Medicine Today A professional medical journal recognised by the Bangladesh Medical and Dental Council (BMDC). en-US (Prof. N.A. Kamrul Ahsan FACS, MS) (Md Fahmid Uddin Khondoker) Fri, 01 Mar 2019 16:31:59 +0000 OJS 60 Comparison between Sutureless and Glue Free versus Sutured Limbal Conjunctival Autograft in Primary Pterygium Surgery <p><strong>Introduction: </strong>To compare and evaluate the safety and efficacy of two surgical techniques for the management of primary pterygium.</p> <p><strong>Materials &amp; Methods: </strong>The study included 176 eyes of 176 patients with primary pterygium. The mean age was 49 ± 12 years (range 24–74 years). Simple excision under local anesthesia was performed followed by closure of the bare sclera by suture less and glue free conjunctival autograft in 76 eyes of 76 patients (group 1), versus the conventional method of a sutured conjunctival autograft in 100 eyes of 100 patients (group 2).</p> <p><strong>Results: </strong>The pterygium recurrence rate was 6% for group 1, 8% for group 2. Graft dehiscence occurred in 4 eyes out of 50 (8%) in group 1. Graft retraction occurred in 6 (12%) out of 50 eyes for group 1 versus 6 eyes (6%) in group 2. Pyogenic granuloma occurred in 3 (3%) eyes out of 100 in group 2. No other serious complications were noted. At the 3 week visit the overall patient satisfaction score was statistically significantly higher for group 1 (P &lt; 0.002) compared to group 2. At 3 months postoperatively, the gain in uncorrected visual acuity (UCVA) ranged from 0.2 to 0.5 Log MAR in 10 eyes.</p> <p><strong>Conclusion: </strong>Sutureless and glue free conjunctival autograft technique is easy, safe, effective, prevents potential adverse reactions encountered with the use of foreign materials. This technique has an acceptable pterygium recurrence rate that is comparable to conventional sutured conjunctival autograft for primary pterygium.</p> <p>Medicine Today 2018 Vol.31(1): 1-8</p> Md Mahmud Ul Huda, Sajed Abdul Khaleque ##submission.copyrightStatement## Wed, 20 Feb 2019 00:00:00 +0000 Antibiotic Resistance in Urinary Tract Infection in a Tertiary Care Hospital in Bangladesh-A Follow-up Study <p><strong>Introduction: </strong>Bacterial resistance to antibiotics is one of the most challenging global health threats. Urinary tract infections (UTIs) are a common infection. Regional surveillance programs are necessary to update knowledge on antimicrobial resistance pattern where empirical antibiotic treatment is the mainstay. The aim of this follow up study is to see the changing trends in bacteriology and antibiotic resistance pattern among urological pathogens in comparison to similar study 5 years back.</p> <p><strong>Materials and Methods: </strong>We performed a prospective study in Comilla Medical College Hospital, Bangladesh during the period of July 2015- June 2016. Midstream clean-catch urine samples were collected from 658 suspected UTI patients with age more than 12 years and inoculated in MacConkey&amp; Blood agar media for semi quantitative urine culture and sensitivity test. Antibiotic susceptibility pattern was done by Kirby-Bauer disc diffusion method following clinical laboratory science (CLS) program.</p> <p><strong>Results: </strong>Culture positive were in 198 samples among 658 inoculated samples. E. coli was isolated from 171(86%) samples which was the most predominant bacteria followed by Klebsiella and Enterococcus. UTI with E. coli was significantly increased in the year 2016 in comparison to 2011. Meropenem, imipenem, amikacin, tazobactum, gentamycin nitrofurantoin, and mecillinum found resistance against 0% to 12% of the urological pathogens. Bacteria offered high degree of resistance against commonly used antibiotics - amoxycillin, amoxiclav, cephradine and cefixime ranging 60% to 86%. Comparative study of 2016 vs 2011 shows significant increased resistance for ceftriaxone, amoxiclav and reduced resistance for nalidexic acid, mecillinum and cefuroxime.</p> <p><strong>Conclusion: </strong>E. coli infection is significantly increaseing in follow up study from 2011 to 2016 with no steady increase in resistance to all antibiotics. Imipenem, meropenem, tazobactum, amikacin and nitrofurantoin still remain more sensitive while comparative study of 2016 vs 2011 shows significant increased resistance for ceftriaxone, and amoxiclave and reduced resistance for nalidexic acid, mecillinum, cefixime and cefuroxime.