral neuropathy.Life threatening intracranial haemorrhage occurred in two patients (8%). Death occurred in 3 cases (12%),2 patients due to intracranial haemorrhage and another from cardiac arrest. In this study,S. creatinine, â2 microglobulin and bony lesion variables showed significant association with treatment response.</p> <p><strong>Conclusion</strong><strong>: </strong>Bortezomib plus dexamethasone is a highly effective and safe regimen for previously untreated multiple myeloma patients. This novel therapy in myeloma represent a new trearment paradigm targeting both tumor and microenvironment which has markedly improve overall response(OR), long progression free survival (PFS) and overall survival (OS)across in all risk groups. Moreover,it can be administered safely in the outpatient setting provided by clinicians.</p> <p>J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 34-41</p> Mahbuba Sharmin, Mohammad Manirul Islam, Abdul Aziz, Salauddin Shah, Md Jalilur Rahman, ASM Anwarul Kabir, Amin Lutful Kabir, Md Rashedul Hasan, Farzana Rahman, SM Humayun Kabir, Khan Abul Kalam Azad ##submission.copyrightStatement## Tue, 03 Mar 2020 04:41:34 +0000 Comparison of Talc Pleurodesis versus Bleomycin in Malignant Pleural Effusion <p><strong>Back ground: </strong>Malignant pleural effusion can cause significant morbidity to terminal patients. Drainage and control pleural effusion can provide great palliation and improve the quality of life of these patients. The purpose of this study was to evaluate which agent, bleomycin or talc pouring for pleurodesis is superior in terms of effectiveness, safety and cost.</p> <p><strong>Methods</strong>: It is a prospective randomized clinical trial from January 2013 to December 2014. A series of 38 patients entered in this trial. Inclusion criteria was diagnosed case of malignant pleural effusion either by fluid cytology or by pleural biopsy. Exclusion criteria was trapped lung, loculated effusions and life expectancy &lt;1 month. Five grams of talc in 50ml of normal saline or 1 unit per kg body weight of bleomycin mixed in 50 ml of normal saline, was administered via chest tube thoracostomy after minimum drainage &lt;100 ml daily in each patient. Treatment success was defined as the absence of recurrent pleural effusion on the chest radiography 1 month after pleurodesis.</p> <p><strong>Results: </strong>Treatment success was achieved in 16 out of 18 patients (89%) in talc slurring group versus 14 out of 20 patients (70%) in the bleomycin group (p=0.154). Fever, pain and hypersensitivity were the side effects of pleurodesis.</p> <p><strong>Conclusions: </strong>These results reflect that talc use was more effective than bleomycin in preventing early recurrence of malignant pleural effusions. Pleurodesis with talc instate of bleomycin can result in significant cost effective.</p> <p>J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 42-48</p> Mohammad Osman Goni, Mohammad Aminul Islam, Kamrul Alam, Mohammad Zaid Hossain, Tazul Islam, Kazi Saiful Islam, Hossain Al Mahmud, Md Alamgir Kabir ##submission.copyrightStatement## Tue, 03 Mar 2020 04:43:21 +0000 An Overview of Sino-nasal masses: A study from Dhaka Medical College Hospital <p><strong>Background: </strong>To study the incidence, clinical presentation and to observe comparison of different sinonasal masses.</p> <p><strong>Materials and Methods</strong>: This Prospective study was carried out from January 2017 to December 2018. Data were collected from 100 patients presented with sinonasal masses. This study is based on history, clinical, radiological, laboratory and histopathological examination.