Bangabandhu Sheikh Mujib Medical University Research Articles

Frequency of Transcription Factor 7-like 2 rs12255372 Mutation among Bangladeshi Adult Type 2 Diabetes Patients

ABSTRACT Background: While the etiology of type 2 diabetes mellitus (T2DM) is complex, genetic markers for T2DM are surfacing fast, and amidst such markers, the transcription factor 7-like 2 (TCF7L2) gene has been emerged as the most promising T2DM-causing gene. The intronic variant rs12255372 of the TCF7L2 gene has been found to be strongly associated with T2DM in different ethnic populations. Objectives: The objectives of this study were to determine the frequency of rs12255372 polymorphism in the TCF7L2 gene in Bangladeshi adult population with T2DM. Materials and Methods: This cross-sectional study was conducted in the Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University. Eighty T2DM patients were recruited consecutively by nonrandom sampling, who signed the informed consent, history, and clinical features including height, weight, and waist circumferences were recorded. Blood samples were collected. Genomic DNA was extracted and single-nucleotide polymorphisms rs12255372 (G>T) were determined by the restriction fragment length polymorphism (RFLP) method. Statistical Analysis: RFLP results were analyzed by the gel electrophoresis to get the frequency of rs12255372 polymorphism. The independent segregation of alleles was tested for Hardy–Weinberg equilibrium using the Chi-square test of goodness of fit. P ≤0.05 was considered statistically significant. Results: The minor (T) allele frequencies (MAF) for rs12255372 (G>T) among T2DM was 28%. The observed genotype frequencies of rs12255372 (G>T) were different than those expected from the Hardy–Weinberg equation. Conclusion: The minor T allele frequency of rs12255372 (G>T) among T2DM participants was about one-fourth.

Acute effect of hemodialysis on FVC, FEV1 and FEV1/FVC% in chronic kidney disease stage- V patients

Background: Chronic kidney disease (CKD) stage-V is associated with impairment of pulmonary functions which may be improved by taking hemodialysis treatment. Objective: To observe the acute effect of hemodialysis on FVC,FEV1 and FEV1/FVC in CKD stage-V patients. Methods: This prospective observational study was carried out in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from September 2015 to August 2016 on 40 male newly diagnosedCKD stage-V patients aged 30-55years who were advised to take maintenance hemodialysis. Forty age and BMI matched apparently healthy male were control. FVC, FEV1 and FEV1/FVC%were assessed by portable digital spirometer. before and after their first hemodialysis session in patients and once in healthy control. For statistical analysis, paired and independent sample‘t’ tests were done, as applicable. Results:Percentage of predicted values of FVC and FEV1 were found significantly lower in patients than the healthy control at baseline but FEV1/FVC%was almost similar to control. Again, FVC, FEV1 and FEV1/FVC were found significantly increased after the end of hemodialysis than the before hemodialysis session. Conclusion:The pulmonary functions were reduced in newly diagnosed CKD stage-V patients and hemodialysis cause immediate improvement of lung functions in patients with CKD stage-V. J Bangladesh Soc Physiol 2022;17(2): 85-90

Role of Dutasteride in the Treatment of Androgenetic Alopecia

This study evaluates the role of dutasteride in the treatment of androgenetic alopecia. A prospective, open-labeled interventional study conducted at the Department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from April 2023 to March 2024. Men with Androgenetic alopecia (AGA) who did not show significant improvement when treated with finasteride at a dose of 1 mg/d for at least six months were enrolled. Ninety patients were recruited after taking informed consent. Patients were treated with dutasteride at a dose of 0.5 mg daily for 24 weeks. Clinical assessment was performed by dermatologists and subjective evaluation of overall assessment was done based onchanges in the size of the vertex spot, hair loss on top of the scalp, bitemporal recession, the amount of hair shedding and hair quality on a 3-point rating scale (increased, no change, or decreased). The mean age of study patients was 36.3±12 years and majority of the patients 30(33.3%) belonged to the age group 41- 50 years with followed by 27(30.0%) in the age group 31-40 years. Regarding subjective evaluation of overall assessment, in case of change in size of vertex spot, majority 77(85.6%) showed decreased, in case of hair loss from top of scalp, majority 83(92.2%) reported decreased, in case of bitemporal recession, majority 82(91.1%) showedno change, in case of hair shedding, majority 87(96.7%) showed decreased and in case of hair quality, 85(94.4%) reported increased and no patient reported of decreased. Regarding clinical assessment of investigator that majority of the patients 40(44.5%) was moderately improved (+2), followed by 30(33.3%) was greatly improved (score of +3), 18(20.0%) was slightly improved (+1) and only 2(2.2%) was unchanged (0). Among the ninety patients of androgenetic alopecia, 3(3.3%) showed decreased libido and 2(2.2%) showed erectile dysfunction. The study concluded that dutasteride is effective and safe in the treatment of androgenetic alopecia. This study will provide the therapeutic basis for dutasteride as an alternative treatment option for patients with AGA recalcitrant to finasteride over six months. Therefore, dutasteride will become a treatment of choice for androgenetic alopecia (AGA) in near future.

