Chattogram Medical College Research Articles

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.

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

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

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

Video Laryngoscopic Endotracheal Intubation in Cardiac Operation Theater - Experience at a Peripheral Tertiary Healthcare Centre of Bangladesh

Background: Endotracheal intubation is an essential primary skill for all anesthesiologists. For cardiac anesthesiologists rapid and proper intubation is more important as failure may cause serious consequences. Video laryngoscope provides a better real time view of the larynx, epiglottis and vocal cords. It also keeps the intubating anesthetist away from the patient as compared to conventional laryngoscopy. This may be very important in this COVID-19 era. To the best of our knowledge the Department of Cardiac Surgery and Cardiac Anesthesia of Chattogram Medical College & Hospital is the first center in Bangladesh to introduce video laryngoscope in cardiac OT.
 The objective of this study was aimed to compare the intubation time, hemodynamic response to laryngoscopy, success rates and operator’s comfort using the conventional Macintosh laryngoscope and video laryngoscope in adult patients undergoing cardiac surgery.
 Materials and Methods: A total of 60 adult patients were included in this comparative study, subjected to general anesthesia for cardiac surgery, intubated using either conventional Macintosh direct laryngoscope or video laryngoscope. Patients were intubated by 3 different consultant anesthesiologists with equal competency of our department.
 Results: There was not much difference between Video laryngoscopy and conventional laryngoscopy in terms of intubation time and success rate. Video laryngoscopy exhibited less hemodynamic response to laryngoscopy and intubation; however, the difference was not statistically significant in this small group of patients. Operators were much more comfortable with Video laryngoscope than conventional laryngoscope particularly with the cases of difficult intubation because of the better glottic view with the former.
 Conclusion: Video laryngoscope is preferred by cardiac anesthetists because of better glottic view.
 Bangladesh Heart Journal 2020; 35(1) : 47-53

Prevalence and Pattern of Birth Defects among Pediatric Surgical Patients: A 12-Year Analysis in a Tertiary-level Government Hospital in Bangladesh

Aims: Birth defects are structural or functional abnormalities which occur during the intrauterine life but can be identified at birth or a later age. Birth defects are major public health concerns and the World Health organization (WHO) is supporting countries for earlier diagnosis and better treatment of these conditions. The aim of the study was to assess the hospital-based prevalence and types of birth defects among the surgical children from a part of the world where these are underreported.
 Materials and Methods: We retrospectively analyzed patients of birth defects admitted in the Department of Pediatric Surgery, Chattogram Medical College Hospital, Bangladesh for a period of 12 years (2008-2019). Data were extracted from annual admission reports, annual audits, mortality and morbidity audits, death registers and computerize data base. Yearly distribution of birth defects, type of defects and their systemic distribution and mortality were analyzed.
 Results: Among a total of 30,301 admitted patients 30.72% (9307 patients) had birth defects. The most common system involved with birth defects was gastrointestinal (GI) system, 30.61% followed by genitourinary (GU), 29.15% system. Congenital inguinal hernia (17.50%) was the most common disease, followed by hypospadias (14.54%) and anorectal malformation (ARM); 13.98%. Mortality from birth defects were 53.25% of all mortalities. ARM was the most common cause of death (23%), followed by gastroschisis (16%) and intestinal atresia (11%). Highest mortality rates were in tracheo-esophageal fistula/esophageal atresia (TEF/EA)- 83.33%, gastroschisis-80.92%; intestinal atresia-42.53%; omphalocele-32.48%; and congenital diaphragmatic hernia (CDH)- 27.78%.
 Conclusion: Pattern of birth defects and outcome varied from other countries. The prevalence is 31% among pediatric surgical admissions. Some conditions have extremely high mortality rates and need better management.

Cytomorphometric Analysis of Exfoliated Buccal Mucosal Cells in Diabetic Patients

