Chittagong Medical College Hospital Research Articles

Visual Inspection of Cervix wiih Acetic Acid as A Method of Cervical Cancer Screening in Tertiary Hospital

Background: Cervical cancer belongs to a glorious natural history which favors well implemented secondary prevention. Considering the various constraints in our country, our study aimed to evaluate Visual Inspection of Cervix with Acetic Acid (VIA) as an alternative or adjunct to cervical cytology (Pap smear) in early detection of cervical cancer and also to assess its effectiveness as a screening method in a tertiary center outside of low resource settings.
 Materials and methods: This cross-sectional descriptive study was carried out at Gynae OPD of Chittagong Medical College Hospital (CMCH) from January to December 2012. A total of 1600 sexually active women with 21 to 60 years old were enrolled in this study by purposive sampling technique. The women underwent a complete clinical evaluation, including Pap smear and VIA. Any positive test was referred to colposcopy and directed biopsy. Finally, data were analyzed with the help of SPSS 16 software.
 Results: Out of 1600, VIA was positive in 135(8.4%) and cytology was positive in 74(4.6%) cases of the true positive 48 cases. The sensitivity of VIA (75%) was much higher than that of Pap smear (48%). The sensitivity ratio 1.54 (p<0.001). The positive predictive value for detection of CIN2 and above was 17% for VIA and 16% for pap (p=0.5). Moreover, patients of lost to follow-up before colposcopy and biopsy were only 4.44% with VIA positive cases while 28.38% with positive Pap smear (p<0.0001).
 Conclusions: The high sensitivity of VIA indicates that it may be a feasible alternative test for detection of precancerous lesions of the cervix not only in limited-resource settings but also in a well-equipped tertiary hospital.
 IAHS Medical Journal Vol 4(2), June 2021; 22-26

Assessment of Platelet Count in Pediatric Patients with Dengue Fever Admitted in A Tertiary Care Hospital of Bangladesh

Background: Dengue is a major vector-borne disease that is prevalent in tropical and sub-tropical countries. A hallmark of dengue fever is thrombocytopenia. This study was conducted to evaluate the platelet count in relation to severity and outcome of dengue infection in a cohort of hospitalized children during 2019 dengue outbreak in Bangladesh.
 Materials and methods: This observational study was carried out in the Department of Pediatrics of Chittagong Medical College Hospital, Chattogram, Bangladesh. One hundred and ninety two consecutive serologically positive dengue cases (Age £ 12 years) admitted from July 2019 to December 2019 were enrolled in the study. Platelet count was done daily from day 3 to 7 days of illness.
 Results: Overall the mean age was 7.04 (±3.23) years with male preponderance (59.4%). As per the nadir platelet count 53 (27.7%) patients had counts >150,000, 66 patients (34.3%) had count between 100,000 and 150,000, 36 patients (18.7) had count between 50,000 and 1, 00,000, 13 patients (15.1%) had count between 20,000 and 50,000 while the remaining 6 patients (3.1%) had profound thrombocytopenia. Children with profound thrombocytopenia were likely to had dengue shock syndrome and prolonged hospitalization. There was no fatality in this series.
 Conclusion: Though thrombocytopenia was common profound thrombocytopenia was not frequent in the hospitalized pediatric patients with dengue infection.
 IAHS Medical Journal Vol 4(2), June 2021; 13-16

Association of Non -Alcoholic Fatty Liver Disease in Diabetes Mellitus-Chronic Kidney Disease Patients

Introduction: Non-Alcoholic Fatty Liver Disease (NAFLD) is now the most common chronic liver condition in the world, affecting up to 9% of people in the developing and up to 30% in the developed world. The aim of the study was to find out the association of Non-Alcoholic Fatty Liver Disease with Diabetes Mellitus-chronic kidney disease (DM-CKD). The aim of the study was to find out the association of Non-Alcoholic Fatty Liver Disease with Diabetes Mellitus-chronic kidney disease (DM-CKD). Methods: This cross-sectional observational study was carried out at the Nephrology department of Chittagong Medical College Hospital, Chittagong for 6 months, where 50 patients of DM-CKD were enrolled. Data was collected by pretested questionnaire through face-to-face interview from those patients who gave consent and fulfilled inclusion criteria. Result: Most of the respondents were male 64% and from upper middle class 48%. Among the respondents 34% had non-alcoholic fatty liver disease. Triglyceride level in presence of NAFLD was more (NAFLD pr.=335.12, SD=158.98) vs NAFLD absent (NAFLD ab.=169.64, SD=35.84) and mean LDL level of the patients without NAFLD was more (NAFLD ab.= 124.76 SD=39.24) vs with NAFLD (NAFLD pr.=71.82, SD= 37.16). Mean LDL level of the patients in absence of NAFLD is more (NAFLD ab.= 124.76, SD=39.24) than those NAFLD present (NAFLD pr.=71.82, SD= 37.16). In this study we found a significant relation between Serum Cretinine level and NAFLD (p=0.022). We also found a higher RBS level in patients with NAFLD t (50) =3.699, p= 0.001. Conclusion: The study found that among DM-CKD patients with NAFLD male from upper middle socio-economic class are more likely to develop the disease. That indicates poor renal function and progression to end stage renal disease is more likely in those patients. Early treatment and strict control of risk factors as well as special attention may halt disease progression in these patients.

