Bangabandhu Sheikh Mujib Medical University Research Articles

Comparison of Lymphocyte/Monocyte ratio (LMR) with Child-Pugh Score and MELD Score in the Determination of Hepatic Dysfunction Severity and Outcome in Cirrhotic Patient

Background: Lymphocyte/monocyte ratio (LMR) is a simple and effective marker that has the potential to predict the severity of hepatic dysfunction in a cirrhotic patient, like the Model for End-Stage Liver Disease (MELD) score and the Child- Pugh (CP) score. However, the usefulness of this newer tool has not yet been tested. Objectives: Comparison of Lymphocyte/Monocyte ratio with Child-Pugh Score and MELD Score in the determination of hepatic dysfunction severity in patients with cirrhosis was the objective of the study. Materials and Methods: This cross-sectional analytical study was conducted on cases of cirrhotic patients in the Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University, dated from September 2018 to August 2019. A total of 40 compensated cases and 82 decompensated cases were included in the process of obtaining informed written consent. Information about clinical profile, laboratory parameters (complete blood count including ESR, serum total bilirubin, serum albumin, ALT, AST, serum creatinine, prothrombin time, INR, etc.) were collected. LMR, MELD score, and CP score were calculated both in compensated and decompensated cirrhotic patients to assess the relationship with the severity of hepatic dysfunction. The correlation between LMR and the CP/MELD score was established by the Pearson correlation test. The receiver operating characteristic (ROC) curve and cut-off values of LMR were obtained, and areas under the ROC (AUROC) curve were calculated to identify the best LMR and/or the MELD score or CPS for predicting hepatic decompensation. The Bland-Altman plot and the Heliey- MacNeil test were used for comparison of measurement techniques. The data were analyzed with the help of SPSS version 20. Observation and Results: The mean age of the decompensated group was higher than that of the compensated group (p<0.05). The mean values for LMR and MELD and CP scores were 7.93±3.08, 5.25±0.43 & 7.10 ±1.19, respectively. Average LMR was significantly higher in compensated cirrhosis patients while CP and MELD Score was lower in that group (p<0.001). MELD and CP were positively correlated with each other (p<0.001). LMR was negatively correlated to both MELD and CP scores (p<0.001). Of all patients, only 4 died (3.3%) and rest 118 (96.7%) survived. The cut off value of LMR, CP and MELD were LMR ≤ 2.18 (sensitivity: 75%, specificity: 87.3%), CPS ≥13.5 (sensitivity: 75%, specificity: 98.3%) & MELD ≥30.5 (sensitivity: 75%, specificity: 94.9%) respectively. Pairwise comparison showed that the difference between the AUCs of MELD and LMR was not statistically significant (0.953 vs 0.887; p=0.081). Patients in the low LMR group showed decreased survival than those in the high LMR group (p=0.000). The no survived group had lower LMR and higher MELD and CP scores than those of the survived group (p<0.001). Conclusion: In comparison with Child-Pugh Score and MELD Score in the determination of hepatic dysfunction severity in cirrhotic patients, Lymphocyte/ Monocyte ratio is a useful tool.

Coagulopathy in pediatric acute promyelocytic leukemia in Bangladesh: A single-center, prospective study

BackgroundAcute promyelocytic leukemia (APL) is one of the most curable subtypes of acute myeloid leukemia in childhood. It usually presents with a characteristic coagulopathy. The aim of the study was to determine the extent and outcome of this coagulation disorder. MethodsThis prospective observational study was conducted at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, and included PML:RAR-α (Promyelocytic Leukemia-Retinoic Acid Receptor-α) positive APL cases. At presentation, all patients were assessed with coagulation parameters and followed up clinically and hematologically while treated with ATRA (all-trans-retinoic acid)-based chemotherapy. The presence of disseminated intravascular coagulation (DIC) was determined using the DIC scoring system of the International Society on Thrombosis and Hemostasis (ISTH). ResultsAmong 20 APL cases, the mean DIC score was 5.75 ± 0.6. DIC was detected in 90% (n = 18/20) of the patients. The incidence of fatal thrombo-hemorrhagic complications was 15% (n = 3/20). Though hemorrhagic complications are common, thrombosis may also occur in pediatric APL.

