Bangladesh Medical College Hospital Research Articles

Clinical Features and Socio – Demographic Factors Affecting the Prevalence of Enteric Fever: A Prospective Observational Study

Background: Enteric fever otherwise called Typhoid fever is a systemic disease caused by Salmonella typhi and Salmonella paratyphi, having reservoir in contaminated water and food. It affects considerable number of populations of the world but regions of South Asia are most commonly affected.
 Aims and Objective: The objective of this study to find the prevalence of Typhoid fever with respect to age, gender, marital status, occupation, seasonal variation, treatment of drinking domestic water source, and clinical features.
 Methodology: This is a cross- sectional observational study conducted at Bangladesh Medical College Hospital (BMCH), Dhanmondi, Dhaka from January to December 2019. Those presenting both outpatient departments or admitted to the inpatient units with complains of fever and abdominal pain underwent blood culture for the diagnosis of Typhoid fever. Patients with informed consent and positive blood culture report (including both Salmonella typhi and Salmonella paratyphi) were included in the study.
 Results: Total 1375 tests were performed, out of which 407 came out to be positive blood culture report (including both Salmonella typhi and Salmonella paratyphi). Out of these tests 31.65% were males and 27.35% were females. Highest occurrence of typhoid fever was observed among males of age group 18 – 45 years and least with patients between age group above 75 years. As for the influence of occupation, male civil servants recorded the highest occurrence in the hospitals while artisans recorded the least. The influence of marital status revealed the highest occurrence in the single males with the married females had the least. In relation to months the prevalence was the highest in the month of July - September (11.42%). Water quality, vaccination and season have great impact on the burden of typhoid fever in population. Fever, diarrhea and abdominal pain are the major symptoms associated with typhoid fever.
 Conclusion: Socio-demographic factors such as age, gender, marital status, and seasonal variation, treatment of drinking water supply, occupation and presenting complaints influenced the distribution pattern of typhoid fever among the population in BMCH, Dhanmondi, Dhaka.
 Bangladesh Crit Care J September 2020; 8(2): 86-90

Post-Tonsillectomy Taste Disturbance; An Unusual Complication of Tonsillectomy

Tonsillectomy is a very common operation to the otolaryngologist and relatively safe in expert hand. Sometimes it bothers the surgeon for its acute and chronic post-operative complications like reactionary hemorrhage, throat pain, referred otalgia, dehydration, velopharyngeal incmpetnce, burns of uvula, soft-tissue injury, dento-mandibular trauma, and respiratory compromise. Although rare, it is often associated with altered taste and temporary or long continued loss of taste sensation. In this article, the authors reported 39 (3.9%) cases of disturbance of taste sensation among 1000 post-tonsillectomy patients during the period 2015 to 2018 in the Bangladesh medical College Hospital. Age of the patents was ranged in between 20 to 30 year. The study was aimed to find out the possible cause of taste disturbance in the post-tonsillectomy patients and obtain informed written consent prior to tonsillectomy

Incidence, Socio-demographic Characteristics and Predisposing Factors of Ectopic Pregnancy attended at a Private Tertiary Care Hospital in Dhaka City

Background: Ectopic pregnancy is frequently occurs among pregnant women.
 Objective: The purpose of the present study was to see the incidence and socio-demographic characteristics of ectopic pregnancy patients.
 Methodology: This cross-sectional study was carried out in the inpatient Department of Obstetrics and Gynaecology at Bangladesh Medical College Hospital, Dhaka, Bangladesh from January 2009 to December 2009 for a period of one (1) year. All clinically suspected cases of ectopic pregnancy within the reproductive age admitted in the department of Obstetrics and Gynaecology at Bangladesh Medical College Hospital, Dhaka were included in the present study. After taking detailed history with particular scrutinization of the menstrual, obstetric and contraceptive history, a thorough physical examination was performed. The ectopic pregnancy was confirmed by laboratory and imaging technique.
 Result: The incidence of ectopic pregnancy in BMCH was 2.16% cases.The mean age with SD of the study population was 24.0±2.87 years. The ectopic pregnancy was closely related with high parity and it had been found that para-2 was the most common which was 20(44%) cases.Pelvic infection (33.0%), past history of abortion or MR (28.0%), and history of infertility (25.0%) were constituted the main bulk of risk factors. Only 3.0% had history of tuberculosis.
 Conclusion: In conclusion young para 2 women with pelvic infection or past history of abortion or MR are most commonly suffering from ectopic pregnancy.
 Journal of National Institute of Neurosciences Bangladesh, 2020;6(1): 59-63

