Chest HRCT Severity Scores among Hospitalized Patients with COVID-19.

Corona Virus Disease 2019 (COVID-19) was declared a pandemic in March 2020. This global health crisis caused thousands of pneumonia related death all over the world since December 2019. RT-PCR is the primary test for diagnosis of COVID-19, though its sensitivity and specificity is variable. Several studies revealed that chest HRCT complements RT-PCR in highly suspected cases or in false negative RT-PCR and helps to gauge disease severity. This study was carried out with an aim to find out the severity scores of chest HRCT in hospitalized patients with COVID-19. This cross sectional descriptive type of observational study was carried out at COVID-19 unit of Sylhet Women's Medical College Hospital, Bangladesh from April 2021 to September 2021. Data were collected from purposively selected 204 patients with COVID-19 by face to face interview, chest HRCT and necessary laboratory investigations. Informed written consent was taken from the participants of the study at the beginning of the interview. Data were analyzed by using SPSS version 21.0. The results of the study showed that mean age of the patients with COVID-19 was 57.9 years with a standard deviation of ±15.8 years. Majority of them (121, 59.3%) were female and the remaining (83, 40.7%) were male. Regarding co-morbidities it was found that each 115 (56.4%) patients were hypertensive and diabetic. Thirty five (16.2%) had ischemic heart disease; 3(1.5%) had congestive cardiac failure and 2(1.0%) had asthma. One (0.5%) patient has atrial fibrillation. In case of 160(78.4%) RT-PCR confirmed patients with COVID-19, chest HRCT was found positive and in 44(21.6%) it was found negative. Among the positive cases mild (7 or less) chest HRCT score was found in 26(12.7%) patients; moderate (8-17) score was found in highest number of patients (128, 62.7%) and severe (18 or more) chest HRCT score was found in 6(2.9%) patients with COVID-19. Chi-square test was carried out to assess the relation of chest HRCT scores with age group, sex, troponin-I, D-Dimer and clinical outcomes within CCU but statistically significant relation was not found (p>0.05). The negative scans were highest (20, 9.8%) in the age group of 41-60 years. Mild, moderate and severe chest HRCT scores was found highest in the age group of 61-80 years (13, 6.4%; 51, 25.0% and 5, 2.5% respectively) (p=0.508). Chest HRCT scans were negative in 18(8.8%) male and 26(12.7%) female. Mild scores were equally distributed between each sex i.e. male 13(6.4%) and female 13(6.4%). Both moderate and severe scores were found more in female (77, 37.7% and 5, 2.5% respectively) than male (51, 25.0% and 1, 0.5% respectively) (p=0.492). Negative chest HRCT scans, mild, moderate and severe scores-all were found more in patients with elevated D-Dimer (p=0.194). Among 204 patients one (0.5%) died in the CCU who had mild score of chest HRCT (p=0.076) but highly elevated Troponin-I (21.70ng/mL). Chest HRCT was found positive among 78.4% of patients with COVID-19 confirmed by RT-PCR. Chest HRCT can help physicians to detect suspected cases and to assess the severity and outcome of the disease. However, further research is recommended to clarify the role of chest HRCT in assessing severity of COVID-19 and prediction of prognosis.

Variations in the Position of Vermiform Appendix in Bangladeshi People.

This cross sectional descriptive study was performed on 70 postmortem vermiform appendices (male 34 and female 36) to find out the various positions of vermiform appendix of Bangladeshi people. The specimens were collected from autopsy laboratory of the Department of Forensic Medicine, Mymensingh Medical College, Mymensingh, Bangladesh by purposive sampling technique from October 2016 to March 2017. The collected samples were divided into four age groups. They were Group A (upto 20 years), Group B (21 to 40 years), Group C (41 to 60 years) and Group D (above 60 years). Dissection was performed according to standard autopsy technique. During postmortem examination abdominal cavity was routinely exposed by classical midline incision from xiphoid process to the symphysis pubis and a semicircular incision around the umbilicus and the flaps were reflected to give a good view of the abdominal cavity along with its contents and then the taeniae coli of the caecum were identified. The three taeniae coli of the caecum converge at the base of the appendix and become its longitudinal muscle coat. The anterior caecal taeniae coli acts as the best guide for identification of the vermiform appendix. The relation of the base of the appendix to the caecum is constant but the position of the vermiform appendix, which is variable, was studied in relation to caecum and the terminal part of the ileum. Accordingly the position of the vermiform appendix was noted either retrocaecal, pelvic, preileal or postileal, subcaecal. All data were recorded in the predesigned data sheet, analyzed by SPSS program (version 21, 2012) and compared with the findings of other national and international studies and standard text books. Among 70 specimens, 44(62.9%) vermiform appendices were retrocaecal in position. The next common position was pelvic which was in 22(31.4%) specimen followed by postileal in 3(4.3%) specimen and subcaecal was observed only in 1(1.4%) specimen. In this study in all age groups incidence of retrocaecal vermiform appendix was highest and it was about 67.6%, 50%, 69.2% and 72.7% in Group A, B, C, D respectively. Pelvic position was 7.1%, 46.9%, 23.1% and 27.3% in Group A, B, C, D respectively. Subcaecal vermiform appendix was absent in Group A, B and Group D. On the other hand postileal vermiform appendix was absent in Group C and Group D. The findings of this study may help the physician and the surgeons for proper diagnosis, management and treatment of disease of vermiform appendix.