Comparison of Acute on Chronic Liver Failure Prognostic Scores after Plasma Exchange and standard Medical Therapy

Introduction: Acute and acute-on-chronic liver failure (ACLF) has a very high short-term mortality rate. Jaundice, hepatic encephalopathy, hepato-renal syndrome, hemodynamic instability, increased susceptibility to severe infections, and finally multi-organ failure may occur in the final stage of ACLF regardless of its underlying etiology. Biochemical parameters play a vital role in assessing the prognosis of the mortality rate of the disease. Aim of the study: This study aimed to compare acute on chronic liver failure prognostic scores in predicting short-term mortality rates after plasma exchange and standard medical therapy. Methods: This randomized control trial was conducted at the Department of Hepatology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from September 2020 to September 2021. All the patients admitted to the Department of Hepatology, BSMMU with ACLF were considered as the study population. A total of 28 patients (14 in each group of PLEX and SMT) were selected as study subjects by simple random sampling technique. All data were analyzed by SPSS version 21.0. Qualitative data were analyzed by Chi-square test and Quantitative data were analyzed by Student´s t-test. Comparison between the two groups in each follow-up was done by unpaired t-test. Result: The majority (57.1%) of patients survived in the PLEX group then 5(35.7%) in the SMT group. The difference was statistically not significant (p>0.05) between the two groups. Serum bilirubin, AST, ALT, MELD score, MELD-Na score, and AARC score were statistically significant (p<0.05) between the two groups. Conclusion: This study concludes that serum bilirubin, serum AST, serum ALT, MELD score, MELD-Na score, and AARC score are statistically significant in patients with ACLF. Serum bilirubin, serum AST, serum ALT, MELD score, MELD-Na score, and AARC score can act as predictors of short-term mortality rate in ACLF after plasma exchange and standard medical therapy.

Patterns of Gastrointestinal Symptoms of Covid-19 Patients in a University Hospital of Bangladesh

The World has experienced a devastating pandemic of COVID-19 caused by SARS-CoV-2 that started at March, 2020 and ended in May, 2023. Most patients of COVID-19, presented with respiratory symptoms and signs. But the number of COVID-19 patients experiencing gastrointestinal symptoms were also significant. The spectrum of gastrointestinal symptoms in the second wave of COVID-19 was observed in this study from July 2020 to September 2020 with an aim to describe the frequency of occurrence and the possible timing of onset and duration of these symptoms. This cross-sectional study was carried out in the COVID-19 outpatient (triage of fever clinic) and COVID dedicated inpatient department of Bangabandhu Sheikh Mujib Medical University (BSMMU) involving at least 79 consecutive patients who were RT-PCR positive for coronavirus 2 (SARS-CoV-2). Gastrointestinal symptoms including anorexia, nausea, vomiting, altered taste, diarrhoea, haematemesis or melena were recorded precisely by face to face interview maintaining proper infection control protocol. Among the 79 COVID-19 patients, 70.88% patients had at least one gastrointestinal symptom & the rest had no GI symptom. Most patients suffered from anorexia (70.88%), followed by diarrhoea (62.02%), nausea (41.77%), loss of taste (36.70%), vomiting (32.90%) & abdominal pain (7.59%), melena (2.53%). Diarrhoea was mild in most cases. The mean duration of diarrhoea and dysgeusia/loss of taste was 2.83 days and 5.8 days respectively. Mean duration of exposure to COVID 19 patient and onset of diarrhoea and dysgeusia was 7.69 days and 3.8 days respectively. This study did not exhibit any association between GI symptoms and severity of the disease. Bangabandhu Sheikh Mujib Med. Coll. J. 2024;3(1):07-11

The Role of HPV Genotype among Colposcopy Diagnosed Cervical Precancerous Lesions

