Dr. Molla Md Iftekhar Hossain, Prof. Dr. Md. Rais Uddin, Dr. Md Rezaul Karim, Dr. Rajesh Kumar Ghose, Dr. Md. Emran Hossain, Dr. ASM Sayem
TAJ , Jul-Dec 2023; 36(2) 1-9
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This study aimed to compare the coronary angiographic characteristics of coronary artery disease in young adults (≤40 years) and older adults (>40 years). This was a retrospective analytic study. The study was conducted at the Department of Cardiology, Rajshahi Medical College Hospital. 100 patients with coronary artery disease were included in this study. Among the 100 patients, 50% were in the ≤40 years’ group (group A) and 50% were in the >40 years’ group (group B). Coronary angiographic characteristics were analyzed for each group. Coronary artery disease was present in 72% of group A and 84% of group B. In group A, single vessel disease (SVD) was the most common pattern (38%, p=0.001), while in group B, double vessel disease (DVD) (36%, p=0.043), triple vessel disease (TVD) (26%, p=0.033), and left main vessel disease (LM) (8%, p=0.035) were more prevalent. Left ventricular dysfunction with hypokinesia was observed in the majority of patients. The left anterior descending (LAD) artery was most commonly involved in both groups, primarily in the mid and proximal segments. The right coronary artery (RCA) was the next commonly affected artery, with differences in involvement site between the two groups. This study highlights that SVD is more common among young adults, whereas DVD, TVD, and LM diseases are more prevalent in older individuals. Older age groups exhibited a higher prevalence of diabetes mellitus, while smoking, dyslipidemia, and hypertension were common risk factors for coronary artery disease in both age groups.
Most. Afroza Nazneen, Tania Afrin Tisha, Summi Leonard Keya
TAJ , Jul-Dec 2023; 36(2) 11-16
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Reconstruction of vagina is a technically challenging surgery. The aim is to create a functionally and aesthetically satisfactory neovagina in a way that will be reliable and suitable for most patients. Use of bilateral Pudendal thigh flap to create a neovagina may overthrow the conventional methods as there is no necessity for postoperative dilation or vaginal intercourse to maintain adequate vaginal length and diameter. Vaginal reconstruction was done with bilateral Pudendal thigh flaps, in seven patients with vaginal agenesis, during 2 years, from July 2021 to June 2023. This method of vaginoplasty is simple, safe, and reliable and has shown satisfactory functional and cosmetic results. The reconstructed vagina has a natural angle and is sensate in its lower part. No postoperative stenting or dilatation is required. The donor site can be closed primarily and the scar is well hidden in the groin crease.
Ashoke Sarker, Md. Amzad Hossain Sardar, Swapna Majumder, Ahmed Masiha Jamil, Shah Md. Roushan Kabir Choudhury, Mst. Wahida Pervin
TAJ , Jul-Dec 2023; 36(2) 17-23
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Background: Subarachnoid hemorrhage (SAH) is a devastating condition. Aside from its neurological morbidities, SAH is associated with significant medical complications. Subarachnoid hemorrhage frequently results in myocardial injury with electrocardiographic (ECG) abnormalities and release of cardiac troponin I. This myocardial injury after SAH is a neurally mediated process that is dependent on the severity of neurological injury. Objectives: This study was designed to determine ECG changes in patients with SAH and these changes were compared with neurological severity as well as elevated troponin I levels. Patients and methods: This cross-sectional descriptive study was conducted over 30 patients with SAH. Demographic (age, sex), hemodynamic (pulse, systolic and diastolic blood pressure) and neurological (GCS, WFNS score) information were recorded. We evaluated their onadmission ECG and Troponin I levels. Results: Out of 30 patients, at least one morphological ECG abnormality was present in 17 patients (56.7%) and a total of 21 different abnormalities were present. There were no significant associations between the number or type of observed ECG abnormalities and WFNS grade. But there was a statistically significant correlation between ischemic like ECG changes and elevated troponin I (p = 0.035). The presence of T inversion also significantly explained an elevated Troponin I concentration (46.2%, p = 0.035). Conclusion: ECG changes are prevalent in acute SAH. Ischemic like ECG changes are related to an increase in Troponin I, suggesting that these ECG changes may indicate neurocardiogenic cause of cardiac injury after SAH.
Dr. Wahida Khatun, Dr. Md. Akkasur Rahman, Dr. Abu Hena Mostafa Kamal
TAJ , Jul-Dec 2023; 36(2) 25-33
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Background: The global pandemic caused by the SARS-CoV-2 virus has resulted in millions of infections worldwide, affecting individuals of all ages and genders. Pregnant women with comorbidities face an increased risk of severe COVID-19 infections, posing significant challenges to their clinical management in dedicated COVID-19 Intensive Care Units (ICUs). This single-center observational study aimed to examine the characteristics and outcomes of COVID- 19-positive pregnant women admitted to a dedicated COVID-19 Intensive Care Unit (ICU) at Rajshahi Medical College Hospital (RMCH) in Bangladesh. Methods: A observational study, analyzing data from pregnant women admitted to hospitals and adult COVID-19 ICUs between March 1, 2020, and December 31, 2021. A total of 21 patients were included in the analysis. Patient demographics, medical histories, gestational age, symptoms, laboratory findings, and clinical outcomes were recorded and analyzed. The primary outcomes assessed were maternal mortality at 30 and 60 days, while the secondary outcomes included the length of ICU and hospital stay, fetal mortality, and preterm delivery. Results: Among the 21 pregnant patients admitted to the COVID-19 ICU, 10 were COVID-positive, and 11 were suspected COVID cases. A total of 11 patients experienced adverse outcomes, resulting in a 52.4% mortality rate. None of the patients had received vaccination against COVID- 19. Conclusion: This single-center observational study provides valuable insights into the characteristics and outcomes of COVID-19-positive pregnant women admitted to a dedicated COVID-19 ICU at RMCH, Bangladesh. Pregnant women with underlying comorbidities may be at a higher risk of severe COVID-19 illness, warranting close monitoring and timely interventions. The study underscores the importance of tailored clinical management strategies for pregnant women infected with SARS-CoV-2 to improve maternal and fetal outcomes. Further, multi-center studies are warranted to validate and expand upon these findings, contributing to the global understanding of COVID-19 in pregnancy.
