Chittagong Medical College Hospital Research Articles

Efficacy of Autologous Blood Clot in Primary Pterygium Excision Compared with Suture Technique

Background: To assess the efficacy of pterygium excision and conjunctival autograft surgery among patients underwent autologous blood clot or using sutures (10-0 monofilament nylon). 
 Materials and methods: A randomized controlled trial was done at Department of Ophthalmology, Chittagong Medical College Hospital, with a study period from February 2017 to November 2018 was conducted with 60 eyes from 60 patients having primary nasal pterygium. They were selected according to inclusion and exclusion criteria and randomized into two groups for conjunctival autograft. Group A (30) was treated with autologous blood clot and Group B (30) was treated with sutures (10-0 monofilament nylon). All surgeries were performed by a single surgeon at single center. Standard examinations were performed preoperatively and postoperatively, preoperative and postoperative outcomes were evaluated and compared statistically where follow up was done at 1st day,7th days, 1-month, 3-month, and 6-month post operation. The mainoutcome variables were postoperative discomfort, graft stability and complications. 
 Results: This study included 60 patients (60 eyes) with a mean age of 46.77±7.04 (SD) (Range 33 to 58 years) in Group A (30) and 46.17±7.53 (SD) (Range 22 to 58 years) in Group B (30). In Group A, male was 22 (73.3%) and female was 8 (26.7%) where Group Bcontained male 20 (66.7%) and female 10 (33.3%). Follow-up at 1st and 7th post operation days showed marked discomfort in Group B (Mean rank 41.82 and 40.62) compared to Group A (Mean rank 19.18 and 20.38) respectively (p<0.001). At 1st post operation day there were 3 (10%) graft retraction in Group Aonly. Within 6 months follow-up, all grafts were stable and there wasonly 1 (3.3%) granuloma in Group B. 
 Conclusion: In primary pterygium excision, autologous blood clot showed excellent post- operative outcomes with much comfort, more stableas well as fewer complications. So, it appears to be an effective means to treat primary pterygium surgically.
 JCMCTA 2020 ; 31 (1) : 42-47

Management of wrist Ganglia by Aspiration Combined with Intralesional Steroid: A Prospective Study

Background: Ganglion is the most common be- nign soft tissue tumour of wrist and it represents about 60-70% of all such soft tissue tumours. There are various types of treatment options such as observation, aspiration, aspiration combined with intralesional steroids and surgical and arthroscopic excision. Many studies showed that surgical excision has the highest success rate but it has lots of dangers. So this study aimed that Aspiration with intralesional steroid, with its many advantages and success rate, may be the best choice for its treatment. 
 Materials and methods: We conducted the prospective study among 367 patients over a period of January 2017 to December 2018 in Surgery Outpatient Department, Chittagong Medical College Hospital, Bangladesh. After the procedure, patients were followed up every month for six months and then every 3 month for 1 year. Maximum follow up period was up to one year.
 Results: In our study it was found that there was female predominance with a male/female ratio of 1/1.41. Highest incidence was found in the age group between 21-30 years (37.1%). 68.4% patients presented with dorsal wrist ganglion and 31.6% with volar wrist ganglion. There was no steroid related local complication. Success rate of our study was 87.2% and recurrence rate was 12.8% within 6 months.
 Conclusion: Aspiration combined by intralesional steroid injection is an effective mode of management for wrist ganglion considering its success rate and post procedure complication rate.
 JCMCTA 2020 ; 31 (1) : 76-80

