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, 11 Jun 2019 07:03:58 +0000 OJS 60 From the Desk of Editor-in-Chief Vol 9(2) <p>Abstract not available</p> <p>J Enam Med Col 2019; 9(2): 71</p> Md Aminul Haque Khan ##submission.copyrightStatement## Thu, 16 May 2019 00:00:00 +0000 Impact of Promotional Activities of Pharmaceutical Companies over Prescribing Practices of Health Professionals <p>Abstract not available</p> <p>J Enam Med Col 2019; 9(2): 72-73</p> Zaida Rahman ##submission.copyrightStatement## Thu, 16 May 2019 00:00:00 +0000 Clinical and Endoscopic Profile of Patients with Upper Gastro-Intestinal Bleeding (UGIB) <p><strong>Background</strong>: Upper gastro-intestinal bleeding (UGIB) is a cause of significant morbidity and mortality. Prevalence as well as mortality is higher in elderly persons above sixty years because of increasing use of nonsteroidal anti-inflammatory drugs and associated comorbidity. Conventionally upper GI bleeding is divided as variceal and nonvariceal sources and the treatment protocol varies accordingly. There are limited data regarding UGIB in our country.</p> <p><strong>Objective</strong>: This observational study was designed to delineate the clinical and endoscopic profile of patients with UGIB in our country.</p> <p><strong>Materials and Methods</strong>: This prospective observational study was done in the Department of Gastroenterology in Enam Medical College &amp; Hospital during the period of 2014–2017. Patients with UGIB were followed until discharge or death. Patients were subjected to upper GI endoscopy, preferably within the first 24 hours. Clinical and endoscopic data of 131 patients were compiled and analyzed in this study. The data were analysed using SPSS version 21.0.</p> <p><strong>Results</strong>: Among the 131 final participants 101 were male and 30 were female. Mean age of the patients was 43.65 ± 18.63 years. Patients mostly presented with both haematemesis and melaena (66, 50.4% patients), 33.6% with haematemesis only, and 16% patients with melaena only. The most common endoscopic finding was duodenal and or gastric ulcer (57); next common lesions were gastric/duodenal erosions (23), oesophageal varices (13), oesophageal erosions/ulcers (10), corrosive burn (10) and carcinoma (7). Forty patients had history of NSAID intake and gastric/duodenal ulcer and/erosions were the most frequent lesions among them (27). One patient with oesophageal varices died due to rebleeding.</p> <p><strong>Conclusion</strong>: In our study peptic ulcer-related bleeding is the most common cause of UGIB. A significant proportion of UGIB is due to corrosive burn (harpic) emphasizing the need for public awareness. Mortality was due to rebleeding.</p> <p>J Enam Med Col 2019; 9(2): 78-83</p> Irin Perveen, Md Quamrul Hasan, Md Abu Mosabbir ##submission.copyrightStatement## Thu, 16 May 2019 00:00:00 +0000 Comparative Study between Retrograde Intrarenal Surgery and Percutaneous Nephrolithotomy for the Treatment of Renal Stones <p><strong>Background</strong>: The prevalence of urolithiasis has increased during the last decades and now affects approximately 9% of the adult population specially in developed countries. European Urology Guidelines recommend PCNL in stones larger than 2 cm in size and ESWL in stones smaller than 2 cm in size as the first treatment option. With advances in technology, new generation flexible ureteroscopes with safe and effective lithotripters such as holmium laser have been developed and RIRS became an important alternative in the treatment of large urinary stones.</p> <p><strong>Objective</strong>: To evaluate the safety and efficacy of retrograde intrarenal surgery (RIRS) in the treatment of kidney stones and to compare its results with those of percutaneous nephrolithotomy (PCNL).</p> <p><strong>Materials and Methods</strong>: We retrospectively analyzed a total of 50 patients ─ 27 patients (20 males and 7 females) who underwent PCNL and 23 patients (17 males and 6 females) who underwent RIRS between January 2015 and December 2017.