Chittagong Medical College Hospital Research Articles

Systemic Lupus Erythematosus (SLE) in a male patient previously diagnosed as Adult Onset Still’s Disease: A Case Report

Adult-onset Still’s disease (AOSD) is a rare clinical entity with unknown etiology, characterized by evanescent rash, arthritis, fever, and other systemic presentation. In this case report, we describe a male patient of 50 years, previously diagnosed as a case of Adult onset still’s disease based on Yamaguchi criteria after the exclusion of other potential diagnoses. Later he was admitted into the Medicine department of Chittagong Medical College Hospital where he was found to have serological features of Systemic lupus erythematosus, another very much uncommon autoimmune disorder in male. On several occasion of his past admissions, SLE and RA were excluded meticulously. He initially responded to oral steroids only, recurrence of symptoms led us to work on the underlying etiology further. Coexistence of SLE in a patient with AOSD is not so commonly found. In our case, we notice this interesting phenomenon which was crucial for his management.
 Bangladesh J Medicine July 2019; 30(2) : 100-103

Hypothyroidism following hemithyroidectomy: a study in a tertiary care hospital, Chittagong, Bangladesh

<p class="abstract"><strong>Background:</strong> Hypothyroidism results from insufficient production and secretion of thyroid hormones. This may be due to disturbance within the thyroid gland itself (primary hypothyroidism) or within the hypothalamic-pituitary-thyroid axis (secondary hypothyroidism). The objective of this study is to determine the incidence, risk factors and management of hypothyroidism occurring after hemithyroidectomy for benign non-toxic thyroid disease.</p><p class="abstract"><strong>Methods:</strong> We conducted a prospective cross sectional study of 50 euthyroid patients with benign non-toxic thyroid disease who had undergone hemithyroidectomy from January 2012 to December 2012 admitted in the department of otolaryngology and Head Neck Surgery, Chittagong Medical College Hospital. All patients were evaluated for age, sex, pre-operative and post-operative TSH levels, histopathology and follow up. Time of diagnosis and therapeutic dose of thyroid hormone were determined for patients with hypothyroidism. </p><p class="abstract"><strong>Results:</strong> As per this study, the incidence of permanent nerve damage was zero whereas the incidence of temporary neuropraxia was found to be around 0.5%. The incidence of temporary and permanent hypocalcemia was found to be around 0.7% and 0.2% respectively. These complications were found more in obese patients and those with malignancies.</p><p class="abstract"><strong>Conclusions:</strong> Taking account of the very low incidence of nerve and parathyroid injury in this series, the authors suggest that meticulous capsular dissection is superior to dissection of the entire nerve in avoiding transcient nerve damage as well as temporary hypocalcemia. However it is stated that a deliberate search for the nerve is definitely indicated in cases where there is likely to be distorted anatomy, as in infiltrating malignancies and recurrent thyroidectomies.</p>

Does Hypothyroxinemia of Preterm Neonates Persist Beyond 7 weeks of Life?

To determine whether hypothyroxinemia in the early neonatal period normalizes by 7 wk of postnatal age. An observational study was carried out from July 2008 through June 2010 in the neonatal and postnatal unit of Chittagong Medical College Hospital, Bangladesh. A total of 150 neonates including 100 preterm and 50 term neonates were selected by convenient sampling. Preterm neonates were stratified according to postconceptional age. By the 3rd generation two site chemiluminesent immunometric assay, free T4 (FT4) and thyroid stimulating hormone (TSH) estimations were done. Within 5-11 d, first samples were collected from all the neonates and the second samples of hypothroxinemic preterm neonates were collected within 42-50 d of birth. Positive correlation of FT4 was found with gestational age (p < 0.0001, n = 100, r = 0.61) in preterm neonates while significant difference was found among the gestational age subgroups (p = 0.0001). No significant differences were, however, found in TSH levels of such age groups of the preterms. Highly significant differences in FT4 and TSH levels between 1st and 2nd samples were found in subgroup analysis of the preterm neonates. In the 1st samples, TSH level correlated positively with gestational age but in the 2nd samples, significant negative correlation was observed. In all neonates with initial hypothyroxinemia, FT4 levels were found to increase to reach the normal levels by 7 wk. FT4 level normalizes by 7 wk of birth in preterm newborn neonates.