A Retrospective Observational Study of Patients with High-Risk Gestational Trophoblastic Neoplasm treated at Chittagong Medical College Hospital

A Retrospective Observational Study of Patients with High-Risk Gestational Trophoblastic Neoplasm treated at Chittagong Medical College Hospital

ASSESSMENT OF CURRENT STATUS OF PNEUMONIA IN CHITTAGONG, BANGLADESH

Methods: The study was conducted on 500 pneumonia patients at the Chittagong Medical College Hospital and Chittagong port city between 23 October 2021 to 8 December, 2021. While the data collection on the hypertension in resource environments has been expanding through use of the standardized surveys, slight is known approximately the how fine treatments are existence applied. The knowledge of gap in the diagnosis, treatment form, and proper vaccination in addition to practicing good fitness is necessary if suitable illness administration is to be developed. Results: Studied through roughly questions asked to suspicious the patients in addition to patient’s guardian. Randomized sampling techniques were used to categorize of different ages from the different wards in addition to areas of CMCH and Chittagong port city. It has been found that out of 500 study participants, 277 (55%) were male and 223 (45%) were female. It has been also found that out of 500 participants about (65, 13%) patients suffer from pneumonia due to intake of cigarettes, patients were (292, 44%) suffer from due to bacterial infections, patients were (123, 25%) suffers from pneumonia due to fungi infection, and patients were (90, 18%) suffer from this diseases due to infection of liquor. Conclusion: This is the brief study conducted in Chittagong Medical College Hospital that assessed Pneumonia patients to recovery complications. It assumes that outcomes of this research work will exertion as the baseline for the future studies in same context. Peer Review History: Received: 3 January 2022; Revised: 8 February; Accepted: 4 March, Available online: 15 March 2022 Academic Editor: Dr. Amany Mohamed Alboghdadly, Princess Nourah bint abdulrahman university, Riyadh, amalbgadley@pnu.edu.sa UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file: Reviewer's Comments: Average Peer review marks at initial stage: 5.0/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Dr. A.A. Mgbahurike, University of Port Harcourt, Nigeria, amaka_mgbahurike@yahoo.com Dr. Bilge Ahsen KARA, Ankara Gazi Mustafa Kemal Hospital, Turkey, ahsndkyc@gmail.com Similar Articles: CURRENT TREND OF RESISTANT FOR THE COMMONLY PRESCRIBED NEW FLUOROQUINOLONES AMONG HOSPITALISED PATIENTS IN SANA'A, YEMEN STUDY OF RESISTANCE FOR RECENTLY MARKETED CARBAPENEM DRUG AMONG HOSPITALISED PATIENTS IN SANA'A, YEMEN

APPRAISAL OF PRESENT SITUATION OF HYPERTENSION IN PORT CITY CHATTOGRAM, BANGLADESH

Background: Hypertension is a very much common disease. While data collection on hypertension in resource poor environments has been improving through the use of standardized surveys, little is known about how well treatments are being applied. Knowledge of gaps in diagnosis, treatment pattern and changing lifestyle is necessary if appropriate illness management are to developed. Methods: Using a community based sample has been taken from Chittagong Medical College Hospital, Chittagong and from the Chittagong city, studied through some questions asked to the suspicious patients. Results: Randomized sampling methods were used to identify adults from 18 to above from different wards and areas of CMCH and Chittagong city. Using World Health Organizations guidelines, data were collected on subject’s demographics, medical history, blood pressure and health behaviors. The study was conducted on 500 hypertensive patients at the Chittagong Medical College Hospital and Chittagong city between 23October 2021 to 8 December 2021, total 7 weeks. This survey was done by a structured questionnaire written in Bangla and English. Conclusion: It might be concluded from this research study that half of respondents were female in addition to half of respondents were male. It can be assumed that outcomes of this research study will play as the baseline for the future studies in same context. Peer Review History: Received: 3 January 2022; Revised: 8 February; Accepted: 4 March, Available online: 15 March 2022 Academic Editor: Dr. Sally A. El-Zahaby, Pharos University in Alexandria, Egypt, sally.elzahaby@yahoo.com UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file: Reviewer's Comments: Average Peer review marks at initial stage: 5.0/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Prof. Dr. Hassan A.H. Al-Shamahy, Sana'a University, Yemen, shmahe@yemen.net.ye Dr. Rima Benatoui, Laboratory of Applied Neuroendocrinology, Department of Biology, Faculty of Science, Badji Mokhtar University Annaba, BP12 E L Hadjar–Algeria, benattouiryma@gmail.com Similar Articles: PRESCRIPTION PATTERN OF ANTI-HYPERTENSIVE DRUGS IN A TERTIARY CARE HOSPITAL IN KERALA AND ADHERENCE TO JNC-8 GUIDELINES SOCIOECONOMIC STATUS EFFECT ON MANAGEMENT OF HYPERTENSION IN COMMUNITY PHARMACY IN SOUTH- SOUTH ZONE IN NIGERIA

