Role of Serum Triglyceride to Detect Severity and Outcome in Acute Pancreatitis.

Though hypertriglyceridemia is an established risk factor for acute pancreatitis, the relationship between hypertriglyceridemia and pancreatitis-associated complications remains controversial. Serum triglyceride could be a simple, routinely available investigation if predictability of the outcome can be validated. Due to scarcity of related studies in Bangladesh, this study aimed to evaluate the role of serum triglyceride to detect severity and outcome in acute pancreatitis. This prospective observational study was conducted in the Department of Gastrointestinal, Hepatobiliary and Pancreatic Disorders (GHPD), BIRDEM General Hospital, Dhaka from April 2019 to January 2021. A total of 153 patients with confirmed diagnosis of acute pancreatitis were selected as study cases according to selection criteria. Detailed clinical and demographic history of each patient was taken along with physical examination and relevant investigations. Developed complications and mortality were also assessed during hospital stay. Collected data were checked for errors and analyzed by using the statistical software SPSS 23.0. The mean age ±SD of the study population was 46.72±13.43 years with a majority in age group 41-50 years (30.10%). About 51.60% patients were male and 48.40% patients were female. Higher frequency of severe cases of acute pancreatitis (according to Glasgow score, BISAP score and Ranson score) was observed in patients with hypertriglyceridemia than patients with normal triglyceride with statistical significance (p<0.05). Mortality and complications were also more frequent in patients with acute pancreatitis with statistical significance (p<0.05). With a cut off value of 218mg/dl, serum triglyceride showed 68.66% sensitivity, 66.28% specificity and 67.32% accuracy for predicting outcome of acute pancreatitis. Findings of this study suggest that serum triglyceride might play a recommendable role in predicting the severity and outcome of patients with acute pancreatitis. However, further extensive study is recommended.

Evaluation of pain and physiological stress during targeted neonatal echocardiography.

BACKGROUND: Targeted neonatal echocardiography (Tn-Echo) is a non-invasive examination which may cause pain/discomfort and physiological instability in neonates, but there is little evidence for the same. We conducted this study to evaluate whether targeted neonatal echocardiography causes pain or physiological stress to newborn infants. METHODS: This cross-sectional study was conducted in a tertiary level NICU. Neonates undergoing targeted neonatal echocardiography were enrolled in this study. Pain was assessed using Premature Infant Pain Profile-Revised (PIPP-R) score before, during and after targeted neonatal echocardiography examination. Heart rate, oxygen saturation, perfusion index and blood pressure were also recorded at the same time points. RESULTS: A total of 88 neonates were enrolled. Mean (SD) PIPP-R score during Tn-Echo was 8.18 (2.6) versus 3.60 (1.8) and 4.24 (2.0) before and after respectively (p value < 0.001). Heart rate and respiratory rate were significantly higher during targeted neonatal echocardiography; oxygen saturation and perfusion index were significantly lower during targeted neonatal echocardiography. Preterm infants had higher PIPP-R score compared to term neonates before, during and after the Tn-Echo [8.76 (2.4) versus 6.81 (2.4); p value < 0.001]. CONCLUSION: Targeted neonatal echocardiography causes significant pain/discomfort and physiological instability in neonates.

Psychotic Symptoms in Dissociative (Conversion) Disorder in Two Tertiary Care Hospitals in Bangladesh.

Dissociative (conversion) disorder (DCR) has a long and controversial history. Some authors wish to classify it with somatoform disorders separate from dissociative disorders; many researchers keep it with DCR. Symptoms pattern also varies in different cultures. This study used the criteria of International Classification of Diseases Tenth Edition (ICD-10). Study was aimed to see the presenting symptom profile of dissociative (conversion) disorder more focusing on psychotic symptoms in tertiary care hospital in Bangladesh. This cross sectional observation was carried out in two different tertiary care hospitals in Dhaka city with preformed pretested questionnaire. Data were collected from 100 consecutive patients from July 2005 to June 2006 and data were analyzed by Statistical Package of Social Science (SPSS) 16.0. Pattern of dissociative (conversion) disorder indicated that symptoms presentations are different in Bangladesh which is difficult to categorize using existing criteria of ICD-10. Among 100 consecutive patients diagnosed as dissociative (conversion) disorder 13 patients had psychotic symptoms. Psychotic presentation of conversion disorder often creates doubts among the clinicians. Careful history taking, identifying the underlying psychosocial stressors will help clinicians to diagnose them accurately. It should be noted that the pattern of presentation in South Asia may be different due to role of culture on symptoms presentation in this region.

Substance Use among the Patients with First Episode Psychosis.

Substance Use Disorder is a frequent problem in Bangladesh and many of these patients develop psychosis. Substance use can cause psychosis and it can modify the course of psychosis. This cross-sectional study was done to see the proportion of substance use in patients with First-Episode Psychosis (FEP) in two tertiary care hospitals in Dhaka, Bangladesh mentioned here as Bangabandhu Sheikh Mujib Medical University and Dhaka Medical College Hospital; from November 2007 March 2009. Fifty consecutive FEP patients were taken as subjects and 50 healthy attendants were recruited as control. Mean age of the patients was 27.24, male (62%) are more having first-episode psychosis than female (38%). Majority of the patients were unmarried (64%). Regarding occupation students were 34%, followed by unemployed 24% and service18%. In control group's occupation; service 34%, housewife 22%. Life time substance use was found double in patients with first-episode psychosis than control. Cannabis was found to be the most common substance causing psychosis. Among the lifetime substance users in fist-episode psychosis patients 77.78% were male where as, in control group 100% patients were male. However, the researcher did not find any of the first-episode psychosis patients taking current use of substance (abuse and /or dependence). The small size of the present study was only 50. Future prospective study is required having large sample size to see the outcome of substance use in first-episode psychosis.

Subtypes of dissociative (conversion) disorder in two tertiary hospitals in Bangladesh.

Dissociative (conversion) disorders are common among the patients attending in and out patients of Psychiatry Department of tertiary hospitals in Bangladesh. This study was done to see the subtypes of dissociative (conversion) disorder according to International Classification of Diseases, Tenth Revision (ICD-10). This is a descriptive, cross sectional study done on 100 consecutive patients from the Departments of Psychiatry, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka and Dhaka Medical College Hospital (DMCH). Study period was July 2005 to June 2006. Among the patients of dissociative (conversion) disorder, mixed dissociative (conversion) disorder was found highest 34%, followed by dissociative convulsion 33%, dissociative motor disorders 19%, dissociative anaesthesia and sensory loss 5%, dissociative amnesia 4%, dissociative fugue 3%. However, the researcher did not find any multiple personality disorder which is relatively common in North America. This finding reflected that there are differences in prevalence of sub types of dissociative disorders in Bangladesh and Western countries.