Northern International Medical College Journal

Postoperative Outcome of Laparoscopic Appendicectomy- A Study of 100 Cases

Md Shoeb Ur Rashid — 2022-09-13

Background : An elegant, reliable procedure that can be easily performed is laparoscopic appendicectomy (LA). In patients with undiagnosed abdominal pain requiring more diagnostic investigations, as well as in patients with perforated appendicitis with or without intra-abdominal abscess, this procedure remain useful and safe.

Objective : To evaluate the postoperative outcome and complication in laparoscopic appendicectomy.

Methods : This prospective observational study was conducted at Rezia Taleb Hospital, Dhaka in Bangladesh. Total 100 cases were included in this study during the period of January 2018 to December 2019. Total 100 admitted uncomplicated acute appendicitis patients who underwent LA were enrolled in this study. Diagnosis is based on patient history (symptoms) and physical examination with an elevation of neutrophilic leukocytosis and raised CRP. In this study inclusion criteria of the cases were- Age <40 years, Alvarado Score 7 or more, Uncomplicated appendicitis, patients who underwent LA for appendicitis, both sexes. Exclusion criteria were - Incidental LA, patients with significant co-morbid medical conditions, patient unwilling to incorporate with the protocol, patients with psychiatric illness, and who lost to follow-up.

Results : Out of 100 patients, most of them 63(63%) were in age group <20 years. The mean age was 21.70±6.21 years. Majority 77(77%) were male and 23(23%) were female and male: female ratio was 3.3:1. Among the 100 respondents, majority 95(95%) presented with migratory right iliac fossa pain and 5 (5%) had early postoperative complication. Majority 95(95%) patient’s pain control occurred within1-2 days with NSAID. Out of 95 Uncomplicated patients; Length of Hospital stay was 1-2 days in 90(94.7%) and 3-4 days in 5(5.3%) cases.

Conclusion : This study showed that laparoscopic appendicectomy had found to be associated with shorter hospital stay, decreased postoperative pain and wound infection.

Northern International Medical College Journal Vol. 12 No.1 July 2020, Page 486-488

A Clinical Study on Maternal and Perinatal Outcome of Oligohydramnios

Aparna Das — 2022-09-13

Background : Oligohydramnios is one of the pregnancy associated common complications facing by obstetrician which is associated with adverse maternal and perinatal outcome such as birth defects, miscarriage, intrauterine growth restriction, still birth, preterm birth, increased operative interference etc.

Objective: To assess the impact of oligohydramnios on maternal and perinatal outcome.

Methods: This cross-sectional descriptive study was conducted at Department of Obstetrics and Gynecology, BSMMU, Dhaka from October 2017 to March 2018.Total 50 patients were enrolled by purposive sampling method according to the inclusion and exclusion criteria. Clinical evidence of oligohydramnios was looked for & confirmed by ultrasonography (USG). Based on Amniotic fluid index (AFI)measurements patients were divided into two groups. Those who have AFI <5cm and 5-8cm. The significance of difference or comparison of means was measured by Chi square test. Maternal and perinatal outcome in pregnancies with oligohydramnios were compared with those with 5-8cm amniotic fluid volume.

Results: The mean age of the study population was 23.3±4.06 years and majority of the cases were multipara (56%) and presented at term (58%). Borderline oligohydramnios (AFI 5-8cm) was found in 74% cases and severe oligohydramnios (AFI <5cm) were found in 26% cases. Most common etiological factor was idiopathic. Fifteen cases (30%) had vaginal delivery and caesarean section rate 70%, no maternal mortality occurred in this study, perinatal mortality rate was 10%, low birth weight baby was 63.6% and NICU admission rate was 53.8%.

Conclusion: An antepartum or intrapartum oligohydramnios is associated with significantly increased incidence of caesarean section for fetal distress and increased incidence of low-birth-weight babies and increased rate of neonatal complications.

