Medicine Today <p>A professional medical journal recognised by the Bangladesh Medical and Dental Council (BMDC).</p> en-US (Prof. N.A. Kamrul Ahsan FACS, MS) (Md Fahmid Uddin Khondoker) Mon, 10 Oct 2022 06:54:36 +0000 OJS 60 Average Working Length of Maxillary Central Incisor- A Single-Centre Study in Bangladesh <p><strong>Introduction: </strong>The permanent maxillary central incisor is the most visible tooth in the mouth and endodontic treatments are frequently performed in maxillary incisors. Over-instrumentation may cause periradicular inflammation, postoperative pain, and inhibition of the healing process. Working length (WL) determination and maintenance is therefore of major importance.</p> <p><strong>Materials and Methods: </strong>This prospective study was conducted in Dhaka Dental College &amp; Hospital, Dhaka from May 2013 to November 2013. A total of 39 cases were included in this study. For electronic method of WL determination iPex NSK (Japan) was used. The radiographic working length was determined by evaluating the position of the end of the file in the canal on the radiograph and it was 0.5 to 1.0 mm short of radiological apex.</p> <p><strong>Results: </strong>Pain (94.9%) and trauma (56.4%) were the most common history among the study population. In clinical findings, caries was the most common (56.4%) than swelling was present in 35.9% cases and discoloration was in 30.8% cases. In all cases we found single root of maxillary central incisors. Mean working length (WL) of our study population by apex locator was 21.423±1.259 and by radiograph it was 21.397±1.176; there was no statistically significant difference in WL between these two methods (p=0.743).</p> <p><strong>Conclusion: </strong>According to radiographic method working length of our study population was 21.39 mm. WL of our study population was found to be less than the values found by the other studies population like Caucasians, African, Sinhalese, Mongolian and Korean.</p> <p>Medicine Today 2022 Vol.34(2): 83-87</p> Abdullah Al Mahmud, Farhad Farzana, Md Atiqul Islam Rabby, Iffat Ara Ferdoushi Copyright (c) 2022 Medicine Today Mon, 10 Oct 2022 00:00:00 +0000 ST Segment Score on Initial Electrocardiogram (ECG) as a Predictor of In-Hospital Outcome of ST-Elevated Myocardial Infarction (STEMI) Patients <p><strong>Introduction: </strong>The process of myocardial infarction progresses over several hours and therefore most patients present when it is still possible to salvage myocardium. ECG is usually a sensitive and specific way of confirming diagnosis. ST segment score (STSS) in myocardial infarction is emphasized but not often quantified. HJ Wellens gave cutoff for STSS in anterior wall MI (AWMI)of 12 mm and inferior wall MI (IWMI)of 7 mm. In this study the predictive value of ST Segment Score (STSS) with patients of STEMI on admission ECG &amp; after thrombolysis had been assessed.</p> <p><strong>Objectives: </strong>Identify patients at higher risk early in the course of their hospital admission &amp; correlation of initial ECG and post thrombolysis ECG regarding clinical outcome.</p> <p><strong>Materials and Methods:</strong>Considering inclusion and exclusion criteria 112 patients admitted in CCU, DMCH during october 2007 to september 2008 were studied of which 64 were inferior STEMI and 48 were anterior STEMI. Like admission ECG, after 90 minutes of starting thrombolytic,another ECG was recorded and calculated. Echocardiography was done for each patient before discharge. Data was collected in a pre-designed form.</p> <p><strong>Results: </strong>The mean age of Group-I was 55.2±12.2 years and that of Group-II 56.9±14.1 years, Group-III 59.2±11.7 years,Group-IV 55.0±12.6 years. Of the 30 patients studied in Group-I 76.7% was male and 23.3% female. Smoking was the most prevalent (60% in Group I, 58.8% in Group II) risk factor. In post thrombolytic ECG shows that in Group-I mean sum of ST elevation decreased to 3.9 ± 1.1 mm from 4.8 ± 1.2 mm. which was approximately (45+14)% of ST resolution, in Group-II(50+19%),in Group-III (55+19)%, in Group-IV(45+23)%.</p> <p><strong>Conclusion: </strong>Significant differences were seen in chest pain, killip class,arrhythmia, echocardiographic LVEF, duration of hospital stay in patients with AWMI &amp; STSS above 12 mm and IWMI &amp; STSS above 7 mm in comparison with below these level even after use of thrombolytics.