Short-term Treatment Outcome of Patients with Acute ST-elevation Myocardial Infarction in a Tertiary Care Hospital.

Outcome of acute ST-elevation myocardial infarction patients varies time to time. The present study was intended to find out the short-term treatment outcome of the patients admitted in hospital. This descriptive study was carried out in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from 15 January 2014 to 14 July 2014. A total of 100 patients admitted with Acute ST-elevation Myocardial Infarction confirmed on the presence of the (a) Typical chest pain of acute ST-elevation Myocardial Infarction (b) Electrocardiogram (ECG) evidence of ST segment elevation in two or more contiguous leads (c) Raised cardiac marker (Troponin I) were included in the study. Patients were randomly enrolled according to the inclusion and exclusion criteria and observe for one week. Data were processed and analyzed by using computer bases software SPSS version 19.0. Descriptive statistical methods were applied for data analysis. P value was considered as statistically significant when it is less than 0.05. Short-term treatment outcome of acute ST-elevation myocardial infarction include mechanical, arrhythmic, ischemic and inflammatory sequelae, as well as left ventricular mural thrombus. In addition to these broad categories, heart failure, arrhythmia, death are other common complications of AMI. The initiation of the complications usually results in explicit sign and symptoms of the acute MI patients. Learning of the complications in the post infarction period and the clinical syndromes develop with each complication, will allow the health care worker to evaluate and manage the complication appropriately.

A Case Report of Porphyria Cutanea Tarda with Hepatitis-C Virus Co-infection.

Porphyria cutanea tarda is a rare disorder of heme metabolism due to deficiency of the enzyme uroporphyrinogen decarboxylase which is manifested as some typical dermatological features and hepatic dysfunction. The Hepatitis-C virus co-infection is common and it can be aggravated by other environmental factors. We report a case of porphyria cutanea tarda in a 37-year-old woman, who presented with recurrent skin blisters and has concomitant Hepatitis-C virus infection. She was taking oestrogen containing oral contraceptive pill for a long duration. The diagnosis of porphyria cutanea tarda was considered on the basis of clinical features and high level of urine porphyrin level. She was put on hydroxychloroquine and combination drugs for Hepatitis-C virus with significant improvement after 3 months of therapy.

Structural Variations of Nose and Paranasal Sinuses in Various Sinonasal Pathologies: Tomographic Study of 50 Cases in Bangladeshi People.

The aim of this study was to determine the frequency of structural variations in nose & paranasal sinuses in computed tomography in Bangladeshi people. This retrospective study was done at the Sir Salimullah Medical College Mitford Hospital and Apollo Hospitals, Dhaka, Bangladesh. Fifty (50) CT scan of Nose and Para nasal sinuses were collected from the patients presented with different sinonasal pathologies in OPD, IPD of both hospitals from July 2013 to June 2014. The scans were reviewed for the presence of different structural variations of nose and paranasal sinuses. The age range of the patients was 25 to 65 years. The most common anatomical variation in this study was hypertrophied inferior turbinate (82%) followed by ethmoidal bulla (70%), deviated nasal septum (64%), agar nasi cell (40%), concha bullosa (38%). In most of the patients we found more than one variation. There is wide range of anatomical variations in nose and paranasal sinuses which might be regarded as the aetiological factors of different sinonasal pathologies. To maximize patients' benefit and to avoid unexpected situations during surgeries as well as dreadful complications, individualized pre-planning through tomographic study should be considered.

Musculoskeletal disorder (MSD) among agricultural workers.

