Chittagong Medical College Research Articles

Association between Glycemic Gap at Admission and In-Hospital Outcome in Patients with Diabetes with Acute Myocardial Infarction

Background: Acute hyperglycemia predicts adverse outcomes in patients with acute myocardial infarction (AMI), but it has a major disadvantage because the association is diminished in patients with diabetes mellitus (DM). Recent studies introduced a more accurate predictor, the glycemic gap (the difference between admission blood glucose and the estimated average glucose), that could anticipate adverse outcomes in patients with diabetes with AMI. Aims: This study aimed to determine the association between glycemic gap and clinical outcome in diabetic patients presenting with AMI to a tertiary hospital in Bangladesh. Methods: Two hundred twenty diabetic patients hospitalized with AMI were included in this study from the Department of Cardiology of Chittagong Medical College Hospital from March 2023 to February 2024. Admission blood glucose and HbA1c were measured, and the glycemic gap was calculated. Patients were prospectively followed during their hospital stay to obtain data regarding major adverse cardiac events (MACEs). Results: The mean (±SD) age of the patients was 56.5 (±10.1) years and 63.6% of them were male. MACEs included in-hospital death, cardiac arrest, cardiogenic shock, arrhythmia and left ventricular failure were observed in 6.4%, 3.6%, 19.5%, 5.5%, and 30.5% of the patients, respectively. Ninety-nine (45%) patients had one or more MACEs. Median (IQR) glycemic gap values were 38.5 (31.9-47.3) and 71.0 (61.0-84.3) in patients without any MACEs and patients with one or more MACEs, respectively (p<0.001). Median (IQR) glycemic gap values were 90.6 (86.0-97.9) and 52.6 (36.1-69.3) in expired and survived patients, respectively (p<0.001). The area under the receiver operating characteristics curve (AUROC) for admission glycemic gap values to predict in-hospital mortality was 0.895[95% confidence interval (CI) 0.768-1.000, p<0.001] and with the best cut-off value of 80.16, glycemic gap had sensitivity and specificity of 92.9% and 89.8%, respectively.The Area Under ROC for admission glycemic gap values to predict MACEs was 0.926 (95% CI 0.874-0.958) and with the best cut-off value of 53.19, glycemic gap had a sensitivity and specificity of 94.9% and 84.3%, respectively. Glycemic gap was an independent predictor of MACEs [odds ratio (OR): 1.11, 95% CI 1.08-1.14, p <0.001] and in-hospital mortality (OR: 1.09, 95% CI 1.05-1.14, p <0.001). Conclusions: Elevated glycemic gap was significantly associated with an increased in-hospital mortality and other MACEs. So, glycemic gap can be used to assess the prognosis of hospitalized AMI patients with diabetes.

Pattern of Pesticide and Herbicide Poisoning Among People Admitted to Medicine Wards of a Tertiary Care Hospital