</p> <p><strong>Results: </strong>During the study period, 100 patients presented with sinonasal masses (male 60, female 40; age group 8-70 years).Nasal polyploid masses were non-neoplastic in 70 (70%) subjects, and neoplastic in 30 (30%) cases. Nasal obstruction was the most common (95%) presenting complaint, followed by rhinorrhoea (48%), hyposmia (30%), intermittent epistaxis (17%), headache (15%), facial swelling (10%) and eye-related symptoms (10%). The most common site of origin of polyploid masses was the middle meatus (54%) followed by the lateral wall of the nasal cavity (15%) and superior meatus (11%). unilateral nasal masses was present in 49% patients, while the remaining patients had bilateral nasal masses. Allergic (60%) and inflammatory (28.5%) polyps were the most common non-neoplastic mass, inverted papilloma (41.17%) and haemangioma (35.29%) were most common benign neoplastic mass; 92.3% of all malignant masses were squamous cell carcinoma. Surgery was the major mode of treatment. it included Caldwell-luc operation (7%), polypectomy (10%), excision of mass (25.0%) and functional endoscopic sinus surgery (44%). Malignancies were treated with radiotherapy or Surgery followed by radiotherapy or Chemoradiotherapy.</p> <p><strong>Conclusions</strong>: The masses in nasal cavity, paranasal sinuses, and nasopharynx encompass a wide spectrum of common and rare diseases and are very common lesions encountered in clinical practice. Endoscopic examination and advanced imaging technique help to reach a presumptive diagnosis but histopathological examination remains the mainstay of final definitive diagnosis.</p> <p>J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 49-53</p> Debesh Chandra Talukder, Satinath Chandra Sarker, Syed Ali Ahasan, Muhammad Mozammal Haque, Mostafa Kamal Arefin, Nadira Musabbir, Chowdhury Md Mushfiqur Rahman, SM Humayun Kabir ##submission.copyrightStatement## Tue, 03 Mar 2020 05:36:47 +0000 Distribution of Pruritus and Its Association With Serum Parathormone Level in Chronic Kidney Disease (Stage-5) Patients On Maintenance Hemodialysis <p><strong>Background: </strong>Pruritus is a common manifestation in patients on hemodialysis. The aim of this study is to determine the distribution of pruritus and evaluate the association between pruritus and serum parathormone levels in chronic kidney disease patients on maintenance haemodialysis.</p> <p><strong>Methods:</strong>This analytic, descriptive, cross-sectional study was performed over 191 patients of maintenance haemodialysis in 2014. Information related to the patients including age, gender, residence, pruritus was extracted from questionnaires. Serum levels of intact parathormone were measured &amp; data were analyzed.</p> <p><strong>Results: </strong>68% of the patients had pruritus. The Mean ± SD of serum parathormone was 53.25±7.96 pg/ml in patients with pruritus and 81.91±9.34 pg/ml in patients without pruritus. Our study showed that most patients with pruritus had normal serum parathormone levels and no significant association was found between pruritus and serum parathormone levels.</p> <p><strong>Conclusion: </strong>serum parathormone level may not play a role in uraemic pruritus in these patients.</p> <p>J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 54-59</p> Rafiqul Hasan, Md Nizamuddin Chowdhury, Md Nazrul Islam, Parvez Iftekher Ahmed, ASM Tanim Anwar, Mohammad Bellal Hossain, Mohammad Shawkat Ali, Md Saidur Rahman ##submission.copyrightStatement## Tue, 03 Mar 2020 00:00:00 +0000 Effect of BMI(Body Mass Index) on BMD (Bone Mineral Density) in Postmenopausal Women <p>Menopause is commonly associated with rapid bone loss and this bone loss manifests as a significant decrease in bone mineral density (BMD). Body weight or body mass index is the most important factor which influences BMD. Aim of this study was to evaluate the association between BMI and BMD in post menopausal women. Also to measure the correlation between age, duration of menopause, weight with BMD. This cross-sectional study was undertaken in the Department of Obstetrics and Gynaecology in Dhaka Medical College Hospital, Dhaka from January, 2012 to December, 2012. The study included women of 50 to 70 years who had menopause with three or more parity. Total 100 women were evaluated by history taking, physical examination and laboratory investigation (BMD).The results showed that there was significant positive correlation between BMI and BMD value of L1-4 and total femur (Pearson‘s coefficient was +0.285, P&lt;0.01 and +.350, P&lt;.001). There was also significant positive correlation between weight and T- score of L1-4 (r =+ .482, P&lt;.01) and Total femur (r = +.513, P&lt; .01). In addition, significant negative correlation was found between BMD with age and duration of menopause. It can be concluded that in postmenopausal women as the BMI decreases bone mineral density also decreases. So, adequate weight and BMI necessary for the prevention of osteoporosis.