Association of Risk Factors with Female Pattern Hair Loss

Introduction: Female Pattern Hair Loss (FPHL) is one of the main causes of hair loss in adult women and has a major impact on individual’s quality of life. It evolves from the progressive miniaturization of follicles that lead to a subsequent decrease of the hair density, leading to a non-scarring diffuse alopecia. In spite of the high frequency of the disease and the relevance of its psychological impact, its pathogenesis is not yet fully understood, being influenced by genetic, hormonal, and environmental factors. Objective: To evaluate etiological factors associated with female pattern hair loss. Materials & Methods: This was a hospital-based case control study, conducted in the Department of Dermatology & Venereology, Bangabandhu Sheikh Mujib Medical University (BSMMU) from March, 2021 to August, 2022. In this study, total 100 females aged 18 to 45 years were enrolled. Among them, 30 females had history of hair loss >6 months, presented to outpatient department, BSMMU were included as case & 70 healthy females who had no history of hair loss included as control according to inclusion & exclusion criteria. Diagnosis of FPHL was made clinically & Ludwig classifications were used to assess the degree of hair loss. Information on possible risk factors for FPHL was collected using a questionnaire interview. Result: The mean age of the patients with FPHL was 41.0±7.77 years with majority belongs to >40 years of age group & their mean duration of hair loss was 26.3±12.0 months. Among the patients of FPHL, 36.7% had history of inadequate intake of iron containing food, 66.7% had family history of alopecia, 36.7% had history of increased bleeding during their menstruation, 20.0% had multiple (>3) childbirth & 23.3% had hypertension. About 86.7% patients with FPHL had low serum ferritin (<30ng/ml) with mean serum ferritin level was 20.25±16.07ng/ml and 66.7% patients of FPHL had low Hb (<12 µg/l) with mean Hb was 11.47±1.52 µg/l. In the multivariate logistic regression analysis significant association found with FPHL were age (OR 2.013, 95% CI 0.672-3.714), family history of alopecia (OR1.231, 95% CI 0.162-1.991) and lower serum ferritin level (OR1.090, 95% CI 1.043-1.139). Conclusion: Age, family history of alopecia, lower serum ferritin may be implicated as risk factors for female pattern hair loss. Medicine Today 2023 Vol.36 (1): 7-11

Effect of Anterior Cervical Decompression and Fusion for Cervical Myelopathy Treatment

Background: Cervical myelopathy is a common cause for neurosurgical outpatient department visit, and a substantial proportion of patient suffering from myelopathy due to cervical spondylosis has to go through surgical management, commonly anterior cervical decompression and fusion in the form of Cloward’s procedure, Smith Robinson procedure, PEEK and Titanium cage implant and fusion. A total of 23 cases were selected according to predefined inclusion and exclusion criteria. Method: This is a prospective study that was conducted in the Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University. Patients with cervical myelopathy undergoing anterior cervical decompression and fusion, in the form of Cloward’s procedure, Smith Robinson procedure, or Anterior Cervical Discectomy with Poly Ether Ether Ketone (PEEK) and Titanium cage implants in a single level for inclusion and exclusion criteria. Results: This study found out that the Modified Nurick grading system is a useful tool to quantify the functional status of the patients suffering from cervical myelopathy and surgery in various forms of anterior cervical decompression and fusion has an impact on the functional status even at an early period of one month. 82.6% of the patients had functional improvement, whereas 13% remained the same. Only one out of the 23 patients deteriorated. Various methods of anterior cervical decompression and fusion or the levels of involvement did not have any statistically significant impact on improvement among the patients. Conclusion: Anterior cervical decompression and fusion is a time-proven treatment modality for the patients suffering from cervical myelopathy owed to external compression due to spondylotic changes and Ossified Posterior Longitudinal Ligament. The functional status of the patients that have been compromised due to the disease shows promising change even in the early period undergoing surgery. Bang. J Neurosurgery 2023; 13(1): 3-9

Clinicopathological Evaluation of Thyroid Dysfunction in Women with Abnormal Uterine Bleeding