Northern International Medical College Journal Vol. 12 No.1 July 2020, Page 489-492

Comparison of Buccal Midazolam with Rectal Diazepam in the treatment of prolonged seizures in children

Khandaker Tarequl Islam — 2022-09-13

Background : Seizure is common neurological disorder in children. It is one of the common causes of referral of child to hospital and often requires emergency intervention. Rectal diazepam is the established first line drug for this purpose, but seizure recurrence and respiratory depression are the two major side effects. Midazolam is a water-soluble benzodiazepine with anticonvulsive activity at physiologic PH, which facilitates its effects on brain tissue. Midazolam is also easy to use, and no adverse events were reported in relation to the route of administration.

Objectives : To compare the efficacy and safety of buccal midazolam with rectal diazepam in the treatment of prolonged seizures in children.

Methodology : This prospective randomized study was conducted in the Department of pediatrics, Sir Salimullah Medical College (SSMC) and Mitford Hospital, from March 2018 to December 2018.Fifty (50) patients aged 3 months to12 months who were convulsing and experiencing prolonged seizure (lasted >5 minutes) were included. Patients was randomly assigned to one of the two treatment arms: rectal diazepam and buccal midazolam. Primary and secondary outcome was compared between 2 treatment arms. Primary outcome was: 1. cessation of visible seizure activity within 10 minutes. 2. without recurrence of seizure in the subsequent hour. Secondary outcome included: 1. proportion with cessation of convulsion and exact time needed for cessation of convulsion within 10 minutes2. proportion of seizure recurrence in the sub sequent hours and within 24 hours after initial control and exact time of recurrence within the respective period. Also the safety and adverse effects were also compared.

Results : The two groups did not differ significantly in sex, age, type of seizures, temperature, and baseline RBS, respiratory rate and blood pressure. Comparing the 2-treatment group, 13 (52%) patient experienced treatment failure who received rectal diazepam compared with 7 (28%) who received buccal midazolam (P>0 .05). For initial cessation of seizures, 18 (72%) seizures terminated within 10 minutes in the diazepam group compared with 19 (76%) in the midazolam and mean time to cessation of the seizure was 4.02±1.03 minutes and 4.4 ± 1.09 minutes respectively (p>0.05). Among the 18 children in whom seizure was initially controlled within 10 minutes by rectal diazepam, 6 (33.33%) of them experienced a seizure recurrence in the subsequent hour compared with 1 (5.26%) of 19 children in the buccal midazolam group (P<0 .05). children who experienced a seizure recurrence within 1 hour after initial control, the mean time torecurrence was 20.0±5.0 vs 25±0.0 minutes in diazepam group and midazolam group respectively (P =0.478). Seizure recurrence after initial control during the 24 hours after treatment was 5 (41.36%)vs 6 (33.33%).The mean time to recurrence within 24 hours was114.00±39.11.53 vs 320.83±173.10 minutes which was highly significant (P<0 .05)

Conclusion : Buccal midazolam was as safe as and more effective with an improved efficacy over 1 hour (P<0

Northern International Medical College Journal Vol. 12 No.1 July 2020, Page 493-498

Clinical profile and outcome of dengue fever in children: In a tertiary care hospital

Farzana Rahman Chowdhury — 2022-09-13

Background : Dengue is the most important arthropod transmitted human viral disease and constitutes an important worldwide health problem including Bangladesh. Although children are the usual victim of dengue infection, there is paucity of published data regarding its clinical profile and outcome in children in our country.

Objective: Now, in case of children Dengue fever is a common cause of acute febrile illness in our country, but the magnitude of it is quite unknown. Therefore, this study aims to find out the common clinical manifestations, the early warning signs and the outcome of dengue fever in different age group of children.

Materials and Methods: The present study was conducted in the Popular Medical College Hospital, Dhanmondi, Dhaka (a tertiary care private hospital) between July to September of 2019 on children of dengue fever from 1year up to 15 years of age. It is a retrospective observational study.