Does reduced oxygen delivery cause lactic acidosis in falciparum malaria? An observational study

BackgroundLactic acidosis with an elevated lactate–pyruvate ratio suggesting anoxia is a common feature of severe falciparum malaria. High lactate levels are associated with parasitized erythrocyte sequestration in the microcirculation. To assess if there is an additional contribution to hyperlactataemia from relatively inadequate total oxygen delivery, oxygen consumption and delivery were investigated in patients with malaria.MethodsAdult Bangladeshi and Indian patients with uncomplicated (N = 50) or severe (N = 46) falciparum malaria or suspected bacterial sepsis (N = 27) and healthy participants as controls (N = 26) were recruited at Chittagong Medical College Hospital, Chittagong, Bangladesh and Ispat General Hospital, Rourkela, India. Oxygen delivery (DO2I) was estimated from pulse oximetry, echocardiographic estimates of cardiac index and haematocrit. Oxygen consumption (VO2I) was estimated by expired gas collection.ResultsVO2I was elevated in uncomplicated median (IQR) 185.1 ml/min/m2 (135–215.9) and severe malaria 192 ml/min/m2 (140.7–227.9) relative to healthy persons 107.9 ml/min/m2 (69.9–138.1) (both p < 0.001). Median DO2I was similar in uncomplicated 515 ml/min/m2 (432–612) and severe 487 ml/min/m2 (382–601) malaria and healthy persons 503 ml/min/m2 (447–517) (p = 0.27 and 0.89, respectively). The VO2/DO2 ratio was, therefore, increased by similar amounts in both uncomplicated 0.35 (0.28–0.44) and severe malaria 0.38 (0.29–0.48) relative to healthy participants 0.23 (0.17–0.28) (both p < 0.001). VO2I, DO2I and VO2/DO2 did not correlate with plasma lactate concentrations in severe malaria.ConclusionsReduced total oxygen delivery is not a major contributor to lactic acidosis in severe falciparum malaria.

Efficacy and Safety of Dexamethasone versus Fentanyl as an adjuvant with Bupivacaine and Lignocaine in Supraclavicular Brachial Plexus Block

Background: Brachial plexus blockade is gaining popularity day by day for the upper extremity surgery.Increasing the duration of local anesthetic action by adding different adjuvant is often desirable toprolong the surgical anesthesia and analgesia. The aim of this study was to make a comparative evaluationof the efficacy and safety of dexamethasone and fentanyl as an adjuvant with bupivacaine-lignocaine insupraclavicular block. Material and methods: This comparative study was carried out in the departmentof anesthesiology in Chittagong Medical College Hospital in collaboration with the department oforthopedic surgery over a period of 22months starting from July, 2012 to April, 2014. A total 130 adultpatients of either sex with American Society of Anesthesiology (ASA) health status I-II were selected forupper limb surgery under supraclavicular brachial plexus block was randomly allocated in to two groupsof 65 patients in each. Group- D was received dexamethasone 2ml (10mg) and Group-F was receivedfentanyl 2ml (100mg) in 38ml of bupivacaine and lignocaine with adrenaline (total volume of 40ml). Result: The mean onset of sensory&amp;motor block was 7.72±1.949min &amp; 8.75±2.008min in group-D and7.60±3.711min &amp; 9.23±5.114min in group-F. Both the results in two group was not statistically significant(p&gt;0.05).The duration of analgesia in group-D was 11.40±0.844hrs and in group-F was 8.62±1.747hrs.Theresults was significantly higher in group-D than group-F (p&lt;0.05). Conclusion: There was significantlyprolonged duration of analgesia and better onset of sensory and motor block in dexamethasone groupthan in fentanyl group without any unwanted effects. JBSA 2019; 32(1): 10-17

Subclinical Hypothyroidism During Valproic Acid Therapy in Children with Epilepsy

