Bangabandhu Sheikh Mujib Medical University Research Articles

Coronary Heart Disease among Male Patients of Age between 25-39- and 40-70-Years Attending Cardiology Outdoor of BSMMU, Dhaka, Bangladesh

Background: Coronary heart disease (CHD) is a major health concern and the top cause of death in Bangladesh. Similar to other South Asian nations, Bangladeshis are highly susceptible to CHD, with early onset and severe progression. The exact pathophysiology remains unclear, but genetics, metabolic syndrome, and traditional risk factors are significant contributors. Aim of the study: The aim of the study was to compare the risk factors and coronary heart disease severity in male patients between 25-39 and 40-70 years. Methods: This cross-sectional observational study took place in the Cardiology Department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, spanning from September to December 2013. It involved 166 male CHD patients aged 25-70. Group A comprised 83 patients aged 25-39, while Group B consisted of 83 patients aged 40-70, selected purposively. Results: The mean age of all participants was 43.6±10.6 years. In both groups, most patients had stable angina (Group A: 80%, Group B: 78%). Group A had 70% smokers, 34% with hypertension, and 30% with a family history of IHD, overweight/obesity, and impaired fasting glucose (IFG). In contrast, Group B had 48% hypertensive patients, with 45% smokers, 39% IFG, 31% overweight/obesity, 29% diabetes, and 12% family history of IHD. Vessel involvement was evenly distributed in Group A, while in Group B, 46% had triple vessel involvement. Conclusion: Among coronary heart disease patients aged 25-39 years, the smoking rate is higher, while diabetes prevalence is lower compared to the 40-70 year’s age group. Conversely, in the 40-70-year-old patient group, there is a higher incidence of hypertension, double vessel diseases, and triple vessel diseases compared to the younger group.

Pattern of Presentation of Lysosomal Storage Disease in Tertiary Care Hospital of Bangladesh

Lysosomal storage disorders (LSD) are a family of genetic diseases that have a devastating impact on the patient and family with a concomitant health burden. These are inherited in an autosomal recessive or, in some cases, in an X-linked manner. Due to the variability of LSD phenotypes, the clinical characteristics of LSD are also heterogeneous. A hospital-based cross-sectional study was conducted at Department of Pediatric Neurology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from July 2022 to June 2022 to explore clinical & laboratory profile of various forms of childhood Lysosomal storage disorders. A total of 59 suspected children of Lysosomal storage disorders (LSD), admitted to hospital during the study period, were included in this study. Among them, 55 cases were diagnosed as Lysosomal storage disorders on the basis of clinical suspicion, biochemical testing and neuroimaging study, and in few cases bone marrow study and molecular genetic testing. Mucopolysaccharidosis 24 (43.64%) and metachromatic leukodystrophy 12 (21.82%) were the most common among all lysosomal storage disorders in our study. Neuroregression 26 (47.27%), microcephaly, and dysmorphism were predominant clinical features. Abnormal neuroimaging changes were found in two-thirds 37 (67.27%) of the cases. Among them, periventricular demyelination 12 (21.82%) and cerebral atrophy 6 (10.91%) were common imaging changes in this study.

Effect of Letrozole and Clomiphene Citrate versus Letrozole Alone for Ovulation Induction in Women with Polycystic Ovary Syndrome

Background: Polycystic ovary syndrome (PCOS) is a common endocrinopathy characterized by oligo-ovulation or anovulation signs of androgen excess and multiple small ovarian cysts. It is thought to be one of the leading causes of female sub-fertility. It has been estimated that PCOS affects 5-10% of females in reproductive age. In this study, we used combination of letrozole and clomiphene vs letrozole alone in ovulation induction in infertile PCOS women. Objective: The objective of the study was to compare the effectiveness of the combination of letrozole and clomiphene citrate and letrozole alone in ovulation induction in infertile women with PCOS. Methods: Randomized controlled trial conducted in the Department of Reproductive Endocrinology and Infertility, Bangabandhu Sheikh Mujib Medical University, Dhaka, from July 2020 to June 2021. A total of 50 women 18-40 years of age with a diagnosis of infertility and PCOS as defined by the Rotterdam criteria and no other known cause of infertility were included in this study. Participants were randomly assigned into two groups by using a computer-generated random table to either 5 mg letrozole alone or the combination of 2.5 mg letrozole and 50 mg CC daily on cycle days 3-7 for two treatment cycle. Statistical analysis was performed by the SPSS program for Windows, version 22.0. Main outcome measured by number & size of mature follicles, endometrial thickness, day 21 serum progesterone & ovulation rate in both groups. The secondary outcome includes pregnancy rate and complication of both treatment arms. Results: Regarding demographic criteria, there was no significant difference between two groups. In the current study, clinical characteristics, laboratory parameters and cycle characteristics were also comparable to both groups and showed no significant difference. Dominant follicles were found 24(52.2%) in group A (CC+Letrozole) and 29(63.0%) in group B (Letrozole Alone) without any significant difference. Mono follicular development was found 18(75.0%) in group A and 24(82.8%) in group B which was not statistically significant. Endometrial thickness and serum progesterone level at 1st and 2nd cycle were not statistically significant between two groups (p>0.05). Ovulation rate was higher in group B than group A (76.0% vs 72.0%) with absolute difference 4.0 and relative ratio 0.95. Pregnancy rate was also higher in group B than group A (24.0% vs 16.0%) with absolute difference 8.0 and relative ratio 0.67. Ovulation and pregnancy rate were not statistically significant between two groups. Regarding side effects, no significant difference was found between two groups. Conclusion: Although it was not statistically significant, ovulation and pregnancy rate was a little higher in alone letrozole group than combined group. The results of this preliminary study suggested that letrozole may have a better role as a first-line treatment for anovulatory patients with PCOS.