Background: Diabetes mellitus is a common metabolic disease that causeschronic hyperglycemia and disturbance in carbohydrate, lipid and proteinmetabolism. It causes various changes in the cells of the oral mucosa, which canbe determined by exfoliative cytology. The aim of this study was to study theCytomorphometric alterations of exfoliated buccal mucosal cells in diabeticpatients and to establish an additional diagnostic tool in diabetic patients inChattogram area.
 Materials and methods: It was a cross-sectional comparative study carried outin the Department of Pathology, Chattogram Medical College, Chattogram. Oralsmears were obtained from 88 diabetic patients and 88 healthy individuals. Thesmears were stained with Papanicolaou solution. The cell diameter and nucleardiameter of 50 clearly defined cells were measured by multi-head microscope(OLYMPUS B51X). The cytoplasmic area and nucleus-cytoplasmic ratio werethen calculated. SPSS software (version 17) was used for statistical analysis ofthe study.
 Results: In the result, mean Cell Diameter (CD), Nuclear Diameter (ND),cytoplasmic diameter (CyD) and N/C ratio of diabetic patients and healthy werefound to be 250.29 ± 29.02 μm, 54.48 ± 4.03 μm, 195.81 ± 27.97 μm, 0.283 ±0.04 and 287.15 ± 25.23 μm, 47.41 ± 2.52 μm, 239.74 ± 24.45 μm, 0.199 ± 0.02.A statistically significant increase in ND & N/C ratio and decrease in CD &CyDwere observed in diabetic patients compared to control. In addition, it wasfound that age, sex, blood sugar level, duration and treatment history ofdiabetes do not affect the morphometric changes significantly.
 Conclusions: Result of this study suggests that diabetes produces definitemorphometric changes in the exfoliated buccal mucosal cells. Exfoliativecytology can be useful as an additional tool to aid in diagnosis of diabetesmellitus.
 Chatt Maa Shi Hosp Med Coll J; Vol.19 (1); January 2020; Page 3-7

Identification of Etiological Agents of Pyogenic Meningitis by Gram Stain Culture in the Patients Admitted in Two Hospital

Background: Bacterial meningitis is an important cause of mortality and long termmorbidity. Early and accurate diagnosis of bacterial meningitis is of criticalconcern.The bacterial meningitis epidemiological landscape is not static andetiological agent varies with age and immune status and different geographic area.A simple Gram stained smear can offer immediate clues to aid the diagnosis ofpyogenic meningitis. This study was performed to identify the causative agents ofpyogenic meningitis.
 Materials and methods: This cross sectional study was carried out in theDepartment of Microbiology, Chattogram Medical College for cytologicalexamination, biochemical tests, Gram’s stain, culture. The gold standard fordiagnosis of any infection including meningitis is the isolation and identification ofthe causative agent.
 Results: Among the 144 suspected meningitis cases, according to cytological andbiochemical findings 36 (25%) were categorized as probable bacterial meningitiscases and 68(47.22%) cases were viral meningitis, normal level of protein, glucoseand cell count were found in 40 (27.78%) cases. Among the 36 cases of probablebacterial meningitis, culture was positive in 12 (33.33%) and Gram’s stain waspositive in 9 (25%) cases. Streptococcus pneumoniae was the predominent organismdetected by isolation in 6(50%).
 Conclusion: S. pneumoniae is the predominant cause of pyogenic meningitis.
 Chatt Maa Shi Hosp Med Coll J; Vol.19 (1); January 2020; Page 24-27

Adherence to Antiepileptic Drugs and Seizure Control Among Patients with Epilepsy

Background: Anti-Epileptic Drugs (AEDs) are the primary therapeutic modes forepileptic patients and have been demonstrated to control seizure, which decreasesmorbidity and mortality associated with epilepsy. There is a paucity of data on drugadherence and seizure control status among epileptic patients in Bangladesh. Theaim of this study was therefore to assess adherence among epileptic patients and tosee association between adherence and control of seizures.
 Methods and materials: A cross-sectional observational study was conductedamong 253 patients who visited into outdoor and admitted inindoor of Neurologyand Medicine Department of Chattogram Medical College Hospital (CMCH) with aclinical diagnosis of epilepsy. Epileptic Patients who had taken AED for at least oneyear or more were recruited in the study to evaluate adherence and seizure controlthrough patient interview. Factors affecting adherence were determined usingregression analysis.
 Results: 38.8% patients were adherent to their treatment and only 33.6% of thepatients had controlled seizure, forgetfulness (35%) was the most reason for nonadherence.Monontherapy was commonly (72.7%) used, among which Valproic acidwas the most commonly utilized (30.4%) single anticonvulsant drug. Many factorswere affecting patient’s adherence such as socio-demographic related factors (age,education, occupation), therapy related factors and cost. Adherence to AED wasfound to have a significant association with seizure control status.
 Conclusions: The rate of adherence observed in this study was low. The mostcommon reason for nonadherence was forgetfulness. The findings indicate thatadherence was associated with well seizure control.
 Chatt Maa Shi Hosp Med Coll J; Vol.19 (1); January 2020; Page 68-73

