Usefulness of Diagnostic Ultrasound for Detection of Common Shoulder Abnormalities Prior to MRI.

Shoulder pain is a common musculoskeletal pain in the general population and results in significant disability, quality of life impairment and financial burden to the health care system. This cross-sectional study was carried out among purposively selected 61 adult patients with shoulder pain and or limited range of motion in the Department of Radiology and Imaging, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from September 2018 to August 2020 to determine the usefulness of USG in detection of common shoulder abnormalities, as an initial imaging modality using MRI as reference standard. The majority of the patients 25(40.98%) were in age group of 51-60 years with mean age of 52.98±10.85 years. In the dectection of rotator cuff pathology, the overall sensitivity, specificity and accuracy of USG for any complete tear were 100.0% each, for any partial tear were 79.71%, 96.57% and 91.80%, for any rotator cuff tear were 83.33%, 96.25% and 91.80%, and for any tendinosis were 90.48%, 99.37% and 96.31% respectively. The sensitivity, specificity and accuracy of USG were 88.23%, 92.59% & 90.16% for long head of biceps tendon sheath effusion, 100.0% each for long head of biceps tendon dislocation, 71.11%, 87.50% and 75.41% for glenohumeral joint effusion, and 58.06%, 96.67% and 77.05% for bursal effusion respectively. From this study, it is concluded that high resolution USG showed high sensitivity, specificity and accuracy compared to MRI in detecting common shoulder abnormalities, and could be considered as the first line imaging modality in the evaluation of shoulder pain.

Role of Transabdominal Ultrasonogram for Evaluation of Placental Maturity in Relation with Fetal Gestational Age.

In this study our main goal is to evaluate the role of ultrasonography (USG) for determination of placental maturity and fetal gestational age. This cross-sectional study was done at the Department of Radiology and Imaging (USG section) Mymensingh Medical College and Hospital, Mymensingh from July 2008 to June 2010, where 60 patients included in this study, who was attending in the department of Radiology & Imaging for transabdominal ultrasonography with early and late pregnancy related complaints. In this study among the 60 patients, the youngest one was eighteen years and oldest one was thirty-nine years old age. Thirty five percent (35.0%) patients were from 26-30 years age group. About 33 patients out of 60(55.0%) were house wives. Most of the patients were presented with amenorrhea (65.0%) 39 out of 60. Among 60 patients, 20 patients (33.3%) were in gestational age within 12-28 weeks, 20 patients (33.3%) were in gestational age within 29-36 weeks and 20 patients (33.3%) were within >36 weeks gestational age. Among them, 20 patients (33.3%) had grade III placenta, 20 patients (33.3%) had grade II placenta, 12 patients (20%) had grade I placenta and 08 patients (13.3%) had grade 0 placenta. Out of 60 patients, 18 patients (30.0%) were in high risk group and 70.0% were normal. Six (6) patients (10.0%) suffered from HTN, 3 patients had RH negative (5.0%) blood group, 3(5.0%) patients suffered from APH, 3 patients suffer from DM and 3 from IUGR. In this study showed hypertension and IUGR had strong correlation with accelerated placental maturation. Maternal DM and Rh sensitization were associated with delayed maturation of the placenta. This study concludes that, USG appears to be the best imaging modality for the evaluation of placenta and its grading. USG is relatively less expensive and it is good considering the diagnostic accuracy in pregnancy profile. It is noninvasive procedure without any radiation hazards and better visualization of the lesion in different section, but this study is not a complete reflection of overall incidence and statistics regarding the ailment in our country. For this a more extensive study over a longer period covering different section of society is very much needed for better outcome.

Proportion and Pattern of Central Nervous System Involvement in Acute Leukemia on Diagnosis.

