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">DOAJ</a>.</p> en-US <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> (Prof Md. Aminul Haque Khan) (Md Fahmid Uddin Khondoker) Tue, 29 Jan 2019 08:14:35 +0000 OJS 60 From the Desk of Editor-in-Chief Vol 9(1) <p>Abstract not available</p> <p>J Enam Med Col 2019; 9(1): 3</p> Md Aminul Haque Khan ##submission.copyrightStatement## Fri, 25 Jan 2019 00:00:00 +0000 Antibiotic for Future: Disarm Bacteria, Don’t Kill!! <p>Abstract not available</p> <p>J Enam Med Col 2019; 9(1): 4</p> Mahmuda Begum ##submission.copyrightStatement## Fri, 25 Jan 2019 00:00:00 +0000 Endoscopic Retrograde Cholangiopancreatography (ERCP) Experience in a Tertiary Level Hospital in Bangladesh <p><strong>Background</strong>: Although endoscopic retrograde cholangiopancreatography (ERCP) was first described as a diagnostic technique, now-a-days we mainly do ERCP with a therapeutic intent for management of various biliary and pancreatic diseases.</p> <p><strong>Objectives</strong>: This study intends to find out the diagnosis obtained by ERCP procedure and the therapeutic interventions done for appropriate cases in a tertiary level hospital in Bangladesh.</p> <p><strong>Materials and Methods</strong>: This prospective observational study was performed in the Department of Gastroenterology in Enam Medical College &amp; Hospital over a period from June 2014 to October 2016. Eighty patients, aged 15–70 years, were selected only for therapeutic ERCP. They were diagnosed and selected after taking history, physical examination and appropriate investigations. ERCP was done under short-term general anesthesia or deep sedation by using propofol or fentanyl. Results are shown in tables.</p> <p><strong>Results</strong>: Majority of the cases were choledocholithiasis (53.75%) followed by cholangiocarcinoma (11.25%), ampullary carcinoma (8.75%), carcinoma of the gall bladder (6.25%), biliary ascariasis (6.25%), biliary stricture (5%), papillary stenosis (5%), chronic pancreatitis (2.5%) and sludge in the CBD (1.25%). Types of therapeutic intervention depended on diagnosis. Papillotomy with stone removal was done in patients with choledocholithiasis. Papillotomy with stenting was done in the patients with cholangiocarcinoma, ampullary carcinoma, gall bladder carcinoma, biliary stricture and paillary stenosis. Papillotomy with worm extraction was done in cases of biliary ascariasis. Papillotomy with clearing of sludge was done for sludge in the CBD and only papillotomy was done in two patients of chronic pancreatitis.</p> <p><strong>Conclusion</strong>: In this study we found that choledocholithiasis and biliary tract malignancy were the two major ERCP findings. Therapeutic interventions were done according to diagnosis. The most common therapeutic intervention was papillotomy with stone removal. Next common intervention was papillotomy with stenting.</p> <p>J Enam Med Col 2019; 9(1): 9-15</p> Mohammad Quamrul Hasan, Nelson Taposh Mondal, Mahbub Hossain, Irin Perveen ##submission.copyrightStatement## Fri, 25 Jan 2019 00:00:00 +0000 Predictive Accuracy of Dobutamine Stress Echocardiography in Detection of Presence and Extent of Coronary Artery Disease <p><strong>Introduction</strong>: Exercise tolerance test (ETT) is an established screening test for coronary artery disease (CAD), but not feasible in 30−40% of patients. Dobutamine stress echocardiography (DSE) is an excellent alternative. Traditionally, inducible worsening of wall motion by 1 grade from baseline provides an index of CAD; worsening by 2 grade or more theoretically represents a more severe perfusion abnormality. The present study represents the inaugural experience of DSE at the National Institute of Cardiovascular Disease, Dhaka.</p> <p><strong>Objective</strong>: To assess the predictive accuracy of DSE results with the presence and extent of CAD in subjects with suspected stable angina pectoris.</p> <p><strong>Materials and Methods</strong>: In this prospective observational study, 35 subjects with intermediate to high probability of CAD were subjected to DSE followed by coronary angiography (CAG) within one month. Comparison of DSE results and predicted coronary artery involvement with angiographic findings were done. Overall sensitivity, specificity, accuracy as well as accuracy by arterial territory involvement were calculated.