Md. Jawadul Haque, Md. Rizwanul Karim, Nelofar Yasmin, Shubhra Prakash Paul, Chaman Ara, Most. Firoza Parvin, Rumana Ferdous, Md. Asadur Rahman, Kowsarunnahar, Md. Maruful Arefin
TAJ, Jul-Dec 2023; 35(2) 01-11
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Introduction: Menstruation-related poor knowledge and understanding among adolescent girls may lead to unsafe personal health care practice that ultimately increases the risk of genitourinary tract infections, drop-out from school, poor academic performance, and overall poor quality of life. Being a developing country, it is an unrecognized problematic area in Bangladesh. Therefore, it is crucial to assess knowledge and practice on menstrual hygiene among urban adolescent girls in Bangladesh. Methods: This was a community-based cross-sectional study conducted in the Department of Community Medicine of Rajshahi Medical College among 495 purposively selected urban adolescent girls. Data were collected using a semi-structured interviewer-administered questionnaire. Results: The majority (57.2%) of the respondents in the study were more than 15 years old, and most (93.3%) were Muslim. Most of the girls (82.5%) have experienced menarche within the age range of 12-15 years, and the majority of respondents, 259 (52.32%), were informed about menstruation before menarche. Their source of information about menarche was mothers in most cases. Out of 495 adolescent girls who participated in this study, 70.9% had good knowledge of menstruation. About 82% of girls used commercially made sanitary pads, and 35.2% changed pads or clothes more than three times a day during menstruation. Conclusion: The majority (70.9%) of adolescent girls had good knowledge of menstruation, and 73.3% had a good practice on menstrual hygiene. Therefore, there is a need to design and implement universal awareness creation and advocacy programs to improve their knowledge of safe and healthy menstruation management and promote good hygienic practices by creating an appropriate supportive home and social environment for all the adolescent girls.
Shantona Rani Paul, Md. Nowshad Ali, S M Ahsan Shahid,3 Subal C. Paul, Md. Najmul Haque, Md. Zamil Hossain
TAJ, Jul-Dec 2023; 35(2) 13-18
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Background: Sigmoid volvulus occurs when the sigmoid colon twists on its mesentery and is a cause of intestinal obstruction. Method: This was a descriptive study conducted at the Surgery department of Rajshahi Medical College Hospital during the period from May 2009 to June 2011. Ethical consideration was taken from all the patients. The sample size was 50 with acute sigmoid volvulus. Data were processed and analyzed through SPSS (Statistical package for social sciences). A value of p ≤0.05 was considered significant statistically. Result: Most patients (56%) were diagnosed with acute sigmoid volvulus from the age range of 51-60, among whom male patients had a prevalence (92%). Most of them (92%) were economically impoverished. 36% of patients came to the hospital for treatment from 37-48 hours of illness. The post-operative complication was mild due to wound infection in 10% of patients. Hospital stay was 8-10 days for 76% of patients without complications postoperatively and 11-13 days for 14% of patients. Severe complication resulting in hospital stay was seen in 4% of patients. Conclusion: Emergency resection of the sigmoid colon and anastomosis in unprepared bowel was an attractive and preferred option in a setting where patients are poor, hospital care often unaffordable and hospital beds are few.
Md. Rezaul Karim, Md. Humayun Kabir Talukder, Rais Uddin Mondol, Rajesh Kumar Ghose, Molla Md. Iftekhar Hossain
TAJ, Jul-Dec 2022; 35(2) 19-26
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This descriptive type of cross-sectional study was conducted to determine the learning styles of undergraduate medical students and their relation with preferred teaching-learning methods. The study period was from July 2017 to June 2018. The study was carried out among the students of the 2nd, 3rd, and 4th phases of the MBBS course at three government and four nongovernment medical colleges in Bangladesh. Out of seven medical colleges, four were within Dhaka and three outside Dhaka. The sample size was 1004. Medical colleges were selected purposively, and a convenience sampling technique was adopted for data collection. Bangla translated version of Fleming's VARK (visual, auditory, read/write, and kinesthetic) questionnaire was used to identify the learning styles of students. Linear regression was used to compare the VARK learning styles scores with teaching-learning methods. The study revealed that out of 1004 medical students 64.2% preferred multimodal learning styles, and the rest, 35.8% preferred unimodal learning styles. Among unimodal learning preferences, auditory (A) and kinesthetic (K) were the most preferred sensory modalities of learning. The most preferred teaching methods among the students were bedside teaching (29.9%), followed by tutorials (25.9%), and practical sessions (20.6%). The most preferred learning method among the students was mixed methods (60.3%). A positive correlation was present between VARK modes and teaching-learning methods (P <0.05). Majority of students preferred multimodal learning styles. Students are able to learn effectively as long as the teacher provides a blend of visual, auditory, read/writing, and kinesthetic activities. The study recommended that teachers be aware of the medical students' learning styles and that aligning teaching-learning methods with learning styles will improve their learning and academic performance.