Cutaneous Manifestations of HIV/AIDS in the Era of Highly Active Antiretroviral Therapy: Evidence from Bangladesh

Abstract Objective: Skin diseases are common and striking features of patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and may vary considerably by ethnic and geographic regions and by the influence of highly active antiretroviral therapy (HAART). However, little information exists regarding the cutaneous manifestations of patients with HIV/AIDS in Bangladesh. This study was performed to elucidate the spectrum of cutaneous disorders in patients with HIV/AIDS in the era of HAART. Materials: This descriptive cross-sectional study was carried out in Chittagong Medical College Hospital, Bangladesh from January 2017 and December 2020. Diagnosed case of HIV/AIDS for HAART therapy and all cases of HIV/AIDS who are already on HAART therapy were included in this study. Descriptive statistical analysis was carried out by using frequencies and percentages. Results: Of 40 patients with HIV/AIDS, 22 (55.0%) were male and 18 (45.0%) were female. The patients ranged in age from 8 to 60years, with a mean age of 38 ± 0.966years. Among all age groups, the highest 19 (47.5%) patients were in the 31- to 40-year age group. Most of the patients were migrant workers [22/40 (55.0%)] with low socioeconomic status [32/40 (80.0%)], and the most common transmission mode was heterosexual activity [36/40 (90.0%)]. Most of the patients [32/40 (80.0%)] had mucocutaneous disorders, 30/40 (75.0%) had infective dermatoses, and 21/40 (52.5%) had non-infective inflammatory dermatoses. Eight of forty (20.0%) patients presented with three or more skin disorders. The most common infective dermatoses were fungal infections [15/40 (37.5%)], followed by viral infections [8/40 (20.0%)], bacterial infections [4/40 (10.0%)], and scabies [3/40 (7.5%)]. The most common noninfective dermatosis was generalized pruritus [6/40 (15.0%)], followed by prurigo simplex [4/40 (10.0%)], psoriasis [4/40 (10.0%)], eczema [3/40 (7.5%)], pruritic papular eruption [1/40 (2.5%)], seborrheic dermatitis [1/40 (2.5%)], urticaria [1/40 (2.5%)], and xerosis [1/40 (2.5%)]. Patients treated with HAART had decreased rates of oral candidiasis and herpes simplex but increased rates of drug reactions [19/40 (47.5%)]. The most common drug eruption following HAART was a morbilliform rash [11/40 (27.5%)], and the most common offending agent was nevirapine. The prevalence of mucocutaneous disorders was higher in patients with a CD4 cell count of <200cells/mm3. Conclusions: A wide range of mucocutaneous disorders is observed in Bangladeshi patients with HIV/AIDS, and HAART has an impact on the spectrum of HIV/AIDS-associated mucocutaneous disorders. Skin and mucocutaneous disorders are seen at every stage of HIV/AIDS and are the initial presentation in most patients in Bangladesh. There is a need for increased attention to the diagnosis and treatment of skin diseases affecting the quality of life of patients with HIV/AIDS.

C-Reactive Protein, Lipid Profile and Body Mass Index in Patients of Liver Cirrhosis