Introduction: Acute poisoning has become a major public health problem accounting for significant morbidity and mortality around the globe2. According to WHO data, an estimated 193,460 people died worldwide in 2012 from unintentional acute poisoning. 84% of these deaths occurred in resource-lacking low- and middle income countries3. The toxicity of accessible poisons and the scarcity of adequate medical facilities for poisoning management is responsible for a such a high mortality rate in this region4. Acute pesticide poisoning usually occurs during agricultural use either by accidental exposure or by suicidal attempt, rarely as homicidal2,5&8. This study is designed to assess the patterns of pesticide & herbicide poisoning among rural & urban peoples admitted to medicine ward of a tertiary level hospital and to find out the sociodemographic characteristics of the respondents. So that the supply of these agents be properly regulated to prevent easy accessibility and misuse. Materials and Methods: It was a hospital based cross-sectional observational study conducted at indoor Department of Medicine, Chittagong Medical College Hospital for six months period from 01/01/2019 to 31/06/2019. Ethical clearance was taken from ethical review committee of Chittagong Medical College and informed consent was obtained from each participants. Hundred patients above 12 years of age with a relevant history and clinical signs and symptoms of any type of pesticides and herbicides poisoning who fulfilled the selection criteria were selected consecutively for the study. Data was collected using a pretested, multi-structured questionnaire which comprised of questions to identify demographic data, type and circumstances of poisoning. Results: Regarding motive of poisoning in our study 81% patient took pesticide & herbicide poisoning for suicide and 19% admitted with accidental case. This result is consistent with the study where most common reason of pesticide & herbicide poisoning was suicide (93.3%) 20. A study performed at Rajshahi Medical College from January 1991 to December 1994 showed that out of those 405 cases of OPC poisoning 310 were suicidal (76.54%) and 95 were homicidal (23.45%) poisoning28. The present study revealed that factors responsible for the suicidal attempt were familial disharmony in 46% of cases, marital problems in 19%, financial problem in 16%, mental disorder in 3% and 11% due to other reasons. Shadequl-Islam et al. reported the motive of pesticide poisoning in their study that 45% of cases were due to familial disharmony, 15% unknown, 13.3% depression, 8.3% marital problems, 5% financial problems and 13.3% due to other reasons26. In most cases, the patient could access to the poison by self-purchasing from poison retailers. Conclusion: This study has indicated that young adults, males and socially underprivileged people are at a higher risk of pesticides and herbicides poisoning. This study showed pesticides & herbicides poisoning is the most common modes of suicidal deaths. Pesticides are mostly misused purposefully as an easy means for committing suicide. Early diagnosis and treatment is mandatory in order to minimize mortality from these potentially lethal compounds. It is recommended that the supply of pesticides be properly regulated to prevent easy accessibility and misuse. Medicine Today 2023 Vol.36 (1): 36-40

Frequency and outcome of sodium disturbances in children admitted with acute watery diarrhea in a tertiary hospital of Bangladesh

Background: Acute watery diarrhea (AWD) is one of the common causes of hospital admissions in pediatric age group. Majority of children with dehydration suffer from different electrolyte abnormalities which needs to be identified and treated. Objectives: To investigate the frequency and outcome of sodium disturbances in AWD among children admitted in a tertiary hospital in Bangladesh. Method: In this prospective observational study, 121 children of 2 months to 5 years of age admitted in the Department of Pediatrics, Chittagong Medical College Hospital with AWD were included. Clinical features and sodium levels on admission were recorded. Patients were followed up during their hospital stay to record the outcomes. Children were grouped in hyponatremia (serum sodium <135mmol/l), hypernatremia (serum sodium >145mmol/l) and normonatremia (serum sodium 135–145mmol/l) and compared. Results: Of the 121 children, 38.0% and 62.0% had moderate and severe dehydration, respectively. The majority (58.7%) had normal sodium levels. Sodium disturbances was found in 41.3% cases. There were 26.4% cases of hypernatremia and 14.9% cases of hyponatremia among them. Out of 18 hyponatremic patients, 77.8% had mild hyponatremia and the rest 22.2% had moderate hyponatremia. Among 32 hypernatremic children, 62.4% had mild, 18.8% had moderate and 18.8% had severe hypernatremia. The case fatality rate was 2.6% and all of them had hypernatremic dehydration at admission. Conclusion: Sodium disturbances particularly hypernatremia is more frequent and is associated with high case fatality rate among children hospitalized with acute watery diarrhoea. BANGLADESH J CHILD HEALTH 2022; VOL 46 (3) : 110-114

Outcome of Surgical Intervention of Spinal Tuberculosis Patients

Background: Spinal tuberculosis is approximately 2% of all cases of tuberculosis. Both conservative and surgical management are practiced for its management worldwide. However, surgical management has excellent outcome. Objectives: The aim of the study was to document the clinical and neurological outcomes of surgical intervention of spinal tuberculosis patients getting admitted in a tertiary care hospital of Bangladesh. Materials & Method: This hospital based interventional study was conducted in the department of Neurosurgery, Chittagong Medical College and Hospital for a period of 12 months. Thirty-two cases with spinal tuberculosis underwent surgical intervention were enrolled in the study. All patients were treated with standard anti- TB drugs pre and postoperatively and were followed up regularly after surgery for 3 months. Neurological function and pain were evaluated preoperatively and postoperatively by Frankel’s grade scale and visual analogue scale (VAS) respectively. Post operative outcomes were finally assessed 3 months after operation. Results: Out of 32 cases, 2 were lost to follow up. Among the available 30 cases, 16 were men and 14 were women. The mean age was 36.10 (±13.70) years and age range were 18 to 65 years. At the final follow-up, the VAS score significantly improved from 6.97 (±1.87) preoperatively to 1.43 (±0.89) postoperatively (P < 0.001) and all patients became pain free, with final VAS score 0-3. At the final follow-up, the ESR and CRP significantly improved from preoperative status (P < 0.001). Twenty-nine (96.7%) patients improved by at least one Frankel grade and remaining one (3.3%) patient maintained their preoperative Frankel grade. Post operative deterioration was not observed in any of the included case. Out of 11 cases with bowel bladder dysfunction before surgery 10 (90.9%) recovered within three months. Conclusion: Surgical intervention was safe and had satisfactory results in terms of symptomatic and neurological improvement. Bang. J Neurosurgery 2023; 12(2): 94-101

