Journal of Shaheed Suhrawardy Medical College

Acute Pancreatitis: Association with Primary Hyperparathyroidism: A Case Report

Afiyat Nawar Haque — 2023-12-17

Association between primary hyperparathyroidism and acute pancreatitis is very rare. We report a case of a 45-year-old female presented with acute pancreatitis. Primary hyperparathyroidism was diagnosed after that episode of pancreatitis. She had no additional risk factor for pancreatitis. It’s been 10 months after her successful parathyroid surgery, there has been no recurrence of abdominal pain and her serum calcium is within normal limits. The purpose of reporting this specific case is that this pathology is uncommon in occurrence and indicates the importance of keeping in mind all the causes of pancreatitis before declaring it as idiopathic.

J Shaheed Suhrawardy Med Coll 2022; 14(1): 65-67

Detection of Carbapenemase Genes by Molecular Method among Gram-Negative Bacilli Isolates from Tertiary Care Hospital in Dhaka, Bangladesh

Hasbi Ara Mostofa — 2023-12-17

Background: Imipenem resistance in Gram-negative bacilli is a global epidemic that is increasing day by day.To warn this global epidemic, identification and ongoing surveillance of carbapenem-resistant genes among Gram-negative bacilli needed.
Objectives: This cross-sectional study was performed todetect the imipenem resistant genes among Gram-negative bacilli isolated from different samples in Dhaka medical college hospital.
Methods: About 300 samples (wound swab, urine, endotracheal aspirate, blood, and sputum) were collected from July 2015 to June 2016. Among them, 204 isolates were Gram negative bacilli. Eighty imipenem resistant Gram-negative bacilli were isolated by disc diffusion method. Among them, carbapenem resistant genes (blaNDM-1, blaKPC, VIM, IMP) were detected by PCR.
Results: A total 300 samples were analyzed. Out of 204 Gram negative bacilli,80 (39.21%) imipenem resistance was detected by the Disc Diffusion method. Out of 80 imipenem resistant organisms, 42 (52.5%) were positive for blaNDM-1, 6 (7.34%) were positive for blaKPC, 29 (36.25%) were positive for VIM, 13 (16.25%) were positive for IMP.
Conclusion: This study illustrates the emergence of carbapenemase genes producing Gram negative bacilli isolates from patients. Close surveillance across all hospitals in Bangladesh is required.

J Shaheed Suhrawardy Med Coll 2022; 14(1): 3-7

Demography of Epistaxis at Tertiary Level Hospital

Md Harun or Rashid — 2023-12-17

Background: Epistaxis is a common otolaryngological emergency worldwide. Many of the population suffer from it in their lifetime. This study was conducted to describe the demography of epistaxis among the patients who came to Pabna Medical College Hospital and Dhaka Medical College Hospital.

Objective: To evaluate the frequency of epistaxis among populations of different groups of age, sex, habitat, and circadian variation.

Methods: This cross-sectional study was conducted among 100 patients who came with epistaxis at Pabna Medical College Hospital and Dhaka Medical College Hospital of Bangladesh from January 2021 to December 2021.

Results: Male was found to be affected more than female with male to female ratio of 3:1. Eighty percent of the patients were from 5^th to 7^th decade, 60% were from urban and 40% were from rural habitat. Regarding etiology and sex, there were no significant differences between rural and urban habitats. The frequency of epistaxis showed circadian variation, 40% reported to the hospital in the evening, 35% in the morning, and the remaining 25% at late night. The frequency (55%) of epistaxis was more from November to March.

Conclusion: A high incidence in young adults was reported with the preponderance of male over female. The occurrence of epistaxis was strongly related to certain demographic factors. These are the age, sex, and habitat of the patient. This study supports the credibility of management procedure by finding some factors that make a difference in the frequency of epistaxis.

J Shaheed Suhrawardy Med Coll 2022; 14(1): 8-11

Efficacy of Mannitol in the Management of Cerebral Oedema in Hypoxic Ischemic Encephalopathy Stage-II following Perinatal Asphyxia in a Tertiary Level Hospital

Reshma Noor — 2023-12-17

Background: The use of mannitol in reducing cerebral edema in case of perinatal asphyxia in Hypoxic Ischemic Encephalopathy Stage-II is considerably contributing.

Objective: To find out the efficacy of mannitol in reducing cerebral edema in Hypoxic Ischemic Encephalopathy Stage-II following perinatal asphyxia.