Faisal Bin Selim Khan, Abu Shahin Mohammed Mahbubur Rahman, Md Zahirul Haque, M Khalilur Rahman
TAJ , Jul-Dec 2023; 36(2) 35-46
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Background: Paraquat Poisoning is not unknown in clinical practice. However, the data from our country is scanty. Therefore, to find the outcome of paraquat poisoning in a tertiary level hospital was the objective of this study. Methods: The study was a longitudinal descriptive study and conducted at department of Medicine, Rajshahi Medical College Hospital. Patients of paraquat poisoning were approached for inclusion. Informed written consent was taken from the patients and/or attendants. Data were collected by face-to-face interview by the researcher with an aid of a semi-structured questionnaire. All available investigation reports, follow up notes, discharge papers and death certificates were scrutinized. A total 30 patients were included in this study. Results: Total 30 subjects were interviewed. Mean age was 25.33±8.86 (SD) years with female to male ratio-2:1. Majority were from rural area (90%). About 94% consumed with an intention of suicide. Most of the patients had renal impairment (53.3%) and hepatic impairment (50%) as complication. 63.3% patients reached to hospital >12 hours after ingestion of poison and 36.7% reached within 12 hours. Of all, 33.3% (n=10) patients survived. Possible cause of death was Multi organ failure (MOF) (40.0%), Acute renal failure (25.0%), ARDS (15.0%) and Hepatic failure (20.0%). However, overall outcome is not dependent with to time reaching hospital after poisoning but with amount of poison ingested (p<0.05). Conclusion: About 67% patients died following ingestion of the paraquat poisoning and it is not dependent with the time required to reach the hospital rather to the amount of poison ingested.
Farhana Yasmin, Md. Jawadul Haque, Antara Biswas, Muhammad Zubayer Alam
TAJ , Jul-Dec 2023; 36(2) 47-56
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Introduction: Obesity is a major public health concern in Bangladesh, driven by socioeconomic factors, lifestyle choices, physical activity levels, and demographics. The influence of technology and industrialization has disrupted behavioral patterns among rural residents, leading to increased susceptibility to weight gain and non-communicable diseases. To gain precise insights, a cross-sectional study was conducted to assess the prevalence of obesity and identify specific risk factors among rural adults. Methods: From September to November 2022, this study was carried out at the Rajshahi Medical College's Department of Community Medicine. Data were gathered by conducting face-to-face interviews with the rural adult population of Puthia Upazilla, Rajshahi, aged 18 to 59.In all, 548 people from Rajshahi's Puthia Upazilla took part in the survey. Result: In this study, respondents had a mean age of 38.84 (±12) years. About 39.78% were overweight, and 14.23% were obese based on BMI. The mean BMI was 25.07 (±5.17) kg/m². Around 20.9% of males and 27.9% of females had a higher risk based on waist-hip ratio. Approximately 43.6% were highly active, while 36.86% had low physical activity levels. About 1.6% reported taking anti-depressant drugs. Around 31.4% consumed fried food 1 to 3 times weekly, and 35.2% drank milk occasionally. Regarding salt intake, 32.1
Zahir Al Imran, S. M. Asafudullah, Khadiza Khanam, Arefa Sultana, Swapna Majumder, Mst. Aynunnahar
TAJ , Jul-Dec 2023; 36(2) 57-63
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Objective: Enlargement of prostate is one of the leading cause of morbidity in men. Alcian Blue stain demonstrates that the acidic mucin is present in prostatic adenocarcinoma but absent in nodular hyperplasia of prostste. So this histochemical marker can be used in distinguishing them. This study aims to determine the role of Alcian Blue stain in differentiating prostatic adenocarcinoma from the nodular hyperplasia of prostate. Materials and Methods: This cross-sectional study was conducted in the Department of Pathology, Rajshahi Medical College, Rajshahi and in the Department of Pathology, Bangabandhu Sheikh Mujib Medical University (BSMMU) during the period of March 2018 to February 2020. Specimens were processed routinely for Haematoxilin and Eosin stain. The Alcian Blue stain was performed to demonstrate the presence of acidic mucin and the findings were categorized as positive or negative staining. Statistical analyses was carried out by using the Statistical package for Social Sciences (SPSS) version 20 for Windows. The components of accuracy test were computed by respective formulae for the tests. Result: The study involved a total 60 specimens of prostatic tissue among which 30 were histopathologically diagnosed cases of prostatic adenocarcinoma and another 30 were histopathologically diagnosed cases of nodular hyperplasia. Among the 30 cases of prostatic adenocarcinoma the acidic mucin was positive in 25 (83.3 %) cases and negative in 5 (16.7%) cases but in nodular hyperplasia it was positive in 8 (26.6%) cases and negative in 22 (73.4%) cases. The sensitivity of Alcian Blue stain in favour of malignancy was 83.3% and specificity was 73.3%. The overall diagnostic accuracy of Alcian Blue stain was 78.3% and it showed a statistically significant difference in staining between the cases of adenocarcinoma and nodular hyperplasia, indicated by p<0.05. Conclusion: Alcian Blue stain has a valuable role in differentiating prostatic adenocarcinoma from the nodular hyperplasia. So it can be used in the diagnosis of prostatic adenocarcinoma.