Visceral Adiposity Index: An Effective Tool for Predicting Metabolic Syndrome in Bangladeshi Adult Population

Background: Obesity induces adipocyte dysfunction with secretion of adipokines, which results in a cascade of chemical reaction which triggers the atherogenic process and insulin resistance leading to a set of metabolic abnormalities i.e., metabolic syndrome. The Visceral Adiposity Index (VAI) is a simple, gender-based obesity index and has been proposed to be a predictor of metabolic syndrome. Objective: Our study aims to evaluate the effectiveness of the Visceral Adiposity Index (VAI) in prediction metabolic syndrome in Bangladeshi adult population. Methods: This cross-sectional study was carried out in Department of Biochemistry and Molecular Biology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from January to June of 2017. A total of 200 apparently healthy subjects (108 men and 92 women) were selected for the study, who attended the out-patient-departments of the same institution. Anthropometric measurements were recorded, e.g., height, weight, waist circumference (WC). Body mass index (BMI) was calculated. Overnight fasting blood samples were collected to estimate plasma glucose and serum lipid profile. Then VAI was calculated for men and women separately and evaluated as a tool in diagnosis of metabolic syndrome among the participants. Receiver operating characteristic (ROC) curves were plotted to assess the performance of VAI in metabolic syndrome prediction by gender. The power of metabolic syndrome prediction was quantified by the area under the curve (AUC) with 95% confidence intervals. Results: The mean age of the study participants was 42.4±5.2 years. Among 108 men, 63 had metabolic syndrome, while among 92 women, 31 had metabolic syndrome. Sensitivity and specificity of VAI in predicting metabolic syndrome in male study subjects were 83.2% and 70.3%, respectively, while in female study subjects 80.1% and 70.5% respectively. Receiver operating characteristic (ROC) curve analysis showed that the optimal cutoff value of VAI in male study subjects was 2.16 and area under the curve (AUC) value was 0.907, while in female study subjects, the values were 2.25 and 0.918 respectively (P<0.001). Conclusion: The Visceral Adiposity Index (VAI) was found simple, accessible, and effective obesity index to predict metabolic syndrome in apparently healthy adults. Mugda Med Coll J. 2022; 5(2): 88-92

Efficacy of Bath PUVA in the treatment of Palmoplantar hyperkeratosis

Background: Palmoplantar hyperkeratosis, or palmoplantar keratoderma, is a combination of skin conditions that are characterized by excessive thickening of the skin, mainly on the soles and palms. There are various treatment methods for keratoderma, and one of those methods are treatment through bathwater PUVA. It is a type of photochemotherapy. Objective of the study: The aim of the study was to observe the efficacy of bath PUVA treatment for palmoplantar hyperkeratosis. Methodology: This randomized clinical trial study was conducted at the Department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. The study duration was 6 months, from September 2007 to February 2008. A total of 30 patients presented with with palmoplantar hyperkeratosis were enrolled in this study through random sampling method following the inclusion and exclusion criteria. Results: Majority of participant (33.3%) were from the age group of 31-40 years. The mean ±SD age was 38.40±10.89 years, and the age range of the participants was 20-58 years. 70% of the participants were male, 83.3% were from low socioeconomic class, and 36.7% were businessmen respectively. Histopathological diagnosis revealed that 52% patients had psoriasis, 33% had nonspecific dermatitis, and 10% patients had chronic inflammatory dermatitis. Gradual improvement was observed from baseline to 8 weeks follow-up in regards to palmoplantar surface area involvement, erythema, and hyperkeratosis. 46.7% of the participants reported skin tenderness, and 93.3% have a burning sensation and no other side effects. Conclusion: Bath PUVA may be an effective option in the treatment palmoplantar keratosis particularly of psoriatic patients. A mild form of nonspecific dermatitis may be treated with bath PUVA. Mugda Med Coll J. 2022; 5(2): 76-81

Repair of Surgical Defect by Pectoralis Major Flap Versus Free Radial Forearm Flap in Buccal Carcinoma: Assessment of Quality of Life