Farming is a large and main industry in Bangladesh. Large numbers of people are directly involved in farming and have very unique exposure compare to other sectors. Musculoskeletal problems among farmer population are not infrequent. This study was carried out among 200 farmers in one selected district. The study revealed that musculoskeletal problems were common among the farmers working in a traditional way. All the respondents were male. The age of all respondents lie between 20-60 years. Among them 22.5% farmers were illiterate, about 45.5% below Class V. About half (42%) of the respondents had reported pain in different parts of the body at least one or more times during working in land. And about two third (65.5%) of the farmers had history of joint pain and stiffness in last 12 month. Most of the farmers who suffered from musculoskeletal symptoms were 41-60 years. Specially who worked more then 20 years (82.6%) and average 6 hours per day (66.7%). The occurrence of musculoskeletal problems in various part of the body included Knee pain - 48.1%, Back pain (back ache) - 22.9%, Waist pain (low back ache) - 13.3%, Neck pain - 18.3% and shoulder pain - 10.7%. Length of work in year and daily average working hours were found significant association with musculoskeletal pain. It was found that musculoskeletal pain were more common among the farmers when they worked in squatting position (52%) and specially during weeding of plants (31%). Among them only 22% also engaged in other business. Most of the farmers complained dull aching pain (40.6%), only 2.3% noticed severe acute pain, but about 86% farmers' temporary stop their work for pain and 80% get relief after discontinue of work. About 75% respondents visited doctors for their pain which was statistically significant (p=0.001). It was found that the rates of musculoskeletal complaints are more among those individuals who worked relatively bad ergonomic condition, such as body position probably play an important role.

Disabling hearing impairment in the Bangladeshi population.

OBJECTIVE: This study aimed to determine the prevalence of hearing impairment in Bangladeshi people of all ages. METHODS: A nationally representative cross-sectional survey was carried out in 2013. A total of 4260 subjects (1774 males and 2486 females), with a mean age of 32 years, participated. Hearing impairment was determined by pure tone audiometry and otoacoustic emissions testing. RESULTS: Disabling hearing loss (greater than 40 dB loss in adults, and greater than 30 dB loss in children younger than 15 years, in their better hearing ears) was present in 9.6 per cent (95 per cent confidence interval, 8.5-10.8 per cent) of the respondents. Hearing loss was more prevalent in socio-economically deprived people and in those older than 60 years. Multiple logistic regression analysis identified age, socio-economic deprivation, family history, impacted ear wax, chronic suppurative otitis media, otitis media with effusion, and otitis externa as the significant predictors of disabling hearing loss. CONCLUSION: Deafness prevention should focus mainly on chronic suppurative otitis media, otitis media with effusion, and impacted ear wax prevention, integrated within the primary healthcare system and addressing the equity issue.

Prevalence of colorectal diseases in immunological fecal occult blood test (I-FOBT) positive patients in a tertiary care hospital in Bangladesh.

Bleeding lesion anywhere in the GI tract can cause positive reaction to Immunological Fecal Occult Blood Test (FOBT). Although any colonic lesion can cause occult lower GI bleeding, relative frequency of this lesion not known. Guaic based tests require prior preparation and dietary restriction and less sensitive and specific than IFOBT for detection of occult bleeding .IFOBT is specific for human hemoglobin and is more sensitive and specific for detection of occult bleeding from any colonic lesion. Aim of this study was to diagnose occult gastrointestinal bleeding with positive IFOBT and the prevalence of colorectal disease in IFOBT positive patients in a tertiary care hospital in Bangladesh. This was a prospective cross sectional study conducted in Department of gastroenterology in collaboration with clinical pathology, BSMMU, Dhaka during the period of January 2009 to December 2009. In this study 200 patients meeting the inclusion criteria were included. Detailed clinical history and physical findings were recorded; FOBT was done on single stool specimen. Positive occult bleeding was confirmed in 90 patients of whom 80 patients underwent colonoscopy. The mean age of study population was 36.73±13.64 (range 16 to 72) years. At colonoscopy lesion were identified in 46(57.50%) patients, of which colonic polyp in12 (15%), colorectal cancer in 11(13.7%), inflammatory bowel disease in 3(3.75%), hemorrhoids and anal fissure in 7(8.75%), tuberculosis in 5(6.25%), and proctitis in 1(1.25%) cases. A positive IFOBT is more sensitive and specific test than other FOBT for detection of occult lower GI bleeding of colonic origin. In this study colorectal diseases were detected in 57.50% of the IFOBT positive patients, so IOBT can be used as an important diagnostic tool for detection of occult lower GI bleeding.

Dual use of tobacco among Bangladeshi men.