Background: Liver cirrhosis leads to the abnormalities in liver function.
 Objective: This study aimed to determine the C-reactive protein (CRP) and lipid profile in cirrhotic patients as well as their correlation with patients age and body mass index.
 Methodology: This case- control study was conducted in the Chittagong Medical College Hospital and People’s Hospital Limited, Chattogram from October 2017 to March 2018 for a period of six months. Venous blood was collected from 25 patients and 25 controls after 8 hours overnight fasting. Inflammatory marker (CRP) and Serum lipid status were recorded for each participant.
 Results: The mean serum C-reactive protein; total cholesterol; Triglycerides; High Density Lipoprotein and Low Density Lipoprotein level were 2.448 ± 1.174; 132.228 ± 15.352; 100.228 ± 20.564 mg/dl; 53.081 ± 9.994 mg/dl and 59.108 ± 18.634 mg/dl in cirrhotic patients. CRP value was significantly higher in patients compared to healthy individuals (p < 0.05). The extent of decreasing lipid profile (except HDL) was also significantly related to the progress in cirrhosis (p < 0.05). The positive correlation of age and BMI of patients were associated with CRP and various lipid variables.
 Conclusion: The higher CRP value and extent of decreasing lipid profile (except HDL) in patients may serve as a baseline for further studies that required to determine the predictive values of lipid profiles as a means to estimate the extent of liver damage in cirrhotic patients.
 Bangladesh Journal of Infectious Diseases June 2021;8(1):27-31

Early and Late Haemodynaemic Effects after Adding Fentanyl to Bupivacaine-Lignocaine Mixtures in Supraclavicular Brachial Plexus Block: A Randomized Control Trial

Background Objectives: Haemodynamic changes are very crucial issues during regional anaesthesia. The purpose of the present study was to observe the immediate and late haemodynaemic effects after adding fentanyl to bupivacainelignocaine mixtures in supraclavicular brachial plexus block. Methodology: This randomized clinical study was conducted in the Department of Anesthesiology in Chittagong Medical College Hospital (CMCH) from March 2011 to May 2012 for a period of one year. All patients with the age group of 18 to 65 years who were selected for upper limb surgery distal to the mid arm were the study population. The random allocation of the patient was done into Group A patients (control group) who were received injection Bupivacaine (0.25%) with injection lignocaine A (1%) with injection Normal saline (0.9%). Group B patients (treatment group) were received injection bupivacaine (0.25%) with injection Ligonocaine A (1%) with injection fentanyl. With all aseptic precaution, supraclavicular brachial plexus block was done using paresthesia technique. Pulse and blood pressure were measured at baseline, intra-operatively and post-operatively. Result: A total of 60 patients were enrolled in this study with 30 patients in each group named group A and group B. The mean age of group A and group B were 32.43±12.25 and 34.90±13.05 respectively (p=0.453). The mean pulse rate of group A (79.53±5.03) and group B (78.10±4.26) at baseline level increased at the time of injection (88.30±5.77 and 85.63±4.87 respectively). At 8 hours interval mean pulse rate of group A was 86.47±5.51 compared to that of group B (86.07±3.08). The mean systolic blood pressure of group A (126.50±18.21) and group B (120.07±11.61) at baseline level increased at 0 minute at the time of injection (129.70±15.34 and 123.17±10.57 respectively). The mean diastolic blood pressure of group A (71.73±11.20) and group B (72.73±11.45) at baseline level increased at 0 minute (75.97±12.74 and 75.80±12.85 respectively). At 8 hrs interval mean diastolic pressure of group A was71.73 ±11.20 compared to that of group B (71.73±11.20). Conclusion: In conclusion there is no significant immediate or late haemodynaemic effects after adding fentanyl to bupivacaine-lignocaine mixtures in supraclavicular brachial plexus block. J Bangladesh Coll Phys Surg 2022; 40: 17-22

Dermatological Manifestations of HIV/AIDS Patients in the Era of HAART: Report from an ART Center of Chattogram

Introduction: Skin diseases are common striking features of HIV/AIDS patients and may vary considerably due to ethnic and geographic regions and currently by the influence of HAART also. However, there is a dearth of information in Bangladeshregarding the dermatological manifestations in HIV/AIDS patients. The purpose of this study is to find out the spectrum of cutaneous disorders in HIV/AIDS patients in the era of HAART. Materials and Methods: A descriptive cross-sectional study has been carried out to find the targeted results in the Chittagong Medical College Hospital, Bangladesh between the periods 2017 and 2020. Results: Of the 40 patients with HIV/AIDS, 22 (55%) were males and 18 (45%) were females. The age of the patients ranged from 8 to 60 years with mean age 38 (±0.966 SD) years. The age-specific cumulative HIV/AIDS cases at 31-40 years were high 19 (47.5%) among all age groups. The majority of the patients were migrant worker 22 (55%) with low socio-economic 32 (80%) background and common transmission mode was heterosexual 36 (90%). Most of the patients 32 (80%) had mucocutaneous disorders and Infective dermatoses accounted 30 (75%) and the non-infective inflammatory dermatoses were 21 (52.5%). Eight (20%) patients presented with 3 or more skin disorders. Common infective dermatoses were fungal infections 15 (37.5%) followed by viral infections 8 (20%), bacterial infections 4 (10%) and scabies 3 (7.5%). Common non-infective dermatoses were generalized pruritus 6 (15%) followed by prurigo simplex 4 (10%), psoriasis 4 (10%), eczema 3 (7.5%), pruritic papular eruption 1 (2.5%), seborrhoeic dermatitis 1 (2.5%), urticaria 1 (2.5%) and xerosis 1 (2.5%).Patients treated with HAART had decreased rates of oral candidiasis, herpes simplex, but increased rates of drug reactions 19 (47.5%). The most common drug eruption following HAART is morbiliform rash 11 (27.5%) and the commonest offending agent is nevirapine. The prevalence of mucocutaneous disorders were higher in patients with CD4 <200 cells/mm3. Conclusions: A wide range of skin disorders (80%) is observed in Bangladeshi HIV/AIDS patients and HAART had an impact on the spectrum of HIV/AIDS associated mucocutaneous disorders. They are seen at every stage of HIV/AIDS and are often the initial presentation in most instances within our environment. There is a need for increased attention to the diagnosis and treatment of skin diseases affecting the quality of life of HIV/AIDS patients.