Background: Cancer is the leading cause of death and a major contributor to reduced life expectancy in every country on Earth [1]. Cervical cancer (CC) is a serious global health concern that is more common in developing countries, especially those on the Indian subcontinent. More and more women are suffering from CC. Cervical cancer is mostly caused by the Human Papillomavirus (HPV), a sexually transmitted virus that is one of the most common illnesses of the reproductive system. Objective: The aim of this study is to evaluate the role of HPV genotype among colposcopy diagnosed cervical precancerous lesions. Methods: The cross-sectional observational study was conducted in the Department of Gynecological Oncology of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from July 2021 to June 2022. A total of 132 subjects were included in the study. Data were collected by face-to-face interview and analyzed by appropriate computer based programmed software Statistical Package for the Social Sciences (SPSS), version 24. Results: In this study, the mean age was found to be 36.7±6.3 years, with a range from 31 to 60 years, the majority 53 (40.2%) of patients completed SSC and 118 (89.4%) were housewives and 125(94.7%) were Muslims. In this study most of the patients 101 (76.5%) came from middle-income families. About 45 (34.1%) patients were married between the ages of 15-17 years, 45 (34.1%) were between 16-18 years during their first delivery and 56 (42.4%) had 3-4 children. Most of the patients 92(69.7%) had history of received OCP. About 10(7.0%) patients were found HPV 16 positive followed by 1(0.7%) HPV 18, 3(2.1%) other HR-HPV, 3(2.1%) HPV 16 & other HR-HPV and 1(0.7%) HPV 16-HPV 18 & other HR-HPV. Most of the 95 (72.0%) patients had CIN I, 30 (22.7%) had CIN II and 7 (5.3%) had CIN III identification by colposcopy reports. In this study 59 (44.7%) patients had CIN I followed by 13 (9.8%) had CIN II, 9 (6.8%) had CIN III, 5 (3.8%) had CIS and 46 (34.8%) ..

A Study on Thyroid Dysfunction in Patients with Psoriasis

Background: Psoriasis is a common and chronic inflammatory skin disease which is characterize by clearly defined red and scaly plaques. The plaques of psoriasis can be disfiguring and severely pruritic and/or painful. Itching is often the most bothersome symptom of psoriasis. Methodology: In this hospital based cross-sectional study, a total of 180 people in the all age group were included. Individuals attending the Dermatology Out-patient Department of Bangabandhu Sheikh Mujib Medical University (BSMMU) were selected during the study period from July’2023 to Januray’2024. Total 90 patients with diagnosed cases of psoriasis were selected as study group and 90 age and sex matched healthy individuals were selected as controls. Results: No significant difference was noted in the values of FT3, FT4 and TSH hormones in the values among the control group and patient group. In males 10 (10.2%) were hypothyroid, 51 (86.4%) euthyroid and 2(3.4%) was hyperthyroid whereas, in females 5(16.13%) were hypothyroid, 25 (80.65%) euthyroid and 1 (3.2%) were hyperthyroid. Conclusion: No significant difference was noted in the values of FT3, FT4 and TSH hormones in the values among the control group.

Diagnostic Performance between Colposcopy Findings and Histopathology Reports

Background: Cervical cancer is the most frequent cancer in women worldwide. With appropriate screening, the condition can be prevented and treated. Colposcopy is a useful tool in the diagnosis and management of precancerous cervical lesions following primary screening. The gold standard for identifying precancerous lesions is histopathology. Objective: The aim of this study is to evaluate the diagnostic performance between colposcopy findings and histopathology reports Methods: The cross-sectional observational study was conducted in the Department of Colposcopy Clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from July 2022 to June 2023. A total of 62 subjects were included in the study. The questionnaire was pretested, corrected and finalized. Data were collected by face-to-face interview and analyzed by appropriate computer based programmed software Statistical Package for the Social Sciences (SPSS), version 24. Results: In this study, the mean age was found to be 36.8±11.9 years, with a range from 20 to >51 years maximum 44 (71.0%) of the patients were within the age group of 20 - 40 years. The majority 37 (59.7%) of patients completed SSC and most of the patients 56 (90.3%) were housewives. Most of the patients 59 (95.2%) were Muslims and about 32 (51.6%) came from middle-income families. About 25 (40.3%) patients were married between the ages of 15-17 years. About 25 (40.3%) were between 16-18 years during their first delivery and about 26 (41.9%) had 3-4 children and 21 (33.9%) had more than 4 children. Most of the patients 43(69.4%) had history of received OCP. Regarding colposcopic diagnosis, 12.9% (n=8) were normal, 69.4% (n=43) were CIN I, 9.7% (n=6) were CIN II and 8.1% (n=5) were CIN III and 30.6% (n=19) chronic cervicitis, 46.8% (n=29) CIN I, 6.5% (n=4) CIN II, 6.5% (n=4) CIN III, 4.8% (n=3) carcinoma in situ and 4.8% (n=3) were invasive squamous cell carcinoma by the histopathological diagnosis. Conclusion: Colposcopy had a rather high diagnostic accuracy for histopathologically verified precancerous cervical lesions. Even if the results of the screening tests are normal, patients who report with postcoital and postmenopausal bleeding should have colposcopies and biopsies. Colposcopy also has a high sensitivity, therefore it is simple to use the "see and treat" approach to lower dropout rates.