Background: Soft tissue reconstruction of the oral cavity is the most critical factor in achieving a successful functional result. Malignant lesions occurring in the buccal area are usually treated with primary surgical and/or radiotherapy of the head and neck region. Depending on the location and size of the buccal tumor, radical surgical treatment often affects all oral function such as speech, swallowing, chewing, oral rehabilitation, nutrition and appearance. To maximize postoperative function, flap repair is currently the preferred method for reconstruction of buccal defects after major surgery. Among the flaps most commonly used are pedicle pectoralis major myocutaneous flap and the free radial forearm fasciocutaneous flap. The choice of the best reconstructive option is still controversial. Objective: To find out the quality of life after repair of surgical defect by pectoralis major flap versus free radial forearm flap in buccal carcinoma. Methods: This prospective study was conducted in the department Otolaryngology- Head & Neck Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka from September 2017 to August 2019. A total number of 44 cases of buccal carcinoma patient who had the inclusion criteria were enrolled as a study sample. These subjects were selected from the Department of Otolaryngology-Head & Neck Surgery, Department of Oral & Maxillofacial Surgery, Bangabandhu Sheikh Mujib Medical University, Shahbag, National Institute of ENT, Tejgaon, Dhaka. Comparison of nominal or ordinal variables between patients who have undergone surgery with either the RFFF or PMMF were analyzed using a chi-square test. The UW-QOL scores were compared for each domain using the nonparametric Mann-Whitney test. P-value < .05 was accepted as the level of significance. Results: In this study 40 out of 44 patients were completed UW-QOL questionnaires. The median age was 52 (range 40-65years), the male-female ratio was 1.44:1. All were habituated in either smoking or betel leaf/ nut or alcohol. Most of them were illiterate to the primary level of education and suffering from stage- iii tumor. All these variables were statistically insignificant except gender. Patients reconstructed with RFFF felt better in shoulder domains than PMMF but felt worse appearance domains and these were statistically significant in both 3 months and 6 months postoperatively. Conclusion: The study result had shown that reconstruction of the defect after buccal cancer resection using either RFFF or PMMF significantly influences patient’s quality of life. This study will provide valuable information for surgeons who will decide reconstruction modalities for buccal cancer and also will help the patients getting a better outcome. Bangladesh J Otorhinolaryngol 2023; 29(1): 32-38

Endoscopic removal of ingested foreign body in children: experience of a tertiary care hospital of Bangladesh

Purpose: Foreign body ingestion is a common incident in children & majority of ingested foreign body removed spontaneously, few percentages (10%) remain in GI tract. The timing of endoscopy depends on some clinical & radiological parameters. The aim of this study to is to observe clinical profile of foreign body ingestion in children in Bangladesh. Methods: This cross-sectional descriptive study was conducted from February 2016 to December 2019 in the department of Paediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. A total of 29 cases of upper GI tract foreign bodies were studied. Patients with history of ingested foreign body, were clinically examined. Asymptomatic foreign body ingestion was frequently observed. Routine neck and chest X-ray in both AP and lateral views were obtained for these cases. Flexible endoscopy for foreign body extraction with suitable foreign body retriever was used to remove the foreign bodies. Data were expressed as percentage & number. Results: Foreign body was commonly seen 22 (75.9%) in 1-5 years of age. Sex distribution of foreign body ingestion cases, where 15 (51.7%) were male child. Among the ingested foreign bodies only 3 (10.3%) were removed within 24 hours of ingestion, 10 (34.5%) cases were removed between 24-48 hours and the remaining 16 (55.2%) were removed after 48 hours. Coin was the most common foreign body 19(65.5%). Other foreign bodies were metallic chain 3 (10.3%), button battery 2 (6.9%), others 5 (17.2%). Conclusion: The study showed that foreign body ingestion is more common in 1-5 years age group, coin was the most commonly ingested foreign body.

Correlation between Perfusion-Weighted Magnetic Resonance Imaging (MRI) Features with Histopathological Grading of Glioma

Background: Gliomas are the most common primary neoplasm of the brain. It histopathologically grades I to IV. I and II are low grade while III, IV are high grade. Low-grade gliomas are usually subject to either strict follow-up or surgery. The treatment for high grade gliomas is typically surgery, followed by concomitant radiation therapy and chemotherapy. Conventional MRI has limitations for the grading of gliomas. In addition to conventional MRI techniques, a variety of new techniques such as perfusion-weighted MRI which noninvasively measures cerebral perfusion that can be used for better assessment of glioma. This will be helpful for therapeutic approach and counseling about prognosis of the patient. Methods: This cross sectional observational study was conducted in the Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University from IRB clearance to 18 months. The patients who fulfill the selection criteria were enrolled in this study. Written informed consent was taken from the patients and/or the legal guardian/ responsible family members after completely explaining to them the procedure and the purpose of the study. Patient’s data was collected in questionnaire/data collection sheet. The privacy of the patient was strictly maintained and the patient’s information will not be disclosed to any source. The study data will only be used for the purpose of this scientific study. This study was not causing any additional harm to the patients. All the patients were evaluated by a standard conventional contrast-enhanced study with perfusion-weighted image on Siemens 3 Tesla MRI. The histopathological grading of the tumor was done as per the WHO classification of 2007. Then correlation was done between PWI finding and WHO histopathological grading. Results: Measurement of relative cerebral blood volume in glioma patients was done in PW-MRI preoperatively. Out of the 35 tumors evaluated, 17 were found as low rCBV and 18 as high. Histopathological examination of glioma was done postoperatively. Among 35 tumors, 19 are low grade gliomas and 16 are high grade gliomas. For the correlation between relative cerebral blood volume in preoperative PW MRI and histopathological grading of glioma, Spearman’s Rank Correlation Coefficient Test was done. We found a significant positive coefficient value of r = 0.572 with a significant p-value of p = <0.001. A single cutoff relative cerebral blood volume value of 1.7 for low versus high grade glioma was found to be 77.8% sensitive and 88.2% specific. Conclusion: The present study ascertains that histopathological grading of glioma is positively correlated with relative cerebral blood volume in PW MRI. Bang. J Neurosurgery 2022; 12(1): 12-19

