Chattogram Medical College Hospital Research Articles

Respiratory Syncytial Virus Infection in Children with Bronchiolitis

Background: Respiratory Syncytial Virus (RSV) is the most common organism causing bronchiolitis. Bronchiolitis is almost always diagnosed clinically. As a result, the availability of bedside sensitive rapid RSV antigen tests is critical for timely RSV acute respiratory infection diagnosis. Methods and materials: This study was conducted to detect RSV antigen positivity and the sociodemographic profile of children with RSV antigen positive bronchiolitis. From October 2022 to March 2023, this observational study was conducted in the pediatrics department of Chattogram Medical College Hospital. Ninety-two nasopharyngeal swabs from children younger than two years, were tested for RSV antigen. The mean and standard deviation were used to express the demographic data. Chi-square analysis was used to examine differences in group proportions. Results: RSV antigen positivity was detected in 45.7% of the 92 cases, with a mean age of 4.18±3.08 months. Severe bronchiolitis cases were more common (22.8%) among antigen positive cases and had the longest hospital stay. During the months of November (42.4%) and December (29.3%), RSV infection levels peaked. This study describes that during the seasonal epidemics, RSV was the main concern, as the number of positive cases decreased in the months that followed. The signs and symptoms of RSV positive and negative cases were not significantly different. Conclusion: A simple, low-cost and bedside RSV test can be considered as a valuable diagnostic tool in a low resource setting. J Bangladesh Coll Phys Surg 2024; 42: 368-378

Serum Electrolytes and Calcium Levels in Neonates Receiving Phototherapy for Neonatal Jaundice

Background: Neonatal Jaundice (NJ) is one of the most common causes of neonatal admission. Phototherapy is an important treatment modality for NJ. However, this treatment modality may itself result in changes of different biochemical parameters. The study aimed to evaluate the changes in serum electrolytes (Sodium, potassium and chloride) and calcium in neonates receiving phototherapy for NJ. Materials and methods: One hundred and two term neonates admitted to the Special Care Newborn Unit, Chattogram Medical College Hospital for the management of NJ by phototherapy were enrolled in this prospective observational study. Serum bilirubin, sodium, potassium, chloride and calcium were measured before and after 48 hours of phototherapy and compared. Results: The mean gestational age and mean age of admission of the neonates were 38.6±0.6 weeks and 6.42 ± .67 day respectively. The mean sodium, potassium and calcium level before therapy was respectively, 138.4±1.8 mmol/L, 4.1±0.3 mmol/L and 8.8±0.3 mg/dl. There was significant decrease in the level of mean sodium (136.4±1.6 mmol/L), potassium (3.8 ± 0.3 mmol/L) and calcium (8.4±0.4 mg/dL) after phototherapy. All neonates had normal level of serum calcium, sodium, potassium and chloride before phototherapy. After 48 hours of phototherapy, 46 (45.1%) of them had abnormal values with the incidence hypocalcaemia, hyponatraemia and hypokalemia respectively in 21.6%, 25.5% and 10.8% of the neonates. Conclusion: Neonates undergoing phototherapy are at risk of developing hyponatraemia, hypokalaemia and hypocalcaemia. Closed monitoring is essential to observe the changes in sodium, potassium and calcium and should be managed accordingly. IAHS Medical Journal Volume 6(2) December 2023; 83-86

To Assess the Association Between Decreased Uric Acid Level and Blood Pressure

Background: Asymptomatic hyperuricemia is commonly viewed as an entity that should not be treated. Treatment of asymptomatic hyperuricemia in patients with renal impairment is still in debate. There is no evidence to rationalize pharmacotherapy for patients with hyperuricemia with no complication and serum uric acid concentration is below 10 mg/dL. Objectives: To evaluate the association between decreased uric acid level and blood pressure. Methods: This was a single-center, single (patient blinded, placebo-controlled study conducted in chattogram medical college hospital over 1 year. Patients of both sexes aged above 18 years with eGFRs of 15 to 60 mL/ min/1.73 m2 (as calculated with the 4-variable MDRD) and serum uric acid levels ≥7 mg/dL were included. Patients were selected in purposive technique divided randomly by lottery into two groups. One group received febuxostat 40-mg tablet once daily and another group received placebo tablets at the same time. Both groups received antihypertensive and antidiabetic medication and diuretics as per needed. Drugs and placebo were continued throughout the study period. Patients were evaluated at baseline, 3rd and 6th months for history, physical examination, assessment of any adverse events or end points and relevant investigations. Results: 35 patients in each group were analyzed. Baseline characteristics were similar between the two groups. In febuxostat group the mean uric acid was decreased from 8.55 (±1.05) to 4.92 (±0.64) mg/dl, which was statistically significant (p <0.001) and in placebo group increased from 8.10 (±0.6) to 8.99 (±0.27) mg/dl which was statistically significant (P=0.001) after 6 months follow up. In case of mean eGFR in the febuxostat showed a nonsignificant increased from 25.28 (± 7.59) to 27.01 (±8.29) ml/min/1.73 m2, but in placebo group there was decreased mean eGFR from 26.81 (± 7.31) to 23.32(±7.72) ml/min/1.73 m2 which was statistically significant (p <0.001) and between group difference in eGFR was significant at 6 months (p = 0.048). Moreover after 6 months of treatment systolic and diastolic blood pressure were significantly lower in febuxostat group than placebo (p <0.05). Conclusion: Compared to placebo, febuxostat slowed the decline in eGFR in CKD stage 3 and 4

