Journal of Enam Medical College <p>Official organ of the Enam Medical College, Savar, Dhaka, Bangladesh. A peer-reviewed journal published three times a year in January, May and September. Full text articles available.</p> <p>Journal of Enam Medical College is included in <a title="DOAJ" href="" target="_blank" rel="noopener">DOAJ</a>.</p> Enam Medical College en-US Journal of Enam Medical College 2227-6688 <ul><li>Copyright on any research article is transferred in full to Journal of Enam Medical College upon publication in the journal. The copyright transfer includes the right to reproduce and distribute the article in any form of reproduction (printing, electronic media or any other form).</li><li>Articles in the Journal of Enam Medical College are Open Access articles published under the Creative Commons CC BY License (<a href=""></a>)</li><li>This license permits use, distribution and reproduction in any medium, provided the original work is properly cited.</li></ul> College News Vol 10(2) <p>Abstract not available</p> <p>J Enam Med Col 2020; 10(2): 130-131</p> Rukhsana Parvin Copyright (c) 2020 Journal of Enam Medical College 2021-05-22 2021-05-22 10 2 130 131 10.3329/jemc.v10i2.53541 From the desk of Editor-in-Chief Vol.10(2) <p>Abstract not available</p> <p>J Enam Med Col 2020; 10(2): 63</p> Md Aminul Haque Khan Copyright (c) 2020 Journal of Enam Medical College 2021-05-22 2021-05-22 10 2 63 63 10.3329/jemc.v10i2.53529 Covid-19 — An Epic Pandemic is on the Loose! <p>Abstract not available</p> <p>J Enam Med Col 2020; 10(2): 64-68</p> Iftikhar Ahmed Copyright (c) 2020 Journal of Enam Medical College 2021-05-22 2021-05-22 10 2 64 68 10.3329/jemc.v10i2.53530 A Female with Evans Syndrome Presented with Pancytopenia <p>Evans syndrome is an uncommon haematological disorder characterised by autoimmune haemolytic anaemia (AIHA), immune thrombocytopenia (ITP) and/or immune neutropenia. It may occur in all ethnic groups, all ages and has no sex predilection. The direct antiglobulin test (DAT) is almost invariably positive. This condition generally runs a chronic course and is characterised by frequent exacerbations and remissions. Corticosteroids and/or intravenous immunoglobulin (IVIG) are the most commonly used first line therapy. Here we report a case of a female who presented with severe shortness of breath, palpitation and low grade fever and on examination she was found severely pale and mildly icteric. Her CBC and PBF showed pancytopenia. Indirect bilirubin and LDH were raised and direct Coomb’s test was positive. She was labeled as a case of Evans syndrome and responded to oral prednisolone. On subsequent follow-up her haematological profiles remained normal.</p> <p>J Enam Med Col 2020; 10(2): 114-117</p> Md Rezaul Karim Chowdhury Md Haroon Ur Rashid Md Mahbub Hossain Shafayet Hossain Riyan Copyright (c) 2020 Journal of Enam Medical College 2021-05-22 2021-05-22 10 2 114 117 10.3329/jemc.v10i2.53537 An Unusual Cause of Efferent Loop Obstruction <p>Efferent loop obstruction is a very rare post-gastrectomy obstruction that can occur following Billroth-II or Roux-en-Y reconstruction. Here we report a case who underwent gastrojejunostomy for gastric outlet obstruction 30 years back and now developed efferent loop obstruction due to phytobezoar. The efferent loop obstruction was successfully resolved by laparotomy.</p> <p>J Enam Med Col 2020; 10(2): 118-121</p> Ashok Kumar Sarker Copyright (c) 2020 Journal of Enam Medical College 2021-05-22 2021-05-22 10 2 118 121 10.3329/jemc.v10i2.53538 Rare Scar Sarcoidosis: A Dermatologic Masquerader <p>Infiltration of sarcoid granuloma in old cutaneous scars is one of the uncommon cutaneous manifestations of sarcoidosis. Here we report the case of a 32-year-old female who presented with swelling and irritation in a 9-month-old appendicectomy scar. An incisional scar biopsy was done and it revealed non-caseating granuloma. On query she had inflammatory polyarthritis and persistent dry cough for last two months. High resolution CT (HRCT) revealed right paratracheal, both hilar, paraaortic, and subcarinal lymphadenopathy with pulmonary nodular densities in both lung fields. FNAC from mediastinal node revealed non-caseating granuloma consistent with sarcoidosis. Successful regression of cutaneous inflammation was achieved using a course of oral steroids, hydroxychloroquine and methotrexate. The incidence of scar sarcoidosis is rare and therefore not well-understood. However, inflammatory alterations in preexisting scars may be important indicators of disease onset.