Exploring Factors Influencing Cancer Patients' Understanding of Diagnosis, Prognosis, and Emotional Well-being under Palliative Care: A Cross-sectional Investigation

Introduction: The demographic characteristics of cancer patients correlate with their awareness of diagnosis, prognosis, and the psychological distress associated with their condition. Objectives: The purpose of this study was to evaluate patients' knowledge of psychological distress, diagnosis, and prognosis who were presenting to the palliative medicine department of a tertiary hospital in Bangladesh. Methodology: This cross‐sectional study was conducted among 377 patients living with cancer attending the Department of Palliative Medicine, Bangabandhu Sheikh Mujib Medical University, Bangladesh from November 2021 and March 2022. Information on the clinical and sociodemographic aspects was gathered through a structured questionnaire and in-person interview, and the degree of distress was measured using a distress thermometer. After information was gathered, descriptive statistics were used to analyze it. Result: Approximately 16.2% of patients were unaware of their diagnosis, with two-thirds (68%) lacking awareness of prognosis. Over half (54.1%) reported significant distress. Gender, education, employment status, and head-and-neck cancer diagnosis were linked to diagnosis awareness, while educational level predicted prognosis awareness. Younger age, head-and-neck or hematological cancer diagnosis and lack of awareness regarding diagnosis and prognosis were associated with distress. Conclusions: Higher education and socioeconomic status correlate with patients' awareness of diagnosis and prognosis. However, distress remains higher among those unaware of prognosis.

Comparative Demographic and Clinical Profile of Preeclamptic and Normal Pregnant Women in the Third Trimester

Background: Preeclampsia is a pregnancy-specific, multi-system disorder characterized by elevated blood pressure and proteinuria after 20 weeks of gestation. Its exact etiology remains unknown, and globally, it stands as a prominent cause of maternal and infant morbidity and mortality. This study aimed to assess the comparative demographic and clinical profile of preeclamptic and normal pregnant women in the third trimester. Methods: This case-control study took place in Bangabandhu Sheikh Mujib Medical University Hospital and Dhaka Medical College Hospital, Dhaka, Bangladesh, spanning from July 2011 to June 2012. The study enrolled 100 pregnant women, with 50 cases diagnosed with preeclampsia and 50 controls representing normal pregnant women. Data analysis was conducted using SPSS version 23.0. Results: The mean ages of cases (25.8 ± 4.4 years) and controls (27.1 ± 3.1 years) were similar (P=0.177). A predominant proportion of cases (74%) and controls (66%) belonged to a lower social class (P=0.383). BMI assessment showed no significant difference (P= 0.645). Most participants in both groups were preterm (P=0.235) and primigravida (P= 0.422). The case group exhibited significantly higher mean serum ferritin than the control group (P<0.001). Hemoglobin and hematocrit levels showed no significant differences (P=0.761 and P=0.231, respectively). Elevated serum ferritin (>20 ng/ml) was prevalent in 76% of cases and 44% of controls (P=0.001). The odds of elevated serum ferritin in preeclampsia were approximately 4 times higher than in normal pregnancies (95% CI=1.7–9.5). Variations in serum ferritin levels across gestational ages are illustrated. Conclusion: The study found no significant correlation between preeclamptic and normal pregnant women's demographic and clinical status in the third trimester, except for serum ferritin levels. Further research is needed to obtain a clearer understanding of these relationships.

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.

Assessment of Measurable Residual Disease on Day 28 of First Induction Chemotherapy in Acute Myeloid Leukaemia Patients

Background: Measurable residual disease (MRD) is an independent, strong, prognostic marker in acute myeloid leukaemia (AML) that is important for risk stratification and treatment planning. This study assessed the MRD on day-28 after first induction chemotherapy in AML patients. Objective: To assess measurable residual disease status on day 28 after the first induction chemotherapy in newly diagnosed acute myeloid leukaemia patients. Methodology: This cross-sectional study was conducted at the Department of Haematology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from April 2021 to March 2022 among a total of 25 newly diagnosed AML patients who were admitted and received induction chemotherapy with DA (7+3). On Day-28, bone marrow aspiration was done with standard procedure and first pull of 2ml bone marrow sample was sent to a laboratory for MRD evaluation by multiparameter flow cytometry. MRD was considered positive when value was ?0.1%. Results: On day 28 of post induction chemotherapy most of the patients (92%) achieved morphological remission and among them more than half (52.2%) were MRD positive. The presence of CD14 myeloid marker and baseline higher serum uric acid level was significant in MRD positive patients and cytarabine dose 150 mg/m2 was found significant in MRD negative patients. Conclusion: More than half of the Acute Myeloid Leukaemia patients, treated with standard induction chemotherapy and achieved morphological remission on day 28 of chemotherapy, had positive measurable residual disease assessed by multiparameter flow cytometry. Positive MRD indicates relatively poorer prognosis and may necessitate more cycles of induction followed by more intensive consolidation which may include haematopoietic stem cell transplantation.