Patient Waiting Time in Emergency Department of a Tertiary Level Hospital

Background: Patient waiting time is an important factor of utilizing hospital service, patient satisfaction, quality of management etc. Hence, emergency department (ED) performance can be best assessed by measuring patients’ waiting time and affecting factors at this department.
 Objective: To determine patient waiting time at ED and associated factors in a tertiary level hospital.
 Materials and methods: This cross sectional study was conducted in ED of Chattogram Medical College & Hospital (CMCH), Bangladesh. A total of 175 patients or their attendants at ED were enrolled by convenient sampling technique. Data were collected by face- to- face interview with pretested semi-structured questionnaire and observational checklist. Descriptive statistics was used for analysis by MS Excel and SPSS 21st version windows software.
 Result: Around half (47.40%) was male followed by female (32%) and children (20.6%). Mean (± SD) age of the patients was 33.69 ± 21.33 years. More than half (52.6%) were from rural areas followed by urban areas (47.7%). Average monthly family income was Tk. 23891.43(±13033.76). Mean (±SD) waiting time for collecting ticket, consultation with doctor, physical examination, and nursing services were 8.06(±7.98) minutes, 5.46(±6.95) minutes, 2.30(±1.11) minutes and 8(±6.22) minutes respectively. More than two fifth (41.1%) patients had waiting time within 5 minutes. The ratio of doctor/patient, nurse/patient, ticket provider/patient and trolleys & wheel chairs bearer/patient were 1:115, 1:58, 1:115 and 1:40 respectively. Majority of the patients (57.7%) were transferred to Inpatient Department (IPD). Statistically significant relationship was found between satisfaction on overall management and overall waiting time of ED (χ2 = 22.47, df =6, p=0.001).
 Conclusion: Majority (48.1%) found satisfied with waiting time at the emergency department.
 JOPSOM 2019; 38(2): 15-21

Value of PAP’s Smear with Regard to DNA Testing for Identification of Cervical Precancerous Lesions in VIA Positive Cases

Background: Carcinoma cervix is one of the cause of female death in developing country like Bangladesh. Prevention can be done by several screening procedure like VIA, Pap's smear, HPV DNA testing, Colposcopy and colposcopy directed biopsy. We can markedly reduce the mortality and morbidity by these procedures and can be detected carcinoma in precancerous and very early carcinoma stage. This study was conducted to compare HPV DNA testing and pap’s smear for identification of cervical precancerous lesions in VIA positive cases.
 Materials and methods: It was an analytical type of cross sectional study. Data were obtained in outpatient Department of Gynecology and Obstetrics, Chattogram Medical College Hospital, Chattogram from July 2014 to December 2014. Total 90 subjects were included in the study consecutively after considering inclusion and exclusion criteria and taking written informed consent. Data analysis was done by SPSS (Version 17).
 Results: Histopathology findings of biopsy materials of colposcopy positive cases where 8(28.6%) were chronic cervicitis, 10(35.7%) were CIN I, 7(25.0%) were CIN II, 3(10.7%) were CIN III. Total 20(71.4%) cases were found positive or precancerous. Regarding validity analysis of different tests that were performed for cervical precancerous conditions taking histopathology results as a gold standard, sensitivity of Pap’s smear was found lower (75.0%) than the HPV DNA whereas specificity of Pap’s Smear was higher (87.5%) then the specificity of HPV DNA (75.0%).
 Conclusion: HPV DNA testing was both more sensitive and specific near to Pap cytology. So the use of a less invasive and more user friendly primary screening strategy like HPV-DNA testing may be required to achieve the coverage necessary for effective reduction in cervical cancer mortality.
 Chatt Maa Shi Hosp Med Coll J; Vol.18 (2); July 2019; Page 27-32

Effect of Combined Use of Oral Prednisolone and Propranolol in the Treatment of Infantile Hemangioma: A Single Center Study

Background : Infantile hemangioma is a benign vascular tumor. Considerable controversy exists as to the management of hemangiomas. The purpose of this study was to see the efficacy and safety of orally administered prednisolone and propranolol in combination for treatment of potentially disfiguring or functionally threatening hemangiomas
 Materials and methods: In this prospective study, thirty two patients of hemangioma with age range of 1 month to 5 years were included who were treated with oral propranolol (1 mg/kg/ day in two divided doses) and oral prednisolone (2 mg/Kg/ day in single dose) in combination. This study was conducted in outpatient Department of Pediatric Surgery of Chattogram Medical College Hospital from January 2016 to December 2017. Changes in size and color of lesions were the two evaluating factors to see the efficacy of the treatment. Therapeutic response was graded as excellent, good, poor and no response.
 Results: Overall therapeutic response was 92.62% (29 patients). Excellent response was noted in 21 patients (65.62%) and in 3 patients (9.38%) there was no response. Range of treatment period was 6 to 20 weeks. No side effects except excessive weight gain was noted (6.25%).
 Conclusion: Combined use of low dose oral prednisolone and propranolol is more effective and safe for treatment of hemangioma.
 Chatt Maa Shi Hosp Med Coll J; Vol.18 (2); July 2019; Page 23-26