</p> <p>Medicine Today 2022 Vol.34(2): 88-92</p> Md Mahmudul Karim, HI Lutfur Rahman Khan, Md Faruk, Mohammad Addus Salam Copyright (c) 2022 Medicine Today Mon, 10 Oct 2022 00:00:00 +0000 Tibial Plateau Injury: Mechanical Implantation with Plates and MIPO Approach Tertiary Level Hospital in Bangladesh <p><strong>Introduction: </strong>Proximal tibial injuries are challenging to treat because of articular surface involvement, frequent congestion, and precariat soft tissue conditions, particularly after high-energy traumas. The treatment is intended to restore the unity of the joint surfaces that supports the typically depressed tibial plateau cartilage, use a strong device to stabilize the fracture and prevent further damage, to enable early recovery. We describe our treatment approach, using closed or open decrease and internal fixation, polyaxy plates, automatic bone-gloss, or other osteoconductive material enhanced by autologous platelet gel, where required. Surgery depends on the timing of the soft tissue and is typically done directly or under the guidance of a skilled surgeon using tissue-sparing techniques as much as feasible.</p> <p><strong>Materials and Methods: </strong>A prospective analysis of all (n=58) proximal tibial fractures at the Islamic Bank Medical College Hospital and multicentral tertiary level hospital, Rajshahi, Bangladesh, from January 2019 to June 2021. Patient data were collected by evaluating hospital diagrams, office records, preoperative and after operative radiograph. Fractures were classified in the classification of OTA/AO. In 78 % of the 12-month post-surgery group, the Rasmussen score's evaluation of functional outcomes found positive to outstanding results.</p> <p><strong>Results: </strong>Total Number of patient n=58 tibial proximal (intra-articular) fractures have been identified. The mean age was 43 years (range 19–79) at surgery, whereas women and 39 men were 19. The most frequent injury mechanism was linked to traffic accidents (RTA), representing 75% of cases. 09 (18.4%) AO/OTA types A, 31 (53.5%) AO/OTA type B and 18, (31.1%) AO/OTA type C fractures have been identified. Most (90 %) cases (44) were treated with open reduction and internal fixation, using polyaxially anatomical angular stability locking Plates.</p> <p><strong>Conclusions: </strong>Internal fixing using locking plates, following the MIPO principles (Minimally Invasive Percutaneous Osteosynthesis), offers an acceptable reduction of fractures with excellent outcomes for the medium-term clinical results.</p> <p>Medicine Today 2022 Vol.34(2): 93-98</p> Md Abdur Rashid, Sayed Ahmed, Reza Nasim Ahmed Copyright (c) 2022 Medicine Today Mon, 10 Oct 2022 00:00:00 +0000 Seroprotection of Hepatitis B in Children with Steroid Sensitive Nephrotic Syndrome <p><strong>Introduction: </strong>Children with Steroid sensitive nephrotic syndrome is associated with lower seroconversion of hepatitis B vaccine due to prolonged period of proteinuria, prolonged period of steroid therapy</p> <p><strong>Objective: </strong>The primary aims of this study was to assess the seroconversion rate in children with steroid sensitive nephrotic syndrome (SSNS) who were previously vaccinated against hepatitis B and to compare with the titre of vaccinated healthy children. The secondary aims was to study the association of antiHBs titre in different clinical types of diseases and comparison of persistant antibody titre after prolong post vaccinal duration in both nephritic syndrome and control group.</p> <p><strong>Materials and Methods: </strong>This cross sectional study was carried out in the department of Paediatric Nephrology, Bangabandhu Sheikh Mujib Medical University, Dhaka from July 2014 to June 2015. A total of 75 vaccinated Children against hepatitis B aged 1 to 12 years of both sex suffering from steroid sensitive nephrotic syndrome were included in this study. Seventy five healthy children against hepatitis B were taken to compare the immunogenecity of hepatitis B vaccine as comparison group.</p> <p><strong>Result: </strong>Out of seventy five children with steroid sensitive nephrotic syndrome (SSNS) 51(68%) were male and 24 (32%) were female. Most of the patients belonged to 2-4 year group (39.6%) and of them 42% had 1st attack. In comparison group most of the healthy children belonged to 2-4 year age group 22(28.2%). In nephrotic syndrome group, majority(57.3%) of the patients with nephrotic syndrome had antibody titre &lt;10 miU/ml( not seroprotected). On the contrary 78.7% healthy control were seroprotected (antibody titre &gt;10 miU/ml)and this difference was significant (p value =&lt;0.001). In nephrotic syndrome group significant titre was present in 2-4 years post vaccinal duration which also declined after 9-10 years post vaccinal duration group . In healthy control group significant titre was present in 2-4 years post vaccinal duration group which also declined gradually after increasing post vaccinal duration.