The most common malignant neoplasm in Childhood is Leukemia which is about 41% of all malignancies. Incidence of CNS involvement is less than 5% in Acute Lymphoblastic Leukemia and 6-29% in Acute Myeloblastic Leukemia at Diagnosis. For Successful treatment of childhood leukemia it is mandatory, to give sufficient therapy directed to the CNS to treat sub clinical or overt CNS Leukemia. Without Central Nervous System- Directed therapy, relapses originating from the CNS in up to 75% cases. For this purpose it is crucial to find out the CNS involvement in acute leukemia at diagnosis. This study was conducted to find proportion and pattern of central nervous system involvement (central nervous system manifestation and/or cerebrospinal fluid findings) in acute leukemia at diagnosis in Bangladesh. A cross sectional study was conducted from May 2012 to November 2012 in the Department of Pediatric Hematology and Oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Total 50 samples were included those having age <15 years newly diagnosed with acute leukemia by purposive sampling. Common age group 1-5 years (48%), 32 patients (64%) were male and 18 patients (36%) were female. Out of 32 male patients 4 patients presented with CNS manifestation and among 18 female patients 2 patients presented with CNS manifestation. There is no association between sex and CNS presentation (P value 0.89). 25 (50%) patients had total leukocyte count >11,000-1,00,000. Twelve (24%) patients had total leukocyte count <4,000. Eight (16%) patients had total leukocyte count 4,000-11,000, and rest 05(10%) patients had leukocyte count >1,00,000. Proportion of CNS manifestation was found 6/50 patients. Eight (8) patients were suffering from AML and 42 patients were suffering form ALL. Among 8 AML patients 1 (11.1%) patient had CNS manifestation and Among 42 ALL patients 5(11.1%) patients had CNS manifestation. Out of 6 patients with CNS manifestation, 2 (04%) patients presented with clinical manifestation, and 5(10%) had positive CSF findings. Pattern of CSF finding of 50 leukemic children CNS-1 90%, CNS-2 02%, CNS-3 08%, and no patients had traumatic lumber puncture with concomitant presence of blasts cells. There is significant association was found between hyper leukocytosis and CNS manifestation (p=0.138) but there is no statistically significant association between positive CSF findings and neurological findings (p=0.082). At conclusion, CNS manifestation is not uncommon (6/50 patients) was found in acute leukemia at diagnosis. So, every patient of acute leukemia should be examined carefully for CNS involvement along with CSF cytospin.

The HRCT Evaluation of 105 Suspected COVID 19 Patients of MMCH and RT-PCR Correlation.

In this study our main goal is to evaluate the HRCT evaluation of 105 suspected COVID 19 patients of MMCH and RT-PCR correlation. This experimental and observational study was done at Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from May 2020 to October 2020. Where 105 suspected COVID 19 patients of MMCH and RT-PCR correlation were included in the study. During the study, 43.05% of the patients exposed indirectly to the virus, followed by 44.1% didn't exposed any virus, 21% exposed directly. Diabetes mellitus was 35.7%, HTN - 46.2%, 82.95% had fever, 72.45% had cough, 78.75% had respiratory distress and 49.35% had no diseases. After CT scan diagnosis, positive to infection were found in 98 patients, among them 34 patients had mild type, 22 had severe type of infection where as in RT-PCR diagnosis 69 were positive and 36 were negative to infection. From our study we can conclude that, the most common pattern of COVID-19 pneumonia on HRCT images are pure GGO and GGO and Crazy Paving. Also GGO with consolidation with prominent distribution in the posterior and peripheral part of the lung. Further study is very much needed for better outcome.

Study on Endoscopic Retrograde Cholangiopancreatography.

Endoscopic retrograde cholangiopancreatography (ERCP) is a modern & universally established modality in the evaluation and treatment of suspected biliary and pancreatic disease. In Bangladesh, ERCP services are limited to few tertiary care centers mostly in the capital & large city. ERCP was 1st introduced in Mymensingh on 3rd April 2016 in a private hospital. Since then, Mymensingh Medical College Hospital (MMCH) provides ERCP services to a large volume of patients in collaboration with private center for diagnostic accuracy & therapeutic purpose. The aim of this study was to evaluate our experience in ERCP, to characterize & evaluate the aetiology, findings of ERCP & frequency of complications. This prospective type of study was carried out by the department of hepatology, MMCH from 3rd April 2016 to 10th July 2018 in collaboration with that private center where ERCP has been established. All patients undergoing ERCP during this period were included. Aetiology & findings were assessed at the time of ERCP & complications were assessed during procedure, index hospitalization & within 30 days after the procedure by telephone contact. A total of 301 consecutive ERCP were performed during the study period. Among them, 182(60.5%) were male & 119(39.5%) were female with an age range of 18-78 years. The most common indications for ERCP were: cholangiocarcinoma in 98(32.56%) & choledocholithiasis in 95(31.56%) followed by periampullary growth in 93(30.89%), suspected CBD stricture in 12(4%) & chronic pancreatitis in 2(0.66%). The most common findings were choledocholithiasis (32.56%), cholangiocarcinoma (32.56%), biliary obstruction due to periampullary growth (30.56%). Biliary fistula with distal bile duct stricture was found in (1.66%), bile duct stricture in (1.33%), chronic pancreatitis in (0.66%), and organic papillary stenosis with deformed bulb were discovered in (0.34%) case. All ERCPs were done for therapeutic purpose. Endoscopic sphincterotomy was the most common therapeutic procedure (87.04%) of which biliary stenting was done in (67.44%) & stone extraction in (33.71%). Stone extraction from biliary tree was successfully done in 94 cases (98.67%) but it was unsuccessful from biliary tree in 4 cases (1.33%) & also from pancreatic duct in a separate case. The most frequent complication was Post-ERCP pancreatitis in 9 patients (2.99%) followed by acute confusional state (1.33%). Post-ERCP cholangitis occurred in (0.99%) & death was reported in 2 cases (0.66%) due to anaesthetic hazard.