Methods: It was a prospective observational study done in the Paediatric department of Shahid Suhrawardy Medical College Hospital, Dhaka from September 2016 to February 2017. According to inclusion criteria total 120 neonates were included in this study by purposive sampling. Among them, 60 neonates were selected as case (treated with mannitol) and 60 were taken as control (treated without mannitol). Data were collected in a structured questionnaire.

Results: During the study period, a total of 120 patients were studied. In the study group (Group -A), 78.33% were delivered by LUCS whereas in Group-B, the figure was 66.6%. The mean birth weight of neonates of these two groups were 1.9 + 0.76 kg and 1.73 + 0.89 kg respectively. PROM, APH, malpresentation, and multiple gestation were statistically significant risk factors in both groups (P=<0.05). About 79.67% neonates of group-A (with mannitol) and 70% of group-B (without mannitol) had radiological improvement following treatment revealing no statistically significant difference (P= >0.05).

Conclusion: From the result of the present study, it can be concluded that there is no significant difference in the management of cerebral edema following perinatal asphyxia with HIE stage-II between the groups treated with mannitol and without mannitol.

J Shaheed Suhrawardy Med Coll 2022; 14(1): 12-15

Outcome of Closed Reduction and Percutaneous Cross K-Wire Fixation of Supracondylar Fractures of Humerus in Children

Khandaker Haris Mohammed — 2023-12-17

Background: Supracondylar fractures of humerus are common skeletal injuries in paediatric age group in between 50-70% of elbow injuries. They are often associated with complications and are very notorious for neurovascular injuries between 5 to 9 years of age.

Objective: To evaluate the outcome of supracondylar fracture of humerus with closed reduction and percutaneous cross k-wires fixation.

Materials and method: A prospective study of 30 patients of Gartland type III fractures admitted in the orthopaedics department of 250 Bedded General Hospital, Tangail from January 2021 to December 2021.

Results: Regarding FLYNN CRITERIA, there were 24 excellent, 3 good,2 fair, and 1 poor results. Fair and poor results were due to poor compliance to follow-up and postoperative rehabilitation. There were 4 cases with pin tract infection, 1 with elbow stiffness, and 1 with cubitus varus.

Conclusion: Closed reduction and percutaneous cross k-wire fixation is a very effective and minimally invasive way of treatment of displaced supracondylar fractures of humerus. Crossed K-wire biomechanically better way of the stability of fracture reduction

J Shaheed Suhrawardy Med Coll 2022; 14(1): 16-19

Comparison between Preoperative Overnight Fasting Versus Oral Rehydration Solution (ORS) Administration Until Two Hours before Abdominal Surgery Under General Anaesthesia

Md Amirul Islam — 2023-12-17

Background: Preoperative fasting is a major concern to protect the gastric aspiration which is very dangerous. However overnight fasting is uncomfortable and has many deleterious effects on the human body. In many countries fasting until 2 to 3 hours before surgery has been practiced but in Bangladesh, overnight fasting is still being practiced in routine cases.

Objectives: The objective of this study was to compare the effectiveness between preoperative overnight fasting and oral rehydration solution administration until two hours before abdominal surgery under general anaesthesia.

Methods: A total of 100 patients of ASA (American Society of Anesthesiologist) class I and II, age above 18 years, and BMI < 30 kg/m² were scheduled for abdominal surgery under GA (General Anaesthesia) were included in this study. Then all patients were randomized into two groups as patients who were on overnight fasting for 10 hours (Group A-Controlled, n=50), and patients who were on ORS until 2 hours before abdominal surgery (Group B-ORS, n=50). All patients had their last meal at 11 AM before the day of surgery. Patients in group A will not take anything orally or via any route, except their ongoing vital medications if present. Patients in group B received 500 ml of standard ORS in the early morning on the day of surgery after waking up from bed (from 05 AM to 06 AM) and another 500 ml until 2 hours before the surgery (06 AM to 07 AM). As the primary outcome gastric residual volume and gastric fluid pH in both group was measured immediately after anaesthesia induction. Several physiological measures (thirst and hunger, nausea/vomiting, cognitive function) were measured with the help of a preformed questionnaire.

Results: Mean gastric residual volume immediately after induction was statistically significant (p<0.05) between the two groups. However, the mean gastric fluid pH was statistically insignificant (p>0.05). The ORS group (Group B) became less thirsty before surgery (P=0.001). Postoperative nausea/vomiting (PONV) was less in group B (P=0.029) than in group A. The patient’s recovery time was significantly less in ORS group (P=0.003). Postoperative cognitive performance was better in group B (P=0.001).

Conclusions: Oral rehydration solution administration until two hours before surgery is effective and can be considered routinely before abdominal surgery conducted under general anaesthesia except for delayed gastric emptying.

