Northern International Medical College Journal An official Journal of the Northern International Medical College. Full text articles available. Northern International Medical College en-US Northern International Medical College Journal 2221-0377 Biological clock- our 24 hours’ rhythms <p>Abstract not available</p> <p>Northern International Medical College Journal Vol.10 (2) Jan 2019: 363-365</p> BH Nazma Yasmeen ##submission.copyrightStatement## 2020-02-10 2020-02-10 10 2 363 365 10.3329/nimcj.v10i2.45428 Efficacy of combination therapy of Hyaluronic acid and Methylprednisolon verses Hyaluronic acid single therapy in knee Osteoarthritis : A comparative study <p><strong>Background: </strong>Osteoarthritis of knee joint is one of the most common problem which cause pain, loss of function even joint disability and increases misery and morbidity in old age. Now a day’s intra-articular injection of single Hyaluronic acid or corticosteroids (Methylprednisolone) are using for knee osteoarthritis cases. But the combined therapy by injection of both Hyaluronic acid and Methyl prednisolone are not so much practiced and still under debate.</p> <p><strong>Objectives: </strong>To compare the efficacy of intra-articular injection of combined Hyaluronic acid and Methyl prednisolone with single Hyaluronic acid alone.</p> <p><strong>Methods: </strong>A prospective, comparative study was done in Northern International Medical College Hospital, Dhaka, during May 2017 to April 2018 at Out Patient Department with 80 patients (132 knees). Patients were randomized into two groups: Group-A with 40 patients with 15 unilateral and 25 bilateral knee cases (65 knees) were treated with combined Hyaluronic acid and Methyl prednisolone and Group-B with 40 patients with13 unilateral and 27 bilateral knee cases (67 knees) were infiltrated with single Hyaluronic acid. Results were evaluated with Knee Society Score (KSS) and Visual analogue score (VAS) at the 1st week, 1st month and 3rd month after injection.</p> <p><strong>Result: </strong>In both Group (A and B) patients of age 61–70 years were highest, 50% and 45% respectively. Male and female ratio was 1:2.2. At the 1st week KSS for pain in Group-A (mean 65.6) was better than Group-B (mean 57.4). At the 1st month mean pain scores (Group-A 72.4, Group-B 64.4) and the 3rd month (Group-A 81.4, Group-B 75.6) and mean function scores at 1st week (Group-A 61.3, Group-B 49.6)), 1st month (Group-A65.1, Group-B 53.6) and 3rd month (Group-A68.4, Group-B 59.4). The KSS for pain and function improved in combination therapy group.VAS decreased in both groups.</p> <p><strong>Conclusion: </strong>As combination therapy by Hyaluronic acid and Methyl prednisolone showed better efficacy than single Hyaluronic acid. Therefore, combination of these two drugs in a single vial can be used as an effective and easy nonoperative treatment of knee osteoarthritis.</p> <p>Northern International Medical College Journal Vol.10 (2) Jan 2019: 366-369</p> Sk Ashraf Ullah Fakhruddin Ahmed Nasreen Sultana Sk Akbar Hossain ##submission.copyrightStatement## 2020-02-10 2020-02-10 10 2 366 369 10.3329/nimcj.v10i2.45429 Use of Magnesium Sulphate in Persistent Pulmonary Hypertension of Newborn <p><strong>Background: </strong>One of the common causes of respiratory distress in neonate is persistent pulmonary hypertension of newborn (PPHN) and has been estimated to occur in 2 per 1000 live born term infants.</p> <p><strong>Objective: </strong>To evaluate the effect of injectable Magnesium Sulphate (MgSO4) in the treatment of Persistent Pulmonary Hypertension of Newborn.</p> <p><strong>Methodology: </strong>It was a prospective, nonrandomized, clinical study conducted from August 2015 to July 2017 among 25 neonates having moderate to severe PPHN in the Pediatric Cardiac Intensive Care Unit (CICU) of Dhaka Shishu (Children) Hospital. Injectable Magnesium Sulphate was used along with other supportive management. Outcome measures include drop of pulmonary vascular resistance and increase oxygenation. Side effects of Magnesium Sulphate were observed and outcome was recorded. Data were analyzed by using SPSS version 17.</p> <p><strong>Results: </strong>There was significant improvement of oxygenation and decrease in pulmonary vascular resistance at 72 hours after use of MgSO4 (p=000). Complications were present in 28% cases which include hypotension in 16% patients, urinary retention in 8% and altered GI function in 8% cases. Mortality was 16% among study population.