</p> <p>J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 60-66</p> Tabassum Ghani, Subinoy Krishna Paul, Afrina Begum, - Noorjahan, Mandira Sarkar, Taufiqua Hussain, Mosammat Gul A Anar, Md Sohel Rana, Md Sazzad Hossain ##submission.copyrightStatement## Tue, 03 Mar 2020 05:53:12 +0000 Histopathological Evaluation of Gastro Protective Effect of Trigonella Foenum Graecum Seed (Methi) and omeprazole in Experimentally Induced Gastric Ulcer in Rats <p><strong>Context: </strong>Peptic ulcer is a common disorder of the stomach and duodenum. Bangladesh is a developing country with a very high point prevalence of duodenal ulcer disease (11.9%) and a H. pylori prevalence of more than 90% in asymptomatic adults and 80% in children at the age of 5 years. The multifactorial pathogenesis of peptic ulcers is secretion of gastric acid. The main therapeutic target is the control of this secretion using antacids, H2 receptor blockers (ranitidine, famotidine) or proton pump blockers (omeprazole and lansoprazole). However, nowadays, gastric ulcer therapy faces a major drawback because most of the drugs currently available in the market show limited efficacy against gastric diseases and are often associated with severe side effects. Thus, there is an urgent need to identify more effective and safe antiulcer agents. In this context, the use of medicinal plants for the prevention and treatment of different pathologies is in continuous expansion worldwide. From the ancient time, various plants were used in traditional medicine with reputation as efficacious remedies. 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 foenum-graecum (Fenugreek, Methi) is one of them 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 demonstrate the gastro-protective effect of aqueous extract and ethanolic extract of Trigonella foenum-graecum seed (Fenugreek, Methi) and omeprazole on ethanol induced gastric ulcer in 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. 1 ml of absolute ethanol (5ml/kg body wt.) was orally administered to all groups by gastric intubations to induce gastric ulcer in all groups except normal control. Omeprazole suspension (20mg/kg body wt) was used as synthetic anti ulcer drug in study. Aqueous and ethanolic extract of Trigonella foenum-graecum seed(500mg/kg body wt) were used respectively orally. Histopathological analysis was carried out to evaluate the gastroprotective activity of aqueous 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 and ethanolic extract of Trigonella foenum-graecum seed (500mg/kg/body wt) showed very significant prevention in ethanol induced gastric ulcer. Results of the study showed that in case of ethanol treated rats gross examination showed a large amount of haemorrhagic lesions confined mostly in the gastric corpus. Histologically lesion involved about two-third of the mucosa layer and exfoliation of the mucosal cells was detected. Meanwhile, red blood cells were present in the gastric mucosa and edematous submucosa was discovered. However aqueous and ethanolic extract of Trigonella foenum-graecum seed significantly reduced the haemorrhagic lesions, tissue proliferation, infiltration of cells and sloughing induced by ethanol. This prevention was statistically very significant (P&lt;0.001).</p> <p><strong>Conclusion: </strong>The aqueous and ethanol extracts of Trigonella foenum-graecum seed and omeprazole possess gastro protective properties.