J Shaheed Suhrawardy Med Coll 2022; 14(1): 20-27

Correlation of FNAC with Histopathology in the Diagnosis of Differentiated Thyroid Carcinoma

Shahnaz Pervin — 2023-12-17

Background: Fine-needle aspiration cytology (FNAC) is an important diagnostic tool for differentiating between neoplastic and non-neoplastic lesions of the thyroid. The current study was carried out to observe the comparison between preoperative fine needle aspiration cytology (FNAC) and postoperative Histopathology in the diagnosis of Differentiated Thyroid Carcinoma.

Methods: This cross-sectional observational study was conducted in the department of Pathology, Rajshahi Medical College (RMC), Bangladesh from January 2019 to December 2020. Clinically suspected and diagnosed by FNAC, a total of forty patients of differentiated thyroid carcinoma attending outpatient and inpatient department of Otolaryngology, RMCH were enrolled in this study. Biopsy material was examined for histopathological diagnosis.

Results: In this study, out of forty cases, 35 were papillary and 5 were follicular carcinoma. Mean age was 25.48+9.70 years and Male: Female was 1:6. Among 40 cases of FNAC findings, 33 cases (82.5%) were classic papillary carcinoma, 01(2.5%) case was follicular variant of papillary carcinoma, 5 cases were (12.5%) were follicular lesion and 01(2.5%) case was nodular goitre. Among 40 cases of histopathological findings, 32(80%) cases were classic papillary carcinoma, 03(7.5%) were follicular variant of papillary carcinoma and 5 cases were follicular carcinoma. In histopathological findings, none of them was nodular goitre. So, all FNAC findings were consistent with histopathological findings except nodular goitre which was diagnosed as classic papillary carcinoma in histopathology.

Conclusion: FNAC is a safe and relatively accurate method for preoperative evaluation of thyroid malignancy before surgery. Therefore it is a reliable diagnostic test for evaluation of thyroid carcinoma.

J Shaheed Suhrawardy Med Coll 2022; 14(1): 28-31

Comparison of the Diagnostic Accuracy of Magnetic Resonance Cholangiopancreatography (MRCP) with Ultrasound and Computed Tomography (CT) in Evaluation of Patients with Obstructive Jaundice

Farhana Shimu — 2023-12-17

Background: Obstructive jaundice patients need surgical intervention to overcome the biliary obstruction. For planning these complex interventions, the radiologist has to precisely assess the etiology, location, level, and extent of the disease.

Aim: To compare the diagnostic benefit of Magnetic Resonance Cholangiopancreatography (MRCP) with Ultrasound and Computed Tomography (CT) in the evaluation of patients with obstructive jaundice taking histologic tests and anatomical findings after surgical intervention as gold standard.

Study Design: This prospective study included 72 patients who were referred to DCIMCH radiology department with clinical features of biliary obstructive disease.

Materials and Methods: All patients were evaluated by Ultrasonography followed by Computed tomography (CT) and Magnetic Resonance Cholangiopancreatography (MRCP). The results were read by radiologists blinded to other imaging findings. The characteristic histopathological diagnosis / surgical findings (as applicable) were considered as gold standard.

Results: Diagnostic accuracy of MRCP (98%) in the diagnosis of benign and malignant diseases was relatively high (98% and 98%) as compared to CT (82.86% and 91.43% in benign and malignant respectively) and USG (88% and 88%). In the diagnosis of benign diseases, MRCP was 100% sensitive compared to ultrasound (80.77%), which was more sensitive than CT scan (54.55%).In the diagnosis of malignant diseases, MRCP was more sensitive (95.83%) as compared to CT scan (91.67%), which was more sensitive than ultrasonography (79.17%).

Conclusion: MRCP is the best imaging investigation in the pre-operative evaluation for obstructive jaundice patients.

J Shaheed Suhrawardy Med Coll 2022; 14(1): 32-36

Correlation of Forced Vital Capacity and Peak Expiratory Flow Rate with Serum Estrogen and Progesterone Levels in Combined Oral Contraceptive Pill (COCP) User

Farhana Islam — 2023-12-17

Background: Combined oral contraceptive pill (COCP) is the most commonly used contraceptive method in Bangladesh. This COCP has some effects on different organs including the lungs. So, there may be a relationship between forced vital capacity (FVC) and peak expiratory flow rate (PEFR) with serum estrogen and progesterone levels in combined oral contraceptive pill (COCP) users.

Objective: To observe the relationship between FVC and PEFR with serum estrogen and progesterone levels in combined oral contraceptive pill users (COCP-U).