Background : Valproic Acid (VPA) is an effective anticonvulsant widely used for the treatment of epilepsy in children, but there are pitfalls in VPA therapy, especially in case of various endocrine organs like thyroid. So the aim of this study was to evaluate the thyroid dysfunction in terms of subclinical hypothyroidism during Valproic Acid (VPA) therapy in children with epilepsy.&#x0D; Methods: The study was conducted in the Department of Paediatrics, and Shishu Bikas Kendra, Chittagong Medical College Hospital (CMCH) over one year duration on 50 newly diagnosed idiopathic epileptic children who were decided to start Valproate at the dose of 20mg/kg/day. At the same time similar number (n=50) of age and sex matched children visited the paediatric OPD for other health events(e.g. acute upper respiratory infection, Influenza like illness and Acute watery diarrhoea) other than epilepsy were included in the study as control group. Thyroid function status like serum levels of Thyroid-Stimulating Hormone (TSH) Free Triiodothyronine (FT3) and Free Thyroxin (FT4) were evaluated at baseline and after six months. Moreover, serum VPA level was also measured in children receiving valproate at follow up visit. Anti thyroid peroxidise antibody (Anti TPO ab) was checked at follow up visit in those having TSH level beyond normal reference range. After collecting all data it was analyzed by SPSS-19.&#x0D; Results: In the current study, cases consisted of 30(60%) male and 20(40%) female children. Male to female ratio was 1.5:1. Gender and age were matched in cases and control group (p&gt;0.05). Most of the population in the cases were from rural areas 29(58%) and most of them 40(80%) belonged to middle class family. The mean±SD of TSH level significantly increased after six months in comparison with base line values (1.76±0.57μIU/ml vs. 2.70±1.50μIU/ml, p&lt;0.05) and with control group at follow up visit (1.74±0.73μIU/ml vs 2.70±1.50μIU, p&lt;0.05). On the other hand, in the control group there were no significant changes of TSH level in comparison with base line (1.82±0.55μIU vs 1.74±0.73μIU/ml, p=0.16). The mean±SD of FT4 value decreased significantly in the cases after six months though remained within normal reference range (1.24±0.27ng/dl vs1.11±0.13ng/dl, p&lt;0.05) FT3 level remained unchanged. Five (10%) epileptic children in the cases were found to have subclinical hypothyroidism at follow up who had TSH level beyond the normal reference range. Anti thyroid peroxidase antibody was negative among them. In contrast, no one in control group was found to have TSH level beyond the normal limit. All cases were clinically euthyroid. No significant correlations were found between TSH level and serum VPA level (r2 = 0.035 p= 0.193).&#x0D; Conclusion: Subclinical hypothyroidism develops in children with epilepsy during VPA therapy. Proper attention should be given so that development of overt hypothyroidism can be avoided.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.17 (2); Jul 2018; Page 14-20

Efficacy and Safety of Fentanyl as An Adjuvant with Bupivacaine and Lignocaine in Supraclavicular Brachial Plexus Block

Background: Adding narcotics to local anesthetic is very effective in prolonging the analgesic effects. The aim of this study is to evaluation the efficacy and safety of fentanyl as an adjuvant with bupivacaine-lignocaine in supraclavicular block.&#x0D; Methods: This analytical study was carried out in the department of anesthesiology in Chittagong Medical College Hospital in collaboration with the department of orthopedic surgery over a period of 22 months starting from January 2012 to December 2014. A total 130 adult patients of either sex with American Society of Anesthesiology (ASA) health status I-II were selected for upper limb surgery under supraclavicular brachial plexus block was randomly allocated in to two groups of 65 patients in each. Group- C was received Distilled water 2ml and Group-F was received fentanyl 2ml (100 g) in 38ml of bupivacaine and lignocaine with adrenaline (Total volume of 40ml).&#x0D; Results: The mean onset of sensory &amp; motor block was 10.49±0.75 min &amp; 9.41±0.76 min in group-C and 7.60±3.711min &amp; 9.23±5.114min in group-F. The duration of analgesia in group-C was 3.81±0.88 hrs and in group-F was 8.62±1.747 hrs.&#x0D; Conclusion: There was significantly prolonged duration of analgesia and better onset of sensory and motor block in fentanyl group without any unwanted effects.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.17 (2); Jul 2018; Page 31-35