Length of Vermiform Appendix in Bangladeshi People of Different Age and Sex.

A cross sectional descriptive study was performed on 70 postmortem vermiform appendix (male 34 and female 36) to find out the length of vermiform appendix of Bangladeshi people in different age and sex. The specimens were collected from autopsy laboratory of the Department of Forensic Medicine, Mymensingh Medical College, Mymensingh, Bangladesh from October 2016 to March 2017 by purposive sampling technique. The collected samples were divided into four age groups. They were Group A (upto 20 years), Group B (21 to 40 years), Group C (41 to 60 years) and Group D (above 60 years). Dissection was performed according to standard autopsy techniques. The vermiform appendix was collected and preserved in 10% formol-saline solution. The length of the vermiform appendix was determined by measuring the distance from its base to tip with the help of a flexible thread. Then the thread was placed on measuring scale graduated in centimeter which represents the length of vermiform appendix. The data were analyzed by using student unpaired 't' test and compared with the findings of other national and international studies and standard text books. It was observed that length of vermiform appendix gradually decreased as age advanced. The mean±SD length of vermiform appendix was 9.41±1.26cm, 8.63±1.32cm, 7.96±1.20cm and 6.81±0.75cm in Group A, B, C and D respectively. Mean length of vermiform appendix in male was 9.92±1.55cm in Group A, 9.09±1.19cm in Group B, 8.04±1.10cm in Group C, 6.88±0.86cm in Group D and in female mean length of vermiform appendix was 9.12±1.06cm in Group A, 8.31±1.34cm in Group B, 7.79±1.60cm in Group C, 6.69±0.63cm in Group D. Statistical analysis shows that the mean differences of the length of vermiform appendix between A & D, B & D were statistically highly significant. The mean difference between Group A & C was moderately significant. Between Group C & D the difference was statistically significant and between Group A & B, B & C were statistically non significant. No significance difference of length of vermiform appendix between male and female was observed. The present study will help to increase the information pool on the length of vermiform appendix of Bangladeshi people.

Challenges in HbA1C Level as a Diagnostic Tool of Diabetes and Pre-Diabetes in Middle-Aged Population: The Bangladesh Study.

Worldwide prevalence of diabetes is found to be the human health at an alarming rate. However, large numbers of patient remain undiagnosed. Oral glucose tolerance test (OGTT) still is regarded as gold standard in diagnosis of blood glucose abnormality. Although the less number of bodies are considering measurement of HbA1C as an alternate tool to identify risk group. This study was undertaken to evaluate the role of measurement of HbA1C in the diagnosis of diabetes and pre-diabetes in middle-aged Bangladeshi subjects and carried out in the department of Biochemistry, BIRDEM from July 2013 to June 2014. A total 177 subjects of age within the range of 30-45 years were selected for the purpose and classified into healthy control (n=62) pre-diabetes (n=69) and diabetes (n=46) groups based on the values of OGTT. Middle aged Bangladeshi subjects attending Bangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) hospital, the HbA1C values were 5.0-5.6% in control group, 5.6-6.2% in pre-diabetes and 8.1-9.7% in diabetes group (95% CI). The optimal cut-off value of HbA1C related to pre-diabetes diagnosed by OGTT was 5.6%, which showed the sensitivity 47.8%, specificity 74.2%, positive predictive value 67.3% and negative predictive value 58.5%. Variants of hemoglobin especially Hemoglobin E (HbE) is prevalent in South East Asia including Bangladesh. The presence of genetic variants of hemoglobin can profoundly affect the accuracy of HbA1C measurements. So measurement of HbA1C may not be used as an alternate tool of OGTT to identify people of diabetes and pre-diabetes in certain situation.

Serum Calcium Status among Pregnancies Complicated By Pre-Eclampsia in Bangladesh.