Mohammad Mohibur Rahman, Kazi Khairul Alam, Md. Humayun Kabir Talukder, Md. Rezaul Karim, Mohammad Rashadull Islam, Md. Kamrul Islam
TAJ, Jul-Dec 2022; 35(2) 27-33
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Background: The assessment is an integral part of the clinical teaching-learning process in undergraduate medical education. Methods: This cross-sectional study was conducted to identify the views of fresh MBBS graduates about the present assessment status of 'Allied Subjects of Surgery' in undergraduate medical education in Bangladesh. The study was conducted from January 2021 to December 2021. Self-administered semi-structured questionnaires were administered to collect data from 40 fresh MBBS graduates. Data were collected from purposively selected 40 fresh MBBS graduates who passed the MBBS course with the completion of internship training within five years working in government and private hospitals or giving health care services in their chamber after getting permission from the respondents. Results: This Study revealed that the conditions of different issues like formative assessments, summative assessments (Professional examinations), short answer questions (SAQ), multiple choice questions (MCQ), structured oral examinations (SOE), objective structured clinical examinations (OSCE) and short cases were poor and in case of long cases were very poor in most of the Allied Subjects of Surgery compared to General Surgery, Otolaryngology and Ophthalmology. These differences were also statistically highly significant in all cases. Conclusion: Hence it can be recommended that most of the Allied Subjects of Surgery should get optimum importance during the assessment procedures in undergraduate medical education of Bangladesh according to the health needs of the community and current global health care situation.
Suravi Sarker, Mrinal Kanti Das, Al-Mirajun Hoque, Sunandita Sarkar, Sharmin Sultana, Shahela Jesmin, Rokeya Khatun
TAJ, Jul-Dec 2022; 35(2) 35-41
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Background: Lower uterine compression suture (Cervical-Isthmic apposition suture technique) is a new but effective method to arrest postpartum hemorrhage (PPH). The effectiveness of the suture is not only due to local compression of the anterior and posterior walls of the uterus but also related to the indirect compression of the intramyometrial vessels running from the lateral edge of the lower uterine segment to its media part. Objectives: The aim of this study was to determine the outcome of uterine compression sutures for the management of PPH due to placenta previa during cesarean section. Materials and methods: This hospital-based prospective observational study was conducted in the Department of Obstetrics and Gynecology of Rajshahi Medical College Hospital from January 2016 to December 2017. A total of 45 women who developed severe postpartum hemorrhage due to placenta previa during cesarean section were selected preoperatively or postoperatively as the study case. A lower uterine compression suture was given to all the patients. If the bleeding was not well controlled, then other adjunctive procedures were performed. Patients with a bleeding disorder, type I placenta previa, cases other than placenta previa, and morbid adherents of placenta were excluded from the study. The patients were examined postoperatively and again in 2nd week and 6th week after hospital discharge for evaluation of any complications. Data regarding history, physical findings, and investigation were collected from the patient and the patient's record. Result: Among the total of 45 cases, PPH was controlled in 88.9%(40) cases with compression sutures in the lower uterine segment, and only 11.1% (5) cases required additional procedures. It was observed that higher age groups, multiparous women, patients with <37 weeks of pregnancy, and previous history of cesarean section were significantly associated with a higher amount of bleeding. Conclusion: Lower uterine compressive compression suture is an effective and safe method to control PPH due to placenta previa during cesarean section and can preserve the uterus for further pregnancy and menstruation.