</p> <p><strong>Conclusion: </strong>MgSO4 is effective in improving oxygenation and reduction of pulmonary vascular resistance in PPHN</p> <p>Northern International Medical College Journal Vol.10 (2) Jan 2019: 370-372</p> Mohammad Abdullah Al Mamun Sheuly Begum Manzoor Hussain Dr Abdul Jabbar ##submission.copyrightStatement## 2020-02-10 2020-02-10 10 2 370 372 10.3329/nimcj.v10i2.45430 Analysis of Blood Donor Deferral in a Tertiary Care Hospital <p><strong>Introduction</strong>: Selection of proper donor according to stringent selection criteria is the prerequisite for safe blood transfusion practice. It is widely known that a large number of blood donors are deferred for different reasons.</p> <p><strong>Objective</strong>: The aim of present study is to evaluate the incidence and different reasons of blood donor deferral in atertiary care hospital.</p> <p><strong>Methodology</strong>: This retrospective cross-sectional study was carried out in Transfusion Medicine and Clinical Haematology Department of BIRDEM General Hospital, Dhaka, during the period from July 2016 to June 2017.The blood donor of either sex attending the mentioned department were selected purposively and categorized into four groups according to their age for this study. Donors were selected and deferred by medical officer according to national guideline. Deferred blood donors were recorded in register book and were analyzed retrospectively.</p> <p><strong>Results</strong>: In current study, 1152 blood donor (8.8%) were deferred attending for allogeneic blood donation during the study period. Out of 13082 registered blood donor 11961were male (91.43%) and 1121 were female (8.57%) and deferral rate was 2.37 times more in female. Majority of the deferred donors (55.38%) were under the age of 40 where 26.82% were in between 40-49 years and 17.8% were in the range of 50 years and above. Age range of highest deferred donors (32.20%) was between 30-39 years. The number of temporary and permanent deferral were 836 (72.57 %) and 316 (27.43%) respectively. Anaemia (33.01%), underweight (21.53%) and hypotension (17.34%) were the most common reason of temporary deferral. Chronic uncontrolled hypertension (42.4%), donors with medication (16.77%) and asthma (15.18%) was the most common cause of permanent deferral.</p> <p><strong>Conclusion</strong>: The deferral rate was low and most of the deferred donors were young adult. Temporary deferred donors were higher than permanent deferred donors. The most common reasons for temporary deferral were anemia, underweight and hypotension. Permanent deferral causes were chronic uncontrolled hypertension, donors on medication for various reason and asthma. Donors should be informed with a clear message on their deferral status. It is important to determine the rate and causes of donor deferral for the safety of blood transfusion and to guide the recruitment efforts for safe blood transfusion and to avoid the permanent loss of blood donors.</p> <p>Northern International Medical College Journal Vol.10 (2) Jan 2019: 373-376</p> Farida Parvin Daanish Arefin Biswas Bepasha Naznin Tamanna Afroz Mohammad Ali Tashmim Farhana Dipta ##submission.copyrightStatement## 2020-02-10 2020-02-10 10 2 373 376 10.3329/nimcj.v10i2.45431 Utilization of Essential Service Package by rural community <p><strong>Background: </strong>Government has implemented Essential Service Package (ESP) under Health, Nutrition and Population Sector Program (HNPSP) to reach and maintain the highest attainable level of health care to the people of Bangladesh.</p> <p><strong>Objective: </strong>To assess the utilization of Essential Service Package by rural community.</p> <p><strong>Methodology: </strong>A descriptive, cross-sectional study was carried out during January 2011 to June 2011 on 160 respondents of age 18 years and above.Sample was selected purposively from Nababganj Upazila under Dhaka district. After taking informed consent data were collected by face to face interview using structured questionnaire. Data analysis was done by SPSS version 16.</p> <p><strong>Results: </strong>The study revealed that highest number (71.9%) of respondents attended Upazila health Complex (UHC) to utilize ESP services. Among the respondents female (85.6%) were more than male. The lower class (19.4%) and middle class population (46.9%) utilized significantly more than upper class (8.7%).The most of the respondents had primary level of education (31.9%). Utilization of Expanded Programme on Immunization (EPI) (82.9%), Antenatal care (ANC) (16.2%), Family planning (FP) (11.2%), treatment of communicable diseases (40%) and limited curative care (12.5%) were found. Regarding Behavioural change communication (BCC) (41.3%) said that they got health education from the UHC and 58.9% response was negative.