Neutrophil Lymphocyte Ratio as a Prognostic Factor in Acute Pancreatitis

Background: Different scoring systems are currently in use to stratify the severity of the acute pancreatitis to guide clinicians in triaging patients with the aim of improving outcomes. The Neutrophil-Lymphocyte Ratio (NLR) provides a rapid indication of the extent of an inflammatory process. Its value to predict the severity of acute pancreatitis has not been well studied. The aim of this study was to investigate the prognostic value of the NLR in acute pancreatitis patients.
 Materials and methods: This hospital based observational study was conducted at Medicine ward of Chittagong Medical College Hospital (CMCH) for one year period from January 2015 to December 2015. One hundred and four adult patients with a diagnosis of acute pancreatitis who fulfilled the defined inclusion and exclusion criteria were selected for the study. After obtaining informed consent clinical interviewing and physical examination were done according to predesigned case record form. Then blood was collected within one hour of admission. After getting the result, final selection were done following exclusion criteria. The patients were arranged into three groups according to NLR tertiles. Main outcome measures were intensive Care Unit (ICU)/High Dependency Unit (HDU) admission, Length of Stay (LOS) in the hospital and in-hospital mortality. 
 Results: According to NLR tertiles, patients in the 3 tertile (NLR³7.6) had significantly more ICU/HDU admissions (40.6% vs. 0%), longer average LOS (7.91 vs. 4.03 days) and more death (12.5% vs. 0%) compared with those in the 1rd tertile (NLR< 3.6). The higher the NLR tertile, the Modified Early Warning Score (MEWS) also increased significantly. According to the ROC curve, NLR values were superior in predicting ICU/HDU admission and hospitalization for ³ 7 days compared to WBC and MEWS values. 
 Conclusion: Elevation of the NLR during admission was significantly associated with severe acute pancreatitis and is a negative prognostic indicator in acute pancreatitis. It is superior to total WBC and modified MEWS in predicting adverse outcomes of acute pancreatitis.
 JCMCTA 2020 ; 31 (1) : 90-95

Knowledge, Attitudes and Practices Related to Breast Cancer Screening Among Female Doctors of a Tertiary Care Hospital in Bangladesh

Background: Doctors with inadequate knowledge and unfavorable practice in their own life will be sub-optimal in their performance in community. This study aimed to determine the Knowledge, Attitudeand Practice (KAP) regarding Brest Self Examination (BSE) Clinical Breast Examination (CBE) and mammographyas screening test for breast carcinoma among female doctors.
 Materials and methods: This cross-sectional study was conducted on working female doctors of Chittagong Medical College Hospital, a tertiary care hospital of Bangladesh. A semi-structured self-administered questionnaire was used for data collection which was consisted of four parts: i) Demographic characteristics ii) KAP about BSE iii) KAP about CBE iv) KAP about mammography. A total of 100 forms were distributed and 84 were returned back.
 Results: The mean (SD) age of the female doctors was 38.92 ±7.52 (Range, 27-59 years).Family history of Breast cancer was positive in 15.5% and 96.4% of the doctors were married, Out of those with positive family history, 4 (30.76%) were 1st degree relatives of the respondents. Regarding to their knowledge proportion of doctors had heard about BSE, CBE and mammography were 100%, 97.6% and 100% respectively. But proportion of doctors did not know the exact starting age for BSE and mammography were 61.9% and 11.9% respectively. Moreover, 13.1% didn’t know who should do the BSE, 11.9% reported that, trained nurse should do CBE, about 41% reported that CBE should be done by either mammography or ultrasonography. Regarding attitude majority considered BSE (100%), CBE (96.4%) and mammography (91.7%) as useful tool for early detection of breast cancer. Out of 36 doctors age 40 years 23.8% never practiced BSE and only 11.1% done mammography for themselves.
 Conclusion: Though doctors had positive attitude towards BSE, CBE and mammography as screening tests their knowledge and practices regarding these test were not optimal. Emphasis should be laid on BSE and CBE in undergraduate and postgraduate courses for doctors.
 JCMCTA 2020 ; 31 (1) : 48-53

Relationship of High-Sensitivity C- Reactive Protein (Hs-Crp) with the Components of Metabolic Syndrome

Background: Metabolic syndrome is associated with both the development of Hypertension, Diabetes Mellitus and an increased risk of adverse cardiovascular outcome. It is considered aspro inflamatory state linked with low grade systemic inflammation. C- reactive protein is a powerful biomarker of chronic systemic inflammation. Aim of this study is to evaluate the relationship of Highsensitivity C-reactive Protein (hs-CRP) with the components of Metabolic Syndrome (MetS) among hospitalized patients.
 Materials and methods: 50 patients of 18 years and above with metabolic syndrome, attending outdoor or admitted to Medicine Department of Chittagong Medical College Hospital from January 2016 to December 2016 were enrolled for this cross sectional study. The National Cholesterol Education Panel (NCEP) ATP – III, 2001 criteria was used for the diagnosis of MetS. Results: hsCRP level was found increased in almost every components of MetSin univariate analysis but the differences were not statistically significant. Patients with MetS had higher value of hs-CRP than without MetS (5.18±1.98 Vs 3.51± 1.63mg/l) with a p value 0.023. 
 Conclusions: Patients with metabolic syndrome had higher levels of hs-CRP than those without metabolic syndrome and hs-CRP levels increased directly with increasing number of its components.
 JCMCTA 2020 ; 31 (1) : 71-75