</p> <p>J Enam Med Col 2020; 10(2): 122-125</p> Richmond Ronald Gomes Md Rashidul Hasan Athai Majumder Kazi Tamanna Akter Copyright (c) 2020 Journal of Enam Medical College 2021-05-22 2021-05-22 10 2 122 125 10.3329/jemc.v10i2.53539 Reviewers in this Issue Vol 10(2) <p>Abstract not available</p> <p>J Enam Med Col 2020; 10(2): 132</p> Editor in Chief Copyright (c) 2020 Journal of Enam Medical College 2021-05-22 2021-05-22 10 2 132 132 10.3329/jemc.v10i2.53542 Jejunogastric Intussusception: A Rare Complication of Gastric Surgery <p>Abstract not available</p> <p>J Enam Med Col 2020; 10(2): 126-129</p> Kaniza Kabir Shanta Mashah Binte Amin Copyright (c) 2020 Journal of Enam Medical College 2021-05-22 2021-05-22 10 2 126 129 10.3329/jemc.v10i2.53540 Non-Diabetic Renal Disease in Type 2 Diabetic Patients with Nephropathy <p><strong>Background</strong>: In diabetic patients a good proportion of nephropathy is due to nephropathy other than diabetic renal disease. The detection of superimposed primary nondiabetic renal disease in diabetic patients has an obvious prognostic and therapeutic importance.</p> <p><strong>Objectives</strong>: To find out the proportion of diabetic subjects suffering from nondiabetic renal disease (NDRD) and to describe histological varieties in appropriate group.</p> <p><strong>Materials and Methods</strong>: This crosssectional study was done in Department of Nephrology, Dhaka Medical College &amp; Hospital, Dhaka from August 2015 to October 2016. Total 37 type 2 diabetic patients were selected. Renal biopsy was done and four cases were excluded due to inadequate sample. Tissue was sent for histopathology and direct immunofluorescence (DIF) examination. On the basis of histological diagnosis of biopsy reports patients were divided into three groups. Group I: Isolated NDRD, Group II: NDRD superimposed on diabetic nephropathy (mixed lesion) and Group III: Isolated diabetic nephropathy (DN). Each patient was evaluated for retinopathy from Ophthalmology department. Based on the presence or absence of retinopathy 33 patients were again divided into two groups. Group A includes patients with diabetic retinopathy (DR) and Group B includes patients without diabetic retinopathy.</p> <p><strong>Results</strong>: NDRD was found in 57.6% cases, NDRD plus diabetic nephropathy (DN) in 21.2% and isolated DN in 21.2% cases. In Group A (patients with DR) NDRD, DN and mixed lesion were present in 7 (41.2%), 5 (29.4%) and 5 (29.4%) cases. In Group B (patients without DR) NDRD, DN and mixed lesion were present in 12 (75%), 2 (12.5%) and 2 (12.5%) cases respectively. p value (0.189) was not significant.</p> <p><strong>Conclusion</strong>: Kidney disease other than diabetic nephropathy can occur in type 2 diabetic patients. In this study NDRD was found in high frequency. Lack of retinopathy is a poor predictor of nondiabetic kidney disease. Therefore, renal biopsy should be recommended in type 2 diabetic patients with risk factors of NDRD for accurate diagnosis, prompt initiation of disease-specific treatment and ultimately better renal outcome.</p> <p>J Enam Med Col 2020; 10(2): 73-78</p> Jubaida Khanam Chowdhury AKM Rashed Ul Hasan Rajee Mahmud Talukder Md Nizamuddin Chowdhury Md Nazrul Islam Copyright (c) 2020 Journal of Enam Medical College 2021-05-22 2021-05-22 10 2 73 78 10.3329/jemc.v10i2.53531 Outcome of Varus Derotation Osteotomy for Containment of Femoral Head in Advanced Perthes Disease <p><strong>Background</strong>: Legg-Calve-Perthes (LCP) disease, or idiopathic avascular necrosis of the femoral head occurs during early childhood and is caused by impaired circulation in the femoral head. Varus derotation osteotomy (VDO) was described over half a century ago, and is now a popular method for the operative treatment of Perthes disease.</p> <p><strong>Objective</strong>: To find out the clinical and radiological outcome of varus derotation osteotomy for containment of femoral head in advanced Perthes disease.</p> <p><strong>Materials and Methods</strong>: This observational study was conducted in the Department of Orthopaedic Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka from March 2015 to September 2017. Total 20 cases of advanced Perthes disease were enrolled. Pre- and post-operative period were evaluated by interview and clinical examination by using a semi-structured questionnaire. Demographic and clinical information were recorded. All patients had a pre- and post-operative x-rays. We used visual analog scales (VAS) for scoring pain; Wiberg’s central edge angle, epiphyseal extraction index, neck shaft angle and Larson (Iowa) hip score were used to assess the outcome of VDO. Comparison of continuous variables between the two groups was made with Student’s t-tests. Comparison of proportions between Herring groups B and C were made with chi-square tests. p&lt;0.05 was considered as significant. All the data were compiled and sorted properly and the quantitative data were analyzed statistically by using Statistical Package for Social Sciences (SPSS 22.0).