Rita Ghosh, Rajesh Kumar Ghose, Md. Rezaul Karim, Shahin Ara, Md. Azizul Haque, Md. Nazmul Haque, Mita Rani Joysoual
TAJ, Jan-Jun 2023; 36(1) 1-8
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Background: The study aimed to see the effectiveness and role of ivabradine on the quality of life in chronic heart failure suffering patients. This open-label Randomized controlled Trial was conducted to assess the effect of ivabradine plus conventional medical management over conventional medical management on quality-of-life parameters among 100 patients of chronic heart failure from January 2021 to December 2021 in the Department of Pharmacology & Therapeutics in collaboration with the Department of Cardiology & Medicine, Rajshahi Medical College Hospital, Rajshahi. Materials and methods: According to the drug allocation study population was divided into a control group (50 patients) and an experimental group (50 patients). Minnesota Living with Heart Failure questionnaire (MLWHFQ) was used to assess the quality of life, and the resting heart rate was measured by 12-lead electrocardiography. Baseline demographic and clinical characteristics were recorded, and patients were followed up at four weeks and 12 weeks of treatment. Results: The comparison of mean differences of MLWHFQ score at first and second follow-up visits between the two study groups was statistically significant [t (100) = 2.43 p < 0.05 & t (100) = 6.60 p < 0.001 respectively]. According to the MLWHFQ cut-point score, it was also observed that poor baseline quality of life gradually shifted to good quality after four weeks and 12 weeks of treatment, and it was proportionately higher in the experimental group. Relations between the respondents of both study groups and their different qualities of life during the first follow-up visit (2 = 13.69, df = 2, p < 0.05) and second follow-up visit (2 = 22.79, df = 2, p < 0.001) were statistically significant.The comparison of the mean (±SD) heart rate between the two study groups was statistically significant (p <0.001) only during the second follow-up visit. Conclusion: This study concluded that adding ivabradine to conventional medical management in treating patients with chronic heart failure improves their symptoms, quality of life, and heart rate and ultimately reduces the morbidity and mortality of such patients
Md. Jawadul Haque, Farhana Yasmin, Md. Ashfaq Arif, Nahreen Rahman, Rehana Parven, Md. Asaduzzaman, Muhammad Zubayer Alam
TAJ, Jan-Jun 2023; 36(1) 9-15
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Introduction: Healthcare-associated infections represent significant obstacles to providing highquality healthcare and have been directly linked to ineffective infection control procedures. There is currently a shortage of trustworthy data in Bangladesh describing the epidemiology of hospital-acquired infections (HAIs), which is necessary for the development of effective infection prevention and control measures. This study's goal was to assess the frequency, nature, and risk factors of HAIs in acute care hospitals in Northern Bangladesh. Methods: This was a pilot point prevalent survey conducted in the medicine, surgery, gynecology, and obstetrics departments of Rajshahi Medical College Hospital between August 2022 to September 2022. Data were collected by two questionnaires for disease profile and hospital-acquired infection. In addition, a checklist was used for the observation of the infection prevention and control (IPC) status of different wards. Result: Approximately 900 patients' data were collected during this time period. The overall prevalence of HAI was found to be 3.7%. The prevalence of HAI, especially surgical site Infection (SSI), in the obstetrics ward, was 4.2%, and the Medicine ward was 3.9%, respectively. The prevalence of hospital-acquired infection in the surgery ward is 7.7%. Approximately 41.7% of patients developed SSI on the 6th post operative day (POD). The Infection prevention and control status of different wards was similar, which was not satisfactory. Conclusion: This surveillance might help concerned authorities and policymakers by making some crucial steps to monitor and reduce hospital-acquired infections and HAIs in hospitals.