</p> <p><strong>Results</strong>: DSE identified 82 abnormal segments, 66 with 1 grade change in 23 subjects (Group A) and 16 with 2 grade change in 8 subjects (Group B). CAG detected 54 significant lesions, 23 (42.59%) in left circumflex (LCX), 18 (33.33%) in left anterior descending (LAD), 11 (20.37%) in right coronary (RCA) and 2 (3.7%) in left coronary (LCA) artery. DSE had a sensitivity of 93.1% and a specificity of 66.7%. The accuracy was 88.57% overall, 94.29% for LAD and 91.43% for both LCX and RCA territories. Group B subjects had significantly higher number of coronary stenosis per patient (2.63 versus 1.38, p&lt;0.001), triple vessel (62.5% versus 8.6%, p=0.003) and lower single vessel CAD (0% versus 47.8%, p=0.005).</p> <p><strong>Conclusion</strong>: This study shows that DSE is a reliable test for prediction of the presence and extent of CAD.</p> <p>J Enam Med Col 2019; 9(1): 16-24</p> Moeen Uddin Ahmed, AQM Reza, Khaled Mohsin ##submission.copyrightStatement## Fri, 25 Jan 2019 00:00:00 +0000 Electrolyte Disturbances in Acute Exacerbation of COPD <p><strong>Background</strong>: Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality worldwide. Acute exacerbation is an acute and sustained worsening of a patient’s condition from a stable state and it is associated with significant electrolyte disturbances.</p> <p><strong>Objectives</strong>: The main objective of this study was to determine the prevalence of electrolyte disturbances in patients with acute exacerbation of COPD and to determine possible effects of these electrolyte disorders.</p> <p><strong>Materials and Methods</strong>: This observational prospective study was carried out in the Department of Pulmonology, Enam Medical College &amp; Hospital from 1<sup>st</sup> January to 31<sup>st</sup> December 2017. Sixty patients with acute exacerbation of COPD were included. Serum electrolytes and arterial blood gases were measured.</p> <p><strong>Results</strong>: Low level of serum sodium (131 ± 5.66 mEq/L) and potassium (3.20 ± 0.44 mEq/L) were found in subjects with acute exacerbation of COPD. In patients with respiratory failure Na<sup>+</sup> and K<sup>+</sup> levels were even lower.</p> <p><strong>Conclusion</strong>: Serum electrolytes in acute exacerbation of COPD patients should be monitored routinely and should be corrected early to avoid poor outcomes.</p> <p>J Enam Med Col 2019; 9(1): 25-29</p> Md Haroon ur Rashid ##submission.copyrightStatement## Fri, 25 Jan 2019 00:00:00 +0000 Diagnostic Accuracy of Fine Needle Aspiration Cytology in Diagnosis of Tuberculous Lymphadenitis <p><strong>Background:</strong> Tuberculosis is still a global health problem. Most common presentation of extrapulmonary tuberculosis is tuberculous lymphadenitis. In our setting, keeping huge burden of tuberculosis in mind, clinicians have to depend on pathological diagnosis of enlarged lymph nodes, i.e., cytomorphology with acid-fast staining in diagnosing these cases so that diagnosis and management of such cases can be initiated quickly. Fine needle aspiration cytology (FNAC) of lymph nodes has been a simple, rapid and cost-effective procedure for diagnosis of various causes of lymphadenopathies.</p> <p><strong>Objective:</strong> To determine the diagnostic accuracy of fine needle aspiration cytology in providing a diagnosis of tuberculous lymphadenitis patients in Bangladesh.</p> <p><strong>Materials and Methods</strong>: This cross-sectional study was done on 317 subjects in Bangabandhu Sheikh Mujib Medical University (BSMMU) in collaboration with icddr,b. After clinical examination, fine needle aspiration (FNA) was done. The FNA materials were processed for Papanicoulaou staining (PAP stain), Ziehl-Neelsen staining and culture for the diagnosis of tuberculosis. Sensitivity, specificity, positive and negative predictive values of FNAC were determined where culture was taken as the gold standard.</p> <p><strong>Results</strong>: Initially 351 clinically suspected tuberculous lymphadenitis patients were enrolled, but 34 cases were excluded due to diagnosis of malignancy. Among them 123 were male and 194 were female. Mean age was 27.91±13.16 years. Among the subjects 95.9% presented with cervical lymphadenopathy, others presented with lymphadenopathy of axillary or other groups of lymph nodes. The results of cytomorphological diagnosis of TB were in 58.36% cases, and culture was positive in 23.3% cases. Sensitivity, specificity, positive predictive value and negative predictive value of cytomorphological diagnosis were 79.7%, 48.1%, 31.9% and 88.6% respectively.