Tract Size in Percutaneous Nephrolithotomy (PCNL) : Does It Really Matter?

Background : Percutaneous Nephrolithotomy (PCNL) is the treatment of choice in removal 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 is to compare the safety and efficacy of PCNL using different tract size.
 Materials and methods: This hospital based prospective interventional study was conducted on patients with 1 to 4 cm renal stones who underwent PCNL either by Minior Standard PCNL technique in Chattogram Medical College Hospital and different private hospitals in Chittagong from July 2016 to June 2018. Patients aged above 12 years of age, irrespective of gender with normal renal function were evaluated to compare stone clearance, total operative time, need for blood transfusion, postoperative pain and other complications. 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 64 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 2.64 ± 0.94 cm and 2.776 ± 0.97 cm in standard-PCNL group. Mean tract size was 18.44 ± 1.32 F (16-20) and 26.7 ± 5 F (24-30) respectively. In mini-PCNL operative time was significantly longer than that of standard PCNL with 110.31 ± 21.77 vs 95.94 ± 19.82 min respectively. Conversely, there was an advantage of mini-PCNL over the standard one in terms of a significantly reduced hemoglobin drop (0.5 ± 0.25 vs. 0.8 ± 0.34) gram and hospital stay (2.13 ± 0.79 vs.3.38 ± 1.13 days) respectively though there was no statistical difference in terms of stone clearance rates between two groups (86.7% vs. 93.33%). There was no statistical difference in terms of Visual Analogue Scale (VAS) score (5.44 ± 1.5 vs.6.19 ± 1.65) for pain perception. The complication rate of mini-PCNL had no significant difference with that of standard PCNL (10% vs 13.6%). No statistical difference was recorded in terms of postoperative fever (³38oC) between two groups (2 in each group, 6.67%, p=1). Blood transfusion requirement was much less in mini PCNL group (10% vs. 33.33%).
 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 to standard 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.
 Chatt Maa Shi Hosp Med Coll J; Vol.18 (2); July 2019; Page 18-22

Let’s Explore: Predictive Ability of Urinalysis for Diagnosis of Urinary Tract Infection in CKD Patients

Background: Immuno-compromised Chronic Kidney Disease (CKD) patients are more vulnerable to infection. Among all infections, Urinary Tract Infection (UTI) is the main culprit of increased morbidity and mortality. So to combat this and to retard disease progression, control of UTI is a prime concern for this group of patients. Quantitative urine culture is the 'gold standard' method for definitive diagnosis of urinary-tract infections, but it is intensively time and labor consuming. For initiating early empirical treatment even in absence of localizing symptoms, the same day result is very helpful. Culture may lead to delaying of diagnosis. The microscopy of urine thus may be an essential tool for the diagnosis of patients with urinary tract infections. The aim of this study was to evaluate the diagnostic performance of the common urinalysis parameters in comparison to urine culture as the reference method.
 Materials and methods: We evaluated 1000 urine samples, submitted for urine analysis and culture admitted in Nephrology ward, Chattogram Medical College Hospital, a large tertiary care hospital for one year from 1st January 2017 to 31st December 2017. A cross-sectional study was done. Different Cut-off values were determined from different studies obtained by comparing the results with urine cultures. The test characteristics by the sensitivity, specificity, PPV and NPV were calculated for bacteria and White Blood Cells (WBCs) Red Blood Cells (RBC) glucose in urine and albuminuria. A practical diagnostic threshold of bacteriuria was determined. The diagnostic performance of culture was compared with different parameters of urinalysis.
 Results: Among the 1000 urine specimens submitted for culture, 618 cultures (61.8%) were positive, and 382 were (38.2%) negative. The cut-off value for pyuria was determined ³10 pus cell/HPF and compared for bacteriuria (Sensitivity: 69%, specificity: 36%, PPV: 64%, NPV: 42%) and presence of sugar and albumin in urine were found associated significantly with culture positivity at 95% CI (Sensitivity: 15%, specificity: 90%, PPV: 70%, NPP: 39% and sensitivity: 97%, specificity: 6%, PPV: 62%, NPP: 59%) respectively. And association between RBC and pus cell in urine microscopy was significant.
 Conclusions: UTI is a common infection in CKD patients with high incidence. Though culture is the gold standard, but urinalysis by cell count for pyuria, dipsticks for the presence of sugar or albumin may be helpful to diagnose UTI. The association of these all characteristics with growth in culture was statistically significant.
 JCMCTA 2020 ; 31 (1) : 26-30