Analysis of the Occurrence of Antibiotic Resistant Bacteria in the Hospital's Effluent and its Receiving Environment.

The use of antibiotics on a regular and excessive basis is a major factor in the spread of antibiotic-resistant bacteria. Patients discharge un-metabolized or relatively low doses of non-metabolized antibiotics through urine and stool, which might enter into the environment through sewage disposal and promote the emergence of antibiotic resistant bacteria. This study is designed to investigate how excessive use of antibiotics in the hospital sector and their release into hospital wastes contribute to the spread of antibiotic-resistant bacteria in different environmental settings. In this study, liquid hospital waste was collected from the sewage of Chittagong Medical College Hospital (CMCH), Bangladesh as well as from its distribution position in Chittagong city, Bangladesh. A total of 5 samples were collected from different positions in Chittagong city, including CMCH liquid waste. After collection, total bacteria and total cefixime resistant bacteria were counted by the total viable count (TVC) method. The result of bacteriological enumeration showed that a high magnitude of cefixime-resistant bacteria were available in all the hospital’s associated waste samples. The highest proportion of cefixime resistant bacteria (23.35%) was found in sample 2, whereas 17.4%, 7.6%, 5%, and 1.32% were found in samples 1, 3, 4, and 5, respectively. The total number of cefixime-resistant bacteria decreased with the increase in distance between the sample collection site and the hospital drain. This means that resistant bacteria developed in the hospital effluent are transferred to the environmental distribution sites.

Nutritional Outcome and Growth Monitoring in Under-Five Children of Severe Acute Malnutrition with and without Edema in Bangladesh: A Five-Year Retrospective Review of Facility-Based Inpatient Care

Introduction: Severe acute malnutrition (SAM) is an important cause of death in children. Bangladesh has a huge burden of SAM in under-five children, but documentation of their protocolized management and outcome is not so frequent. Objective: Our aim was to identify the pattern of the nutritional outcome and growth monitoring of 0-59 months old children with severe acute malnutrition treated with identified medical complications where the presence or absence of edema is an important clinical factor. Methods: This was a facility-based retrospective observational study that was conducted in the Severe Acute Malnutrition block of Chittagong Medical College Hospital, Chittagong. Here, a total of 485 patients were admitted during the period from 2013 to 2017. Based on WHO & National guidelines, admission and discharge criteria were considered and determined. A structured and prescribed data format was prepared and data were collected from the hospital records. Daily clinical follow-ups and weight monitoring of the patients were also documented. Both descriptive and analytic analyses were executed. After Data collection, it was cleaned, edited, and stored in excel, epi-INFO, and analyzed by SPSS. P-value Results: 54.84% of the admitted patients were cured and discharged during the study period. The mean age of the observed patients was 22.35 ± 15.8607 months. The majority of the patients came from rural areas and about 50% of them belonged to lower-middle-class families. The median weight gain of the children at SAM block during the clinical review was found to be moderate (7.35g/kg/day). About 2/3rd of the admitted patients stayed in the hospital for two weeks. The mean duration of hospital stay (in days) of the patients with edema (15.64 ± SD 7.133 days) was higher than that of the patients without edema (9.47 ± SD 5.881 days). 4.3% of patients did not gain weight during their hospital stay, and overall 8.04% of patients died during this period. Conclusion: More than half of the admitted patients showed moderate to good weight gain during their hospital stay. Non-edematous patients started to gain weight early and their mean weight gain was also higher. A greater portion of patients who had edema was cured (117, 81.8%) but defaulter & death rates, where contributed to a significant overall outcome (188, 38.76%), were more in non-edematous patients.