Drug use Pattern with Standard Indicators in Chattogram Medical College Hospital in Bangladesh

Irrational prescription being a global problem leading to ineffective, unsafe treatment. This study was conducted between November 10, 2019 to January 20, 2020 to assess drug use pattern using WHO/INRUD core prescribing indicators at Chattogram Medical College Hospital (CMCH). Total 500 patients were selected randomly. The results showed average number of drugs per encounter is 4.41 (optimal range = 1.6–1.8), generic drug prescription was 1.54% (optimal value = 100%), encounters with an antibiotic prescribed were 32.6% (optimal range =20.0–26.8%), encounters with an injection prescribed were 24.8% (optimal range =13.4–24.1%), drugs prescribed from EDL were 50.43% (optimal value = 100%) and drugs prescribed from the WHO EDL were 56.96% (optimal value = 100%). Average consultation time was 3.1 min (optimal value ≥10 min), average dispensing time was 35 s (optimal value ≥90 s) and the patients’ knowledge of correct dosage was 62.1% (optimal value =100%. The hospital had no copy of EDL and key drugs available in the stock were 82% (optimal value =100%). The concept of generic prescribing was negligible. There was reduced prescription of drugs from the National List of Essential Medicines, the prescription of antibiotics and injections was slightly higher than normal. Shorter consultation and dispensing time may lead to inadequate information about the medication being given to patients and patients had little chance to obtain information about their treatment. This study necessitates we are in need of strict scrutiny on the prescribing method of our country. So, we can achieve the goal of rational use of drug.

Effects of Short Wave Diathermy Therapy in Patients with Adhesive Capsulitis of Shoulder (ACS)

There are varieties of management option for Adhesive capsulitis of shoulder (ACS) also known as Periarthrosis and in general population commonly known as Frozen Shoulder. Short Wave Diathermy (SWD) is one of the important therapeutic option for frozen sholder. The aim of the study is to determine effectiveness of SWD in order to improve the pain and range of motion in Adhesive Capsulitis. A total 56 subjects were selected for this non-randomized controlled trial in the Department of Physical Medicine and Rehabilitation, Chattogram Medical College Hospital with adhesive capsulitis in a period of 6 months. The subject were divided into two intervention groups; group-A with conventional treatment plan with SWD and group-B with conventional treatment only. Tool used for assessment were Visual Analogue Scale (VAS) to measure pain with Tenderness Grading (TG) and Shoulder Pain and Disability Index Score (SPADI). The analysis was done to measure the difference of effectiveness of both interventions by independent t-test with SPSS-20. Among 56 patients regarding analysis of sex in both groups male and female were matched (p>0.05) and male - female ratio was 1.66: 1. Considering socioeconomic status, poor was 21.4%, middle class was 44.6% and rich was 33.9%. Among all patients 35.7% were housewives, 16.1% were service holder, farmers were 12.5%, businessmen were 16.2% and laborers were 3.6%. In total patients, 48.2% had right shoulder involvement, 50.0% had left side involvement and one patient had both sided disease. There were 92.7% patients who had localized pain and only 7.3% had radiation. Majority of the experienced pain in the evening was 56.4% and rest had pain at night was 43.6%. About half of the patients in both groups had constant and intermittent type of pain 47.5% and 45.5% respectively other types were sharp and dull. Significant difference between Group A and Group B was found at week 2, week 4 and week 6 follow-up (p<0.05) whereas initial follow-up was non-significant in VAS analysis (p>0.05). Significant difference between Group A and Group B was found at week 2, week 4 and week 6 follow-up (p<0.05) regarding change of tenderness grading in Group A, then Group B patients. Significant difference between Group A and Group B was found at week 2, week 4 and week 6 follow-up (p<0.05) regarding SPADI. When SWD is combined with conventional management of adhesive capsulitis it gives better reduction in pain and disability. Conventional treatment plan with SED is more effective in the management of pain and reduce disabilities in patients with ACS. Bangladesh Med J. 2021 Sept; 51(1): 1-7