Surgical Management and Per-operative Findings of Women with Ectopic Pregnancy

Background: Management of ectopic pregnancy is very crucial issue for the survival of the patients.
 Objective: The purpose of the present study was to observe the surgical management and per-operative findings of women with ectopic pregnancy.
 Methodology: This cross-sectional study was carried out in the inpatient Department of Obstetrics and Gynaecology at Bangladesh Medical College Hospital, Dhaka, Bangladesh from January 2009 to December 2009 for a period of one (1) year. All clinically suspected cases of ectopic pregnancy within the reproductive age admitted in the department of Obstetrics and Gynaecology at the Bangladesh Medical College Hospital, Dhaka were included in the present study. In most of the cases, laparoscopy or laparotomy was done to confirm the diagnosis and manage the cases.
 Result: A total number of 48 cases of ectopic pregnancy women were recruited for this study. The highest number of ectopic pregnancy occurs in the ampulla of the fallopian tube which was 27(58.3%) cases. The right tube had been found to be affected more than the left which was 30(62.5%) cases and 18(37.5%) cases respectively. Most of the patients were presented with ruptured tubal pregnancy which was 30(62.5%) cases. Opposite tube was normal looking in 25(52.1%) cases. Unilateral salpingectomy and salpingectomy with contra lateral tubectomy were operated in 32(66.7%) cases and 10(20.8%) cases respectively.
 Conclusion: In conclusion most of the ectopic pregnancy is occurred in the site of ampulla of fallopian tube in right side which are mostly surgically managed by unilateral salpingectomy.
 Journal of Current and Advance Medical Research 2020;7(1): 12-16

Laparoscopic repair of inguinal hernia: Prospective evaluation at a tertiary care center

Background: Treatment of groin hernias continues to evolve. The emergence of laparoscopic inguinal hernia surgery has challenged the conventional gold standard Lichtenstein’s tension free mesh repair. Laparoscopic technique to achieve surgical correction over groin hernia is increasingly being practiced in our country, and it is imperative to test the overall outcome of this technique in a tertiary care setting.
 Objectives: Current study was aimed at evaluating the per-operative events, early and late outcomes of laparoscopic groin hernia repair techniques. End points of evaluation were postoperative pain, hospital stay, resumption of normal activities, chronic pain and recurrence.
 Methods: Within a 2-year period, 45 patients of groin hernias of different clinical types underwent laparoscopic inguinal hernia repair in Bangladesh Medical College Hospital were recruited in this prospective observational study. Preoperative findings, intraoperative course, postoperative and follow-up data were analyzed to evaluate the outcomes. Observations were made regarding operating time, operative hazards, postoperative pain, incidence of early post-operative morbidities, hospital stay, resumption of activities. Total 24 months follow-up was carried out with regards to normal activity, late complications notably chronic groin pain and recurrence.
 Results: The mean age of 38.1±11.1 years, 27(60%) patients underwent TEP repair whereas, TAPP procedure was carried out in 18 patients (40%). For unilateral hernia repair using TEP technique, mean operative time was 50.3±4.2 mints and 61.7±5.3 mints for direct and indirect variety (D/I), with the corresponding rates for TAPP repair being 65.0±2.2 mints and 72.8±3.2 mints (D/I) respectively. Conversion rate to other operative procedure was 6.67%. The overall surgery related early post-operative morbidity was 7.4% (TEP) and 16.8% (TAPP). 3 out of 45 patients (6.67%) experienced chronic pain in the groin in the study. However, there was no single incidence of recurrence observed during the follow up period.
 Conclusion: Laparoscopic groin hernia repair techniques are safe and feasible, offers the benefits of minimally invasive surgery and becoming the procedure of choice specially for bilateral and recurrent inguinal hernias.
 Journal of Surgical Sciences (2019) Vol. 23(2): 54-58

Ultrasound guided truncal blocks for post operative analgesia – A study of 100 cases for the first time in Bangladesh