INTRODUCTION: Dual use of tobacco (using smoking and smokeless forms) in Bangladesh is uncommon in women but common in men. Dual users are at additional risk of cancers and heart diseases compared with a single form of tobacco use. Knowledge about their socioeconomic background is necessary for planning appropriate interventions. We report here socioeconomic background of the dual users of tobacco from a nationally representative survey. METHODS: The study adopted a probability proportionate to size sampling technic of divisional population stratified into urban and rural areas to recruit men aged 25 years or older from their households. A total of 4312 men were recruited. Variables included questions on 20 household assets, tobacco use and other behavioral risk factors, and measurement of body weight and height. RESULTS: The average age of dual users was 46.7 years old compared to 43.4 and 52.3 years for smokers and smokeless tobacco users. Prevalence of "smoking only," "smokeless only" and "dual use" of tobacco was 40.6%, 15.2%, and 14.2%, respectively. Among all tobacco users, dual users constituted 20%. These dual users had lower educational achievement, rural residence, lower intake of fruit, and higher intake of alcohol. They were more undernourished as indicated by a thin body mass index compared to nonusers and smokers. Dual users were of socioeconomically deprived as measured by wealth quartiles constructed out of household assets. CONCLUSION: Dual use of tobacco is common in Bangladesh, and it is intimately linked with socioeconomic deprivation. Poverty reduction strategy and campaigns should address tobacco control not only tobacco in general, but its dual use in particular.

Neurological status of children with congenital heart defects.

Congenital heart defect (CHD) is the most common birth defect & a significant cause of childhood morbidity & mortality. Structural brain abnormalities are more common in children with CHD than general population. This study details the cognitive, motor and behavioral development of a child with congenital heart disease who is on medical management. In this retrospective descriptive study, abnormalities in neurobehavioral status of infant & children (6-42 months of age) with CHD, who are on medical management were assessed by a standardized neurobehavioral assessment test, BSID-II. Fifty-eight children were included, who were diagnosed as a case of congenital heart disease & confirmed by Colour Doppler echocardiography in the Paediatric Cardiology Department of Bangabandhu Sheikh Mujib Medical University, Bangladesh. Mean age of the children was 23±13 months (range, 6 to 42 months); M:F = 1:1.9. Among them 22(37.9%) had cyanotic and 36(62.1%) had acyanotic congenital heart disease. Neurobehavioral and neurologic abnormalities were documented in a significant number of children. BSID-II showed 23(39.7%) had delayed metal development, 24(41.4%) had motor impairment and 16(27.6%) had non-optimal behavioral performance. Interestingly, infant and young children with acyanotic congenital heart defects were more likely to demonstrate severe neurologic compromise than were those with cyanotic defects. Findings of this study suggest that the prevalence of neurobehavioral abnormalities in infants and young children with congenital heart defects has been under predicted & indicates that delay in closure (surgery/device) puts the patient at an increased risk of neuro-developmental insult.

Laryngeal histoplasmosis.

Histoplasma capsulatum is an endemic granulomatous fungus disease. Involving the larynx of an immunocompetent patient with this is a rare manifestation. A sixty years old farmer who was previously diagnosed and treated as pulmonary tuberculosis was presented as a progressive change of voice and intermittent attack of unproductive cough with no history of stridor and fever for last 7 months. Clinical and imaging investigations were suggestive of laryngeal tuberculosis or laryngeal neoplasm. Laryngoscopy revealed edema, erythema and leukoplakia of the right vocal cord. Histopathological report showed intracellular hyphae of Histoplasma capsulatum, features were consistent with histoplasmosis. Patient were treated accordingly and improved. Laryngeal histoplasmosis present as a mimicker of squamous cell carcinoma or tuberculosis, may lead to the misdiagnosis and mistreatment of tuberculosis or laryngeal cancer. A high index of suspicion and a thorough histologic workup is needed to establish the diagnosis correctly.

Role of adenosine deaminase in diagnosis of tubercular pleural effusion.

The diagnosis of pleural tuberculosis (TB) continues to be a challenge in clinical practice. Traditional diagnostic methods are very useful for the diagnosis of pulmonary TB but have a low yield when applied to pleural fluid. It is produced during the inflammatory process triggered by the M. tuberculosis. Usefulness of adenosine deaminase (ADA) estimation in pleural fluid has been shown as a reliable chemical bio-marker specially when there is suspicion of tuberculosis in endemic areas. ADA level was determined in the pleural fluid of 100 patients present with pleural effusion admitted at Mymensingh Medical College Hospital during the period of March 2012 to September 2012. ADA level was >40IU/L among the 52 tubercular pleural effusion patients with sensitivity & specificity is 100% and 66% respectively. Thus is evident that ADA level can be used along with conventional methods for diagnosis of pleural TB.