A Clinico-epidemiological Study of Malaria Patients Admitted in A Tertiary Care Hospital of Bangladesh

Malaria is a public health problem in 90 countries around the world affecting 300 million people and responsible for about 1 million deaths annually. Bangladesh is considered as one of the malaria endemic countries in Asia. Every year large number of people suffered for malaria. But there is little studies about clinico-epidemiology of malaria. Aim: To study the epidemiological and clinical aspects of malaria. Methods: This is a Prospective observational study that was conducted in all medicine unit of Chittagong Medical College Hospital, Chittagong, Bangladesh during August 2017 to June 2018. Total 55 patients were included in the study having malaria diagnosed by blood slide examination or rapid diagnostic test. Patients were enrolled in this study after getting written informed consent from the patient or attendant. Detail demographic and clinical data were recorded in structured case report form. Patients were regularly followed up and outcome recorded. Results: Results showed males (65.5%) of 25±15.109 years of age were the main sufferer. Majority (45%) came from low socio-economic condition (<5000 taka/month). 65.5% patients denied any history of recent travel to malarias’ area. 69.1% cases give history of using mosquito net, but only 25.5% have insecticide treated mosquito net. Majority (89.1%) were diagnosed as severe malaria and only few (10.9%) as uncomplicated malaria. Most of the diagnosis done at Chittagong Medical College Hospital, mainly presenting with coma or altered consciousness and convulsion. At field level diagnostic test done in 67.27% cases, of which RDT in 14.5%, BSE in 45.5% and both in 7.3% cases. 78.2% cases outcome were good with improvement and death occurred in 21.8% cases, mainly due to acute renal failure. Conclusion: Though we are making significant effort to control malaria, still we have to improve in controlling malaria based on both preventing the infection and on prompt effective treatment of the infection and illness when it does occur

A Clinico-epidemiological Study of Malaria Patients Admitted in A Tertiary Care Hospital of Bangladesh

Malaria is a public health problem in 90 countries around the world affecting 300 million people and responsible for about 1 million deaths annually. Bangladesh is considered as one of the malaria endemic countries in Asia. Every year large number of people suffered for malaria. But there is little studies about clinico-epidemiology of malaria. Aim: To study the epidemiological and clinical aspects of malaria. Methods: This is a Prospective observational study that was conducted in all medicine unit of Chittagong Medical College Hospital, Chittagong, Bangladesh during August 2017 to June 2018. Total 55 patients were included in the study having malaria diagnosed by blood slide examination or rapid diagnostic test. Patients were enrolled in this study after getting written informed consent from the patient or attendant. Detail demographic and clinical data were recorded in structured case report form. Patients were regularly followed up and outcome recorded. Results: Results showed males (65.5%) of 25±15.109 years of age were the main sufferer. Majority (45%) came from low socio-economic condition (<5000 taka/month). 65.5% patients denied any history of recent travel to malarias’ area. 69.1% cases give history of using mosquito net, but only 25.5% have insecticide treated mosquito net. Majority (89.1%) were diagnosed as severe malaria and only few (10.9%) as uncomplicated malaria. Most of the diagnosis done at Chittagong Medical College Hospital, mainly presenting with coma or altered consciousness and convulsion. At field level diagnostic test done in 67.27% cases, of which RDT in 14.5%, BSE in 45.5% and both in 7.3% cases. 78.2% cases outcome were good with improvement and death occurred in 21.8% cases, mainly due to acute renal failure. Conclusion: Though we are making significant effort to control malaria, still we have to improve in controlling malaria based on both preventing the infection and on prompt effective treatment of the infection and illness when it does occur.

Chest Trauma Evaluation and Outcome of Management in a Tertiary Hospital-One Year Experience