Nitazoxanide – A New Option in Biliary Ascariasis

This prospective study was conducted in the in-patient department of medicine, Chittagong Medical College Hospital (CMCH), Chittagong, Bangladesh from February 2016 to September 2016. The study included 70 patients admitted to emergency department of medicine. Clinical assessment was performed in all the cases. Detailed history was taken as per site, severity and nature of pain. Nitazoxanite is a newly recommended antihelminthic agent elicits its activity by interfering with pyruvate: ferredoxin oxidoreductase (PFOR) enzyme dependent electron transfer reaction, which is essential for anaerobic energy metabolism. It is given by the oral route with good bioavailability and is well tolerated, with primarily mild gastrointestinal side effects. Nitazoxanide (500mg) tablet was given twelve hourly for 3 days. Relieve of pain after taking antihelminthic was observed and serial ultrasonogram was performed to determine the worm present or absent in biliary tree. In this study majority of the patients presenting biliary ascariasis were females (74.3%) and the most common age group affected was within 18 to 35 years of age. Among the total respondents, 88.57% were cured, while only 11.43% were not cured off their diseases.

Nitazoxanide – A New Option in Biliary Ascariasis

This prospective study was conducted in the in-patient department of medicine, Chittagong Medical College Hospital (CMCH), Chittagong, Bangladesh from February 2016 to September 2016. The study included 70 patients admitted to emergency department of medicine. Clinical assessment was performed in all the cases. Detailed history was taken as per site, severity and nature of pain. Nitazoxanite is a newly recommended antihelminthic agent elicits its activity by interfering with pyruvate: ferredoxin oxidoreductase (PFOR) enzyme dependent electron transfer reaction, which is essential for anaerobic energy metabolism. It is given by the oral route with good bioavailability and is well tolerated, with primarily mild gastrointestinal side effects. Nitazoxanide (500mg) tablet was given twelve hourly for 3 days. Relieve of pain after taking antihelminthic was observed and serial ultrasonogram was performed to determine the worm present or absent in biliary tree. In this study majority of the patients presenting biliary ascariasis were females (74.3%) and the most common age group affected was within 18 to 35 years of age. Among the total respondents, 88.57% were cured, while only 11.43% were not cured off their diseases

Prevalence of Urinary Tract Infection in Patient with Indwelling Catheter in Chittagong Medical College Hospital

Background: Hospital acquired urinary tract infection among the hospitalized catheterized patient due to different indications are a common morbility. The objective of study to see the prevalence hospital acquired urinary tract infection among the patients of indwelling catheter admitted in the department Medicine of Chittagong Medical College Hospital.&#x0D; Methods: It was a hospital based obsevational study conducted on purposively selected (Non-probability) hospitalized patients who got indwelling catheter had admitted into the Medicine ward, Chittagong Medical College Hospital from 1st January 2013 to 30th June 2013. Total 50 patients were selected. Urine was analyzed for growth of organism and sensitivity was also done in case where growth was positive. Data was analyzed by statistical method with the software SPSS-20.&#x0D; Results: Results showed that 15 (30%) developed bacteriuria or urinary tract infection with catheter. Development of bacteriuria was not affected by sex, age. People who introduce the catheter has some influence with the occurrence of UTI. E.coli, Klebsella, Proteas and Pseudomonas aeroginosa were the most common bacteria isolated. Imepenam was found the most sensitive antibiotic.&#x0D; Conclusion: Catheter play an important risk for occurrence of UTI. So it should be avoided if possible.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.17 (1); Jan 2018; Page 42-45

A Survey of Factors Influencing Drug Choice and the Prescribing Attitudes Among Junior Doctors of Two Major Tertiary Care Hospitals in Chittagong City