Efficacy of Oral Prednisolone in the Management of Idiopathic Granulomatous Mastitis

Background: Idiopathic granulomatous mastitis (IGM) is a benign inflammatory lesion of the mammary gland. Globally it possesses a major diagnostic and therapeutic problem. To date, there is no universally agreed treatment for this condition. Many treatment modalities have been attempted from conservative therapy to mastectomy but none of them has shown satisfactory results. Recent studies have shown promising results of corticosteroids on idiopathic granulomatous mastitis, so steroid therapy can be an effective treatment for idiopathic granulomatous mastitis. The goal of the study is to provide a therapeutic strategy in the future for idiopathic granulomatous mastitis. Methods: Our study included all patients with idiopathic granulomatous mastitis confirmed histologically by core needle/incisional biopsy at the general surgery unit of Chittagong Medical College Hospital and the private hospitals in the Chittagong Metropolitan City for a period of one year from October 2016 to September 2017. A total of seventy patients were included in the study provided they fulfilled predetermined criteria. All of them were included in this study by purposive sampling. After diagnosis oral prednisolone (1mg/kg/day) was given and the cases were observed by personal interview and through telephone interview. The patients were on follow-up for 06 months. Age, size of the breast lump, breast pain, nipple discharge, and skin changes were recorded in all cases. Results were analyzed using mean, percentage, and proportion as appropriate. Results: The mean age was 26.35±13.5 years ranging from 19 to 40 years. Out of 70 patients, Core cut biopsy was done in 55 patients (78.58%), and incisional biopsy with abscess drainage was performed in 15 patients (21.42%). 59 patients (84.28%) had complete recovery after a single cycle of steroid treatment, remaining 11 patients (15.72%) had recurrence, among them 6 patients were cured after 2nd cycle of steroids but unfortunately, 5 patients did not respond. Though complications were found in 50 patients, all of them made good progress in the short term. Conclusion: We recommend steroid therapy as the first-line treatment in our study. However, prospective, randomized clinical trials are needed to determine the treatment algorithm. Mediscope 2024;11(1): 22-26

Left ventricular hypertrophy (LVH) in different stages of chronic kidney disease (CKD) patients and its correlation with anaemia

Background : Chronic kidney disease (CKD) is a public health problem that increases the risk of cardiovascular morbidity and mortality. Heart failure with preserved ejection fraction characterized by left ventricular hypertrophy (LVH) and diastolic dysfunction is a common cardiovascular complication of CKD. Anaemia is present in both dialysis & non dialysis CKD patients. Anaemia causes left ventricular hypertrophy (LVH) which in turn leads to increases morbidity and mortality in CKD, even before progression of chronic kidney disease (CKD) to end stage renal disease (ESRD). Our study is aimed at to evaluate the prevalence of left ventricular hypertrophy (LVH) and its correlation with anaemia in hospitalized CKD patients. Materials and Methods : A cross-sectional study was done on 50 patients of different stages of CKD admitted in the chittagong medical college hospital (CMCH). All the clinical data were reviewed and recorded. Data was analyzed by SPSS-18 and p value <0.05 was considered statistically significant. Results : Majority of study population 64% was male, 36% was female. Most of the male patient (40%) of the study population were having abnormal left ventricular mass index (>130 gm/m2). More patients with severe left ventricular hypertrophy were found in stage 5 of CKD in female and male which was 8 and 23 respectively. Regarding correlation of Hb% with LVMI there was a significant negative correlation was found (r= -0.420, p = 0.003) between them means if Hb% decreases LVMI level increases. It was also found in male and female patients separately ( for male r = -0.778, p = 0.001 and for female r = -0.746, p = 0.001). Conclusion : Anemia is widely prevalent in our CKD patients. Severity of anemia is correlated to left ventricular hypertrophy in these patients. Hence correction of anemia early in these group of patients can halt or prevent cardiovascular morbidity and mortality. J Bangladesh Coll Phys Surg 2024; 42: 25-30