Comparison among Different Culture Media for the Detection of Dermatophytes.

Dermatophytes are a group of closely related fungi that have the capacity of invading the keratinized tissue of human to produce infections known as dermatophytosis which is commonly referred to as ringworm. Other than routine microscopy, different culture media are available for the detection of dermatophytes from patient's specimen. This cross sectional study was designed to evaluate the outcome of three different culture media and microscopy for the detection of dermatophytes from clinical samples. Skin, hair and nail samples from 84 clinically suspected cases of dermatophytosis who attended at OPD of Dermatology Department, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh from July 2014 to June 2015 were screened by direct microscopic examination using potassium hydroxide (KOH) mount. All the samples were inoculated for culture in Sabouraud's Dextrose Agar (SDA), Dermatophytes Test medium (DTM) and Sabouraud's Cycloheximide Chloramphenicol Agar (SCCA). The percentage of samples positive by microscopy was 37.5%, whereas the rate of positivity by culture was 47.6% which showed that culture was more sensitive than microscopy for the diagnosis of dermatophytosis. The efficiency of SDA and SCCA was found to be almost equal. There was no statistically significant difference between SDA and DTM in primary isolation of dermatophytes, though isolation rate was slightly higher in DTM. Though direct examination by microscopy is an efficient screening technique, culture should be done for accurate diagnosis. As DTM is easy to evaluate even without handling the growth of culture in the laboratory, it is recommended to use as screening medium for the detection of dermatophytes.

Sonographic Evaluation of Colonic Carcinoma in Comparison to Colonoscopy.

Colon cancer is one of the main causes of cancer death. Diagnosis requires the examination of the entire large bowel by means of radiological or endoscopic techniques. Though there is not a remarkable advancement in gastrointestinal (GI) tract evaluations, the modern radiological imaging methods emphasize the importance of ultrasonography (US) evaluations and stand US out as the scanning method in malignancies of the GI tract. The objective of this study is to investigate the role of ultrasonography in the diagnosis of cancers of the colon & it's accuracy in comparison to colonoscopy. This cross sectional analytical study included a total of 62 patients, including 38(61.29%) male and 24(38.71%) female patients who came at Mymensingh Medical College Hospital & Popular Diagnostic Center, Mymensingh from January 2013 to November 2015 & whose ultrasonography and endoscopic examinations were planned with suspicion of colon cancer. Considering the colonoscopic biopsy as a gold standard, the sensibility, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the ultrasonography were evaluated manually. All patients underwent ultrasonography and colonoscopy and results were compared with histopathologic diagnosis. Malignancy was histopathologically identified in 37(59.68%) patients. The sensitivity of ultrasound to identify colon cancer was 86.48%, its specificity was 84%, positive predictive value and negative predictive value was 88.89% & 80.77% respectively. The sensitivity of endoscopic intervention was 100%, its specificity was 96% and positive predictive value was 93.7%. Likewise, a series of analytical and clinical parameters were evaluated, in an attempt to establish associated factors of a colon cancer by means of the statistical package SPSS 13.0 for Windows. Therefore, we believe that abdominal ultrasonography which is non-invasive, easily accessible, cost-efficient method may detect a colonic mass or wall thickening consistent with a colonic carcinoma with a high degree of accuracy.

Primary extramedullary esophageal plasmacytoma - a case report.

Extramedullary plasmacytomas are very uncommon tumors, may occur commonly in the upper respiratory passages. These are rarely seen in the middle and lower gastrointestinal system and exceptional to originate in the esophagus. We present a novel case of a 65-year old man who presented with dysphagia and weight loss. After taking detailed clinical history and physical examination endoscopy was performed that showed an ulcero-proliferative lesion involving the lower third of esophagus. Histopathological examination revealed sheets of malignant plasma cells, some with prominent nucleoli. Immuno-histochemistry could not be done due to unavailability. A bone marrow biopsy was performed which was negative for involvement. This is a rare case of esophageal plasmacytoma diagnosed on endoscopy in a patient presenting with dysphagia.

Parotid gland metastasis - an unusual presentation of adenocarcinoma of lung.

