Journal of Rangpur Medical College

Salivary Acetylcholine Concentration and Dementia: A Comparative Study in Dhaka City of Bangladesh

2023-10-10T07:31:13+00:00

Introduction: Dementia is rapidly becoming a major public health problem worldwide . In dementia, the rate of acetylcholine deficiency is very high. Therefore, it can be assumed that acetylcholine levels may play a potential role in the pathogenesis of dementia.

Objective: To evaluate the relationship of salivary acetylcholine concentration with the events of dementia.

Methods: This comparative cross-sectional study was carried out during the period of July 2014 to June 2015. Among the purposively selected 120 respondents, 60 respondents were suffering from dementia were selected from the Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorder (BIRDEM), National Institute of Neuroscience (NINS), and the Dementia Care Project of Sir William Beveridge Foundation, and the rest 60 were without dementia selected as the comparison group.

Results: Out of all study subjects, the mean (±SD) age of dementia patients was 73.10(±4.93) years with an age range of 62 to 84 years and that of in comparative group was 71.20(±5.89) years with an age range of 64 to 85 years. Male (60.0%) was predominant in dementia patients. The mean (±SD) value of Salivary acetylcholine in the dementia group was found 153.93(±98.04) pg/ml and that of in comparative group was 411.50(±112.50) pg/ml. Here Salivary acetylcholine was found lower in dementia patients than comparative group (p<0.001)

Conclusion: Salivary acetylcholine level can help to diagnose the risk of development of early dementia.

J Rang Med Col. September 2023; Vol. 8, No. 2: 3-6

Socio-demographic Status and Psychiatric Morbidity of Suicide Attempters in a Tertiary Care Hospital of Bangladesh

2023-10-11T06:28:38+00:00

Background: Suicide is a worldwide growing but neglected problem crossing culture, geographies, religious, social and economic boundaries. Suicide is a perplexing phenomenon of taking one’s own life. As versatile human beings are, reasons behind suicide attempts are also unique. There is paucity of study on the clinical characteristics of these patients from a psychosocial and psychiatric point in Bangladesh.

Objective: The study was aimed to assess the socio-demographic profile and psychiatric morbidity in attempted suicide patients.

Methods: This cross-sectional observational study was carried out for 4 months (May’2017-September’2017) at the Rangpur Medical College Hospital, Rangpur, Bangladesh. ). A total of 101 patients were purposively selected from the patients with suicidal attempt from different departments of the hospital (Medicine, Surgery, Head-Neck & Otorhinolaryngology). Informed written consent was obtained from all patients. The interview was conducted once the patient was considered fit for a psychosocial assessment using a semi-structured questionnaire and clinical interviews. Diagnosis was made according to DSM-IV. Data was entered and analyzed using SPSS version 24 and results were expressed as proportions and percentages.

Results: The majority of suicide attempts seen are in socio-economically-deprived young persons. Majority were <20 years age (41.59%), Female (53.47%), Unmarried (51.49%), Rural dwellers(72.28%), students (38.62%) and 58% attempts were impulsive. 63% without any prior suicidal thoughts, 56% resorted to poisoning, 49% attempted due to domestic quarrel, 65% suffered from a psychiatric disorder and major depressive disorder (18%) was found to be one of the commonest diagnosed disorders.

Conclusion: Psychiatric disorders and their co morbidities are common in suicide attempt patients which calls for implementation of hospital guidelines for routine psychiatric and psychosocial assessments.

J Rang Med Col. September 2023; Vol. 8, No. 2: 7-13

Assessment of Crown-Heel length, Head Circumference, and Mid-Arm Circumference for Estimation of Small for Gestational Age in Rural Area

2023-10-11T06:30:58+00:00

Background: The burden of having small for gestational age (SGA) children is high in low- and middle-income countries, mainly in South Asia. Identifying these low birth weight and SGA infants and referring them to higher centers for effective intervention will help reduce neonatal mortality and morbidity. Anthropometric measurements of the neonatal population, especially birth weight measurements, constitute an important scientific research tool for studying the determinants and consequences of impaired or excessive fetal growth.

Objective: To find an alternative anthropometric procedure, the present study was done to measure and compare birth weight with crown heel length (CHL), head circumference (HC), and mid-upper arm circumference (MUAC) as predictors of birth weight in small for gestational age (SGA).