Background: The magnitude of rational prescribing is well known but the irrationalities and errors in prescriptions are seen worldwide as the training of future doctors is still not up to the mark. This study aimed to find out the factors influencing drug choice and the prescribing attitudes among junior doctors of two major tertiary care hospitals in Chittagong city.&#x0D; Methods: A cross-sectional questionnaire survey was conducted among the junior doctors of Chittagong Medical College Hospital (CMCH) and Chattagram Maa -O- Shishu Hospital Medical College (CMOSHMC) to assess the factors influencing drug choice and the prescribing attitudes among junior doctors during August 2016.&#x0D; Results: The questionnaires were provided to 220 participants of whom 162 (73.63%) participants provided a complete response to the survey. The response rate was 75.89% in CMOSHMCH and 71.29% in CMCH. The majority (87.03%) of junior doctors mentioned that they are highly influenced by their supervising senior doctors’ patterns of prescriptions. About 79.01% of them took the cost of drugs into consideration while prescribing. 58.64% of the prescribers reported their confidence while prescribing without supervision. On the otherhand, 33.33% doctors mentioned that side effects of the drug changed their patterns of prescriptions. Only one-third (33.95%) of the junior doctors opined that the pharmaceutical promotional offers never influence them.&#x0D; Conclusion: Junior doctors decide their drug of choice mainly by copying their supervising senior doctors’ prescriptions without knowing how to choose, and they feel less confident while prescribing. Issues of drug cost, adverse drug reactions concerned the majority of the participants, but they do not have the clear ideas on how to deal with these practice behaviours. Moreover, pharmaceutical promotional offers significantly persuaded the junior doctors’ prescription patterns. So, there is a need for the continuous medical education programs in hospital settings to train the junior doctors for building capacities and competencies while prescribing.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.17 (1); Jan 2018; Page 17-22

Efficacy and Safety Profile of Extended Release Tolterodine in Symptomatic Overactive Bladder

Background: Overactive Bladder (OAB) is a debilitating medical condition having the symptoms of urinary frequency and urgency with or without urge incontinence. Tolterodine was the first drug developed specifically for the treatment of OAB. It is a competitive muscarinic antagonist that exhibits similar affinities for muscarinic receptor subtypes M1 to M3. Tolterodine may be a more target specific drug that possesses stronger selectivity for the urinary bladder than for the salivary glands. In a pilot study in healthy volunteers, tolterodine was well-tolerated and showed greater function than on salivation.&#x0D; Objectives: To study the efficacy of tolterodine (ER) in relieving symptoms of overactive bladder with its adverse effects to determine the safety of the drug.&#x0D; Methods: This study was conducted at the Department of Urology, Chittagong Medical College Hospital, Chittagong, Bangladesh, from March, 2014 to June, 2015. Purposive sampling was done. Bladder diary was used for evaluating the symptoms of the patient during baseline and 08 weeks follow up. Perceived level of benefit of the patients was assessed and graded using Likert scale. Data analysis was conducted by SPSS version-21.&#x0D; Results: Out of 80 patients, 19 (23.75%) were male and 62 (76.25%) were female with a male: female ratio 1:3.2. The study revealed that the most of the patients, 48 (60.0%) were subjected to much benefit followed by 23 (28.75%) patients experienced little benefit and 09 (11.25%) patients with no benefit from the treatment.&#x0D; Conclusion: With mild form of side effects tolterodine showed a significant level of efficacy on overactive bladder.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.17 (1); Jan 2018; Page 34-37