Ultrasound guided (USG) nerve block techniques have been used for post operative analgesia for truncal operations to limit the perioperative use of NSAID and opioids. USG visualization offers safe blocks by optimal needle positioning, direct visualization of peripheral nerves and local anesthetic distribution. In Bangladesh, first ultrasound guided nerve block studies were started in the Dept. of Anesthesia, Analgesia and ICU of Bangladesh Medical College hospital. This Study has been carried out in the operation theatre and post operative room. Ultrasound guided Rectus sheath block, Subcostal TAP block, Classical TAP block, Ilio inguinal and Ilio hypogastric nerve block provide post operative analgesia of the abdominal wall. PEC 1, PEC 2 and Serratus Anterior plain block provide post operative analgesia for anterior chest wall. This study was done with 100 patients coming for abdominal surgeries and anterior chest wall surgeries. These blocks were given after induction and before giving incision in case of general anesthesia or after operation in case of spinal anesthesia. This study is an audit of ultrasound guided nerve blocks in terms of analgesia score, patient satisfaction, outcome of anesthesia and complications. Journal of Bangladesh Society of Anaesthesiologists 2015; 28(1): 29-31

Growth Pattern of Exclusively Breastfed Babies in Urban Affluent of Bangladesh

Objective: To find out the growth in the exclusively breastfed babies of the affluent mothers and to compare the figures with those of the children in the industrialized countries. Methods and materials: Fifty-three babies were selected in 1 year time period for this cross-sectional study under 6-month of age with prefixed criteria, such as exclusively breastfed and not fed with any formula feeding. Recommended schedule of immunization (EPI) was followed to weigh and measure for supine length. Data were analyzed in PC through SPSS and some calculations were done in calculator too. Place and time of work: Data were collected from August 2011 to June 2012 in the Pediatrics Department of Bangladesh Medical College Hospital and the Researcher’s Chamber at Dhanmondi, Dhaka. Results: The data of developed countries showed that in first 3-month of age, children grow in weight 30 gm/day and in length 3.5 cm/month, followed by weight gain of 20 gm/day and linear growth 2 cm/month in next 3-6 months. Our babies could be compared to those figures, with 33.54 gm/day in the weight gain and 4.17 cm/month in linear growth in the first 3 months. The average weight gain during the next 3 months (3-6 months of age) was 22.3 gm/d and linear growth for this period was 2.12 cm/month.Conclusion: Babies of our country in well-off families can grow optimally in comparison to the growth of the babies in the industrialized countries, or even can exceed, if they are exclusively breastfed and brought up ensuring immunization and follow up in educated mothers. DOI: http://dx.doi.org/10.3329/bjms.v13i4.20627 Bangladesh Journal of Medical Science Vol.13(4) 2014 p.466-469

Chorangioma - A Case Report

We present a female patient with pregnancy associated with normal live birth and the unusual concomitance of chorangioma. It was an incidental finding during the routine microscopic examination of the placenta of the 30 year multipara whose pregnancy was clinically normal. She was admitted to the Bangladesh Medical College Hospital for labor at 34 weeks gestation. She was investigated thoroughly because of irregular pervaginal bleeding before delivary. Caesarian section was done at 37th weeks of pregnancy. The placenta was found enlarged, irregular and haemorrhagic. Histopathological examination from the sections of specimen was done and diagnosed as Chorangioma. The case is presented as below.DOI: http://dx.doi.org/10.3329/jom.v14i2.19671 J Medicine 2013, 14(2): 185-186