Assessment of Frequency of Polypharmacy along with its Relation to Dementia and Drug Adherence among Admitted Geriatric Patients in Medicine Wards of a Tertiary Care Hospital

Background: Polypharmacy has been associated with adverse drug reactions, medication errors and non- adherence to prescribe drugs and geriatric population is more prone to this condition. On the other hand, dementia is a major concern among growing chronic diseases in the ageing society and its assessment has not been adequately done in our setting. Method: One hundred subjects aged more≥60 years were included in this analytical cross-sectional from the Medicine Department of Chattogram Medical College Hospital from November 2018 to April 2019. A structured case record form collected data, and drug adherence were measured by Morisky Medication Adherence Scale-8 (MMAS-8). PP was defined as intake of e”5 drugs. Cognitive impairment was classified as presence or absence of dementia by Mini-cog tool. Results: The average age of individuals was 65.56±6.9 years and 62 were men. The prevalence of polypharmacy, dementia, and drug non-adherence was respectively, 56%, 47%, and 49%. Patients with polypharmacy were more likely to be non-adherent (odds ratio: 2.4; 95% CI: 1.1-5.4; p=0.039) and demented (odds ratio: 3.38; 95% CI: 1.1-11.8; p=0.019) than the elderly patients without polypharmacy. Conclusion: As there is significant association between polypharmacy with dementia and drug nonadherence, judicious use of drugs is mandatory to reduce these risk. J MEDICINE 2023; 24: 3-9

Role of Carbetocin over Oxytocin Followed by Caesarian Section

Introduction: Prevention of post-partum hemorrhage (PPH) is a major issue due to its impact on maternal mortality and morbidity. Primary post-partum hemorrhage (PPH) is the leading cause of maternal mortality in low- income countries and the primary cause of nearly one quarter of all maternal deaths globally. Aim of the Study: The aim of this study was to assess the effect of carbetocin over oxytocin in consequence of PPH. Methods: This was a cross- sectional study conducted in the Department of Obstetrics and Gynecology at Chattogram Medical College Hospital (CMCH), Chittagong, Bangladesh during the period from March 2018 to February 2019.Study population was the patient (n=100) with the risk of develops primary PPH following cesarean section. Women fulfilling inclusion criteria was included in the study and divided into 2 groups- Experimental group (n=50 cases) received 100μg of IV carbetocin through intravenous route; Control group (n= 50 cases) received 10 IU oxytocin through intravenous route. Data collection was done by the researcher after taking the written consent. Statistical analyses were done by SPSS 23. Result: In total 100 patients from both the groups completed the study. In our study we found the mean age was 25.20±5.43 years in carbetocin group and 25.90±5.83 years in oxytocin group. Regarding obstetric indications in carbetocin group majority (28.0%) patients had prolonged labour, 13 (26.0%) P/H/O C/S, 9 (18.0%) obstructed labour. In oxytocin group majority (38.0%) patients had P/H/O C/S, 14 (28.0%) had obstructed labour and 8 (16.0%) had prolonged labour. In 2 hours post-operative mean pulse was found 71.6±7.3 beats/min in carbetocin group and 68.9±5.9 beats/min in oxytocin group. Conclusion: In our study, it can be concluded that Carbetocin is as effective and safe as Oxytocin in the prevention of PPH following caesarean section. Carbetocin is more heat stable than oxytocin which is of crucial importance to resource poor settings like us. .......

Case Report: Hemophagocytic lymphohistiocytosis associated with acute polymyositis

Hemophagocytic lymphohistiocytosis (HLH) is a rare condition marked by uncontrolled histiocyte proliferation and activation, and phagocytosis of normal hematopoietic cells. This disease is rare, and a concurrent presentation with acute polymyositis is rare. A 14-year-old male was admitted to Chattogram Medical College Hospital with a high-grade fever for 25 days, generalized severe body aches, and multiple large joint pain in the lower limb for the same duration. On examination, the patient was found to have splenomegaly, tenderness in both knee joints, symmetrical proximal weakness of both lower limbs, several sensory losses, and loss of bowel and bladder control. The laboratory data showed that he had anemia, thrombocytopenia, hyperferritinemia, hypertriglyceridemia, hypofibrinogenemia, hypoalbuminemia, raised D-dimer, and serum creatine phosphokinase (S. CPK). Along with these, a bone marrow biopsy revealed hemophagocytic cells, and he was diagnosed with HLH with acute polymyositis (PM). The patient was treated with intravenous (IV) hydrocortisone and dexamethasone. Clinical stability was achieved with gradual improvement of initial symptoms and biochemical markers. The patient was discharged with oral steroids at a tapering dose and was advised to regularly follow-up.