Traumatic gut injury: a study of 100 cases in Mymensingh Medical College Hospital.

This study was done to find out the mode of presentations, management options and the factors which dictate the out-come of the patients with traumatic gut injury. It has been carried out in the department of Surgery, Mymensingh Medical College Hospital in 100 patients with traumatic gut injury from January 2009 to December 2010. Most of the patients were within 21-30 years (47%) and male patients were the predominant group (90%). In this study penetrating injury was more common (57%) than non-penetrating (43%) injury as a cause of gut injury. Stab (64.91%) was the main mechanism of penetrating abdominal trauma; while road traffic (58.14%) was the main mechanism of non-penetrating abdominal trauma. Diagnosis was made on clinical presentation, physical examination and some investigations. Abdominal pain (98%) was the chief complain and chief sign was abdominal tenderness (98%) and absent bowel sound (91%). Small gut injury was present in 71% patients, 20% patients had large gut injury and 9% had both gut injury. In small gut, jejunum (49.29%) was the most vulnerable portion and right sided colon (55%) was the most affected portion in large gut trauma. Spectrum of injury in small gut included single perforation (63%), multiple perforations (23%), laceration (11%) and devascularization (3%) injury. Primary repair in 60.87%, resection & anastomosis in 27.54% and resection anastomosis with proximal diversion in 11.59% patients were done in small gut injury. Injuries in the large gut were classified into three categories according to Flint Colon Injury Severity Scoring. Highest incidence was in Grade I (60%) category, second in Grade II (35%) and Grade III (5%) was the third one. Simple primary repair in 40%, primary repair or resection anastomosis with proximal diversion in 30%, loop ileostomy in 20% and Hartman's procedure in 10% were done in patients of large gut injury. Resection anastomosis with proximal diversion was performed in patients of both small and large gut injury. Outcome of management was quiet acceptable with 47% of patients having uneventful recovery. Delayed presentation, delayed definitive management, haemodynamically unstable patient, site and number of injuries in the gut were the crucial factor for the overall 44% morbidities of this series. Morbidity rate was 9%. More than half of the patients (56.04%) discharged from the hospital within 10 days. Only a few patients could be followed up for a few months after surgery, who reported to have a satisfactory outcome with no morbidity.

Single layer gastro-intestinal anastomosis in gastric cancer surgery.

Gastrojejunostomy is one of the most important procedures in gastric cancer surgery. Anastomosis between different parts of the stomach and the intestine is a basic technical component in all gastrointestinal procedure. This study evaluated complications of gastrojejunostomy in gastric cancer surgery with two methods: single-layer and double-layer anastomosis. This study was carried out in the Department of Surgery in Mymensingh Medical College Hospital from January 1st 2010 to June 30th 2012. Fifty patients with carcinoma stomach who needed gastrojejunostomy were included in this study. These patients with average age of 43.22 years were divided in two groups (25 in each group); single-layer and double-layer anastomosis. In single-layer anastomosis gastrojejunostomy was performed in interrupted method with absorbable suture (3/0 vicryl). Double-layer anastomosis was carried out with continuous suture (2/0 silk, 2/0 catgut). Possible post-operative complications like anastomotic leakage, pelvic abscess, abdominal sepsis, anastomotic stenosis and wound infection were evaluated. In the single-layer group, 2 patient (4%) developed anastomotic leakage, wound infection and only 1 patient (2%) developed abdominal sepsis, pelvic abscess and anastomotic bleeding. No patient developed anastomotic stricture. In double-layer group, no patient developed anastomotic leakage but wound infection only in 1 patient (2%). Gastrojejunostomy with single-layer hand-sewn suture technique is safe without serious complications in comparison to double-layer suture technique. More-over operation time is less and cost is less in single-layer method.

Status of blood pressure among individuals consuming saline water.