</p> <p><strong>Conclusion: </strong>In nephrotic syndrome group significant titre was present in 2-4 years post vaccinal duration which also declined after 9-10 years post vaccinal duration group. In healthy control group significant titre was present in 2-4 years post vaccinal duration group which also declined gradually after increasing post vaccinal duration.</p> <p>Medicine Today 2022 Vol.34(2): 99-105</p> Md Ashraful Islam, Taslima Akter, Iftekhar Ul Hoque Khan Copyright (c) 2022 Medicine Today Mon, 10 Oct 2022 00:00:00 +0000 Role of Maternal & Fetal Factors in Relation to Low Birth Weight <p><strong>Introduction: </strong>Low birth weight (LBW) continues to remain a major public health problem worldwide. There are numerous factors contributing to LBW both maternal and fetal. The mortality of low birth weight can be reduced if the risk factors are detected early and managed by simple techniques.</p> <p><strong>Objective: </strong>To identify the maternal and fetal factors associated with low birth weight.</p> <p><strong>Materials and Methods: </strong>This case control study was conducted in Department of Pediatrics, Khulna Medical College&amp; Hospital from January 2019 to June 2019. After delivery of the baby weight of the newborn was measured with digital weighing scale. Mothers of babies with birth weight &lt;2500 gm were enrolled as cases and mothers of babies with birth weight _2500 gm were enrolled as controls.</p> <p><strong>Results: </strong>Total 96 mothers were enrolled in this study and 48 mothers in each group. All the information was recorded in a pretested questionnaire. Statistical analysis was done by SPSS. Primipara mother had 3.153 times more likely to deliver LBW baby. Patients having anemia had 3.316 times more likely to deliver LBW baby. Patients having hypertension had 4.120 times more likely to deliver LBW baby. Preterm delivery had 28.927 times more likely to deliver LBW baby. Primipara, anemia, hypertension and preterm delivery were significantly associated with LBW. In multivariate analysis, preterm had 20.619 times more likely to deliver LBW.</p> <p><strong>Conclusion: </strong>Primipara, anemia, hypertension and preterm delivery were significantly associated with LBW.</p> <p>Medicine Today 2022 Vol.34(2): 106-110</p> Tasnuva Islam, Abdullah Al Mahboob, Forrukh Ahammad Copyright (c) 2022 Medicine Today Mon, 10 Oct 2022 00:00:00 +0000 Comparison of Lipid Profile in Different Types of Steroid Sensitive Idiopathic Relapsing Nephrotic Syndrome in Children during Active Disease and Remission <p><strong>Introduction: </strong>Nephrotic syndrome is a disease of relapse and remission. Relapse rate is more than 80%. Hyperlipidemia and hypoalbuminemia are important characteristic of nephrotic syndrome. Hyperlipidemia persist even after remission of disease in frequent relapse nephrotic syndrome possibly due to frequent attack of disease and frequent use of steroid. Hyperlipidemia causes premature atherosclerosis, progressive renal injury leading to chronic renal failure, cardiac complications (myocardial infarction, hypertension), cerebrovascular disease and frequent relapse of nephrotic syndrome.</p> <p><strong>Objectives: </strong>The aim of study was to see the lipid profile and comparison of lipid profile among different types of steroid sensitive idiopathic relapsing nephrotic syndrome during active disease and in remission.</p> <p><strong>Materials and Methods: </strong>A cross sectional study included 120 ( 40 in each group) children aged 2-16 years with steroid sensitive idiopathic relapsing nephrotic syndrome patients who were admitted or attended in out patients department (OPD) in paediatric nephrology department Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, during December 2014 to December 2015. They were clinically examined and fasting lipid profile was done in each case during active disease and after one month of urinary remission. The study population were divided into three groups- Infrequent relapse nephrotic syndrome (IFRNS), frequent relapse nephrotic syndrome ( FRNS ) and steroid dependent nephrotic syndrome (SDNS) based on clinical response.</p> <p><strong>Results: </strong>Total patients were 120 (40 in each group). The study showed a male predominance with a male to female ratio 2.24:1, male patients were 69%, female 31%. In all cases, there were increased mean total cholesterol, low density lipoprotein ( LDL ) , triglyceride (TG) and high density lipoprotein (HDL) was normal during active disease, more raised in FRNS and SDNS.There was significant decrease in the mean level of total cholesterol, LDL and triglyceride during remission ( p &lt;0.001). Cholesterol became normal but triglyceride and LDL remained elevated even after one month of urinary remission in FRNS and SDNS.