Banghabandhu Sheikh Mujib Medical University Research Articles

Prediction of Motor Myelopathic Severity in Patients with Cervical Spondylotic Myelopathy: How to Approach?

Background: Cervical spondylotic myelopathy (CSM) is a challenging thing to diagnose as it has subtle symptoms and insidious onset. But, there is a relationship between signal intensity change of the spinal cord on MRI and cervical spondylotic myelopathy through which motor myelopathic severity in these patients can be predicted. Objective: The purpose of this study was to predict the motor myelopathic severity in patients with CSM with the help of magnetic resonance imaging (MRI). Methodology: This cross-sectional study was carried out in the Department of Neurosurgery at Banghabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from October, 2011 to March, 2013 for a period of one and half year. All patients who presented with cervical spondylotic myelopathy were included in this study. MRI of cervical spine was performed to all patients. Results: A total number of 36 patients with cervical spondylotic myelopathy were included in this study. Among the 36 study patients, all had normal intensity in the spinal cord on sagittal T1WI of MRI; however, there was variable intensity on sagittal T2WI of MRI. Low Nurick score was found in 24 (66.6%) patients who had type 0signal intensity on (T2WI) MRI. High Nurick score was found in 3 (8.3%) patients who had type 0 signal intensity on (T2WI) MRI. Low Nurick score was found in 2 (5.5%) patients who had type 1 signal intensity on (T2WI) MRI. High Nurick score was found in 6 (16.6%) patients who had type 1 signal intensity on (T2WI) MRI. Only 1 patient (2.7%) having high Nurick score (3- 5) had type-2 signal intensity on (T2WI) MRI (p<0.001). Conclusion: Prediction of motor myelopathic severity in patients with cervical spondylotic myelopathy can be done perfectly with the help of signal intensity change of the spinal cord on MRI which is very much helpful in patients’ management. Bang. J Neurosurgery 2023; 12(2): 71-75

Relation Of Serum Uric Acid Concentrations With Etiology And Severity In Patients With Cirrhosis Of Liver

Background: Hyperuricemia is now an established factor to cause oxidative stress, insulin resistance and systemic inflammation. So it is likely that hyperuricemia might be involved in hepatic necro-inflammation and destruction which are the common underlying pathophysiology of cirrhosis. On the other hand, as uric acid is the end product of cellular degradation, increased hepatocyte destruction due to any etiology increases the level of serum uric acid which might further aggravate hepatic necro-inflammation, cirrhosis & complications. Objectives: To assess serum uric acid concentrations in patients of cirrhosis of liver and its relation with cirrhosis of different etiology, disease severity and liver enzymes. Materials and Methods: This cross sectional observational study was carried out in the Department of Gastroenterology, BSMMU, Bangladesh during the period of September 2015 to October 2016. A total of 220 diagnosed cases of cirrhosis of liver due to any cause from inpatient & outpatient Department of Gastroenterology of Banghabandhu Sheikh Mujib Medical University were enrolled as the study population. Serum uric acid level was measured in each patient and its relationship with different etiology of cirrhosis, severity of cirrhosis and liver enzymes were assessed. Results: The mean age was found to be 47.8 ± 14.6 years and male: female ratio was 1.9:1. Majority patients (52.3%) belonged to CTP Class C. The mean (±SD) value of serum uric acid was 6.19 (±3.25mg/dl) and hyperuricemia (>7 mg/dl) was detected in 27.73% patients. Among all etiologies of CLD, the higher mean (±SD) level of serum uric acid was found in NAFLD (19.54 ±2.20 mg/dl). There was positive correlation of serum uric acid with liver enzymes. Conclusion: Mean serum uric acid level increased gradually as the cirrhotic patients progressed to higher CTP classes & there was positive correlation of serum uric acid with liver enzymes. It requires further large scale multicenter studies with increased sample size & prolong follow-up to establish serum uric acid as a risk factor of CLD.