Md. Mostafizur Rahman, Md. Shakhawat Hossain, Shah Md. Ahsan Shahid
TAJ , Jul-Dec 2023; 36(2) 65-70
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Introduction: Choledocholithotomy followed by T-tube has long been a standard surgical treatment for choledocholithiasis. It is still a preferred choice in many hospitals where minimally invasive procedures are not feasible. The use of T-tube is not without complications. To avoid complications associated with T-tube, we have performed primary closure of the common bile duct (CBD) after exploration. This pilot study assessed the safety of primary closure of CBD, which would help form a basis for implementation on a wider scale. Aim of the study: To compare the outcome in primary closure of the common bile duct and Ttube drainage after choledocholithotomy. Methods: This cross-sectional study was conducted in the Department of Surgery at IBNSina Medical College &Hospital, Dhaka, and Delta Medical College& Hospital, Dhaka Bangladesh; from January 2021 to December 2022. A total of 80 patients were selected purposively, and were randomly divided into two groups: The t-tube drainage group and the primary closure group. Each group consisted of 40 patients. Data were entered and analyzed using SPSS software. Ethical clearance was obtained from the hospital's ethical review committee. Result: The most common presentation in the primary closure group was jaundice with 18 patients (45%) but most of the patients in the T-tube group presented with acute cholecystitis with 21 patients (52.5%).In primary closure patients the mean operating time was observed to be 60±15mins while that in the case of T-tube drainage patients was 90±10 mins. The total duration of hospital-stay in primary closure patients ranged from 6-10 days with an average duration of 8 days which was much shorter than that of T-tube drainage patients which ranged from 10-16 days with an average of 13 days. Conclusion: Primary closure following laparoscopic CBD exploration is safe and feasible for selected patients with choledocholithiasis.
Jarin Sazzad, Md. Shah Alam, Md. Ahsanul Haque, Quazi Tamanna Haque, Haimanti Shukla Das, Mahmuda Naznin, Md. Mizanur Rahman
TAJ , Jul-Dec 2023; 36(2) 71-76
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Background: Enteric fever caused by Salmonella species is a systemic febrile illness that can be fatal since its characterization in 1880. Enteric fever may remain asymptomatic carrier and sometimes fatal that it can be difficult to diagnose based on symptoms alone because they are similar to those of other febrile disorders. In developing countries, enteric fever is common global health problem due to poor standard of personal hygiene, contaminated food, inadequate safe water and sanitation. Methods: This is a cross-sectional study that was conducted in the Microbiology Department of Rajshahi Medical College Hospital for one year from January 2021 to December 2021 to identify Salmonella species by Automated Blood Culture (Fastidious Antibiotic Neutralization method) followed by subculture in MacConkey’s agar, Xylose lysine deoxycholate agar, and Salmonella Shigella agar media in suspected enteric fever cases. This study included suspected cases of enteric fever as determined by the physician who fulfilled the inclusion and exclusion criteria. Results: Among 127 suspected cases of enteric fever 64(50.39%) culture positive bacteria isolated by automated blood culture (FAN) method and out of that Salmonella species 38 (59.37%) and others bacteria 26(40.63%) following subculture in MacConkey’s agar, Xylose lysine deoxycholate agar and Salmonella Shigella agar media. Regarding gender, the majorities (61.4%) of culture-positive patients were male, and the majority (65.35%) came from rural areas. Conclusion: Especially for patients who have received antibiotics, we propose that the automated blood culture approach followed by subculture could be employed as a novel diagnostic method for typhoid fever.
Md. Abdul Hakim, Shahanaz Akter Bijou, Md. Shoyeb Rahman, Abu Sayem Muhammad Jakee Azam Sohan, Md. Sied Iqbal, Nawshin Nawar
TAJ , Jul-Dec 2023; 36(2) 77-82
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Objectives: The cause of this observation turned into a change to evaluate the clinical and radiological abilities of 35 intraosseous ameloblastomas. Study design: Data regarding the patients' time, sex, tumour locations, and surgical remedy history, just like the radiographic findings and the type of recurrences, had been analyzed. Results: The patient ranged from 10 to 69 years (mean, 27.8 years). 19 (54.29%) of the 35 topics were males, and 16 (45.71%) were females. 33 (94.29%) of the 35 ameloblastomas had been located in the mandible. The swelling turned into changed into the maximum now no longer; uncommon vicinity symptom and changed right into an expert via way of 13(37.14%) patients. Radiographically, 22 (62.85%) of the 35 tumours had been unilocular with a well-demarcated border. Of the final 13 instances, 10 had been multilocular and 3 had been of cleaning soap bubble appearance. 16 instances of ameloblastoma had advanced in a cyst. The not unusual place recurrence charge turned into changed to 20%, and the commonplace vicinity age of the affected person at recurrence was modified to 26.4 years. Conclusion: When the assessment of ameloblastoma in greater younger humans stays unsure after medical and radiologic examination, a biopsy is necessary. Follow-up at normal durations after surgical operation is likewise recommended.