Introduction: Abnormal uterine bleeding describes any variation from normal bleeding patterns in nonpregnant, reproductive-aged women beyond menarche lasting for at least 6 months. Regular cyclic menstruation results the choreographed relationship between the endometrium and its regulating factors. Any type of disturbance between the regulatory mechanism of pituitary ovarian axis or pelvic diseases results in abnormal uterine bleeding. Thyroid hormones play a key role in the menstrual and reproductive function of women. It is recognized universally that menstrual disturbances may accompany clinical alterations in thyroid function. Objectives: To evaluate the thyroid dysfunction in patients with abnormal uterine bleeding. Materials and Methods: This cross sectional study was conducted in Department of obstetrics & gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka from April 2023 to December 2023. Women with abnormal uterine bleeding were included in the study. Sample was selected by purposive sampling. Sample size was 100. Detail demographic data were collected from the informant and recorded in structured case report form. Clinical examination and relevant investigation were done meticulously. Data was collected by using a semi-structured questionnaire. Data was processed and analysed with the help of computer program SPSS and Microsoft excel. Quantitative data expressed as mean and standard deviation and qualitative data as frequency and percentage. Result was presented in the form of tables, pie chart, graphs, bar diagrams, histogram & charts etc. Results: In this study, the maximum numbers of cases (43.0%) were between 26-35 years age group. Mean age was 29.57 ± 8.27 years. Large numbers of respondents came from urban area (58%). On evaluation of types & causes of AUB, maximum patient belongs to AUB-L (leiomyoma) group (53%) followed by AUB-A (adenomyosis) (28%); AUB-P (polyp) (8%); AUB-O (ovulatory) (9%) and AUB-M (malignancy) (2%). Present study showed that prevalence of thyroid disorders is 26% in AUB patients. The prevalence of Hypothyroidism was 18% and Hyperthyroidism was 8%. Thyroid dysfunction is associated with menstrual abnormalities in females of all age groups. Conclusion: Abnormal uterine bleeding has a strong association with thyroid disorders. The most common type of disorder is subclinical hypothyroidism. Thus, all patient of AUB must be evaluated for thyroid dysfunction. Medicine Today 2023 Vol.36 (1): 1-6

The Observation at Mean Oedema Index Variations with Location and Histological subtypes in Supratentorial WHO G-I Meningiomas

Background: The term meningioma is the noncommittal, all-encompassing name coined by Harvey Cushing for this tumor of meninges which is usually benign. The severity and variety of the peritumoral brain oedema may limit operative exposure and increase the difficulties of intraoperative procedures; however, its pathogenesis is not clearly documented. Several factors, such as tumor size, location and histology, mechanical compression of draining vein by the tumor have been proposed as mechanism of peritumoral brain oedema Aims: The objective of this study was to determination of mean oedema index in different locations and histological subtypes in patients with supratentorial WHO GI meningiomas Methods: The study was conducted in the Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from September, 2016 to March, 2018. This study was a cross sectional study. Data collection sheets were used to collect necessary information. Total 75 cases were selected consistent with inclusion and exclusion criteria. Tumor volume and localization and the presence of peritumoral brain oedema (PTBOe) were determined by MRI (Magnetic Resonance Image). All patients underwent microsurgical removal of tumor. Surgically resected meningiomas were classified histopathologically based on criteria of the new World Health Organization (WHO) classification. Regarding location and histological subtypes of tumor the study population were divided into 6 groups and 8 groups respectively.Statistical analyses were done by Statistical Packages for Social Sciences (SPSS-v.25). Results: A total 75 cases were selected consistent with inclusion and exclusion criteria from September, 2016 to March, 2018. Regarding location; the mean oedema index for each of the six groups was calculated and recorded. The F value was 5.97 and the P-value was 0.0001 which was less than 0.05. This result signifies that there was association between perilesional oedema in supratentorial meningioma to its location. So, Mean Oedema Index in Intracranial Supratentorial Meningiomas vary with its location. On the other hand, regarding histopathological subtypes, meningiomaswere divided into eight groups-the mean oedema index of each of the eight groups was calculated and recorded. The F value was 1.62 and P-value was 0.145 which was more than 0.05. This result signifies that there was no association between perilesional oedema in supratentorial meningioma to its histological subtypes. So mean oedema index in intracranial supratentorial meningiomas does not vary with its histological subtypes. Conclusion: Mean Oedema Index in Intracranial Supratentorial Meningiomas vary with its location but does not vary with histological subtypes Bang. J Neurosurgery 2023; 13(1): 10-13

Assessment of High Serum Cystatin C as an Early Marker of Renal Impairment in Pre Eclampsia

Introduction: Preeclampsia is the most common medical complication during pregnancy and one of the leading causes of maternal and perinatal morbidity and mortality in Bangladesh. Kidney has role in both adaptive physiology of normal pregnancy and in pathophysiology of preeclampsia. Among the new biomarkers, serum Cystatin C can reliably reflect the GFR in both healthy and hypertensive pregnant women. It is important to evaluate the diagnostic efficiency of Cystatin C as a marker of renal function in preeclampsia. Aim: To assess high serum Cystatin C level as an early marker of renal impairment in pre-eclamptic patients. Materials and Methods: From March, 2021 to February, 2022 (A total of 12 months) a cohort study was conducted among 66 pregnant women, aged 18 to 40 years with pre-eclampsia and normal serum creatinine (0.5-0.8mg/dl) at their 20-28 weeks of gestation attending the antenatal clinic and admitted in the Department of Feto maternal Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, selected by non random purposive and convenient sampling. Results: Out of 66 respondents, final analysis was done with 62 patients. Among 62 study samples, 76% patients had “High Cystatin C” level that was greater than 0.84 and renal impairment developed in 15% pregnant women. Majority of the participants were in 25-30 age groups (46.8%). The mean serum creatinine level of the pregnant women increased throughout follow up and it was statistically significant (p<0.05) in both cases. No significant difference was found between serum Cystatin C in renal impaired and normal renal function pre eclampsia patients at a cut off value of 0.84. ROC analysis of serum Cystatin C level for detection of renal impairment among Pre eclamptic patients found a cut-off value of ≥1.49 showed the highest Youden index of 0.721. The sensitivity, specificity, PPV, NPV and accuracy of serum Cystatin C were 77.78%, 94.34%, 70.00%, 96.15% and 91.94%. Conclusion: Higher Cystatin C level in pre-eclampsia reflected renal impairment at an early stage even before conventional marker like serum creatinine raise. The diagnostic efficiency of Cystatin C as a marker of renal function in pre eclampsia can be used to reduce maternal morbidity and mortality of Bangladesh. Medicine Today 2023 Vol.36 (1): 12-16