</p> <p>Medicine Today 2019 Vol.31(1): 9-14</p> Md Mahabubul Islam Majumder, Tarek Ahmed, Saleh Ahmed, Ashiqur Rahman Khan, Chinmoy Kumar Saha ##submission.copyrightStatement## Wed, 20 Feb 2019 00:00:00 +0000 Diagnostic Role of Bone Marrow Examination in Detecting Haematological and Nonhaematological Disorders <p><strong>Introduction: </strong>Bone marrow study has wide application in clinical medicine. It is important test not only for diagnosis of haematological diseases but also for various systemic illnesses. The aim of this study is to determine the indications, the spectrum of haemotological and non haematological disorders diagnosed by using this procedure.</p> <p><strong>Materials &amp; Methods: </strong>It was a prospective study comprising 152 patients who underwent bone marrow examination for evaluation of haematological and nonhaematological disorders in the Department of Haematology, Enam Medical College Hospital during the period of 2012 to 2017.</p> <p><strong>Results: </strong>In our study male to female ratio was 1.6:1 and common age group was &gt;45years (n-65, 42.76%). Most common indications for bone marrow examination were pancytopenia (26.97%, n-41) and diagnosis of leukaemia/myeloproliferative neoplasm (25.66%, n-38). 90.13% (n-137) marrows were pathological. Non-malignant conditions were 40.79% (n-62) and malignant conditions were 49.43% (n-75). Non malignant haematological condition were 33.55% (n-51), malignant haematological conditions were 47.37% (n-72). Most common nonmalignant haematological conditions were aplastic anaemia (15.13%, n-23) and immune thrombocytopenic purpura (9.87%, n-15). Visceral leishmaniasis was found 3.29% (n-5). Acute myelogenous leukaemia (14.47%, n-22) and multiple myloma (11.18%, n-17) were the most common malignant haematological condition. Secondary deposit was found 1.97% (n-3).</p> <p><strong>Conclusion: </strong>Bone marrow examination is a simple invasive procedure for diagnosis of both haematological and nonhaematological diseases when routine investigations failed to reach the final diagnosis.</p> <p>Medicine Today 2019 Vol.31(1): 15-18</p> Md Rezaul Karim Chowdhury, Md Haroon Ur Rashid, Amina Begum ##submission.copyrightStatement## Wed, 20 Feb 2019 00:00:00 +0000 Medication Adherence Patterns to Anti-diabetic Drugs among Type 2 Diabetic Patients <p><strong>Introduction: </strong>The aim of the present study was to evaluate the pattern of medication adherence to anti-diabetic drugs among type 2 diabetic patients at two tertiary level hospitals in Mymensingh.</p> <p><strong>Materials and Methods: </strong>An observational, cross sectional study was conducted from January 2016 to June 2016 among patients attending at Endocrine Outpatient Department of the Mymensingh Medical College Hospital and Medicine Outpatient Department of the Community Based Medical College Hospital, after obtaining requisite consent from the patients. Once the consultation by the physician was over, the patients were interviewed. Medication adherence was assessed through the specific four questions patient questionnaire, the modified morisky instrument that has high reliability and validity and the patient was considered to be highly adherent if he or she answered in the negative to all four questions (score-0).</p> <p><strong>Results: </strong>In a pool of 300 type 2 diabetics, more than half were female (n=223, 74.3%). The mean age of the patients were found to be 50.59 ± 12.57 years. Less than half (37%) of the patients were considered highly adherent, 44% patients were considered moderately adherent and 19% patients were considered poorly adherent to the prescribed anti-diabetic drugs.</p> <p><strong>Conclusion: </strong>The participants in the area of study were moderately adherent to their anti-diabetic medications. Measures should be taken to improve patient’s adherence to the prescribed treatment.