Comparison of American orthopedic foot and ankle society score between anterior to posterior lag screws versus posterior buttress plating for posterior malleolus fixation in tri-malleolar ankle fracture

Background: Posterior malleolar fractures are frequent, occurring in up to 44% of all ankle fractures. Surgical management typically involves anterior to posterior (AP) lag screws or posterior buttress plates. This study aimed to compare the AOFAS (American orthopedic foot and ankle society) score between AP lag screw and posterior buttress plating for posterior malleolus fixation in tri-malleolar ankle fracture. Methods: This quasi-experimental study was conducted at the department of orthopedics and traumatology, Chittagong medical college hospital, Chattogram, Bangladesh, from November 2020 to October 2021. It involved 28 patients with ankle fractures, equally divided into two groups. Group A received AP lag screw fixation, and group B underwent posterior buttress plating. Data analysis was performed using MS office tools and SPSS version 23.0. Results: The posterior plating group demonstrated superior postoperative AOFAS scores compared with the AP screw group with statistically significant differences (88 versus 81, p=0.008). Significant differences were noted in the AOFAS pain score (p=0.045) and function score (p=0.019) at the final follow-up between the two groups. Conclusions: Patients with tri-malleolar ankle fractures in whom the posterior malleolus is treated with posterior buttress plating show superior postoperative AOFAS scores at follow-up compared to those treated with AP screws.

Increased Body Mass Index & Waist Circumference are Associated with Female Infertility: A Cross-Sectional Study

Background: The prevalence of obesity and overweight are increasing and has become an epidemic worldwide. Obesity has detrimental influences on all systems, including reproductive health. Obesity can lead to menstrual disturbance, anovulation, miscarriage, pregnancy complications and subfecundity and infertility. This study aimed to investigate the effects of body mass index (BMI) and waist circumference (WC) on infertility in women of childbearing age. Methodology: This was a hospital based cross-sectional observational study comprising hundred (100) infertile women aging 18-35 years in Outpatient Department of Obstetrics & Gynaecology and Endocrinology in Chittagong Medical College Hospital and Department of Biochemistry, Chittagong Medical College, Chattogram. Samples were taken by non-probability consecutive sampling. Important variables in this study were age, BMI, waist circumference and Blood Pressure. Results: Most of the infertile women were 21-30 years. In the study, among the infertile women increased BMI was found in 50% cases and increased waist circumference was found in 76% cases. Conclusion: Overweight and obese patients should be informed about the importance of pre-pregnancy weight reduction and should be encouraged to lose weight before the treatment to reduce the poor obstetrical outcomes due to obesity. Eastern Med Coll J. July 2023; 8 (2):39-42

Prevalence of Skin Cancer in Chronic Arsenicosis in Chittagong Medical College Hospital, Bangladesh