Prenatal & Perinatal Risk Factors of Autism Spectrum Disorder

Background: Autism spectrum disorder (ASD) is lifelong neurodevelopmental disorder characterized by impairments in social function, communication, and certain behaviors. The etiology of ASD is unclear & it is believed to be multi-factorial, among those several prenatal & perinatal factors are found to be significant. So, the necessity of this study is to detect the presence of known risk factors of ASD which in turn may help in the early diagnosis and intervention for better long-term outcomes. Objective: To find out prenatal and perinatal risk factors of ASD. Method: A case control study was conducted with 112 cases of ASD and 201 controls of 2-6 years of age. The study was carried out in Center for Neurodevelopment and Autism in Children (CNAC), in the department of Paediatrics, Bangabandhu Sheikh Mujib Medical University and Autism Welfare Foundation (AWF). ASD was diagnosed by DSM-IV TR criteria. Mothers were interviewed and data were collected by semistructured questionnaires. Results: Total 5 risk factors were identified as the risk factors of ASD. They were: advanced paternal age (OR=2.84) and maternal age (OR=1.87); male baby (OR=2.01); environmental stress during pregnancy (OR=1.61) and preterm delivery (OR=1.80). Conclusions: It is concluded that advanced paternal age, maternal age, male baby, environmental stress during pregnancy and preterm delivery are associated with increased risk of ASD. BANGLADESH J CHILD HEALTH 2022; VOL 46 (3) : 115-121

Frequency of Hypocalcemia and Hypomagnesemia in Autistic Spectrum Disordered Children of Bangladesh

Background: Autistic spectrum disorder (ASD) in children is commonly associated with mitochondrial dysfunction and mineral deficiency. Studies have highlighted links between Ca2+ and Mg2+ deficiency and neuronal excitability, along with connections between iron deficiency and behavioral abnormalities in individuals with ASD. Objective: This study was aimed to assess the frequency of hypocalcemia and hypomagnesemia in autistic spectrum-disordered children of Bangladesh. Methods: This cross-sectional study was conducted in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University, Dhaka from March 2014 to January 2015. The study included 100 randomly selected male children, with 50 in a healthy control group (Group A) and 50 diagnosed with autistic spectrum disorder (Group B). Children with ASD were selected from the Parents Forum (DOHS, Mohakhali), while the control group was chosen from schools with typically developing children. Fasting serum levels of various components along with calcium and magnesium were measured, and statistical analysis was conducted using independent sample 't' tests and proportion (Z) tests, with a significance level set at p-value ˂0.05. Results: In this study, out of 50 autistic spectrum disorder cases, the frequencies of hypocalcemia and hypomagnesemia were 74% and 52%, respectively. A comparison with the control group revealed significantly higher frequencies of both hypomagnesemia and hypocalcemia in the ASD group, with p-values <0.001. Conclusions: Among most children with autism spectrum disorder in Bangladesh, hypocalcemia and hypomagnesemia are prevalent. These prevalences are significantly higher than those observed in healthy children. J Rang Med Col. March 2024; Vol. 9, No. 1: 55-58

Vitamin D and it’s Association with FokI VDR Polymorphism in Patients with Asthma-COPD Overlap

Background: Asthma-COPD overlap is a new phenotype in respiratory ailments. It has been shown that this group of patients might possess vitamin D3 deficiency. The association of vitamin D receptor (VDR) gene polymorphism with serum vitamin D status in ACO patients has not been investigated yet. Objective: To assess the association of VDR gene polymorphism (FokI) with serum vitamin D status in patients with Asthma-COPD overlap. Methods: This cross-sectional study was carried out in the Department of Physiology of Bangabandhu Sheikh Mujib Medical University, Dhaka, from January 2018 to July 2018 on 23 (twenty-three) patients (aged ≥40 years) with ACO. For comparison, 24 (twenty-four) apparently healthy age, smoking duration and BMI matched subjects were selected. For all participants single nucleotide polymorphism of VDR gene FokI (rs10735810) was done by DNA extraction, polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP). Vitamin D3 was measured by using automated analyzer: ARCHITECT Plus ci4100. The results were expressed as mean with standard error (mean±SEM) and frequency distribution. The data were statistically analyzed by Graphpad prism (Version 7) using independent sample ‘t’ test, two sample proportion test, Fisher exact test and ANOVA test. In the interpretation of results, ≤0.05 level of probability (p) was accepted as significant. Results: The mean±SEM of serum 25(OH)D were 16.37±0.78 and 18.46±1.01 ng/ml in control and study groups, respectively. The frequency distribution of FokI genotype was 86.95% (FF), 8.69% (Ff), 4.35% (ff) and 91.66% (FF), 4.17% (Ff), 4.17% (ff) in ACO patients and healthy subjects, respectively. When FoKI VDR SNP was analyzed with serum vitamin D status in patients with ACO, statistically no association was seen. Conclusions: FokI VDR SNP is not associated with serum vitamin D status in patients with ACO. J Rang Med Col. March 2024; Vol. 9, No. 1: 22-27