Clinical Presentation and Outcome of Ruptured Uterus in A Tertiary Hospital

Background: Ruptured uterus is an obstetric emergency, carrying increased risk of maternal and perinatal mortality and morbidity especially in the developing countries. To determine the various aspects such as antecedent factors, clinical profile, management, outcome of ruptured uterus in a tertiary hospital.&#x0D; Methods: This prospective cross-sectional study conducted in the Department of Obstetrics and Gynecology in Chittagong Medical College Hospital, Chittagong, from January 2010 to December 2010. 70 consecutive admitted patients during this period was taken in this study.&#x0D; Results: During study period total 13635 obstetric patients were admitted and among them 70 cases were of ruptured uterus which gives an incidence of 0.5%. 92.85% of the women were multiparous. 77% patient did not have any antenatal care. 81% were illiterate and 82% belong to low socio-economic class. Common risk factors were mal-handling of labor by untrained dai (44%) cephalopelvic disproportion (35%) previous caesarean scar (34.28%) shoulder presentation 15%, abused of oxytocic drug (14%). Shock and sepsis were the prominent presenting features. In most cases, the tear was in the lower segment and in 54 patients (80%) the tear was complete. 25 (37%) patients had sub-total hysterectomy, 22 had repair and 13 (19.4%) had total hysterectomy. Maternal and fetal mortality rate was 11.42% and 88.5% respectively.&#x0D; Conclusion: A high incidence (1 in 195) of ruptured uterus mainly because of inadequate natal and intranatal care, high parity, mismanagement of labor, Low socio-economic condition and illiteracy.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.17 (1); Jan 2018; Page 29-33

Retinal Changes in Severe Malaria in Bangladeshi Children

Background: In malaria endemic areas diagnosis of severe malaria by microscopy and immunodiagnostic test is confounded by asymptomatic peripheral blood parasitemia. In such settings, retinal changes by ophthalmoscopy showed some diagnostic utility. Contribution of ophthalmoscopy in diagnosis of severe malaria in children is not well studied in Bangladesh. The aim of this study was to describe the retinal findings in children of cerebral and non-cerebral severe malaria by direct and indirect ophthalmoscope and relate their outcome and to determine the course of changes in the fundus.&#x0D; Methodology: In this prospective observational study 130 consecutive children aged between 6 months to 12 years admitted with confirmed severe Plasmodium falciparum malaria in pediatrics ward of Chittagong Medical College Hospital, Chittagong, Bangladesh were assessed by both direct and indirect ophthalmoscopy during the period of April 2008 to March 2009.&#x0D; Results: Out of 130 patients 80 children had cerebral malaria and of these 49 (61.2%) had some degree of retinopathy; 24 (48%) of 50 with non cerebral severe malaria had retinopathy. Predominant retinal changes were Retinal hemorrhage and Macular whitening each in 53 (40.77%) patients, followed by peripheral whitening, Vessels changes and papilloedema in 50 (38.46%), 40 (30.77%) and 14 (10.78%) patients respectively. With indirect ophthalmoscope as reference, direct ophthalmoscopy had a high sensitivity to detect macular whitening, and papilloedema but was less sensitive to detect peripheral whitening and vessel changes. Patients with retinopathy had more chance to had unfavorable outcome (Death) in comparison to the patients who had not {Odds ratio:1.09 (95% CI:1.017-1.167)}. Most of these retinal changes were transient and resolved gradually as clinical condition improved.&#x0D; Conclusion:Features compatible with malarial retinopathy were commonly found in our children with severe malaria. Ophthalmoscopy is an important clinical tool to aid in diagnosis and prognosis in children. However, indirect ophthalmoscopy provides better information than direct ophthalmoscopy.&#x0D; Bangladesh J Child Health 2018; VOL 42 (3) :118-124

Incidence of heart failure in patients of acute ST elevation myocardial infarction with impaired renal function

Ischemic heart disease is a common cardiac disorder and significant cause of mortality and morbidity worldwide. Effective risk stratification is integral to the management of patients with acute coronary syndromes and associated chronic kidney disease may adversely affect acute ST elevation myocardial infarction (STEMI) outcome. This prospective study was conducted in the Department of Cardiology, Chittagong Medical College Hospital after approval of the protocol for the study with duration of one year. For these purpose 100 patients of STEMI diagnosed by clinical, biochemical and ECG criteria were included in the study. After getting serum creatinine level, estimated glomerular filtration rate was calculated and if it is &lt;60 ml/min then the patient was selected for the study. Among the 100 patients inferior MI was 34%, anterior MI was 20%, extensive anterior MI was 12%, antero-septal MI was 18%, infero-lateral MI was 10%, lateral MI was 2%, high lateral MI was 3% and antero-inferior was 1%. Of these patients heart failure was found in 21% of the patients. The association between incidence of heart failure patients and eGFR was statistically significant (p &lt; 0.05). From this study, it was concluded that impaired renal function among MI patients plays a role for an adverse outcome. Early detection of renal impairment is necessary to avoid increased morbidity and mortality.&#x0D; Mediscope Vol. 6, No. 1: Jan 2019, Page 7-11

