Anwer Khan Modern Medical College Research Articles

Pulmonary Embolism with Floating Right Atrial Thrombus Successfully Treated with Streptokinase

Massive Pulmonary Embolism (PE) is associated with significant mortality, especially if compounded by haemodynamic instability, right ventricular dysfunction and right atrial thrombus. Thrombolysis can be lifesaving in patients with major embolism and cardiogenic shock, and accelerates the resolution of thrombus. Only three fibrinolytic agents - namely streptokinase, urokinase, and recombinant tissue plasminogen activator (Alteplase) have been approved in the treatment of PE, with studies demonstrating similar safety profiles. We report the case of a 33 year old Bangladeshi female with a history of recent ankle fracture and immobilization, who presented with massive PE, leading to cardiac arrest. Upon rapid resuscitation, urgent echocardiogram revealed right ventricular dysfunction with floating right atrial thrombus, and she was successfully treated with 1.5 million IU of Streptokinase over 2 hours as per accelerated regimen recommended by the European Society of Cardiology (ESC) guidelines, resulting in successful resolution of the right heart thrombus, and significant clinical improvement. Subsequent CT Pulmonary Angiogram confirmed the diagnosis of PE, and she was anticoagulated to a PT/INR of 2.0 to 3.0.Anwer Khan Modern Medical College Journal Vol. 7, No. 1: Jan 2016, P 60-63

Sero-Prevalence of Anti HCV Among Blood Donors Attended at Transfusion Medicine Department of DMCH in 2013

Bacground: Post transfusion hepatitis through blood and blood product is still very high in our country. This present study was carried out to find out the prevalence of sero Positive of anti HCV among the blood donors attended at transfusion medicine department of DMCH in 2013 and also to prevent transmission of HCV infection through blood transfusion.Methodology: This cross sectional study was carried out at transfusion medicine department of DMCH from 1st January 2013 to 31st December 2013.Total blood donors were 27,560. Among total 31890 blood donors, relative donors were 25,773.and remaining 6,117 donors were voluntary donors. Blood donors of 18 - 60 years of both sexes were included in this study. Among 31,890 blood donors relative blood donors were 25,773(80.81%), voluntary blood donors were 6,117.(19.18%)Among 31,890 blood donors Anti HCV Sero positive were 33(0.1034%).Result: Among total blood donors male and female were 25,880 ( 81.15 % ) and 6010 (18.85 %) respectively. Age ranges of donors were 18 -40 years 28500 (86.23 % ) and 41 -60 years 3390 (10.63 %).Conclusion: Frequency of HCV seropositive among donors were 33 (.1034 %).Anwer Khan Modern Medical College Journal Vol. 6, No. 1: January 2015, Pages 25-27

Application of Connectionist Approach in Classification of Nutritional Status Among Arsenic Affected people in Rural Areas in Bangladesh

Various methods can be applied to build predictive models for the clinical data with binary outcome variables. This research aims to explore and compare the process of constructing common predictive models. Models based on an artificial neural network (the connectionist approach) and binary logistic regressions were compared in their ability to classifying malnourished subjects and those with over-weighted participants in rural areas of Bangladesh. Subjects were classified according to the indicator of nutritional status measured by body mass index (BMI). This study also investigated the effects of different factors on the BMI level of a sample population of 460 adults of six villages in Bangladesh. Demographic, enthropometric and clinical data were collected based on a total of 460 participants aged over 30 years from six villages in Bangladesh that were identified as mainly dependent on wells contaminated with arsenic. Out of 460(140 male and 320 females) participants 186(40.44%) were identified as malnourished (BMI<18.5 gm), and the remainder 274(59.56%) were found as over-weighted (BMI>18.5 gm). Among other factors, arsenic exposures were found as significant risk factors for low body mass index (BMI) with a higher value of odds ratio. This study shows that, binary logistic regression correctly classified 72.85% of cases with malnourished in the training datasets, 76.08% in the testing datasets and 75.26% of all subjects. The sensitivities of the neural network architecture for the training and testing datasets and for all subjects were 84.28%, 84.78% and 81.72% respectively, indicate better performance than binary logistic regression model. DOI: http://dx.doi.org/10.3329/akmmcj.v5i2.21128 Anwer Khan Modern Medical College Journal Vol. 5, No. 2: July 2014, Pages 23-29