Comparison between Clinical and Bacteriological Profile of Febrile Neutropenic and Non Neutropenic Pediatric Leukemic Patients

Background: Infection is an important cause of morbidity and mortality in children with leukemia. To improve the quality of care and survival, it is important to understand the clinical presentation and bacteriological profile during febrile episodes of these patients. The aim of this study was to compare the clinical presentation and bacteriological profile of febrile neutropenic and nonneutropenic pediatric leukemic patients. Materials and methods: This was a cross sectional observational study conducted at Chittagong Medical College Hospital (CMCH) over a period of 12 months. Study population (n=60) were all hospitalized pediatric leukemic patients who were febrile and on anticancer chemotherapy. By purposive sampling two groups were made. Group A (n=30) was febrile neutropenic and group B (n=30) was febrile non-neutropenic patients. The Clinical presentation, bacteriological profile and antibiotics susceptibility patterns in both groups were analyzed. Results: Mean (±SD) age of the patients was 6.41±3.05 years. Acute Myeloid Leukemia (AML) patients were high in Group-A (60%) and Acute Lymphoblastic Leukemia (ALL) patients were high in Group-B(80%). Gastroenteritis, skin infection and sepsis were more in group A than group B (p<0.05). Upper respiratory tract infections were significantly more in group B than group A (p<0.05). Among 60 samples, 7 (12%) were blood culture positive for bacteria. The isolated organisms were E. coli, Klebsiellaspp, Salmonella, Staph aureus and others. Amikacin Meropenem and Vancomycin were the effective agents. Conclusion: Febrile neutropenic episodes were more common in AML patients undergoing chemotherapy. Gram negative sepsis, gastroenteritis and skin infection were high in febrile neutropenia, but upper respiratory tract infections were high in febrile non neutropenia. JCMCTA 2021 ; 32 (2) : 25-29

Clinical Presentation, Management and Outcome of Gestational Trophoblastic Diseases Admitted in Chittagong Medical College Hospital

Background: Gestational Trophoblastic Disease (GTD) is a heterogeneous group of diseases that includes partial and complete hydatidiform mole, invasive mole, choriocarcinoma and placental site trophoblastic tumour. The study aimed to determine the clinical presentation management options and outcome of GTD in patients admitted in a tertiary hospital of Bangladesh.
 Materials and methods: This prospective observational study included 50 patients with GTD from the Obstetrics and Gynaecology Department of Chittagong Medical College Hospital, during the period of July 2013 to December 2013. The demographic profile, clinical presentation, management, outcome and complications were studied.
 Results: Mean age was 25.40 ± 8.34 years with most of the patients (46%) were in age group 20 - 29 years. 42% participants were primigravida. The commonest symptom after bleeding per-vaginum (94%) was amenorrhea (90%). Maximum cases (80%) were of complete hydatidiform mole. Rate of progression to invasive mole and choriocarcinoma were found 6% and 10% respectively. Suction evacuation and hysterectomy were the treatment option. One patient (2%) expired due to excessive bleeding.
 Conclusion: The majority of cases are cured by simple suction uterine curettage. Regular follow up is important to estimate the true incidence of this disease.
 JCMCTA 2021 ; 32 (2) : 128-131

Assessment of Neurodevelopmental Status and Risk Factors for Adverse Neurodevelopmental Outcome in Late Preterm Infants at 6 Months Corrected Age : An Prospective Observational Study

Background: Late Preterm (LP) infants, previously considered low risk, have been identified to be at risk of developmental problems in infancy and early childhood. There is limited information on the outcome of these infants in low and middle income countries. This study was aimed to assess the neurodevelopmental status of LP born neonates and to determine factors associated with adverse neurodevelopmental outcome in a tertiary hospital of Chattogram, Bangladesh.
 Materials and methods: In this prospective observational study, 108 LP (34 to <37 completed weeks gestation at birth) infants were enrolled from the Special Care Neonatal Unit (SCANU) Chittagong Medical College Hospital (CMCH) from June 2018 to May 2019. Neurodevelopmental assessment was done by Rapid Neurodevelopmental Assessment (RNDA) at 1, 3, and 6 months of Corrected Age (CA).
 Results: Of the 108 enrolled children, 30 (27.8%) attended all 3 follow-up, 69 (63.9%) had incomplete follow-up, and 9 (8.3%) died. At final follow-up, out of 30 infants, 25 (83.3%) had no abnormality in all 8 domains of RNDA. Three infants (10.0%) had abnormalities in one domain and 2 (6.7%) had abnormalities in 5 domains. Gross motor abnormality was most common abnormality (13.4%), followed by speech (10.0%), and cognition (6.7%). Small for gestational age was found to be the only independent predictive factor for Neurodevelopmental Abnormality (NDA) in LP infants.
 Conclusion: This study demonstrates that 16.7% of the LP infants had evidence of neurodevelopmental impairment at 6 months of corrected age. SGA was an important risk factor of adverse neurodevelopmental outcome. Thus, LP infants in Bangladesh require long-term follow-up to monitor developmental outcome.
 JCMCTA 2021 ; 32 (2) : 70-74