</p> <p><strong>Conclusion: </strong>Hyperlipidemia persist during remission of steroid sensitive relapsing nephrotic syndrome. Children with FRNS and SDNS should be addressed with lipid lowering medication, healthy foods and healthy life style. Multicenter prospective studies with larger sample are needed for validating the findings of the present study.</p> <p>Medicine Today 2022 Vol.34(2): 111-116</p> SM Shamsul Hoque, Md Ashraful Islam, Taslima Akter, Ranjit Ranjan Roy, Md Habibur Rahman Copyright (c) 2022 Medicine Today Mon, 10 Oct 2022 00:00:00 +0000 Combination of Thyroxine with Vitamin B12 on Motor Nerve Conduction Study of Ulanr Nerve in Newly Diagnosed Hypothyroid Female <p><strong>Introduction: </strong>Combination of thyroxine with vitamin B12 can improve the motor nerve conduction study of ulnar nerve in newly diagnosed hypothyroid female.</p> <p><strong>Objectives: </strong>To observe the combined effects of thyroxine with vitamin B12 on motor nerve conduction study of ulnar nerve of newly diagnosed hypothyroid female</p> <p><strong>Materials and Methods: </strong>This prospective interventional study was carried out in the Department of Physiology, Sir Salimullah Medical College (SSMC) between July’ 2015 to June’ 2016 on 40 newly diagnosed hypothyroid female. Among them, 20 hypothyroid patients received only thyroxine (HT-T4 ) and another 20 hypothyroid patients received combined therapy of thyroxine with vitamin B12 (HT-C) for 90 consecutive days. Motor 2 nerve conduction study of ulnar nerve was studied to observe the electrophysiological status and vitamin B12 level was also estimated to observe its level by using standard method. The statistical analysis was done by ANOVA test, paired, independent sample ‘t’ test and Chi-square (χ 2 ) test as applicable.</p> <p><strong>Results: </strong>In this study, latency was significantly decreased, amplitude and NCV were significantly increased in motor functions of ulnar nerve of hypothyroid patients after 90 days supplementation of combined therapy of thyroxine with vitamin B12 in comparison to those of their pre-supplemented state and also to those of patients with only thyroxine treatment.</p> <p><strong>Conclusion: </strong>The combination of thyroxine with vitamin B12 can reduce the symptoms of hypothyroid neuropathy and accelerate the nerve conduction velocity of motor functions of ulnar nerve more efficiently than the treatment with thyroxine alone.</p> <p>Medicine Today 2022 Vol.34(2): 117-120</p> Farjana Ahmed, Nayma Sultana, Md Arifuzzaman Chowdhury, Shyamal Chandra Banik, Kartik Chandra Saha, Mahaboba Rahman Copyright (c) 2022 Medicine Today Mon, 10 Oct 2022 00:00:00 +0000 Evaluation of Extra-Cranial Carotid Arteries by Digital Subtraction Angiogram (DSA) in Stroke Patients in a Tertiary Care Hospital <p><strong>Introduction: </strong>Carotid artery stenosis is one of the important causes of ischemic stroke. This may be diagnosed by Doppler Ultrasound and Digital Subtraction Angiogram (DSA) both of which have some advantages and disadvantages.</p> <p><strong>Objective: </strong>The aim of this study was to assess extra-cranial carotid artery with the help of DSA among patients of ischemic stroke and transient ischemic attack (TIA).</p> <p><strong>Materials and Methods: </strong>This observational cross sectional study was conducted in the Department of Neurology in Bangabandhu Sheikh Mujib Medical University (BSMMU) Dhaka from July 2013 to June 2015 for a period of two years. This study included a total of 50 patients. Diagnostic performance test of DSA was done at 50%, 50-69%, 70-99%, 100% cut off point of stenosis of right internal carotid artery (RICA) and Left internal carotid artery (LICA).</p> <p><strong>Results: </strong>The mean age of cases was 61 ± 11.42 years. Out of 50 vessels, maximum cases were diagnosed as &lt;50% stenosis of carotid artery (26 cases of RICA, 23 cases of LICA. Out of 50 vessels, 50%-69%, 70 but _ less than near occlusion and total occlusion were found among 10, 10, 4 vessels in RICA and 10, 9, 8 vessels in LICA respectively. The present study showed that 50 vessels of RICA was measured by DSA and diagnosed 28 (56%), 10 (20%), 7 (14%) and 5 (10%) carotid vessels as _ 50%, 50-69%, _70% but less than total occluded and total occluded cases respectively. This study also showed that 50 vessels of LICA was measured by DSA and diagnosed 23 (56%), 12 (24%), 8 (16%), 7 (14%) carotid vessels as _ 50%, 50-69%, _ 70% but less than total occluded and total occluded cases respectively<strong>.