Relation of Serum Uric Acid Concentrations with Etiology and Severity in Patients with Cirrhosis of Liver

Hyperuricaemia is now an established factor to cause oxidative stress, insulin resistance and systemic inflammation. So it is likely that hyperuricemia might be involved in hepatic necroinflammation and destruction which are the common underlying pathophysiology of cirrhosis. On the other hand, as uric acid is the end product of cellular degradation, increased hepatocyte destruction due to any etiology increases the level of serum uric acid which might further aggravate hepatic necroinflammation, cirrhosis and complications. The aim of this study is to assess serum uric acid concentrations in patients of cirrhosis of liver and its relation with cirrhosis of different etiology, disease severity and liver enzymes. This cross sectional observational study was carried out in the Department of Gastroenterology, Banghabandhu Sheikh Mujib Medical University, Bangladesh during the period of September 2015 to October 2016. A total of 220 diagnosed cases of cirrhosis of liver due to any cause from inpatient and outpatient Department of Gastroenterology were enrolled as the study population. Serum uric acid level was measured in each patient and its relationship with different etiology of cirrhosis, severity of cirrhosis and liver enzymes were assessed. The mean age was found to be 47.8 ± 14.6 years and male: female ratio was 1.9:1. Majority patients (52.3%) belonged to Child-Turcotte-Pugh Class C. The mean (±SD) value of serum uric acid was 6.19 (±3.25mg/dl) and hyperuricemia (>7 mg/dl) was detected in 27.73% patients. Among all etiologies of cirrhosis, the higher mean (±SD) level of serum uric acid was found in Non-alcoholic Fatty Liver Disease (19.54 ±2.20 mg/dl). There was positive correlation of serum uric acid with liver enzymes. Mean serum uric acid level increased gradually as the cirrhotic patients progressed to higher CTP classes and there was positive correlation of serum uric acid with liver enzymes. It requires further large scale multicenter studies with increased sample size & prolong follow-up to establish serum uric acid as a risk factor of cirrhosis of liver.
 Bangladesh Med J. 2021 January; 50(1) : 46-51

Effect of Anterior Nasal Packing on Eustachian Tube Function and Middle Ear Pressure

The present study includes evaluation 60 ears of 30 nasal patients admitted to department of Otolaryngology and Head-Neck Surgery at Banghabandhu Sheikh Mujib Medical University. Each patient underwent nasal surgery followed by anterior nasal packing for 48 hours. All patients were investigated by tympanometry prior to surgery, 2nd post operative day before pack removal and on 7th post operative day 5 days after pack removal. This study shows that nasal packing result in Eustachian tube dysfunction and negative middle ear pressure which is reversible in nature.
 Bangladesh J Otorhinolaryngol; April 2017; 23(1): 27-31

Diagnostic test validity of CT-scan for detection of liver abscess

Background: Detection of hepatic abscess is very crucial for the management of the patient. Objective: The purpose of the present study was to validate the diagnostic ability of CT-scan during detection of hepatic abscess. Methodology: This cross-sectional study was carried out in the Department of Radiology and Imaging at Mymensingh Medical College Hospital (MMCH), Mymensingh, Banghabandhu Sheikh Mujib Medical University (BSMMU), Dhaka and Dhaka Medical College Hospital (DMCH), Dhaka during the period of January 2006 to December 2007 for a period of two (02) years. Patients admitted in the Department of Medicine and Department of Hepatobiliary of MMCH, BSMMU, and DMCH with the clinical diagnosis of hepatic abscess with the presentation of fever, abdominal pain, anorexia, nausea/vomiting, loss of appetite, jaundice, weight loss and ascites were selected as study population. CT scan and histopathology were performed to all the patients. Result: A total number of 50 suspected cases of hepatic abscess patients were recruited for this study. Maximum patients were within 56 to 65 years age range. 15 (30%) patients were within 56 to 65 years age range. In case of hepatic abscess, 11 patients were diagnosed as having hepatic abscess by CT and confirmed by histopathological evaluation. One patient was diagnosed other lesion by CT and confirmed by histopathology. Of 38 patients of other lesions, which were confirmed by CT, two confirmed as hepatic abscess and 36 were other lesions by histopathology. The sensitivity of CT scan in the diagnosis of hepatic abscess was 84.6% (95% CI 54.55% to 98.08%). However specificity was 97.3% (95% CI 85.84% to 99.93%). The accuracy was 94.0% (95% CI 83.45% to 98.75%). The area under the curve value was 0.09 (95% CI 0.000 to 0.211) which was statistically significant. Conclusion: In conclusion CT-scan has a very high specificity with sensitivity for the detection of hepatic abscess.