A descriptive study was done in the Department of Dermatology and Venereology; Chittagong Medical College Hospital, Chittagong, during the period of July 2004 to June 2008, to find out the prevalence of skin cancer among various skin manifestations of chronic arsenicosis. All suspected patients of chronic arsenicosis coming from endemic zones of Bangladesh were the study population. A total number of 234 patients of chronic arsenicosis were included in this study. The patients were diagnosed by physical examination and by estimation of arsenic level of scalp hair. The majority of the patients came from Noakhali, Chitagong, Feni, Laxmipur, Comilla and Chandpur districts. The mean age of the patients was 27.80 years ± 10.22 SD (Range: 12-70 years). About 70% patients were around 30 years of age. The male & female ratio was 1.9: 1. Most of them came from average socio-economic status. About 28.6 % patients were students, while about 25% patients were daily labour. 94 % patients used tube well as drinking water source. 12.8o patients had family history of chronic arsenicosis and about 19% patients took alternative medicines (homeopathic /kobirajee) for treatment of the same or other illness. The cent percent patients presented with hypo and hipermelanosis (rain drop pigmentation), while 90,6 % patients were with hyperkeratosis in palms and soles. The measurement of arsenic in scalp hair was done. The mean arsenic level of scalp hair was found to be 2.63 1.39 SD (range: 2.0 - 17.6 mg/kg). Skin biopsy for histopathology was done for suspected patients and skin lesions of 21.4% patients were detected as arsenical keratosis. Among the total patients, 6 (six) patients were found to develop skin cancers (2.6 %). Among them, 3 patients developed Squamous Cell Carcinoma (SCC), 1 patient developed Basal Cell Carcinoma (BCC), while Bowen's disease and Melanoma was found in I patient each. Regarding treatment response, about 48% patients showed good response with topical ........

Trends of Mortality and Morbidity due to Ascariasis: A 14-year Analysis in a Tertiary Hospital in Bangladesh

Background: Ascariasis is still a major public health concern and is termed as neglected tropical disease. There are surgical morbidity and mortality due to ascariasis. Objective: The general objective of the study was to analyze the trend of hospital admission and mortality from ascariasis at a tertiary government hospital in Bangladesh. Methodology: This was a retrospective chart review performed in the department of pediatric surgery at Chittagong Medical College Hospital, Chattogram, Bangladesh from a period of January 2006 to December 2019. Patients of 0 to 12 years of age who were admitted and diagnosed as intestinal or biliary ascariasis were analyzed for yearly trend for admissions, surgeries, and mortalities. Results: There were a total of 33,426 patients with various disease admitted and among them 2799 (8.67%) patients were diagnosed as intestinal ascariasis and 375(1.12%) patients were diagnosed as biliary ascariasis. Admission rate for intestinal ascariasis decreased from 15.87% in 2006 to 8.67% in 2019 and that for biliary ascariasis decreased from 1.87% to 0.98 %. The surgical load for intestinal obstruction decreased from 5.20% in 2006 to 1.09% in 2019 among all surgeries. Only one surgery was performed for biliary ascariasis. Mortality rate of ascariasis among all mortalities decreased from 20% to 5%. There was no death from biliary ascariasis. Conclusion: Surgical morbidity and mortality from intestinal ascariasis decreased over time but ascariasis is still causing loss of valuable lives. Bangladesh Journal of Infectious Diseases, June 2023;10(1):24-30

Associated with the 30-Day Outcome of Spontaneous Cerebellar Hemorrhage

Background: Spontaneous cerebellar hemorrhage (SCH) is a potentially life-threatening condition that results in early neurological deterioration, significant disability, and adverse consequences. Therefore, knowledge of the factors that potentially affect the outcome is crucial for a sound clinical decision-making framework and implementing efficient therapeutic measures. Objectives: This study aimed to identify possible clinical, radiological, and therapeutic factors associated with 30-day outcomes in patients with acute SCH. Methods: Sixty-six computerized tomography (CT) diagnosed cases of SCH above 18 years of age who were admitted and managed in the Department of Neurosurgery of Chittagong Medical College Hospital from October 2021 to September 2022 were enrolled prospectively in this study based on inclusion and exclusion criteria. Data regarding demographic, clinical, radiographic, and treatment modalities was recorded. The 30-day outcome was assessed by the Glasgow Outcome Scale (GOS) score and analyzed. A poor outcome was defined by GOS ≤3. Results: The mean age was 65.6±10.8 years and 56.1% were male. The median Glasgow Coma Scale (GCS) score on admission was 13 [interquartile range (IQR) = 8-14]. Twenty-five patients (37.9%) underwent surgical management [evacuation of the cerebellar hemorrhage and placement of an external ventricular drain (EVD) in 7 (28%); EVD alone in 12 (48%), and only evacuation in 6 (24%) cases of surgically managed] and 41 (62.1%) were treated conservatively. The 30 day mortality rate was 36.4%. Regarding 30-day outcomes, 47% (31) of patients had a poor outcome after 30 days. On univariate analysis, GCS score on admission, hematoma size, hematoma volume, ventricular extension, 4th ventricle obstruction, hydrocephalus, tight posterior fossa, ratio between transverse diameter of cerebellar hematoma and posterior fossa, intervention type, and need for mechanical ventilation were significantly associated with 30-day poor outcome. .....