</p> <p>J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 67-75</p> Rumana Afroz, Md Ismail khan, Kazi Afzalur Rahman, Mahbuba Jahan Lotus, Mir muhammad Shoyeb Shahabuddin, Tasnin Afrin, Nahid Yeasmin, Kawsar Jahan Moon ##submission.copyrightStatement## Tue, 03 Mar 2020 05:54:19 +0000 Evaluation of the Various Clinical Presentations of Adult CNS Tuberculosis <p><strong>Background: </strong>Central nervous system (CNS) involvement is one of the most important extrapulmonary manifestations of tuberculosis (TB) causing considerable mortality and morbidity. Presentations of CNS TB are extremely variable. Treatments are generally more effective if the disease can be detected early. This study is to find out the various clinical patterns and investigation findings that might help in early detection of CNS TB.</p> <p><strong>Objective</strong>: This study was conducted to detect various clinical manifestations of adult CNS TB at an earlier stage of evaluation.</p> <p><strong>Methods: </strong>This was a hospital based observational study (cross sectional type) conducted on 30 patients of CNS TB who were admitted in Sir Salimullah Medical College Mitford Hospital, Dhaka during a period of 6 months from October 2013 to April 2014</p> <p><strong>Results</strong>: Among the participants 53% were male and 47% were female, with a male female ratio of 1.13: 1. Mean age of the participants was 35.17±6.14 years. Tuberculosis involving brain (i.e. cranial TB) was most common (30.4%) in 15-24 years age group whereas spinal form of TB was most common (42.8%) in 25-34 years age group. Mean age of the participants having Brain TB was 36.46±6.90 years. Mean age of the participants having spinal TB was 32.36±12.52 years. Highest number of the cranial forms of TB was tuberculoma (52.2%) in this study and was found mostly in the young adults. Spinal TB was found in 25-34 years age group in highest number, all but one were Potts disease. Tuberculoma and tuberculous meningitis had an equal distribution in female sex while males had a higher (53.8%) occurrence of tuberculoma. On the other hand, spinal involvement was commoner in male sex (43.5%).Fever was the most common symptom noted in all forms of CNS TB patients (78.26% for brain and 71.43% for spinal cord TB patients) followed by headache and loss of consciousness representing 2nd and 3rd common symptom in brain TB patients. Most common clinical signs in brain TB were signs of meningeal irritation (65.22%), cranial nerve palsies and papillodema while spastic paraparesis with sensory level being the commonest in spinal cases. Tuberculoma was the most frequent neuro-radiologic findinds in case of brain TB patients and paraspinal soft tissue shadow with vertebral collapse was commoner in spinal TB patients.</p> <p><strong>Conclusion: </strong>This study has highlighted the relative frequency of various types of brain and spinal TB lesions along with the symptoms, signs and laboratory findings in Bangladeshi adult patients. In Bangladesh, tuberculosis should be always an important differential diagnosis in patients of fever with headache as well as spastic paraplegia or quadriplegia for any duration in any sex group.</p> <p>J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 76-84</p> KM Nazmul Islam Joy, Narayan Chandra Kundu, Mahfuza Akhter, Mohammad Zaid Hossain, Abu Hayat Mohammad Waliur Rahman, Md Mizanur Rahman, - Md Saifullah, Mohammad Abdur Rouf, Mohammad Majharul Haque ##submission.copyrightStatement## Tue, 03 Mar 2020 06:17:31 +0000 Incision and drainage of perianal abscess with primary fistulotomy in case of co-existing low variety fistula <p><strong>Background: P</strong>erianal abscess is a clinical condition frequently encountered by surgeons. Perianal abscess originates from an infection arising in the cryptoglandular epithelium lining the anal canal. Occasionally; bacteria, fecal material or foreign matter can clog an anal gland and tunnel into the tissue around the anus or rectum, where it may then collect in a cavity called an abscess. About half of perianal abscess may manifest as fistula-in-ano which increases the risk of abscess recurrence requiring repeated drainage. Treating the fistula at the same time of incision and drainage of abscess reduce chances of recurrent abscess development and therefore likelihood of repeat surgery. Primary fistulotomy in case of low variety fistula may be advantageous for perianal abscess because fistulas are more commonly traceable and can be laid open with full preservation of external anal sphincters.