Anindita Sarkar, S. M. Asafudullah, Khadiza Khanam, Arefa Sultana, Nazifa Islam, Samrose Sultana, Sunandita Sarkar
TAJ, Jan-Jun 2023; 36(1) 17-22
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Objective: The present study is to ascertain the relative frequency, histologic types, and age distribution of both neoplastic and non–neoplastic ovarian lesions in the Rajshahi medical college hospitals and compare the results with similar studies in other regions of this country and abroad. Methods & Materials: This cross-sectional study was conducted in the Department of Pathology, Rajshahi Medical College, over one year from January 2021 to December 2021. A total of 144 cases of ovarian lesions were included in this study. Inflammatory conditions and developmental anomalies were excluded. Result: Out of 144 cases of ovarian masses studied, 104 (72%) were neoplastic. The common types were Surface epithelial tumors (70%), germ cell tumors (23%), and sex-cord stromal tumors (7%). The age range of ovarian tumors was 5 to 70 yrs, and the highest incidence was between 21-50 yrs. Most of the ovarian tumors were bilateral (85%). Conclusion: Varying types of both non-neoplastic and neoplastic ovarian lesions were seen. Benign tumors were more common than malignant tumors in all age groups. Surface epithelial cell tumors, followed by germ cell tumors, were the most common tumor. Serous cystadenoma was the most common tumor. Tumour types varied in different age groups.
Chaman Ara, Laila Shamima Sharmin, Fardoushi Begum, Sanchita Sarker, Md. Belal Hossain, Shahida Yeasmin, Md. Sanaul Haque Mia
TAJ, Jan-Jun 2023; 36(1) 23-31
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Introduction: Community-acquired pneumonia (CAP) top the list of causes of under-five children mortality worldwide. Therefore, properly assessing and controlling these risk factors may help decrease the morbidity and mortality in under-five children suffering from CAP in Bangladesh and thereby help improve the quality of life of our future generation. Objective: To assess the risk factors of CAP among under-five children ( 2-59 months ) in a tertiary-level hospital in Rajshahi. Materials and methods: This case-control study was carried out in the Department of Pediatrics and EPI Center of Rajshahi Medical College Hospital, RMCH, from January 2017 to December 2018 to determine the risk factors of CAP among children under five. For this study, 246 children aged two months to 59 months were selected by purposive sampling. One hundred twenty-three were cases that were taken indoors, and 123 were healthy controls taken from the outpatient department & EPI center. After taking written consent from guardians, history was taken, and a physical examination was done. All information was recorded in a predesigned data sheet. The chi-square test and odds ratio were used to demonstrate significance. Results: Among 246 children, more patients of both groups were male and came from rural areas. Cases were predominantly under 12 months and came from lower socioeconomic status. A statistically significant association was found between social class and CAP (<0.001); the father's literacy was inversely related to CAP (p-value <0.001). Types of housing, living room ventilation, overcrowding, fuel and cookers used for cooking, parental smoking, malnutrition, history of diarrhea and presence of anemia, prematurity, and low birth weight were significantly associated with CAP (p-value <0.05). Conclusion: Proper assessment of these risk factors and controlling them may help decrease the morbidity and mortality in under-five children suffering from CAP in Bangladesh and thereby help improve the quality of life of our future generation.
Md. Mamun-ur Rashid, Md. Shafiqul Islam, Most. Firoza Parvin, ANM Saifullah, Bimal Chandra Shil, Md. Habibur Rahman, Mst. Musarrat Sultana
TAJ, Jan-Jun 2023; 36(1) 33-40
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Background: Serum cholinesterase mainly comes from the liver, a sensitive indicator of the synthetic capacity of the liver. It can be used as a prognostic marker for cirrhosis. Objectives: To measure the serum cholinesterase level in cirrhotic patients and to correlate its level with the severity of the disease as per the Child-Pugh score. Methodology: This cross-sectional study was conducted in the Department of Gastroenterology, Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh, from January 2018 to December 2018. Fifty adult patients with cirrhosis of the liver were enrolled. Fifty healthy individuals were also taken to compare serum cholinesterase levels. Cirrhotic patients were grouped strictly into A, B, and C classes, as per the Child-Pugh score. Serum cholinesterase level was measured in all participants. The correlation between cholinesterase level and the severity of the disease was analyzed. Result: Mean age of the patients was 47.42 ± 12.40 years and 47.22 ± 11.99 years in cirrhotic patients and healthy group, respectively. The number of patients in the Child-Pugh A, B, and C subgroups was 12 (24%), 20 (40%), and 18 (36%), respectively. The mean serum cholinesterase level was 2938 ± 1561 U/L in cirrhotic patients and 9036 ± 2024 U/L in the healthy group. Serum cholinesterase level in different Child-Pugh class was 4740 ± 1046 U/l (Child A), 3157 ± 1161 U/l (Child B), and 1493 ± 500 U/l (Child C). Serum Cholinesterase was positively correlated with serum albumin and negatively correlated with bilirubin, prothrombin time, and INR. A negative correlation was found between serum Cholinesterase level and the severity of the disease. Conclusion: Serum cholinesterase level was low in cirrhotic patients, and its level was inversely correlated with the severity of the disease. Thus it can be used as a prognostic marker of cirrhosis. However, further study with a large sample size could explain this more precisely.