Lung cancer is the most frequent malignant disease and the most common cause of cancer death in the world. Primary carcinoma of the lung was an uncommon cancer until the 1930s. Common cell types in bronchial carcinoma are squamous 35%, Adenocarcinoma 30%, Small-cell 20%, Large-cell 15%. We present a case of a bronchial neoplasm metastasis to the parotid gland. A 50 years old male patient presented with a 7×5cm painless parotid mass that was metastatic adenocarcinoma on histopathology. Then we thoroughly examined the patient and he was investigated accordingly. There was an abnormal shadow in the lung on chest x-ray, CT revealed a lung tumour on left side. Metastasis to the parotid gland from any distant primary site is quite unusual. We are going to present this case in the journal because of its rarity. Parotid gland metastasis from the lung is rare & if a careful examination is not performed primary focus may be overlooked, negatively affecting the lifetime survival rate & the prognosis of the patient.

Case report on carotid body tumor.

A 40 years old lady presented to us with the complaints of repeated attack of syncope with left sided neck swelling. Ultrasonography, Color Doppler study and arteriography were done which revealed a solid vascular mass in the carotid bifurcation. Mass was resected and histopathology was done. Histopathologic findings were typical of a carotid body tumour. As carotid body tumour is a rare disease. So, we are going to present this in this article.

A case of acute insulin poisoning with attempt to suicide.

A 18 years old girl with no known comorbidities was admitted in female medicine ward through the emergency department with rapid onset of semi consciousness due to hypoglycaemia (plasma glucose in admission was 2.0mmol/L). She had history of self-injection of insulin (regular insulin 300 units) subcutaneously in abdominal wall. However she didn't developed serious complications of hypoglycaemia and was subsequently discharged after conservative treatment.

Cirrhosis of liver and portal vein thrombosis - a review article.

Cirrhosis is characterized by diffuse hepatic fibrosis and nodule formation which can occur at any age with significant morbidity and is an important cause of premature death. Occlusive portal vein thrombosis (PVT) is common complication of chronic liver disease with prevalence ranging from 1% to 16% of population. The occurrence of portal vein thrombosis is influenced by local factors (cirrhosis with associated liver architectural changes and increased resistance effects), systemic factors (inherited and acquired abnormalities leading to hyper coagulability) and development of hepatocellular carcinoma. The majority of patients with cirrhosis PVT are diagnosed on radiographic studies although in some patients PVT may present with decompensated chronic liver disease but the natural history of PVT in patients with cirrhosis is largely unknown. However patients with cirrhosis and PVT have been shown to have inferior survival in comparison with patients without PVT.

Duodenal carcinoid tumor - a case report.

Carcinoid tumors are well differentiated neuroendochrine tumors which most frequently involve the gastrointestinal tract; however duodenal carcinoid tumors are rare. They can present with various clinical symptoms and are difficult to diagnose. A 52 years old lady presented with the symptoms of recurrent upper abdominal pain, burning sensation of whole body and passage of loose stool. On endoscopy of upper GIT, there was a duodenal polyp. Polyp was removed by endoscopic resection and tissue was taken for biopsy. Histological findings of biopsy specimen shows carcinoid tumor. As duodenal carcinoid tumor is a rare presentation so we are going to present this case in this article.

Clinical profile of 250 cases of amoebic liver abscess.

Liver abscess is an emergent public health burden with considerable morbidity. Its prevalence varies from country to country. This prospective study was carried out in the Department of Medicine, Mymensingh Medical College Hospital, Mymensingh and Sher-E-Bangla Medical College Hospital, Barishal, Bangladesh from January 2004 to December 2009 to asses clinical pictures of 250 cases of amoebic liver abscess. Majority of patients were male (84%) presenting with upper abdominal pain (96.8%). High grade fever was present in 74% cases. Vomiting & nausea in 29.2% while loss of appetite in 42% patients. Only 4% patients showed diarrhea. On examination, tenderness in right hypochondriac was the predominant signs (95%) associated with hepatomegaly in 80% cases. Seventy eight percent cases showed leucocytosis. Serum alkaline phosphatase was raised in 66% patients. Colour of the aspirate was chocolate/brown in 80% cases. It is our experience that although complications are found hardly, they may take a menacing course if diagnosed, managed or both at the eleventh hour.

Hepatocellular carcinoma metastasis to the tip of the coracoid process.