</p> <p><strong>Methods: </strong>216 consecutive patients (91.6% males, 8.33% females); mean age, 39 (range 18-70 years) from July, 2015 to January, 2019 with perianal abscesses were treated by incision and drainage and primary fistulotomy. 38 patients had comorbidities as diabetes mellitus, obesity (BMI&gt;26), tuberculosis. Patients were followed up clinically for 2 months. Digital rectal examination performed to assess anal tone before, one week and one month after surgery.</p> <p><strong>Results: </strong>Operative time was on average 17 minutes (15-20 minutes). Average hospital stay was 1 day and complete healing time ranged from 30-60 days. Persistent fistulas developed in four patients after surgery (1.85%). Bleeding occurred in 2 patients (1%). Many patients had transient minor incontinence in the form of flatus and loose stool incontinence but eventually resolved after two weeks. No major incontinence was found. Patient’s satisfaction of the treatment maneuver in relation to abscess recurrence and fistula occurrence was 95%. All patients remained fully continent. Operative time, hospital stay, and time for complete wound healing were the same in both groups.</p> <p><strong>Conclusion: </strong>Primary fistulotomy for co-existing low variety fistula at the time of drainage of perianal abscess results in very few persistent fistulas and no added risk of fecal incontinence.</p> <p>J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 85-89</p> Mohammad Nazmul Hoque Masum, Asif Yazdani, Md Shahnawas Biswas, Mohammad Masum, Masfique Ahmed Bhuiyan, Md Nabir Hossain, Md Atiar Rahman ##submission.copyrightStatement## Tue, 03 Mar 2020 06:17:53 +0000 Induction of Labour by Intravaginal Misoprostol In Intra Uterine Death of Fetus at Ssmc and Mitford Hospital, Dhaka <p>Intra uterine fetal death occur in 1% of pregnancy. The patient goes into labour in most of the cases, spontaneously. Retained dead fetus may cause disseminated intravascular coagulation sometimes resulting death of a mother. Objective: The aim was to find out the reults after using intravaginal Misoprostol in Intrauterine fetal death in last trimester of pregnancy.</p> <p><strong>Study design: </strong>This was a cross sectional observational study prospective in nature on 160 cases of intra uterine fetal death patients in indoor of department of Gynae and Obstertrics of Sir Salimullah medical college Hospital, Dhaka from 02/01/13 to 01/07/13, for a period of 6 months.</p> <p><strong>Result: </strong>60% of the patients were primi gravida. Mean age of the patients was 22.12±4.3 years 44% were in 33 to 36 weeks of pregnancy when induction was done. 41 (82%) patients having Bishops score d” 6 reqired 21±8.25 hours where as 09 (18%) patients having Bishops score e” 6 needed 10±1,1 hours to complete the delivery. There were no reports of maternal mortality. All the patients delivered per vaginally except one (2%) who needed ceasearean section due to development of chorioamnionitis.</p> <p><strong>Conclusion: </strong>Intravaginal misoprostol can aid in vaginal delivery safely.</p> <p>J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 90-93</p> Mahenaz Afroz, Begum Rokeya Anwar, Afroza Khanom, Prodip Kumar Biswas, Sadia Islam, Rozana Rouf ##submission.copyrightStatement## Tue, 03 Mar 2020 09:04:53 +0000 Ocular Fundus Changes in Pregnancy Induced Hypertension <p><strong>Purpose</strong>: Preeclampsia and eclampsia is one of the leading causes of maternal and fetal morbidity and mortality worldwide. Visual disturbances in (pre)eclampsia seem to be frequent phenomena. Therefore, the obstetrician/gynecologist may encounter women with serious, and sometimes debilitating, pathology of the visual pathways.