Role of Neutrophil-Lymphocyte Ratio in Predicting Severity of COVID-19

Background: Higher neutrophil-lymphocyte ratio (NLR) is considered as cardinal findings with prognostic potentials in identification of severe COVID-19 cases. However, whether baseline NLR could be a predictor of disease severity and outcome remained to be investigated. Hence, this study was conducted with an aim to evaluate the relation of NLR (on admission) with disease severity. Objective: The objective of the study was to estimate the neutrophil-lymphocyte ratio among COVID-19 patients and its role in predicting disease severity. Method: This cross-sectional study was conducted in Bangabandhu Sheikh Mujib Medical University (BSMMU) from July 2020 to June 2021. Ninety-four COVID-19 admitted patients were enrolled following inclusion & exclusion criteria. Informed consent was taken from the subjects. Ethical clearance was obtained from institutional review board (IRB) of BSMMU. Complete blood count for N-L ratio was done by standard procedure on admission by SYSMEX XN-2000 haematology analyser. Clinical and laboratory information were recorded with a semi-structured questionnaire. After collection of all the required data, analysis was done by SPSS 24.0. Results: Mean age of the patients was 56.59±12.25 years, wherein maximum patients were male (67%), non-smoker (80.9%), and retired/current service holder (51.1%). Maximum patients were hypertensive (61.7%) and diabetic (56.4%). Besides, maximum study patients (64.9%) were in severe category of COVID-19, followed by moderate (20.2%) and mild (14.9%) category according to National Guidelines on Clinical Management of COVID-19 criteria. Mean NLR was 5.40±4.35 (SD), wherein on admission NLR was significantly higher among severe COVID-19 patients compared to mild/moderate category (6.90±4.64 vs 2.61±1.53, p <0.05). 28-days hospital mortality was found to be significantly associated with NLR (p<0.05). Receiver operator curve analysis found highly significant cut-off value for NLR (3.42) with 75.4% sensitivity and 75.8% specificity in predicting severe COVID-19 patients (AUC= 0.841, p value <0.001). Multivariate logistic regression analysis found NLR as an independent predictor for severe COVID-19 (OR=4.68, 95% CI: 1.29-16.81, P=0.019). Pearson correlation analysis showed that NLR had significant positive correlation with CRP and D-dimer as p value <0.05. Conclusion: NLR can predict the disease severity and outcome of hospitalized COVID-19 patients. However, further larger study is recommended.

Serum IgG and IgA level in children with acute lymphoblastic leukaemia and its relation with outcome in induction chemotherapy