</p> <p><strong>Conclusions</strong>: FNAC is an effective diagnostic method for tuberculous lymphadenitis. It can diagnose granulomatous inflammation as well as reactive and other disease conditions including malignancies, thereby providing more information about the patient’s disease status.</p> <p>J Enam Med Col 2019; 9(1): 30-33</p> Tamanna E Nur, Afroz Shirin, Moni Mohan Saha ##submission.copyrightStatement## Fri, 25 Jan 2019 00:00:00 +0000 Awareness Level of Cervical Cancer among Rural Women Attending Manikgonj 250-Bedded District Hospital, Manikgonj <p><strong>Background</strong>: Cervical cancer is a typically slow-growing cancer that may not have symptoms, but can be early diagnosed by Pap smear and Visual Inspection of Cervix with Acetic Acid (VIA). The burden of the disease is increasing in developing countries day by day due to the ascending trend of transmissible diseases such as HIV and Human Papilloma Virus (HPV).</p> <p><strong>Objective</strong>: The main aim of this study was to assess the level of awareness regarding cervical cancer among the women attending outpatient department of Manikgonj 250-bedded district hospital, Manikgonj.</p> <p><strong>Materials and Methods</strong>: This study was conducted among the women attending the OPD of Obstetrics &amp; Gynaecology Department of Manikgonj 250-bedded district hospital from June, 2017 to October, 2017. The respondents were selected by random sampling. A pre-structured, interview-based data collection sheet was prepared, which was used as a research tool. Data were collected by interview of the patients and then data were gathered, decorated and tabulated after data cleaning and edition. Then the results were presented in tabular and figure forms. As it is a descriptive type of cross-sectional study p value determination was not required to see the level of significance.</p> <p><strong>Results</strong>: In this study mean age of 50 respondents was 24.18 ± 6.63 years. The maximum respondents (62%) were from 20−30 years age group. Out of 50 respondents 46% were married and 24% were unmarried. Among the study subjects 84% knew about cervical cancers, 28% respondents knew about the disease from uthan boithok and 26% by electronic and print media. Thirty six percent respondents knew about the risk factors of the disease, 42 (84%) heard about the disease, 60% thought that they are at self risk and 12% respondents underwent screening before. Among those (70.45%) who did not undergo screening blamed not having adequate knowledge about the risk factors. Seventy two percent of total respondents knew that district hospital is a center for screening. Fifty percent women did not have any knowledge regarding vaccination.</p> <p><strong>Conclusion</strong>: Majority respondents in this study did not know clearly about cervical cancer, specially its risk factors, vaccination, prevention and clinical profile of the disease.</p> <p>J Enam Med Col 2019; 9(1): 34-40</p> Farzana Rahman, Avisak Bhattacharjee ##submission.copyrightStatement## Fri, 25 Jan 2019 00:00:00 +0000 USG-Guided Percutaneous Aspiration: an Effective Way for Managing Appendicular Abscess <p><strong>Background</strong>: During last 2−3 decades image-guided drainage procedures have been developed complementing modern surgical drainage techniques. The development of interventional radiological procedure has made percutaneous puncture and drainage of abdominal fluid collection possible. Image-guided percutaneous drainage of appendicular abscess has become well-established because of its proven safety and efficacy.</p> <p><strong>Objectives</strong>: To evaluate the safety and feasibility of USG-guided percutaneous aspiration for draining appendicular abscess with special attention to the need for conversion and to see the nature of complications after draining of abscess.</p> <p><strong>Materials and Methods</strong>: Between May 2013 to May 2014, 25 cases of appendicular abscess were selected from the admitted patients (surgery department) in Enam Medical College &amp; Hospital who underwent USG-guided percutaneous aspiration. Procedure was performed mostly under local anaesthesia. Patients were followed up for 6 months. Interval appendicectomy was not performed routinely.</p> <p><strong>Results</strong>: USG-guided aspiration was successful in 23 (92%) patients and in 2 (8%) patients procedure failed. Single attempt was successful in 21 (84%) cases and 4 (16%) patients needed double attempt for draining appendicular abscess. In 23 (92%) patients, PCA was done under local anaesthesia and two (8%) patients needed general anaesthesia. Complications developed in 4 (16%) patients. Four (16%) patients needed follow-up USG. Average hospital stay was 5 days (2−8 days) and average duration of using I/V antibiotic was 3.5 days (2−5 days).