</strong></p> <p><strong>Conclusion: </strong>DSA as the gold standard has amply been performed in most diagnostic circumstances of carotid artery stenosis. So, the present study was done to evaluate extra cranial carotid arterial system by DSA in stroke patients in Bangladesh.</p> <p>Medicine Today 2022 Vol.34(2): 121-124</p> Reza Nasim Ahmed, Most Mahmuda Begum, Md Abdur Rashid, Md Shafiul Azam, Mst Fatematujjahura, Md Raseul Kabir Copyright (c) 2022 Medicine Today Mon, 10 Oct 2022 00:00:00 +0000 Impact of Platelet Count on Non-ST Elevation Myocardial Infarction: In-Hospital Outcome <p><strong>Introduction: </strong>Incidence of ACS is increasing in developing countries like Bangladesh. Many factors can influence in hospital outcome of NSTEMI Patient. Platelet count is one of them. The aim of present study was by measuring platelet count to detect the severity of NSTEMI patients and their in hospital outcome.</p> <p><strong>Objective: </strong>The aim of present study was to observe the impact of platelet counts on in hospital outcome of NSTEMI.</p> <p><strong>Materials and Methods: </strong>The study was conducted in Shahid Sheikh Abu Naser Specialized Hospital, Khulna from January 2021 to November-2021. NSTEMI Patient Presented within 24 hours of chest pain was included in this study. Data were collected by direct interview from Patient and venous blood was drawn for platelet count. Continuous data were expressed as mean ±SD. Categorical data were analyzed with x2 test. Student’s ‘t’ test was used for analysis of Continuous variables. Comparision between groups was done by unpaired t-test. Multiple logistic regression analysis was done to determine the association between lower platelet counts and adverse hospital events in NSTEMI patients. P-values &lt;0.05 were be considered statistically significant.</p> <p><strong>Results: </strong>100 Patients are included in this study. They are devided into two groups. Group-1 having platelet count &lt;200000/cmm) and Group-II having platelet count &gt; 200000/cmm. Bleeding, Q-wave MI, arrythmia and heart failure were significantly (P&lt;0.05) higher in group-I but stroke and death were similar in both groups.</p> <p><strong>Conclusion: </strong>Lower platelet count in NSTEMI patient is associated with adverse in-hospital outcome.</p> <p>Medicine Today 2022 Vol.34(2): 125-129</p> Md Zahidur Rahman, Sudipto Saha, Md Ikhtiar Hassan Khan, Swadesh Kumkar Chakrovortty, SK Abdullah Al Mamun Copyright (c) 2022 Medicine Today Mon, 10 Oct 2022 00:00:00 +0000 Comparative Study of Radiation Exposure of Patients undergoing Transradial and Transfemoral Coronary Angiogram and Percutaneous Coronary Intervention <p><strong>Introduction: </strong>Coronary artery disease (CAD) is now the leading cause of death worldwide. Percutaneous coronary interventions (PCIs) are an important group of technologies for the diagnosis and treatment of patients with CAD. PCI is usually performed using the transfemoral (TF) approach but the transradial (TR) approach has been increasingly used as an alternative to TF approach due to less vascular complications, earlier ambulation and improved patient comfort. Accurate assessment of radiation exposure during PCI is paramount important as radiation has many short and long term hazards. TR and TF route has distinct advantages and disadvantages. But in respect of radiation exposure of patients there are controversial evidence between TR and TF approach.</p> <p><strong>Objective: </strong>To compare the radiation Exposure in patients with percutaneous coronary intervention by TR and TF approach.</p> <p><strong>Materials and Methods: </strong>This prospective observational comparative study was conducted in the National Institute of Cardiovascular Diseases, Dhaka, from June 2015 to May 2016. A total of 200 patients were selected and categorized into two groups (Group I= Trans radial, n =100) and (Group II = Trans femoral, n= 100). Again divided into subgroups (group Ia, trans radial CAG = 70, group IIa, trans radial PCI =30) and (group IIa, trans femoral CAG =70, group IIb, trans femoral PCI = 30). Then different outcome variables were evaluated and compared.</p> <p><strong>Results: </strong>Patient demographics were the same in both groups. Fluoroscopy time during TR and TFCAG and PCI was (4.4.±1.6 min vs 4.1±3.9 min, p=0.61) and (11.7±1.3 min vs 11.1±1.5 min, p=0.13) respectively. Regarding radiation dose during TR and TF coronary angiogram, Dose area product(DAP) were (2732±1195.5 mGym2vs 2434±488.0 mGym2, p=0.07&amp;) and Air Kerma (AK) were (307.6 ±112.2 mGy vs 283.7±48.5 mGy, p=.10) with statistically no significant difference of radiation dose (DAP and AK) between two groups. Utilization of Contrast volume during TR and TF angiogram (64.8±8.9 vs 68.2±7.5, p=0.01) were less in trans radial group. Also Utilization of Contrast volume in TR-PCI and TF- PCI (168.0±13.0 vs 177.7±19.9 ml ,p=0.03) were less in trans radial PCI.