Association between Chronic Idiopathic Urticaria and Helicobacter Pylori Infection

Chronic idiopathic urticaria (CIU) is a recalcitrant skin disease characterized by pruritic wheals lasting more than six weeks in the absence of a physical cause. A case-control type of analytical study was conducted from January 2012 to August 2012 on patients of chronic idiopathic urticaria attending the outpatient department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University, Dhaka. The objective of the study was to see the association between chronic idiopathic urticaria and Helicobacter pylori infection. In serum, IgG positive individuals, female covers about two-thirds (14 respondents with 73.3%) than male counterparts (5 respondents with 26.3%). Among the IgG negative individuals, females were again more in percentage (63.6%) and males were 36.4%. Serum IgG for H. Pylori positive respondents were highest among the students (42.1%) followed by housewives (31.6%) and in IgG negative individuals, the same trend exists. When we considered education level for IgG positivity, it was found that graduate and above educated respondents showed higher results (42.1%) and SSC level showed next incidences (26.3%). In IgG negative group, the same trend exists. We found the same positivity for IgG of H. pylori among the different food intake, heat, and sunlight exposed history respectively whereas food intake history covers more in IgG negative individuals. Most of the IgG positive respondents were ill-looking (94.7%), though IgG negative individuals were also ill-looking. Chronic idiopathic urticaria is a disorder that often baffles dermatologists and allergists alike. Without a known cause, it is nearly impossible to prescribe an effective treatment.
 Bangabandhu Sheikh Mujib Med. Coll. J. 2022;1(1):20-23

Assessment of radiation level and potential risk to public living around major hospitals in central and western Bangladesh

Human beings are continuously bathed in radiation coming from natural and artificial sources. Although the use of radiation in medical applications is beneficial to patients, it also contributes significantly to the health hazard for radiation workers and the public if radiation-generating equipment and radioactive sources are not handled properly. 96% dose contributed from medical uses of ionizing radiation in the US population among man-made sources as per NCRP Report No. 160. There is no extensive study conducted on the large hospitals in Bangladesh following the In-Situ method. We used a real-time digital portable radiation monitor with Garmin eTrex Global Positioning System at 320 monitoring points for radiation monitoring and positioning around the ten largest hospitals in central & western Bangladesh from September to November 2021. The mean radiation dose rates around Bangabandhu Sheikh Mujib Medical University, Dhaka Medical College Hospital, Evercare Hospital, Khulna Medical College Hospital, Mitford Hospital, National Institute of Cancer Research Hospital, Popular Hospital, Rajshahi Medical College Hospital, Shaheed Suhrawardy Medical College Hospital, and Square Hospitals were measured as 0.145 ± 0.012 μSv/h, 0.135 ± 0.009 μSv/h, 0.148 ± 0.008 μSv/h, 0.139 ± 0.01 μSv/h, 0.133 ± 0.007 μSv/h, 0.153 ± 0.011 μSv/h, 0.144 ± 0.012 μSv/h, 0.137 ± 0.008 μSv/h, 0.145 ± 0.01 μSv/h, and 0.153 ± 0.009 μSv/h, respectively. The mean excess lifetime cancer risk (ELCR) of the public who lives nearby the hospital's boundary was estimated at 1.05 × 10−3, 0.983 × 10−3, 1.071 × 10−3, 1.004 × 10−3, 0.964 × 10−3, 1.084 × 10−3, 1.043 × 10−3,0.996 × 10−3, 1.051 × 10−3 & 1.112 × 10−3 respectively. ELCR in most of the locations around the ten largest hospitals in central & western Bangladesh is higher than the global average value. Radiation monitoring is significant for minimizing the public's radiation risk and keeping hospital environments as radiation-free as possible.