Background: Immunosuppression in children with Acute Lymphoblastic Leukaemia (ALL) escalates vulnerability to severe infectious complications which leads to higher morbidity and mortality rates among patients. Immunoglobulins are important part of defence mechanism of the body contributing to the humoral immunity. Of all the immunoglobulins, IgG and IgA represents most common type of antibody in blood circulation and provides most long-lived antibody-based immunity against invading pathogens. In earlier years, studies have shown that, serum immunoglobulins are found to be decreased during chemotherapy and this reduction is related with severe sepsis and death in patients. Early identification of immune status can be much useful for assessment of severity and better risk stratification of the patients. Objective: Evaluation of serum IgG and IgA levels in children with ALL and its relationship with sepsis in induction phase of chemotherapy. Method: This prospective observational study was conducted in the Departments of Paediatric Haematology & Oncology and Department of General Paediatrics, Bangabandhu Sheikh Mujib Medical University, Dhaka. During January 2022 to December 2022, a total 60 paediatric patients of newly diagnosed ALL were included as study population. As control, 30 patients were included in this study from General paediatrics and Paediatric Haematology & Oncology, BSMMU to compare baseline immunoglobulin levels with the study group. Complete history and physical examination of all patients were undertaken, and all prior reports were collected. Serum IgG and IgA level assay was done before starting chemotherapy and at the end of induction chemotherapy in the study group. Patients diagnosed with ALL received chemotherapy modified UK-ALL 2003 protocol. History and data of any event of sepsis, along with the symptoms of complications were taken from all patients during the course of induction chemotherapy. Results: The mean age of the cases were 5.49±3.15 (mean ± SD) years, which ranged from 1.9 to 15 years. Among the cases, 41 patients (68.3%) were male and 19 (31.7%) females. Seven (11.7%) subjects expired during induction chemotherapy. In comparison to the control group the mean IgG level in the study group was lower at baseline and even lower at the end of induction and it was statistically significant (p<0.05). The mean IgG level was low in patients with septic events in comparison with the patients with no septic events. Difference of mean of IgG between septic and aseptic patients was significant only at the end of induction chemotherapy (p<0.05). The mean IgA level was low in study group in comparison with the control group and it was statistically significant (p<0.05) only at the end of induction chemotherapy. The mean IgA level was low in patients with septic events in comparison with the patients with no septic events. Difference of mean of IgA between septic and aseptic patients was significant (p<0.05). Based on the receiver-operator characteristic (ROC) curves of change of S. IgG, with a cut off value 50% decreased from baseline having 68.8% sensitivity and 29.7% specificity for prediction of sepsis. Considering change of S. IgA with a cut off value 50% decreased from baseline having 67.6% sensitivity and 27.5% specificity for prediction of sepsis. Conclusion: In our study, the mean IgG and IgA level of the cases were low in comparison to the control group. The mean IgG and IgA level of the patients were lower who had infectious complications, and it was more marked after induction chemotherapy. Therefore, evaluation of immunoglobulin profiles is recommended to be considered in patients with ALL in further studies.

HE4 as a Biomarker for Diagnosis of Malignant Ovarian Masses in Bangladeshi Population

Ovarian cancer is one of the commonest cancers in gynecology with very high fatality to case ratio. In approximately 70% of all cases of ovarian cancers, the disease is not diagnosed before reaching an advanced stage. Thus early diagnosis of ovarian malignant tumor becomes a key factor in improving the survival rate of patients. This study was aimed to evaluate HE4 (Human Epididymis 4) biomarker for the diagnosis of ovarian malignancy in admitted patients with pelvic mass of ovarian origin scheduled for surgery from Obstetrics and Gynecology department of different medical colleges of Dhaka city and Bangabandhu Sheikh Mujib Medical University (BSMMU). It was a cross-sectional analytical study carried out by non-probability sampling. For this study, 110 admitted patients with ovarian tumor scheduled for surgery were selected.Purpose and procedure of the study was explained in details and informed written consent was taken from all the study subjects before collection of blood sample. Clinical information was taken from the patients’ hospital notes. Before surgery serum HE4 was measured and after surgery, histopathology reports were collected for each patient.Depending on histopathology reports, patients were categorized as benign and malignant. Diagnostic efficacy of HE4 was evaluated with respect to sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and likelihood ratios considering histopathology report as gold standard. To evaluate the performance of HE4 based on optimal cut-off (34.3 pmol/L), we found better sensitivity, NPV and satisfactory likelihood ratios but low specificity and PPV compared to suggested cut-off. The findings of this study shows that HE4 is not a useful biomarker to help in the assessment and management of patients with suspected ovarian cancer.
 Bangladesh J Med Biochem 2019; 12(1): 11-15

Study of Correlation of Serum Adiponectin Concentration with Different Lipid Profile Components

Adiponectin is a hormone, secreted from adipose tissue. It is inversely correlated with body fat mass. This hormone has also anti-inflammatory and ant-iatherogenic properties. This study was purposed to explore the relationship between serum adiponectin concentration and lipid profile. This cross-sectional analytical study was carried out in the Department of Biochemistry, Bangabandhu Sheikh Mujib Medical University (BSMMU) from March 2016 to February 2017. By non-probability sampling, a total of 156 study subjects were selected from apparently healthy adult individuals attending outpatient department of BSMMU. Serum adiponectin level positively correlated with serum HDL cholesterol (r=0.246, p value 0.002) concentrations and negatively correlated with serum total cholesterol (r=-0.171, p value 0.033) and serum triacylglycerol level (r=-0.3, p value 0.00). So, from this study it can be concluded that adiponectin has an important role in the metabolism of lipid profile components and responsible for controlling the concentration of serum lipid profile components. When adiponectin concentration of blood increases it is responsible for raised serum HDL-C concentration and decreased total cholesterol and triacylglycerol concentration.
 Bangladesh J Med Biochem 2019; 12(1): 6-10