</p> <p><strong>Conclusion: </strong>The basis of the results, no significant differences were found in patient of radiation dose in both TR and TF group. Furthermore utilization of contrast volume was lower in trans-radial CAG and PCI. Trans radial CAG and PCI can be performed with the same safety as for the trans femoral approach.</p> <p>Medicine Today 2022 Vol.34(2): 130-135</p> Forhad Karim Mazumder, Khaled Mahmood, Abul Hasnat Md Jafar, Enamul Hoq, Rubaba Sharmin Copyright (c) 2022 Medicine Today Mon, 10 Oct 2022 00:00:00 +0000 Spectrum of Upper Gastrointestinal Endoscopic Findings in Patients with Dysphagia: A Study of 147 Cases <p><strong>Introduction: </strong>This retrospective descriptive cross-sectional study was done to see upper gastrointestinal endoscopic findings in patients presenting with dysphagia.</p> <p><strong>Materials and Methods: </strong>Reports of patients undergoing upper gastrointestinal endoscopy were retrieved from endoscopy records. Data regarding age, gender, and endoscopic features and impressions were collected. The data analysis was done using IBM SPSS® v21 (IBM, Armonk, New York). Frequency, proportions, mean ± SD, and range were calculated.</p> <p><strong>Results: </strong>Out of 147 participants, the mean age of the participants was 53.46 ± 15.99 years. There was an equal proportion of participants of each gender (50.3% female and 49.6% male). The prevalence of endoscopic abnormalities was 93.8%. Most of the participants had carcinoma esophagus (38.7%, 57) followed by gastritis (35.3%, 52), gastric polyp (10.8%, 16), and duodenitis (8.8%, 13).</p> <p><strong>Conclusion: </strong>Dysphagia is an alarming symptom that warrants prompt evaluation. With diagnostic and therapeutic value, upper GI (gastrointestinal) endoscopy remains a rapid initial effective tool in the evaluation of patients with dysphagia.</p> <p>Medicine Today 2022 Vol.34(2): 136-139</p> Ramesh Lamichhane, Madhusudan Saha, Gopal Kumar Yadav Copyright (c) 2022 Medicine Today Mon, 10 Oct 2022 00:00:00 +0000 Effect of Activity (ADL) Modification on Reduction of Pain in Patients with Chronic Non-Specific Low Back Pain <p><strong>Introduction &amp; Objective: </strong>: Low back pain is the commonest cause of activity limitations and absence of work in developing country like Bangladesh. The aim of this study was to chalk out the association between ADL modification with chronic low back pain.</p> <p><strong>Materials &amp; Methods: </strong>: This Randomized Clinical Trial was performed in the Department of Physical Medicine and Rehabilitation, JRRMCH, Sylhet. Eighty patients of 30 to 60 years old, fulfilling the selection criteria were included in this study. Patients were divided into two groups after randomization by lottery method. Patients of Group-A were treated with NSAID, Anti-ulcerant &amp; Activity (ADL) Modification while patients of Group-B were treated with NSAID and Anti-ulcerant only. Patients of both groups were treated for six weeks. Main outcome measures were Subjective Pain Intensity Score, VAS, Tenderness Index, Disability due to pain, Spinal Mobility Index and Oswestry Disability Index.</p> <p><strong>Results: </strong>Majority of the patients of both groups were 30 to 40 years old (52.5% in Group-A and 47.5% in Group-B). Males were predominant in both groups. While majority belongs to middle socio-economic class, occupationally farmers were majority in both groups (22.5% in Group-A and 20% in Group-B). VAS was better in patients who received instructions about activity (ADL) modification than those who did not receive them. Subjective Pain Intensity Score and Tenderness Index improved in both groups but their difference was not statistically significant. Disability due to Pain and Spinal Mobility Index, both the variables improved at the end of 3rd week and their difference was statistically significant (P&lt;0.05).</p> <p><strong>Conclusion: </strong>From the study it can be concluded that Activity (ADL) Modification helps to reduce pain in patients with chronic non-specific low back pain.