</p> <p>Medicine Today 2019 Vol.31(1): 19-22</p> Kartick Chanda Shaha, Mohammed Asaduzzaman Khan, Farhana Akter, Bhagyoshree Karmokar Jyoti ##submission.copyrightStatement## Wed, 20 Feb 2019 00:00:00 +0000 Vaginal Delivery versus Elective Caesarean Section for Breech Presentation - Experience in Institute of Child and Mother Health (ICMH) <p><strong>Introduction: </strong>Compared with a fetus with cephalic presentation, a breech fetus faces increased risk during labour and delivery of asphyxia from cord compression and of traumatic injury during delivery of the shoulders and head. Caesarean section avoids most of this risk. The purpose of this study was to evaluate the feasibility of vaginal delivery of uncomplicated singleton breech presentation by evaluating early neonatal morbidity and mortality as well as maternal morbidity following vaginal and caesarean delivery for breech presentation.</p> <p><strong>Materials and Methods: </strong>This is a cross sectional comparative study.104 women with singleton breech presentation at term in labour were included consequetively in labour ward of Institute of Child and Mother Health (ICMH). Informed consent was taken from them. Neonatal and maternal outcome were recorded and statistical analysis was done using SPSS version 22.</p> <p><strong>Results: </strong>APGAR at 5 min and Neonatal Intensive Care Unite (NICU) admission were not affected by mode of delivery. Long term neonatal outcome is similar in either mode of delivery. Maternal morbidity and duration of hospital stay is increased in caesarean births.</p> <p><strong>Conclusion: </strong>Neonatal outcome did not depend on mode of delivery though maternal morbidity and cost of care is increased following Caesarean Section. Proper selection of cases and by improving skill &amp; confidence in new generation obstetrician, vaginal delivery of singleton fetuses in breech presentation at term remains a safe option that can be offered to a woman in a tertiary care centre.</p> <p>Medicine Today 2019 Vol.31(1): 23-26</p> Mahe Jabeen, Sabiha Shimul, Ummay Salma, - Jebunnesa ##submission.copyrightStatement## Wed, 20 Feb 2019 00:00:00 +0000 Demographic Characteristics of Diabetic Neuropathy Patients Attended at a Tertiary Care Hospital in Dhaka City <p><strong>Introduction: </strong>Diabetic neuropathy is one of the early complications of diabetes mellitus patients which is very difficult to face in the daily living activities. The purpose of the present study was to see the demographic characteristics of diabetic neuropathy patients.</p> <p><strong>Metarials &amp; Methods: </strong>This descriptive type of cross-sectional study was conducted in the Department of Neurology including Neuropathy Clinic and in collaboration with department of Endocrinology at Banghabandhu Sheikh Mujib Medical University, Dhaka from January 2012 to December 2013 for a period of two (2) years. Adult diabetic patients presented with neuropathic pain with symmetrical involvement of distal limbs from indoor and outpatient department of Neurology including Neuropathy clinic as well as indoor and outpatient department of Endocrinology, BSMMU were enrolled in the study population. Data was collected by face to face interview. Information was collected by taking medical history and clinical examinations and subsequent laboratory investigations.</p> <p><strong>Results: </strong>A total number of 102 cases were recruited for this study who were clinically diagnosed as painful diabetic polyneuropathy. Female was predominant than male 55(53.9%) cases and 47(46.1%) cases respectively. The male and female ratio was 1:1.2. Majority were in the age group of more than 55 years which was 55(53.9%) cases. The mean age with SD of the study population was 52.79±9.42 years. Among 102 patients type II DM was predominate than type I patients which were 95(92.2%) cases and 8(7.8%) cases respectively. The mean duration of DM with SD was 6.51±3.6 years. However the mean duration of neuropathic pain was 1.68±1.155 years.</p> <p><strong>Conclusion: </strong>In conclusion majority of the diabetic neuropathy patients are female suffering from type II DM in the middle age.</p> <p>Medicine Today 2019 Vol.31(1): 27-30</p> Mohammad Mashudur Rahman, Abu Nasir Rizvi, Mohammad Nazim Uddin, Rashida Akter Khanam, Muhammad Abdul Momen Khan, Shafia Khanam ##submission.copyrightStatement## Wed, 20 Feb 2019 00:00:00 +0000 Risk Factors Analysis for Abnormal Semen Characteristics in Sub-Fertile Male <p><strong>Introduction: </strong>This study aimed to identify the risk factors for abnormal semen parameters in male partner of sub-fertile couples.