Detection of Extended Spectrum Beta Lactamase Producing Escherichia Coli and Klebsiella Species Isolated from Urine Samples of UTI Patients by Phenotypic and Genotypic Methods

Background: Escherichia coli and Klebsiella spp. are the most common organisms causing urinary tract infection (UTI) and commonly responsible for extended spectrum beta lactamase (ESBL) production. This study was carried out to detect ESBL producing uropathogenic Escherichia coli and Klebsiella spp. by phenotypic and genotypic method. Rapid and accurate detection of ESBL producing E. coli and Klebsiella spp. has an important role to avoid treatment failure. Materials and Methods: This was a cross sectional observational study and carried out in department of microbiology in Chittagong Medical College, Bangladesh from January to December 2017. Urine was collected from suspected UTI patients and standard microbiological and biochemical tests were carried out. ESBL producing E. coli and Klebsiella spp. were identified by phenotypic confirmatory disc diffusion test (PCDDT). Polymerase chain reaction (PCR) was performed by using standard protocol with specific primers. Results: 448 urine samples were collected. Among them, 140 showed bacterial growth; 72 were E. coli and 35 were Klebsiella spp. Among E. coli 38(52.8%) and in Klebsiella spp. 15(42.9%) were detected as ESBL producers by PCDDT respectively. Among E. coli, 41(56.9%) and in Klebsiella spp. 21(60%) strains produced ESBL genes by PCR. Out of 38 phenotypically positive E. coli, 7 strains do not carry any detectable genes. Similarly, out of 15 phenotypically positive Klebliella spp. 3 isolates did not produce any detectable gene. On the other hand, 10 E. coli isolates and 9 Klebsiella spp. carry detectable genes although these were not phenotypically ESBL producers. Moreover, ESBL producing E. coli and Klebsiella spp. showed more multidrug resistant than Non-ESBL producing E. coli and Klebsiella spp. Conclusion: This study revealed that large portion of E. coli and Klebsiella spp. was ESBL producers. PCR can detect some additional cases of ESBL producing isolates. So, PCR can be used along with phenotypic ......

Comparative Study of FNAC and Histopathology in Diagnosis of Thyroid Swelling

Background: Neck swelling is a common clinical presentation in ENT practice and it carries significant morbidity and even mortality if not managed properly. Thyroid swelling being the most common type among them. We conducted a study to assess the role of FNAC in diagnosing the nature of thyroid swelling and comparing its result with histopathology finding. The aim and objectives of this study is to observe the correlation between preoperative Fine Needle Aspiration Cytology (FNAC) and post operative histopathology in the diagnosis of thyroid lesions.
 Materials and methods: A cross sectional study was done in the Department of Otolaryngology-Head & Neck Surgery and Department of Pathology, Chittagong Medical College, Chattogram from January 2018 to December 2020. Eighty (80) patients, both male and female of different age groups were included. The selected patients were subjected to clinical examination, routine hematological investigation, thyroid hormone test, USG, thyroid Scan, FNAC and histopathological examinations of the thyroidectomy specimens. Correlation between FNAC and histopathology reports were done in those patients.
 Results: In this study, age range of the patients were 11 years to 70 years. Out of 80 patients of thyroid swelling, the most of the patients 28(35%) were 31-40 years of age groups. out of 80 patients of thyroid swelling, 26(26.25%) were male and 59(73.75%) were female and male female ratio was1:2.81. On FNAC 64(80%) were non neoplastic and 16(20%) were neoplastic. Out of 64(80%) of non neoplastic lesions, 62(77.50%) were nodular goitre and 2(2.5%) were lymphocytic thyroiditis and out of 16(20%) neoplastic thyroid swelling, 2(2.50%) were follicular lesion, 12(15%) were papillary carcinoma, 1(1.25%) was follicular carcinoma and 1(1.25%) was suspicious for malignancy. On histopathology, out of 80 patients of thyroid swelling 60(75%) were non neoplastic and 20(25%) were neoplastic. out of 60(75%) non neoplastic, 59 (73.75%) were nodular, 1(1.25%) was Lymphocytic thyroiditis and out of 20(25%) neoplastic lesions, 3(3.75%) were follicular adenoma,13(16.25%) were papillary carcinoma,3(3.75%) were follicular variant of papillary carcinoma and 1(1.25%) was follicular carcinoma.
 Conclusion: It is concluded from the present study that female are more affected in our region. Non neoplastic lesions of the thyroid were more common (Nodular goitre being the commonest) than neoplastic lesions (Papillary carcinoma being the commonest). FNAC is essential diagnostic tool for thyroid swelling but final diagnosis to rule out thyroid cancer is surgical excision and histopathology.
 Chatt Maa Shi Hosp Med Coll J; Vol.22 (1); January 2023; Page 19-22