This case control cross sectional study was carried out in the department of biochemistry, Mymensingh medical college in collaboration with the outpatient department, family planning model clinic and antenatal obstetric ward of Mymensingh medical college hospital, Mymensingh during the period of July 2003 to June 2004. The aim of the study was to explore the status of serum calcium among pregnancies complicated by pre-eclampsia in Bangladesh as a means to monitor the possibility of management of these patients. A total of 82 subjects were selected and were grouped as Group I (32 healthy women with uncomplicated pregnancy as control subjects) and Group II (50 pregnant women with pre-eclampsia as cases). Serum calcium was estimated by colorimetric method from each sample. Statistical analysis was done by using SPSS windows package. Among the groups, mean±SD (Standard Deviation) of Group I and Group II serum calcium were 8.71±1.00 and 10.78±1.44 mg/dl respectively. By comparing Group I with Group II highly significant difference were found in case of serum calcium (P<0.001). It is evident from the study that serum calcium level significantly increases among pregnancies complicated by pre-eclampsia in Bangladesh.

An evaluation of serum magnesium status in pre-eclampsia compared to the normal pregnancy.

Pre-eclampsia is a disease which causes significant maternal and fetal morbidity and mortality, especially in the developing countries. Despite numerous studies, the etiology of pre-eclampsia has not yet been fully elucidated. Although several evidences indicate that various elements such as serum Magnesium, Calcium etc. might play an important role in pre-eclampsia. The present study prospectively determines and evaluate whether maternal serum levels of magnesium has any association with pre-eclampsia or not. It was a cross sectional study carried out in the Department of Biochemistry, Mymensingh Medical College from July 2009 to June 2010. A total of 108 subjects were selected with the duration of pregnancy from 28th week of gestation to term of which 42 were normal pregnant women (as control) and 66 were pre-eclamptic (34 with mild and 32 with severe preeclampsia) admitted in the Obstetrics and Gynaecology department of Mymensingh medical college hospital. Serum Magnesium level was determined in the laboratory by colorimetric method using recommended commercial kit. Student's unpaired t-test was used to see the statistical significance of the difference between the mean values of the estimated parameters. The mean serum levels of Magnesium in normal pregnant group was 1.91±0.08mg/dl, mild pre-eclamptic group was 1.8±0.11mg/dl,and in severe pre-eclamptic group was 1.75±0.10mg/dl. The mean serum Magnesium of women with mild pre-eclampsia as well as severe pre-eclampsia was significantly (p<0.001) decreased in comparison to that of the control. A significant (p<0.05) decrease in serum magnesium was also found in subject with severe pre-eclamptic compared to that of the mild pre-eclamptic. So, these results indicate that reduction in serum levels of magnesium during pregnancy might be a possible contributor in the etiology of pre-eclampsia and supplementation of this element as diet or drugs may be of value to prevent pre-eclampsia.

Serum iron status among visceral leishmaniasis patients.

This case control cross sectional study was carried out in the Department of Biochemistry, Mymensingh Medical College, Bangladesh in cooperation with the Department of Microbiology, Medicine units of Mymensingh Medical College Hospital and Fulbaria & Muktagacha Upazilla Health Complexes, Mymensingh during the period of July 2006 - June 2007. The aim of the study was to explore the status of serum iron among visceral leishmaniasis patients in Bangladesh as a means to monitor the possibility of management of these patients. A total of 120 people of different age groups were included in this study. Subjects were divided into two groups - Group I (Control) consisting of 60 apparently healthy persons matched by age, sex and socioeconomic status with the cases and Group II (Case) consisting of 60 "ICT for Kala-azar" positive VL patients. Serum iron was estimated by colorimetric method with ferrozine from each sample. Statistical analysis was done by using SPSS windows package. Among the groups, mean±SD (Standard Deviation) of Group I and Group II serum iron were 100.67±20.83 and 76.76±8.64µgm/dl respectively. By comparing Group I with Group II highly significant difference were found in case of serum iron (P<0.001). It is evident from the study that serum iron level significantly decreases among visceral leishmaniasis patients in Bangladesh.

Serum albumin and creatinine clearance rate among smear positive pulmonary tuberculosis patients in Bangladesh.