Kikuchi-Fujimoto Disease: A Diagnostic Dilema

Fujimoto (KD) disease or histiocytic necrotizing lymphadenitis is a rare, benign, self limiting cervical lymphadenitis of unknown etiology. Since Tubercular lymphadenopathy is the commonest cause for chronic cervical lymphadenopathy in developing and tropical country like Bangladesh. Occasionally it is misdiagnosed as TB and subsequently shows unresponsiveness to ATT. As a result the morbidity increases and cost of antitubercular treatment (ATT) in wrong diagnosed case is enormous. We report a similar case of misdiagnosis. We report a 26 year old lady who reported with history of right sided neck pain and fever since last 2 months. Clinical examination revealed enlared right sided lymph nodes in the neck. Fine needle aspiration cytology revealed features suggestive of granulomatous lymphadenitis. The case was suspected to be tuberculosis and anti-tubercular therapy (ATT) was started immediately. Since the patient did not respond, lymph node biopsy was done and the histological features suggested the diagnosis of Kikuchi's disease. She did well after recommended treatment. DOI: http://dx.doi.org/10.3329/akmmcj.v5i2.21134 Anwer Khan Modern Medical College Journal Vol. 5, No. 2: July 2014, Pages 51-53

Knowledge and Health Problems Related to Health Behavior among the Secondary School Children in Rural Community of Dhamrai Upazila, Dhaka

In Bangladesh, there are 18,756 secondary schools in which 17.91 million students are enrolled. School children are more vulnerable to be attacked by various types of communicable diseases due to poor health behaviors. The aim of this study was to find out knowledge and health problems related to health behavior among the secondary school children. This descriptive cross sectional study was carried among 795 secondary school children by purposive sampling from 22nd to 24th January 2014 in different school s of Dhamrai Upazila, Dhaka. Data were collected on a pretested questionnaire by face to face interview. Data were analyzed manually and by using computer. The study revealed that majority of the respondents were Muslims by religion, 45% had education level Class VII and mean age was 13±1.7 years. Most of them 45% & 40% students father's and Mothers education level respectively was HSC and above. About 50% students father's occupation were service and 33% were businessman. Mostly about 79% students mother's were housewife. Among all about 71% students were found having 2-3 brothers and sisters respectively. About 20%, 9% and 7% respondents don't agree on drinking clean boiled water, avoidance of smoking and care of nails as a healthy behavior. 25%, 13% and 11% respondents don't practice drinking clean boiled, regular brushing of teeth and care of nails. About 95%, 74% and 67% learned on health behavior from family teachers and text books respectively. About 19%, 14% and 10% students were suffering from common cold, unhealthy hair and itching respectively. Knowledge regarding health behavior among the secondary school children was found still worse. The study recommends more effective implantation of awareness program to improve knowledge regarding health behavior. DOI: http://dx.doi.org/10.3329/akmmcj.v5i2.21127 Anwer Khan Modern Medical College Journal Vol. 5, No. 2: July 2014, Pages 18-22

Investigation of Unnatural Death

A complete systematic investigation of unnatural death helps the court hugely to give an acceptable judgement. Legal officers like officer-in-charge of a police station, magistrates, witnesses of death circumstances and the forensic pathologists are basically involved in such investigation. Proper and true documentation by investigating officer are necessary. Identification of the deceased person, cause of death, manner of death, mode and mechanism of death, time since death, weapons used to cause the injuries etc. are opined in the investigaiton report as per direction given in the code of criminal procedure. These matters have been discussed in this article. DOI: http://dx.doi.org/10.3329/akmmcj.v5i2.21130 Anwer Khan Modern Medical College Journal Vol. 5, No. 2: July 2014, Pages 34-38