A.K.M. Shamsul Alam, Md. Ibrahim Hoshen, Be-Nazir Ahmmad, Sanchita Sarke, Md. Ruhul Amin, Fazlur Rahman, Md. Belal Uddin
TAJ , Jul-Dec 2023; 36(2) 83-92
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The relationship between serum LDH (lactate dehydrogenase) and the course of neoplasia had been well established in different studies. It might be a promising tool as assessing serum is easy, readily available and cheap in the prognosis of childhood Acute Lymphoblastic Leukemia (ALL). This study is aimed to evaluate the role of serum LDH before and after induction of remission in childhood ALL. This study was conducted at the Department of Pediatrics, Rajshahi Medical College Hospital, and Rajshahi for a period of two years. Total 30 children aged from 1-12 years newly diagnosed cases of ALL were included. Each patient underwent clinical evaluation and relevant investigations. All information was recorded in a separate case record form. Collected data were analyzed using the statistical software SPSS 23. Mean age of the studied children was 5.03±3.17 years. Male children were 66.7% and female children were 33.3%. Mean value of serum LDH was significantly lower at 29th days of induction of remission compared to the value before chemotherapy (432.40±310.52 U/L vs. 829.10±345.58 U/L, p<0> +0.75, p<0.001). This study observed significant reduction of LDH after chemotherapy and positive linear relation with peripheral blast cells.
Sumona Raisa Nodi, Md. Mizanur Rahman, Md. Shah Alam, Sabera Gul Nahar, Quazi Tamanna Haque, Sifat E Siam, Md. Shahin Aktar Roni
TAJ , Jul-Dec 2023; 36(2) 93-100
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Background: The increase in the incidence of fungal infections, especially those caused by Candida albicans and non albicans Candida species, necessitates the understanding and treatment of Candida-associated infection. Due to frequent use of antifungal drugs, a shift is observed towards non-albicans Candida species and change in the pattern of susceptibility of antifungal drugs. The aim of this study was to isolate and identify the Candida species from different superficial candidial infections in adult patients and to observe their antifungal susceptibility patterns. Materials and Methods: A cross sectional study was performed over a period of one year in at tertiary care hospital that involved 180 patients. The candidial species were isolated, their antifungal susceptibility patterns were determined from vaginal swab, oral swab and skin appendages. Results: Commonest age group involved was of 30-39 years age (30%, 54/180). Among 67 culture positive samples,C. albicans was the most common isolates and found in 39/67(58.21%) cases. Non-candidal species likeC. tropicalis and C. kruseiwere isolated in16/67(23.88%), 09/67 (13.43%)cases respectively. Caspofungin was found to be the most sensitive and fluconazole was found to be the least sensitive antifungal drugs. Non-albicansCandida species showed more antifungal resistance than C. albicans. Conclusions: Candida albicans were predominant isolated from the superficial candidial infection but C. tropicalis was the most frequently isolated among non albicans species. They showed a wide range of susceptibility towards different antifungal agents and fluconazole was found to be less sensitive drugs.
Md. Azizul Islam, S M Shahinul Islam, Md. Jawadul Haque, and Md. Mokter Hossain
TAJ , Jul-Dec 2023; 36(2) 101-109
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Background: The Prostate gland is the male secondary sexual organ most commonly affected by benign or malignant neoplasm. Prostate cancer (Ca-P) is one of the most commonly diagnosed cancers in men and is now the third commonest cause of cancer death in western countries. The aim of the study was to evaluate the use of serum prostate-specific antigen levels in differentiating prostate cancer from benign prostatic hyperplasia. Methods: The present study is a cross-sectional observational study. The study was conducted at the outpatient department and indoor patients at the department of Urology, Rajshahi Medical College Hospital (RMCH), Rajshahi, and different private clinic in Rajshahi City during the period from July 2019 to June 2020. The study population included male patients above 50 years of age, who attended in the department of Urology, Rajshahi Medical College Hospital (RMCH), Rajshahi, and different private clinic in Rajshahi City complaining of irritative or obstructive lower urinary tract symptoms (LUTS) suspected as clinically prostate cancer or benign prostatic hyperplasia (BPH Statistical analysis of the results was obtained by using window-based computer software devised with Statistical Packages for Social Sciences (SPSS-24). Results: The age distribution of the prostatic carcinoma and BPH patients. Prostatic carcinoma was observed to be significantly higher from 80 years onwards, while BPH was common between 60 - 80 years (p = 0.00001). Table 10shows the validity or accuracy of the free/total ratio of serum PSA as a diagnostic test in differentiating prostatic carcinoma from BPH in patients with total PSA levels between 4-10ng/ml. The percentage of false positives was significantly higher when total PSA ratio was used to diagnose the disease compared to when free to total PSA was used as a diagnostic tool (p<0.000001). The overall accuracy of total PSA was also significantly lower (61.45%) than that of free/total PSA (91.67%) (p< 0.011526). Conclusion: Free and total prostate specific antigen (PSA) is increased significantly in carcinoma prostate than benign prostatic hyperplasia but free/total ratio of serum prostate specific antigen level significantly decreases in prostatic carcinoma than benign prostatic hyperplasia.