</p> <p>Medicine Today 2022 Vol.34(2): 140-144</p> Khandaker Md Kamrul Islam, Md Ahsanul Hoque, Mahamuda Akter Copyright (c) 2022 Medicine Today Mon, 10 Oct 2022 00:00:00 +0000 Demographic Study of Dermatological Manifestations of DM Patients Attending in a Medical College Hospital <p><strong>Introduction: </strong>Diabetes mellitus (DM) is a common metabolic disorder and is significant for its ability to adverse effect of various organs. Skin manifestations in this condition are due to metabolic derangements, chronic complications and infections, which are commonly observed after developing clinical diabetes mellitus, but may also precede the disease.</p> <p><strong>Aim: </strong>The aim of this study was to understand dermatological manifestations in diabetes mellitus relation with demographic parameters.</p> <p><strong>Materials and Methods: </strong>It was a hospital based cross sectional study carried out among 80 randomly selected diabetic patients with/without skin lesions. Patients were then asked for their willingness to participate in the study. Skin examination was carried out and skin lesions were identified. All data was recorded in the pre-designed, pre-tested, and semi-structured questionnaire developed for the study. Data was analyzed using SPSS version 26. Frequencies and percentages were calculated for the necessary data.</p> <p><strong>Result: </strong>: Mean age of the subjects was 51.0±13.2 years, minimum age 25 and maximum 80 years. It was observed that, out of 80 patients, 52 (65.0%) were aged between 41–60 years. 52 (65%) were female and 28(35%) were male patients. 46(57.5%) were housewives and 16(20.0%) were service holders, 10(12.5%) were farmers and other 8(10%). 41(51.2%) from middle class, 38(47.5%) from lower class and 1(1.3%) were from upper class. 61.2% patients came from rural area and 38.8% patients from urban area. The mean duration of diabetes mellitus was 6.6±5.1 years, 42.5% patients duration had 5-10 years followed by 36.3% below 5 years and 21.3% patients had DM more than 10 years. Out of 80 patients, a total of 39(48.8%) DM patients had skin manifestations and 41(51.2%) had no skin manifestations. Among 39 DM patients with skin disease, 19(48.7%) having a single, while 8(25.5%) had two and 13(30.8%) patients had three or more skin lesions. 22(56.4%) patients found diabetic dermopathy, diabetic foot ulcer 12(30.8%), fungal infections 9(23.1%), bullous lesions 7(17.9%), diabetic foot gangrene 5(12.8%), lypodystrophy 5(12.8%), pruritus 5(12.8%), xerosis 5(12.8%) cases, scleredema 3(7.7%), ichthyosis 2(5.1%) and bacterial infections 2(5.1%). Age, sex, educational level, socioeconomic status, residence found no significant association (p&gt;0.05), but duration of diabetes mellitus was significantly associated with the presence of dermatological manifestations (p=0.001).</p> <p><strong>Conclusion: </strong>The spectrum of skin manifestations due to DM in this study population is similar to that in other parts of the world. Diabetic dermopathy, Pruritus and fungal infections are the most common cutaneous manifestations in DM patients. The presence of skin manifestations can highlighten the suspicion for DM enabling early diagnosis and management and thereby can be helpful for preventing complications.</p> <p>Medicine Today 2022 Vol.34(2): 145-149</p> Sk Mamun Ar Rashid, Ratan Lal Dutta Banik, Sharup Chandra Poddar Copyright (c) 2022 Medicine Today Mon, 10 Oct 2022 00:00:00 +0000 Study of Changes in Serum Calcium Level during Postmenopausal Period of Women in Bangladesh <p><strong>Introduction</strong>: The study was designed to evaluate the serum calcium levels may be altered in postmenopausal women.</p> <p><strong>Materials and Methods: </strong>This case control study was carried out in the Department of the Biochemistry, Mymensingh Medical College, Mymensingh, from January 2015 to December 2015. The subjects were selected on the basis of inclusion and exclusion criteria by purposive (non-random) method. This study included 50 postmenopausal women as case.</p> <p><strong>Results: </strong>The results were compared with 50 apparently healthy premenopausal women as control. All statistical analysis was done by SPSS windows package. The values were expressed as Mean ± SD. Statistical significance of difference between two groups were evaluated by using student’s unpaired t-test. Serum calcium level was analyzed. Serum calcium was determined by using colorimetric method. The mean value of serum calcium was 8.59±1.02 (mg/dl) respectively in group B (Case) and 6.36 ± 1.06 (mg/dl ) in group A(Control). The levels of serum calcium was significantly decreased in group B.</p> <p><strong>Conclusion: </strong>Menopause has an effect on serum calcium which leads to increased risk of development of osteoporosis. The present study may facilitated the clinicians and gynecologists to update their knowledge in regard to serum calcium level of women associated with menopause.