This case control study was carried out in the Department of Biochemistry, Mymensingh Medical College in cooperation with the Outpatient Department and Medicine Units of Mymensingh Medical College Hospital, Fulbaria Upazilla Health Complex, Mymensingh and some DOTS centers of BRAC, a non-government organization during the period of July 2006 to June 2007. The aim of the study was to explore the status of serum albumin & creatinine clearance levels in smear positive Bangladeshi pulmonary tuberculosis patients as a means to monitor the possibility of management of these patients as these levels decrease significantly. Serum albumin level was investigated in TB patients for monitoring the nutritional status of TB patients and also for the adjustment of serum calcium level. Creatinine clearance rate was investigated in TB patients for monitoring the impairment of renal function and nutritional depletion in tuberculosis patients. A total of 120 people of different age groups were included in this study. Subjects were divided into two groups- Group I (Control; n=60) - apparently healthy people selected matching by age, sex and socioeconomic status with the cases and Group II (Case; n=60) - people with smear positive pulmonary tuberculosis. Serum albumin was estimated by colorimetric principle. Serum creatinine was also estimated by colorimetric principle & creatinine clearance rate was estimated from serum creatinine by Cockcroft- Gault equation. Statistical analysis was done by using SPSS windows package. Among the groups, mean±SD of serum albumin in Group II (3.74±0.44gm/dl) was significantly lower (p<0.001) than that in Group I (4.85±0.31gm/dl). Mean±SD of creatinine clearance rate in Group II (35.36±8.29ml/min) was also significantly lower than that in Group I (84.16±20.20ml/min). It is evident from the study that serum albumin & creatinine clearance rate levels significantly decrease in smear positive Bangladeshi pulmonary tuberculosis patients.

Serum magnesium status among acute myocardial infarction patients in Bangladesh.

This case control cross sectional study was carried out in the Department of Biochemistry, Mymensingh Medical College in collaboration with Cardiology Department of Mymensingh Medical College Hospital, Mymensingh during the period of July 2004 to June 2005. The aim of the study was to explore the status of serum magnesium among acute myocardial infarction (AMI) patients as a means to monitor the possibility of management of these patients. A total of 100 subjects were selected and were grouped as Group I (50 healthy control subjects) and Group II (50 subjects of AMI Cases). Serum magnesium was estimated by colorimetric method from each sample. Statistical analysis was done by using SPSS windows package. Among the groups, mean±SD (Standard Deviation) of Group I and Group II serum magnesium were 2.16±0.25 and 1.71±0.17mg/dl respectively. By comparing Group I with Group II highly significant difference were found in case of serum magnesium (p<0.001). It is evident from the study that serum magnesium level significantly decreases among acute myocardial infarction patients in Bangladesh.

Study on serum glucose level among smear positive pulmonary tuberculosis patients in Bangladesh.

This case control study was carried out in the Department of Biochemistry, Mymensingh Medical College, Bangladesh in cooperation with the Outpatient Department and Medicine Units of Mymensingh Medical College Hospital, Fulbaria Upazilla Health Complex, Mymensingh and some DOTS centers of BRAC, a non-government organization during the period of July 2006 to June 2007. The aim of the study was to explore the status of serum glucose level in smear positive Bangladeshi pulmonary tuberculosis patients. A total of 120 people of different age groups were included in this study. Subjects were divided into two groups - Group I (Control; n=60) - apparently healthy people selected matching by age, sex and socioeconomic status with the cases and Group II (Case; n=60) - people with smear positive pulmonary tuberculosis. Serum glucose (fasting) was estimated by colorimetric principle. Statistical analysis was done by using SPSS windows package. Among the groups, mean±SD of serum glucose (fasting) in Group II (5.91±1.02mmol/L) was significantly higher (p<0.001) than in Group I (4.87±0.57mmol/L). It is evident from the study that serum glucose level significantly increases in smear positive pulmonary tuberculosis patients.

Body iron status among acute myocardial infarction patients.

This case control cross sectional study was carried out in the department of Biochemistry, Mymensingh Medical College in collaboration with Cardiology department of Mymensingh Medical College Hospital, Mymensingh during the period of July 2004 to June 2005. The aim of the study was to explore the status of body iron among acute myocardial infarction (AMI) patients in Bangladesh as a means to monitor the possibility of management of these patients. A total of 100 subjects were selected and were grouped as Group I (50 healthy Control subjects) and Group II (50 subjects of AMI Cases). Serum iron, total iron binding capacity (TIBC) & transferrin saturation were estimated from each sample. Statistical analysis was done by using SPSS windows package. Among the groups, mean±SD of Group I serum iron, TIBC & transferrin saturation were 71.84±9.10, 336.66±35.39 & 21.73±4.88 respectively and of Group II serum iron, TIBC & transferrin saturation were 137.55±18.22, 267.99±34.97 & 52.40±11.74 respectively. By comparing Group I with Group II highly significant difference were found in case of serum iron (p<0.001), TIBC (p<0.001) and transferrin saturation (p<0.001). It is evident from the study that body iron (serum iron, TIBC & transferrin saturation) level significantly increases among acute myocardial infarction patients in Bangladesh.

Patch testing in contact dermatitis of hands and feet.

Eighty clinically diagnosed cases of allergic contact dermatitis of hands and feet when subjected to patch testing, Seventy four (92.5%) cases showed positive patch test reactions to different suspected antigens. Maximum number of cases belonged to housewives and tea garden workers which showed positive patch test reaction to vegetables and soaps and detergents and pesticides, respectively.