Community Acquired Pneumonia in Bangladesh: Sensitivity Pattern, Clinical Courses and Outcome of a Cross Sectional Population

Background: Pneumonia acquired outside the hospital by an immune-competent individual is defined as community acquired pneumonia (CAP). It is to be distinguished, on the basis of a wider spectrum of pathogens, from nosocomial pneumonia from pneumonia in an immune-compromised host. Community-acquired pneumonia is associated with a significant mortality and morbidity. Etiology of CAP varies geographically and the understanding of local epidemiology plays an important role in decision making for empirical treatment before test results are available. Primary decisions about empirical antimicrobial treatment required knowledge of predominant microbial patterns and their sensitivities.
 Objectives: The aim of this study was to identify the bacterial etiology of CAP, their sensitivity towards empirical therapy and to observe the clinical course as well as short term outcome in hospitalized adult patients.
 Methodology: It was one year-long observational prospective study on 87 patients diagnosed with CAP admitted in Chattogram Medical College Hospital, second largest tertiary care hospital during August 2018 to July 2019. Sputum for Gram and Z-N staining, culture and sensitivity, blood for culture, sensitivity and PCR for Streptococcus pneumonia, Mycoplasma pneumoniae, Legionella pneumophila and Chlamydophila pneumonia were done. Patients were followed up for in-hospital outcome and 30-day mortality.
 Results: The mean age was 49.59 years and male - female ratio was 1.56: 1. Fever, chest pain and cough were the most common clinical findings. Klebsiella pneumoniae was identified (39.1%) in the majority of the patients, followed by Pseudomonas aeruginosa (10.3%), Staphylococcus aureus and Escherichia coli (5.7%). Staphylococcus aureus was positive in blood culture of one patient. Four samples were positive in PCR and identified Streptococcus pneumoniae. The sensitivity to meropenem, levofloxacin and amikacin was highest. The mean duration of hospital stay was 6.34 ± 2.37 days along with in-hospital mortality and 30-day mortality was 6.9% and 16.1% respectively.
 Conclusion: The bacteriologic profile of community acquired pneumonia revealed Gram-negative bacteria as pre-dominant organism by conventional sputum and blood culture. But need for further serologic tests for atypical and viral pathogens and development of institutional antibiogram to facilitate the choice for empirical therapy is required.

A case-control study to determine the risk factors of dengue fever in Chattogram, Bangladesh

ObjectivesIn a tropical country like Bangladesh, where the climatic condition favors the growth of Aedes mosquito vectors, the success of dengue prevention depends largely on the proper identification and control of risk factors. Therefore this study was aimed to explore the potential risk factors and their association with dengue infection. Study designA case-control study including 150 cases and 150 controls was conducted in Chattogram district of Bangladesh. Cases were confirmed dengue patients admitted in Chattogram medical college hospital and Bangladesh institute of tropical and infectious diseases during August and September 2019. On the other hand, controls were non-dengue patients admitted in other departments of the same hospitals through gender, age, and location matching. MethodsThe questionnaire data were collected through telephone-based interviews, which included general demography, daily life activities, housing and surrounding environment of participants. Chi-square and binary logistic regression were performed to identify potential risk factors. ResultsThe study found that travel history to the high incidence area, staying most of the daytime in office (AOR = 18.10), living in 21–40 years old houses (AOR = 9.74), and the temporary residency in the city (AOR = 10.20) were statistically significant risk factors for getting dengue infection. However, day time sleep, house type and structure, number of family members, morning and evening walk, plant in resident, and junk yard around 250 m of the house were also showed a significant effect in chi square test. ConclusionsResults strengthen our understanding regarding the role of factors associated with daily lifestyle and living environment of people in the development of dengue and hence support the dengue control program in Bangladesh. The study will provide a basis for future extended research covering different parts of the country.

