Prevalence of Organic Colonic Lesions by Colonoscopy in Patients with Irritable Bowel Syndrome Fulfilling Rome III Criteria.

Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder usually diagnosed by using symptom-based diagnostic criteria. Recent evidence suggests the presence of organic diseases in some patients fulfilling the diagnostic criteria of IBS which may be missed unless investigations are performed. The aim of this cross-sectional study is to find out the prevalence of organic colonic lesions at colonoscopy in patients with IBS fulfilling the Rome III criteria.The study was conducted in the department of Gastroenterology OPD of the North East Medical College, Sylhet, Bangladesh from December 2016 to December 2017. Consecutive 153 patients of IBS diagnosed by validated Bangla version of ROME III criteria were included in this study. Colonoscopy was done for each patient and findings were recorded. Prevalence of colonic disease was compared between those meeting criteria for IBS, according to the presence or absence of co-existent alarm features, and by IBS subtype. A substantial number of patients 43(28.1%) fulfilling the Rome III criteria were found to have organic colonic lesions at colonoscopy. No significant difference was found regarding colonic lesions among patients with IBS symptoms with or without alarm features (p=0.876). Colonic polyp was the commonest findings in 19(12.1%) subjects at colonoscopy, followed by colonic ulcers in 16(10.5%) subjects. Organic colonic lesions are found to be more common among relatively older age group patients (p=0.011). A significant number of patients with symptoms compatible with IBS exhibited colonic lesions following investigation with a predilection towards older age. Careful clinical evaluation and relevant investigations are necessary to reduce diagnostic uncertainty.

Serum-ascites albumin gradient in differential diagnosis of ascites.

The present study was aimed to find out causes of ascites based on serum-ascites albumin gradient (SAAG) and to compare the diagnostic accuracy of the serum-ascites albumin gradient, proposed as a new biochemical criterion for the differential diagnosis of ascites and to evaluate the value of serum-ascites albumin gradient in differential diagnosis of ascites. This study includes 50 patients with ascites admitted in Medicine wards of Comilla Medical College Hospital, Comilla during the period of July 2010 to June 2011. Blood was drawn from the antecubital vein and ascetic fluid was obtained by paracentesis at the same time. Determination of the concentrations of albumin in both the serum and the ascitic fluid was carried out simultaneously. Considering SAAG value of ≥1.1g/dl is high SAAG and a SAAG value <1.1g/dl is low SAAG. Out of 50 patients, male patients were 36 and female patients were 14. Male and female ratio was 2.5:1. Age range was 21 years to 70 years. Most of the patients fall in age group of 41-50(28%).Among the 50 patients with ascites, cirrhosis of liver accounted for 68%, followed by tubercular peritonitis 12%, nephrotic syndrome 8%, congestive cardiac failure 6%, hepatocellular carcinoma 4% and malignancy related 2%. In this study serum ascites albumin gradient accurately identified the cause of ascites in 97% cases. In contrast the exudate-transudate concept identified only 83% correctly. Serum ascites albumin gradient was found superior to the exudate-transudate concept. So, differential diagnosis of ascites should be based on the serum ascites albumin gradient which is a better distinguishing marker.

Assessment of anaemia in patients with rheumatoid arthritis.

The present cross-sectional study was conducted in the Department of Medicine, Mymensingh Medical College Hospital, Mymensingh from December 2009 to November 2010 to find out the association of iron deficiency, in anaemia with rheumatoid arthritis and to find a sensitive and less invasive marker to differentiate iron deficiency anaemia from the anaemia of chronic disease. A total of 45 patients of rheumatoid arthritis were provisionally included in the study. Of them, 12 patients were excluded as they did not allow for aspirating the bone marrow, leaving 33 patients to complete the study. The mean age of the patients was 42.6 years (22-66 years) with female to male ratio being roughly 3:1. Majority (97%) of the patients presented weakness followed by 78.8% dizziness, 54.5% palpitation, 24.2% pallor, 12.1% breathlessness, another 12.1% smooth tongue and 6.1% nail change. About 79% of the patients were positive for RA test and nearly 70% of patient had moderate anaemia. The mean serum ferritin was significantly reduced in patients with hypochromic with or without microcytic anaemia than that with normocytic normochromic anaemia (p<0.001). While total iron binding capacity was found to be significantly increased in patients with iron deficiency anaemia than that in patients with anaemia of chronic disease (p<0.021). The serum iron level was considerably reduced in the former group than that in the later group (p<0.066). Bone marrow iron grading revealed 48.5% of the patients with iron depleted and 51.5% with iron repleted. Serum ferritin level of patients with iron depleted bone marrow was significantly decreased than that in patients with iron repleted bone marrow (p<0.001). Serum iron level of the former group was also reduced than that of the later group (p<0.133). Total iron binding capacity was significantly raised in patients with iron depleted group than that in patients with iron repleted group (p<0.001). The study finds that anaemia of chronic disease and iron deficiency anaemia frequently coexist in patients with rheumatoid arthritis and serum ferritin and total iron binding capacity are considered good indicator for differentiating iron deficiency anaemia from the anaemia of chronic disease. Serum iron levels will not help for differentiating.