Risk Assessment of Cyclophosphamide and Mycophenolate Mofetil after Induction Treatment of Lupus Nephritis: A Single Center Quasi-Experimental Study

Background: The comparative safety of immunosuppressive drugs such as cyclophosphamide and mycophenolate mofetil for patients with lupus nephritis remains controversial. The study aimed to investigate the specific side effects of cyclophosphamide and mycophenolate mofetil in lupus nephritis patient after induction treatment.
 Materials and methods: It was a quasi-experimental study performed in the Department of Nephrology of Chittagong Medical College Hospital. A total of 100 patients of lupus nephritis who fulfilled the designated criteria were enrolled in this study by non-probability voluntary sampling method. The treatment was given on patient’s choice. After screening and treatment initiation, patients were assessed at 12 and 24 weeks. All the data were compiled in a structured case record form.
 Results: In the present study 48 patients (53.3%) in mycophenolate mofetil group and 42 patients (46.7%) in intravenous cyclophosphamide group completed 24 weeks of induction treatment of lupus nephritis. Infections were common in both treatment groups but significantly higher with intravenous cyclophosphamide group ((33.3% vs. 8.3%). Upper gastrointestinal syndrome occurred with 20(41%) patients in mycophenolate mofetil group and 7(16.7%) patients in intravenous cyclophosphamide group (RR=5.8333). Regarding other adverse effect, 10 patients of intravenous cyclophosphamide and two patients of mycophenolate mofetil group had amenorrhea (23.8% vs.4.2%). Alopecia (11.9%) was seen only by intravenous cyclophosphamide group ((RR=0.0798).
 Conclusion: Induction therapy with Mycophenolate mofetil was superior to intravenous cyclophosphamide in lupus nephritis in this study. Mycophenolate mofetil appeared to be better tolerated than cyclophosphamide.
 Chatt Maa Shi Hosp Med Coll J; Vol.22 (1); January 2023; Page 28-32

Admission Lipid Profile and Discharge Outcome in Ischemic and Hemorrhagic Stroke

Background: Changes in the lipid profile have been suggested as a risk factor for developing ischemic stroke. Their role in hemorrhagic stroke is not clear. The study aimed to evaluate the lipid profile levels and discharge outcomes of patients who were admitted to a tertiary hospital in Bangladesh and also to determine the difference in the lipid profile of patients with ischemic and hemorrhagic stroke.
 Materials and methods: This retrospective analytical study included 65 hospitalized stroke patients from the Neurology Unit of Chittagong Medical College Hospital. Data regarding age, sex, risk factors of stroke, lipid profile [Total Cholesterol (TC) Triglyceride (TG) Low-Density Lipoprotein cholesterol (LDL-C), and High-Density Lipoprotein Cholesterol (HDL-C)] levels, and discharged outcomes [Favourablemodified Rankin Scale (mRS)score £2 and unfavourable-mRS >2] were extracted from the register and compared between ischemic and hemorrhagic stroke patients.
 Results: Out of 65 patients, 55 (84.6%) had ischemic and 10 (15.4%) had hemorrhagic stroke. Hypertension (67.7%), smoking (50%), diabetes (40%), and family history of stroke (38.5%) were common risk factors. The most common lipid abnormality was high LDL-C (86.2%), followed by low HDL-C (63.1%), high TG (47.7%), and high TC (35.4%). There was no difference in the lipid profile ofischemic and hemorrhagic stroke patients. Forty-seven (72.3%) patients were in poor functional status during discharge and discharged outcome was not associated with admission lipid profile. Compared to patients with unfavorable outcomes, patients with favorable outcomes at discharge were significantly younger, had shorter durations of hospitalization, had lower mRS scores at admission.
 Conclusion: Dyslipidemia in the form of high LDL-C and low HDL-C were common in stroke patients be it infarct or hemorrhage. There was no difference in the lipid profile of the two categories of stroke.
 Chatt Maa Shi Hosp Med Coll J; Vol.22 (1); January 2023; Page 23-27