Quazi Tamanna Haque, Md. Shah Alam, Jarin Sazzad, Md. Tamjid Ali, Md Ahsanul Haque, Md Mizanur Rahman, Sumona Raisa Nadi
TAJ, Jan-Jun 2023; 36(1) 41-46
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Background: Urinary tract infections (UTIs) are the most prevalent type of infection during pregnancy and are notoriously difficult to treat. Significant maternal and fetal risk is associated with UTI during pregnancy, with the most prevalent clinical manifestations being asymptomatic bacteriuria, acute cystitis, and acute pyelonephritis. Objectives: To identify Klebsiella species causing urinary tract infection among pregnant women and its antimicrobial susceptibility pattern by modified Kirby Bauer disc diffusion method in Rajshahi Medical College Hospital. Materials and Method: A descriptive cross-sectional study was conducted between July 2021 to June 2022 in the Microbiology Department of Rajshahi medical college and the Gynecology and Obstetrics Department of RMCH to determine the antimicrobial susceptibility pattern of Klebsiella species causing urinary tract infection in pregnant women. The urine samples were inoculated onto MacConkeys agar, blood agar, nutrient agar, and chromogenic UTI agar media and incubated aerobically at 370 C overnight (18-20 hrs). Results: In all trimesters, 294 urine samples were obtained from pregnant women with asymptomatic and symptomatic UTIs. Among the 114 (38.77%) culture-positive samples, 111 (97.36%) were single isolates, whereas 3 (2.63%) included multiple isolates. Klebsiella spp. comprised 21 out of 117 culture-positive bacterial isolates (17.94%). Regarding antimicrobial susceptibility testing, Klebsiella spp. demonstrated a significant degree of sensitivity to meropenem and nitrofurantoin. In this investigation, Klebsiella spp. was found to be the cause of bacteriuria among pregnant women. Conclusion: Doctors should adhere to the antimicrobial susceptibility test results when selecting the appropriate medications to treat pregnant women with UTIs.
Mst. Romena Khatun, Kh. Md. Faisal Alam, Sabera Gul Nahar, Nurjahan Begum, Md. Khaled Shahrear, Quazi Tamanna Hauqe
TAJ, Jan-Jun 2023; 36(1) 47-54
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Background: Antimicrobial drug resistance is a matter of worldwide concern. Different microorganisms, including bacteria, are becoming more resistant day by day. So it is of utmost importance to know the antimicrobial susceptibility pattern not only for initiation of treatment but also for prevention of drug resistance. By determining minimum inhibitory concentration (MIC) by Epsilometer-test (E-test), we can determine the exact dose of a particular drug. Aims: The study is aimed to determine the MIC of different antibiotics against intermediate isolates of P. aeruginosa isolated from clinically suspected patients of chronic suppurative otitis media (CSOM). Materials and Methods: A cross-sectional type of descriptive study was conducted in the Department of Microbiology, Rajshahi Medical College, Rajshahi, during the period of January 2019 to December 2019 to identify the causative bacteria of CSOM with their antibiotic susceptibility pattern. A total of 96 aural swabs were collected from clinically suspected cases of CSOM, irrespective of age and sex, in the ENT department of Rajshahi Medical College Hospital, Rajshahi. Isolation and identification of bacteria were made as per standard procedure, and then antimicrobial susceptibility testing was performed by the disc diffusion method. At last, E-test was performed on different antibiotics against intermediate isolates of P. aeruginosa. Results: Among 73 isolates, 37 showed intermediate susceptibility towards selected antibiotics such as beta-lactams (Ceftazidime, Ceftriaxone), aminoglycosides (Gentamicin), and quinolones (Ciprofloxacin) by disc diffusion method. Among 37 intermediate isolates, P. aeruginosa was 14 in number. Regarding MIC breakpoints in terms of susceptibility, out of 14 intermediate isolates of P. aeruginosa, 09(64.28%) isolates were susceptible, 03(21.43%) intermediate, and 2(14.28%) were resistant to different antibiotics by E-test. Conclusion: In this study, higher susceptibility of different antibiotics against intermediate isolates of P. aeruginosa was observed by E-test than the disc diffusion method.