Background: Chest trauma is responsible for 50% of deaths due to trauma. This kind of death usually occurs immediately after trauma. Various therapeutic options have been reported for management of chest injuries like clinical observation, thoracocentesis, tube thoracostomy and open thoracotomy.
 Methods: This is an observational study carried out in the department of Casualty, Chittagong Medical College Hospital over a period of one year (from April 2015 to March 2016). All the patients (both male and female) admitted in the casualty units within the specified period were included in this study.
 Result: The mean age was found 37.7±18.1 years and male-female ratio was 11.8:1. Almost one third (35.7%) patients were affected by road traffic accident. 42(27.2%) patients were found open pneumothorax followed by rib fracture-41(26.6%), haemopneumothorax-31(20.1%), pneumothorax- 14(9%), haemothorax-12(7.8%), chest wall injury-6(3.9%), tension pneumothorax-5(3.2%), and flail chest-3(1.9%). More than three fourth (80.5%) patients were managed by tube thoracostomy followed by 28(18.2%) observation and 2(1.3%) ventilatory support. No thoracotomy was done in emergency department. Re-insertion of ICT was done in 6(4.7%) patients. More than two third (68.2%) patients recovered well, 43(27.9%) patients developed complications and 6(3.9%) patients died.
 Conclusion: Most of the patients were in 3rd decade with male predominance. Road traffic accident was the commonest cause and open pneumothorax was the commonest chest trauma. Three-fourths were managed by tube thoracostomy. Nearly one third of the patients had developed complications and about four percent of patients died.
 Journal of Surgical Sciences (2019) Vol. 23 (1) : 19-24

Chest Trauma Evaluation and Outcome of Management in a Tertiary Hospital - One Year Experience

Background: Chest trauma is responsible for 50% of deaths due to trauma. This kind of death usually occurs immediately after the trauma has occurred. Various therapeutic options have been reported for management of chest injuries like clinical observation, thoracocentesis, tube thoracostomy and open thoracotomy. Objective: To observe the pattern and outcome of management in chest trauma
 Methods: This is an observational study carried out in Casualty department of Chittagong Medical College Hospital (CMCH), Chittagong, between April 2015 to March 2016. Our study was included all patients, both sexes, following chest injury at Casualty units of Chittagong Medical College Hospital. All the data were recorded through the preformed data collection sheet and analyzed. Result: The mean age was found 37.7±18.1 years with range from 12 to 80 years. Male female ratio was 11.8:1. The mean time elapsed after trauma was found 6.1±3.1 hours with range from 1 to 72 hours. Almost one third (35.7%) patients was affecting road traffic accident followed by 42(27.3%) assault, 35(22.7%) stab injury, 15(9.7%) fall and 7(4.5%) gun shot . More than three fourth (80.5%) patients were managed by tube thoracostomy followed by 28(18.2%) observation and 2(1.3%) ventilatory support. No thoracotomy was done in emergency department. 42(27.2%) patients was found open pneumothorax followed by 41(26.6%) rib fracture, 31(20.1%) haemopneumothorax, 14(9%) simple pneumothorax, 12(7.8%) haemothorax, 6(3.9%) chest wall injury, 5(3.2%) tension pneumothorax, and 3(1.9%) flail chest. About the side of tube 60(39.0%) patients were given tube on left side followed by 57(37.0%) patients on right side, 9(5.8%) patients on both (left & right) side and 28(18.2%) patients needed no tube. Regarding the complications, 13(30%) patients had persistent haemothorax followed by 12(29%)tubes were placed outside triangle of safety, 6(13.9%) tubes were kinked, 6(13.9%) patients developed port side infection, 2(4.5%)tube was placed too shallow, 2(4.5%) patients developed empyema thoracis and 2(4.5%) patients developed bronchopleural fistula. The mean ICT removal information was found 8.8±3.6 days with range from 4 to 18 days. Reinsertion of ICT was done in 6(4.7%) patients. More than two third (68.2%) patients were recovered well, 43(27.9%) patients developed complication and 6(3.9%)patients died. More than two third (66.9%) patients had length of hospital stay 11-20 days.
 Conclusion: Most of the patients were in 3rd decade and male predominant. Road traffic accident and tube thoracostomy were more common. Open pneumothorax, rib fracture and haemopneumothorax were commonest injuries. Nearly one third of the patients had developed complications. Re-insertion of ICT needed almost five percent and death almost four percent.
 Journal of Surgical Sciences (2018) Vol. 22 (2) : 110-117