Dr. Md. Najmul Haque, Dr. Mst. Rupali Yasmin, Dr. Shantona Rani Paul
TAJ , Jul-Dec 2023; 36(2) 111-119
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Background: Serum alpha-fetoprotein (AFP) has long been used to complement imaging tests in the screening and diagnosis of hepatocellular carcinoma (HCC), its utility as a predictive marker of long-term risk for HCC in HBV patients is contentious. Objective: The current study is aimed to assess the serum alpha-fetoprotein with the tumor character and HBV status of HCC to assess its resectability. Methods: This was a single-center, cross-sectional study done from September 2020 to August 2021 at the department of Hepatobiliary, pancreatic, and liver transplantation surgery at BSMMU. A total of 27 HCC patients who met the inclusion criteria were enrolled in the study. Clinical, laboratory, and imaging findings were obtained using a standardized data collecting sheet with the patients' informed agreement. AFP was measured by automated chemiluminescence analyzer (LIAISON XL, DiaSorin, Italy) in the Department of Biochemistry & Molecular Biology, BSMMU. Statistical analyses were performed using SPSS version 22. Quantitative variables were expressed as mean standard deviation and examined using an unpaired t-test. The qualitative data were represented by frequencies and percentages, and the Chi-Square test and Fisher exact test (where applicable) were used to determine any association. The statistical tests were conducted with a 95% confidence interval, and P<0.05 was deemed statistically significant. Results: Majority of the tumors were single and located in the right lobe. Local extension and distant metastasis were preset in unresectable patients of group 2.Hepatitis B virus was positive in 16 (59.3%) patients and DNA was detectable in 8 (29.6%) patients. HBV positivity and detectable HBV DNA was significantly associated with poor resectable status in group 2 but insignificant in group 1. Conclusions: In this study, the overall resectability was 37%. HBV positive HCC patients are significantly associated with poor resectability when serum AFP is raised and it would be more indicative when HBV DNA is detected.
Swapna Majumder, S.M.Asafudullah, Khadiza Khanom, Arefa Sultana, Zahir Al Imran, Taslima Hossain, Ashoke Sarker
TAJ , Jul-Dec 2023; 36(2) 121-128
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Background: Papillary thyroid carcinoma (PTC) is the most frequent histologic type of all thyroid malignancies followed by follicular thyroid carcinoma (FC). Follicular variant of papillary thyroid carcinoma (FVPTC) is the second most common variant of PTC. A diagnostic dilemma may arise, when histologically the distinctive nuclear features are either not well developed or present focally within an encapsulated thyroid lesion. A panel of immunomarkers has been tested to overcome the limitation of histopathology. P63 is commonly used immunomarkers among them. Objectives: The aim of the present study was to see the expression of P63 in PTC including FVPTC and FC in order to evaluate their possible roles in the differential diagnosis between these two mimics. Patients and methods: This cross-sectional descriptive study was conducted over 44 cases with histologically confirmed papillary and follicular thyroid carcinoma. Immunohistochemistry was done for P63. Results: Out of the 44 cases, 39 were histologically diagnosed as papillary thyroid carcinoma (27 were classical PTC & 12 were FVPTC) and the rest 5 were follicular thyroid carcinoma. In the present study, P63 showed 74.4% positivity with varying intensity and extent of staining in papillary thyroid carcinoma. Positive immunoreactivity of P63 was highly significant in distinguishing papillary from follicular thyroid carcinoma (P=0.003). Conclusion: This study suggested that the use of P63 may be helpful in the diagnosis of papillary and follicular thyroid carcinoma along with histopathological examination.
Most Ishita Khanom, Fatima Jomrud Mohol, Shahin Sharmin, Saian Fariya, Saraban Tahura, Abul Bashar Muhammad Reza, Afrida Anzum
TAJ , Jul-Dec 2023; 36(2) 129-134
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Background: The placenta of diabetic women has attracted much interest to the researchers from different disciplines, largely because it is thought that placental damage or dysfunction may be partially responsible for the unduly high incidence of perinatal complications in maternal diabetes. As postnatal placental examination is of immense significance to understand the fetal and perinatal conditions in antenatal and perinatal periods due to placental dysfunction or compromise resulting from diabetes in pregnancy. Objectives: The aim of this study was toinvestigate the morphological changes in placenta of pregestational and gestational diabetes mellitus. Methods: This cross-sectional comparative study was carried out in the Department of Anatomy, Rajshahi Medical College, Rajshahi in collaboration with the Department of Obstetrics & Gynae, Rajshahi Medical College Hospital and Diabetic Hospital Rajshahi, Bangladesh over a period of three years from January 2019 to December 2021. The study was conducted on 70 pregnant women, among them 35 women were diabetic and 35 women were non-diabetic. Then shape, weight, thickness and diameter of placenta were compared between diabetic and non-diabetic pregnant women. Data were analyzed by SPSS software, version 24 and p value < 0 xss=removed> 500 gm) as compared to 5.7% of placenta from the non-diabetic pregnant women (p = 0.001). Over two-thirds (68.6%) of the placenta of the former group were larger (≥ 400 cc) as opposed to 14.3% of the non-diabetic mothers (p < 0.001). Thickness and diameter of the placenta were fairly comparable between the study groups (p = 0.445 and p = 0.164, respectively). Conclusion: The study concluded that placentas of diabetic mothers are significantly larger and heavier than those of the non-diabetic mothers. Thickness and diameter of the placenta were also greater in pregnant mothers with diabetes or GDM than those in non-diabetic mothers.