Methodology: This cross-sectional study was carried out in the Department of Physiology, Sir Salimullah Medical College (SSMC), Dhaka between July 2017 and June 2018. A total of 30 apparently healthy young women, age ranged 20 to 30 years were included in this study, who were combined oral contraceptive pill users (COCP-U) for at least 6 months. Another 30 age and BMI matched combined oral contraceptive pill nonusers (COCP-NU) were also taken as control for comparison. FVC and PEFR of all the subjects were measured by using Digital Auto Spirometer (MINATO AS-507). Moreover, their serum estrogen and progesterone levels were done to observe their levels and also to observe the relationship between them if present. Statistical analysis was done by Independent t-test and Pearson’s Correlation Coefficient test.

Result: Spirometric parameters like FVC and PEFR were significantly higher in COCP-U women than those of nonuser women. Moreover, the mean serum estrogen and progesterone levels were also significantly higher in COCP users in comparison to those of non-users. Here, FVC showed positive and PEFR showed negative correlation with serum estrogen level and FVC showed negative, PEFR showed positive correlation with serum progesterone level in COCP users, though the relationships were statistically non-significant.

Conclusion: The positive correlation of FVC and PEFR with serum estrogen and progesterone indicates, that improvement of pulmonary function occurs in COCP-U due to its estrogen and progesterone contents, which may be by increasing the strength of the muscles along with decreased airway resistance.

J Shaheed Suhrawardy Med Coll 2022; 14(1): 37-42

Effect of Meconium Stained Liquor on Mode of Delivery and Fetomaternal Outcome in a Tertiary Level Hospital

Rifat Sultana — 2023-12-17

Background: The appearance of meconium-stained liquor during labour is generally considered to be a sign of hypoxia and a predictor of poor fetal outcome.It is one of the clinical events where normal pregnancy can turn into a high risk one for the mother as well as for the foetus.

Objective: To evaluate the obstetric outcome in meconium stained liquor during labour.

Study design: Prospective comparative study.

Study setting and period: Gynaecology and Obstetrics department of Sir Salimullah Medical College and Mitford Hospital (SSMC and MH), Dhaka, between January 2019 to June 2019.

Study population: The study patients in labour with meconium stained amniotic fluid and women in labour but having clear amniotic fluid who admitted for delivery during study period.

Result: A total 75 cases were enrolled in the study as case and 75 cases were enrolled as control. The mean age was found 29.14±5.59 years in case group and 28.9±6.2 years in control group. Patients received irregular ANC was 20(26.7%) and 25(33.3%) in case and control group respectively. Patients who did not receive ANC was 24(32.0%) in case group and 12(16.0%) in control group. Mean gestational age at delivery was found 38.87±1.4 weeks in case group and 38.75±1.6 weeks in control group. Primigravida was predominant in both groups. Caesarean deliveries were high (80.0%) in cases and it was much higher with thick meconium (74.7%) as compared to thin meconium (25.3%). APGAR scores in first minute and fifth minute were also low in cases. Birth asphyxia was found 20.0% in case group and 6.3% in control group. Meconium aspiration syndrome 25.0% and convulsion 3.8% developed only in cases. Neonatal ward admission was 22.0% in case group and 6.3% in control group. Neonatal mortality was higher (3.8%) in cases than control 1.3%. Majority (6.65%) patients had post partum hemorrhage in case group and 3(4.0%) in control group.

Conclusion: Meconium stained amniotic fluid were associated with higher rate of caesarian delivery, increased need for neonatal resuscitation, increased rate of birth asphyxia with hypoxic ischemic encephalopathy, meconium aspiration syndrome, hospital admission, and mortality. Electronic foetal monitoring, timely obstetrical intervention and neonatal care can reduce associated complications and improve foetal outcome.

J Shaheed Suhrawardy Med Coll 2022; 14(1): 43-49

Stress of the COVID-19 and its Consequences on Irritable Bowel Syndrome Patients in A Selected Tertiary Level Hospital in Bangladesh

Dilip Kumar Ghosh — 2023-12-17

Background: The COVID-19 pandemic represents a multiple stress. Stress can worsen the symptoms of (IBS) patients.

Aims & Objective: The aim of the study was to assess the stress of COVID -19 and its impact on IBS patients during the pandemic situation among the Bangladeshi population.

Methods: This cross-sectional study was conducted among the self-reported previously diagnosed IBS patients aged 18 years and above, irrespective of sex, in the Gastroenterology department of ShaheedSuhrawardy Medical College Hospital. Data was collected by a structured questionnaire which included the patient’s socio-demographic, clinical symptoms of IBS, personal habits, comorbidities, self-reported stress due to COVID-19, and its effect on the symptoms of IBS.