Climate change is taking its toll in the form of saline water intrusion into the mainland of Bangladesh, which is one of the lowest-altitude countries in the world. The study was carried out with the objective to assess the blood pressure status associated with salinity in saline prone selected areas of Bagherhat and Tangail districts from March 2008 - June 2008 of rural Bangladesh. Two hundred and ninety subjects were selected purposively from both the districts. About 70% of the respondents were males and below forty years of age. More than two thirds of the respondents were illiterate; belong to 4-5 member family, with monthly family income of less than Tk. 4000 per month. Only one third of the respondents were smokers. More than two thirds of the respondents from salinity area had salinity level of 2-3%. Among them majority were drinking saline water for 6-10 years and 26% were drinking for more than ten years. About 20% of the non saline respondents' systolic blood pressure was 110-120 mm of Hg and 26% of saline area had systolic blood pressure >135-140 mm of Hg. Mean systolic BP among salinity area was more than that for non salinity area. About 19% of the non saline respondents' diastolic blood pressure was ≤ 85 mm of Hg. About one third had ≥ 90 mm of Hg, among them 31% were from saline area. Mean diastolic BP among salinity area was more than non salinity area. There was no history of heart disease, and less than 1% was diabetic among them. About two thirds had mean arterial pressure <70 mm of Hg, among them majority were from non saline area. About one third had >70 mm of Hg, among them majority were from saline area. The study concluded that systolic and diastolic blood pressures of saline group were significantly higher than that of the non saline group.

Budd-Chiari syndrome.

A 16 years old boy hailing from Comilla presented with sudden onset of upper abdominal pain, ascites and generalized muscle wasting for 3 months. Ultrasonogram (USG), Color Doppler and Venography was done and diagnosed him a case of Budd-Chiari syndrome. The patient was treated with salt and water restriction, diuretics, repeated palliative ascetic fluid aspiration with re-accumulation within 1-2 days. He was also given Low molecular weight Heparin for 7 days, overlapped and followed by warfarin 10mg/day with target INR 2.5-3.5. Consultation with hepatobiliary surgeon was done for shunt operation, but operation was not possible due to poor general condition. This patient improved satisfactorily with low molecular weight heparin, warfarin and supportive measures. Budd-Chiari syndrome is a rare veno-occlusive disorder involving hepatic vasculature.

A primary hypertrophic osteoarthropathy or pachydermoperiostosis.

A young boy of 17 years presented with arthalgia and arthritis of multiple joints unresponsive to treatment, generalized clubbing and enlargement of distal part of the extremities for 5 years and hyperhidrosis for 3 years. On examination, thickening of the facial skin and seborrhoea were found associated with acne. The patient has a Marfanoid appearance with column like legs and spade like fingers. There was no evidence of cutis vertices gyrata. Mild anaemia was present and vital signs were within normal limits. Examination of the musculoskeletal system revealed pain and swelling of the knee, ankle, elbow, wrist and proximal & distal interphalangeal joints. The spine and gait were normal. Radiographs of the limbs revealed subperiosteal new bone formation. The patient was diagnosed as a case of the autosomal dominant disorder, Primary Hypertrophic Osteoarthropathy or Pachydermoperiostosis.

Iron chelation therapy and thalassemia - an overview.

New developments in the epidemiology, treatment and prognosis of thalassemia have dramatically altered the approach to the care of affected patients. In the last 30 years, conventional treatment of ß-thalassemia major, based primarily on regular blood transfusions and iron chelation therapy with desferrioxamine (DFO) has markedly improved the prognosis of the disease. Adequate administration of parenteral DFO reduces or prevents iron accumulation. The unavailability of DFO (dysferol) for most patients with thalassemia major and the failure of prescribed therapy to prevent complications in other patients have led to a search for alternative iron chelators; one of them, deferiprone (DFP) has been commercially available. Patients may ultimately benefit from having a choice between several chelators, including orally active drugs. Combination therapy and organ-targeted chelation, may soon have a considerable impact on the therapeutic outcome and quality of life of patients with thalassemia.

Tuberculous pleural effusion.