Knowledge, Attitude and Practice Regarding COVID-19 among Healthcare Workers in Chattogram, Bangladesh

Background: The coronavirus disease 2019 (COVID-19) is a pandemic respiratory disease caused by the highly contagious novel coronavirus (SARS-CoV 2). COVID-19 pandemic continues to challenge healthcare services worldwide. Healthcare Workers (HCWs) are more susceptible to COVID-19 infection than the general population due to frequent contact with infected individuals. This study was aimed to assess the knowledge, attitude and practice among HCWs towards COVID-19 in some COVID dedicated hospitals of Chattogram, Bangladesh.
 Materials and methods: This descriptive cross-sectional study was conducted at three hospitals (Chittagong Medical College Hospital, Chattogram 250 Bed General Hospital, and Bangladesh Institute of Tropical and Infectious Disease) in Chattogram, from January 2021 to August 2021. The study included 393 HCWs (Physicians and nurses) by a non-probability convenient sampling method. An interview administered questionnaire was used to evaluate their knowledge, attitude and practices regarding COVID-19 and their associations with the participants’ characteristics.
 Results: Participants were predominantly female (230/393, 58.0%) and physicians (313/393, 77.0%). Almost all had sufficient knowledge (85.8%) and good preventive practice (92.1%) towards COVID-19, however, there was also a rather low level of positive attitude recorded, at 69.0%. Factors associated with KAP were, Knowledge: being a physician and higher education. Attitude: age >40 years, Practice: being a physician.
 Conclusion: The findings demonstrated sufficient knowledge and good preventive practice towards COVID-19, however, positive attitude was lower. Therefore, it is an identified requirement to continue with additional education and training strategies to offer a positive viewpoint of the pandemic for all HCWs.
 JCMCTA 2021 ; 32 (2) : 79-84

Fetus-in-Fetu: A Rare Entity

Background : Fetus in fetu is a rare congenital anomaly in which a malformed fetus or parasitic fetus grows within the body of its twin. It is a parasitic twin of a Diamniotic, monozygotic twin. Fetus in fetu is often overlooked in the differential diagnosis of an abdominal mass in infants and children. Teratoma is one of the closest differentials and must be excluded. Unlike teratomas, fetus in fetu is a benign disorder. The objective of our study is to describe the sonographic findings of an extremely rare pathology. We therefore the present diagnosis, pathology, management of fetus-in-fetu.
 Case Presentation: On 6th June 2021, a two years boy was brought by his parents to Chittagong Medical College Hospital (CMCH) for treatment with the complains of abdominal mass, occasional abdominal pain and loss of appetite. The patient was evaluated radiologically by plain radiographs, USG and pre & post contrast CT scan of the abdomen. All radiological modalities showed a mass in the left lumber region having internal bony structures likelong bone, vertebra and teeth. CT scan played the vital role in clearly demonstrating the bones and confirming the presence of vertebra. Radiologically a diagnosis was made as fetus-in-fetu and the possibility of Teratoma was excluded by the presence of vertebra. The patient underwent surgery and the mass was completely excised. A deformed parasitic fetus enclosed in a complete capsule was removed from the patient’s abdominal cavity. Autopsy of the specimen showed deformed limbs, presence of vertebra, long bone, other soft tissue, organogenesis around an axis and histopathology confirmed the presence of vertebra, bone and bone marrow, cardiac muscle, nerve tissue, intestine, renal tubules with glomerulus, lymphoid tissue, respiratory epithelium and skin. All findings were compatible with fetus-in-fetu.
 Conclusion : Although fetus in fetu is a rare condition, correct diagnosis using imaging can be made before surgery. It should be considered as a diffential diagnosis for lump abdomen especially in infant. Complete excision is curative.
 JCMCTA 2021 ; 32 (2) : 151-155

Functional Outcome of Proximal Fibular Osteotomy in Medial Compartment Osteoarthritis of The Knee Joint