Short-term and low-dose liraglutide plus metformin decreased body mass index and insulin resistance more than metformin alone in obese women with polycystic ovary syndrome: An open-label randomized controlled study

Background and objectives: Reduction of weight improves different manifestations of polycystic ovary syndrome (PCOS). This study compared the effects of liraglutide plus metformin versus metformin alone on weight loss and metabolic profiles in obese women with PCOS. Methods: This open-label randomized controlled clinical trial consecutively recruited newly-diagnosed PCOS patients of reproductive age with obesity (body mass index ≥ 27.5 kg/m2). Following randomization into two equal groups, Group-1 received treatment with metformin 1000 mg daily alone while Group-2 was given metformin 1000 mg plus subcutaneous (SC) liraglutide 1.2 mg daily for 12 weeks. Anthropometric, biochemical and hormonal data and ovarian morphology were assessed at baseline and after 12 weeks. Clinical information and side effects were recorded every four weeks after initiation of the treatment. Glucose, lipids, and all hormones were analyzed by glucose oxidase, precipitation method, and chemiluminescent microparticle immunoassay respectively. Insulin resistance was measured by homeostatic model assessment (HOMA-IR). Results: Study included 30 participants comprising 15 for each group. Among 15 participants, 5 dropped out from the Group-1 and 1 dropped out from the Group-2. The final analysis was done among 24 participants (Gr-1: 10 and Gr-2: 14). Waist and hip circumference (WC, HC) significantly (p <0.05) decreased in patients treated with only metformin. Menstrual irregularity, BMI (body mass index), HC, systolic blood pressure (BP), 2h-OGTT glucose, fasting insulin, and HOMA-IR significantly (p < 0.05) decreased in the patients of Group-2 after 12 weeks compared to baseline status. Percentage changes of weight, BMI and HOMA-IR improved significantly (p < 0.05) in cases of Group-2 than those in Group-1. Side effects were though numerically higher in the Group-2 patients, but reduced with time. Conclusions: Addition of liraglutide with metformin was superior to metformin alone for lowering of BMI and insulin resistance among obese PCOS women with acceptable side effects. IMC J Med Sci. 2024; 18(1):002. DOI: https://doi.org/10.55010/imcjms.18.002 *Correspondence: Muhammad Abul Hasanat, Room# 1524, Level-15, Block-D, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka-1000, Bangladesh. ORCID iD: orcid.org/0000-0001-8151-9792; Email: aryansowgat@gmail.com

Non-invasive diagnosis of liver fibrosis in children with chronic hepatitis B by transient elastography

Background Chronic hepatitis B (CHB) is one of the most alarming global health problems. Children with CHB mostly remain asymptomatic but serious sequelae like cirrhosis and hepatocellular carcinoma may develop at any age. Liver biopsy, despite being the gold standard, is not preferable for the diagnosis of liver fibrosis because it is invasive and painful. Transient elastography, a noninvasive marker for fibrosis, could play an important role in this disease.
 Objective To observe the role of transient elastography in the assessment of the progression of liver damage in children with chronic hepatitis B.
 Methods This cross-sectional study was conducted at The Department of Paediatric Gastroenterology and Nutrition of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Based on the inclusion and exclusion criteria, there were a total of 55 cases of CHB. Besides proper clinical history, physical examination, and initial investigation, transient elastography was performed in all of the cases. Liver biopsy was taken in 20 patients with raised serum ALT level after taking proper consent. Elastographic findings were compared with clinical, biochemical, virological, and histological findings.
 Results The mean age was 11.46 (SD 3.6) years and 68.7% were male. Most (65.4%) of the patients were asymptomatic at presentation and biochemically normal. Liver stiffness measurements had positive but insignificant correlation with liver biopsy (r=0.43, P=0.06). Sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy for transient elastography were 80%, 53.3%, 36.3%, 88%, and 60% respectively. Areas under the ROC curve were 0.76 (95%CI 0.47 to 1.0) for patients with significant fibrosis (F? 2). Using a cut off value of 8.05 kPa, patients with significant fibrosis were detected with a sensitivity, specificity of 80% and 53%, respectively.
 Findings of transient elastography were significantly associated with clinical findings like anaemia, jaundice, hepatosplenomegaly, stigmata of CLD and biochemical findings like serum ALT, AST as well as virological parameters.
 Conclusion Transient elastography has a limited role in confirming a diagnosis of significant fibrosis. But because of good sensitivity, transient elastography can be used as an initial presumptive diagnostic tool for assessing significant hepatic fibrosis. A cut off value of less than 8.05 in transient elastography can be used for exclusion of significant fibrosis.