Efficacy of Segmental Thoracic Spinal Anaesthesia in Laparoscopic Cholecystectomy

Introduction: Segmental Thoracic Spinal Anesthesia (STSA) in Laparoscopic Cholecystectomy represents a significant advancement in the field of anesthesiology, offering a viable alternative to the traditional general anesthesia (GA) for this procedure. Aim of the study: The aim of this study was to assess the efficacy of segmental thoracic spinal anaesthesia in laparoscopic cholecystectomy. Methods: This prospective observational study, conducted at the Department of Anaesthesia, Analgesia and Intensive care medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, from June to December 2023, included 60 patients undergoing laparoscopic cholecystectomy. They were divided into two groups of 30 each: Group A received segmental thoracic spinal anesthesia, and Group B underwent surgery under general anesthesia. Result: Group A and Group B were demographically similar, with no significant differences in age, sex, BMI, ASA grading, or cholecystectomy indications. Group A had a shorter anesthesia duration (83.0 ± 25.1 min) compared to Group B with 97.8 ± 29.5 min (p=0.0407). Surgical time and intraoperative fluid volume showed no significant difference. Group A experienced more bradycardia (13.3%) and shoulder pain (16.7%), while Group B had more nausea (13.3%) and hypotension (10%). Postoperatively, Group A had a shorter hospital stay and quicker recovery. Group A reported less shoulder pain (6.7% vs. 26.7%, p=0.0395) and no nausea. VAS scores were consistently lower in Group A at all postoperative times, indicating better pain management. Conclusion: The study conclusively demonstrates that thoracic segmental spinal anesthesia offers comparable significant advantages in laparoscopic cholecystectomy with shorter durations of anesthesia, quicker postoperative recovery, and reduced postoperative pain.

Value of Reticulocyte Count, Absolute Reticulocyte Count and Platelet Count for Bone Marrow Recovery Status on Remission Induction Phase

Reticulocyte count performed on a supravitally stained blood film is a initial and common laboratory method of determining early hematological recovery. This method is rapidly replaced by automated flow cytometry methods which have the advantage of much greater precision, before other test become positive after chemotherapy. A prospective observational study was carried out in the Department of Laboratory Medicine in collaboration with Paediatric Haematology and Oncology, Bangabandhu Sheikh Mujib Medical University during a period of one year to evaluate the bone marrow recovery in children with acute lymphoblastic leukemia by automated reticulocyte analysis over platelet count. Total fifty patients were enrolled in this study on remission induction phase. All patients were between 8 months to 15 years’ age range with a mean age of 5.5 ± 3.2. At the end of the study out of 50 cases, Ret% and Abs ret count showed early recovery in a median of 6 days before the platelet count recovery and concluded that reticulocyte parameter showed earlier haematopoietic recovery than the platelet count recovery.

Comparison of the Effects of Nitroglycerin, Labetalol and Lidocaine in Hypertensive Patients in Attenuation of the Endotracheal Intubation Reflex

Background: Laryngoscopy and tracheal intubation integral parts of general anesthesia which may cause acute haemodynamic instability. Hypertensive patients are more prone of developing cardiovascular complications such as pulmonary oedema, cardiac failure and cerebrovascular haemorrhage. To attenuate such intubation reflex, some drugs are used, e.g., opioids. lidocaine sodium nitroprusside, nitroglycerin, beta blockers, calcium channel blockers etc. Objective: The purpose of the study is to see the effectiveness of nitroglycerin, labetalol and lidocaine in attenuation of intubation reflex and their anesthetic outcome in hypertensive patients. Methods: This randomized controlled study was carried out in the Department of Anesthesia, Pain, Palliative and Intensive care Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, between March and September of 2021. A total of 90 patients were included: 30 in each group as per inclusion and exclusion criteria. Group A patients received inj. nitroglycerin 2 minutes before intubation, while group B patients received inj. labetalol 0.25mg/kg 5 minutes before intubation, and group C was given 2% lidocaine 1.5mg/kg 2 minutes before intubation. Haemodynamic status of all patients was checked before and after intubation. Results: Mean age of the patients was 44.4±10.9 years in group A, 47.6±9.4 years in group B and 46.4±10.6 years in group C. Heart rate after intubation was low and statistically significant in groups-B after 1.2 and 5 minutes. Regarding mean arterial pressure (MAP), group A patients had significantly low blood pressure. Rate pressure product (RRP) of the patients was significantly low in group B at 1 minute, 2 minutes and 5 minutes. Regarding ECG changes sinus tachycardia was observed in 26.6%, 86.6% and 20% in group A, group B and group C immediately after intubation. Groups B patients showed lower incidence of sinus tachycardia than that of two other groups and showed no premature ventricular contractions, whereas group A (6.7%) and group C (3.3%) showed premature ventricular contractions. Conclusion: Labetalol showed better rhythm control, mean arterial pressure and less incidence of tachycardia. To summarize, labetalol is safer and more effective than nitroglycerin and lidocaine to attenuate the endotracheal intubation reflex in hypertensive patients. Mugda Med Coll J. 2023; 6(2): 64-70