Cervical Rib a Very Rare Cause of Secondary Raynaud's Phenomenon

Secondary Raynaud's phenomenon (or syndrome) due to thoracic outlet obstruction or syndrome (TOS) from cervical rib is very rare. Cervical rib occurs in only 1% of the general population. It is an uncommon cause for thoracic outlet syndrome (TOS). The clinical manifestations of thoracic outlet syndrome are mainly neurological. Arterial complications are rare and potentially severe. The authors report a case of a 30 year-old woman with left cervical rib that developed embolism in the subclavian artery, due to compression. DOI: http://dx.doi.org/10.3329/akmmcj.v5i2.21133 Anwer Khan Modern Medical College Journal Vol. 5, No. 2: July 2014, Pages 49-50

Infant Feeding Practices Among the Mothers of Selected Different Socio-economic Groups in Dhaka City

This study was conducted to understand the infant (0-12 month) feeding practices among different classes' mothers in Dhaka city. The study was carried out among the 183 mother-infant pair of the upper, middle and lower socio-economic classes in Dhaka city and purposive sampling method was applied. The study was conducted at following areas in Dhaka city which were selected purposively. The mean age of upper class, middle class and lower class were 35±4, 25±3 and 21±7 in years. Regarding first feeding it was observed that upper (75%), middle (85%) and lower class (48%) first gave colostrum. It also observed that 18% of upper class mother first gave powder milk, while in case of middle class it was 5%. In lower class preference of giving honey and sugar water were 21% and 12% respectively. The starting time of breast feeding indicated that in upper classes (74%) breast feeding initiated within one hour, while in middle (75%) and lower classes (84%) it was given within 12 hours. It was highlighted that 44% upper and 36% lower class mothers started complementary feeding at 3 month of the baby respectively, while in middle class 61% mother started complementary foods at 5 month of their baby. In case of duration of breast feeding practices, middle and lower classes breast-feed continued longer time than upper class. Majorities of the upper class prefered egg, soup, fruit juice while middle class liked meat-fish, egg, khichuri, fruits. On complementary feeding the lower class choiced mainly rice-potato, dal, khichuri or vegetables. The study result should not be generalise and need further large scale research. DOI: http://dx.doi.org/10.3329/akmmcj.v5i2.21124 Anwer Khan Modern Medical College Journal Vol. 5, No. 2: July 2014, Pages 5-8

Adenosine Deaminase in Diagnosis of Tuberculosis: A Review

The diagnosis of tuberculosis (TB) continues to be a challenge in clinical practice. Traditional diagnostic methods are very useful but do not provide enough sensitivity and specificity. Adenosine deaminase (ADA) has been developed and widely used for the diagnosis of TB. ADA is an enzyme that increases in TB because of the stimulation of T-cell lymphocytes by mycobacterial antigens. This article reviews the characteristics, metabolism and clinical uses of ADA for the diagnosis of TB in clinical practices. There is sufficient data supporting yield of ADA in various body fluids for the diagnosis of TB. ADA may be used for early diagnosis of TB, especially in case of negative acid fast bacilli (AFB) smear from the body specimens. DOI: http://dx.doi.org/10.3329/akmmcj.v5i2.21132 Anwer Khan Modern Medical College Journal Vol. 5, No. 2: July 2014, Pages 43-48

Genetic Polymorphism of NAT2 Gene and its Association with Prostate Cancer

A N acetyltransferases 2 (NAT2) is one of the phase II metabolizing enzyme that participate in the bioconversion of heterocyclic arylamines into electrophilic nitrenium ions, which are important ultimate carcinogens that are directly implicated in tumor initiation process. Prostate epithelial cell express N acetyltransferases (NAT) enzymes and recent molecular epidemiological studies have analyzed the relationship between NAT2 in etiology of prostate cancer. A review by chen (2001) in prostate cancer (PCa) suggests that the frequencies of some polymorphisms in certain genes differ among different racial and ethnic groups. In a case control study in India by Srivastava and Mittal (2005), observed significant association between rapid acetylator genotype NAT2 and PCa in tobacco users (OR = 3.43, 95% CI: 1.68-7.02, p< 0.001) when compared with controls. Hamasaki et al (2003) in Japanese men, observed the frequency of the NAT slow acetylator genotype was statistically higher among prostate cancer patients (17.1%) compared with controls (8.6%). Another case control study in Turkey by Kosova et al. (2009), concluded that Nat2* 6A and NAT2 *7A/B gene polymorphism were significantly associated with prostate cancer. DOI: http://dx.doi.org/10.3329/akmmcj.v5i2.21131 Anwer Khan Modern Medical College Journal Vol. 5, No. 2: July 2014, Pages 39-42