</p> <p><strong>Conclusion: </strong>The overall utilization of ESP services is good. To utilize the ESP from the existing UHC facilities for the rural community population is needed to be strengthening for achieving the health goals.</p> <p>Northern International Medical College Journal Vol.10 (2) Jan 2019: 377-380</p> Shafia Khatun Nayan Nasreen Begum Mumtaz Rahman Abid Maheen Dohja Fazilatun Nessa Nazneen Suraya Ahmed Chowdhury ##submission.copyrightStatement## 2020-02-10 2020-02-10 10 2 377 380 10.3329/nimcj.v10i2.45432 Disease pattern and Biochemical profile as a predictor of outcome of Critically sick neonates in a Neonatal Intensive Care Unit <p><strong>Background: </strong>Neonatal Intensive Care Unit (NICU) is predominately concerned with the management of critically sick neonates having acute life threatening conditions. Usually neonates having respiratory distress, acute neurological deterioration, severe infection and prematurity contribute the major admission in a NICU.</p> <p><strong>Objective: </strong>To find out the disease pattern and biochemical profile as a predictor of outcome of critically sick neonates in NICU.</p> <p><strong>Methods: </strong>This observational prospective study was carried out at NICU of Dhaka Shishu (Children) Hospital from January 2015 to July 2015. Total 121 neonates were enrolled according to inclusion criteria and analyzed some important biochemical profile specially electrolyte and blood gas status as a part of proper management as well as to predict their outcome.</p> <p><strong>Results: </strong>Among critically sick neonates, perinatal asphyxia was common disorder followed by sepsis. Biochemical profile specially electrolyte and acid-base disruption play important role to the outcome of critically sick neonates. Low pH, low potassium and high base-deficit level were found to have worse outcome.</p> <p><strong>Conclusion: </strong>Perinatal asphyxia constitutemajor cause of admission ofcritically sick neonates. Early detection of electrolyte and acid-base status is helpful to care and overall survival of these neonates. Mortality was the highest among neonatal sepsis followedby perinatal asphyxia. Metabolic acidosis and hypokalemia were the predictor of outcome of such critically sick neonates.</p> <p>Northern International Medical College Journal Vol.10 (2) Jan 2019: 381-385</p> Mir Mohammad Yusuf BH Nazma Yasmeen MAK Azad Chowdhury ##submission.copyrightStatement## 2020-02-10 2020-02-10 10 2 381 385 10.3329/nimcj.v10i2.45433 Current Disease pattern and Out-come of patients in a Medical Unit of a Pediatric Hospital <p><strong>Background: </strong>Epidemiological trends of diseases and causes of mortality is not constant, it is always changing. Analysis of admitted patients gives us information on the burden of diseases in the community as well as cause of mortality.</p> <p><strong>Objectives: </strong>To determine current pattern of admissions and their outcomes in a tertiary care Pediatric hospital.</p> <p><strong>Material and Methods: </strong>A descriptive study was carried out at Dhaka Shishu (Children) Hospital over a period of one year from 1st January to 31st December, 2015. All the admitted patients during the study period were included and data were collected from medical records for analysis of age, residence, mode of admission, referral source, disease profile and outcome. Final diagnosis and mortality were grouped according to involved organ system. Data were analyzed by using SPSS version 17.0.</p> <p><strong>Results: </strong>Total 1424children with a male and female ratio of 1.5:1 were admitted in one year. Patients younger than 5 years were 73%and 27% were less than one year. Respiratory infection, neurologic, hematology, oncologic conditions were the main diseases. Mortality was 2.6% and it was highest in nonspecific infection group followed by respiratory, hematologic, neurologic, and oncologic diseases. Mean duration of hospital stay was 11.5 days. Most patients 59.1% were admitted through Emergency Department(ED) and came directly to the hospital. Fifty percent of admissions were from Dhaka and neighboring areas and rest were from other cities and rural areas of Bangladesh.