Prostate Volume Measurement by Ultrasonography Over 40 Years Age of Bangladeshi Population

Background: Benign prostatic hyperplasia (BPH) or benign prostatic hypertrophy, is a histologic diagnosis status characterized by proliferation of the ‘glandular elements’ of the prostate, which may lead to an enlarged prostate gland. In many studies, people over the age of 40 years found as the most vulnerable for BPH. Ultrasonography is a prominent method to determine prostate volume or size. Aim of the study: The aim of the present study was to evaluate the prostate volume measurement for the Bangladeshi population over the age of 40 years by ultrasonography.Methods:This prospective, observational study was conducted in the Department of Anatomy, Chattogram Medical College Hospital, Chattogram, Bangladesh during the period from January 2019 to December 2020. In total 157 suspected patients of benign prostatic hyperplasia were selected as the study population. All patients were clinically diagnosed for BPH, based on the present prostate symptoms and digital rectal examination. To measure the prostate volume, abdominal ultrasonography was performed for all the patients. After enucleation, another ultrasonogram was performed for all the patients to measure the existing sizes of the prostates of the patients. All the data were processed, analyzed, and disseminated by MS-word and SPSS programs as per need.Results:Finally, in this study in analyzing the volumes of the prostates of the participants according to the abdominal ultra-sonographic reports of pre-operative stage we observed, in 9%, 34%, 31%, 30%, 21% and 32% patients, the prostate sizes (In cc) were <20, 21-40, 41-60, 61-80, 81-100 and >100 cc respectively. On the other hand, after enucleation, in 11.46%, 24.20%, 28.66%, 27.39%, 7.01% and 1.27% patients, the prostate sizes (In cc) were found <20, 21-40, 41-60, 61-80, 81-100 and >100 cc respectively. The mean changes of prostate sizes between pre- and post-operative stages among the participant was not significant where the P value was found 0.464.Conclusion:The findings of this study support the applications of abdominal ultrasonographic evaluation for suspected benign prostatic hyperplasia patients to know about the exact volumes of their prostates for selecting the appropriate surgical approach.

Metabolic Syndrome Among Physicians: A Pilot Study from Chattogram, Bangladesh

Background : Although the information on Metabolic Syndrome (MetS) in the general population from different parts of Bangladesh is available, the information regarding the same is scarcely available from physicians of Bangladesh. This study was aimed to assess the prevalence of MetS among physicians working at Chattogram Medical College Hospital, Bangladesh.
 Materials and methods : Data was collected for this cross-sectional study from 255 working physicians of Chittagong Medical College Hospital in 2018. The participants filled a structured questionnaire followed by physical and biochemical measurements including waist circumference, blood pressure, lipid profile, and fasting blood glucose. National Cholesterol Education Program’s Adult Treatment Panel III report (ATP III) defines criteria were used to identify physicians with the MetS.
 Results : Among 255 participants (males - 192 and females - 63), 100 (39.2%) were with MetS. Prevalence of same was higher in females (41.3%) than males (38.5%). The elderly physicians (>40 years) had a higher prevalence compared to the younger (£40 years) physicians [72 (50.3%) vs. 28 (25.0%)]. In the males, low High-Density Lipoproteins-Cholesterol (HDL-C) was the major contributor to the prevalence of MetS followed by high blood pressure. However, in females, low HDL-C and greater waist circumference contributed the maximum to MetS.
 Conclusion : This study showed a high prevalence of MetS among physicians of Bangladesh, and thereby warrants the urgent implementation of preventive health care strategies to reduce both morbidity and mortality related to this medical problem. Further studies ought to focus on the working conditions and lifestyles of individuals in these high-risk groups.
 Chatt Maa Shi Hosp Med Coll J; Vol.20 (2); July 2021; Page 65-68

A Prospective Observational Study between the Value of Sputum Cytology and FNAC of Bronchial Growth in Diagnosing Lung Cancer at Chattogram Medical College Hospital, Bangladesh

Background: Lung disease is viewed as perhaps the most far reaching and deadly malignancies all throughout the planet. The most seasoned and most crucial technique is based on sputum cytology. The last outskirts for getting sufficient material are fine needle yearning cytology (FNAC) of bronchial development. Aims and Objective: To relate the meaning of sputum cytology and fine needle goal cytology of bronchial tissue under CT rules for diagnosing cellular breakdown in the lungs. Materials and Methods: This potential observational investigation was completed by the division of medication in Chattogram Medical College Hospital, Chattogram, Bangladesh. Where data was collected from January 2019 to June 2020. A total of 50 patients with a suspected history, symptoms, and risk profile of having primary lung cancer, as demonstrated by chest radiography and CT scan, were chosen for the research population. Fifty patients with clinical and biochemical verification of suspected. All collected data were coding and input in SPSS-25 for further analysis. Both descriptive and inferential statistics were tested. Results: Among the 50 patients the vast majority of the patients were 51-60 years of age and the biggest number of the (94 %) patients were male. Sputum cytology is 8% touchy which isn’t steady with different examinations and CT guided FNAC is 94% sensitive. Conclusion: A definitive point of picture guided histological or cytological examination is to stay away from unnecessary thoracotomy and accomplish a particular determination with sensible exactness and least results. So, in this examination we found that sputum cytology is 8% delicate which isn’t steady with different investigations and CT guided FNAC is 94% touchy to last histological analysis of lung cancer. The discoveries recommended that CT guided FNAC discovered to be protected, feasible and viable.