Results: The study respondents consisted of 210 IBS patients, among them 71.90% were male and 28.10% were female. The majority of the study population (43.0%) belonged to age group of 31-40 years and mean age 35.12 ± 11.55 years. Most of the respondents (91.9%) reported stress due to the COVID-19 pandemic. The most commonly reported causes of stress were fear of a family member being infected with the virus (94.8%), followed by fear of self-infection (90.5%), and death due to COVID-19 infection (68.1%). Most of the stressed respondents (72.9%) reported that stress usually exaggerates IBS symptoms. Almost 25.7% of the subjects consulted a physician for stress aggravation of the symptoms, 21.0% used sedatives due to stress, and 21.0% modiﬁed IBS medications due to stress. Moreover, 36.2% of the participants reported hampered daily activities due to IBS symptoms exacerbation.

Conclusion: The study revealed that most of the IBS patients had been suffering from stress during the COVID-19 pandemic situation. IBS patients should be advised to participate in mental health education programs to adjust to the current pandemic COVID-19 situation.

J Shaheed Suhrawardy Med Coll 2022; 14(1): 50-56

Assessing Vitamin D Levels and Demographic Profiles of Adult Outdoor Patients: A Descriptive, Cross-sectional Study in a District Medical College Hospital of Bangladesh

ABM Shakil Gani — 2023-12-17

Background: Vitamin D deficiency is a highly prevalent nutritional deficiency in Bangladesh. While the majority of the research has been done in the large metropolitan area, few studies have been conducted at the district level. Furthermore, little information has been discovered about the demographics of people with vitamin D deficiency. Thus, this study aimed to identify the district-level demographics of those who suffer from vitamin D insufficiency.

Methods: A descriptive cross-sectional study was conducted among 197 participants attending medicine outdoors at Sheikh Hasina Medical College Hospital, Tangail, Bangladesh. Detailed interview on socio-demographic and lifestyle factors and anthropometric measurement was conducted. Serum vitamin D level was estimated by chemiluminescent immunoassay. Data were analyzed by SPSS 22.0.

Results: About 46.2% of respondents had insufficient and 36.5% had deficient vitamin D levels. Serum vitamin D level was 22.68 ng/ml ± 7.83. Females (84.92%) had hypovitaminosis D more than males (78.87%) which was statistically significant. BMI, occupation, and monthly income had no significant role in different vitamin D status groups. Among females, wearing Burka had a significant relationship with low vitamin D levels.

Conclusion: Females are more prone to suffer from low vitamin D levels especially those who had less sun exposure due to choice of clothing. Prophylactic supplements of vitamin D may be considered in this group.

J Shaheed Suhrawardy Med Coll 2022; 14(1): 57-61

Socio-demographic Profile of the Causes of Death due to Organophosphorus Poisoning - A Retrospective Study

Parveen Sultana — 2023-12-17

Background: Poisoning is a global issue occurring all over the world involving people of all ages and genders, from all ethnic and economic groups. It is estimated, there are 1 to 5 million cases of Organophosphorus poisoning per year worldwide with approximately 300,000 deaths.

Aim of the study: To assess the demographic pattern of death due to organophosphorus poisoning with respect to age, sex, occupation, education, and socioeconomic status.

Materials and Methods: A retrospective study was conducted by the department of Forensic Medicine, Sheikh Hasina Medical Colleges, Tangail, from January 2020 to December 2020.

Result and discussion: 85(20.68%) were due to poisoning, out of those poisoning cases 77 (90.58%) were due to organophosphorus compound poisoning. The incidence was higher in females (51.94%) than in males. 90.00% of the victims in our study were married females, and 63.64% of cases were below Secondary education. Among the male deaths 83.78% were from rural areas, female rural deaths were 82.50%. Housewife (38.9%) were the major victims.

Conclusion: Illiteracy, Poverty, Cheap availability of organophosphorus compounds, lack of employment, and stressful lifestyle were the common reasons behind suicidal poisoning. Health education of farmers, other agricultural laborers, and young people about the toxic and detrimental effects of organophosphorus compounds will help in preventing suicidal and accidental poisoning to some extent.

J Shaheed Suhrawardy Med Coll 2022; 14(1): 62-64

Perspective of Integrated Teaching

Rubina Afroz Rana — 2023-12-17

Abstract not available

J Shaheed Suhrawardy Med Coll 2022; 14(1): 1-2