Most. Afroza Nazneen, Mohammad Ali Choudhury
TAJ, Jan-Jun 2023; 36(1) 55-61
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Abstract: This article introduces plastic surgeons' various roles in managing diabetic foot ulcers. The role of plastic surgeons is multidimensional and, of course, challenging. Sometimes, the healing process of diabetic ulcer is as simple as only adequate wound care. Sometimes, the ulcer needs reconstruction through a skin graft or flap coverage. Unfortunately, some patients need amputation or disarticulation. Again, plastic surgeons are maximizing patients' future movement ability in the case of amputation. Thus, an experienced plastic surgeon can provide an optimum lifestyle to the diabetic patient.
Monjur Ahmed, Ahsanul Hoque, Nur A Zannat, A B M Zafar Sadeque, Tariqul Islam Khan
TAJ, Jan-Jun 2023; 36(1) 63-73
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Background: Transcutaneous electrical nerve stimulation (TENS) is widely used as a therapeutic adjunct in the management of low back pain. It is a relatively safe, non-invasive, and easy-to-use modality, making it an attractive treatment option. For more than four decades, TENS has been applied in the treatment of acute and chronic pain syndromes. Short wave diathermy (SWD) is a modality that produces deep heating by converting electromagnetic energy to thermal energy. Short wave diathermy (SWD) is also a popular therapy for low back pain. Methods: This randomized controlled clinical trial was conducted to evaluate the comparative efficacy between TENS and SWD on chronic nonspecific low back pain patients. One hundred twenty patients with chronic low back pain were treated according to inclusion & exclusion criteria. Patients were equally distributed in three groups. Group-A patients (n=40) were treated with NSAID+ADL, Group-B patients (n=40) were treated with NSAID+ADL+TENS, and Group-C patients (n=40) were treated with NSAID+ADL+SWD. Written informed consent was obtained from all patients. Data were calculated and analyzed by computer-based software SPSS (Statistical Package for Social Science) Windows 16.0 version. Main outcome measure (s): Subjective pain intensity score, visual analogue scale, tenderness index, disability due to pain, spinal mobility index, and Oswestry disability index. Results: The mean duration of pain was found to be 23.90±2.57 months in group A, 21.0+1.50 months in group B and 22.1±1.89 months in group C. The visual analog score was improved individually in group-A, group B and Group C after treatment, which was statistically significant (P<0>0.05). In this current study, it was observed that the entire variable individually improved in Group-A, Group B, and Group C. So, all three treatment groups benefited from drugs and therapy. However, these were not statistically significant (P>0.05) between Group B and Group C. Conclusion: Beneficial effects of TENS and SWD were seen in the study population, but no firm conclusion could be drawn.
Lt Col Md Humayun Kabir, Brig Gen (Rtd) Md Abdul Latif Khan, Col Md Shirajul Islam Khan, Lt Col A T M Rezaul Karim, Md.Mostafizur Rahman, Ahmed Masiha Jamil
TAJ, Jan-Jun 2023; 36(1) 75-82
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Background: Tinea pedis is a dermatophytosis of the feet usually occurs between the toes with the webspace between the fourth and fifth digits but, in many cases, may appear as an extensive pattern on the bottom and sides of the feet. Terbinafine and itraconazole were evaluated with the efficacy/effectiveness and toxicity in the systemic treatment of Tinea pedis and compared with each other. Objective: To compare the efficacy and safety of terbinafine vs. itraconazole in treating tinea pedis. Materials and Methods: A total of 50 patients were selected, and they were divided into groups (groupA and group B), each of which included 25 patients. Group A was given oral Terbinafine 250 mg daily for two weeks. Group B was given oral Itraconazole 200mg daily for the same duration. Patients were observed for the efficacy and side effects of the trial medicines. A baseline complete blood picture, liver and renal function test, and urine analysis were done and repeated frequently during therapy. Results: Most patients were in the fourth decade in both groups, and the male-to-female ratio was almost 4:1. Two groups of people were studied: group-A with terbinafine 250 mg daily and group B with itraconazole 200 mg daily for 14 days. Evaluated weekly during treatment and 02 weeks after cessation of therapy, and finally on 08th week to see the clinical improvement and adverse effects. The clinical response was found in chronic hyperkeratotic type: 08/08, 08/08; chronic interdigital type: 07/07, 07/06; vesico-bullous type: 06/05, 06/05; Mixed type: 04/03, 03/02 in group-A and group-B respectively. On average, 92% clinical improvement was found in group-A and 84% in group B. Most patients had nausea (20.0%) followed by 08% diarrhea in group A. On the other hand, in group B, most patients had nausea (28.0%), followed by 4.0