First Ever Organ Transplantation from A Brain-Dead Person in Bangladesh: A Successful Outcome of The Human Organ Transplantation Act

On the 19th of January 2023, a historic event took place in the field of medical practice and country’s healthcare system. A 20-year-old girl named Sarah Islam was pronounced clinically dead on Wednesday (18 January, 2023) while being treated at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, with her terminal illness as she has been suffering from tuberous sclerosis since her childhood. Her final act was termed 'heroic' by her attending physicians as she became the first patient in the country to donate her organs while being brain-dead. The next day in the early morning (19 January, 2023) doctors conducted the country's first-ever cadaveric kidney transplantation as taken from her. The recipients were two females in their 30s who were reportedly recovering well after the surgery. Those two surgeries were performed separately at Bangabandhu Sheikh Mujib Medical University (BSMMU) Hospital and the National Kidney Foundation Hospital in Dhaka. The Human Organ Transplantation Act (HOTA) officially came into force in Bangladesh on April 13, 1999, allowing organ donations from both living and brain-dead donors; after long discussion, some amendments were ratified by the Parliament in 2018. The Act places some legal requirements around the collection and preservation of human organs as well as ensuring their transplantation into a human body. Few years back, religious leaders came forward to issue a fatwa (religious approval) that recognize both living and brain death criteria and permit both living and brain-dead donors to donate organs for transplantation. Based on that fatwa and a long medical discussion the country’s parliament passed this Act. Enacting the HOTA shows an immense influence in our society on cadaveric organ donation and transplantation especially from brain-dead individuals, and we hope that this historic donation will create more awareness and pave a new path for organ donation campaign in the country in near future. CBMJ 2024 January: vol. 13 no. 01 P: 102-106

Comparison of Different Diagnostic Methods of Helicobacter Pylori Infection in Children

Background: Helicobacter Pylori Infection (HPI) is usually acquired during childhood, without specific treatment this infection rarely resolves spontaneously. Therefore, correct diagnosis is necessary for the effective eradication and there is no single test can be regarded as the gold standard for the identification of H. pylori.Objective: To compare the sensitivity, specificity, and accuracy of the stool antigen test, serologic test, rapid urease test, and histology for the diagnosis of H. pylori infection.Materials and Methods: This cross-sectional descriptive study was conducted at the Department of Pediatric Gastroenterology & Nutrition, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from April 2019 to October 2021 on 54 children aged less than 18 years suspected to be H. pylori infection, who attended the outpatient as well as admitted. In a typical data sheet, a complete clinical history, exam results, and investigation reports were documented. Results were expressed as sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy.Results: The gastro-duodenal biopsy and Rapid Urease Test (RUT) (100%) have the highest sensitivity, followed by serology (95%), and Saturation (SAT) (70%). Highest specificity was found in gastro-duodenal biopsy 88.2% followed by RUT 67.6% & SAT 41.2% and only 32.4% by serology. The gastro-duodenal biopsy had the highest diagnosis accuracy (92.6%), followed by RUT (79.6%), serology (55.6%) and SAT (51.9%).Conclusion: In the study, the gastro-duodenal biopsy and rapid urease test both showed high sensitivity, specificity, and negative predictive value; as a result, the combination of these tests constituted the best alternative for making the diagnosis. Because of their high sensitivity, serological tests may be useful non-invasive screening methods. KYAMC Journal Volume: 14, No: 03, October 2023: 130-137.