Incidence of non biliary non alcoholic acute pancreatitis in a tertiary hospital

Background: Acute pancreatitis is an important cause of hospital admission with acute abdomen. It is responsible for significant morbidity and also mortality in patients.
 Objective: To determine the incidence of non-biliary nonalcoholic acute pancreatitis (Non A non B) and also to compare the incidence with alcoholic and biliary pancreatitis in the department of surgery of Chittagong Medical College Hospital, Bangladesh as well as with the developed countries
 Methods: This prospective study was carried on 75 patients of both sex having acute abdominal pain characteristic of acute pancreatitis and serum amylase >3 times normal, admitted in General Surgery wards in CMCH and supported by biochemical test during June 2008 to May 2010.
 Results: The mean (±SD) age was 36.1±15.4 years and 32.7±14.3 years in male and female group respectively (p>0.05) and maximum number was found in the age group of 20-30 years in both groups. Choledocolithiasis were 2(33.3%) and 7(21.9%) in male and female respectively evaluated by USG. Sludge in GB 1(16. 7%) in male and 7(21.9%) in female. Biliary ascariasis 3(50.0%) and 16(50.0%) in male and female respectively. Alcoholic was found 4(16.0%), Biliary 2(8.0%) and Non Alcoholic non Biliary 19(78.0%) in male patients. Biliary 32 (64.0%) and Non Alcoholic non Biliary 18(36.0%) in female patients. The difference was statistically significant (p<0.05). It was observed that the total patients were 75 among them Alcoholic was 4(5.3%), Biliary was 34(45.3%) and Non Alcoholic non Biliary was 37(49.3%) of study patients.
 Conclusion: Non-A non-B acute pancreatitis accounts for about a half - of all cases of acute pancreatitis and is significantly less frequent among female patients. Biliary pancreatitis was higher in female subjects. Bilio pancreatic ascariasis is 50.0% in both male and female subjects.
 Journal of Surgical Sciences (2017) Vol. 21 (2): 85-88

EVALUATION OF CURRENT SCENARIO OF CANCER DISEASE AT CHATTAGRAM IN BANGLADESH

Objective: Now a day Cancer is the furthermost dangerous diseases. It can develop almost anywhere in the body. Cancer is a disease whose treatment process takes too long time and also too costly.
 Methods: This is a survey work on cancer due to current increasing of the number of cancer patients in Bangladesh. This evaluation was conceded in Chittagong Medical College Hospital, Bangladesh, from 10th November 2019 to 25th February 2020. Here, 31 cancer patients were evaluated.
 Results: In this work, it is observed that most of the cancer patients were female. In this study, it was also observed the cancer was occurred highly at the age of 41-50 years (30%), then age limit 31-40 (20%).Most of the female are bearing ovary cancer (26%) and Breast cancer (29%) and also male are affected by Thyroid cancer (26%). We found that 60% of patients were being treated with chemotherapy alone. Doctors were commonly prescribed of chemo drugs Cisplatin (21%) and Folinic acid (29%).
 Conclusion: Government should highlight on the expansion of specific cancer center. Such types of centers can also deliver rehabilitation as well as relaxing care for dangerous cancer patients to release their highdistress.
 Peer Review History: 
 Received 26 February 2020; Revised 7 March; Accepted 9 March, Available online 15 March 2020
 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 
 
 Average Peer review marks at initial stage: 4.0/10
 Average Peer review marks at publication stage: 7.0/10
 Reviewer(s) detail:
 Name: Dr. Dalia Kamal Zaffar Ali
 Affiliation: Modern University for technology and information, Egypt
 E-mail: dr.moda88@gmail.com
 
 Name: Dr. Mohammad Tauseef
 Affiliation: Department of Pharmaceutical Sciences
 College of Pharmacy, Chicago State University
 E-mail: mtauseef@csu.edu
 Comments of reviewer(s): 
 
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Comparative Study of Vitamin D Among Diabetic And Nondiabetic Chronic Kidney Disease Patients

Background: Chronic Kidney Disease (CKD) is a major health problem in Bangladesh. Diabetes mellitus is the most common cause of this pathology. Among individuals with CKD, vitamin D deficiency is very much prevalent. But there are not enough studies comparing vitamin D status of diabetic and nondiabetic CKD patients. So, this study aimed to compare the 25(OH)D levels between these two groups.
 Materials and methods: This cross-sectional comparative study was carried out in the Department of Biochemistry and the Department of Nephrology, Chittagong Medical College Hospital from June 2013 to May 2014. Fifty (50) diabetic CKD patients and fifty (50) age-sex matched nondiabetic CKD patients of 18-85 years fulfilling the required enrolment criteria were purposively selected to form two comparing groups. Patient-profiles were completed by history and physical examination. Anthropometric and clinical parameters were analysed along with fasting and 2 hours after breakfast plasma glucose, serum creatinine, eGFR, serum calcium, serum phosphate and 25(OH)D. Data were analysed by computer-based statistical software. The confidence level was fixed at 95% and p-value of <0.05 was considered significant.
 Results: In the study, all patients in both groups had hypovitaminosis D and the vitamin D deficiencies in diabetic and nondiabetic CKD patients were 100% and 84% respectively. Mean 25(OH)D was significantly lower in the diabetic group (5.48 ± 0.39 ng/mL) compared to nondiabetic one (9.08 ± 0.75 ng/mL), but the severity of vitamin D deficiency did not seem to correlate with CKD stages.
 Conclusion: In conclusion, this study establishes the high prevalence of vitamin D deficiency in both diabetic and nondiabetic CKD patients, but the deficiency was more severe in diabetic ones.
 JCMCTA 2019 ; 30 (2) : 16-21