Clinical Association of Lupus Erythematosus with Patients of Vitiligo: A Case Control Study

Background: Vitiligo is an idiopathic acquired depigmentary skin/ mucous membrane disorder. Lupus erythematosus and vitiligo are diseases of autoimmune origin. A genetic explanation for the association between lupus erythematosus and vitiligo has recently been attempted. Objective: To find out the association of lupus Erythematosus in patients of vitiligo. Methods: This case control study was carried out in the department of Dermatology & Venereology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka during the period of January 2023 to December 2023. A total of 180 patients with and without vitiligo from both genders and different ages for case and control groups were included in the study based on inclusion and exclusion criteria. Patients were divided into two groups, 90 patients with vitiligo as cases and 90 patients without vitiligo (healthy subjects) as controls. Wood’s lamp examination was performed for diagnosis of vitiligo. LE was diagnosed based on ACR criteria and laboratory test including Complete blood count, Urinalysis, ANA, anti-ds DNA, VDRL and Skin biopsy. Patients with lupus erythematosus and patients without lupus erythematosus were considered as group I and group II respectively. Results: In this study, the mean age was found 41.7±12.8 years in case group (Vitiligo) and 42.1±13.6 years in control group (Healthy subjects).More than half (51.1%) of the patients were female in case group and 41(45.6%) in control group. There was no significant difference was found regarding age, sex, anemia, leucopenia, thrombocytopenia, proteinuria, ANA and anti ds-DNA. Family history of vitiligo was significantly higher in vitiligo patients than healthy patients (26.7% vs 12.2%). The majority 45(50.0%) presented with generalize followed by 21(23.3) acrofacial, 13(14.4%) focal, 10(11.1%) segmental and 1(1.1%) mucosal of vitiligo. Lupus erythematosus was higher in vitiligo patients than healthy patients (4.4% vs 1.1%) but the difference was not statistically significant between the two groups (p=0.184). Conclusions: This study concluded that family history of vitiligo was significantly higher in vitiligo patients than healthy patients. Lupus erythematosus was higher in vitiligo patients than healthy patients, but not statistically significant. J Rang Med Col. March 2024; Vol. 9, No. 1: 33-38

Prevalence of Transitional Vertebra in Lumbar Disc Herniation in Bangabandhu Sheikh Mujib Medical University

Background: Lumbosacral transitional vertebrae (LSTV) occur as a congenital anomaly in the segmentation of lumbosacral spine that occur during intrauterine life. LSTV includes lumbarization and sacralization of the lumbosacral region. A transitional vertebra(TV) may have varying formations, the common feature being an atypical lumbosacral articulation between transverse process of the most inferior lumbar vertebra and the sacrum. There has been a lot of discussion regarding the prevalence of LSTV in lumbar disc herniation(LDH). Most of the studies showed increased prevalence while other studies showed TV is an incidental finding and there is no increased prevalence in LDH. LDH is a quiet common ailment encountered in neurosurgical practice. Numerous causes have been attributed to it. LSTV might have great importance in patients who clinically seem to have LDH where it’s presence in plain X-ray might provide a supportive evidence for diagnosis and it can help to counsel the patient. We will be able to recommend a plain x-ray of lumbosacral spine first, having history and clinical findings suggestive of LDH and can save the cost of MRI investigation until decision for operation. Beside this LSTV is an important entity for spinal surgeons , radiologists and also for those who do interventional procedures in the spine. For this reason the prevalence of TV in LDH should be known. This study was not carried out in our country yet. So this study will enrich our demographic information and will also help the spinal surgeons to counsel the patients about their congenital spinal morphological variation and different facts related with this. Objectives: General objective of this study is to observe the prevalence of LSTV in patients with LDH. Specific objective of this study was to identify the diathroidal joint or fusion between transverse process of last lumbar vertebra and ala of sacrum, to count the vertebral number from C2 to S1 in whole spine screening film, to identify the transitional vertebra as sacralization or lumbarization or absence of TV, to predict the future possibility of development of LDH from plain X-ray of lumbosacral spine. Methods: This study was a cross sectional type of observational study and was conducted in Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University (BSMMU). The patients (N=45) who fulfilled the selection criteria was enrolled in this study. Patient’s data were recorded in a predetermined data sheet. Patients were informed in details about the study, its merits and demerits in easy and understandable language and then informed consent was taken. Also assurance was given that all the information and records would be kept confidential and the study result would help the neurosurgeons to counsel the patients with LSTV about future possibility of development of LDH from plain X-ray of lumbosacral spine. This study was not responsible for any additional harm to the patient and study had no potential risk to the patient and no experimental drugs were used in this study. Results: A total of 45 patients of LDH were studied to see the prevalence of lumbosacral TV in LDH. Based on history and clinical findings, 100% of patients presented with low back pain, 100% of patients presented with sciatica, and 62.2% presented with gait difficulty and 02.2% of patients presented with cauda equina syndrome. Mean age of patients having LDH herniation was 38.08 ± 10.15 years. LSTV was found in 31.11% of patients with LDH. In this study, LSTV was diagnosed by plain X ray of Lumbosacral spine (A/P view) and supplemented with MRI of L/S spine with screening of whole spine (in most cases). Diagnosis of transitional vertebra was done by researcher and was further confirmed by guide and faculty members of BSMMU. In relation to gender, prevalence of LSTV in male was 25.9% and in female was 38.9% which indicated higher prevalence of TV in female but this is not statistically significant (p value 0.356).Incidence of disc herniation in patients with TV was at the space above the transition in 85.7% of cases. The most likely explanation for this is that the motion segment cephalad to the LSTV has to bear additional stresses by virtue of it being juxtaposed to a relatively non-mobile segment Conclusion: This study reveals that the prevalence of LSTV in LDH is 31.11% which is near the upper limit of its prevalence(according to literature). Association of TV with LDH can not be obtained as a control group of patient without LDH was not considered. So further study should be carried out incorporating large number of patients with control group with long study period to generalize the findings to target population. Bang. J Neurosurgery 2023; 12(2): 76-85