</p> <p><strong>Materials &amp; Methods: </strong>This was a prospective study of 100 diagnosed infertile &amp; sub-fertile couples in the age group between 23-58 yrs old male were from 1st March 2013 to 28th Feb 2014 treated in Dhaka Combined Military Hospital (CMH). On the basis of sperm count the cases were grouped as follows. normozoospermia, oligozoospermia &amp; azoospermia. Semen analysis was done in all the cases, The results were described with arithmetic mean and standard deviation. Male partners with normal semen parameters was undertaken among the sub-fertile couples attending the General Outpatient Department (GOPD) of CMH Dhaka. The history was taken from selected individual and it includes personal, socio-economics, occupational, medical, surgical history and drug intake to find out risk factors for abnormal semen parameters.</p> <p><strong>Results: </strong>In Normozoospermia mean and SD of sperm count, sperm abnormally, sperm motillity were 65.98±5.05, 24.44±1.57 and 45.5±2.94 respectively. In 0ligozoospermia the mean and SD of sperm count, sperm abnormality, sperm mtility were 7.74±1.23, 41.1±3.78, 14.54±2.77 respectively. In azoospermia the mean and SD of sperm count, sperm abnormality, sperm motility were absent.</p> <p><strong>Conclusion: </strong>Here data statistically showed person with normozoospermia having good sperm morphology &amp; motility than oligozoospermia and azoospermic subjects thereby causing male infertility which was responsible for hindrance in achieving pregnancy clinically. Using tight undergarment or working in hot atmosphere depresses spermatogenesis. Mumps orchitis permanently damage spermatogenesis. Bacterial or viral infection depresses the sperm count. Diabetes, malnutrition, heavy smoking reduces spermatogenesis. β-blocker, antihypertensive were likely to hinder spermatogenesis. The efferent ducts might be obstructed by infection like tubercular, gonococcal or by surgical trauma.</p> <p>Medicine Today 2019 Vol.31(1): 31-35</p> Afroza Akhter, Liza Chowdury, Mahbuba Akhter, Samira Haque ##submission.copyrightStatement## Wed, 20 Feb 2019 00:00:00 +0000 Plasma Fibrinogen and Fibrin Degradation Product (FDP) in Preeclampsia <p><strong>Introduction: </strong>Hypercoagulable state is seen in preeclampsia which acts as a risk factor for thromboembolism &amp; DIC. Altered coagulation indices (serum Fibrinogen &amp; FDP) have been reported in patients with preeclampsia and have been suggested as a sensitive marker for detection of bleeding complications. This study was carried out to compare the coagulation indices in preeclamptic women.</p> <p><strong>Materials &amp; Methods: </strong>This cross sectional study was conducted in the Department of Physiology, Dhaka Medical College (DMC), Dhaka from January to December 2014. Total 100 women aged 18 – 40 years were selected from the department of Obstetrics &amp; Gynaecology of DMCH, Dhaka for this study. Among them 50 were preeclamptic and age matched 50 healthy nonpregnant women were considered as control group. Fibrinogen &amp; Fibrin Degradation Product (FDP) were analyzed on automated coagulation analyzer.</p> <p><strong>Result: </strong>In this study, serum Fibrinogen &amp; FDP were significantly higher in preeclamptic than those of healthy women. Moreover, 100% &amp; 64% preeclamptic patient had raised serum Fibrinogen &amp; FDP respectively.</p> <p><strong>Conclusion: </strong>From this study it can be concluded that serum Fibrinogen &amp; FDP are directly related with preeclampsia.</p> <p>Medicine Today 2019 Vol.31(1): 36-38</p> Sharmin Sultana, Susmita Nargis, Heera Lal Roy, Qazi Shamima Akhter, Rukhsana Afroz ##submission.copyrightStatement## Wed, 20 Feb 2019 00:00:00 +0000 Volume Preload versus Ephedrine Infusion for Prevention of Hypotension Due to Spinal Anesthesia for Cesarean Section <p><strong>Introduction: </strong>Spinal anesthesia is used for 95% of planned cesarean sections in Bangladesh. It provides a fast and profound sensory and motor block. However, hypotension is a very common complication of spinal anesthesia during cesarean section, causing significant maternal and fetal morbidity and mortality. It could be associated with severe nausea, vomiting and even unconsciousness and pulmonary aspiration in the mother and for the baby hypoxia, acidosis and neurological injuries may result.