Efficacy of Lignocaine in Three Different Routes In Attenuation of Haemodynamic Response Associated With Endotracheal Intubation : A Comparative Study

Background: Transient haemodynamic instability i.e tachycardia and hypertension is an inevitable outcome of laryngoscopy and endotracheal intubation which can have serious effects in patients with COPD, IHD or hypertension that can lead to ischaemia, infarction, arrhythmia or cardiac arrest in vulnerable patients. Administration of lignocaine is one of the techniques used to attenuate haemodynamic response associated with endotracheal intubation. The present study was designed to compare the changes in blood pressure and heart rate that occur before and after the endotracheal intubation in three different routes intravenous( i.v.) local spray over laryngeal inlet or nebulization.
 Materials and methods : It was a randomized double blind clinical trial. It was conducted at the Department of Anaesthesiology, Chittagong Medical College Hospital, Chattogram from July 2005 to June 2007. A total of one hundred and fifty adult patients (ASA I, Mallampati grade 1 & 2) scheduled for elective surgery under general anaesthesia wereselected. Patients were randomly allocated in three groups A,B and C, by lottery .Group A received 2% lignocaine i.v., Group B received 10% lignocaine spray over the laryngeal inlet and vocal cords and group C patients were nebulized with 2% lignocaine solution.
 Results: The rise in Systolic, Diastolic and mean arterial pressure with local spray was significantly lower than with intravenous and nebulized group and the rise in heart rate was significantly lower with local spray group than with nebulization group and intravenous group. Data were processed using software SPSS version 11.5. The test statistics used to analyse the data were Chi-squire(c2) test and Anova.
 Conclusion: The findings of this study reflects the local spray of 10% lignocaine over laryngeal inlet prior to intubations attenuates the rise in blood pressure and heart rate more than intravenous administration of lignocaine or nebulization of lignocaine.
 JCMCTA 2019 ; 30 (2) : 86-91

Age at Orchidopexy for Undescended Testes: How Far Beyond Are We From Guidelines?

Background : Recommendations for age at orchidopexy for Undescended Testis (UDT) have changed from time to time in accordance with change of knowledge regarding its pathology and prognostic features. In most developed countries, recommendation for ideal time of orchidopexy is between six months to one year. This study investigates the age of patients who underwent orchidopexy for undescended testis in this institute to assess the current trend of age at orchidopexy in this region.
 Materials and methods : This is a retrospective study carried out in the Department of Pediatric Surgery, Chittagong Medical College Hospital from January 2017 to December 2019. Patients of UDT who visited the outpatient department, admitted in this ward or underwent orchidopexy in this department were retrospectively evaluated from hospital records, operating theatre register, patient files and admission profile and departmental audits. Number of patients, side of involvement and age distribution were calculated.
 Results: A total of 218 patients of UDT attended OPD (1.91% of total OPD) 96 patients were admitted (1.33 % of all admissions) and 82 patients underwent orchidopexy (1.48 % of total surgeries) during the study period. Age at orchidopexy ranged from 8 months to 12 years with a median age of 5 year 11 months. Only 5 patients (6.10 %) underwent orchidopexy at the recommended time of between 6 months to one year.
 Conclusion: Many patients attended OPD after the recommended age and many underwent surgery at a later age which increases their risk of malignancy and testicular atrophy.
 JCMCTA 2019 ; 30 (2) : 47-51

Fine Needle Aspiration Cytology of Thyroid Swellings With Histopathological Corellation