Sadia Afrin, D.H.M. Fazle Rabbi, Rashed Mustafa, Wali Ahmed, Akhtari Afroze
TAJ, Jan-Jun 2023; 36(1) 83-87
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Background: The volumetric measurement of the maxillary sinuses is essential in assessing the incidence of sinusitis and cancer and measuring the intimate relationship between teeth and maxillary sinuses. There have been reports in multiple studies that there is racial variation concerning age and gender. This study aims to determine whether the sinus volume of males and females differ and its relation to age. Methods: This descriptive observational study was carried out among 100 respondents between the age of 11- 60 years who were residing in Rajshahi during the study period of one year, i.e., January 2018 to December 2018. The data has been collected from the Department of Radiology and Imaging of Rajshahi Medical College Hospital (RMCH) from the patients who had undergone CT scan examinations. The measurements were directly taken from a computer provided with an electronic caliper. After that, the sinus volume was calculated manually using the following formula (height x width x depth x 0.5). The quality of the data was obtained diligently, and ethical issues were properly maintained in all the steps of this study. Results: There were 50 males and 50 females, ranging from 11 – 60 years of age, where the mean (± SD) age was 36.7 (± 14.8) years. The mean (± SD) volume of the maxillary sinus in the male group was 17 (± 4.6) cm3 for the right side and 17.5 (± 4.7) cm3 for the left side, which was significantly more than the female group, 14.7 (± 3.7) cm3 for the right side and 15.1 (± 3.7) cm3 for the left side (p = 0.031). Concerning age, the distribution of maxillary sinus volume showed the highest values between 21-30 years of age, and then it decreased both on the right and left side; this finding was found to be statistically significant (p = 0 .018). Conclusion: This study provides salient information regarding maxillary sinus volume among the people of the Rajshahi district of Bangladesh. This study's results will help establish a reference dataset regarding anatomical measurements of the maxillary sinus.
Mita Rani Joysoual, Shahin Ara, Md. Nazmul Haque, Rita Ghosh, Tamanna Afroze, Saqib Salah Aufi
TAJ, Jan-Jun 2023; 36(1) 89-95
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Background: Metformin is recommended as first-line pharmacotherapy for patients with type 2 Diabetes Mellitus (T2DM) who fail to achieve glycemic control through lifestyle modification. Metformin initially lowers blood glucose, but as diabetes progresses, it alone frequently fails to maintain glycemic control, and additional therapies are required. Empagliflozin is a potent and selective sodium-glucose co-transporter 2 (SGLT2) inhibitor that is effective in reducing blood sugar levels as monotherapy or add-on to existing therapy with significant improvements in glycemic control and weight. Materials & Methods: This quasi-experimental study was conducted in the Department of Pharmacology and Therapeutics in collaboration with Rajshahi Diabetic Association General Hospital, Rajshahi, for one year from January 2021 to December 2021 on 50 uncontrolled T2DM patients (glycosylated hemoglobin, HbA1c > 7.0 to ≤ 10.5%) for more than 12 weeks. The investigating drug, empagliflozin 10 mg (1 tablet) as a once-daily dose, was added to the ongoing treatment of each patient as 3rd line treatment and was followed up at 6 and 12 weeks. Results: The mean FBS at baseline was 10.8 mmol/L, which declined to 8.5 mmol/L at six weeks and then to 7.2 mmol/L after 12 weeks of intervention with Empagliflozin as add-on therapy in patients with uncontrolled T2DM. The overall reduction of FBS from baseline to 12 weeks of intervention was statistically significant (p < 0.001). Simultaneously the mean HbA1c also reduced from 9.4% to 7.7
Hamida Pervin, Shahela Jesmin, Nazmun Nahar, Nahid Yusuf, Mst. Shorifa Rani
TAJ, Jan-Jun 2023; 36(1) 95-106