Monjur Ahmed, Ahsanul Hoque, Nur A Zannat, A B M Zafar Sadeque, Tariqul Islam Khan
TAJ , Jul-Dec 2023; 36(2) 135-143
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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. 120 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) Age, Sex, Occupational status, Socioeconomic status, 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. But, 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.
Chaman Ara, Laila Shamima Sharmin, Fardoushi Begum, Sanchita Sarker, Md. Belal Hossain, Shahida Yeasmin, Md. Sanaul Haque
TAJ , Jul-Dec 2023; 36(2) 143-153
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Introduction: Community acquired pneumonia (CAP) top the list of causes of under five children mortality in the world. 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 in improving 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 is a case control study which 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 under five children. For this study, total 246 children, aged 2 months to 59 months, were selected by purposive sampling technique. 123 were cases who were taken from indoor and 123 were healthy controls who were taken from out patients department & EPI center. After taking written consent from guardians, history was taken and physical examination was done. All information were recorded in a predesigned data sheet. Chi-square test and odds ratio were used to demonstrate level of significance. Results: Among 246 children greater number of patients of both group were male and came from rural area. Cases were predominant under 12 months and came from lower socioeconomic status. A statistically significant association was found between social class and CAP (<0.001), father’s literacy was inversely related to CAP (p value <0.001). Types of housing, ventilation of living room , overcrowding, types of 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 in improving the quality of life of our future generation.
Nur-E-Saud, Ayrin Parvin, A. S.M. Fahad Ar Rahman, Dipa Roy, Farhadul Islam, and Ariful Haque
TAJ , Jul-Dec 2023; 36(2) 155-162
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Introduction: A better prognosis has resulted from the use of molecular techniques in cancer diagnosis. The FGFR family of genes is one of the major gene families involved in the carcinogenic pathways of different malignancies. Tumorigenesis, uncontrolled cell proliferation, and a number of pathologic diseases are linked to improper FGFR activation. The family of genes known as FGFRs encodes cell surface membrane receptors with tyrosine kinases.The development of oral squamous cell carcinoma (OSCC) may be significantly influenced by fibroblast growth factor receptor 1 (FGFR1). Analyzing these elements' expression patterns may provide fresh perspectives on illness management strategies including genetic mediated target therapy. Objectives: In order to improve care and prevent future difficulties from oral squamous cell carcinoma (OSCC), the current study sought to assess the expression of FGFR1 genes in OSCC tumors as a result of the discovery of biomarkers and early diagnosis. Methods:In order to assess the expression of FGFR1 genes in 16 OSCC samples, 16 normal specimens from the same sample, free from cancer margin and 4 control samples from other patient free from cancer, the Oral and Maxillofacial Surgery DepartmentatDental Unit of Rajshahi Medical College Hospital was collected. Trizol and the appropriate kits were used for RNA extraction and cDNA synthesis. Real-time PCR was used to assess the FGFR1 gene's expression following the construction of a specific primer set in order to find and validate molecular biomarkers. The data is analyzed using the ANOVA and independent t-test. Statistics were shown to be significant when P<0.05. Results:According to the findings, there are notable variations in the expression of the FGFR1 gene between tumor and normal or control tissues (P < 0.001). Patients over 60 are more likely to have OSCC, and the majority of them smoke 8. Retromolar trigon 8 is the most frequent location, and the majority of them are in stages III and IV. The FGFR1 gene expression does not significantly differ according on a patient's age, gender, religion and behavior, including whether they smoke, drink, or chew paan. It also does not differ depending on the tumor's location, stages and grade. Conclusions: The FGFR1 gene was often expressed differently in cancerous and control tissues, confirming the gene's involvement in OSCC. The expression of FGFR1 is not correlated with factors such as gender, age, history of smoking, alcohol intake, chewing paan, tumor site, degree of differentiation, or TNM stage. The current investigation demonstrated the critical function of the investigated gene in the diagnosis of OSCC. To verify this, though, more research is required.