</p> <p><strong>Results</strong>: The mean duration of operation was 60.65 ± 23.56 minutes in the RIRS group and 50.55 ± 12.77 minutes in the PCNL group (p&lt;0.047). The hospital stay was significantly shorter in the RIRS group (2.21 ± 0.9 vs 5.29 ± 1.53 days in the RIRS and PCNL groups, respectively; p&lt;0.016). Stone-free rates after one session were 88.6% and 84.8% in the RIRS and PCNL groups respectively. Blood transfusions were required in five patients in the PCNL group. Complication rates were higher in the PCNL group.</p> <p><strong>Conclusion</strong>: This study reveals that RIRS can be an alternative to PCNL in the treatment of kidney stone.</p> <p>J Enam Med Col 2019; 9(2): 84-89</p> Deb Prosad Paul, Debasish Das, ASM Zahidur Rahman, Tarafder Habibullah, Sonia Akter, Md Mahfuzul Momen ##submission.copyrightStatement## Thu, 16 May 2019 00:00:00 +0000 Study on Risk Factors and Microorganisms for Surgical Site Infection following Caesarean Section among 100 Patients in a Tertiary Hospital in Bangladesh <p><strong>Background</strong>: Lower uterine caesarean section is a common mode of delivery now and surgical site infection is one of the most common and dreaded complication of surgery. It is associated with significant morbidity and delayed recovery and it lengthens hospital stay and costs. Identifying risk factors for surgical site infection in caesarean wound and modifying them can be beneficial for patient management during surgery and optimizing good clinical outcome. Identifying microorganisms with their sensitivity has epidemiological as well as therapeutic implications.</p> <p><strong>Objective</strong>: To identify risk factors for surgical site infection in caesarean section wound and find out microorganisms responsible for such infection.</p> <p><strong>Materials and Methods</strong>: In this study 100 women with surgical site infection after caesarean section were included. They were selected randomly from four maternity units of Dhaka Medical College Hospital. Each patient of caesarean section was followed strictly up to discharge from hospital and also for 30 days postoperatively for any evidence of infection. Wound swab was sent in each case for microbiological study. Data were collected in structured questionnaire and analysed by computer using spreadsheet.</p> <p><strong>Results</strong>: Among 100 women studied, 73% had inadequate or no antenatal check-up, 52% had duration of labour pain &gt;12 hours, 52% had duration of ruptured membrane &gt;12 hours, 94% women underwent emergency caesarean section, 62% had operation time &gt;1 hour, 61% had haemoglobin level &lt;60%, 46% women had intervention by untrained birth attendant, and 43% women had &gt;500 mL blood loss during operation. In bacteriological study, microorganisms were identified in 55% cases, among them Staphylococcus aureus (20%), E. coli (11%), Acinetobacter (7%), Pseudomonas (6%) and Proteus (5%). During sensitivity test Staphylococcus aureus was mostly sensitive to ceftriaxone (50%) and amikacin (33%) and E. coli to amikacin (80%). In four cases (2 proteus and 2 pseudomonas) out of 55 organisms were resistant to all antibiotics.</p> <p><strong>Conclusion</strong>: Most of the risk factors for surgical site infection during caesarean section identified in this study can be modified through intervention. However, the microorganisms detected from our patients showed a high degree of resistance for commonly prescribed antimicrobials in our set-up.</p> <p>J Enam Med Col 2019; 9(2): 90-96</p> Sayma Afroz, Maliha Rashid ##submission.copyrightStatement## Thu, 16 May 2019 00:00:00 +0000 Role of Resistance Index in Differentiation of Benign and Malignant Breast Masses Compared with Histopathological Diagnosis <p><strong>Background</strong>: Breast tumor remains a worldwide public health problem for women. Linear array sonography is currently one of the main diagnostic methods for detecting breast lumps. Duplex color Doppler sonography has been helpful to distinguish malignant from benign breast disease and also to predict the disease prognosis.