Despite prevention programs, tuberculosis is still endemic in developing countries. Extrapulmonary tuberculosis is increasing globally in the face of recent emergence of Human Immunodeficiency Virus (HIV) infection. Pleural tuberculosis is a common problem in daily clinical practice. We assessed 26 cases of tuberculous pleural effusion admitted in Bangabandhu Sheikh Mujib Medical University from 2002 to 2007. The diagnosis was based upon clinical examination, tuberculin reaction, imaging, pleural fluid analysis and response to antitubercular chemotherapy a surrogate clinical determinant. Apparently promising newer biochemical pleural fluid measurements were not utilized due to a number of limitations. The presenting symptoms found in this prospective analysis are fever (100%), nonproductive cough (73%), pleuritic chest pain (38%), loss of weight (38%) and shortness of breath (38%). A high index of suspicion after confident exclusion of malignancy and pneumonia is a clue to diagnosis. Out of 80 cases of extrapulmonary tuberculosis admitted during the study period, tuberculous pleural effusion constitutes 32.50%.

Seroprevalence of Hepatitis B, Hepatitis C, HIV Infections in Blood Donors of Khulna, Bangladesh.

To determine changes (Trends) in infection rates of Hepatitis B surface antigen (HBsAg), Hepatitis C virus (HCV) and Human immunodeficiency virus (HIV) in blood donors of Khulna Population. Specimens of 34953 voluntary blood donors & party or relative donors in Transfusion Medicine Department of Khulna Medical College Hospital from 2007 to 2009 were screened for HBsAg, anti-HCV, anti-HIV 1 & 2 reactivity in a cross-sectional survey by rapid test method. Reactive samples were verified using a recognized confirmatory test which consisted of a second generation enzyme immune assay (HBsAg), anti-HCV antibodies by anti-HCV EIA & for HIV by western Blot, respectively. The seroprevalence of HBsAg, Anti-HCV, HIV antibody 1 & 2 was 1.4%, 0.09% & 0.03% respectively in all blood donors. Prevalence of confirmed positivity was 0.62% for HBsAg, 0.04 % for Anti-HCV, 0.02% for HIV Western Blot. Between 2007 to 2009 a decreasing trend was observed in HBsAg frequency, HCV frequency decreased in 2009 compared to 2007. One HIV positivity found in 2009. Although the frequency of transfusion transmitted infections is low, party or relative donors have some risk factors than voluntary blood donors. Through more scrutiny in donor selection, improved serological test & reevaluation of infections routes in donor, infection reduction can be achieved.

Uroflowmetry before and after transurethral resection of prostate for bladder outlet obstruction.

This prospective study evaluates the effectiveness of uroflowmetry to follow up the patients of benign prostatic hyperplasia treated by transurethral resection of prostate. Total sixty eight patients of 50 to 70 years age group attending for the treatment of BPH with bladder outlet obstruction in the department of Urology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka were recruited for the study. All the TURP's were performed by experienced urologist. Patients were advised to come after 3 months and 6 months for follow up visits. In each visit, the patients were evaluated through history, physical examination and relevant investigations including IPSS and uroflowmetry. Significant improvement was observed in term of Qmax, voided volume, and voiding time in all patients after TURP. Mean (+/-SD) IPSS change in pre to post TURP was 16.2(+/-0.76) (p<0.05). The objective parameters of uroflowmetry correlated well with the subjective parameters represented by IPSS in this study.

Gestational anemia.

Gestational anemia is a common public health problem in our country. Most anemia during pregnancy results from an increased need for iron as her body is making more blood. Often dietary supplementation does not provide enough iron to meet the extra needs. Also the growing baby takes all the iron it needs from mother, regardless of how much iron is stored in mother's blood. Gestational Anemia contributed significantly to maternal morbidity and mortality, IUGR, preterm delivery and perinatal morbidity and mortality. A high proportion of women in both industrialized and developing countries become anemic during pregnancy. The most important cause of gestational anemia due to iron deficiency, because high iron requirements during pregnancy are not easily fulfilled by dietary intake. Adequate iron stores can help a pregnant women replace lost red blood cells. So, iron supplementation is strongly recommended for all pregnant women in developing countries. Oral iron intake is the treatment of choice and almost all pregnant women can be treated effectively with oral iron preparation during their pregnancy period.