Hypospadias Repair in Children: A 5-Year Experience from a Pediatric Surgery Department of Chittagong Medical College

Background: Hypospadias a very common condition in the children and the incidence is increasing. Here we present our experience of managing hypospadias patients over the last five years. 
 Materials and methods: It was a retrospective study from 2014 to 2018 in the Department of Pediatric Surgery, Chattogram Medical College Hospital. Records of all hypospadias patients were analyzed and type of hypospadias, age at repair, type of repair and admission with complication of hypospadias were recorded. 
 Results: A total of 492 boys were admitted with the diagnosis of hypospadias and 272 boys underwent hypospadias surgery. Distal penile hypospadias (148 patients, 30%) was the commonest variety followed by coronal hypospadias (144 patients, 29%). Age at surgery ranged from 6 months to 19 years with a mean age of 7±4 years. General anesthesia was given in 133 patients (64.7%) spinal anesthesia in 93 patients (31.8%) local anesthesia in 7 patients (2.4%) and caudal block in 3 patients (1%). Urethro-cutaneous fistula, failed urethroplasty and meatal stenosis are the admissions with hypospadias complications. 
 Conclusion: Hypospadias is still common with substantial number of complications. Health education is necessary to reduce age at surgery.
 JCMCTA 2020 ; 31 (1) : 38-41

Antibiotic resistance and sensitivity pattern of Metallo-β-Lactamase Producing Gram-Negative Bacilli in ventilator-associated pneumonia in the intensive care unit of a public medical school hospital in Bangladesh

ABSTRACT Background Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in intensive care units (ICU), accounting for 25% of all ICU infections. Antimicrobial resistance is increasing and becoming a significant health problem worldwide, increasing hospital length of stay, mortality and costs. Identifying antibiotic resistance patterns in VAP is important as this can cause outbreaks in ICUs. To date, there have been limited studies assessing this in Bangladesh. Consequently, the primary objective of this research was to study the species of bacterial growth and to determine the antibiotic resistance patterns of Metallo-β-Lactamase (MBL) producing gram-negative bacilli among ICU patients with VAP in a public medical school hospital, Bangladesh. In addition, identify the factors associated with a positive culture to provide future guidance. Method Cross-sectional study performed in the Chattogram Medical College Hospital, Bangladesh. Mueller Hinton agar plates were used for antibiotic sensitivity testing by the Kirby-Buer disc diffusion test. Results Among 105 clinically suspected VAP cases, qualitative cultures were positive in 95 (90%) of them. The most common bacteria identified were Acinetobacter spp. (43.2%), Klebsiella spp. (20%) and Pseudomonas spp. (18.9%). A positive culture was not associated with patients’ age or gender. Among 41 isolated Acinetobacter spp., 38 (92.7%) were resistant to gentamicin followed by 36 (87.8%) to ceftriaxone. Among 24 isolated Klebsiella spp., 22 (83.3%) were resistant to ceftriaxone. Among 18 isolated Pseudomonas spp., 16 (88.8%) were resistant to ciprofloxacin, and 13 (72.2%) were resistant to ceftriaxone. Among nine isolated E. coli, all were resistant to ceftriaxone and ciprofloxacin. All four Proteus spp. (100%) isolated were resistant to ciprofloxacin. Additionally, phenotype MBL producing was 65.22% and genotype was 45.65% among imipenem resistant pathogens. Imipenem resistant pathogens were sensitive to amoxyclav, amikacin¸ azithromycin, ceftazidime, ceftriaxone, colistin and gentamycin. Conclusion A positive culture was detected in 90% of VAP patients, but it was not associated with the patients’ age and gender. The most common bacteria identified were Acinetobacter spp., Klebsiella spp. and Pseudomonas spp., where the majority of these were resistant to ceftriaxone. The results are being used to provide future guidance on the empiric management of VAP in this hospital.