</p> <p><strong>Objectives</strong>: The purpose of this study was to evaluate the role of spectral Doppler as a method to measure the vascular resistance index in differential diagnosis between the benign and malignant breast neoplasm.</p> <p><strong>Materials and Methods</strong>: This cross-sectional study was carried out in department of Radiology &amp; Imaging of Enam Medical College &amp; Hospital during January 2015 to December 2017. Sonography was done in 153 women having breast lumps. Among them histopathology was done in 105 cases. Ultrasonographic findings and histopathological report analyses were done using SPSS 13.0.</p> <p><strong>Results</strong>: The study was done in 105 women with mean age 31.6 ± 4.5 years. On ultrasonogram, lesions were diagnosed as benign in 65 (62%) cases and malignant in 40 (38%) cases. Out of sonographically diagnosed 65 benign lesions having peripheral vascularity and decreased RI, 63 (97%) were proved benign histopathologically. With these criteria for diagnosis of benign lesion, sensitivity was 94%, specificity 92%, positive predictive value 95%, negative predictive value 89% and accuracy 93%. Sonographically 40 lesions were diagnosed as malignant. Among them 37 (92.5%) cases were proven malignant histopathologically and showed central vascularity and increased RI having sensitivity of 92%, specificity 94%, positive predictive value 89%, negative predictive value 95% and accuracy 93%.</p> <p><strong>Conclusion</strong>: The analysis of vascular resistance index combined with findings on grayscale sonographic images correlates well with histopathological reports and can be of great assistance in the assessment of breast masses with high sensitivity and specificity.</p> <p>J Enam Med Col 2019; 9(2): 97-103</p> Mashah Binte Amin, Tarana Yasmin, Samar C Sarkar, Khaleda Parvin Rekha, Rushaida Haque Leeba, Nasima Akhter ##submission.copyrightStatement## Thu, 16 May 2019 00:00:00 +0000 Drug Management Pattern and Their Adverse Effects in Patients of Cervical Carcinoma Attending Two Tertiary Care Hospitals in Dhaka City <p><strong>Background</strong>: Cervical cancer remains a significant health burden worldwide. It is the second most commonly diagnosed cancer and third leading cause of cancer death among females in least developed countries. There were an estimated 527,600 new cervical cancer cases and 265,700 deaths worldwide in 2012. Bangladesh stands 11th in the world in cervical cancer fatalities with 17.9 women dying in 100,000 due to the largely sexually transmitted disease every year.</p> <p><strong>Objective</strong>: The present study was done to evaluate the pattern of drug management, their adverse effects and socio-demographic characteristics of the patients of cervical carcinoma admitted and treated with chemotherapy in two tertiary care hospitals of Bangladesh.</p> <p><strong>Materials and Methods</strong>: It was a cross-sectional observational study carried out from January to December 2015 at Dhaka Medical College &amp; Hospital and National Institute of Cancer Research Hospital. During this period, 109 patients were selected by purposive sampling technique using a set of pre-tested structured questionnaire. Data analysis was done using SPSS version 21.0.</p> <p><strong>Results</strong>: Most of the patients were in 5th decade (51.4%), from low (59.6%) income family and were married (98.16%). The mean duration of treatment for cancer was found 11.34 <strong>± </strong>5.32 months. Cisplatin (93.57%), 5 fluorouracil (63.3%) and paclitaxel (12.8%) were the most frequently prescribed drugs either alone or in combination. The adverse effects for cisplatin were gastrointestinal toxicity, nephrotoxicity, myelosuppresion and for 5-fluorouracil were myelosuppression, diarrhea, hyperpigmentation, dizziness, neuropathy, increased risk of infection.