Cardiac Involvement in Ankylosing Spondylitis

Background: Ankylosing spondylitis can lead to heart disease, including aortic incompetence, conduction defects, mitral valve disease, cardiomyopathy, and pericarditis. Early detection of cardiac abnormalities is crucial for effective treatment and prognosis, as they increase with age, disease duration, and peripheral arthritis presence. Objectives: This study aimed to determine the type, prevalence, and extent of cardiac involvement in patients diagnosed with ankylosing spondylitis. Methods: The study were collected in the Department of Medicine and Rheumatology units of Bangabandhu Sheikh Mujib Medical University and Dhaka Medical College Hospital from January 2022 to December 2022. Diagnosis was established based on clinical features, physical examinations, and relevant laboratory and imaging studies. Patients with a history of rheumatic fever, syphilis, or those who declined participation were excluded from the study. Results: A total of 80 patients with ankylosing spondylitis underwent clinical examination, electrocardiography, and echocardiography to assess cardiac involvement. Among the participants, eight patients (10%) were found to have aortic insufficiency. Two patients had both aortic insufficiency and first-degree heart block, one had only first-degree heart block, and one had mitral insufficiency. Presents the cardiovascular manifestations detected in 12 patients (14%) with ankylosing spondylitis. Peripheral arthritis was present in 64% of the 12 patients with cardiovascular lesions, compared to only 34% of the 68 patients without such lesions. Conclusion: This hospital-based observational study investigated cardiac involvement in ankylosing spondylitis patients. Due to the small sample size, definitive conclusions were difficult to make, but the findings suggest that cardiac involvement is relatively common, emphasizing the need for early detection of cardiac abnormalities for effective treatment and prognosis.

Health Care Seeking Behavior among the Parents for their Autistic Children

Background: Autism Spectrum Disorders (ASD) are increasing alarmingly in recent times. Objective: The purpose of the present study was to find out the pattern of health care seeking behavior of the parents for their autistic children. Methodology: This cross-sectional study was conducted at Centre for Neurodevelopment and Autism in Children at Bangabandhu Sheikh Mujib Medical University, Dhaka from January to December 2013. The respondents were the parents of autistic children who came to the centres with their children. Results: About 61(66.3%) cases were in 2 to 6 years of age. Among the siblings, 8(8.7%) had autism and relatives of 8(8.7%) children had other developmental disorder. It is revealed that 67(72.8%) consulted specialist doctor, 23(25%) attended special teacher in scientific center. As many as 65(70.7%) were aware about autism and 80(87%) knew about the services provided at scientific centers. About 36(39.1%) had barriers to attend scientific centers. Lack of awareness (18 out of 36) was the most important barrier. Majority of the parents (79.3%) attended regularly to the health care centers for follow up. Conclusion: In conclusion raising awareness, dissemination of information, knowledge about autism including its risk factors and decentralization of health care facilities can overcome the impediment of getting appropriate health care. Journal of Current and Advance Medical Research, July 2022;9(2):83-90

Imaging and Histological Characteristics of Non-Hybrid and Hybrid Fibro-Osseous Lesion at Maxillofacial Area

Background: The integration of clinical, radiographic and pathology findings-based information has long been intrinsic to diagnosis and proper management. Objective: The purpose of study was to observe the imaging features of hybrid and non-hybrid Fibro-Osseous Lesion at Maxillofacial Area among the participants. Methodology: This cross-sectional study was conducted in the Department of Oral & Maxillofacial Surgery at Dhaka Dental College & Hospital, Dhaka, Shaheed Suhrawardy Hospital, Dhaka and Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2004 to December 2005. Participants were selected for the study who attended into outpatient and inpatient departments with fibro-osseous lesions during study period, irrespective of age & sex. A standardized structured data collection sheet was used to collect necessary information of the study history of the patients and clinical examination; radiology, histopathology and macroscopic findings of surgical specimen were recorded. Result: Most of the patients’ age was between 11 to 30 for both hybrid and non-hybrid form. Among them average age of the patients was 24.98 years (±SD 13.4).The mean age of the Non-hybrid group is 26.35 (±SD 13.92) years and mean age of Hybrid group is 17.17 (± SD 6.18) years. In hybrid form most of the radiological pattern was mixed type (83.3%) but in non-hybrid form all other mentioned radiological character were found. In cross-section of surgical specimens of hybrid form cavitation were found in all cases (100.0%) but it was not detected in a single case in non-hybrid form (0.0%). Multicystic haemorrhagic spaces were seen in 100.0% cases of hybrid form whereas none was detected in non-hybrid. Conclusion: The Imaging and histomorphology of fibro-osseous lesion is very important tools to proper diagnosis and management. Journal of Current and Advance Medical Research, July 2022;9(2):79-82

Evaluating the Impact of Surgical Occurrence of Bile Duct Injuries in Laparoscopic Cholecystectomy- A Retrospective Observational study