</p> <p><strong>Methods</strong>: This is a cross sectional observational study was conducted over a period of 12 months (January 2016-December 2016) at Dhaka Medical College Hospital, Dhaka, Bangladesh. Patients with severe preeclampsia and eclampsia were included in the study. The association was measured with Chi-squared test and p value of 0.05 was treated as significant.</p> <p><strong>Results: </strong>During this 12-month period, 100 patients with severe preeclampsia and eclampsia were studied the mean age was 26.4 ± 5.5 years. The association between retinal changes and different variables was statistically significant positive association between the presence of retinal changes and blood pressure (P= 0.0118), proteinuria (P= 0.0025). However, age (P= 0.7123), and gravida (P= 0.7998) were not associated with occurrence of retinopathy in our study. The most common retinal change was noted and narrowing of arterioles, (83%) that retinal changes were significantly more in patients with severe hypertension, exudate (12%) and haemorrhages (10%) observed in present study. The presence of macular edema (5%) and retinal detachment (2%) are the warning signs for termination of pregnancy to save the vision of the mother.</p> <p><strong>Conclusion</strong>: It is called that eye is the gateway of medicine, so in pregnancy induced hypertension presence of changes in the retinal arterioles and retinal haemorrhages may indicate similar changes in the placenta. Since the well-being of the foetus depends on the placental circulation, ophthalmoscopic examination of mother’s fundus may give a clue to similar micro-circulation changes in the placenta and indirectly to the foetal wellbeing.</p> <p>J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 94-99</p> Rashida Khanom, Jamsed Faridi, Jinnatun Nur, Sumaiya Akter, Kamalesh Chandra Basu ##submission.copyrightStatement## Tue, 03 Mar 2020 09:05:03 +0000 Prevalance and association of Helicobater Pylori with gastro-duodenal mucosal lesions in patients with dyspepsia <p>Helicobacter Pylori a very common worldwide infection is responsible for number of upper GIT lesions like gastritis, peptic ulcer disease, gastric carcinoma and mucosa associated lymphoid tissue lymphoma. On the other hand, dyspepsia is a wide spectrum of nonspecific upper GIT symptoms for which patients very frequently visit gastroenterology clinics. The objective of the study was to find prevalence of Helicobacter Pylori among the patients with dyspeptic symptoms who had gastro-duodenal mucosal lesions on upper GIT endoscopy and also if there is any association between these two variables. 164 cases of dyspepsia were done index upper GIT endoscopy as per inclusion and exclusion criteria from April 2018 to December 2018 in Seikh Sayera Khatun Medical College Hospital, Gopalganj. Two gastric biopsies (from antrum and body) were taken and immediately placed in a commercial RUT (rapid urease test) kit. Positive test (rapid urease test) was indicated by change in the color of the kit from yellow to pink or red within 24 hours. Out of 164 patients, 62 (37.8%) patients had gastro-duodenal mucosal lesions and rest(62.2%) showed normal upper GIT at endoscopy. Among the 62 patients highest (38) number of the patients endoscopy showed gastritis and least (3) showed gastric ulcer. Among 62 patients with endoscopic gastro-duodenal mucosal lesions, 36 patients were infected with Helicobacter Pylori. On the contrary 27 patients out of 102 subjects who had normal upper GIT at endoscopy recorded infected with Helicobacter Pylori. Statistically analysis was done using chi-square test with the help of SPSS software windows version 25. The level of statistical significance was set at 0.05. In our study it was observed that statistically there was significant relation of Helicobacter Pylori with gastro-duodenal mucosal lesions as P value was less than 0.05. In this study, we found that Helicobacter Pylori was significantly associated with gastro-duodenal mucosal lesions among the patients with dyspeptic symptoms. So, our suggestion will be to confirm H. pylori infection if anybody has gastro-duodenal mucosal lesions if a subject does upper GIT endoscopy for dyspeptic symptoms.