Tubeless & Stentless PCNL in Selected Cases – Our Experience in Bangladesh

Introduction: PCNL is well-accepted method of management of renal stone. In PCNL post operatively usually Nephrostomy tube and JJ stent are used. But Nephrostomy tube and JJ stent has some morbidity. Tubeless and JJ stentless PCNL in selected cases reduces the morbidity. This study will evaluate the results of PCNL with and without Nephrostomy tube and JJ stent in the management of renal stone in selected cases. Methods: From July 2008 to June 2010 total 70 cases of renal stone were managed by PCNL dividing into two groups Group A -PCNL with nephrostomy tube and JJ stent, Group B- Nephrostomy tubeless and JJ stent less PCNL with only ureteric catheter for 24 – 48 hour post operatively. All cases were operated in Urology department of Bangladesh Medical College Hospital, and two other private hospitals located in Dhaka. In all cases initially placed a ureteric catheter and at the end of the procedure compression at renal angle about 10 min in Group –B, in Group A Procedure ended with Nephrostomy tube and JJ stent. Ureteric catheter was removed 24 hour-48 hour after operation. JJ stent was removed 3 weeks after operation. Exclusion criteria for the tubeless and JJ stentless approach were more than one percutaneous access, significant perforation of the collecting system, large residual stone burden, significant postoperative bleeding, ureteral obstruction and renal anomaly. The incidence of complication, length of hospitalization, analgesics requirement and interval to return to normal activities were evaluated. Results: All 70 percutaneous procedures were performed without significant complication, none of the patients demonstrated urinoma in postoperative renal Ultrasound scan. In Group- B length of hospital stay was < 3 days, the average analgesia requirement was 98 mg of Inj.Pethedin, patient return to normal activity earlier then Group -A. Conclusion: Nephrostomy tubeless and JJ stent less Percutaneous Nephrolithotomy with ureteric catheter for 24- 48 hours post operatively is a safe and effective procedure. Hospital stay and analgesia requirements are less and returns to normal activities are faster. DOI: http://dx.doi.org/10.3329/jss.v16i1.14443 Journal of Surgical Sciences (2012) Vol. 16 (1) : 18-25

Some Epidemiological Aspects Of Subfertile Women Who Underwent Laparoscopy

Objective: Epidemiological aspects of sitbfertile women underwent laparoscopy. Place of Study: This retrospective study was done in the Obstetrics and Gynaecology Department of Bangladesh Medical College hospital. Duration: July 2003 to June 2004. Study Population: Women suffering from primarv and secondary subfertility, who had under gone laparoscopy. Total 61 patient had laparoscopy for evaluation of subfertility. No documents were available for 6 patient and they were excluded from the study. Result: The study group comprises 55 cases of which 67.37% was of primary and 32. 73", was of secondary subfertility. Professional women group (56.4%) was higher than housewife group (43.6%). In this study 11.11% had history of spontaneous abortion and 33.33% had history of MR. In this study menstrual period was within 7 days in 70.9% cases and in 10.9% cases were more than 7 days, in 14.54% cases menstrual cycle was more than 35 days and in 3.64% cases were less than 22 days. 40% of the patient did not used any contraceptive. Conclusion: The number of subfertility visits' has increased in the last few rears because of increasing awareness for available services and option for resolving subfertilitv. Prompt investigation and appropriate referral allow a couple to receive advice and treatment to help them reach their goal. Journal of Shaheed Suhrawardy Medical College Vol 2No.1 June 2010 page 6-9 DOI: http://dx.doi.org/10.3329/jssmc.v2i1.12343

Study of Glucose-6-phosphate Dehydrogenase (G6PD) Status in Preeclampsia

Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is one of the common enzymopathy and may be one of the risk factor for complicated pregnancy. Objectives : To measure erythrocyte G6PD level in pregnant women with preeclampsia in order to observe this enzyme status and also to measure Hb, TC of RBC, serum bilirubin, reticulocyte count to observe hemolytic status. In addition, to correlate this enzyme level with all these hematological parameters in order to find out any relationships among them. Methods: This cross sectional study was carried out in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka from January to December 2008. For this, 30 pregnant women with preeclampsia, age ranged from 20 to 34 years during their third trimester (>24th weeks) were studied (group B). They were selected from the Obstetric and Gynae Out Patient Department (OPD) of BSMMU and Bangladesh Medical College Hospital (BMCH) of Dhaka City. For comparison age matched 30 apparently normal pregnant women of the same gestational age (control group - group A) were also studied. They were selected by personal contact. Erythrocyte G6PD level was measured by Spectrophotometric method using kit of Randox. Serum bilirubin, hemoglobin concentration, total count of RBC and reticulocyte count were measured by standard laboratory techniques. For statistical analysis ANOVA, independent sample t test, Chi-square test and Pearson's correlation coefficient test were performed by using SPSS for windows version-12 as applicable. Results: In this study, erythrocyte G6PD level was significantly lower in preeclampsia in comparison to that of control but their percentages of involvement was not statistically significant. In addition, hemoglobin concentration and RBC count were significantly lower and serum bilirubin and reticulicyte count were significantly higher in the study group than those of control group. On the other hand, erythrocyte G6PD level was positively correlated with hemoglobin concentration and total count of RBC while negatively correlated with serum bilirubin and reticulocyte count and all these relationships were statistically significant in the study group. Conclusion: Therefore, this study revealed that presence of G6PD deficiency associated with hemolysis in preeclampsia may act as a contributory factor for the development of this complicated pregnancy. Key words: G6PD; preeclampsia DOI: 10.3329/bsmmuj.v2i2.4758 BSMMU J 2009; 2(2): 56-60