Results: A total of 58 cases were enrolled. The common clinical presentations included fever (100%), arthralgia (81.9%), cough/ coryza (17.2%), headache/retro orbital pain (3.4%), and rash (10.3%). The common early warning signs at the time of admission were persistent vomiting (41.4%), severe abdominal pain (27.6%), Hepatomegaly (6.9%). Regarding clinical course, in Dengue fever (DF), Dengue Hemorrhagic fever (DHF) and Dengue Shock Syndrome (DSS) total 36 (62%), 14 (24.2%), 8 (13.8%) children are affected respectively.

Conclusion: The clinical manifestations of dengue fever are like other viral infections, but the disease severity is more in dengue. Thus, if we able to find out the more common clinical findings of dengue fever, it would help us in early diagnosis and early initiation of appropriate treatment. In this study we found that the most common clinical symptom was fever, found in 100% cases, arthralgia in 81.9%, cough/ coryza in 17.2%, headache / retro orbital pain in 10.3% and rash in 3.4% cases. Among the 58 cases 36 (62%) were diagnosed as DF, 14 (24.2%) as DHF and 8 (13.8%) as DSS and no death was occurred.

Northern International Medical College Journal Vol. 12 No.1 July 2020, Page 499-502

Anthropometric study of facial indices among Bangladeshi women

Nazma Farhat — 2022-09-13

Background: Craniofacial anthropometric values and indices are vital for experts from different walks of science. Variations in such values are evident in racial and geographical attribute. Furthermore, anthropological classification would assist clinicians in planning regional surgeries, forensic identification and many more.

Objective: In this study we aimed to measure the head-face landmarks in a particular population and to correlate their association.

Methodology: To assess intra population variation, the fronto-occipital circumference, facial height, bizygomatic breadth, bitragion breadth, bigonial breadth, width of mouth, intercanthal width, biocular breadth and body height of 100 Bangladeshi women (age 25-45 years) were measured and craniofacial indices were calculated. Frequencies were observed while comparing the variables by ANOVA using SPSS version 17.

Result: The mean values of facial indices revealed as prosopic index 103.8 ± 12cm, zygomandibular index 81.1 ± 7.44cm, canthal index 36.93 ± 2.3cm and circumference-interorbital index 2.26 ± 0.4cm. 86% of subjects were clustered to hyperleptoprosope group (very narrow face) and 69% had wide jaw with closely placed eyes. No significant (p>0.05) correlation was denoted between variables and facial indices.

Conclusion: The result of this study would provide an access to baseline data of local standards for anthropometric evaluation which might help the clinicians in planning regional surgeries and forensic experts in identification.

Northern International Medical College Journal Vol. 12 No.1 July 2020, Page 503-506

Assessment of dyslipidemia and its association with Type 2 Diabetes Mellitus in Bangladeshi subjects

Jannatul Ferdous — 2022-09-13

Background : Globally incidence of Type 2 Diabetes Mellitus (T2DM) shows an upward trend which a challenge for physicians and public health specialists. Patients with T2DM have 2- 4-fold increased risk of coronary artery disease (CAD), the leading cause of death among people with T2DM. Dyslipidemia considered an important factor for cardiovascular complication of T2DM.

Objective : Assessment of dyslipidemia and its association with T2DM in Bangladeshi subjects.

Methods : A case control study was conducted in CARe Medical College Hospital, Dhaka, during the period of July 2018 to June 2019. A total 153 subjects were included in study of which 90 belonged to Group-I were T2DM and 63 subjects were healthy Controls in Group-II. The Fasting glucose, postprandial glucose. Serum Lipid Profile were assayed in patients and controls, using standardized assay methods. Data were analyzed by using SPSS version 21.