Outcome of Surgery in Ruptured Aneurysm: A Study of 48 Cases

Background : Rupture aneurysm is a dangerous clinical condition of a patient. The  aim of this study is to find out the outcome of rupture aneurysm after microsurgical  clipping. Method: This was a prospective cross sectional study and was conducted at the  department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka  from January 2011 to April 2022. Results : Among 48 patient 30(62.5%) were male. It was documented that 32(66.6%)  patients were belong to 51-60 years. It was evident that the most of the clinical  presentation was history of sudden severe headache 48(100%), 32(66.6%) patients  had presented with vomiting and brief loss of consciousness had 24(50%). The  highest percentage of WFNS grading of during admission were (1-3), 32(66.6%). Peroperative  rupture during surgery were 16(33.33%). During discharge good recovery  was occurred 38(79.7%) and 5(10.5%) had death. Conclusion: We have treated all the case by microsurgical clipping. Still microsurgical  clipping is one of the gold standard procedure for rupture intracerebral aneurysm.  Bang. J Neurosurgery 2023; 12(2): 114-121

Neuropsychiatric Manifestations and Neuroimaging Changes of Neurologic Wilson Disease–A Cross Sectional Study

Background: Wilson disease is genetic disorder of copper metabolism which causes hepatic & neurologic manifestation mainly. Chelator therapy is usually given as first line treatment in symptomatic wilson disease. Objective:  Objective of our study was to evaluate the neuropsychiatric menufestations of wilson disease. Methods: A Cross sectional study was conducted at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, a tertiary care premier Postgraduate Medical Institution of Bangladesh. Forty five (45) patients of neurologic wilson disease were evaluated at In-patient department of Paediatric Neurology, during the period of January 2015 to December 2020. Diagnosis of Neurologic wilson disease was done, based on the characteristic clinical features of progressive deterioration of scholastic performances, dysarthria and gait disorder along with ophthalmologic findings, biochemical & neuroimaging findings. Results: Total numbers of studied cases were 45. Mean age was 124.65± 20.69 months and male to female ratio was 1.8:1. Most of the patient (83.33%) arrived from poor socio-economic background and rural area (66.67%) of Bangladesh.  Among them 20.0% had history of consanguineous mating parents and 17.78% had another affected sibs. Common presenting features were progressive deterioration of school performance (89.74%), gait disturbance (92.31%),   dysarthria (92.31%) and dystonia (41.03%) of our studied children. Neuropsychiatric manifestations were very common among the affected children. Changes in behavior was present in 62.22% cases, and among them mania were present in 57.77% children. Other common neuropsychiatric manifestations were depression (35.55%), generalized anxiety disorder in 31.11% and loss of memory in 20% cases. Ophthalmological manifestations like KF ring (83.33%) also found in majority of patient. Neuroimaging study showed  basal ganglia hyperintensity in 63.63.% , white matter hyper intense signal changes 18.18% cases and ischemic change in grey matter in 18.18% cases. Conclusion: In our study about two third cases of Neurologic Wilson diseases may present with Neuropsychiatric manifestations in children. Behavior changes were commonest neuropsychiatric manifestations which includes depression, mania, generalized anxiety disorder and loss of memory.In neuroimaging study bilateral basal ganglia hyperintensity were found in about three-fourth cases of our studied children. J Bangladesh Coll Phys Surg 2024; 42: 144-148

Neuroimaging Changes and Treatment Outcome of Tubercular Meningitis- Experiences 22 Cases in a Tertiary Care Center