Pattern of Tumour among Hepatocelluar Carcinoma Patients attended at a Tertiary Care Hospital in Dhaka City

Background: The pattern of hepatocelluar carcinoma may vary in different patients.
 Objective: The purpose of the present study was to see the pattern of hepatocelluar carcinoma among the patients attended at a tertiary care hospital in Dhaka city.
 Methodology: This cross-sectional study was carried out in the Department of Radiology and Imaging at Dhaka Medical College, Dhaka and Banghabandhu Sheikh Mujib Medical University, Dhaka from January 2007 to May 2008 for a period of around one and half year. All the patients presented with hepatocellular carcinoma at the age group of more than 20 years with both sexes were selected as study population. The patients were undergone CT-scan examination and the confirmation was performed by histopathological examination. The details of the pattern of tumor among the hepatocellular carcinoma patients were examined and were recorded.
 Result: A total number of 50 patients were recruited in this study after fulfilling the inclusion and exclusion criteria. Mean age with SD of study population was 48.78 ±12.07. Within 25 cases of HCC as diagnosed by CT scan 13(52%) had solitary lesion 7(28%) had multiple lesions and remaining 5(20%) had diffuse lesions. The tumour size of 8 cm or more was the highest which was 10 in numbers. However, 4 to 8 cm was found in 7(28.0%) cases and 3 to 4 cm was detected in 3(12.0%) cases.
 Conclusion: In conclusion most of the HCC is solitary lesion with more than 8 cm in size.
 Journal of Current and Advance Medical Research 2019;6(1):6-9

Demographic Characteristics of Diabetic Neuropathy Patients Attended at a Tertiary Care Hospital in Dhaka City

Introduction: Diabetic neuropathy is one of the early complications of diabetes mellitus patients which is very difficult to face in the daily living activities. The purpose of the present study was to see the demographic characteristics of diabetic neuropathy patients.
 Metarials & Methods: This descriptive type of cross-sectional study was conducted in the Department of Neurology including Neuropathy Clinic and in collaboration with department of Endocrinology at Banghabandhu Sheikh Mujib Medical University, Dhaka from January 2012 to December 2013 for a period of two (2) years. Adult diabetic patients presented with neuropathic pain with symmetrical involvement of distal limbs from indoor and outpatient department of Neurology including Neuropathy clinic as well as indoor and outpatient department of Endocrinology, BSMMU were enrolled in the study population. Data was collected by face to face interview. Information was collected by taking medical history and clinical examinations and subsequent laboratory investigations.
 Results: A total number of 102 cases were recruited for this study who were clinically diagnosed as painful diabetic polyneuropathy. Female was predominant than male 55(53.9%) cases and 47(46.1%) cases respectively. The male and female ratio was 1:1.2. Majority were in the age group of more than 55 years which was 55(53.9%) cases. The mean age with SD of the study population was 52.79±9.42 years. Among 102 patients type II DM was predominate than type I patients which were 95(92.2%) cases and 8(7.8%) cases respectively. The mean duration of DM with SD was 6.51±3.6 years. However the mean duration of neuropathic pain was 1.68±1.155 years.
 Conclusion: In conclusion majority of the diabetic neuropathy patients are female suffering from type II DM in the middle age.
 Medicine Today 2019 Vol.31(1): 27-30

Diagnostic Accuracy of Gray Scale Sonography for the Detection of Malignant Breast Tumour