Role of Serum Alphafetoprotein in Diagnosing Hepatocellular Carcinoma at the Hepatology Unit of A Tertiary Care Hospital

Background: Hepatocellular Carcinoma (HCC) is responsible for a large proportion of cancer deaths in Bangladesh. Alpha-fetoprotein (AFP) is a serum glycoprotein recognized as a marker for HCC, which is used to detect HCC. This study aimed to observe the level of AFP in the diagnosis of patients with HCC.
 Materials and methods: This cross sectional observational study has been carried out in the Department of Hepatology, Chattogram Medical College Hospital, Chattogram, Bangladesh, from January 2017 to December 2019. A total of 169 patients were enrolled in this research after consent. Patients were admitted to the hospital based on ultrasonographic findings and ultrasonographic guided Fine Needle Aspiration Cytology (FNAC) was done. 19 patients were lost from follow-up and 150 patients had completed the procedure and were finally evaluated. AFP was measured by automated Chemiluminescent immunoassays.
 Results: The age distribution of the study patients revealed that almost one-fourth (24%) of patients belonged to 51-60 years of age. The mean age was 55.6±16.64 years ranged from 25-80 years. The majority (90%) of patients were male and 15(10%) were female. It was observed that 64(42.7%) patients had HBsAg positive and almost onethird (29.3%) patients had Anti-HCV positive. Mean serum AFP was 8615.3 ±3629.3IU/ml and the range was 5.19-172000 IU/ml.AFP level was normal (<20 IU/ml) in 30 (20%) patients, moderately elevated (20-399 IU/ml) in 99(66%) patients and markedly elevated (>400 IU/ml) in 21 (14%) patients. Mean AFP was found 997.5±1813.8 IU/ml in multifocal HCC, 250.0±157.6 IU/ml in solitary HCC and 57455.7±82995.3 IU/ml in CLD with HCC. The mean AFP is statistically significant in different USG findings.
 Conclusions: Serum AFP level used alone is sufficient enough for HCC diagnosis majority of patients. But sometimes confirmation by FNAC can be helpful when confused in HCC diagnosis.
 JCMCTA 2021 ; 32 (1) : 40-43

Comparison of Conventional and Automated Blood Culture Methods for The Diagnosis of Neonatal Septicemia

Neonatal Septicemia is a serious clinical syndrome and the definitive diagnosis is based on positive blood cultures which are obtained either by conventional or automated method. Early availability of proper isolation and identification of causative bacteria facilitates the timely initiation of appropriate antibiotic therapy. Thereby the present study was conducted to identify the bacterial causes of neonatal septicemia in the fastest possible time by comparing conventional and automated blood culture methods.This cross sectional study was done during the period from January 2018 to December 2018 and included clinically suspected cases of neonatal septicemia admitted to Neonatal Intensive Care Units of Chattogram Medical College Hospital (CMCH) and Chattogram Maa-Shishu O General Hospital (CMSOGH). Out of 178 samples, automated method detected 29 (16.3%) and conventional method detected 26 (14.6%) blood culture positive samples. The yield of bacteria by automated method was 100% and by conventional method was 89.7%. Number of bacteria isolated only by automated method were 3 (10.2%). Mean time for isolation of bacteria by automated method was 26.38 hours and by conventional method was 46.34 hours. Automated method detected 47.05% of isolated bacteria in first 24 hours but none of them were detected by conventional method within first 24 hours. Among the isolated bacteria, Klebsiella spp was most common (62.0%). Most of the isolates were resistant to Ampicillin, Cefotaxime and Ceftazidime. Analyzing the findings of the study, there was no significant difference in the rate of isolation in each time interval (p=0.157) of two methods but there was significant difference in the mean time of isolation of bacteria between two methods (p=0.000004).
 Bangladesh J Med Microbiol 2021; 15 (2): 12-18

Level of Knowledge about Covid 19 during Pregnancy.