Background : To assess the diagnostic accuracy of aspiration cytology as a pre-operative screening procedure and this study was done to reach a consensus and to find out the best diagnostic tool for assessment of thyroid swellings pre-operatively.
 Materials and methods : A cross sectional study was carried out in the Department of Otolaryngology & Head Neck Surgery of Chittagong Medical College Hospital (CMCH) between March 2014 to March 2015. Total 50 patients were included in the study, where pre-operative Fine Needle Aspiration Cytology (FNAC) and post operative histopathology were done to find out the correlation. Data were analyzed and presented as both qualitative and quantitative data as applicable using SPSS version 20. The quantitative data were analyzed by mean, standard deviation. The qualitative data were analyzed by Mc NEMAR test (Mc NEMAR c2 test).
 Results : 50 cases were included in the study. FNAC revealed 40 non- neoplastic lesion, 5 papillary carcinoma, 4 follicular neoplasm and 1 was suspicious for malignancy. Histopathology revealed 38 non neoplastic and 2 neoplatic lesion among 40 non neoplastic cases. 5 cases which were diagnosed as papillary carcinoma thyroid on FNAC were also proved to be same on histopathology. Out of 4 follicular neoplasm 1 was non neoplastic and other 3 were neoplstic. The suspicious for malignancy lesion was proved as cystic papillary carcinoma on histopathology. The sensitivity of FNAC was 81.82%, specificity was 97.44%, positive predictive value was 90%, negative predictive value was 95% and accuracy was 94%.
 Conclusion : FNAC of Thyroid is more specific then sensitive with high accuracy rate. Therefore FNAC should be adopted as an initial investigation of thyroid disease.
 JCMCTA 2019 ; 30 (2) : 36-40

Factors Influencing Adherence to Disease Modifying Antirheumatic Drugs and Its Effects on Disease Activity in Rheumatoid Arthritis Patient

Background: Non-adherence in patients with Rheumatoid Arthritis (RA) using Disease Modifying Antirheumatic Drugs (DMARDs) will not only affect the patient’s disease activity, but also the rheuma-tologist’s treatment decisions, and lead to higher health care costs. Poor adherence has been shown to be linked to different factors in different studies. There is paucity of study among the RA patients of Bangladesh in this issue. This study was conducted to evaluate the factors influencing adherence to DMARDs and its effects on disease activity in RA patient.
 Materials and methods: It was a hospital based cross-sectional study. Total 107 diagnosed cases of RA, on DMRDs at least for 3 months were included from Rheumatology Clinics of Medicine and Physical Medicine Department of Chittagong Medical College Hospital (CMCH) from January 2018 to December 2018. Severity of RA was assessed by Disease Activity Score (DAS-28) while drug adherence was measured by Morisky Medication Adherence Scale-8 (MMAS-8) questionnaire. The Beliefs about Medicines Questionnaire (BMQ) was used to assess beliefs about the necessity of medication and concerns about it.
 Results: Out of the 107 RA patients there was female predominance with a male to female ratio of 1:2.15 and mean age was 45.53±12.13 years with a range of 18-69 years. Non-adherence with DMARDs was found among 80.4% of cases. Non adherent patients had significantly higher disease activity as measured by DAS-28. Except belief about medication no other socio-demographic and disease related factors were associated with adherence level. Higher adherence was associated with stronger perceptions of necessity of treatment and less concerns about treatment.
 Conclusion: Frequency of low adherence among RA patients was high and patients with lower medication adherence tended to have higher disease activity. The strongest relation with adherence was found to be beliefs about the necessity of the medication and it is modifiable. This provides hope to improve adherence.
 JCMCTA 2019 ; 30 (2) : 62-69

Comparison of Outcome on Early and Late Initiation Of Operative Treatment in Children With Lateral Condyle Fracture of Humerus

Background: Lateral condyle fracture of humerus in children is the second most common fracture around elbow occurs less commonly than supracondylar fracture in the range of 15% to 20% that must be treated by operation. To find out the demographic variations, causes, functional movements and complications of late cases of lateral condyle fracture of humerus in children treated by open reduction and internal fixation and also comparison with early cases.
 Materials and methods: This prospective interventional study was carried out in the Department of Orthopaedic Surgery, Bangabandhu Sheikh Mujib Medical University and Chittagong Medical College Hospital for the duration of 03 years and 06 months. Total 24 patients of fracture lateral condyle of humerus in children age ranges from 02 to 14 years were selected but due to loss of follow up, 20 children were taken in account for the study. Total patients were divided into two groups- group I: early (Up to 4 weeks) and group II: late (5 to 12 weeks) according to time interval from injury to operative treatment.
 Results: In this study, Out of 20 patients, male (85%) were more than female (15%) left side involvement was 60% and right side was 40%. Among causes of injury, 55% was due to sports injury, 30% was fall from height and 15% from RTA. 35% initially treated by plaster cast, 60% by traditionally bone setter. 55% were misdiagnosed, complications were 10% in group I and 30% in group II. Outcome was satisfactory with 100% in group I and 70% in group II.+
 Conclusion: Outcome was better in early cases by operative treatment but late cases up to 12 weeks should be treated by operation.
 JCMCTA 2019 ; 30 (2) : 10-15