Background: Gray scale sonography is an important diagnostic tool for the detection of malignant breast tumour. Objective: The purpose of the present study was to find out the diagnostic validity gray scale sonography to detect malignant lesions of breast. Methodology: This cross-sectional study was carried out in the department of Radiology and Imaging, in collaboration with the department of Surgery and Pathology at Banghabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from July 2008 to June 2009 for a period of one year. Women presented with clinically suspected breast mass from outpatients’ department (OPD) or inpatient department (IPD) were purposively selected and was Ultrasonographic diagnosis. 2-D Real-Time B-Mode Ultrasonographic examinations were done using high frequency (7.5 MHz) linear transducer. Result: Test of validity was done for color Doppler Sonographic findings in evaluation of benign and malignant breast lesion. Out of 50 cases, 23 cases were true positive; 4 cases were false negative; 1 case was false positive; 22 cases were true negative confirmed by histopathology. Here sensitivity and specificity of Gray scale ultrasonography were 85.18% and 95.0% respectively. Here accuracy of Gray scale study was 90.0%. Positive predictive value was 95.83% and negative predictive value was 84.61%. Conclusion: Gray scale ultrasonography is a useful method in the differentiation between benign and malignant breast masses.

Diagnostic Test Validity of CT-Scan for Detection of Hepatocellular Carcinoma

Background: CT-scan can detect hepatocelluar carcinoma among the patients.Objective: The purpose of the present study was to see the pattern of hepatocelluar carcinoma among the patients attended at a tertiary care hospital in Dhaka city.Methodology: This cross-sectional study was carried out in the Department of Radiology and Imaging at Dhaka Medical College, Dhaka and Banghabandhu Sheikh Mujib Medical University, Dhaka from January 2007 to May 2008 for a period of around one and half year. All the patients presented with hepatocellular carcinoma at the age group of more than 20 years with both sexes were selected as study population. The patients were undergone CT-scan examination and the confirmation of tumor was performed by histopathological examination.Result: A total number of 50 patients were recruited in this study after fulfilling the inclusion and exclusion criteria. The sensitivity, specificity and accuracy of CT-scan in detecting hepatocellular carcinoma was seen to be 66%, 92% and 72% respectively. The PPV and NPV were 96.15% (95% CI 79.06% to 99.40%) and 45.83% (95% CI 34.53% to 57.58%) respectively. However, the Positive Likelihood Ratio and Negative Likelihood Ratio were 7.89 (95% CI 1.19 to 52.28) and 0.37(95% CI 0.23 to 0.60).Conclusion: In conclusion CT-scan is a good diagnostic tool for the detection of hepatocellular carcinoma.Journal of National Institute of Neurosciences Bangladesh, 2018;4(2): 133-136

Detection of Virulence Factors and Antimicrobial Resistance in Enterococci Isolated from Urinary Tract Infection

Background: The genus Enterococcus is of increasing significance as a cause of nosocomial infections and this trend is exacerbated by the development of antibiotic resistance.Objective: The aims of this study was to find out the susceptibility pattern and the prevalence of virulence genes in Enterococcus strains isolated from urinary tract infection in Bangladesh.Methodology: This cross-sectional study was conducted in the Department of Microbiology at Dhaka Medical College, Dhaka from January 2015 to December 2015 for a period of one (01) years. All the admitted patients in the Dhaka Medical College & Hospital, Dhaka and Banghabandhu Sheikh Mujib Medical University, Dhaka who were presented with clinical features of urinary tract infection at any age with both sexes were included as study population. The antimicrobial susceptibility of the strains was determined using the disk diffusion method; vancomycin susceptibility pattern was detected by MIC method. PCR was performed for the detection of genus-species, vanA, vanB gene and potential virulence genes.Result: Out of 84 Enterococci, majority (71.42%) of the isolates were E. faecalis followed by 23.81% were E. faecium. Regarding antimicrobial susceptibility pattern, 100% isolated Enterococci were sensitive to vancomycin, linezolid and teicoplanin. Most of the Enterococci were resistant to ciprofloxacin and ceftriaxone (92.86%) followed by 88.10% to gentamicin and 85.71% to azithromycin and rifampicin. No VRE was identified and the range of MIC for vancomycin was 1-4 µg/ml. None of the Enterococci was positive for vanA and vanB genes. Out of total E. faecalis and E. faecium, 87.50% were positive for ebp and 77.5%, 72.5%, 55.0%, 45.0%, 40.0% and 10.0% of isolates were positive for gelE, esp, ace, cyl, asa and hyl respectively.Conclusion: Almost all the virulence genes were more prevalent in E. faecalis isolates.Bangladesh Journal of Infectious Diseases 2017;4(2):30-34