Background: Tuberculous meningitis (TBM) is caused by Mycobacterium tuberculosis (M. tuberculosis) and is the most common form of central nervous system (CNS) tuberculosis (TB).The prevalence of TB meningitis remains largely underestimated because clinical manifestations are nonspecific in early stages of the disease. Prompt diagnosis is critical for initiating appropriate therapy, facilitating measures to prevent dissemination of this highly contagious disease and to combat fatal complication in children Aims: To evaluate the role of neuroimaging changes and treatment outcome of tubercular meningitis. Methods: This prospective hospital-based cohort study was conducted in Department of Paediatric Neurology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, during January 2022 to December 2022. Children age belonged to 1 month to 10 year diagnosed as TBM during study period were enrolled in this study. Detailed history, clinical examination, CSF analysis and other relevant investigations were done. Data were recorded in standard questionnaire. Statistical analyses of the results were obtained by using window-based computer software devised with Statistical Packages for Social Sciences (SPSS-22). Results: Total 22 diagnosed case of TBM was enrolled and evaluated. Among them two third (63.63%) children were in 5-10 year age group. Male (59%) were outnumbered than female (36.36 %).Male female ratio was 1.6:1. More than half (59%) of patients came from urban area. All of the patients were vaccinated. Cent percent (100%) patients were presented with fever followed by headache (77.27%), sign of meningeal irritation (54.54%), vomiting (54.54%) and seizures (50%). Most common complication was hemiparesis (45.45%) followed by cranial nerve palsy (40.90%), visual problem (9.09%) and hydrocephalus (4.54%). Abnormal neuroimaging changes were found in 100% cases. Common findings were hydrocephalus (40.90%), tubercloma (36.36%), basilar enhancement (18.18%), Benign enlargement of subdural space & cerebellar hyperintensity (9%) and thalamic infract was present in 4.54% cases. Anti TB and steroid treatment were given in 100% cases and among them18.18% cases were required shunt procedure. More than one-third cases (40.90%) were completely normal without any no sequelae. Among abnormal sequelae found in two third (59%) cases. Speech impairment (36.36%) was most common followed by GDD (18.18%), hemiparesis (13.63%), quadriparesis (9.09%) and epilepsy in 9.09% cases. Conclusion: In our study all children of TBM were presented with fever followed by other predominant clinical features headache, vomiting, seizures and   sign of meningeal irritation.  Abnormal neuroimaging changes were found in all cases. Common findings were  basilar enhancement, hydrocephalus, tubercloma, benign enlargement of subdural space & cerebellar hyper intensity and thalamic infract. After treatment more than one-third cases were completely normal without any no sequelae. J Bangladesh Coll Phys Surg 2024; 42: 214-218

Treatment Outcome in Locally Advanced Rectal Carcinoma and Its Correlation with Hypo-Fractionated Radiotherapy and Concurrent Chemoradiotherapy

Introduction: Rectal cancer is the second most common type within the large intestine, posing significant health risks globally. In Bangladesh, it ranks high among diagnosed cancers. Improved diagnostic methods aid in early detection, which is crucial for effective management. Treatment typically involves a combination of surgery, radiotherapy, and chemotherapy. Preoperative chemoradiotherapy is a standard approach. However, newer methods like preoperative hypo-fractionated radiotherapy with surgery promise better outcomes, including reduced recurrence rates and enhanced survival, with potential cost and time savings. Aim of the Study: The study aims to evaluate and contrast the efficacy of hypofractionated radiotherapy and concurrent chemoradiotherapy in patients with locally advanced rectal carcinoma. Methods: The study, conducted at the Department of Clinical Oncology at Bangabandhu Sheikh Mujib Medical University Shahbagh, Dhaka, Bangladesh and the Department of Radiation Oncology at the National Institute of Cancer Research and Hospital (NICR&H) in Mohakhali, Dhaka, Bangladesh, aimed to compare treatments for locally advanced rectal cancer over 1.5 years (From January 2018 to June 2019). A total of 80 patients were divided into two groups; Group A received hypofractionated radiotherapy, while Group B received oral capecitabine alongside external beam radiotherapy. Inclusion criteria involved confirmed adenocarcinoma within specified stages, with ethical clearances obtained. Patients underwent evaluations before treatment and response assessments posttreatment. Treatment modalities were defined, focusing on radiotherapy and chemotherapy. Data were analyzed using SPSS software, employing various statistical tests. Results aimed to address study objectives while minimizing biases. Result: The study involved 80 patients, divided into Groups A and B, each with 40 individuals. Group A mainly comprised individuals aged 41-50 (45%), followed by 31-40 (25%). Group B had the highest proportion aged 31-40 (30%) and 41-50 (32.50%). Both groups showed male predominance (1.3:1). Moderately differentiated tumors were common, with Group A having more poorly differentiated tumors. Stage III was predominant pre-treatment (65% Group A, 70% Group B). Most patients presented with per rectal bleeding (80%) and alteration of bowel habits (56.25%). Response rates to treatment were similar between groups. Tumor downsizing was more frequent in Group B. Sphincter-sparing surgery was feasible in both groups with no significant difference. Conclusion: The study comparing preoperative hypofractionated radiotherapy (RT) to concurrent chemoradiotherapy (CCRT) for locally advanced rectal carcinoma found similar efficacy in tumor response, downsizing, and sphincter preservation. Statistical analysis showed no significant differences. Both approaches showed acceptable short-term outcomes, offering clinicians options based on patient and resource considerations.