Background: Proximal Fibular Osteotomy (PFO) has been proposed as a new surgical option for pain relief in patients with medial compartment knee osteoarthritis. It is simple, safe and affordable. To assess functional outcome of proximal fibular osteotomy in medial compartment osteoarthritis of knee joint.
 Materials and methods: This prospective hospital based clinical trial was carried out in the Department of Orthopedic Surgery Chittagong Medical College Hospital (CMCH) Chattogram from July 2019 to June 2020. A total of 30 patients with knee osteoarthritis were enrolled through inclusion and exclusion criteria by purposive sampling. Proximal fibular osteotomy was done after taking written informed consent. Data was recorded in a predesigned case record form. All the patients were followed up to 6 months when final outcome was assessed by Oxford Knee Score. All the data were analyzed statistically by using Statistical Package for Social Sciences (SPSS-25). The result was expressed as frequency, percentage and mean ± SD. Level of significance was calculated at p<0.05.
 Results: In this study, out of 30 cases, majority of the cases (57.7%) was in 55-64 years of age group. Mean ± SD pre-operative and post-operative VAS score were 7.13 ± 1.408 and 2.10 ± 0.803 respectively. According to Oxford Knee Score (OKS) pre-operative and postoperative mean ± SD were, 18.00 ± 2.117 and 36.53 ± 2.403. Mean ± SD pre-operative and post-operative Tibio Femoral Angle were 182.97 ± 1.810 and 178.63 ± 1.377 respectively. Mean ± SD pre-operative and post-operative Medial Joint Space (mm) were 1.223 ± 0.378 and 3.816 ± 0.982 respectively. Mean ± SD pre-operative and postoperative Lateral Joint Space (mm) were 6.640 ± 1.209 and 5.050 ± 0.897 respectively.
 Conclusion: After analyzing the results of present study, it can be concluded that proximal fibular osteotomy is a new, simple procedure in the management of medial compartment osteoarthritis of the knee which may delay the need for definitive knee procedures like unicompartmental knee arthroplasty or total knee replacement.
 JCMCTA 2021 ; 32 (2) : 137-141

Clinico-epidemiological Study on Self-induced Poisoning Caused by Substances Other than Organophosphorus Compound

Background: Though Organophosphorus Compounds (OPC) are mostly used for self-induced poisoning, non- OPC poisoning cases are increasing day by day. This study was done to describe clinical pattern and outcome of poisoning other than OPC.
 Materials and methods: This observational study was conducted in the Medicine Ward of Chittagong Medical College Hospital. Data were collected in structured case record forms. Total 204 patients (n=204) were included in the study after fulfilling the inclusion criteria. Data were analyzed with SPSS and expressed as percentage, mean with standard deviation as appropriate.
 Results: Out of 204 patients, most were female (60.8%). Most of the patients were young, 56.9% patients were unmarried, 60.8% poisoned patients resided in metropolitan area, most were with low educational level, 57.4% patients came from the middle class socioeconomic group, 82.4% patients were poisoned by a single agent and 17.6% by multiple agents. Offending agents were identified in 96.6% cases. Poisoning by drugs was the highest (47.1%) followed by rat killer poisoning (22.5%) poisoning by non-OPC insecticides (6.9%) corrosive poisoning (6.4%) chemical poisoning (3.9%) and alcohol poisoning (1%). Family disharmony was the underlying cause of self-harm in 47.1% cases, financial constraints in 8.3%, social crisis in 7.8%, failure in love affairs in 6.4% and academic failure in 2.5% patients. 14.7% patients poisoned themselves to gain some benefit by the act of self-harm. 81.4% patients were discharged with advice, 2.9% died.
 Conclusion: Burden of Non-OPC poisoning is high. Outcome is not so fatal as OPC, but the problem has to be addressed in large scale.
 JCMCTA 2021 ; 32 (2) : 34-40

Martius Graft Repair of Vesico-Vaginal Fistula: Experience at A Tertiary Care Center in Bangladesh

Background: Vesico-Vaginal Fistula (VVF) is a pathology with severe social repercussions. Resolution of VVF can be achieved through multiple surgical, abdominal or vaginal techniques, which will generally depend on the fistula's characteristics and the surgeon's experience. In this study we describe our experience with vaginal approach to treat VVF using Martius graft repair.
 Materials and methods: This prospective observational study included 50 VVF patients operated in the fistula center of Chittagong Medical College Hospital, during the period of January 2013 to December 2014. The success rate and complications of Martius graft repair of VVF.
 Results: The leading age group was 26 to 35 years (50.0%) and age range from 16 to 60 years with a mean age of 32.1 (±SD 8.10) years. The majority (72.0%) was from low socioeconomic class and had short stature (64.0%).48% fistula was midvaginal, 28% was juxtracervical and 54% was <2 cm in size and 40% were associated with vaginal stenosis and urethral avulsion. In 36% cases postoperative complication were developed. 82% patients were fully cured, 6% cured with urethral incontinence, 2% cured with vaginal stenosis and in 10% cases surgery was failed.
 Conclusions: The vaginal technique for the treatment of VVF reinforced by Martius graft is safe and effective with low rate of complications.
 JCMCTA 2021 ; 32 (2) : 85-89