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Background: Gestational diabetes mellitus (GDM) is a public health issue, mainly affecting the Southeast Asian region and Bangladesh( prevalence 9.7 % - 12.9%). It has a significant adverse impact on maternal and fetal outcomes. Obesity is one of the common nutritional problems complicating pregnancy in developed countries. Body mass index > 30 kg/m2 is a globally accepted definition of obesity. The body fat percentage is considered to be higher in the Asian population compared to the European population at the same level of BMI, and therefore, different cut-off levels are recommended for Asians. The provisional recommendations for the Asian Pacific region published in February 2000 by the WHO regional office for the western pacific, the International Association for the Study of Obesity, and the international obesity Task Force are overweight at BMI >23 and obese at BMI > 25 kg/m2. There is a strong association between maternal obesity and gestational diabetes mellitus. So it needs to be addressed energetically to avoid maternal and fetal morbidity and mortality. Materials and methods: This cross-sectional type of comparative study was carried out in the Gynae outdoor and indoor departments of Rajshahi medical college hospital, Rajshahi, and Rajshahi Diabetic Hospital. All patients following inclusion and exclusion criteria on the basis of history and clinical examination were selected. 37 patients are obese having BMI > or = 25 kg/m2 and 55 having BMI < 25>0.05). Cesarean section incidence was higher in all GDM patients, and the difference was not statistically significant. Preterm delivery was 13.51% in GDM with obese patients and 3.64% in GDM with non-obese patients, which was statistically significant. Maternal postpartum complications, including PPH, UTI, and wound infection, were 10.81%, 21.62%, and 5.41 %, in GDM, with the obese group and 3.64%, 12.73%, and 1.82%, respectively, in the non-obese group. The rest of the variables had statistically insignificant differences between the two groups (P> 0.05). Fetal distress was not statistically significant. Regarding perinatal outcome, macrosomia was 16.22% and 5.45% in obese and non-obese groups, respectively. The difference was statistically significant between the two groups (P< 0> 0.05). Conclusion: The current study finding indicates that obesity in GDM patients is associated with more maternal and perinatal pregnancy complications. Thus pre-pregnancy weight reduction and appropriate weight gain during the antenatal period in all women, especially in women with gestational diabetes, might reduce pregnancy and labor complications and improve maternal and perinatal outcomes.
Dilruba Sultana, Be-Nazir Ahmmad, Abul Kashem, Md. Fazlul Kader, Mrinal Kanti Das, Md. Belal Uddin, Md. Sanaul Haque Mia
TAJ, Jan-Jun 2023; 36(1) 107-112
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Background: Diarrheal disease is one of the leading causes of morbidity and mortality among young children under five years of age in developing countries. The longer duration of diarrhea increases the chance of morbidity and mortality. Zinc supplementation decreases the duration of diarrhea. It is a straightforward, acceptable, low-cost, and effective treatment that could easily be affordable in our country. Objective: This study aimed to determine the effect of zinc supplementation on the duration of acute watery diarrhea. Materials and Methods: A total of 106 subjects were included in this study over six months, from December 2014 to May 2015. Detailed information was obtained from each patient. A total of 106 patients were taken. Among them, 53 patients (group A) were given zinc with Oral Rehydration Salts (ORS), and 53 patients (Group B) were given ORS only. However, three patients in each group were lost during follow-up. Data were analyzed by using a standard statistical method (SPSS version 16.0). Results: The duration of diarrhea was three days in 56% of patients in the zinc-supplemented group, but it was only 20% in the control group. The frequency of stool gradually decreased over five days. It was more marked in zinc supplemented group. The p-value was 0.001. Vomiting occurred in 30% of patients in zinc supplemented group, and in the control group, it was only 20%. The p-value was 0.5. So, we conclude that oral zinc administration in acute watery diarrhea (AWD) decreases the duration and causes early recovery and may be considered in the management of AWD. Conclusion: Oral zinc administration in acute watery diarrhea decreases the duration and frequency of diarrhea in children aged six months to five years by changing the natural course of acute diarrheal disease.