Maternal Risk Factors Associated With Autistic Children

The present study has been carried out to find out the distribution of prenatal, perinatal and postnatal factors associated with autistic children. The study was conducted on 270 autistic children with age ranges of 3-10 years attending special schools in Dhaka city exclusively for autistic children during July ,2001 to July ,2012 .Mean age of mother was 31.78 SD± 5.94 years .Socio demographic characteristics showed 84% housewives, 37% educated up to masters level. Mean family monthly income was Tk.24,596 SD±11,464.Antenatal factors showed 42.2% mothers anemic,44.4% had H/O pre eclampsia,40% threatened abortion, 38.1% had gestational diabetes. Perinatal factors showed obstructed labor to be 64.4%.Post natal factors showed birth asphyxia to be 47.0% and neonatal jaundice 72.6% . The study showed a higher maternal age is significantly associated with autism.(p=0.007, RR=1.18,95% CI, 0.87- 1.60) and birth asphyxia is strongly associated with autism (p=0.001,OR=8.86 , 95% CI, 1.91-41.04) .The increasing prevalence of ASD`s indicates that it is multifactorial in which genetic, prenatal, social, developmental, nutritional and environmental factors play major roles. DOI: http://dx.doi.org/10.3329/akmmcj.v5i2.21126 Anwer Khan Modern Medical College Journal Vol. 5, No. 2: July 2014, Pages 14-17

Recipients Perception of Blood Transfusion Risk in Some Selected Tertiary Care Hospitals

This was a descriptive study carried out in the Medicine, Surgery, Gynae and Orthopedics ward of three randomly selected tertiary care hospitals at Dhaka, Bogra and Rangpur. It was aimed to evaluate the extent of understanding about the risk of blood transfusion among the blood recipients, to identify the common indications for blood transfusion through record review, to determine the recipients knowledge about indications of blood transfusion, their level of understanding about blood group, blood donors, and risk of blood transfusion and to find out the socio-demographic condition of recipients admitted at tertiary care hospitals. It was found that most of the respondents 63.17% were in the age group of 15-39 years and 56.95% were between primary to secondary level of education. More than half 56.83% respondents were housewife. The idea about indications of blood transfusion was found among 60.37% respondents. The idea about own blood group was found among 73.54% respondents. However, 52.93% respondents were unaware about the persons who can donate blood. Professional blood donor were the choice for own to only 15.60% respondents. The study also identified 57.32% respondents having risk of blood transmissible diseases. The respondents idea about transmissible diseases were identified as AIDs, Hepatitis-B, Syphilis and Malaria by 90.48%, 42.38%, 5.25% and 5.25% respectively. The study demands awareness and motivational program among younger and adult females in regards to transfusion transmissible diseases and its prevention. The importance of knowing blood group,donor selection and adverse effects of transfusion may also considered as a part of awareness program. It also demands a large scale community based survey to generate information towards development of effective strategy in minimizing risk of transfusion transmissible diseases in particular. DOI: http://dx.doi.org/10.3329/akmmcj.v5i2.21129 Anwer Khan Modern Medical College Journal Vol. 5, No. 2: July 2014, Pages 30-33