Role of Naked Eye Single Tube Red Cell Osmotic Fragility Test (NESTROFT) in Detecting Beta-Thalassemia Trait

Thalassemia is one of the commonest inherited diseases in Bangladesh. The birth of a thalassemic child places considerable strain, not only on the affected child and its family but also on the community and the nation at large. To reduce the burden of the society and to reduce the disease incidence by providing genetic counseling, detection of carrier is important. The present study evaluates the role of ‘Naked Eye Single Tube Red Cell Osmotic Fragility Test’ (NESTROFT) in detecting ß-thalassemia trait. The current study is a cross sectional study done during the period of September 2008 to August 2009. The study subjects were sibs, parents and relatives of thalassemia patients of age more than 1 year attending Pediatric department of Chittagong Medical College Hospital. Sample size was 50. Here subjects with lowered osmotic fragility test were detected and later on Hb- electrophoresis was done. All the data were recorded and analyzed by SPSS programme. The Sensitivity, Specificity and predictive value of positive and negative tests were computed and they were 92.6%, 80%, 92.6% and 80% respectively. False positive cases were found. The present study found NESTROFT to be both sensitive and reasonably specific and of high negative predictive value. However, multicenter study with large sample is needed to recommend NESTROFT as a single screening test for detection of ß-thalassemia trait.J Bangladesh Coll Phys Surg 2018; 36(4): 145-152

Intermediate Release Oxybutynin in Symptomatic Overactive Bladder

Background : Anticholinergic drugs are recommended as first line with Oxybutynin (IR) being one of the most commonly recommended drug. Older pharmacological agent such as propanthelene, dicyclomine and tricyclic antidepressent like imipramine have been used but have become alternative due to poor patient tolerability and lack of strong evidence from clinical trials. A combination of behavioral therapy and drug therapy has been shown to be more effective than either drug therapy or behavioral therapy alone. To assess the efficacy of Oxybutynin (IR) on number of micturition per day, episodes of incontinence per day and voided urinary volume along with the adverse effects of Oxybutynin (IR) and safety of the drug. Materials and methods: This study was conducted at the Department of Urology, Chittagong Medical College Hospital, Chittagong, from July, 2012 to June, 2013. Purposive sampling was done. Bladder diary was used for evaluating the symptoms of the patient during baseline and 08 weeks follow up. Perceived level of benefit of the patients was assessed and graded using Likert scale. Data analysis was conducted by SPSS version-21. Results: Out of 84 patients, 25 (29.8%) were male and 59 (70.2%) were female. Male female ratio was 1:2.4. The study revealed that the most of the patients, 49 (58.33%) were subjected to much benefit followed by 26 (30.95%) patients experienced little benefit and 09 (10.71%) patients were not benefited from the treatment. Conclusion: Oxybutynin showed a significant level of efficacy on overactive bladder with an acceptable level of side effects.&#x0D; JCMCTA 2018 ; 29 (1) : 23-27

Disease Profile and Outcome of Patients Admitted to A Pediatric Intensive Care Unit