Reconstructive Run for Life : A Case Report

Southeast part of the country resides more than 35 million people and Chattogram Medical College Hospital is the center hub for trauma management of this region. Trauma includes industrial injury as well as road traffic accident along with electric burn. Plastic Surgery department deals with this trauma patient for soft tissue coverage. The study shown four electric burn and one cancer patients having flap surgery for their wound coverage. In this study patients selected randomly over a period of one year. Wound at different part of body including head, neck, palm, hand, axilla and heel. We gave five different flaps to cover trauma and cancer defect. Wounds like various trauma including electric burns, cancer and snake bite. Snake bites are common in this hilly terrain. Cancer like SCC and malignant melanoma is also common in the long marine shore of Bay of Bengal. Flap maintain form and function of affected part which improves quality of life. Most of patients are young teenage, only two are elderly. About six months follow up flapsshow, are in good functionaland cosmetic outcome with no residual morbidity. All patients undergonea rehabilitation procedure to normal life.
 JCMCTA 2019 ; 30 (2) : 102-108

Rohingya Crisis: An Added Challenge in Neurosurgical Arena of Chattogram Medical College Hospital

Rohingya are the group of people who has an specific ethnic, linguistic and religious group lived in the former Arakan state, renamed as Rakhain state of Myanmar. These people are homeless, stateless and disowned by their own government. Chattogram Medical College Hospital is the only tertiary level government hospital nearest to the Rohingya camp where Rohingya patients are referred from local health care providers. On a cross sectional observational demographic study conducted in the Department of Neurosurgery, CMCH revealed that, total number of admitted patient in CMCH is 757 among which 137 (18.09%) patient was admitted in Department of Neurosurgery since the Rohingya citizens are forcibly displaced from their land. Traumatic brain injury (31) , spinal injury (22) and gun shot wound (3) are the most common presentation as a result of ethnic cleansing. But lack of primary health care support, proper health education leads to development of hydrocephalus (8), meningocele (8), meningomyelocele (1) in children and delayed presentation of ICSOL (15) and Spinal SOL (2) are also observed among the admitted patients. 67 (48.90%) patients were treated conservatively and 70 (51.09%) patients are treated operatively. Despite the existing over crowded patients from the Chattogram Division, these Rohingya patients made an added challenge to the Department of Neurosurgery. Proper strategic plan should be carried out for the management of neurosurgical condition for decreasing mortality and morbidity and thus support humanity above all. Bang. J Neurosurgery 2020; 9(2): 111-116

A Comparative Study between SAM with Edema and SAM without Edema and Associated Factors Influencing Treatment, Outcome & Recovery

Severe acute malnutrition (SAM) is an established contributor of under-five mortality and morbidity. Achieving desired treatment outcome has proven to be challenging. There is limited data concluding the success of treatments in the study area. Objective: This study was aimed to compare the recovery from severe acute malnutrition with identified medical complications where presence or absence of edema denotes a major predictor among children aged 0-59 months of age. Methods: This was a retrospective observational study on facility based management which was conducted in SAM block of Chattogram Medical College hospital, Chattogram, Bangladesh. Here a total of 485 patients were admitted during the period of 2013-2017 and among them, 266 patients were successfully discharged from the hospital. Based on WHO & National guidelines for management of severely malnourished children in Bangladesh, treatment protocol, admission and discharge criteria were followed. A structured and prescribed data format was prepared and data were collected from the hospital records. Daily observation, monitoring and follow-up notes of the patients were also recorded. After data collection, they were cleaned, edited and stored into excel, EPI-INFO and analyzed by SPSS. Results: More than half of the admitted patients were cured and routinely discharged. 8.04% patients died during this period. 39.7% (193) children recovered according to the set discharge criteria as per guidelines. Mean age of the observed patients was 22.35±15.8607 months. More than half of the admitted patients showed moderate to good weight gain during hospital stay. Mean weight gain was higher in non-edematous patients. 50% of non – edematous patients started to gain weight in 3-5 days while 76% of edematous patients required 6-10 days to start weight gain. 4.3% patients did not gain weight during hospital stay. Both descriptive and analytic analyses were executed. P value<0.05 was considered as statistically significant Conclusions: The mean duration of hospital stay (in days) of the patients with oedema (15.64±SD 7.133 days) was higher than that of the patients without oedema (9.47±SD 5.881 days). But greater portion of patients with edema were cured. Independent-Sample T Test revealed the difference statistically significant, where t=(438,485)=-9.878, p=0.002.