</p> <p>Medicine Today 2022 Vol.34(2): 150-152</p> Susmita Nargis, Rasel Bhuyan, Heera Lal Roy, Kazi Muhammad Mahmudul Hasan, Pijush Kumar Chakraborty Copyright (c) 2022 Medicine Today Mon, 10 Oct 2022 00:00:00 +0000 Determinants of Male Infertility among Married Couples in a Tertiary Hospital in Bangladesh <p><strong>Introduction: </strong>Infertility may be defined as a lack of conception after 1 – 2 years of unprotected coitus. In a normal population approximately 60 % of couples will achieve pregnancy within 6 months, 80 % by 12 months, and 90 % by 18 months leaving approximately 10 % of couples arbitrarily classified as infertile. A general classification of causes of infertility are male 35 – 40 %, female 40 – 50 %, sexual 10 % and unknown 10 %.</p> <p><strong>Objective: </strong>To see the determinants of male infertility among the infertile couples who attending the outpatient department of infertility unit of the department of obstetrics and gynaecology of Bangabandhu Shiekh Mujib Medical University, Shahbag, Dhaka.</p> <p><strong>Materials and Methods: </strong>This prospective observational study was conducted in the Infertility unit, Department of Obstetrics and Gynaecology, Bangabandhu Shiekh Mujib Medical University (BSMMU), Dhaka, during the period from 31.10.2016 to 21.03.2018. 500 infertile male patients were recruited from the out-patient department of infertility unit who came to take treatment for their infertility problem. They were analyzed by data collection sheet and the results were plotted in the table.</p> <p><strong>Result: </strong>The socio-demographic characteristics of the study subjects (n = 500).Husbands age group was 22 -55in years, Mean ± SD (34.0 ± 5.9). Educational level of male partners was, no education = 5 (1.0%), primary = 27 (5.4%), secondary = 152 (30.4%), graduate = 148 (29.6%), postgraduate = 74 (14.8%), 0thers = 94 (18.8%). Occupation of male partners was, unemployed = 6 (1.2%), service = 356 (71.2%), business = 138 (27.6%). Diabetes: In male = 28 (5.6%).Mumps: In male = 7 (1.4%). Chicken pox: In male = 18 (3.6%). Hypertension: In male = 10 (2.0%). Orchitis: In male = 6 (1.2%). Personal history of husband: Smoking = 129 (25.8%). In male patients, Testosterone level normal (10 – 30 nmol/L) in 133 (26.6%) patients and above normal (&gt;30 nmol/L) in 367 (73.4%) patients. The semen analysis of the husbands of the infertile female patients.In quality of semen poor (&lt;4%) in 305 (61%) patients. Regarding semen quality, oligospermia (&lt;15 million/ml) was in 480 (96%) patients and azospermia (0% count) in 20 (4%) patients. In case of motility of sperms, rapid linear below normal (&lt;50%) was in 90 (18%). In case of slow linear (SL), below normal (&lt;15%) in 324 (64.8%) patients. In case of morphology of sperms, below normal (&lt;14million/ml) in 25 (5%) patients.</p> <p><strong>Conclusion: </strong>This study shows a significant percentage of male are suffering from infertility. There is considerable association of determinants of infertility among the male partners.</p> <p>Medicine Today 2022 Vol.34(2): 153-156</p> Shaheen Ara Anwary, Md Alfazzaman, Zeenat Mahzabin Copyright (c) 2022 Medicine Today Mon, 10 Oct 2022 00:00:00 +0000 Management of Uncommon Presentation of Choronic Osteomyelities of Humerus Using Ilizarov Technique in a 2 Years Old Child: A Case Report <p><strong>Introduction</strong>: Chronic osteomyelitis is a surgical disease that can require significant dedication from both patient and surgeon to eradicate. Treatment requires isolation of pathogen, significant debridement for removal of all infective and necrotic material, then bony and soft tissue reconstruction.</p> <p><strong>Objective: </strong>We shall try to highlight the option of management of a pan-Diaphyseal osteomyelitis of a children in the new era of osteosynthesis by Ilizarov.</p> <p><strong>Discussion: </strong>A two years old baby presented to us with the H/O chronic discharging sinus and arm sling for around 3 months. After clinical history taking and examination, radiography and pus testing (C/S) and sequestrum and pathological fracture was the identifying points we took the plan for exploration curettage and drainage. Finally we fix the arm by Ilizarov osteosynthesis for more than 3 months. The wound healed and osteomyelitis resolved.</p> <p><strong>Conclusion: </strong>Use of Ilizarov osteosynthesis for fixation and wire tension effect to resolve the infection1,2</p> <p>Medicine Today 2022 Vol.34(2): 157-158 </p> Chowdhury Foyzur Rob, Md Gulam Mustofa, SM Shahnewaj, Md Akhlas Bhuiyan, Tanvir Ahmed, Sahel Ahmed, Habibur Rahman Copyright (c) 2022 Medicine Today Mon, 10 Oct 2022 00:00:00 +0000