Validity of Gray Scale Sonography along with Color Doppler Spectral Analysis for the detection of Malignant Breast Tumour

Background: Detection of mass in the breastis very essential for the early treatment.Objective: The purpose of the present study was to validate the Doppler sonography to detect the pathological lesions of breast.Methodology: This cross sectional study was carried out in the Department of Radiology and Imaging in collaboration with the Department of Surgery and Department of Pathology at Banghabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from July 2008 to June 2009 for a period of one (01) year. Clinically suspected women with breast mass who were attended in the OPD or inpatient department were selected purposively as study population. All the patients were examined by 2-D Real-Time B-Mode Ultrasonography by using high frequency (7.5 MHz) linear transducer. Blood flow was studied using Duplex sonography in which Gray scale 2D sonography was combined with Pulsed Doppler. Test of validity was done for color Doppler Sonographic findings in evaluation of benign and malignant breast lesion.Result:A total number of 50 cases were recruited for this study. Out of 50 cases,25 cases true positive, 1 false negative, 2 false positive, 22 true negative confirmed by histopathology. Here sensitivity and specificity of color Doppler ultrasonography are 92.59% and 86.95% respectively. Here accuracy of color Doppler study is 90.0% and the positive predictive value was 89.28% and negative predictive value was 90.9%.Conclusion: Color Doppler Ultrasonography is a useful imaging method in the differentiation between benign and malignant breast masses.Journal of National Institute of Neurosciences Bangladesh, 2017;3(1): 10-13

Socio-demographic Characteristics of Hepato-cellular Carcinoma Patients attended at Tertiary Care Hospital in Dhaka City

Background: The hepatocellular carcinoma is one of the most common tumor.Objectives: The purpose of the present study was to see the socio-economic characteristics of hepatocellular carcinoma patients.Methodology: This cross sectional study was carried out in the Department of Radiology and Imaging in Dhaka Medical College, Dhaka and Banghabandhu Sheikh Mujib Medical University, Dhaka from January 2007 to May 2008 for a period of around one and half year. All the patients presented with hepatocellular carcinoma at the age group of more than 20 years with both sexes were selected as study population. The patients were undergone CT-scan examination and the confirmation was performed by histopathological examination.Result: A total number of 50 patients were recruited in this study after fulfilling the inclusion and exclusion criteria. Mean age of my study was 48.78 and SD ± 12.07. Out of 50 patients 43(86%) were male and 7(14%) female. Cultivator was 42% followed by service holder. Medical personnel were 2%. Illiterate group was the top of the list with 40% and most educated was 4%.Conclusion: In conclusion the hepatocellular carcinoma is most commonly occurred in middle age group with a predominance of male.Journal of Current and Advance Medical Research 2016;3(2):39-42

Effect of Pregabalin Use as Preemptive Analgesia after Abdominal Hysterectomy on Heart Rate and Arterial Pressure