</p> <p><strong>Conclusion</strong>: USG-guided percutaneous aspiration is an easy and safe method for draining appendicular abscess with minimum procedural complications.</p> <p>J Enam Med Col 2019; 9(1): 41-45</p> Tarafder Habibullah, Debasish Das, Deb Prasad Paul ##submission.copyrightStatement## Fri, 25 Jan 2019 00:00:00 +0000 Current Management Strategy of Non-Alcoholic Fatty Liver Disease <p>Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide and is becoming the most common indication for liver transplant in the Western world. The disease spectrum varies from steatosis to non-alcoholic steatohepatitis (NASH), advanced fibrosis, cirrhosis and hepatocellular carcinoma. The global prevalence of NAFLD and NASH varies from 24–25% and 1.5–6.45% respectively among general population. Despite the disease burden and adverse outcome of the condition, no highly effective treatment is currently available for NAFLD. Considering its global prevalence and impact clinicians and researchers from different scientific associations worldwide tried hard to develop high-quality international guidelines to improve the management of NAFLD patients in clinical practice. This paper aims to discuss the management options for NAFLD based on five different well-known international guidelines. These guidelines agree on many points and disagree on some points. Notably these guidelines differ in determining alcohol threshold for defining NAFLD, in screening strategies in high-risk patients, the non-invasive test proposed for the diagnosis of NAFLD and advanced fibrosis in patients with NAFLD, in the follow-up protocols and, finally, in the proposed pharmacological treatment strategy.</p> <p>J Enam Med Col 2019; 9(1): 46-56</p> Irin Perveen ##submission.copyrightStatement## Fri, 25 Jan 2019 00:00:00 +0000 A 25-Year-Old Female with Unusually Large Complex Odontoma in Mandibular Molar Area Associated with Unerupted Tooth <p>Odontomas are benign tumours of odontogenic origin consisting of different dental tissues. Usually they are tooth size or smaller, but occasionally complex variety can exhibit considerable growth. They are usually asymptomatic and often are discovered during routine radiograph. Morphologically odontoma can be classified as complex when present as irregular masses containing different types of dental tissues, or as compound if there is superficial anatomic similarity to even rudimentary teeth known as denticles. We report a case of large complex odontoma that causes pain, infection and facial asymmetry.</p> <p>J Enam Med Col 2019; 9(1): 57-59</p> Abdullah Al Faruq, Sharmin Sultana, Hasan Ibn Showkat ##submission.copyrightStatement## Fri, 25 Jan 2019 00:00:00 +0000 A Young Boy with Multiple Bony Overgrowths <p>Hereditary multiple exostoses is a rare autosomal dominant pediatric disorder with an incidence of about 1:50000 characterized by multiple cartilage-capped bony protuberances, called osteochondromas or exostoses, projecting from the metaphyses of long bones. It is caused by loss of function mutations in exostosin-1 and exostosin-2 genes that encode glycosyltransferase enzymes involved in the synthesis of heparan sulfate which has fundamental role in extracellular matrix formation during bone development. It commonly presents with compressive symptoms due to bony overgrowth involving all bones except calvarium and rarely transformed into malignancy. No definite treatment is available, but careful screening of these exostoses with timely referral to respective surgeon prevents long term complications and improves quality of life.</p> <p>J Enam Med Col 2019; 9(1): 60-63</p> MA Hannan, Md Rakibul Hasan, Sharmin Jahan, Md Shahed Morshed ##submission.copyrightStatement## Fri, 25 Jan 2019 00:00:00 +0000 Locally Aggressive Glioma in a 55-Year-Old Female <p>Abstract not available</p> <p>J Enam Med Col 2019; 9(1): 64-66</p> Mashah Binte Amin, Tarana Yasmin ##submission.copyrightStatement## Fri, 25 Jan 2019 00:00:00 +0000 College News Vol. 9(1) <p>Abstract not available</p> <p>J Enam Med Col 2019; 9(1): 67</p> Rukhsana Parvin, Sabreena Mohtarin ##submission.copyrightStatement## Fri, 25 Jan 2019 00:00:00 +0000 Reviewers in this Issue Vol.9(1) <p>Abstract not available</p> <p>J Enam Med Col 2019; 9(1): 68</p> Editor-in Chief ##submission.copyrightStatement## Fri, 25 Jan 2019 00:00:00 +0000