Background: Laparoscopic cholecystectomy (LC) is the gold standard for treating gallstone disease, offering numerous benefits over traditional open cholecystectomy. However, bile duct injuries (BDIs) are a significant complication, contributing to substantial morbidity and mortality. This study aims to evaluate the incidence, causes, risk factors, treatments, and outcomes of BDIs in laparoscopic cholecystectomy in Bangladesh. Material & Methods: This retrospective observational study was conducted at the Department of Hepatobiliary, Pancreatic and Liver Transplant Surgery, Bangabandhu Sheikh Mujib Medical University, Al-Manar Hospital Limited, and Abeer General Hospital, Dhaka, Bangladesh. During this period, a total of 1255 complete hospital records of laparoscopic cholecystectomy conducted over the last 5 years at the study hospital were selected for the study following inclusion and exclusion criteria. Results: Out of laparoscopic cholecystectomy cases, 20 (1.64%) patients experienced BDIs. The most common cause of BDI was clipping or transection of the duct (33.33%), followed by mistaken anatomy (22.22%) and ischemic injury due to clip (18.52%). Acute cholecystitis was the most prevalent risk factor (37.04%). Standard laparoscopic cholecystectomy was performed in 83.33% of BDI cases, with the remaining 16.67% undergoing single-incision laparoscopic cholecystectomy. The majority of patients (74.07%) had no complications after BDI treatment, while 18.52% experienced minor complications, 5.56% had major complications, and 1.85% resulted in mortality. Conclusion: This study highlights the importance of meticulous surgical technique, early recognition, and appropriate management of bile duct injuries in laparoscopic cholecystectomy. By continually refining our understanding of the factors contributing to BDIs and implementing evidence-based strategies to prevent and manage this complication, we can optimize patient outcomes and ensure the highest standards of care in laparoscopic cholecystectomy.

Association of Gastrointestinal Manifestations with Socio-demographic, Lifestyle & Clinical Factors in HIV/AIDS Patients

Background: Gastrointestinal abnormalities in people with HIV/AIDS have been reported since the advent of AIDS. This study aimed to analyze the gastrointestinal manifestations in HIV/AIDS patients in terms of sociodemographic, lifestyle, and clinical characteristics with the association of GI manifestations. Material & Methods: This observational cross-sectional analytical study was conducted at the ART corner and Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka among adult HIV-infected or AIDS patients aged more than 18 years. A total of 122 patients were taken as per inclusion criteria. The study took place from March 2018 to February 2019. Continuous variables were reported as the mean ± standard deviation. The correlation of several GI symptoms with CD4 count was done by the Spearman rank test. Sociodemographic variables (gender, age, income, and education level), lifestyle variables (smoking status, risk consumption of alcohol, and physical activity level), and clinical variables (antiretroviral therapy – duration and class, duration of HIV infection) were assessed through a pre-tested and standardized questionnaire. The chi-square test was used to test the statistical significance of associations, considering a p-value ≤0.05 as statistically significant. All of the data were analyzed and calculated using the Statistical Package for Social Sciences (SPSS version 20.0) and Microsoft Excel 2016. Results: Among the patients, male preponderance was seen with the frequency of 66% (31) and 61.3% (46) with and without GI symptoms respectively. Patients aged 40-49 years old were more frequent with (31.9%) and without (25.3%) GI symptoms. The patients of primary level of education had GI symptoms and had no GI symptoms were 61.7% and 45.3% respectively of the total. Statistically significant (p=0.03) indicating that low CD4+ cell count (≤ 350 cells/mm3) can be considered as an associated risk factor for the occurrence of GI manifestations in HIV infected patients. There was less statistically significant difference in other clinical characteristics between patients with current GI manifestations and without GI manifestations. Here, the statistically significant p-value ≤0.05 is considered. Conclusion: This study concluded that, smoking and low CD4 count (<350cell/mm3) were found significantly associated with the occurrence of presenting GI symptoms. Other sociodemographic, lifestyle, and clinical factors were not significantly associated with the occurrence of GI manifestations.

Outcome of Pregnancies with Severe Oligohydramnios in the 3rd Trimesters

Background: Amniotic fluid volume (AFV) of less than 200 ml is considered as insufficient, and is referred as significant oligohydramnios. Approximately 8% of pregnant women may experience low amniotic fluid levels ( less than normal / AFI < 8 cm ) But among them about 4% of pregnant women are diagnosed with severe or significant oligohydramnios. A range of unfavorable perinatal outcomes, including fatal growth restriction meconium aspiration of fetus, fetal distress and surgical intervention for foetal distress in labour and even perinatal death, are linked to oligohydramnios which are found during the antepartum period of pregnancy. The purpose of the study was to determine the outcome of pregnancies with severe oligohydramnios in the 3rd trimester. Material & Methods: This prospective observational study was carried out on the admitted patients in the Department of Gynecology & Obstetrics at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from February to July 2013 (6 months). A total of fifty women (N=50) having Oligohydramnios in pregnancy were included in the study. Completed data forms were reviewed, edited, and processed for computer data entry. The data analysis was performed using Statistical Package for Social Sciences (SPSS) Version 25.0. The ethical clearance of this study was obtained from the Institutional Review Board (IRB) of BSMMU, Dhaka, Bangladesh. Results: Mean age of the mothers was 25.8 years and two-fifths of the mothers (20, 40.0%) belonged to 21-25 years old. Twenty-three mothers (23, 46.0%) were nulliparous. Of fifty mothers (N=50), eighteen (18, 36.0%) had borderline oligohydramnios & thirty-two (32, 64.0%) had severe oligohydramnios. Normal CTG tracing was found in eighteen patients (18, 36.0%) and abnormal CTG was found in thirty-two patients (32, 64%). Based on fetal outcome (N=50), 23 babies (23, 46.0%) were admitted to the NICU, of whom 7 (7, 14.0%) had birth asphyxia, 8 (8, 16.0%) had neonatal sepsis, 4 (4, 8.0%) had neonatal jaundice, 2 (2, 4.0%) had meconium aspiration syndrome, 4 had stillbirths, and 5 had died as neonates. Conclusion: Nowadays, routine obstetric USG is more routinely used to detect oligohydramnios. In the third trimester of pregnancy, PIH and postdated pregnancies are the most common causes of decreasing amniotic fluid. Unfavourable perinatal outcomes can be avoided with careful fetal heart rate monitoring during antenatal period and at labour. Every case of oligohydramnios necessitates a comprehensive prenatal assessment, parental counselling, and a personalized delivery time and technique. This study found no connection between meconium-stained liquor and oligohydramnios and found that caesarean section deliveries were considerably more common in these women.