Background: Effect of pregabalin on heart rate and arterial pressure is important in its use as preemptive analgesia. Objective: The purpose of the present study was to evaluate the effect of pregabalin use as preemptive analgesia after abdominal hysterectomy on heart rate and arterial pressure.Methodology: This randomized double-blind placebo-controlled clinical trial was conducted in the Department of Anesthesia, Analgesia and Intensive Care Medicine, Banghabandhu Sheikh Mujib Medical University, Dhaka from July 2010 to June 2012 for a period of two years. Women aged between 40-60 years scheduled for abdominal hysterectomy under sub-arachnoid block were selected as study population for this study. A total of one hundred and twenty women meeting the above mentioned criteria were randomly allocated into two equal groups by card sampling. 120 cards, 60 for each group were prepared by another person who was not aware of the study. Group A was known as study group who were received 300mg oral pregnabin one hour before performance of SAB and group B was known as control group who were received matching placebo one hour before SAB. The patients were examined preoperatively and preoperative baseline parameters including heart rate, mean arterial pressure were recorded immediately before sub-arachnoid block (SAB). Patients were visited by the investigators at ½, 1, 2, 4, 12, and 24 h after operation. In each visit, heart rate and mean arterial pressure were measured and were recorded. Result: The present study was conducted on 120 women undergoing abdominal hysterectomy. Of them, 60 received preemptive single oral doses (300mg) Pregabalin (Group A) and the rest 60 received matching placebos (Group B) 1hr before surgery. The mean heart rate with SD before SAB was 79.4±4.7 and 90.5±5.7 in group A and B respectively (p=0.011). After 24 hours of operation the mean heart rate with SD was 73±5 and 85±4 in group A and B respectively (p= 0.043). The mean arterial pressure with SD before SAB was 94.3±5.3 and 95.8±20.4 in group A and B respectively (p=0.569). After 24 hours of operation the mean arterial pressure with SD was 89.4±4.45 and 96.1±2.56 in group A and B respectively (p <0.001). Conclusion: In conclusion the mean heart rate and arterial pressure are statistically significantly changes in the women after abdominal hysterectomy to whom pregabalin is used as preemptive analgesia. Journal of National Institute of Neurosciences Bangladesh, 2016;2(2): 98-102

Histopathological Features of Lymph Nodes of Tuberculous Lymphadenitis Patients: Experience of 50 cases in Bangladesh

Background: Tuberculous lymphadenitis is common manifestation of extra-pulmonary tuberculosis in Bangladesh. Objective: The purpose of the present study was to see the histopathological features of tuberculous lymphadenitis patients. Methodology: This cross sectional study was done at the Department of Pathology at Banghabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from January 2009 to March 2011 for a period of nearly two years. All the patients irrespective of age and sex with the clinical features suggestive of tuberculous lymphadenitis and later on proved to be the same histologically were selected for the study purposively. Relevant information was recorded in a prescribed data sheet and histomorphological findings were recorded accordingly. In cases where fresh specimen was available, caseous portion of lymph node was sent for culture. FiteFaraco staining was also done on lymph node sections in all cases. Result: A total number of 50 tuberculous lymphadenitis patients were recruited for this study of which well formed granuloma was detected in 34(68.0%) cases followed by ill defined and combination of well and ill defined which were 8(16.0%) cases in each. Among 34 well defined cases coalescing and discrete were found in 6(17.6%) cases in each. However, both types were found in 22(64.7%) cases.Conclusion: In conclusion well formed granuloma is most commonly found in tuberculous lymphadenitis with combined variety of coalescing and discrete histopathologic featuresBangladesh Journal of Infectious Diseases 2016;3(2):40-42

Clinical Profiles of Hepatocellular Carcinoma Patients: Experience of 50 cases in Dhaka City

Background: The clinical characteristics of hepatocellular carcinoma are varied from person to person.Objectives: The purpose of the present study was to see the clinical profiles of hepatocellular carcinoma patients.Methodology: This cross sectional study was carried out in the Department of Radiology and Imaging in Dhaka Medical College, Dhaka and Banghabandhu Sheikh Mujib Medical University, Dhaka from January 2007 to May 2008 for a period of around one and half year. All the patients presented with hepatocellular carcinoma at the age group of more than 20 years with both sexes were selected as study population. The patients were undergone CT-scan examination and the confirmation was performed by histopathological examination. All the clinical features of HCC patients were recorded.Result: A total number of 50 patients were recruited in this study after fulfilling the inclusion and exclusion criteria. Mean age of my study was 48.78 and SD ± 12.07. Hepatocellular carcinoma commonly presented with hepatomegaly (96%). Upper abdominal pain (60%), weight loss (60%), anorexia (44%), nausea/vomiting (44%), bruit (21%), jaundice (40%) and ascitis (32%) was also present.Conclusion: In conclusion the hepatocellular carcinoma is most commonly occurred in middle age group with a predominance of male.Journal of Science Foundation 2016;14(2):36-39