Methods: This cross-sectional, analytical study was done in the Department of Anatomy, Rangpur Medical College, Rangpur from July 2020 to June 2021 on 200 newborns of both sexes with gestational age between 37 and 42 weeks. The newborn was selected and measured within 24 hours of birth. 100 term newborns weighted <2.5 kg regarded as SGA were the subjects of the study. Another 100-term newborns weighted >2.5 kg regarded as AGA served as control. The birth weight, head circumference, mid-upper arm circumference, and crown heel length were measured and a comparison of all the variables was done between AGA and SGA newborns. Data was analyzed by using a statistical package for social sciences (SPSS version 26).

Result: The mean± SD of birth weight in AGA and SGA groups was 2.99 ±0.31 and 2.10±0.24 respectively; it was observed that the mean± SD of crown heel length, head circumference, and mid-upper arm circumference and Ponderal index in AGA group was significantly higher than SGA group; however the MAC/HC ratio was almost similar between AGA and SGA groups. All the above variables were significantly correlated with birth weight in both AGA and SGA groups.

Conclusion: Some simple and inexpensive measurements of newborns especially the head circumference of SGA newborns are as effective as birth weight measurement; crown heel length, and mid-upper arm circumference could also be used to predict birth weight in SGA newborns.

J Rang Med Col. September 2023; Vol. 8, No. 2: 14-19

Outcome of Perforator Based VY Advancement Fasciocutaneous Flap for Sacral Pressure Sore Reconstruction

2023-10-11T06:37:10+00:00

Background: Pressure sores are an ancient medical problem; were even found in autopsies of Egyptian mummies. Sacral pressure sore is more common among paraplegic and bedridden patients. The principle of treatment is excision of all dead & devitalized tissue including scars, underlying bursa, and the involved bone, followed by durable coverage with Flap. Various flaps have been used to reconstruct the pressure sore, including Fasciocutaneous flaps, muscle flaps and free flaps. Among various local flaps, perforators based V-Y advancement fasciocutaneous flap is a reasonable and flexible option with good outcomes for sacral pressure sores reconstruction.

Objectives: The purpose of this study was to evaluate the outcome of perforator based V-Y advancement fasciocutaneous flap for sacral pressure sores reconstruction concerning the sociodemographic characteristics of the patients, defect size, and outcome of surgery.

Methods: This was a prospective observational study, conducted in the Burn & Plastic Surgery department of Rangpur Medical College Hospital, Rangpur over a period of three years from August 2018 to September 2021 through purposive sampling. Patients of all ages and sexes having grade IV sacral pressure sores were included in this study. In all cases, perforator- based V-Y advancement fasciocutaneous flaps were used. Surgical technique, patient demographics, and outcome were evaluated.

Results: A total of 30 patients were operated on. The age range was 18 – 65 years, among them 43.33% of patients were in the age range of 31 – 40 years. 80% of patients in this series were male. Traumatic paraplegia was the main cause of sacral pressure sore, and it was 70%. This study showed that in context to the length and breadth of the wound, a majority (30%) of the patients had a wound dimension of 71–90cm2. The smallest wound dimension was (5x6) = 30cm2 and largest wound dimension was (10x16) = 160cm2. Twenty-one sores that ranged from 6cm to 10cm were reconstructed with unilateral flaps and 09 sores that ranged from 11cm to 16cm were reconstructed with bilateral flaps. In this study, 06 (20%) patients had complications and all were managed conservatively. Three patients had infections and were treated according to the culture sensitivity report. Two patients had marginal flap necrosis at the vertical limb of Y which healed conservatively. One patient developed a seroma due to a blockage of the drain tube, which was resolved spontaneously. There was no flap loss in our study. The average follow-up period was one year. No recurrence of pressure sore during this period.

Conclusion: The simplicity of the surgical procedure, minimum or no morbidity in the donor area, and satisfactory outcome in terms of recurrence make this a reasonable option for the reconstruction of the sacral pressure sore.

J Rang Med Col. September 2023; Vol. 8, No. 2: 20-24

Effects of Cement Dusts on Peak Expiratory Flow Rate (PEFR) in Female Cement Dust Exposed Construction Workers

2023-10-11T06:40:29+00:00

Background: Occupational and environmental lung diseases are the major problems of clinical medicine. The cement dust workers are constantly exposed to high amounts of visible ambient air particulate matter, mostly without any respiratory protective device. Therefore, the inhalation of dust over periods of time leads to impaired lung functions.