</p> <p><strong>Conclusion: </strong>Non-specific infection, respiratory or neurologic diseases are main diseases found in admitted patients and these diseases were the main contributor to death as well. Most of the patients approach directly to this hospital and also through emergency department.</p> <p>Northern International Medical College Journal Vol.10 (2) Jan 2019: 386-388</p> M Mizanur Rahman Mirza Md Ziaul Islam M Atiqul Islam AKM Tajuddin Bhuiyan AFM Ashik Imran Mst Laizuman Nahar ##submission.copyrightStatement## 2020-02-10 2020-02-10 10 2 386 388 10.3329/nimcj.v10i2.45434 Early outcome of Lichtenstein technique for complete variety of inguinal hernia repair in a tertiary care hospital <p><strong>Background: </strong>Inguinal hernia repair is very common in day to day general surgical practice. Result of surgical repair is often satisfactory but recurrences following surgery are troublesome both for the surgeon and the patient. Lichtenstein technique is now the most widely performed technique in groin hernia repair.</p> <p><strong>Objective: </strong>The aim of this study was to assess short term outcome of complete variety of inguinal hernia repair by Lichtenstein technique.</p> <p><strong>Methodology: </strong>This was a prospective observational study in which 30 complete variety of inguinal hernia repairs were performed by Lichtenstein technique between January 2014 and December 2017 by same surgical team in surgery department, Holy Family Red Crescent Medical College Hospital (HFRCMCH). Patients were scheduled for follow up visits at the end of first week, third month and sixth month after operation in out-patient department. The main outcome measures were postoperative complications, early recurrence, groin pain.</p> <p><strong>Result: </strong>In this study age of the patients ranged from 30 years to 78 years, the mean age was 51.93 (±SD 10.12) years. Most of the hernia were of indirect type 18(60%) followed by direct type 9(30%). In indirect type (55.6%) of the hernias was right sided and the rest (44.4%) were left sided. On an average each operation lasted for 1.18 hours and oral feeding started 12.69 hours after the operation, Postoperative mean hospital stay that was 2.27 days. Postoperative complications were 2(6.7%) had a prolonged recovery and presented with abdominal distention after operation and 3(10%) patients developed postoperative urinary retention. Scrotal haematoma formation was observed in 2(6.7%) cases and other post-operative complications were local haematoma or seroma formation in incision site, periincisional skin echymosis, postoperative pyrexia, superficial wound infection and post-operative pain were found in 1 (3.3%) cases. Regarding outcome no recurrence or mesh rejection or mesh infection were observed within short time postoperative follow up period.</p> <p><strong>Conclusion: </strong>In this study no recurrence or mesh rejection or mesh infection were observed within short time postoperative follow up period and patient's compliance was good with minimum morbidity. Therefore, Lichtenstein's technique of inguinal hernia repair considered as a safe and effective procedure.</p> <p>Northern International Medical College Journal Vol.10 (2) Jan 2019: 389-392</p> ASM Anwarul Kabir Imtiaz Ahmad Mahbuba Sharmin Khaleda Akhter Md Rashidul Hoq Mohammad Shahidul Alam ##submission.copyrightStatement## 2020-02-10 2020-02-10 10 2 389 392 10.3329/nimcj.v10i2.45435 A study on vitamin D level among the patients attending in a private chamber in Dhaka city <p><strong>Background: </strong>Vitamin D deficiency is one of the most neglected public health issues all over the world. Near about 1 billion people round the world suffer from vitamin D deficiency. Most of the countries in Asia having high prevalence of vitamin D deficiency.</p> <p><strong>Objective: </strong>To find the vitamin D level among the patients attending in a private chamber in Dhaka city</p> <p><strong>Methodology: </strong>A cross sectional observation study was carried out in a renowned diagnostic center of Dhaka city from July 2017 to June 2018. A sample of 1523 adult patients aged 18 years and above, presented with generalized body aches and pains selected conveniently for the study. Blood samples were taken and serum vitamin D levels were measured. In this study, vitamin D concentration below10 ng/ml was considered as vitamin D deficiency, 20–30 ng/ml as insufficiency, and 30–100 ng/ml as vitamin D sufficient. Data were analyzed by using SPSS version 22.