Pattern and Causes of Hearing Loss Among the Patients Attending in an ENT OPD

This cross sectional prospective study was carried out in the Department of Otolaryngology- Head & Neck Surgery, Tairunessa Memorial Medical College Hospital (TMMCH), Boardbazar, Gazipur, Bangladesh in a period of 12 months from 01.01.2012 to 31.12.2012 among those complaining hearing loss attending in ENT OPD. The aim of the study was to find out pattern and causes of hearing loss. Two hundred cases of hearing impaired people were taken and the data were collected by interviewing the cases as per questionnaire from history, examinations & investigation reports. The commonest type of hearing loss was conductive type. In the right ear 114 cases (63.33%) of conductive type of deafness, 36 cases (20%) of mixed type of deafness and 30 cases (16.67%) of sensorineural type of deafness. In the left ear 106 cases (61.62%) of conductive type of deafness, 40 cases (23.25%) of mixed type of deafness and 26 cases (15.13%) of sensorineural type of deafness. This study showed that females (58%) were mostly affected than males (42%) and garments workers (45%) were commonest group of people. From this study we got both ears were involved by disease process in 76% of the patients and only right ear was 14% and only left ear was 10%. The commonest cause of hearing loss is chronic suppurative otitis media. The ear diseases are common in our country but its diagnosis is usually delayed, till then certain amount of hearing loss has occurred. So awareness, early diagnosis and proper treatment are needed to improve the situation. DOI: http://dx.doi.org/10.3329/akmmcj.v5i2.21125 Anwer Khan Modern Medical College Journal Vol. 5, No. 2: July 2014, Pages 9-13

Bangladesh is Experiencing Double Burden with Infectious Diseases and Non-communicable Diseases (NCD's): An Issue of Emerging Epidemics

Unlike many low and middle income countries, double burden diseases are serious problem in Bangladesh. Recently, proper understanding and the need for joint interventions against both infectious diseases and non-communicable diseases (NCD's) has been gradually arising. Cardiovascular diseases (CVD's), diabetes, cancers and chronic lung disease are the most frequent NCD's whereas acute respiratory diseases, diarrhoea, neonatal sepsis and malaria are considered as infectious disease so far. Excess calories intake and unhygienic conditions are the most common risk factors, along with genetic predisposition and lifestyle choices. In addition, under nutrition in childhood also affects the human development in many aspects. The key controls of the situations are primary prevention through maintaining healthy life style during all phase of life. Action should focus controlling the risk factors in a unified fashion. Intervention at all levels of society, from communities to governments, private organizations and nongovernmental groups, is crucial for prevention by intensifying awareness of people about a perfect and healthy lifestyle. DOI: http://dx.doi.org/10.3329/akmmcj.v5i1.18844 Anwer Khan Modern Medical College Journal Vol. 5, No. 1: January 2014, Pages 46-50

Hereditary Anhidrotic Ectodermal Dysplasia - A case report

Ectodermal dysplasia is a hereditary disorder that occurs as a consequence of disturbances in the ectoderm of the developing embryo. The triad of nail dystrophy, alopecia or hypotrichosis and palmoplantar hyperkeratosis is usually accompanied by a lack of sweat glands and a partial or complete absence of primary and/or permanent dentition. Ectodermal dysplasia is a rare genetic disorder and X-linked recessive inheritance is most commonly seen. But we are reporting a rare case of autosomal recessive inheritance of Ectodermal dysplasia in here. DOI: http://dx.doi.org/10.3329/akmmcj.v5i1.18845 Anwer Khan Modern Medical College Journal Vol. 5, No. 1: January 2014, Pages 51-53

From the desk of Editor in Chief

Abstract not available DOI: http://dx.doi.org/10.3329/akmmcj.v5i1.18846 Anwer Khan Modern Medical College Journal Vol. 5, No. 1: January 2014, Pages 54

Public Private Partnership (PPP) in Health Sector of Bangladesh

Public- Private Partnership (PPP) describes a government service or private business venture which is funded and operated through a partnership of government and one or more private sector companies. The term public refers to government including both central and local level state institutions. Defining private sector has become complicated due to the emergence of a large number of institutions called NGOs. The distinction of the private sector and NGOs is often blurred due to various sizes, functions and objectives of NGOs. The simplest way to distinguish between these two is: in case of profit private sector encompassing commercial enterprises of any size and for non-profit private including NGOs sector, which provides voluntary services. This review has grouped both the profit private sector, and non-profit NGOs under the term private sector. It also highlights PPP concept, importance, financing approaches as well as examples of model partnership in health sector in particular DOI: http://dx.doi.org/10.3329/akmmcj.v5i1.18843 Anwer Khan Modern Medical College Journal Vol. 5, No. 1: January 2014, Pages 42-45