Objectives: To observe the effects of cement dust exposure on PEFR in female cement dust workers.

Methods: This cross-sectional study was conducted in the Department of Physiology, Rangpur Medical College, Rangpur from July 2016 to June 2017. A total of 60 female subjects aged 20–50 years were selected for the study. Among them, 30 were apparently healthy workers exposed to cement dust, and 30 apparently healthy height, weight & BMI-matched subjects not exposed to cement dust were selected as control from the surrounding community. Their pulmonary functions were studied by measuring PEFR. For statistical analysis, an unpaired ‘t’-test was performed by computer-based software SPSS-17.0 version for Windows.

Results: The mean measured and mean percentage of the predicted value of PEFR was significantly (p_0.001) lower in cement dust-exposed female workers (CD- EFW) than the non-exposed female workers (CD-NEFW).

Conclusion: From the result of this study, it can be concluded that cement dust (CD) may have harmful effects on some pulmonary functions.

J Rang Med Col. September 2023; Vol. 8, No. 2: 25-28

Clinical Association of Anti-TPO in Patients with Chronic Urticaria

2023-10-11T06:45:10+00:00

Background: Chronic urticaria may occur when the body's immune system attacks its self-tissues. It is a skin condition marked by brief purpuric wheals that last longer than six weeks. Uncertainty surrounds the disease's etiopathogenesis. Autoimmunity and endocrine dysfunction may both be at play, according to the available research.

Objective: This study aimed to evaluate if thyroid immunity is statistically linked with chronic urticaria.

Methods: This case-control study was held from June 2022 to March 2023 at Department of Dermatology & Venerology in IMCH, Popular diagnostic center and Digital Hospital in Gazipur. We examined the prevalence of autoantibodies (Anti-TPO) in 50 chronic urticaria patients and 50 healthy volunteers. In all participants, thyroid hormone and thyroid auto-antibodies were assessed.

Results: Thyroid function abnormalities were found 7 (13.42%) patients and Anti-TPO is positive in 38(76%) patients respectively. Only 2 (4%) of the individuals in the control group had positive anti-TPO tests. With chronic urticaria, anti-TPO levels were considerably greater (P 0.05) than in the control group.

Conclusions: This study shows a significant association between chronic urticaria and thyroid auto-immunity. The test is conducted to detect thyroid auto-antibodies is relevant in patients with chronic urticaria.

J Rang Med Col. September 2023; Vol. 8, No. 2: 29-33

Willingness and Perception About COVID-19 Vaccine Among Rural Adults

2023-10-14T03:24:57+00:00

Introduction: The most successful and cost-effective method of preventing the spread of COVID-19 infection is vaccination. But there are challenges to vaccinating the mass population in a developing country like Bangladesh. This survey aimed to assess the willingness to receive and perception of COVID-19 vaccines and the association of this willingness with the baseline characteristics and the level of perception of the respondents.

Method: This cross-sectional study was conducted among 672 rural people from six villages of Palashbari Upazilla, Gaibabdha district. A convenient sampling technique was used and data were collected by face-to-face interview.

Result: Almost two third of the respondents of this study were _30 years old and the average age of respondents was 37.43±17.13 years. Majorities of the respondents were female (54.6%). About 89.1% of the respondents in this study were willing to be vaccinated and the main reason for this willingness includes respondents’ belief about the vaccine protection against COVID-19 (91.8%) reduced the fear of the respondents (60.6%), government suggestion (45.1%). The main reasons behind unwillingness included fear of side effects (71.8%), doubt about vaccine safety and efficacy (46.5%), and ignorance (59.2%). Regarding perception about the COVID-19 vaccine, more than half of the respondents (51.2%) had good perception whereas 29.8% had average perception and 19.0% of respondents had poor perception. In this study, females were significantly more willing to be vaccinated than male respondents (p=0.027). Respondents age group <30 years were significantly more willing to vaccinate than that of the age group _30 years (p=0.042). Respondents not having chronic diseases group significantly more inclined to vaccinate than that having chronic diseases (p<0.001). A good level of perception was more likely to have willingness than average or poor perception (p<0.001).

Conclusion: The findings of this study reveal that despite the high prevalence of willingness to receive vaccines, still there were the challenges. Policymakers should design effective immunization policies and experts in media and communication should deliver the proper message that is understandable to everyone, especially illiterate rural people.