Fatema Tuz Zohora, Kh. Md. Faisal Alam, Md Shah Alam, Abu Hena Mostofa Kamal, Md Ahsanul Haque,5 Md Mizanur Rahman
TAJ, Jul-Dec 2022; 35(2) 43-49
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Background: Indwelling urinary catheters are frequently used in critically ill patients. Approximately 66% of patients in intensive care have a urinary catheter in place. Catheter-associated urinary tract infection (CAUTI) is a significant cause of morbidity and mortality, affecting all ages. Antibiotic resistance is one of the biggest public health challenges of our time. Infection with antibiotic-resistant bacteria has become an increasingly complex problem in ICU. Objective: To identify catheter-associated uropathogens and their antimicrobial susceptibility pattern by VITEK2 automated system in intensive care unit patients in Rajshahi Medical College Hospital. Material and Method: A cross-sectional descriptive study was conducted in the Microbiology department of Rajshahi Medical College, the Intensive Care Unit of Rajshahi Medical College Hospital, and a commercial laboratory in Rajshahi during the period of January 2021 to December 2021. The specimen (urine) was inoculated in blood agar, nutrient agar, and MacConkey's agar media and incubated aerobically at 37˚C for 24 hours. Bacterial isolations and susceptibility tests were done by VITEK2 automated system. Result: Out of the total 96 samples, culture yielded growth was 36 (37.50%), and culture-negative cases were 60(62.50%). In all age groups, males were predominant, totaling 63 (66.20%). A maximum of 33 cases were found in the age group of 18-30 years where males 23(69.70%) and females 10(30.30%). Among the culture-positive isolates, gram-negative organisms were higher (87.17%) than gram-positive (12.82%). Among 39 isolates, Escherichia coli was the predominant organism of 12(30.76%). Other isolates were Klebsiella spp. 10(25.64%), Pseudomonas spp. 5(12.82%), Acinetobacter spp. 4(10.25%), Enterobacter spp. 2(05.12%), CoNS 3(07.69%) respectively. Regarding the antimicrobial susceptibility test, gram-negative organisms were highly susceptible to Colistin, followed by Ertapenem, Imipenem, Meropenem, and Amikacin. The most effective drugs for Grampositive were Linezolid. Other susceptible drugs against Gram-positive bacteria were Vancomycin and Tigecycline. Conclusion: Most of the isolated bacteria are multidrug resistant. Determining antimicrobial susceptibility by VITEK2 will aid the physician in choosing appropriate antibiotics and treating multidrug-resistant cases.
Bedowra Begum, Shamima Nazneen Rupa, A.S.M. Sayem, Shahnaz Akhter, Susmita Sharmin, Sumayra Jhumu, Mst. Fatema Khatun
TAJ, Jul-Dec 2022; 35(2) 51-58
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Background: Pregnancy is a physiological state with rapid hormonal and metabolic changes that helps the growth and survival of the fetus properly. However, biochemical profile derangement may lead to pregnancy complications and, eventually maybe, death. Objectives: This study aimed to investigate whether lipid profile (Serum total cholesterol, Serum triglyceride, HDL-C, and LDL-C) during 3rd trimester of pregnancy differs from non-pregnant women of similar reproductive life. Materials & Methods: This cross-sectional type of comparative study was carried out in the Physiology Department of Rajshahi Medical College in collaboration with the Maternity and Child Welfare Centre (MCWC), Rajshahi, over a period of 12 months from January 2019 to December 2019 among the pregnant and non-pregnant women to investigate the lipid profile during 3rd trimester of pregnancy. Approval from the Ethical Review Committee (ERC) was obtained prior to the commencement of the study. A pre-designed, validated, structured questionnaire was used to gather information from 120 women by purposive sampling technique. Of them, 60 were pregnant women, and 60 were non-pregnant healthy women. Results: The results showed that the total serum cholesterol, serum triglyceride, and LDL-C were raised among pregnant women compared to non-pregnant women, and these were statistically significant (p < 0> 0.05). In this study, it was found that there was a substantial raised in lipid profile in the 3rd trimester of pregnancy compared with non-pregnant healthy women. So, regular monitoring of the lipid profile of pregnant women should be done to avoid adverse pregnancy outcomes. Conclusion: Total metabolism is increased due to the needs of the growing fetus and the uterus. Basal metabolic rate may be increased up to 30% higher than that of the average for nonpregnant women.
Md Shameem, Kanu Lal Saha, Md. Belal Uddin, Jesmin Jahan, Md Khalilur Rahman, K.M. Saiful Islam
TAJ, Jul-Dec 2022; 35(2) 59-65
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Introduction: Hearing impairment has a devastating, detrimental, and adverse impact on the development of the newborn. Unfortunately, this hidden disability remains undetected for many newborns until it is too late to prevent undesirable and often irreversible damage. It has long been recognized that undiagnosed hearing loss, even a mild loss at birth, can negatively affect speech and language development, resulting in poor academic achievement and social-emotional development. According to WHO 2009, newborns in the NICU are 10-20 times at higher risk of developing hearing loss. The risk factors associated with newborn hearing impairment vary from country to country and even within countries. There has been a paucity of studies on this topic from Bangladesh. This study was done to identify the risk factors associated with newborn hearing impairment in the study place. The objective of the study: To identify risk factors associated with newborn hearing impairment in the study group. Methodology: A prospective observational study was conducted in the department of neonatology, BSMMU. After taking consent from the parents/guardians, a thorough history of these newborns, including particulars of the neonates, family history of hearing loss, treatment history, antenatal, natal, and postnatal history, was recorded in a data collection form. Newborn admitted to the NICU during the study period was the study population. The newborn who meet the inclusion criteria was screened with Transient Evoked Otoacoustic Emissions (TEOAE) close to discharge from the NICU or before one month of age. A second screen was done with TEOAE again after one month of 1st screen but prior to 3 months of postnatal age if referred in 1st screen. Diagnostic Auditory Brain stem Response (ABR) was made to confirm the hearing impairment, and it was done prior to 3 months of postnatal age if referred in both the 1st and 2nd screens. Data were analyzed by statistical package forsocial sciences (SPSS) version 20. Results: 426 valid recordings from 493 newborns admitted in the NICU enrolled consecutively constitute the basis of this study. 14 newborns were found to have hearing impairment among 426 newborns. APGAR ≤ 6 at 5 minutes (odds ratio 20.34, p-value 0.01), TORCH infection (odds ratio 0.64, p-value 0.01), IUGR odds ratio 8.92, p-value 0.02) were independent significant risk factors for hearing impairment. Conclusion: APGAR ≤ 6 at 5 minutes, TORCH infection, and IUGR are independent significant risk factors for newborn hearing impairment. Newborns in NICU with these risk factors should have mandatory audiological evaluation.