Hepatocellular carcinoma (HCC) is the commonest and the most frequent primary malignant tumour of the liver. Chronic hepatitis B is the most common cause of HCC. Metastatic HCC has an aggressive course and a poor outcome. Common sites of hematogenous metastasis are lungs, bones & adrenal glands. Involvement of vertebra, pelvis, rib & skull is reported but coracoid process of scapula is an extremely rare site of metastasis. Thus we are going to present an unusual site of metastasis of HCC to the tip of the coracoid process of left scapula which was presented as a nodular swelling over the lateral aspect of left shoulder. On examination viral marker revealed HBsAg positive & negative negative hepatitis C virus (HCV). Ultrasonography of abdomen revealed large, well defined, heterogenous mass measuring 12×7.5 cm in the left lobe of liver. Chest radiograph showed a small radio opaque shadow on the tip of the coracoid process of left scapula. Fine needle aspiration cytology (FNAC) was done from the nodule & cytological examination showed malignant hepatocytes & traversing endothelial cells resembling hepatocellular carcinoma.

A case of Gaucher's disease progressing to liver cirrhosis.

We are going to present a 17 year old female with Gaucher's disease. The patient presented with fever, cough, respiratory distress & abdominal heaviness. There was mild pallor, redness of palm of hands & raised temperature. Liver was hugely enlarged along with splenomegaly. X-ray chest showed non specific bronchiectatic change in both lungs. Ultrasonography of abdomen revealed marked hepatosplenomegaly with no ascites. Bone marrow examination showed cellular marrow with plenty of megakaryocytes. Most of the cells were smear cells & there was histiocytes proliferation & infiltration of bone marrow by small atypical cells. Histologically, lipid was found in hepatocytes in moderate amount. The portal areas showed high lipid contents in macrophages. Different clinical findings & incidental diagnosis of lipid storage disease submerged us in diagnostic dilemma. We give conservative treatment with antibiotic cefuroxime, syrup lactulose & vitamins and this patient was improved.

A 10 year old boy with rectal carcinoma.

A 10 year old boy with mucinous carcinoma of rectum is a rare case at this age. Here the patient presented with constipation, mucus in stool & abdominal pain since one month. He got consultation from several physicians & went through sonology of whole abdomen several times. There he was missed diagnosed as a case of pyloric stenosis. We came to a probable diagnosis by doing simple digital rectal examination which seemed to be a hard rectal swelling. The diagnosis was established by colonoscopy followed by biopsy. Carcinoma rectum must be considered as a differential diagnosis if patient presents with altered bowel habit, per rectal bleeding, abdominal pain in conjunction with weight loss.

Ultrasonographic evaluation of morphologic pattern of amoebic liver abscess.

We evaluated sonographically 250 cases of amoebic liver abscess (ALA). Seventy eight percent (78%) of the ALA was located in the right lobe of the liver and 15% in the left lobe and rest of the abscesses occupied both lobes. ALA was round in 50% and oval in 40% of the cases without significant wall echoes. Eighty eight percent (88%) of these were inhomogeneous. Twenty one percent (21%) of these lesions was contiguous with the liver capsule. Post therapy sonographic evaluation showed that there was complete resolution of the abscesses within one year in 90% cases, other showed residual abnormalities in the form of hypoechoic in 7% and hyperechoic in 3% cases. We concluded that serological and clinical data in combinations with these non specific sonographic features are sufficient for the management and follow up of ALA obviating the need for expensive and invasive techniques in most of the cases.

POEMS Syndrome.

A 49 years old male patient admitted with 2 years history of lower extremity symmetrical sensorimotor polyneuropathy, sclerodermic skin change, erectile dysfunction, hepatosplenomegaly and monoclonal gammopathy. The clinical evaluation met the criteria for the diagnosis of (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, skin changes) POEMS syndrome. The patient was treated with corticosteroid and melphelan and responded well. We present a case different from the other cases with severe unusual burning sensation all over the body, which was his sole complaint and with this complaint he visited lot of doctors including psychiatrist.

A 12 years old boy with carcinoma rectum.

Primary gastrointestinal malignancy constitutes approximately 2% of pediatric neoplasm and colorectal carcinoma is the second most common malignancy among them. This is one of the rarer diseases in children. Carcinoma of the rectum must be considered as a differential diagnosis in childhood if patient presents with per rectal bleeding in conjunction with abdominal pain & weight loss. In our article a 12 years old boy with Mucin secreting adenocarcinoma is being presented. The patient presented with incontinence of stool, with abdominal pain and history of swelling of left lower abdomen during defaecation. He got admitted in a district hospital for several times and USG of whole abdomen was done for several times but no abnormality was detected. Later on, by simple digital rectal examination (DRE) he was clinically diagnosed as a case of CA Rectum and eventually, the diagnosis was established by colonoscopy followed by biopsy.