Introduction: Coronavirus disease (COVID-19) is a respiratory disease. The aim of this study was to assess the level and knowledge and types of attitudes towards COVID-19 among pregnant women attending OPD of Gynecology for an antenatal check-up in Chattogram Medical College Hospital of Bangladesh.
 Methods: This was an interview-based cross-sectional study that was conducted at the Department of Obstetric Gynae, Ashiyan Medical College Hospital, Barua Khilkhet, Dhaka, Bangladesh during the period from 1st June to 30th July 2020. In total 100 pregnant women who had an antenatal check-up for their current pregnancy in the hospital during the study period were selected as the study population. All data were processed, analyzed, and deiminated by MS Office and SPSS version 25 as per need.
 Result: The majority of the participants were young adults aged between 25-34 years old. Most of them (79%) were housewives. 64% of the participants were of middle economic status. The majority of the participants believed fever and dry cough to be a symptom of COVID-19. 73% believed that pregnant women have a higher risk with COVID-19 than others. 38% thought that COVID is common only in a cold climate, but 49% disagreed with this fact. Proper knowledge of COVID-19 was common in 41% of the participants only. And 35% of the total participants had a positive attitude towards the current pandemic, which was below satisfaction level.
 Conclusion: knowledge level of the participants was found satisfactory but the attitude was found lower than the general satisfaction level.

Dengue Outbreak in Children During 2019: Experience at A Tertiary Care teaching Hospital

Background: Dengue outbreaks are hitting different geographic locations, different clinical manifestations are being reported recently. This study was aimed to describe the clinico-epidemiological profile and outcome of dengue infected children during 2019 dengue outbreak in Chattogram.
 Materials and methods: This hospital based prospective observational study was carried out in the Department of Pediatrics in Chattogram Medical College Hospital. Serologically positive dengue cases (Aged £12 years) admitted from July 2019 to December 2019 were enrolled in the study. Hospital outcome of the patient’s was recorded in terms of mortality, Length of Hospital Stay (LOS) need for ICU.
 Results: Out of total 192 patients as per the National Guideline 66.7% cases were classified as dengue fever without warning signs, 21.9% as dengue fever with warning signs and 11.5% as severe dengue. Overall the mean age was 7.04 (±3.23) years with male preponderance (59%). Along with fever main complaints were abdominal pain (91.7%), vomiting (47.9%) and headache (23.6%). Marked thrombocytopenia (Below 50,000) was present in 37.9%, leucopenia in 27.9% and raised haematocrit in 10.9% of cases. Average LOS was 5.2 (±1.9) days, 18 (9.5%) patients need ICU admission and there was no fatality in this series. Some clinical (Vomiting, flusihing, shock, reduced urinary output) and laboratory (Marked thrombocytopenia, leucopenia, hemoconcentration, pleural effusion and hepatomegaly) variables were associated with severity.
 Conclusion: Fever with abdominal pain were common presentations of dengue fever. Severe dengue patients presented with vomiting, flashing and shock. Marked thrombocytopenia and pleural effusion and/or ascites were related to shock. Appropriate and timely management is very effective in reducing case fatality.
 Chatt Maa Shi Hosp Med Coll J; Vol.20 (1); January 2021; Page 46-50

Pattern of UTI in Chronic Kidney Disease: Experience from A Tertiary Care Hospital, Bangladesh

Background: Urinary Tract Infection (UTI) is common and higher in prevalence in patients with Chronic Kidney Disease (CKD). To find out the frequency and clinicobacteriological pattern of UTI in CKD patients.
 Materials and methods: A cross-sectional study was done on 1000 of CKD patients attending Nephrology Department of Chattogram Medical College Hospital (CMCH) a tertiary level hospital in Bangladesh during January to December, 2017. Cleancatch midstream urine samples were collected from study populations irrespective of symptoms. Macroscopic and microscopic examinations were done. Urine samples were then inoculated in Blood agar and Mac’Conkey agar and incubated aerobically at 37 °C for 18-24 hours. Microscopic observations and conventional biochemical tests were done to identify the isolated organisms. Significant growth of organisms in urine was defined as UTI. The isolated organisms were tested for antimicrobial susceptibility by using modified Kirby Bauer technique.
 Results: The prevalence of UTI was 61.8%. with significant asymptomatic UTI for 28%. Gram-negative organisms were most frequent 564 (93%) with predominant Escherichia coli 399 (64%) followed by Klebsiella 113(18%) and Pseudomonas 39(6%). Among Gram positive isolates, Staphylococcus (6%) was the dominant organism isolated. Regarding antibiotic susceptibility, Gram-negative microorganisms were found to be most sensitive to carbapenem and amikacin whereas Gram-positive microorganisms were most sensitive towards carbapenem, colistin and linezolid.
 Conclusion: In CKD patients, asymptomatic UTI was detected significantly. E.coli was found to be predominant organisms and resistant towards most of the studied common antibiotics.
 Chatt Maa Shi Hosp Med Coll J; Vol.20 (1); January 2021; Page 41-45

Miniaturization of PCNL; Necessity or What?