J Rang Med Col. September 2023; Vol. 8, No. 2: 34-39

Serum Iron Profile in Type 2 Diabetes Mellitus

2023-10-14T03:44:41+00:00

Background: Type 2 diabetes Mellitus is a major growing health issue worldwide. There is a strong relation between iron parameters and type 2 diabetes mellitus. Iron metabolism can directly or indirectly affect the occurrence and development of type 2 diabetes.

Objectives: To observe serum levels in Type 2 Diabetes Mellitus patients.

Methods: This cross sectional study was conducted from to in the Department of Physiology, Rangpur Medical College, Rangpur. For this study, total number of 150 subjects were selected among them 75 non-diabetic healthy subjects were included in group-A and 75 Type 2 Diabetes Mellitus patients were included in group-B. The subjects of group-A were selected from surrounding community of Rangpur district and subjects of Group-B were selected from Diabetic Association and from Outdoor of Endocrinology Department, Rangpur Medical College and Hospital, Rangpur. For statistical analysis independent sample “t”test was performed by computer based software SPSS- 23.0 version for windows.

Results: Mean serum free iron concentration in Group A and Group B were 12.29±3.1 μmol/l and 15.24±6.8 respectively. Mean TIBC in Group A and Group B were 68.06±7.3 μmol/l and 56.89 ± 8.6 respectively. Mean serum ferritin concentration were 131±12.90 mg/ml and 170.50±15.1 respectively. The difference between serum iron, TIBC and ferritin between Group A and Group B were highly significant ( p _ 001 ).

Conclusion: The results obtained from this study suggests that serum iron and serum ferritin were increased and TIBC was decreased in T2DM patients as compared to healthy control.

J Rang Med Col. September 2023; Vol. 8, No. 2: 40-43

Socio-demographic Characteristics and Histopathological Type of Colorectal Cancer in the Northern Part of Bangladesh

2023-10-14T03:50:33+00:00

Background: Colorectal cancer is one of the most common causes of death among patients. This study aimed to see the pattern of colorectal cancer from 2018 to 2021 and to explore its association with age and sex, its site of occurrence, histopathological types & its incidence in different regions of the Rangpur division.

Methods: This cross-sectional study was carried out in the Department of Radiotherapy, Rangpur Medical College Hospital, Rangpur, Bangladesh. All data regarding 434(7.5%) colo-rectal cancers out of 5782(100%) patients were collected from 2018 to 2021. Each of the 434 colorectal cancer patients was interviewed and examined thoroughly before data collection. Age, sex, previous & current data of all patients were recorded properly during the study.

Result: The study showed out of 436 colo-rectal cancers 266(61.3%) were male and 168(38.7%) female with a male-female ratio of 1.58:1. Highest incidence of cancer was in the age group 41-60 years (194,44.7%). Out of 436 cancers 219(50.4%) found in rectum, 29(6.6%) in sigmoid colon and 186(42.8%) in other parts of colon. The most common histopathological type was adenocarcinoma 415(95.62%). Among eight districts of the Rangpur division highest incidence of colorectal cancer was found in Rangpur 194(44.7%) followed by Nilphamari 64(14.7%), Gaibandha 44(10.1%), Kurigragm 40(9.2%), Dinajpur 35(8.06%), Lalmonirhat 34(7.9%), Panchagarh 12(2.7%) and Thakurgaon 11(2.5%).

Conclusion: The incidence of colorectal cancer is higher in males than females. Highest incidence of colorectal cancer in the age group of 41-60 years. Adenocarcinoma is the most common histopathological type of colorectal cancer in both males and females. Incidence of the colo-rectal cancer in the Rangpur district is higher than in other districts of Rangpur division.

J Rang Med Col. September 2023; Vol. 8, No. 2: 44-47

Abernethy Syndrome with Left Renal Artery Stenosis: Our first experience

2023-10-15T08:13:48+00:00

Abernethy syndrome is defined as the congenital diversion of portal blood away from the liver either end-to-side shunt or, side-to-side shunt. Here we are reporting a case of a 15-year-old boy presented with recurrent encephalopathy and uncontrolled hypertension. Persistent rise in blood ammonia level was noted with normal other biochemical parameters. Ultrasound and Doppler study of the abdomen revealed drainage of the portal vein into the inferior vena cava and a small size of the left kidney. Renal artery angiogram and hepatic angiogram were performed, which confirmed the diagnosis of Type 1B Abernethy syndrome with left renal artery stenosis. After counseling the patient and his parents and taking consent, he has been treated with Left renal artery angioplasty, antihypertensive along supportive treatment. The treatment of Abernethy syndrome depends on its type, associated congenital anomalies, and complications. If possible closer of thes hunt is the mainstay of treatment but in case of type 1 malformation with the absence of the possibility to close the shunt may require a liver transplant.