Jarin Sazzad, Md. Shah Alam, Haimanti Shukla Das, Nahreen Rahman, Quazi Tamanna Haque, Kazi Mohaimenur Rahman
TAJ, Jul-Dec 2022; 35(2) 67-73
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Salmonella enterica serovars typhi is a contributing typhoid agent, leading to untreatable infections based upon the rising prevalence of antimicrobial resistance in the said agent. Consequently, the main concern of the health service providers to treat expansively drug resistant (XDR) enteric fever has been dependent on the only remaining oral drug, Azithromycin, for creating emerging resistance against it. Therefore, a cross-sectional descriptive study was conducted in the Microbiology Department of Rajshahi Medical College, Rajshahi, to identify Salmonella species by Fastidious Antibiotic Neutralization (FAN) method in suspected enteric fever cases along with its antimicrobial susceptibility pattern and molecular detection of Azithromycin resistant R717Q gene. Samples were collected purposively. Regarding the population's age distribution, out of 127 specimens, the predominant 37(29.1%) were found within the age group of 35-44 years. Automated blood culture was found positive in 64(50.39%) population; out of them, Salmonella spp were 38(59.37%) of the population. Among them 29(76.31%) have travel history, took street food 25(65.7%), used tap water for drinking 21(55.2%) and had kancha latrine 24(63.1%). It was found that 18.43% were sensitive and 81.57% resistant to Azithromycin. Azithromycin-resistant Salmonella spp. were detected in 31(81.57%), and among Azithromycin resistant R717Q gene was identified in 9(29.03%). The azithromycin resistant R717Q gene was identified by conventional PCR. Because of its oral course of administration, Azithromycin is considered the widely used drug in Bangladesh, which is used once on a dose basis a day. In order to contribute to the development of this drug resistance, there could be many reasons, and among them there are the availability over the counter and the imperfectly done treatment. Thus, this study would be helpful to formulate a regional hospital empirical therapy by antimicrobial sensitivity and resistance pattern of the gene for Azithromycin resistance in Rajshahi Medical College Hospital.
Most. Firoza Parvin, Chaman Ara, Tanjila Momotaj, Sanaul Haque Mia, Md. Belal Uddin, Fardoushi Begum, Md. Mamun-Ur Rashid
TAJ, Jul-Dec 2022; 35(2) 75-82
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Background: Acute poisoning is a common medical emergency in the pediatric unit. It is a common preventable cause of morbidity and mortality in children. Most of the poisoning in children less than five years of age is accidental. This study aimed to determine the associated factors and clinical profile of childhood poisoning. Material & Methods: A cross-sectional descriptive study was carried out among 69 children aged six months to 12 years with a history of poisoning over six months. History, clinical examination, and details of the poisoning were obtained by using a structured questionnaire during admission. Analysis was done through standard statistical tests. Result: Among the 69 children of poisoning, 92.8% were accidental, and 7.2% were suicidal. Most cases (79.7%) were from the 6 - 59 months age group with male-female ratio 1.7:1. Most of the fathers (65.2%) and mothers (75.4%) had primary education, and 75.4% were poor. The most common cause of the poisoning was insecticide (60.9%), and the poison was stored at an available site (91.3%) in an unsealed container (47.8%). Accidental poisoning was more common in younger age group (<5>10 years) in females (80%) patient with h/o familial disharmony (60%). Conclusion: Insecticides and kerosene were the common cause of poisoning. Most of the materials were stored in an unsafe place and stored in an attractive bottle. Poison should be stored in a safe home with a sealed container. Simple and active family preventive measures can reduce accidental poisoning