Md. Ruhul Amin, Be-Nazir Ahmmad, Fazlur Rahman, Md. Mosharrof Hossain, SK. Mohammad Ali Rashed, Md. Sanaul Haque Mia
TAJ , Jul-Dec 2023; 36(2) 163-170
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Background: Pneumonia is the leading cause of death globally among children younger than five years of age. Acute bronchiolitis is also a major public health problem throughout the world. Many children with pneumonia and bronchiolitis are not properly diagnosed, and overuse of antibiotics has led to increasing drug resistance. Objectives: To determine the magnitude of pneumonia and bronchiolitis and to study their treatment modalities practiced in under five children. Methods: This cross-sectional observational study was carried out in the Pediatric inpatient department and outpatient department of Rajshahi Medical college Hospital from October 2015 to March 2016. Total 373 cases between 1 month to 59 months of age with acute respiratory infection who fulfilled the inclusion criteria were enrolled in the study. The inclusion criteria were any child between 1 month to 59 months of age presented with respiratory symptoms including cough/runny nose or breathing difficulty as complained by the caregivers or having chest in-drawing. Detailed information was obtained through structured questionnaire and then analyzed. Results: In this study majority of the children 223 (59.78%) were under 12 months of age. There were 234 (62.73%) male and 139 (37.27%) female cases, male to female ratio being 1.68:1. Among studied children 217 (58.18%) were urban dwellers and 156 (41.82%) were from rural areas and majority of the children 268 (71.85%) came from lower socioeconomic strata. Out of 373 cases, pneumonia was diagnosed in 131(35.12%) cases, bronchiolitis in 88 (23.60%) cases and other acute respiratory tract infections in 154 (41.28%) cases. Most common antibiotic used for the treatment of both pneumonia and bronchiolitis was ceftriaxone in 34.35% and 25
Ayesha Nasrin, Nazia Nusrat Ria, Momena Khatun Munna, Shahnaz Akhter, Fatema Khatun
TAJ , Jul-Dec 2023; 36(2) 171-178
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Background: Shift work has been found to be associated with various health problems that not only affect workers but also economic and industrial sectors of a country. Disturbance of workers’ normal social or biological diurnal rhythms, or both, cause health problems of shift workers. Objectives: The aim of the study was to compare blood pressure between shift and non-shift physicians. Methods: This cross-sectional type of comparative study was carried out in the Department of Physiology in Rajshahi Medical College over a period of 12 months from January 2022 to December 2022 among physicians of Rajshahi Medical College and Hospital aged 25-35 years. Approval from the Ethical Review Committee (ERC) was obtained prior to the commencement of the study and the sampling technique was purposive. Pre-designed, validated, structured questionnaire was used to gather information from 230 physicians in Rajshahi Medical College and Hospital. Results: The mean age of the shift physicians was 30.36 ± 3.13 years and the non-shift physicians was 29.10 ± 3.17 years. Shift physicians were more likely to be overweight (75.70%) than the non-shift physicians (50.40%) with mean BMI of shift physicians was 26.75 ± 1.10 kg/m2 and non-shift physicians was 25.34 ± 2.31 kg/m2. The mean duration shift work of the physicians was 4.91 ± 2.38 years. Among shift physicians 26.10% were hypertensive, 14.80% were pre-hypertensive and among non-shift physicians 10.40% were hypertensive, 9.60% were pre-hypertensive and there was statistically highly significant relationship between duration of shift work and status of blood pressure of the shift physicians. The mean SBP and DBP in shift physician group were also higher than the non-shift physician group and both of them were statistically significant (p < 0.01 and p < 0.05 for SBP and DBP, respectively). Conclusion: Shift work is associated with greater risk of hypertension in shift physicians in comparison to non-shift physicians. As shift work practice is common in industrialized countries as well as in developing countries, interventions to minimize such risk among physicians need to be introduced.
Sujit Kumar Sarker, Dipak Kumar Nag, Md. Yousuf Ali, Naimul Haque, ShammeeTasmia
TAJ , Jul-Dec 2023; 36(2) 179-184
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Background & Objective: Recently there are various treatment modalities for the patients of diabetic macular edema. So, it is very difficult to choose the option. This study was aimed to compare the efficacy of combination of intravitreal injection of bevacizumab with laser photocoagulation versus combination of intravitreal injection of bevacizumab with triamcinolone acetonide in the treatment of DME. Methods & Materials: A prospective observational study was conducted on 50 eyes of fifty patients who were diagnosed with DME at vitreo-retina department of NIO&H. They were divided into 2 groups, Group A (treated with bevacizumab with laser photocoagulation) and Group B (treated with intra-vitreal bevacizumab with triamcinolone acetonide). Follow-up pattern was set after 1 and 3 months of intervention. All the baseline data and outcome data were recorded in a pre-designed data collection sheet and was statistically analyzed by SPSS version 23. Result: Mean baseline BCVA was 0.57±0.29 (SD) Log MAR in group A and 0.70±0.26 (SD) Log MAR in group B (p=0.57). BCVA was 0.40±0.32 (SD) and 0.40±0.37 (SD) in group A and 0.58±0.28 (SD) and 0.45±0.36 (SD) in group B during 1st and 2nd follow-up respectively. Comparison of mean BCVA between two groups at final follow-up was not significant. Improvement of CMT from baseline in every follow up in each group was significant but comparison of mean CMT between two groups at final follow-up was not significant (p=0.64). Though the difference of baseline IOP of both groups are statistically significant, comparison of mean IOP between two groups at final follow-up was not significant (p=0.67). Conclusion: There was significant improvement in mean BCVA and mean CMT within the group in each follow-up. At final follow-up, Combination of intravitreal bevacizumab and triamcinolone acetonide shows better improvement which is non-significant.
Mousumi Mahjabin, Md. Shah Alam, Sabera Gul Nahar, Md. Maruful Arefin, Nahreen Rahman, S.K.R.K.M.A.S.S. Amanathullah, Md Ahsanul Haque
TAJ , Jul-Dec 2023; 36(2) 185-192
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Background: Otomycosis is a well prevalent disease (9-30%) in our country which even might persist for more than 3 months (chronic cases). Now a days, development of antimicrobial drug resistant making difficult to treat such patients all over the world. Objective: To identify fungal agents causing chronic otitis externa with their antimicrobial susceptibility in Rajshahi Medical College Hospital. Material and Method: This cross-sectional descriptive study was conducted from January 2022 to December 2022 in the department of Microbiology at Rajshahi Medical College, Rajshahi. About 110 suspected chronic otitis externa patients were selected from outpatient department of ENT of RMCH & data were collected by a semi structured questionnaire. Fungal organisms isolated and identified by culture, LPCB stain and relevant tests including a specific Czapek Dox Agar media. Antimicrobial susceptibility was done by modified Kirby Bauer disc diffusion method. Data were analyzed using SPSS (version 24.0). Statistical significance was considered when p value < 0.05. Result: In this study, near half (48.18%) aural swab from respondent of chronic otomycosis were culture positive for different fungal species. Among all, A. niger was most common species (50.9%) & 1/5th of them was C. albicans (20.8%) along with other species. Most sensitive drug for different fungal species were voriconazole &itraconazole and most resistant drug were fluconazole and ketoconazole. Conclusion: As common antifungal drugs are resistant to different fungal species & their susceptibility pattern are changes day by day, among otomycosis patients the fungal culture & antimicrobial susceptibility should be done to reduce the morbidity of such patients as well as to reduce the generation of new resistance to antifungal drugs.