Results : Fasting plasma glucose levels [mmol/l, (Mean± SD)] of the study group were Control (4.96 ± 0.76) and T2DM (8.27±2.19) difference was statistically significant (p <0.001), 2 hours post prandial plasma glucose level [mmol/l, (Mean± SD)] of the study groups were Control (5.81±0.87) and T2DM (11.79 ± 2.69). A significant difference found between Control vs T2DM (p <0.001). Fasting Triglyceride [mg/dl, (Mean± SD) was higher in T2DM (189±82.06), compared to Control (142±80.14) and statistically significant p=0.001. Total Cholesterol [mg/dl, (Mean± SD), Control (172±45) and T2DM (189±50.76) p=0.029] was significantly higher in T2DM than healthy subjects. HDL cholesterol [mg/dl, (Mean± SD); Control (30.6±8.10) and T2DM (26±9.94), p<0.001] significantly increased in healthy Controls compared to T2DM subjects. LDL cholesterol [kg/m,2 (Mean± SD); Control (114±43.54) and T2DM (118±49.66), p=0.572] which was not significantly different among the study subjects.

Conclusion : The present study concludes that important parameter of dyslipidemia, Fasting Triglyceride, total Cholesterol, were higher in T2DM patients and statistically significant. LDL cholesterol higher and not significant on the other hand HDL cholesterol was lower but significant difference between T2DM and healthy control found. Therefore, T2DM is associated with higher incidence of dyslipidemia

Northern International Medical College Journal Vol. 12 No.1 July 2020, Page 507-510

Three consecutive recurrent ectopic pregnancy-A Case Report

Shirin Akhter — 2022-09-13

Ectopic pregnancy (EP) is a potentially life-threatening condition, leads to increased maternal mortality and morbidity till date. About 2% of all pregnancies are Ectopic one and recurrence rate is as high as 1 in every 10 pregnancies. Here we present a case who had a history of 2 Ectopic pregnancies – 1st one treated surgically and 2nd one by medical method. Unfortunately, 3rd pregnancy was also an Ectopic one and needed surgical management. Thus, her natural reproductive ability went down and had to go for In vitro fertilization (IVF) pregnancy and successfully got twin baby (Girl, on March,2020).

Northern International Medical College Journal Vol. 12 No.1 July 2020, Page 511-514

Crigler Najjar Syndrome - A Rare case of Jaundice in Children

Bodhrun Naher — 2022-09-13

Crigler-Najjar syndrome (CNS) was first described in 1952 in Maryland, USA as congenital familial non-hemolytic jaundice with kernicterus by Crigler JF and Najjar VA.1 CNS is a rare genetic disorder characterized by abnormalities in bilirubin metabolism and evident by persistent increase of unconjugated bilirubin. During the first days of life, the syndrome clinically manifests as intense unconjugated hyperbilirubinemia without evidence of hemolysis. It consists of two types, type I and type II. Crigler-Najjar Syndrome is mostly autosomal recessive disorder, but variation may occur in the inheritance of CNS II.2 The key pathogenesis is defect in bilirubin conjugation due to complete or partial deficiency of uridine 5'-diphosphate-glucuronosyl transferase (UGT). This enzyme is required for the conjugation and further excretion of bilirubin from the body. In type I CNS the enzyme activity is completely absent and in type II there is partial absence of the enzyme. Therefore, Type I is more severe form and usually fatal with kernicterus at the age of 1-2 years.3-5 TypeII is less severe and has better prognosis. Patients with CN type II suffer from less jaundice, less neurological impairment, and show a fair response to phenobarbitone therapy (serum bilirubin levels decrease by at least 25%).6 Both males and females are equally affected by CNS. The incidence is approximately 1 in 750,000-1,000,000 in the general population.7 Here we report such a rare case.

Northern International Medical College Journal Vol. 12 No.1 July 2020, Page 515-517

Adopt the New Normal

BH Nazma Yasmeen — 2022-09-13

Abstract not available

Northern International Medical College Journal Vol. 12 No.1 July 2020, Page 484-485