Preemptive Analgesia with Pregabalin: It’s Effect on Postoperative Analgesia after Abdominal Hysterectomy

Background: Preemptive administration of single dose pregabalin reduces postoperative narcotic analgesicconsumption after abdominal hysterectomy under sub-arachnoid block. Objectives: The present study was designed to evaluate the effect of pregabalin as a preemptive agent toreduce postoperative pain. Methodology: This randomized double-blind placebo-controlled clinical trial was conducted in theDepartment of Anesthesia, Analgesia and Intensive Care Medicine at Banghabandhu Sheikh Mujib MedicalUniversity, Dhaka from July 2010 to June 2012 for a period of two years. Women aged between 40 to 60years scheduled for abdominal hysterectomy under sub-arachnoid block were selected as study population.A total of one hundred and twenty women were randomly allocated into two equal groups by cardsampling. 120 cards, 60 for each group were prepared by another person who was not aware of the study.Group A was known as study group who were received 300mg oral pregabalin one hour before performanceof SAB and group B was known as control group who were received matching placebo one hour beforeSAB.Pain in the postoperative period was assessed on visual analogue scale and managed with PCAusing morphine. Patients were visited by the investigators at ½, 1, 2, 4, 12, and 24 h after operation. Ateach visit, outcomes were measured in the following order: heart rate, mean arterial pressure, respiratoryrate, SpO2, and VAS pain score, sedation score, and any side effects which would develop. Finally, totalamount of morphine administered in 24 hour was recorded. The time since spinal anaesthesia to firstdose of analgesic was also recorded. Result: The mean 24hrs morphine consumption was 13.3 (±1.5) mg in Group-A, whereas in Group-B was29.1(±2.1) mg. The Group-A showed a significant reduction in morphine consumption then the Group-B(P<0.001). The time interval of first dose of analgesic was 5.2(±0.4) hrs in the Group-A, whereas in theGroup-B was 2.3(±0.2) hrs.The difference was significant (P<0.05).It was seen that side effects like respiratorydepression more in Group-B, dizziness and somnolence was more in Group-A than Group-B.Sedationscore was higher in Group-A than Group-B. Incedence of nausea/vomotting was same in both groups. Conclusion: It is demonstrated that preemptive use of Pregabalin led to significant reduction in narcoticanalgesic requirement and thereby a significant reduction in morphine related side effects. Beside this,pregabalin caused increased levels of sedation which may be beneficial for certain patients in earlypostoperative periods. JBSA 2017; 30(2): 66-74

Relationship between Signal Intensity Change of the Spinal Cord on MRI and Motor Myelopathic Severity in Patients with Cervical Spondylotic Myelopathy

Background: Diagnosis of cervical spondylotic myelopathy (CSM) can be challenging due to subtle symptoms and insidious onset; however, there is a relationship between signal intensity change of the spinal cord on MRI and cervical spondylotic myelopathy. Objective: The purpose of this present study was to find out the relationship between signal intensity change of the spinal cord on MRI and motor myelopathic severity in patients with CSM.Methodology: This cross-sectional study was carried out in the Department of Neurosurgery at Banghabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from October, 2011 to March, 2013 for a period of one and half year. All patients presented with cervical spondylotic myelopathy were included in this study. MRI of cervical spine was performed to all patients.Results: A total number of 36 patients with cervical spondylotic myelopathy were included in this study. Among the 36 study patients, all had normal intensity in the spinal cord on sagittal T1WI of MRI; however, there was variable intensity on sagittal T2WI of MRI. Low Nurick score was found in 24(66.6%) patients who had type 0 signal intensity on (T2WI) MRI. High Nurick score was found in 3(8.3%) patients who had type 0 signal intensity on (T2WI) MRI. Low Nurick score was found in 2(5.5%) patients who had type 1 signal intensity on (T2WI) MRI. High Nurick score was found in 6(16.6%) patients who had type 1 signal intensity on (T2WI) MRI. Only 1 patient (2.7%) having high Nurick score (3-5) had type-2 signal intensity on (T2WI) MRI (p<0.001).Conclusion: There is a direct relationship between signal intensity change of the spinal cord on MRI and motor myelopathic severity in patients with cervical spondylotic myelopathy.Journal of National Institute of Neurosciences Bangladesh, 2015;1(2): 37-40