</p> <p><strong>Conclusion</strong>: The combination of cisplatin and 5-fluorouracil was mostly (50.45%) prescribed followed by cisplatin alone (26.6%) to treat the patients of cervical carcinoma in Bangladesh.</p> <p>J Enam Med Col 2019; 9(2): 104-109</p> Samantha Afrin, Syed Ehsan Noor ##submission.copyrightStatement## Thu, 16 May 2019 00:00:00 +0000 Management of Hollow Viscus Injury following Gunshot at Casualty Department of Dhaka Medical College & Hospital <p><strong>Background</strong>: Gunshot injuries result from the effect of a bullet or projectiles emanating from the use of firearms. Firearm injuries are associated with substantial emotional, physical and financial burden causing an enormous human toll and imposing huge costs on the society. Abdominal injuries are associated with a high incidence of internal injury. These injuries are increasingly seen in many developing countries, which have been attributed to communal and ethnic clashes, political violence and armed robberies.</p> <p><strong>Objective</strong>: The objective of this study was to determine the overall outcome of hollow viscus injury following gunshot on the basis of time duration of presentation and amount of blood loss at the time of presentation.</p> <p><strong>Materials and Methods</strong>: This observational study was conducted at casualty department of Dhaka Medical College &amp; Hospital over a period of one year from October 2014 to October 2015. All admitted patients with hollow viscus injury due to gun shot at casualty department of DMCH were included in this study by selective sampling technique. The main outcome variables were postoperative wound infection, anastomotic leakage, number of deaths and prolonged hospital stays. Data processing and analysis were done using SPSS 17.0.</p> <p><strong>Results</strong>: There were total 76 patients with hollow viscus injury following gunshot during the period under review. All were male patients with mean age 31.13 years. Peak incidence occurred within age group 41–60 (52.6%). The most commonly injured organs were the small bowel in 34 patients (44.7%). Thirty (90.9%) patients presented within three hours of the event (p=0.001). Among six patients who died, 5 (83.8%) presented 10 hours after the event (p=0.001). Among 20 patients, 18 (90%) remained hospitalized more than 15 days, who presented within 4–6 hours of the event (p=0.001). In 29 out of 33 patients (87.9%) who did not suffer from any complications encountered only less than 15% of blood loss at the time of presentation (p=0.001). Among 15 patients who suffered from postoperative wound infection nine patients (60%) lost 30–40% of blood at the time of presentation (p=0.011).</p> <p><strong>Conclusion</strong>: Outcome of the patients with hollow viscus injury following gunshot were found to be related to the time taken to reach the casualty department from the place of event and the amount of blood loss at the time of presentation.</p> <p>J Enam Med Col 2019; 9(2): 110-115</p> Ashok Kumar Sarker, Hasnat Zaman Zim ##submission.copyrightStatement## Thu, 16 May 2019 00:00:00 +0000 Congenital Cytomegalovirus Infection: Evaluation and Management <p>Congenital cytomegalovirus (CMV) infection is the most common congenital infection worldwide and most individuals are eventually exposed to this agent. In developing countries the seroprevalence in women of reproductive age approximates 100%. Cytomegalovirus (CMV) infection has great importance to obstetriciangynecologists and pediatricians. Despite the heavy disease burden, CMV infection is severely under-diagnosed because the majority (approximately 80%) of affected mothers are asymptomatic. The clinical manifestations of congenital CMV infection vary widely, from asymptomatic infection to potentially life-threatening disseminated disease. Prenatal diagnosis of fetal CMV infection can be made by testing amniotic fluid for cytomegalovirus by amniocentesis. Diagnosis of congenital cytomegalovirus infection in neonates should include real-time PCR of saliva, urine, or both, as soon as possible after birth. Antiviral therapy is not routinely recommended for congenital cytomegalovirus infection. Neonates with life-threatening infection and moderately to severely symptomatic congenital cytomegalovirus disease, CNS involvement is considered for immediate treatment that should be initiated within first month of life.