J Rang Med Col. September 2023; Vol. 8, No. 2: 56-59

Multiple Splanchnic Venous Thromboses: A Fatal Complication of Recurrent Pancreatitis

2023-10-15T08:14:55+00:00

Splanchnic Venous Thrombosis (SVT) is a condition associated with high morbidity. The etiologies of SVT include intra-abdominal inflammation or infection, surgical intervention, abdominal malignancies such as hepatocellular carcinoma (HCC) and pancreatic carcinoma, or abnormality in coagulation caused by various reasons such as liver cirrhosis. Most cases of pancreatitis are mild and self-limited. On the other hand, approximately one-quarter of patients with pancreatitis may develop vascular complications such as venous thrombosis. Pancreatitis associated with vascular complications is dangerous and potentially fatal. The survival of patients with pancreatitis and vascular complications depends on the early detection of these complications. We report a case of a middle-aged male who had recurrent pancreatitis. On radiological imaging, the patient was found to have a portal vein, splenic vein, and superior mesenteric vein thrombosis. The etiology of thrombosis was considered to be inflammation around the main portal trunk caused by pancreatitis Patient recovered after emergent and timely management with initially low molecular weight heparin and bridged by oral apixaban therapy. The article focuses on the aspects of etiology, pathogenesis, diagnosis, and management of acute pancreatitis with venous thrombosis.

J Rang Med Col. September 2023; Vol. 8, No. 2: 60-63

Current Dengue Situation in Bangladesh: Heading from Backstreet to Highway

2023-10-10T07:17:16+00:00

Abstract not available

J Rang Med Col. September 2023; Vol. 8, No. 2: 1-2

Application of Artificial Intelligence in Gastroenterology: A Review on Improvement in Diagnosis, Treatment, and Patient Monitoring

2023-10-14T03:58:00+00:00

Artificial intelligence (AI) has significant potential in the field of gastroenterology by aiding in the diagnosis, treatment, and monitoring of patients. With its ability to analyze medical images and patient information, identify risk factors, and enable remote consultations and monitoring, AI can improve accuracy, efficiency, and personalized care for patients. This advancement in technology has the potential to revolutionize patient outcomes. As further research is conducted, the possibilities for AI in gastroenterology will continue to expand, ultimately leading to improved patient outcomes.

J Rang Med Col. September 2023; Vol. 8, No. 2: 48-52

Acceptability of Silver Diamine Fluoride

2023-10-15T08:07:39+00:00

Background: Silver diamine fluoride (SDF) can be used for active carious lesions in primary teeth and can be applied in dental clinics, in school, or in community-based settings with simple armamentarium and minimal support. Silver diamine fluoride causes darkening of carious enamel and dentin after its application.

Method: An electronic literature search in Web of Science, Scopus, Science Direct, PubMed, Google Scholar, African Journal Online, Researchgate, and Google was done in June 2023. Search terms and keywords were combined by Boolean operators. Four independent investigators (research assistants) screened titles, abstracts, and full text of publications. The inclusion criteria were original research articles ( human studies) carried out in African regions and including observational studies (cohort, case-control, cross-sectional), experimental studies (clinical trials, randomized or not) designs, case reports, and case series investigating parents, caregivers, guardians or children acceptability or acceptance of silver diamine fluoride treatment procedure and post-treatment blackening/staining of teeth. Systematic reviews and review articles were excluded.

Results: One article was included as it was assessed to meet the aim of the review. It was a hospital-based study. Parental acceptance of silver diamine fluoride treatment with its black staining was assessed using the Likert scale. Acceptance of post-treatment staining of teeth among parents was higher in posterior teeth than in anterior teeth.

Conclusion: Only one study on the acceptability or acceptance of silver diamine fluoride treatment procedure and post-treatment staining of teeth was identified among African parents. More studies from the diverse ethnic population in Africa will contribute to the existing literature.

J Rang Med Col. September 2023; Vol. 8, No. 2: 53-55