Tamjid Ali, Moshiur Rahman Khasru, A. K. M Salek, Alauddin Sikdar, Quazi Tamanna Haque
TAJ, Jan-Jun 2023; 36(1) 123-118
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Introduction: Epidural steroid injections (ESI) have been utilized for over 50 years in the conservative therapy of prolapsed lumbar intervertebral discs. However, controversy persists regarding their effectiveness in reducing pain and improving function, with literature supporting and opposing them. Aim: To study the effectiveness of epidural steroid injection in treating pain caused by a prolapsed lumbar intervertebral disc and compare the effectiveness between caudal, transforaminal, and interlaminar injection routes. Materials and Methods: A total of 152 patients with back pain with Radiculopathy with a lumbar disc prolapse confirmed on MRI were included in the study. Their pre injection Japanese Orthopedic Association Score (JOA) counted up. In this study, participants were enrolled using a simple randomization procedure (picking a card).in the Department of Physical Medicine & Rehabilitation at BSMMU, Dhaka, from May 2020 to April 2021. Among 152 patients were intervenes as transforaminal (n=62), caudal (n=53), and interlaminar (n=25) approach with subsequently received epidural steroids as methylprednisone. Twelve individuals were dropped from the trial because they failed to show up for their scheduled therapy. Results: The prevalence increased dramatically, leading to a JOA Score at 12 months following injection via any of the three methods 53 (37.26%) via the caudal pathway, 62 (44.21%) via transforaminal, and 25 (18.53%) via interlaminar. At six months and 12 months post-injection, the transforaminal route wassubstantially more efficacious than the caudal (p=0.01) and interlaminar routes (p=0.03). Comparing the caudal and interlaminar methods yielded no statistically significant difference (p=0.36). Conclusion: In the current study, methylprednisone epidural injections effectively treat radiculopathy and back pain caused by a herniated lumbar disc. All three injection techniques are adequate, with the best result obtained by the transforaminal route.
Md. Mottalib Hossain Khan, Md. Ahsanul Haque, Farjana Kabir, Shubhra Kanti Dev Nath, Rozina Aktar Zahan, Nahreen Rahman
TAJ, Jan-Jun 2023; 36(1) 119-125
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Background: Dermatophytes are the most significant fungi because of their widespread involvement in the population and their prevalence worldwide. Bangladesh's hot and humid climate, overcrowded population, poverty, malnutrition, and ignorance make dermatophytosis a common cutaneous infection. These infections occur in both healthy and immunocompromised patients. Dermatophytes are responsible for most cutaneous fungal infections, and the estimated lifetime risk of acquiring a dermatophyte infection is 10-20%. Objective: To isolate and identify different dermatophytes and their antifungal susceptibility pattern in the Rajshahi region. Materials and Methods: Different clinical samples (e.g., skin scrapings, nail clipping, and hair plucking) were collected under aseptic precautions. The isolation and identification of dermatophytes were performed through a microscopic examination using 10% KOH mount, mycological culture, and species identification by lactophenol cotton blue mount from positive culture. In addition, all dermatophytes’ isolates were subjected to antifungal susceptibility testing using the agar-based disk diffusion method in Mueller Hinton agar media. Results: Out of 171 samples, Trichophyton rubrum was the predominant dermatophyte species with 76(71.7%), followed by T.mentagrophyte were 15(14.2%), E. floccosum were 12(11.3%), and M. canis were 03(2.8%). voriconazole, clotrimazole, and itraconazole were more effective drugs. Griseofulvin was the least effective drug, followed by fluconazole. Conclusion: This study indicates dermatophytosis is a common skin disease in northern Bangladesh. Due to the increasing trend of antifungal drug resistance among dermatophytes, treatment should be based on antifungal sensitivity testing.