</p> <p>J Enam Med Col 2019; 9(2): 116-126</p> Md Benzamin, Md Mizanur Rahman, Md Rukunuzzaman, ASM Bazlul Karim ##submission.copyrightStatement## Thu, 16 May 2019 00:00:00 +0000 Superior Ophthalmic Vein Thrombosis with Cerebral Venous Sinus Thrombosis: A Rare Entity in a Child <p>Cerebral venous sinus thrombosis (CVST) is a rare stroke-like syndrome. Sometimes it may be rarely associated with ophthalmic vein occlusion. We present a 10-year-old girl who had severe headache, diplopia, severe congestion of eye, proptosis and orbital pain. She had no signs of meninigeal irritation, no focal deficit except left sided lateral rectus palsy and altered visual acuity. Investigations regarding vasculitis and thrombophillia were normal except thrombocytosis. MRI of brain showed ‘dense triangle sign’ and thickened superior ophthalmic vein. Magnetic resonance venography (MRV) showed occlusion of superior sagital sinus and transverse sinus. She was treated with paracetamol, acetazolamide, rivaroxaban and antibiotics followed by high dose pulse methyl prednisolone. She made a partial recovery within one week and at 3 months follow-up she was completely normal.</p> <p>J Enam Med Col 2019; 9(2): 127-132</p> Kanij Fatema, Muhammad Mizanur Rahman, Laila Areju Man Banu ##submission.copyrightStatement## Thu, 16 May 2019 00:00:00 +0000 Leukemia Cutis in a 32-Year-Old Male with Acute Myeloid Leukemia <p>Leukemia cutis (LC) is a rare cutaneous manifestation of leukemia. Clinical presentation of the disease differs among patients depending on types. LC can precede, follow, occur simultaneously with, or present in the absence of the systemic leukemia. Leukemic involvement of the skin may appear as initial manifestation of recurrence or dissemination of systemic disease. Here we report a case of a 32-year-old male patient known to have acute myeloid leukemia with multiple cutaneous lesions diagnosed as LC.</p> <p>J Enam Med Col 2019; 9(2): 133-135</p> Meher Afsun, Rokon Uddin, Md Abu Baker, Iftekhar Ahmed ##submission.copyrightStatement## Thu, 16 May 2019 00:00:00 +0000 Recovery from Leptospira-Related Acute Liver Failure and Acute Kidney Injury ― A Case Report from Bangladesh <p>Leptospirosis is a zoonosis with protean manifestation caused by the spirochete, Leptospira interrogans. Here we report a 60-year-old male who presented with sudden onset of fever, rigors, myalgia and headache occasionally accompanied by nausea, vomiting and diarrhea. Later during the course of treatment he developed encephalopathy with fulminant hepatic failure and acute kidney injury and was diagnosed as a case of leptospirosis. A timely workup combined with early initiation of antibiotics and hemodialysis led to effective treatment for this patient.</p> <p>J Enam Med Col 2019; 9(2): 136-139</p> Akmat Ali, Richmond Ronald Gomes, Khadiza Begum ##submission.copyrightStatement## Thu, 16 May 2019 00:00:00 +0000 Bithalamic Infarct ― Sequel of Vein of Galen and Internal Cerebral Vein Thrombosis <p>Abstract not available</p> <p>J Enam Med Col 2019; 9(2): 140-142</p> Shafayat Bin Mollah Mosharraf ##submission.copyrightStatement## Thu, 16 May 2019 00:00:00 +0000 College News Vol. 9(2) <p>Abstract not available</p> <p>J Enam Med Col 2019; 9(2): 143</p> Rukhsana Parvin ##submission.copyrightStatement## Thu, 16 May 2019 00:00:00 +0000 Reviewers in this Issue Vol.9(2) <p>Abstract not available</p> <p>J Enam Med Col 2019; 9(2): 144</p> Editor in Chief ##submission.copyrightStatement## Thu, 16 May 2019 00:00:00 +0000