Growth pattern of Exclusively Breastfed Babies in Urban Affluent of Bangladesh

To find out the growth in the exclusively breastfed babies of the affluent mothers and to compare the figures with those of the children in the industrialized countries. Fifty-three babies were selected for this cross-sectional study under 6-month of age with prefixed criteria, such as exclusively breastfed and not fed with any formula. Recommended schedule of immunization (EPI) was followed to weigh and measure for supine length. Data were analyzed using SPSS Version 10.0. Place and time of work: During an 11-month time frame (from May 2007 to April 2008) data were collected from Pediatrics Department of Bangladesh Medical College Hospital and the researcher's chamber at Dhanmondi, Dhaka, where applicable. The data of developed countries showed that in first 3-month of age, the children grow in weight 30 gm/day and in length 3.5 cm/month, followed by weight gain of 20 gm/day and linear growth 2 cm/month in next 3-6 months.1 Our babies could be compared to those figures, with 33.54 gm/day in the weight gain and 4.17 cm/month in linear growth in the first 3 months. The average wt. gain during the next 3 months (3-6 months of age) was 22.3 gm/day and linear growth for this period was 2.12 cm/month. Babies in our country can grow optimally in comparison to those in the industrialized countries or even can exceed, if they are exclusively breastfed and brought up in well-off families with high education of the mothers.TAJ 2009; 22(1): 231-234

Clinical Presentation and Blood Culture Scenario of Typhoid Fever among Urban Children of Bangladesh

Background: Typhoid is a serious disease caused by S. enterica serotype typhi. It is endemic in Bangladesh with occasional epidemic. In children it may present as a nonspecific fever making diagnosis very difficult causing delay in treatment. Moreover, with emergence of multi-drug resistant strains of S. typhi (MDR- St) management has become more difficult. Blood culture is the most reliable and feasible method for choosing the right drug to treat. Objectives: To evaluate the clinical picture at presentation; to facilitate early diagnosis of Typhoid in urban children and to help to apply an early effective therapy against it. Methods: A prospective study was performed on 50 admitted children with typhoid fever in Bangladesh Medical College Hospital. The clinical presentation, source of water supply, sanitation, food habits, sensitivity of blood culture, duration of response to antibiotics etc. were recorded in a structured questionnaire. Results: Male and female ratio was 1.8:1 with a mean age of 5.17 ± 2.63 years. Majority came from medium economic group (46.0%). Fever was the main presenting feature in all cases with mean duration of 9.18 ± 5.15 days at admission. Fever was sudden in onset in 78.0% and irregular in 82.0% cases. Cough, diarrhea and vomiting were common symptoms while constipation was found in 12.0% of cases only. Relative bradycardia was not a common feature. Blood culture was positive in all cases and mostly within 7 days of duration (60.0%). 98.0% of isolated organism was sensitive to Ceftriaxone. There was significant relationship between incidence of MDR-St and non MDR-St with recent travel history (P < 0.05). The mean time to defervescence was 4.80 ± 1.89 days. Mean duration of hospital stay was 9.30 ± 2.10 days. All the cases recovered completely. Conclusion: Clinical presentation of typhoid in children is different from that in adults. MDR-St strains are common in urban area. Random and empirical use of antibiotics is raising the MDR strains against conventional drugs leaving only the best response to expensive antibiotics. We recommend that early diagnosis; proper supportive care and rational use of antibiotics with adequate dose and duration can avoid the morbidity and mortality. Vaccines for infants should be developed and better incorporated in the Expanded Program on Immunization (EPI). There should be a national guideline for effective control of typhoid.