Background: Pediatric Intensive Care Unit (PICU) has very important role in the management of critically ill children who require advanced airway, respiratory, and hemodynamic supports with the aim of achieving a better outcome. To describe the clinical spectrum and outcome patterns of diseases managed at PICU in Chittagong Medical College Hospital (CMCH) in order to provide data, which will assist in improving the management of diseases and the rational allocation of health resources. Materials and methods: It was a retrospective crosssectional study in which records of admissions of children from 29 days to 12 years of age were obtained from the PICU records. Results: A total of 851 patients were analyzed during the period of October 2015 to December 2016, of which 533 (62.6%) were males and 318 (37.3%) were females. The mean duration of hospital stay was 5.2 ±2.1 days (Range 0- 20 days). Among admission cases, Central Nervous System (CNS) was the most common system affected in our study 356 (41%) followed by respiratory system 263(31%) sepsis 89(10.45%) and cardiovascular diseases 55(%). We observed overall mortality rate 46.1%and Leave Against Medical Advice (LAMA) 4.11%. Highest mortality occurred in age group of 29 days to 1 year. Children with encephalitis and sepsis had higher mortality 25% and 21% respectively. Conclusion: The leading cause of admission was CNS infection followed by respiratory diseases and sepsis. The overall mortality rate in our PICU was high. A wellequipped intensive care unit with modern and innovative facilities along with the availability of fulltime trained pediatric intensivists made a significant impact on the outcome of critically ill children in our PICU.&#x0D; JCMCTA 2018 ; 29 (1) : 11-16

Efficacy and Safety of Dexamethasone as an Adjuvant With Bupivacaine and Lignocaine in Supraclavicular Brachial Plexus Block

Background: Perineural injection of corticosteroid has been successfully used to prolong the local anesthetic action. The aim of this study was to evaluation the efficacy and safety of dexamethasone as an adjuvant with bupivacaine-lignocaine in supraclavicular block. Material and methods: This analytical study was carried out in the Department of Anesthesiology in Chittagong Medical College Hospital in collaboration with the Department of Orthopedic Surgery over a period of 22 months starting from January 2012 to December 2014. A total 130 adult patients of either sex with American Society of Anesthesiology (ASA) health status I-II were selected for upper limb surgery under supraclavicular brachial plexus block was randomly allocated in to two groups of 65 patients in each. Group- D was received dexamethasone 2ml (10mg) and Group-C (Control) was received distilled water 2ml in 38ml of bupivacaine and lignocaine with adrenaline (total volume of 40ml). Results: The mean onset of sensory &amp; motor block was 7.72±1.949min &amp; 8.75±2.008min in group-D and 10.49±0.75min &amp; 9.41±0.76 min in group-C. The duration of analgesia in group-D was 11.40±0.844hrs and in group-C was 3.81±0.88hrs. Conclusion: There was significantly prolonged duration of analgesia and better onset of sensory and motor block in dexamethasone group without any unwanted effects.&#x0D; JCMCTA 2018 ; 29 (1) : 47-52

Comparative Outcome of Acute Coronary Syndrome In Diabetics and Non-diabetics

Background : It is well known that Coronary Artery Disease (CAD) is strongly associated with Diabetes Mellitus (DM). When CAD develops in diabetic patients the incidence of Acute Coronary Syndrome (ACS) becomes double. Diabetics also suffer more heart failure, pulmonary edema &amp; renal failure while in hospital. The proportion of ACS in diabetic patients is increasing. This trend will likely continue because the population has become more sedentary and overweight. A few studies available comparing the various outcomes of ACS patients with &amp; without DM in our country yet we know that burden of both ACS and DM in our population is increasing. Materials and methods: This analytical study was conducted from July, 2013 to June, 2104 in the Department of Cardiology of Chittagong Medical College Hospital. Subjects were by purposive sampling and grouped into two groups as diabetic (Group A) &amp; non diabetic (Group B) each group had 100 patients. Data processing and analysis was done with the help of computer using statistical software SPSS version-17 for windows. Statistical analyses were done by appropriate tests of significances (i.e. t-test, chi-square test). Results: The diabetic group had a significantly higher mean age (52.84 ±8.40 years) compared to the non-diabetic group (47.96 ± 9.52) (p=0.000) and majorities of the patients were male. Raised level of Serum Troponin I and mean LVEF was highly significant between the groups. The patients of both groups developed cardiogenic shock and heart failure in a different proportion (10 % and 4%: p= 0.042) which was statistically significant. Arrhythmia was an outcome in both groups without significant difference and recurrent angina was only found in diabetic group (n=06). Conclusion: Our study revealed higher number of complications, mortality and worse clinical features in diabetic ACS patients determining the additional adversities and complicated management with a lower prognostic outcome.&#x0D; JCMCTA 2018 ; 29 (1) : 28-34