Distribution and Determinants of Ludwig’s Angina: Experience of 30 Cases in Bangladesh

Background: Ludwig’s angina produces a serious morbidity. Objective: The purpose of the present study was to find out the risk factors, treatment response of the antibiotics and complication of the Ludwig’s angina, which will help in prevention and management of this potentially dangerous condition. Methodology: A prospective study was carried out from September 2014 to August 2015 at the department of Otolaryngology-Head & Neck surgery of Banghabandhu Sheikh Mujib Medical University (BSMMU), BIRDEM general hospital and DMCH. This study included 30 patients with Ludwig’s angina. In this study minimum age, maximum age and mean age were taken. Result: Highest numbers of patients were in the 3rd decade of life. Out of 30 patients, male were 70% and female were 30%. Majority of the patients (76.59%) were from rural area. And the nutritional statuses of the patients were below average. Almost all the patients came with the complaints of neck swelling, pain and fever. Dental infection was the commonest source of infection. Here growth of colony found 76.67% and Streptococci (strep. Viridans) was found in 30% cases. Maximum patients were treated by parental antibiotics with surgical drainage. Eight patients developed complications, and five patients died in this series. Average hospital stays of the patients were 11.2 days. Conclusion: Most of the patients are male with poor socioeconomic class and Streptococci Viridans is the commonest organism. Journal of Current and Advance Medical Research 2016;3(1):16-21

Vesicocervical fistula following vesicovaginal fistula repair report

Vesicocervical fistula following vesicovaginal fistula repair is a very rare condition. It is a complication following repeated lower uterine cesarean section. We report a case of an young married woman who was admitted in the depart­ment of urology, Banghabandhu Sheikh Mujib Medical University Hospital with vesico-cervical fistula following vesico­vaginal fistula repair. Reposition of cervix into vaginal vault and repair of urinary bladder was done. There was no such report of vesicocervical fistula following vesicovaginal fistula repair from Bangladesh.

Clinico-Demographic Characteristics of Tuberculous Lymphadenitis: Experience of 50 Cases in Bangladesh

Background: Clinical and demographic features are important for the tuberculous lymphadenitis patients for treatment. Objective: The purpose of the present study was to see the clinical and demographic features of tuberculous lymphadenitis patients. Methodology: This cross-sectional study was done at the Department of Pathology at Banghabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from January 2009 to March 2011 for a period of nearly two years. All the patients, irrespective of age and sex with the clinical features, suggestive of tuberculous lymphadenitis and later on, proved to be the same histologically, were selected for the study purposively. Relevant information was recorded in a prescribed data sheet and histomorphological findings were recorded accordingly. In cases where fresh specimen was available, caseous portion of lymph node was sent for culture. Fite Faraco staining was also done on lymph node sections in all cases. Result: A total number of 50 tuberculous lymphadenitis patients were recruited for this study. Among this study population, the age of cases ranged from 12 years to 65 years with a mean age of 26.22 ± 2.52 years. Male and female ratio was 1:1.38. Besides lymphadenopathy, 45 patients had low grade fever; 32 patients had weight loss and 18 patients had cough. Among 50 cases of lymph node tuberculosis cervical lymphadenopathy was 41 (82.0%) cases; 6 (12.0%) cases had supraclavicular lymphadenopathy; 2 (4.0%) cases had inguinal lymphadenopathy and 1 (2.0%) had axillary lymphadenopathy. The mean duration of presentation of lymphadenopathy with standard deviation was 7.06 ± 1.6 months. Thirty eight patients (76.0%) had lymphadenopathy for less than 12 months. Conclusion: In conclusion, young age group people are most commonly affected by tuberculous lymphadenitis with the predominance of female and most of them are presented with low grade fever and weight loss.