Poverty is not the main obstacle for quality cancer care in diagnosed cases: Experience of 520 cases from Bangladesh

9077 Background: Cancer management is expensive everywhere. In the developing countries poverty is always blamed for as to be the main obstacle for quality cancer care. According to WHO report (globocan) 1.295 to 1.36 million people in Bangladesh suffer from cancer. Our health care service is not extensive to diagnose all these cases. A number of diagnosed cases do not get standard specific treatment of cancer. The objective of the study is to find out the main possible reason behind it. Methods: We made a prospective analysis of pre-diagnosis and post-diagnosis expenses using hospital documents &amp; taken interview with specific questionnaire form of 520 cases regardless of age, indication and management who are treated from January 2002 to December 2005 in NICRH, City General Hospital &amp; Bangladesh Medical College Hospital. We calculated the total expenses incurred to each case before specific diagnosis (EBD). These include all investigations, and non-specific treatment costs from the onset of symptoms up to the specific diagnosis. We have estimated the total expenses after diagnosis (EAD). This includes planned specific cancer management according to diagnosis. We made a ratio in percent between them (EBD/EAD×100). Results: 219 cases (42%) spent = 100% of EAD before diagnosis. 94 cases (18%) spent = 200% of EAD before diagnosis. The more this ratio, less the quality of management they could afford. Among them 349 cases (67%) failed to complete planned management, 57 cases (11%) failed to receive any planned management. Only 114 cases (22%) completed their planned management. Queries revealed that 78% patients who failed to complete planned management is due to their financial exhaustion for high pre-diagnostic expenses. Conclusions: We conclude that poverty is not the main obstacle for quality cancer care in diagnosed cases of Bangladesh. High unnecessary pre-diagnostic expenses, which result in financial exhaustion, is one of the major obstacles for quality cancer care. Further study is required to determine how to reduce the redundant pre-diagnostic expenses &amp; find out other removable factors for quality cancer care in developing countries like Bangladesh. No significant financial relationships to disclose.

Implication of human epidermal growth factor receptor-2 (HER-2) over expression in treatment of breast cancer in developing countries—report on 250 cases from Bangladesh

14139 Background: Carcinoma breast is the second most common malignancy in Bangladeshi women. Though HER-2 over expression has profound effect on prognosis of breast cancer, no published data is available about this among Bangladeshi patients. Our aim in this study was to see HER-2 status in Bangladeshi patients, and their relation with other prognostic parameters. Implication of this molecular marker in management of breast cancer in poor country like ours remains controversial, keeping in mind the exorbitantly high cost of Trastuzumab. Methods: This prospective study was conducted in the department of Oncology at Bangladesh Medical College Hospital, National Institute of Cancer Research and Hospital and Ahsania Mission Cancer Hospital Bangladesh, from January 2003 to December 2006. Total 250 women with breast carcinoma were enrolled; biopsy specimens were tested by immunohistochemistry to detect HER-2 status. For recommending treatment with Trastuzumab, patients with 3+ immunohistochemistry results were considered HER-2 positive. Fluorescent In Situ Hybridization (FISH) testing facility was not available. These findings were correlated with age, ER/PR and nodal status. The practical application of marker in terms of use of Trastuzumab was analyzed. Results: Age of patients ranged from 19.75 years to 72 years, mean age was 49.75 years. HER-2 was over expressed in 38.4 % (96) cases and their mean age was 42.92 years compared to 47.61 years in HER-2 negative cases. HER-2 positive cases tended to have higher rates of lymph node metastases (44 out of 96) compared to HER-2 negative (46 out of 154) cases (45.8 % vs 29.87 %). ER/PR was positive in 64 % cases. HER-2 over expression was inversely related to ER / PR expression. Of the HER-2 positive cases, 11.45 % (11 out of 96) afforded treatment with Trastuzumab. Conclusions: HER-2 is over expressed in almost 38 % of breast carcinoma patients in Bangladesh. This expression is associated with relatively young age, lymph node metastasis and lack of ER / PR expression. Only 11.45 % of patients with HER-2 over expression afforded Trastuzumab though 38 % of cases over expressed HER-2. No significant financial relationships to disclose.