</p> <p><strong>Materials and Methods: </strong>This prospective randomized comparative study was conducted in the Department of Anesthesiology at Institute of Child and Mother Health (ICMH) from July 2017 to December 2017, on 110 adult pregnant women who underwent caesarean delivery. All study patients were randomly allocated into two groups. Group I (F group) patients received volume preloading with 15 ml/kg Ringer lactate solution before induction of spinal anesthesia and group II (E group) patients received IV ephedrine (5 mg in 1st minute after spinal anesthesia, 5 mg in 2nd minute and thereafter 1 mg in every minute for 15 minutes).</p> <p><strong>Results: </strong>A statistically significant difference in the incidence of hypotension between group F (48%) and group E (24%) was found (p = 0.03). Regarding side effects, statistically significant (p = 0.23) incidence of nausea and vomiting was found in group F (20%) in comparison to group E (12%).</p> <p><strong>Conclusion: </strong>We conclude that prophylactic IV ephedrine infusion is more effective than fluid preload to prevent spinal anesthesia-induced hypotension during caesarean section without causing significant tachycardia or hypertension.</p> <p>Medicine Today 2019 Vol.31(1): 39-41</p> Md Ashraful Anam, Mohammad Mizanoor Rahman, Md Aminur Rahman, Syed Md Nurul Huda, Md Mostafijur Rahaman, Md Mohim Ibn Sina ##submission.copyrightStatement## Wed, 20 Feb 2019 00:00:00 +0000 Scar Endometriosis: Experience of a Surgeon <p><strong>Introduction: </strong>Cesarean section is a common obstetric surgery worldwide. As incision wound in such a surgery is exposed abundantly to endometrial tissue, incision scar endometriosis can occur. This study reports a surgeon’s experience in managing such an uncommon entity. The aim of this study was to identify risk factors for developing SCE and show the clinical spectrum of presentation. This study also shows our experience in surgical management of surgical scar endometriosis. Extra pelvic endometriosis is defined as the presence and growth of functional endometrial tissue outside the pelvis. Cesarean scar endometriosis (CSE) is a rare form of extra pelvic endometriosis that is usually confused with other surgical problems leading to delay in diagnosis.</p> <p><strong>Materials and Methods: </strong>We reviewed the case records of patients who were diagnosed as CSE in the surgery department of BIRDEM GENERAL HOSPITAL-2 from September 2013 till September 2018.</p> <p><strong>Results: </strong>We found 8 patients of scar endometriosis in 5 years making it one of the rare conditions. The age of the patients range 23–39 years and interval from symptoms to treatment varied from 16 months to 64 months. Five patients had presented to surgery department and 3 were referred from obstetric department. Cyclic pain and swelling in scar area were the most common presenting symptoms. All patients underwent excision of the mass with no recurrence of symptoms at a follow up ranging from 9 to 60 months.</p> <p><strong>Conclusion: </strong>Increasing awareness of this condition among doctors can help in early diagnosis and treatment with gratifying results. Precaution during obstetrical surgery to avoid undue contamination of the wound can reduce incidence of scar endometriosis.</p> <p>Medicine Today 2019 Vol.31(1): 42-45</p> Tamanna Narmeen, MM Masud Pervez ##submission.copyrightStatement## Wed, 20 Feb 2019 00:00:00 +0000 Transition from Millennium Development Goals (MDGs) to Sustainable Development Goals (SDGs): Blueprint of Bangladesh for Implementing the Sustainable Development Goals (SDGs) 2030 <p><strong>Introduction: </strong>The Sustainable Development Goals 2030, titled “Transforming Our World: The 2030 Agenda for Sustainable Development” with 17 goals and 169 targets (including 43 means of implementation) were adopted at the United Nations in September 2015. The Seventh Five Year Plan of Bangladesh (SFYP), “Accelerating Growth, Empowering Every Citizen” for the years 2016-2020, produced by General Economics Division, Planning Commission, can be regarded as the blue print for the early critical phase of Sustainable Development Goals (SDG) implementation.