Objective: Now a days, percutaneous nephrolithotomy (PCNL) is the treatment of choice for retrieval of renal and proximal ureteral calculi. The primary goal of PCNL is to achieve stone free status while minimizing morbidity and complications. In recent years, the instruments used have been miniaturized in an effort to decrease morbidity associated with standard PCNL as well as increase the efficacy of stone removal. The aim of this study was to compare the safety and efficacy of PCNL using different tract size. Patients and Methods: This hospital based prospective interventional study was conducted on patients with 1 to 4 cm renal stones who underwent PCNL either by Mini or by Standard PCNL technique in Chattogram Medical College Hospital and different private hospitals in Chattogram from July 2016 to October 2018. Patients aged above 12 years of age, irrespective of gender with normal renal function were evaluated to compare stone clearance, access time, fluoroscopy time for access, total operative time, need for blood transfusion, postoperative hospital stay, postoperative pain, fever, urinary leakage and other complications between two groups. Those who had previous history of open renal surgery, active urinary tract infection, renal malformation, uncorrected coagulopathy and morbid obesity were excluded. Results: A total of 78 patients were enrolled consecutively for PCNL who were divided equally into two groups randomly for minimally invasive PCNL (Mini-PCNL) and Standard PCNL. The average stone size in mini-PCNL group was 2.59±0.89 cm, and 2.66±0.97 cm in standard-PCNL group (p=0.7). Mean tract size was 18.53 ± 1.29 F (16-20) and 26.11 ± 4.61 F (24-30) respectively with P value <0.001. In mini-PCNL operative time was significantly longer than that of standard PCNL with 112.11 ± 20.29 vs. 98.68± 19.75 minutes respectively with p=.004. Conversely, there was an advantage of mini-PCNL over the standard one in terms of a significantly reduced hemoglobin drop (0.5 ± 0.26 vs. 0.83 ± 0.32 gm%, p value 0.001) and hospital stay (2.18 ± 0.77 vs. 3.39 ± 1.10 days, p value= 0.001), respectively though there was no statistical difference in terms of stone clearance rates between two groups (86.84% vs. 92.11%, p=0.45). There was no statistical difference in terms of visual analogue scale (VAS) score (5.55±1.54 vs. 6.24±1.6) for pain perception. The complication rate of mini-PCNL had no significant difference with that of standard PCNL (10.52% vs 12.50%, p=0.72). No statistical difference was recorded in terms of postoperative fever (eŠ38C) between two groups (2 in each group, 5.2%, p=1 Blood transfusion requirement was much less in mini PCNL group (10.52% vs. 34.2%, p=0.01). Conclusion: In addition to minimal bleeding and excellent stone clearance, mini- PCNL has several features for which it should be considered as an alternative or adjunct tostandard PCNL, URS, and ESWL. These include safe supra-costal puncture, excellent access to nearly all calyces and upper ureter, less hospital stay and suitable for large stones also. Future studies should continue to refine methods to assess complexity and safety and to determine consensus on the use of mini- PCNL. Bangladesh Journal of Urology, Vol. 23, No. 1, January 2020 p.11-16

Epidemiological characteristics of child injury in a tertiary paediatric surgical centre in Bangladesh

While high income countries (HICs) have reduced the mortality from child injury, it is increasing in the low- and middle-income countries (LMICs). However, injury registry and reporting are inconsistent and not well developed in the LMICs. This study aims at describing the epidemiology of child injury in a tertiary paediatric surgical centre in Bangladesh. We retrospectively analysed all patients of injury between 0 and 12 years of age admitted in the Department of Paediatric Surgery, Chattogram Medical College Hospital during January 2017 to June 2020. Analysis was done for the hospital prevalence, age and sex distribution, seasonal variations, mechanism of injury, site of involvement, and mortality from injury. There were a total of 538 patients and male to female ratio was 2.01:1. Hospital prevalence was 6.71%. Mean age was 6.60 ± 3.32 years. School age children were affected more (51.7%); and “6-10 years” age group had the highest number injuries (251 patients, 46.65%). The most common mechanisms of injuries were road-traffic accident (RTA, 35.32%), followed by fall (26.39%) and „stab or cut injury‟ (20.63%). Males experienced more abdominal injuries and females had more perineal injuries (P=0.00). RTA was the commonest mechanism in males (37.05%) and falls were the commonest mechanism in females (32.96%). „Stab or cut injury‟ was the commonest mechanism in infants and toddlers, and RTA was commonest among pre-school and school age children. There were no significant seasonal variations (P=0.09). There were 5.76% intentional injuries. Mortality was 2.60% and major causes of mortality were RTA and animal assaults. Injuries were more prevalent during the mid-childhood with an overall increasing trend with age. Mechanism of injury and site of involvement were different among different age groups and between sexes.
 Asian J. Med. Biol. Res. September 2020, 6(3): 577-586