Association of Vitamin D Level and Forced Expiratory Volume in First Second in COPD Patients

Background: Chronic Obstructive Pulmonary Disease (COPD) is a major cause of morbidity and mortality throughout the world which is preventable as well as treatable disease. In recent years, multiple roles of vitamin D have been highlighted in various diseases. Data on vitamin D status in COPD in Bangladeshi population are still limited. Aim of our study is to see any association between vitamin D level and FEVI (Forced Expiratory Volume in First Second) in COPD patients.
 Materials and methods: Fifty cases of COPD patients were diagnosed by GOLD (Global Initiative for Chronic Obstructive Lung Disease) criteria included in this study conducted at Medicine Department of Chittagong Medical College Hospital for six months period from April 2018 to September 2018. Serum vitamin D 25-OH level were assessed by enhance chemiluminance method and post-bronchodilator FEV1 was measured in all patients by spirometry.
 Results: The mean age of patients was 64.50 ± 7.60 years. The mean serum 25-OHD level was 21.69 ± 7.39 ng/ml and mean FEV1 (%) was 20.62 ± 18.80. There was very strong positive correlation present between, serum 25-OHD and FEV1% of predicted. Only 16% of the COPD patients had sufficient vitamin D level, 42% had insufficient and other 42% had deficient vitamin D status.
 Conclusion: COPD patients with more severe disease tend to have lower serum Vitamin D level.
 JCMCTA 2019 ; 30 (2) : 22-25

A Survey on Causes of Cesarean Sections Performed on Women and Their Knowledge towards the Mode of Delivery

Recently elective cesarean delivery rates have increased alongside with emergency cesarean delivery where less information has been conveyed to the women who have been subjected to C-sections. The main objective of C-section is reducing the incidence of maternal and neonatal mortality during childbirth in dangerous situations. It is recommended when there is a risk to mother or child during vaginal delivery. A descriptive type of cross-sectional study design was used. All the data were collected through structured format in questionnaires. The present study was carried out in the department of Obstetrics and Gynecology in the Chittagong Medical College Hospital. The data was collected from 29th September 2019 to 10th October 2019. Most of the patients who were subjected to c section were within the age range of 15-25 (57%). 41% of the cesarean sections were planned whereas 59% were on the basis of emergency and mostly the decision was doctor’s (66%). 58% of the population had enough information before undergoing C-sections and 42% wasn’t fully aware. Among pain medication intake, only 2% of the patients had taken a combination of three pain medications which include paracetamol, metronidazole and suppository. 80% of the patients consumed a combination of paracetamol and suppository whereas only 10% of population consumed paracetamol and metronidazole. 8% of the patients were managed only with paracetamol. 23% of the cesarean patients had a previous history of ceaser and among them some rare special cases had a previous history of 4 ceasers (2%). 43% of the patients suffered pregnancy induced hypertension and 8% suffered pregnancy induced diabetes. 20% of the c section were due to breech presentation and 80% were due to other reasons which included seventeen factors. Patients are not given enough information about C-section and mostly the decisions are taken by the doctors without the consent of the patients.

Outcome of medical induction of labour in postdated pregnancy

Induction of labour in postdated pregnancy is an important issue in modern obstetric practice. It might play a great role to reduce maternal and perinatal mortality and morbidity. The study aims to determine the outcome of medical induction of labour in postdated pregnancy. It is a cross sectional study carried out in the Department of Obstetrics and Gynaecology, Chittagong Medical College Hospital, Chattogram, Bangladesh from October 2018 to April 2019. In this study among primi gravida 40% patient had vaginal delivery & 60% needed caesarean section, whereas 90% multigravida patient delivered vaginally & 10% needed caesarean section. 48% patient had favourable cervix & induced by oxytocin and remaining 52% patient having unfavourable cervix induced by prostaglandin followed by oxytocin. 55% caesarean section was done for fetal distress and 45% for abnormal uterine action and maternal complication occurred in 28% patient. Among the delivered baby 80% were healthy and 16% were asphyxiated. Oxytocin was found most effective in case of favorable cervix and prostaglandin in unfavorable cervix.