</p> <p><strong>Materials &amp; Methods: </strong>This Review Article was prepared based on updated International Newsletter, Journal and Data from Bangladesh Government Planning Commission.</p> <p><strong>Discussion: </strong>Challenges of Sustainable Development Goals (SDGs) and 7th Plan include resource mobilization, tapping population momentum, managing unplanned urbanization, natural disasters and climate change, utilization of resources, skill development and quality education, improving competitiveness, governance, taming inequality and regional disparity. Bangladesh prepared its own post-2015 Development Agenda and contributed to the international discourse through UN.</p> <p><strong>Conclusion: </strong>The General Economics Division (GED) of the Planning Commission, based on a consultative process initiated in 2013, goals and targets were developed in the context of Bangladesh. Through this process, 11 goals along with 58 targets with corresponding 241 measurable indicators were proposed. Civil society in Bangladesh also produced what is described as “a people-centred, equitable, inclusive, and sustainable Post-2015 Development Agenda.” It came up with 13 Goals,50 Targets and 199 Indicators.</p> <p>Medicine Today 2019 Vol.31(1): 46-59</p> Musfiqa Ashraf, Lokiat Ullah, Muqsuda Ashraf Shuvro, Umme Salma ##submission.copyrightStatement## Wed, 20 Feb 2019 00:00:00 +0000 Term Broad Ligament Pregnancy with a Healthy Newborn <p><strong>Introduction: </strong>Broad ligament pregnancy also known as inter ligamentous pregnancy is a rare type of ectopic pregnancy. It is one type of secondary abdominal pregnancy. Although ultrasonography is usually helpful in making the diagnosis but it is mostly established during laparotomy. Very few successful live births have been reported in this condition, where such pregnancies reached term and with live birth of a baby.</p> <p><strong>Case Report: </strong>A case of 30 year old 2nd gravida of 38 weeks gestation with lower abdominal pain for 20 hours was admitted into Sher-E-Bangla Medical College Hospital, Barishal; Bangladesh. She was suggested for caesarean section as the ultrasonogram revealed transverse lie with complete placenta praevia. Intraoperative diagnosis of right sided broad ligament pregnancy was made and an incision was given on the anterior leaf of the broad ligament and a male live fetus was extracted. Post operative period was uneventful. Both mother and baby were discharged on seventh postoperative day in good health condition.</p> <p><strong>Discussion: </strong>Broad ligament pregnancy usually results from rupture of tubal pregnancy through the tubal serosa and the mesosalpinx, with secondary implantation of trophoblast between the leaves of broad ligament. Incidence of broad ligament pregnancy is reported as 1 in 300 ectopic pregnancies. The prognosis is poor with the risk of dying from an abdominal pregnancy is 7.7 times higher than from other forms of ectopic pregnancy and often results from a delay in diagnosis. Trans-vaginal rather than transabdominal ultrasonography is superior in the evaluation of ectopic pregnancy. If there is no intrauterine pregnancy on ultrasonography and the ectopic sac is beside the lower part of the uterus a strong suspicion of broad ligament ectopic should be considered. Very rarely such pregnancy may reach up to term. Bleeding from placental implantation site is the most life-threatening complication during laparotomy.</p> <p><strong>Conclusion: </strong>Abdominal pregnancy with resultant healthy newborn is very rare. High level of suspicion, careful clinical and ultrasound examinations are the routine means of diagnosis. Bleeding is the single most important life-threatening complication for the mother. Early diagnosis and proper management are vital in order to decrease maternal morbidity.</p> <p>Medicine Today 2019 Vol.31(1): 60-63</p> Md Akbar Hossain, Farida Begum, Sultana Jahan, Israt Sharmin, Nazifatur Raihana ##submission.copyrightStatement## Wed, 20 Feb 2019 00:00:00 +0000