Modified Snodgrass Urethroplasty for Distal Penile Hypospadias: Our Experience at BSMMU Hospital.

Hypospadias is a developmental defect of male urethra characterized by absence of meatal opening at the tip of glans but is present at the ventral surface of penis anywhere along the shaft, even in the perineum. Usually this defect is associated with ventrally curved penis. Surgery is the single option to correct this birth defect. More than 300 techniques have been developed but none is universally acceptable as because, surgery is usually associated with fistula. Rate of fistula formation varies from technique to technique. Now a day, Snodgrass technique is widely practiced because of its low rate of fistula formation. Many factors are responsible for this post-operative complication. Most important one is developmentally defective ventral penile skin where some local factors like vascular and collagen tissues are insufficient. This observational study was performed to evaluate the role of dorsal vascular flap over the neourethra following urethroplasty by Snodgrass technique in terms of post-operative fistula formation in the Department of Paediatric Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from March 2018 to March 2020. A total of 39 patients with distal penile hypospadias were included in this study. All underwent Snodgrass urethroplasty with additional dorsal vascular flap over the neourethra to support this ventrally deficient local factor. The outcome in terms of post operative urethrocutaneous fistula was evaluated. Only two patients (5.15%) developed urethrocutaneous fistula. In conclusion, addition of dorsal vascular flap over the neourethra by Snodgrass technique reduces the rate of the fistula formation.

Impact of Myocardial Blush Grade on In-Hospital Outcome after Primary Percutaneous Coronary Intervention.

Primary percutaneous coronary intervention (PPCI) is the optimal reperfusion strategy in patients with ST elevation Myocardial Infarction (STEMI). However, despite achieving TIMI 3 flow after PPCI, some patients have less optimal perfusion at the myocardial tissue level, as assessed by Myocardial Blush Grade (MBG) and consequently show adverse outcome. This prospective observational study was performed in the National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh from March 2016 to February 2017. Total 74 patients with STEMI who underwent primary PCI and achieved TIMI 3 flow were included among them 37 patients were taken with low MBG (grade 0 or 1) in Group I and other 37 patients with high MBG (grade II or III) were taken in Group II. Mean age of Group I and Group II were 53.70±9.17 and 51.49±9.41 years respectively (p=0.536). Male to female ratio was 5.7:1. Smoking (59.5% versus 35.1%, p=0.036) and diabetes mellitus (43.2% versus 18.9%, p=0.024) were significantly higher in low MBG group than high MBG group. Multi vessel involvement (24.3% versus 5.4%, p=0.022) and anterior MI (72.9% versus 51.4%, p=0.047) were significantly higher in low MBG group. LVEF was significantly lower in low MBG group than high MBG group (49.92?6.60% versus 58.84?4.55%, p=0.003). Among the complications acute heart failure was found significantly higher in low MBG group than high MBG group (8.1% versus 0.0%, p=0.048) along with total adverse in hospital outcome (24.3% versus 5.4%, p=0.041). In study population total mortality was 2.7% and all were in low MBG group (5.4%). Multivariate logistic regression analysis showed MBG was an independent predictor of adverse in hospital outcome after PPCI (OR 6.553, 95% CI 1.984-21.643, p=0.002). Low MBG is associated with more adverse in hospital outcome after PPCI. So, along with TIMI 3 flow following PPCI we have to assess MBG for evaluation of complete reperfusion and further outcome.

Neurofibrosarcoma of the Subglottis-A Rare Case Report.

A frazzled man in his early thirties presented with a 4 year long history of frequent progressive airway obstruction. He had undergone two open laryngeal surgeries and multiple endolaryngeal procedures for excision of a subglottic lesion which recurred. Each time the histopathology showed a different entity ranging from hemangioma and fibrihystiocytic lesion and spindle cell carcinoma. Finally the case was proven to be an intermediate grade sarcoma of neurogenic origin. He underwent widefield laryngectomy with placement of Provox-2 prosthesis followed by radiotherapy. Five years following surgery, he is progressing well. The case is being reported for its rarity and also for the histogenetic problems associated with this group of lesions. Authors found only one other case of laryngeal neurofibrosarcoma that was reported 29 years back [3].

Tuberculous otitis media.

Tuberculosis is one of the most common infectious diseases of developing countries including Bangladesh. It rarely affects the middle ear. The objective is to review the literature on tuberculous otitis media and know the facts, incidence, etiology, clinical presentation, investigations and treatment of tuberculous otitis media. It is characterized by painless otorrhoea which fails to respond to the usual antimicrobial treatment, in a patient with evidence of tubercle infection elsewhere followed by multiple tympanic membrane perforations, abundant granulation tissue, and bone necrosis, preauricular lymph node enlargement. Loss of hearing is also found in patients with development of the diseases seen by the otoscopy. Combination chemotherapy is prescribed. Surgery may be required in some cases to remove sequestra and improve drainage. A high level of clinical suspicion is needed for early diagnosis and antitubercular therapy should be started as soon as possible to prevent the possible complication.