</p> <p>J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 100-104</p> Abu Raihan Siddique, Liakat Hossain, Mushtaque Ahmad Rana, Probir Kumar Banerjee, Anisur Rahman, Md Asraf Uddin Chowdhury, Hashmi Sina, Sabiha Yeasmin, Abu Tanvir Siddique ##submission.copyrightStatement## Tue, 03 Mar 2020 09:31:10 +0000 Frequency of dengue infection in febrile patients attended Dhaka Medical College Hospital during January to December, 2018 <p><strong>Introduction: </strong>Dengue is a major public health concern in our country. The alarming thing is that the seasonal trend of dengue infection is changing with time in Bangladesh due to climate change and unplanned urbanization. Our study was conducted to determine the frequency of dengue virus infection among the febrile patients in 2018 at Dhaka Medical College Hospital (DMCH) and to observe the seasonal trend.</p> <p><strong>Materials and Methods: </strong>The study was carried out on 899 febrile patients attended in DMCH from January to December, 2018. Whole blood samples were collected and sera were tested for dengue NS1 antigen and anti-dengue IgM antibodies using commercial test kits (NS1 by OMC Healthcare (Pvt.) Ltd &amp; IgM antibody by Omega Diagnostics Ltd.), respectively. All negative dengue cases were tested for anti Chikungunya antibody to exclude chikungunya.</p> <p><strong>Results: </strong>Of the total 899 febrile patients, 350(38.93%) were positive for Dengue infection. Out of them 264(75.43%) were positive for NS1, 82 (23.43%) were positive for IgM and 4 (1.14%) were positive for dengue NS1antigen + anti dengue IgM antibody. More than 50% patients belonged to age group 15-29 years. Males were predominant. More than 60% cases were detected in the post monsoon season.</p> <p><strong>Conclusion: </strong>Highest dengue cases were detected in this year in comparison to the previous year’s probably due to re-emergence of DEN-3 serotype. Due to pattern of climate change, seasonal trend of dengue infection was not maintained. Moreover, unplanned urbanization and poor solid waste management have worsened the situation more.</p> <p>J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 105-111</p> Nusrat Sultana, Nusrat Fatema, Mohammad Zaid Hossain, Md Anisur Rahman, Naznin Nehar, Mst Marufa Yeasmin, Rabeya Sharmin, Afroza Akbar Sweety, Monira Pervin ##submission.copyrightStatement## Tue, 03 Mar 2020 09:39:05 +0000 Factors Responsible for Premature Discontinuation of Long Acting Reversible Contraceptives A Study Conducted In Model Family Planning Clinic of Dhaka Medical College Hospital Over A Period of One Year <p><strong>Background: </strong>Despite the improvement in availability and utilization of Long Acting Reversible Contraceptive (LARC) methods which comprises intrauterine contraceptive devices(IUCD) and implants, premature discontinuation is becoming a public health concern and its consequence may lead to failure of a program. Therefore identifying the causal factors are important for designing a strategy to overcome the problem.</p> <p><strong>Objectives: </strong>To measure discontinuation of intrauterine contraceptive device (IUCD) and implants and identify baseline characteristics associated with premature discontinuation.</p> <p><strong>Materials and Methods: </strong>This retrospective study was conducted among the clients attended in Model Family Planning Clinic of Dhaka Medical College Hospital from January,2018 to December, 2018. Records of all clients who discontinued LARC prematurely (before device expiration) and clients who wished for discontinuation but did not do so during this period were explored.</p> <p><strong>Results:</strong>Total 233 implants were removed during the study period among them 87 were removed before their expiry date. Total 252 clients came for early removal (within 1 year of insertion) of cuT but only 39 were removed. On the other hand 82 clients came for premature discontinuation(after 1 year of their insertion) during this period, among which 18 were removed before the date of expiry. Side effects associated with the method itself and the procedure, expulsion, failure and other similar inconveniences contributed for discontinuation.