Comparison of salbutamol with normal saline and salbutamol with magnesium sulphate in the treatment of severe acute asthma.

This study compared the efficacy and safety of nebulized magnesium sulphate with salbutamol to normal saline with salbutamol as the initial treatment of severe acute asthma patients. The present study was designed as a randomized open controlled clinical trial. The study was conducted Mymensingh Medical College Hospital over a period of 11 months from December 2009 to October 2010. Patients admitted with severe acute asthma having inclusion criteria were the study population. Among 120 study population 60 were in salbutamol with magnesium sulphate group and 60 were in salbutamol with normal saline group. The study finding showed that peak flow at baseline was similar in two groups. At 10 minutes after nebulization, the mean±SD percentage increase in peak flow was greater in magnesium sulphate group (20±4%) than in the normal saline salbutamol group (13±3%). At 20 minutes the percentage increase in peak flow was greater in magnesium sulphate group (35±7%) than in the normal saline salbutamol group (24±6%) p value <0.001. Magnesium sulphate plus salbutamol group reached PEF near to 60% which is not in saline salbutamol group. There was no significant changed in respiratory rate, pulse rate, systolic, diastolic blood pressure and clinical evidence of unwanted adverse effect.

Fasting glycaemic and lipidaemic status in acute coronary syndrome patients within 24 hours of onset of chest pain.

This is a descriptive type of cross sectional study done in Mymensingh Medical College Hospital during the period of June 2008 to November 2009 to estimate and analyze the fasting blood glucose (FBG) and fasting lipid profile of acute coronary syndrome (ACS) patients within 24 hours of onset of chest pain. Total 50 patients of either sex diagnosed as acute coronary syndrome whose fasting blood sample would have been collected within 24 hours of chest pain were included. Among 50 patients 42(84%) were male and 8(16%) were female. Age range was 30-80 years with a mean ± SD of 50.74 ± 12.05 years. Among 50 ACS patients, 9 patients (18%) suffered from unstable angina (US), 2(4%) from non-ST segment elevation myocardial infarction (NSTEMI) and 39(78%) suffered from ST segment elevation myocardial infarction (STEMI). Study results revealed 41(82%) patients had euglycemia (70-110 mg/dl), 2(4%) patients had impaired fasting glucose (IFG) (110-125 mg/dl), and 7(14%) patients had hyperglycemia (>126 mg/dl). Dyslipidemia found in 38(76%) patients. Among them total cholesterol (TC) >200mg/dl in 14(28%), decreased level of HDL-C (< 40 mg/dl in male and <50mg/dl in female) in 22(44%), increased level LDL-C ≥ 130 mg/dl in 13(26%), and TG >150 mg/dl was found in 16(32%) patients.

Seasonal variation in types of stroke and its common risk factors.

The present descriptive cross-sectional study was conducted in the Department of Medicine, Mymensingh Medical College Hospital, Mymensingh, Bangladesh over a period of one year during November 2009 to October 2010. The study was conducted to describe the variations in types of stroke (ischemic stroke and hemorrhagic stroke) during summer and winter. An attempt was also made to observe the frequency of common risk factors of stroke by seasons. A total of 292 patients of any age irrespective of sex fulfilling the WHO criteria of acute stroke and confirmed by CT scan were selected from consecutive admission in the Department of Medicine, Mymensingh Medical College Hospital. Detail history and thorough clinical examinations were done. Routine and relevant investigations were carried out. The mean age of the patients was 59.9±14.3 years. A male preponderance was observed in the study. In summer 66% of patients and in winter 34% of patients were presented. Ischemic stroke was present in 54.1% patients and 45.9% patients had haemorrhagic stroke. The study found that the frequency of ischaemic stroke during summer (62.4%) was significantly greater than that during winter (37.8%). The frequency of haemorrhagic stroke during winter (62.2%) was significantly greater than that during summer (37.6%). Hypertension was the most important risk factor and other risk factors were smoking, diabetes mellitus, tobacco chewing, ischemic heart disease, dyslipidemia, oral contraceptive pill, alcohol consumption, atrial fibrillation and past history of stroke. Increasing age was also noted as a risk factor (60.7% >60 years). Most of the risk factors were homogenously distributed between two seasons and between ischemic and haemorrhagic group. Hypertension was significantly higher in haemorrhagic stroke patients compared to ischemic stroke patients.