Fiber Bragg grating sensor for monitoring bone decalcification.

INTRODUCTION: Estimation of decalcification is a vital tool to discern bone health. Different techniques are used for its quantitative measurement, e.g. DEXA, QCT & QUS. All these techniques, although noninvasive, suffer from limitations such as radiation exposure and inaccurate values. Recently, fiber optic techniques are fast emerging for medical applications owing to their various attractive features like immunity to EMI/RFI, geometric versatility, chemical inertness, etc. MATERIAL AND METHODS: The effect of decalcification on strain response of a goat tibia was investigated in vitro using fiber Bragg grating (FBG) sensing technique. The bone was strained by using three-point bending technique and corresponding Bragg wavelength shifts were recorded. Two similar bone samples from the same animal were taken and one was partially decalcified. Strain response of decalcified and untreated bone was taken concurrently to monitor the effects of calcium loss and that of degradation with time. RESULTS AND CONCLUSION: The strain generated for same stress increased with greater degree of decalcification and a steep increase occurred after 2g calcium loss, indicating the onset of damage. The strain response, therefore gives a direct indication of the degree of calcium present in the bone. LEVEL OF EVIDENCE: Level III.

A ten year clinicopathological study of female genital tuberculosis and impact on fertility.

INTRODUCTION: To determine the histological pattern of involvement, clinical presentation, impact on fertility in women with genital tuberculosis. METHODS: A total number of 68 cases of gynaecological tuberculosis affecting different parts of female genital tract from 56 patients were selected. The age range of the patients was 17-36 years with mean age of 25.6 years. The diagnostic procedures used included endometrial curettage and biopsy, histopathological examination, culture and Mycobacterium Tuberculosis Polymerase Chain Reaction (MTB PCR), laparoscopy, Hysterosalpingography (HSG) and Ultrasonography (USG). Most of the specimens received were biopsies of endometrial curettage for evaluation of infertility. In 7 cases, specimens of total hysterectomy with bilateral salpingo-oophorectomy were submitted with lesions involving multiple sites. RESULTS: Patients presented with infertility (65-70%), pelvic/abdominal pain (50-55%), and menstrual disturbances (20-25%). Tuberculosis involved the endometrium in 55.88%, tubes in 23.53%, ovaries in 14.71% and cervix in 5.88% of the 68 cases. The endometrium(38 cases)was in the proliferative phase in 31 cases (81.57%), secretory phase in 4 cases (10.52%) and it was atrophic in 3 cases (7.89%).Caseation was present in 9 out of 68 cases and Ziehl-Neelsen (ZN) stain revealed Acid Fast Bacilli (AFB) in tissue sections in only 4 cases . After therapy, 9 patients conceived of which 8 suffered spontaneous abortions. Only one patient had a successful pregnancy and the baby was born through caesarean section. CONCLUSIONS: Genital tuberculosis is an important cause of female infertility in developing countries like India, Nepal, Bangladesh and Pakistan. Successful uterine pregnancy is rare after treatment and chances of ectopic pregnancy are high.

Hydatid cyst of radial bone.

Hydatidosis is a parasitic disease caused by Echinococcus granulosus or, less frequently Echinococcus multilocularis. The liver and lungs are most often affected; hydatid disease of radius without involvement of other sites is extremely rare. Osseous hydatid disease should be included in the differential diagnosis for cystic lesions of bone. The diagnosis of bone hydatidosis is primarily based on radiological and histopathological findings. Here we present a case of hydatid cyst in the lower third of radius in a 34-year old woman. The cysts were removed with wide excision and post-operative albendazole was given. No recurrence was observed on two years follow-up.

Observations of hepatic encephalopathy profile in a tertiary care centre.

A study was conducted among 67 patients presenting with hepatic encephalopathy to establish the aetiological diagnosis and record the incidence of acute and chronic liver diseases. They all had undergone thorough clinical and laboratory evaluation. The factor precipitating encephalopathy was also identified. Among 67 patients 19 (28.4%) had acute liver disease and 48 (71.6%) had chronic liver disease. Majority of patients had grade 2 encephalopathy at presentation. Among the acute cases most common aetiology was acute viral hepatitis due to hepatitis B and E viruses whereas alcoholic liver disease was the most frequent cause of chronic liver disease. The most common precipitating factor was gastro-intestinal haemorrhage.

Sinonasal tuberculosis in diabetics : An unusual presentation and diagnosis.

Sino-nasal Tuberculosis constitutes 5-6% of Head & Neck tuberculosis1. We present two cases of sino-nasal tuberculosis in diabetic hosts not only due to the clinical rarity and unusual presentation as in one case which presented with subperiosteal abscess, but also to emphasize on the effective modality of management which constituted transnasal endoscopic clearance supplemented with antitubercular regimen.