Saian Fariya, Fatima Jomrud Mohol, Shahin Sharmin, Most Ishita Khanom, Saraban Tahura, Abul Bashar Muhammad Reza, Afrida Anzum
TAJ , Jul-Dec 2023; 36(2) 193-200
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Background: The mental foramen is an important anatomical landmark during surgical intervention and anaesthetic nerve block procedure involving inferior alveolar nerve and mental nerve. Objectives: The aim of this study was to determine the variation of position of mental foramen in relation to side and sex. Methods: This cross-sectional type of descriptive study was conducted over a period of 1 year from January 2021 to December 2021 in the Department of Anatomy, Rajshahi Medical College, Rajshahi. This study was performed on 250 dry adult human mandibles (148 were male and 102 were female mandibles) which were collected from the students of Department of Anatomy, Rajshahi Medical College, Rajshahi as well as other Medical Colleges after fulfilling the inclusion criteria. Data were collected purposively with the help of a semi-structured questionnaire. All the measurements were performed using digital sliding Vernier calipers and the data were analyzed via SPSS software, version 24.0. Statistical significance was evaluated as appropriate probability level p < 0> 0.05) but distance from posterior border of ramus of mandible to lateral margin and vertical diameter of mental foramen were statistically significant (p < 0> 0.05). Conclusion: This study might help us in establishing a reference data-base in our country for the Anatomists in general, Dental Surgeons and Maxillofacial Surgeons.
Murad-Ud-Daula, Mohd. Alamgir Hossain, Rizvi Yazdanee, Shakhawout Azam Abbease, S M Monjur Morshed, Abdul Alim
TAJ , Jul-Dec 2023; 36(2) 201-206
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Background: Pediatric femur shaft fractures are common in children, especially in developing countries, and are associated with significant morbidity and mortality. Titanium Elastic Nail System (TENS) has now become the preferred stabilization method in pediatric long bone fractures, particularly femoral shaft fractures. Objective: This study was to evaluation of the Titanium Elastic Nailing System (TENS) for intramedullary fixation of pediatric femoral shaft fractures. Materials and Methods: The study conducted Multicentered based non-randomized prospective study was performed in the Department of Orthopaedic Surgery, Rajshahi Medical College Hospital, Rajshahi, Bangladesh, from January 2021 to December 2022.There was a total of n=40 pediatric patients (5-16 years old; 31 males, 9 girls) who had retrograde TENS fixing for femoral diaphyseal fractures. Gustilo and Anderson's classification criteria were used to classify fractures into Grades I through III. Results: TENS was a safe and effective treatment option for pediatric femur shaft fractures, with all patients achieving fracture healing without major complications. The mean duration of follow-up was 21 months (range 3-39 months). After an average of 9 weeks, the radiographic union was confirmed for all fractures with grade 3 callus development, and by 9.5 weeks, patients may recover full weight bearing. Flynn's criteria evidenced an excellent outcome in 33 patients (82.5 %) and a good outcome in 7 patients (17.5 % Six patients had limb lengthening, four had varus mal-alignment, and three had rotational. In 4 cases, closed reduction failed, and 2 required nail corkscrewing. Conclusion: The study TENS is a reliable treatment option for pediatric femur shaft fractures in a resource-limited setting like Bangladesh. It is a minimally invasive technique that allows early mobilization and reduces the risk of complications associated with traditional treatment methods.
Chowdhury NF, Haque MJ, Hoque S, Rashid AM,4 Khan MT, Roy A, Das CK
TAJ , Jul-Dec 2023; 36(2) 207-2014
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Introduction: Though the health situation of Bangladesh has been improved substantially over the years, the low birth weight (LBW) rate is still pretty high. LBW has been associated with high probability of infection, malnutrition, mental deficiencies and behavioural and learning problem in later life. The principle focus of this study was to ascertain the proportion of LBW and its associated maternal risk factors identification. Materials & methods: It was a cross-sectional type of descriptive study done at two tertiary level hospitals – Rajshahi Medical College Hospital and Islami Bank Medical College Hospital. A total of 270 mothers were interviewed within 1 month of their delivery. The purposively selected participants were asked about their socio-demographic characters and other associated factors related to birth of the babies. Weights of the babies at birth were documented from hospital records. Result: Proportion of LBW was found 28.1% with no significant sex variation. Majority of the LBW babies were found in mothers of 15-20 years of age group. Mothers’ educational qualifications, occupations, early age pregnancy and type of pregnancy were associated significantly for LBW. Less than 37 weeks of gestational age of baby, home delivery, NVD were also significant risk factors of LBW. Residence and sex of neonate were not significantly associated with LBW. Conclusion: Proportion of LBW in tertiary care hospitals were found 28.1%. Early maternal pregnancy, lower gestational age, higher parity, NVD and home delivery played an important role in the incidence of LBW.