Comparison of response and toxicity of induction chemotherapy with cisplatin and 5-fluorouracil versus cisplatin and paclitaxel followed by concurrent chemoradiotherapy in advanced head and neck cancer

Background: Head and neck cancer poses a prevalent oncological challenge in Bangladesh, often diagnosed in advanced stages. Standard treatment for inoperable cases involves concurrent chemo-radiotherapy, but induction chemotherapy has shown significant benefits. This study aimed to compare the response and toxicity of induction chemotherapy with cisplatin and 5-fluorouracil versus cisplatin and paclitaxel followed by concurrent chemo-radiotherapy in advanced head and neck cancer. Methods: From January 2019 to June 2020, a multicenter study enrolled 150 cases with inoperable squamous cell carcinomas in the head and neck. Ethical approval was obtained from Bangabandhu Sheikh Mujib Medical University. Divided into two arms, Arm A had 75 patients receiving cisplatin and 5-fluorouracil, while Arm B had 75 patients receiving cisplatin and paclitaxel for three cycles. Results: After 24 weeks of treatment, complete response rates were 53.33% in Arm A and 56.0% in Arm B, with partial response rates of 29.33% and 32.0% respectively. Overall response was 82.66% in Arm A and 88.0% in Arm B, showing no statistically significant difference (p>0.05). Arm A exhibited more anemia, oral mucositis, skin toxicity, and hand- foot syndrome, while Arm B had higher neuropathy. Hematological and non-hematologic toxicities during concurrent chemo-radiotherapy were similar in both arms. Conclusions: Induction chemotherapy with cisplatin and paclitaxel, followed by concurrent chemo-radiotherapy, is equally effective as induction chemotherapy with cisplatin and 5-fluorouracil, followed by concurrent chemo-radiotherapy, in treating advanced head and neck squamous cell carcinoma. However, the former regimen demonstrates significantly fewer toxicities, indicating a safer treatment option.  

Association of COVID-19 symptoms and functional status of the COVID-19 survivors in a tertiary health care center in a developing country

Background The COVID-19 pandemic has affected people globally, causing widespread illness and functional limitations. Methods This cross-sectional study aimed to investigate the association between COVID-19 symptoms and the functional status of COVID-19 survivors at Bangabandhu Sheikh Mujib Medical University (BSMMU) in Bangladesh. A total of 244 COVID-19 survivors were enrolled in the study, and their symptoms and functional status were assessed using standardized questionnaires. The post-COVID-19 functional status scale (PCFS) was used to assess the entire range of functional outcomes. Results Among the participants 57.4% were male and 42.6% were female. The mean (SD) age of the patients was 44.6 ±14.7 years where 37.7% were from the 20-35 years age group. The mean duration of suffering from COVID-19 was 15.9 ±6.1 days where 61.5 % of the patients had a duration of suffering of 11-20 days. Out of the 244 patients, 40 patients had no functional limitation (grade 0 functional status in the PCFS scale) while 100 had negligible functional limitation and 14 had severe functional limitation. We found patients who were suffering from multi-symptoms were statistically significant with PCFS scale grade 4, whereas grade 1 was found to be statistically significant with only respiratory distress. There was a significant association between the duration of COVID-19 symptoms and post-COVID-19 functional status for patients who experienced symptoms for 14 days or more (p<0.05). Conclusions Considering the negative impact of COVID-19 symptoms on functional status, comprehensive care and support are required for COVID-19 survivors.

Early Outcome after Surgical Repair of Postnatal Myelomeningocele

Introduction: Myelomeningocele repair is a relatively uncommon procedure. Much of this has been attributed to improve nutrition and early detection. Our aim is to detect early (30 days) outcome of pediatrict patients undergoing postnatal myelomeningocele repair. Material and Methods: The prospective observational study was carried out on 68 patients presented with myelomeningocele who underwent surgery with age ranged from one (1) month to two (2) years got admitted in the department of neurosurgery, Bangabandhu Sheikh Mujib Medical University from January 2020 to May 2023. Results: Maximum age was found 1 month to 3 months, female baby were predominant which was 40(58.8%), majority 48(70.6%) were medium size, common location were Dorsal (14.7%), Lumbar (45.6%) and Dorsolumbar (33.8%). CSF leak found (8.8%), decreased power of limbs found (38.2%), wound infection was found (5.9%), hydrocephalus found (39.7%), New hydrocephalus (2.9%) and New neurological deficit (1.5%). The duration of hospital stay 4.1±0.8 days. Conclusion: Most complications occur within 30 days of myelomeningocele repair. Wound infection was found in 5.9%. Mostly occurs between 1 to 3 months of age. Early repair of myelomeningocele reduces neurological impairment significantly.