Analysis of Breast Pain: A study of 110 Cases

A prospective type of analytical study was carried out on 106 patients with breast pain to analyze the causes of breast pain. This study was conducted from August, 2002 to January 2004 at breast clinic of Bangladesh Medical College Hospital (BMCH) and at Department of Surgery of BMCH. Sampling was done purposively and a structured questionnaire was used for data collection by interviewing followed by examining the patient in the first phase. In the second phase, Mammography and FNAC (Fine Needle Aspiration Cytology) was done. Majority of the patients (35.8%) were in the age group of 21- 30 years and the mean age was 27.61± SD10.5 years. About 48.1% breast pains were due to ANDI (Aberration of Normal Development and Involution) and among the other causes nonspecific pain 15.1%, breast abscess 14.2% and carcinoma of breast were only 1.9%. The performance status of all the patients were in between 0- 1. Mammography was done in 54 patients and of them 44 was found positive for fibrocystic disease (41 cases) and fibroadenoma (3 cases). FNAC was done in 50 patients and 36 were found positive with fibroadenoma (22 cases), fibrocystic change (8 cases), chronic breast abscess (2 cases), mitotic lesion (2 cases), and neurofibroma (2 cases). So painful breast diseases are helpful in seeking further medical care for appropriate intervention Keyword: Breast pain, Mastalgia, ANDI. doi: 10.3329/jom.v10i2.2818 J MEDICINE 2009; 10 : 77-81

All Members of a Single Family including a 5-Months Old Infant having Tuberculosis - A Case Report

Introduction : The incidence and number of tuberculosis (TB) cases have been increased dramatically all over the world. It is a major public health problem in Bangladesh too. Case Summary : A 5-months old male infant, immunized as per EPI schedule, 3rd issue of a nonconsanguinous parents residence at downtown, Dhaka from a poor socioeconomic background was admitted into the Paediatrics ward, Bangladesh Medical College Hospital on 11th March 2004 with fever for 1 month, dry cough for 21 days, loose motion and vomiting for 14 days. He was weaned from breast milk at 3 months of his age and there was gross malfeeding history. BCG vaccine was given at 6 weeks. His mother had also been suffering from recurrent febrile illnesses and weight loss for many months. Baby was looking ill but conscious, mildly pale, afebrile with no dyspnoea. Z score of wt/age, lth/age, wt/lth and OFC were -2.9, -3.5, -0.3 and -0.3 respectively. Fontanel was open and normal. There was no lymphadenopathy and BCG mark was present. Breath sound was vesicular with fine crepitation on right lung. He was treated initially as septicemia by combined parenteral antibiotics. But response was not satisfactory. Lab data yielded raised ESR, eosinophillia, pyuria and haematuria with sterile culture. Chest X ray was abnormal. Mantoux Test (MT) was found strongly positive (18mm/72hrs.). Other family members were immediately screened for TB and all revealed positive. Complete Blood Count, MT and Chest X ray were chosen as screening methods for them. We treated with anti tubercular therapy to all of them including baby. We also corrected the feeding practice of the patient and kept in close monitoring. He showed remarkable clinical improvement with weight gaining. We discharged him as disseminated tuberculosis with having pulmonary tuberculosis among all other family members and advised for follow up. They all were cured. At present, they are healthy and baby is now 4 years of age with good physical and mental growth. Conclusion : TB can mimic everything. A high index of suspicion by the clinician is essential for early diagnosis. Message: Family members of affected child must be screened for active TB Keywords : Tuberculosis; Tuberculosis in infant; Pan family tuberculosis. DOI: 10.3126/saarctb.v6i2.3056 SAARC J. Tuber. Lung Dis. HIV/AIDS 2009 VI (2) 38-42

Noonan’s Syndrome of a 25 years old female

Noonan's syndrome is an autosomal dominant disorder with a webbed neck that mimics turner syndrome. However, the syndrome has also been found to be genetically heterogeneous. Noonan syndrome is characterized by short stature, hyperkeratosis of skin, distinct facial features, lymphoreticular abnormalities, nail dystrophy. No abnormality in chromosome number has so far been reported. Here we present a 25 year old female who came to Bangladesh Medical College Hospital in May'08, with generalized skin eruptions and left leg swelling. Key words: Noonan's syndrome, genetic disorders DOI: 10.3329/bjms.v8i3.3986 Bangladesh Journal of Medical Sciences Vol.8(3) 2009 p68-71