</p> <p><strong>Conclusions: </strong>Higher level of discontinuation of LARC may substantially contribute to high fertility rate, unwanted pregnancies and induced abortions. Also, premature termination makes the method less cost effective. Therefore appropriate counseling, follow up care and management of side effects along with information on contraceptive effectiveness, insertion and removal procedure are very important.</p> <p>J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 112-118</p> Shahfinaz Mehzabin, Afroza Kutubi, Mohammad Mahbub Elahi, Debashish Bar, Umme Jamila Akther Manni, Mazharul Islam ##submission.copyrightStatement## Tue, 03 Mar 2020 09:48:29 +0000 Spondylitis Presenting With Cauda Equina Syndrome in a 12 Year Old Boy <p>A 12-year-old boy presented with a 2-week history of low back pain and 10-day history of weakness of the lower limbs,5-day history of inability to pass urine. An MRI scan of the lumbar spine showed dehiscent lamina of L5,S1 and an epidural abscess. He was admitted to hospital and treated with a high dose of IV antibiotics followed by radical surgical excision of the lesion. Histopathology showed features of abscess. He eventually recovered bowel and bladder control and regained muscle power in the lower limbs. Infection is not a common cause of cauda equina syndrome. Aggressive surgical treatment combined with a prolonged antibiotic regime is recommended to achieve a satisfactory result.</p> <p>J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 119-122</p> Sukriti Das, Musannah Ashfaq, Kaniz Fatema Ishrat Jahan, Shamsul Islam Khan, Rakibul Islam, Md Moidul Islam ##submission.copyrightStatement## Tue, 03 Mar 2020 09:59:17 +0000 Broad Ligament Pregnancy: A Rare Case Repor <p>Broad ligament pregnancy is a rare obstetric condition. Its diagnosis is quite difficult and management is challenging. Here we report a case of a 26 years old primi gravida conceived following laparoscopy and ovulation induction. Diagnosis of the broad ligament pregnancy was done by a transvaginal ultrasound at her 9 weeks and was proceded with laparoscopy followed by laparotomy. A right broad ligament pregnancy was found and the sac with fetus was removed. Laparoscopy was converted into a laparotomy as there was an uncontrollable bleeding from the broad ligament. Here we present a case of this extreme rare type of broad ligament pregnancy.</p> <p>J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 123-125</p> Maruf Siddiqui, Nusrat Ghafoor, Fahmida Naznine, Rusmila Shamim Abdullah, T A Chowdhury ##submission.copyrightStatement## Tue, 03 Mar 2020 10:00:36 +0000 Ascaris lumbrocoides in the Right Maxillary Sinus-a rare case <p><strong>Introduction</strong>: Sinusitis is fairly a common condition in an Otolaryngology clinic.However sinusitis due to Ascaris lumbrocoides obstructing the maxillary ostium is a very rare case.</p> <p><strong>Objective</strong>: To report a very rare case of round worm in the Right Maxillary sinus.</p> <p><strong>Case report</strong>: A nine year old girl presented with right nasal blockage and dull aching pain over the right maxilla and foul smelling discharge from the right nostril for a week duration. Examination revealed a cord like structure in the right nostril which was very painful on manipulation. Examination under generl anesthesia revealed a 15 cm long dead Ascaris lumbrocoides in the right nostril emerging from the right maxillary sinus obstructing its ostium. After removal of the round worm, patient and the immediate family members were treated with Albendazole.</p> <p><strong>Conclusion: </strong>In rare occasions, particularly in underdeveloped countries, clinicains should be midful that round worms can be a cause of sinusitis.</p> <p>J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 126-128</p> Kanu Lal Saha, Md Sajibur Rashid, Sonam Jamtsho, Debesh Chandra Talukder ##submission.copyrightStatement## Tue, 03 Mar 2020 10:03:14 +0000