Pediatric Laparoscopic Cholecystectomy: Clinical Significance of Cases

Background: Cholecystectomy in children is relatively uncommon, despite being one of the most common surgical procedures in adults. However, the number of cholecystectomies in children has increased over the past two decades. The most common reason for juvenile patients to have cholecystectomy, according to a few research conducted on Western cultures, is biliary dyskinesia. However, in the majority of pediatric patients, gallstones are the cause of symptomatic gallbladder illness. The aim of this study was to describe the characteristics of pediatric patients who underwent laparoscopic cholecystectomy. Material & Methods: This was a retrospective study and was conducted in the Department of Pediatric Surgery of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh during the period from May,2017 to February, 2020. In our study, we included 24 cases with gallbladder illness who underwent pediatric laparoscopic cholecystectomy. Results: A total 24 pediatric patients underwent laparoscopic cholecystectomy during the study period. Out of them 17 (70.8%) were 10 to 18 years old and 7 were below 10 years old. The cases comprised 10 male (41.7%) and 14 female (58.3%). Mean body weight was 53.3 Kg. Mean height was 151.3 cm and mean BMI was 24.43 Kg/m2,with 15 patients(62.5%) being overweight. Fever (83.3%) and vomiting (79.2%) were the most common presenting feature. Most of the cases (87.5%) presented with multiple gall stone. 33.3% of patient comes with anemia ,where hemolytic disorder is predominant comprising 29.3% of patient. Comparison between overweight and non overweight patients reveal that preoperative complications like CBD dilatation, CBD stone and choledocholithiasis were significantly high in overweight patients. Conclusion: In conclusion, cholecystectomy is rarely performed in pediatric populations. We found Laparoscopic cholecystectomy (LC) is a safe and effective treatment for pediatric cholelithiasis. The cause of the increased incidence of pediatric cholelithiasis is obesity and life style as well as its natural history, must be investigated further.

Efficacy of Loop Electrosurgical Excision Procedure in the Management of Cervical Intraepithelial Neoplasia (CIN) –in A Tertiary Level Hospital

Background: Cervical intraepithelial neoplasia (CIN) is the potentially premalignant transformation and abnormal growth of surface epithelial cells of the cervix. CIN is a precancerous condition and curable. Loop electrosurgical excision procedure (LEEP) is a simple, outpatient procedure of removing the transformation zone of cervix. The aim of our study was to evaluate the efficacy of large loop electrosurgical excision procedure (LEEP) as a treatment procedure for cervical intraepiethelial neoplasia. Methods: This prospective observational study was conducted at Colposcopy clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU) from June, 2017 to May, 2019. All consecutive patients having colposcopicaly and histopathologicaly proven high grade lesion by colposcopy directed punch biopsy were included in this study. All eligible patients with high grade lesion were underwent LEEP and followed up on 15 days post-procedure, 6 months, 12 months with colposcopy. Results: Sixty (60) cases were undergone LEEP, among them 48 (80%) cases were diagnosed as CIN2 and 12 (20%) cases were CIN3 by colposcopy- directed biopsy. One patient (1.7%) needed hospital admission to controll intra-operative bleeding and in postoperative period 7 (11.7%) patients had mild to moderate post-operative bleeding which was controlled well after application of morsel’s pastes and electro-cautery, one patient (1.7%) had pelvic infection. On 6 months follow-up, in case of CIN2 patients, cure rate was 93.5% (43 of 46) and 1 (2.2%) patient had persistent CIN-2. Patient with persistent CIN2 had re-excision and followed up at 12 month with colposcopy. Among case of CIN-3, the cure rate was 81.8% (9 of 11) and 1 (9.1%) case had CIN2. P-value was 0.244, which was not statistically significant. Overall cure rate on 6 month follow-up was 91.2%. On 12 months follow-up cure rate for CIN2 was 97.8% and for CIN3 was 90.9%. Overall cure rate was 96.5%. P-value was 0.352, which was not statistically significant. Conclusion: Loop electrosurgical excision procedure (LEEP) has a good outcome as a diagnostic and treatment procedure for cervical intraepithelial neoplasia. Bangladesh Medical Res Counc Bull 2023; 49(2): 113-119