</p> <p><strong>Results</strong>: In the present study, mean visual analog scale <strong>(</strong>VAS) score and epiphyseal extraction index (EEI) were significantly (p&lt;0.001) lower in Herring Group B in comparison to that of Group C, but mean WCEA, NSA and HLS were significantly (p&lt;0.001) higher in Herring Group B in comparison to that of Group C.</p> <p><strong>Conclusion</strong>: Varus osteotomy gives good results in children aged 6–12 years who do not exhibit any femoral head deformity or flattening, especially those with good containment in abduction in advance Perthes disease.</p> <p>J Enam Med Col 2020; 10(2): 79-85</p> Mohammad Masud Rana Nokul Kumar Datta Mohammad Ishaq Bhuiyan Md Asadullah Ripon Abu Zihad Mohammad Salim Copyright (c) 2020 Journal of Enam Medical College 2021-05-22 2021-05-22 10 2 79 85 10.3329/jemc.v10i2.53532 Prevalence of Overweight and Obesity among Medical Students of Enam Medical College, Savar, Dhaka <p><strong>Background: </strong>Overweight and obesity are recognized as “escalating epidemics” affecting both developed and developing countries. Of the factors contributing to obesity, stress seems to be particularly important as stressful condition leads to irregularity in diet, lack of exercise and addiction. Medical students are exposed to a lot of stress throughout their education. Hence, this study was undertaken to find out the prevalence of overweight and obesity among undergraduate medical students.</p> <p><strong>Objectives: </strong>The present cross-sectional study was intended to find out the prevalence of overweight/obesity among medical students of Enam Medical College and its association with their sociodemographic and life-style pattern.</p> <p><strong>Materials and Methods: </strong>This cross- sectional study was conducted among medical students in Enam Medical College, Savar, Dhaka from March to July 2017. A total of 283 1<sup>st</sup> and 2<sup>nd</sup> year MBBS students were included in the study. After getting permission from college authority and concerned Ethical Committee data were collected using a semi-structured questionnaire containing the variables of interest. Blood pressure and anthropometric measurements (weight and height) were noted. Data were analysed using SPSS (Statistical Package for Social Sciences) version 16.0.</p> <p><strong>Results: </strong>In the present study, the prevalence of overweight and obesity was 21.2% and 6.0% respectively. Males were found more overweight or obese (70.1%) compared to females (29.9%) (p=0.041). No other sociodemographic variables were found associated with overweight or obesity. Family history of obesity was observed for evaluation of overweight/obesity among the respondents (p=0.018) although family history of hypertension and/or diabetes did not influence the overweight/ obesity. Systolic and diastolic blood pressures of the overweight/obese group were higher than their normal counterparts (p=0.003 and p=0.002). There was no association between BMI and behavioral variables such as exercise, sleep, entertainment and food behavior.</p> <p><strong>Conclusion: </strong>More than one-quarter of the undergraduate medical students are overweight or obese and overweight or obesity are more predominant in males. Overweight and obese students generally have family history of overweight or obesity. Behavioural factors such as taking exercise, time spent on sleep and entertainment and food habit are not associated with BMI.</p> <p>J Enam Med Col 2020; 10(2): 86-92</p> Noortaj Begum Jakia Sultana Shila Sabreena Mohtarin Sharmin Sultana Rukhsana Parvin Md Aminul Haque Khan Copyright (c) 2020 Journal of Enam Medical College 2021-05-22 2021-05-22 10 2 86 92 10.3329/jemc.v10i2.53533 Vitamin D Deficiency among the Children: A Silent Epidemic in a Selected Rural Area of Bangladesh <p><strong>Background</strong>: Vitamin D deficiency is widespread among the children worldwide. Most of the third world countries have the high prevalence of vitamin D deficiency, especially among the children. Unfortunately very less research work has been conducted on this subject and Bangladesh is no exception to this. Vitamin D deficiency among the Bangladeshi children has not been investigated at a level that could bring the phenomenon to the fore of the concerned stakeholders and policy makers.</p> <p><strong>Objective</strong>: To assess the prevalence of vitamin D deficiency among children in Kaliakoir Upazila, Gazipur District, Bangladesh.