Md. Ruhul Amin, Al-Mirajun Hoque, Md. Maruf Hussain, Partho Moni Bhattacharyya, Md. Amzad Hossain Sardar, Md. Aminul Hasan, Md. Mahidul Alam
TAJ, Jan-Jun 2023; 36(1) 127-134
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Background: In developing countries, pregnancy-associated acute kidney injury (PAAKI) is a significant cause of maternal and neonatal mortality and morbidity. A systematic evaluation is essential to understand its frequency and severity in our setting. Objectives: Primary aim of our study was to evaluate the epidemiological profile and outcome of patients with pregnancy-associated acute kidney injury. Patients and Methods: The study was conducted in the Department of Nephrology, Rajshahi medical college hospital, from January 2019 to March 2020. A total of 83 patients with pregnancy-associated acute kidney injury were evaluated. Patients who had a history of chronic kidney disease or were diagnosed as a case of chronic kidney disease were excluded from the study. Result: The mean age±SD was 25.39±5.90 years. The majority were <30 years of age (56.6%). Only 24.1% had completed regular antenatal checkups. Preeclamsic toxaemia was present in 10.8% of patients. 85.5% of delivery was performed at hospitals/ clinics, and 75.9% of delivery was done by cesarean section. Unskilled birth attendants did 9.7% of delivery. Anaemia was present in 41.0% of patients at presentation, and 67.5% received a blood transfusion. Maternal mortality was 32.5%, and neonatal mortality was 21.7%. Renal replacement therapy was given in 56 (67.5%) patients. Among them, 47 (83.9%) received hemodialysis. Common causes of pregnancy-associated acute kidney injury were found to be sepsis (77.1%), postpartum hemorrhage (41.0%), disseminated intravascular coagulation (21.7%), severe preeclampsia (16.9%), HELLP syndrome (2.4%) and transfusion reaction (7.2%). 31.4% of patients recovered completely, and 10.8% of patients developed chronic kidney disease. Conclusion: Providing good quality perinatal care is essential to reduce the frequency of pregnancy-associated acute kidney injury and maternal and neonatal mortality related to this.
Sanchita Sarker, Be-Nazir Ahmmad, Md. Mosharrof Hossain, Subal Chandra Paul, Chaman Ara, Md. Asgar Hossain
TAJ, Jan-Jun 2023; 36(1) 135-141
DOI:
Background: Exclusive breastfeeding provides nutritional and immunological support for the normal growth and development of the infant. Bangladesh is traditionally a breastfed community. The probability of having an acute respiratory infection (ARI) episode was higher for formula-fed infants than fully breastfed infants during the first four months of life. The risks for partially breastfed infants fell between those of formula-fed and fully breastfed infants, suggesting a dose-response effect of breastfeeding on the risk of respiratory infection. Objective: This study compares exclusive, partial, and non-breastfed groups regarding the frequency and outcome of acute respiratory infection. Materials and methods: This cross-sectional comparative study was done at the Department of Pediatrics, Rajshahi Medical College Hospital, from January 2013 to June 2013, a period of six months. A total of 300 cases of infants suffering from ARI were selected. Among them, 100 are each for exclusive breastfed (EBF) babies, partially breastfed babies (PBF), and non-breastfed (NBF) babies. In addition, demographic profile, frequency, severity of attacks, outcomes, and length of hospital stay were assessed. Results: Most EBF babies came to the hospital with a history of one or two attacks of ARI, but PBF and NBF babies had multiple attacks. i.e., two, three, or more attacks. Most of the NBF and PBF have presented with severe attacks (84% and 72%, respectively), whereas only 42% of EBF babies presented with severe attacks; nonetheless, a maximum of 58% of EBF babies present with mild attacks. The severe attack is more frequent in the PBF and NBF groups than in the EBF groups. Conclusion: Frequency, severity, and hospital staying of ARI attacks are found to be more in the PBF and NBF group of babies than in EBF babies. Better outcomes were found in EBF group babies.
Md. Azizul Haque
TAJ, Jan-Jun 2023; 36(1) 1-1
DOI:
A recent field of science and technology is artificial intelligence (AI). It already significantly impacts various human activities at all societal scales, ranging from individuals to social organizations, corporations, and countries. Almost every industrial, economic, and societal sector is experiencing rapid growth in artificial intelligence, from information technologies to commerce, manufacturing, space, remote sensing, security, defense, transport, and vehicles, and, since the turn of the century, medicine and health care.1 Deep learning tools and AI are expected to have an impact on healthcare on three different levels: for clinicians, primarily through quick, accurate image interpretation; for health systems, through improved workflow and the potential to lower medical errors; and for patients, through the ability to process their data to improve health.2 Soon, almost every clinician will be utilizing AI technologies. Deep neural networks (DNNs), which can read medical scans, pathology slides, skin lesions, retinal pictures, electrocardiograms, endoscopy, and many more domains, were primarily used for pattern recognition in this. Radiology is one area where artificial intelligence has received much attention. Over two billion chest X-rays are performed globally each year, making them the most used type of diagnostic scan. One study evaluated the performance of one deep neural network and four radiologists in identifying pneumonia in over 112,000 tagged frontal chest X-ray images. The results showed that the algorithm could outperform the radiologists.