Cancer of the NES complex (Nasal Cavity, Ethmoid, Sphenoid Sinuses): A retrospective review.

During the period January 1983 to September 1993, 36 patients of Nasal Cavity, Ethmoid / Sphenoid Sinus Cancers were treated at Radiotherapy Department, Medical College. Calcutta. All were treated by irradiation alone. Local control was achieved in about 50% of cases at 6 weeks following completion of treatment. Informations with respect to tumour extension to suspected areas of spread, are very much necessary for accurate Radiotherapy treatment planning and for this reason C.T. Scan imaging is mandatory in pre-treatment work-up of NES Complex cancers. Precision Radiotherapy with utmost care to avoid or lessen Radiation dose to optic nerve, is the most suitable method of treatment for our patients. Stringent and prolonged follow-up necessary to know the treatment outcome as the tumours of NES Complex are characterised by 'delayed recurrence'.

Risk behavioural practices of rural mothers as determinants of childhood diarrhoea.

Maternal behaviours related to certain child care practices which possibly have a contributory role in causation of diarrhoea in children were studied. Comparison was made between behaviours of mothers in 108 families having diarrhoeal children (Case families) with mothers of 72 families having age and neighbourhood matched non diarrhoeal children (control families) using a logistic regression model. Five risk behaviours were identified and these are bottle feeding (OR-2.87; CI-1.30 to 6.34), non-use of soap for cleaning feeding container (OR-2.61; CI-1.30 to 5.23), water storage in wide-mouthed container (OR-2.75; CI-1.27 to 5.96), use of pond water for the same (OR-2.36; CI-1.15 to 4.84) and indiscriminate disposal of children's stool (OR-1.99; CI-0.97 to 4.08). Around 83 per cent of diarrhoeal families could be predicted using these five variables only. The first three of these five risk behaviours were responsible for occurrence of significantly higher incidence (3 or more episodes) of diarrhoea in the case families. All these risk behaviours are amenable to change if suitable intervention is initiated. The result of this study would be helpful in reducing diarrhoea associated morbidity to a substantial level.

PIP: A number of studies have documented the existence of a relationship between certain behavioral practices at the family level and an increased incidence of diarrhea among children. Findings are reported from a study in which mothers' behaviors in diarrheal and control families were compared to selected child care practices which may help cause diarrhea in children. The authors compared the behaviors of mothers in 108 families having children with diarrhea (case families) with mothers of 72 families having age and neighborhood matched nondiarrheal children (control children) using a logistic regression model. The following risk behaviors were observed: bottle feeding, non-use of soap for cleaning feeding containers, water storage in wide-mouthed containers, the use of pond water for the same, and the indiscriminate disposal of children's feces. 81.5% of diarrheal families could be predicted using only these 5 variables. The most significant risk behavioral practices of mothers were bottle feeding, non-use of soap for cleaning feeding containers, and drinking water storage in wide-mouthed containers. All of these risk behaviors are subject to change if exposed to the appropriate interventions.

Review on development and community implementation of oral rehydration therapy.

The review of the current status and implementation of Oral Rehydration Therapy at the community level have been presented in this communication with special emphasis on its development, ORS access rate, ORS use rate and home available fluids. The global ORS supply has gone up an increased eleven folds since 1981. Similarly the ORS access rate has also increase from 46% to 68% in 1991. However, the global ORS use rate was low (21%). The major constraints during ORT implementation which have been reported by several scientists are also discussed.

PIP: Dehydration is the major reason children die from diarrhea. The key element of the WHO Diarrhoeal Disease Control (CDD) Programme is implementation of oral rehydration therapy (ORT). ORT implementation includes production and distribution of packets of oral rehydration salts (ORS), training of medical and paramedical personnel and education of mothers, and operational/health services research for identification of suitable strategies for implementation. Most ORT-related research has been done in hospitals. Community health workers in India have been given ORS packets to use to treat diarrhea cases at home. Operational research in India shows that volunteer health guides can train mothers to give available and culturally acceptable home fluids to children with mild diarrhea before dehydration develops. Use of home available fluids greatly reduces the need for ORS packets. Another possible alternative to ORS was sugar salt solution (SSS) or household formula, but research shows that mothers tend to prepare SSS inaccurately. The success of the CDD program depends on ORS production and proper distribution. In India, more than 100 companies produce about 130 different commercial ORS products, indicating a need for quality control. The best indicators to evaluate India's CDD program are ORS access and ORT use rates. In India, the 1991 ORS and ORT use rates were only 7% and 14%, respectively. The approach to ORT in India is mothers should treat children with diarrhea with no dehydration, village level workers should manage dehydrated patients with ORS, and health professionals at the nearest health facility should treat severely dehydrated patients with either ORS or intravenous fluids. ORT has reduced child mortality in India from 1.9% to 0.6%. Major barriers to ORT implementation are scarcity of resources, lack of political commitment, managerial and organizational problems, and problems related to community participation, health personnel, and dissemination of information.