</p> <p><strong>Result: </strong>Out of 1523 patients 69.5% were women and 30.5% men. Urban and rural distribution was 63.16% and 36.84% respectively. Among the participants vitamin D deficiency was 54%, 35.8% vitamin D insufficient, and only 9.8% had normal level of vitamin D, regarding age specific deficiency highest 71.8% was in 71-80 years age group. Out of 1058 female 39.5% were vitamin D deficient, 45.6% had insufficient vitamin D level. Only 14.9% female were found normal level. Age specific deficiency found highest 63.8% in 61-70 year age group. On the other hand out of 465 male participants, 24% were vitamin D deficient, 34% were insufficient and 42% had normal level vitamin D. Highest deficiency 42.5% found in age group 61-70years.</p> <p><strong>Conclusion: </strong>Considering the study result deficiency was higher among female than male. In female vitamin D deficiency increased after age of 31year. Vitamin D deficiency found highest in old age and middle age group. Over all age specific deficiency found significantly highest in 71 – 80 years. In both male and female Vitamin D deficiency was found highest above 61years of age.</p> <p>Northern International Medical College Journal Vol.10 (2) Jan 2019: 393-396</p> Moushumi Afrin Eva Nasreen Begum ASM Anawrul Kabir Khondoker Wasee Ahmed Mahbuba Sharmin Sumanta Kumar Saha Md Bodroddoza Bayazid Shahriar Hasan ##submission.copyrightStatement## 2020-02-12 2020-02-12 10 2 393 396 10.3329/nimcj.v10i2.45475 Salmonella Hepatitis in Children : An Update <p>Salmonella hepatitis is one of the atypical presentations of typhoid fever and can be defined as reversible involvement of liver during the course of typhoid fever. There have been more than 150 cases of salmonella hepatitis reported both in developed and developing countries. The documented incidence varies widely from 1 to 26% of patients with Typhoid fever. It presents with jaundice and tender hepatosplenomegaly. Investigation shows slightly raised transaminase levels with or without 5 adenosine neucleosidase and or decreased prothombin time index. It complicates into hepatic encephalopathy and bleeding diathesis. A positive culture for Salmonella from blood or stool is essential to differentiate Salmonella hepatitis from other causes of acute hepatitis. Hepatic pathology is characterized by the presence of typhoid nodules with marked hyperplasia of reticuloendothelial system. The ALT/LDH ratio &lt; 9 is suggestive of Salmonella hepatitis which is &gt; 9 in viral hepatitis. The prognosis is usually good as Salmonella hepatitis responses with specific antibiotic therapy and jaundice resolves with clinical improvement. The clinical course can be severe with high mortality (20%) sometime. In our country where enteric fever is endemic, the recognition of Salmonella hepatitis is of clinical importance .</p> <p>Northern International Medical College Journal Vol.10 (2) Jan 2019: 397-399</p> Sadika Kadir Tamanna Begum Md Rafiqul Islam Golam Nabi Md Ashraful Haque Naima Sharmin Hoque BH Nazma Yasmeen ##submission.copyrightStatement## 2020-02-10 2020-02-10 10 2 397 399 10.3329/nimcj.v10i2.45436 A very young patient with Tubercular Meningitis and its complications <p>A case report on a successful management of an eight months old boy with Tubercular Meningitis with Multiple Tuberculoma in Brain with Obstructive Hydrocephalus with Left sided Lower motor neuron type Facial Palsy with Right Sided Hemiparesis. Tuberculous meningitis (TBM) is Mycobacterium tuberculosis infection of the Brain Meninges.1,2 In TBM inflammation occur mainly in the base of the brain and when the inflammation affect the brain stem subarachnoid area, cranial nerve roots then symptoms may occur like space-occupying lesions.3,4 TBM is more common in children than in adults, especially children aged 0-5 years.5 In children central nervous system tuberculosis usually presents as tubercular meningitis, post-tubercular meningitis hydrocephalus, and rarely a space-occupying lesions known as tuberculomas.6 TBM accounts for 2–5% of all active cases of Mycobacterium tuberculosis.7 Pulmonary infection coexists in 25–83% of TBM.8-10 Predominately primary CNS infection is found in children and leptomeningeal infection presents as meningitis, cranial nerve (CN) palsies (most commonly CN 2, 3, 4, and 7), and communicating hydrocephalus.11</p> <p>Northern International Medical College Journal Vol.10 (2) Jan 2019: 400-401</p> Rowshan Jahan Akhter BH Nazma Yasmeen ##submission.copyrightStatement## 2020-02-10 2020-02-10 10 2 400 401 10.3329/nimcj.v10i2.45437