A Study on Relapsed b-Cell Lymphoma in Elderly Patient of Bangladeshi Population with Rituximab, Gemcitabin and Oxaliplatin: an Effective Salvage Regimen

High-dose therapy (HDT) with stem-cell support is the reference treatment for relapsed lymphoma, but is not appropriate for all patients. In Bangladesh High-dose therapy with stem cell support is not yet available. Conventional salvage chemotherapies have been used with limited efficacy and significant toxicity. Rituximab, gemcitabin and oxaliplatin are active as single agents in relapsed or refractory lymphoma, and have demonstrated synergistic effects in vitro and in vivo. Twenty two patients with relapsed or refractory or b-cell lymphoma received up to Six cycle of R-GemOx (rituximab 375mg/m2 on day 1, gemcitabine 1000mg/m2 and oxaliplatin 100mg/m2 on day 2). The majority (60%) had diffuse large b-cell lymphoma. After four cycle of R-GemOx, the overall response rate was 90% (45% complete response (CR)/unconfirmed CR (CRu). High CR/CRu rates were observed in all histological subtypes. In patients who had previously received rituximab, the CR/CRu rate after six cycles was 70%. The 2 year event-free and overall survival rates (median follow-up of 24 months) were 55%, respectively, among responders, the probability of being disease free for 2 years was 70%. Treatment was generally well tolerated. R-GemOx shows promising activity with acceptable toxicity in patients with relapsed/refractory b-cell lymphoma. DOI: http://dx.doi.org/10.3329/akmmcj.v5i1.18838 Anwer Khan Modern Medical College Journal Vol. 5, No. 1: January 2014, Pages 29-34

Avian Influenza & Human Health

The world is now under human pandemic threat by avian influenza viruses. As the human, animal and the environment interact closely from the dawn of the civilization, human health is tremendously influenced by animal health and their health issues. In last few centuries the world has suffered a number of influenza pandemics killing millions of people such as Spanish Flu (1918), Asiatic or Russian Flu (1889-1890), Asian Flu (1957-1958) etc. The exceptional capability of genetic mutation of the influenza viruses offered threats to the whole world time to time. Like all other countries Bangladesh also not away from the heat of the situation. Human cases of avian influenza subtype H1N1, H3, H5N1, and H9N2 have already been reported from Bangladesh. This article reviews the information available on pandemic potential of avian influenza viruses. The article also sheds light on different avian influenza viruses along with some emphasis on clinical and preventive aspects of the avian influenza viral infections, and on avian influenza pandemic preparedness of Bangladesh. DOI: http://dx.doi.org/10.3329/akmmcj.v5i1.18839 Anwer Khan Modern Medical College Journal Vol. 5, No. 1: January 2014, Pages 35-38

Lipid Profile, Glycaemic and Anthropometric Status of Students of a Private Medical College in Dhaka City

Over weight and obesity are recognized as recent threat which affecting both developing and developed countries. Obesity and its associated morbidities are leading cause of most noncommunicable diseases. Few recent studies have indicated the presence of increasing in over weight and obesity among children and adolescent but there is no study among adult groups. This cross sectional study was done to assess the prevalence of overweight, obesity and metabolic variables with their relation among medical students. Our result reveals that 8.6% & 1.9% male and 15% & 3.2% female are suffering from overweight and obesity (based on BMI) respectively. More females (31.3% and 65.2%) are centrally obese than males (3.5% and 34.8%) (According to Waist Hip ratio and Waist Height ratio respectively). But according to Waist circumference more males (30.7%) are obese than females (24%). There is also significant difference of male and female BP. DBP & SBP of male (79.22mmHg & 118.9 mmHg) have high normal level than female (72.71mmHg & 108.67mmHg) (P<0.001). There is no significant difference of glycaemic status and lipid profile with central obesity. Although male students have high upper level of blood pressure, female students are more obese than males (both according to BMI and central obesity). High blood pressure and obesity both acts as risk factors for the development of non communicable disease. Student's awareness therefore should be increased to reduce central obesity & BP within normal range. DOI: http://dx.doi.org/10.3329/akmmcj.v5i1.18837 Anwer Khan Modern Medical College Journal Vol. 5, No. 1: January 2014, Pages 23-28