</p> <p><strong>Materials and Methods</strong>: A cross-sectional study was conducted in children aged 0 month to &lt;18 years attending Upazila Health (pediatrics) Complex and community clinics with minor illness. After obtaining informed written consent, venous blood was taken and serum 25(OH) D levels were determined by direct enzyme linked immunosorbent assay. Serum 25(OH) D was categorized as deficient (&lt;10 ng/mL), insufficient (10–29 ng/mL) and sufficient (30–100 ng/mL).</p> <p><strong>Results</strong>: Deficient serum 25(OH) D level was found in 30.15% infants of up to one year age group, 35% in 2–5 years, 35.21% in 6–11 years and 37.21% in 12–16 years age group. Insufficient level was found in 52.38% in infants up to one year, 50% in 2–5 years, 54.93% in 6–11 years and 59.30% in 12–16 years age group.</p> <p><strong>Conclusion</strong>: The prevalence of vitamin D deficiency and insufficiency among children in rural Bangladesh is high. The study recommends that vitamin D supplementation in rural Bangladeshi children should be formally launched from first day of birth up to minimum adolescence.</p> <p>J Enam Med Col 2020; 10(2): 93-98</p> Sarker Shamima Ahmed Copyright (c) 2020 Journal of Enam Medical College 2021-05-22 2021-05-22 10 2 93 98 10.3329/jemc.v10i2.53534 Study on Menorrhagia: Correlation with Fibroids <p><strong>Background</strong>: Excessive menstrual bleeding called menorrhagia is a common presentation of females seeking medical attention. Normally there is considerable variation in menstrual cycle length, duration and flow.</p> <p><strong>Objective</strong>: To find out the assocation of fibroids in patients presenting with menorrhagia.</p> <p><strong>Materials and Methods</strong>: This cross-sectional prospective study was done from January to June 2013 among the female patients admitted in the department of Gynaecology &amp; Obstetrics in Dhaka Medical College &amp; Hospital. Patients presented with the complaints of menorrhagia and treated by surgical management were included.</p> <p><strong>Results</strong>: Total 96 patients were included. The age range was 28–49 years with mean age 41.08 ± 5.174 years. In 92 (46.5%) patients excessive per vaginal bleeding was noted. Pain during menstruation was another major complaint (45, 46.5%). Lower abdominal heaviness was reported in 32 patients (16.2%). In about half of the patients (49%) uterine fibroid was diagnosed. In 29 patients (30.2%) adenomyosis was the finding. Out of 47 fibroid cases 39 (83%) had per vaginal bleeding history. Only 10 patients without fibroid experienced pervaginal bleeding. Chi-squared test was done to see whether there was any association between these two variables and the result was highly significant (p&lt;0.001).</p> <p><strong>Conclusion</strong>: As medical treatment is disappointing and surgery is the mainstay of treatment of menorrhagia caused by fibroids, diagnosis should be confirmed by different imaging techniques. Advancement in the field of imaging like saline infusion sonohysterography and hysteroscopy helps greatly to diagnose submucous fibroids and save patients from undue prolongation of medical treatment.</p> <p>J Enam Med Col 2020; 10(2): 99-103</p> Rokshana Parvin Nupur Masuda Begum Farhana Shabnam Fahmida Sultana Touhid Uddin Rupom Copyright (c) 2020 Journal of Enam Medical College 2021-05-22 2021-05-22 10 2 99 103 10.3329/jemc.v10i2.53535 Hirschsprung’s Disease: Diagnosis and Management <p>Hirschsprung’s disease (HD) is a rare genetic congenital defect of intestine causing failure of migration of parasympathetic ganglionic cells in some definite part of intestine, resulting in functional intestinal obstruction. It commonly involves rectosigmoid region of colon but other parts of colon or total colon, even small intestine may be affected. Incidence is 1/5000 live births. It is one of the common pediatric surgical problems and 2<sup>nd</sup> most organic cause of constipation. Symptoms may be evident from 1<sup>st</sup> day of life. About 90% infants with Hirschprung’s disease fail to pass meconium in 1<sup>st</sup> 24 hours of life. About 80% HD cases are diagnosed in early few months of life and present with abdominal distention, constipation, poor feeding, vomiting etc. HD enterocolitis is a devastating condition related to mortality. HD may be associated with some congenital anomalies and syndrome. High index of suspicion is the main key to diagnosis. Radiological investigation supports the diagnosis and rectal biopsy for histopathology is confirmatory. Although it is a surgical problem, physician can play a key role in early diagnosis and thus help to prevent HD enterocolitis-related mortality and restore near-normal life.</p> <p>J Enam Med Col 2020; 10(2): 104-113</p> - Md Benzamin - Md Rukunuzzaman Md Wahiduzzaman Mazumder ASM Bazlul Karim Copyright (c) 2020 Journal of Enam Medical College 2021-05-22 2021-05-22 10 2 104 113 10.3329/jemc.v10i2.53536