Measles Infection and Vaccination Status against Measles in Children during 2019-2020: A Hospital Based Study in Chattogram

Background: Despite widespread availability of a safe and cost-effective vaccine, Measles outbreak is reported from different regions of Bangladesh in the recent past. This study was aimed to Identify the related features of Measles infection in children during the upsurge of Measles infection in Chattogram during 2019-2020, when Bangladesh was about to achieve Measles elimination.
 Materials and methods: This prospective observational study included all the Measles infected children admitted in the Pediatric Ward of Chittagong Medical College Hospital, Chattogram during the period from September 2019-February 2020. In this hospital patients up to 12 years after neonatal period are admitted. Patients whose guardian did not give consent were excluded. Measles cases were diagnosed clinically according to case definition criteria by WHO. Demographic, clinical features, Measles vaccination status of both affected children & their mother and associated complications were recorded in a predesigned form. Data were analyzed and results were given in a tabulated form. The aim of this study was to evaluate the characteristics of Measles infection and their vaccination status in children during its upsurge in 2019-2020.
 Results: Affected children 13(20%) were suffered in spite of vaccination. Among the 65 affected children 44 (67.6%) were below one year of age, youngest one was 2 months old. Male to female ratio was 1.8:1. 80% (n=52) children were not vaccinated, 35 of them not yet attained the age of vaccination. 17 children attained the age but vaccination was delayed due to cough and cold, fever, bronchopneumonia or Measles itself. Complications were common among them, Bronchopneumonia 47 (72.3%) and Purulent conjunctivitis 38 (58.5%). There was no case fatality.
 Conclusion: Children are being affected by Measles before attaining the age of first dose of vaccination and incompletely vaccinated or unvaccinated children have a role in the upsurge of Measles.
 Chatt Maa Shi Hosp Med Coll J; Vol.22 (1); January 2023; Page 33-37

Clinical Predictors of Sodium Disturbance in Children Presenting with Acute Watery Diarrhea in a Tertiary Hospital of Bangladesh

Background: Sodium disturbances, either hyponatremia or hypernatremia, are the most common electrolyte imbalance encountered in managing children with acute watery diarrhoea. Early diagnosis and prompt management of these conditions by identifying clinical predicting factors in diarrheal children under 5 years of age are critically essential to prevent deaths in such children, especially in resource-limited settings. Our study aimed to evaluate clinical predicting factors associated with sodium disturbance in children hospitalized with acute watery diarrhea.
 Materials and Methods: In this cross-sectional study, 121 children of 2 months to 5 years of age admitted in the Department of Pediatrics, Chittagong Medical College Hospital, Chattogram for acute watery diarrhea were included. Clinical features and sodium levels on admission were recorded. Children were grouped in hyponatremia (serum sodium <135mmol/l), hypernatremia (serum sodium >145mmol/l) and normonatremia (serum sodium 135–145mmol/l) and compared.
 Results: Of the 121 children, 18 (14.9%) were hyponatremic, 71 (58.7%) isonatraemic, and 32 (26.4%) hypernatraemic. Logistic regression analysis revealed that children who did not receive ORS before admission, had severe dehydration and lethargy on admission would be more likely to have hyponatremic dehydration. Children who were younger, received concentrated ORS, thirsty and had convulsions on admission would be more likely to have hypernatremic dehydration than children with isonatremia.
 Conclusion: The type of ORS used and age appears to be good predictors of sodium disturbance in children admitted with AWD.
 Chatt Maa Shi Hosp Med Coll J; Vol.22 (1); January 2023; Page 71-75

Role of TaqMan array card in determining causative organisms of acute febrile illness in hospitalized patients.

Acute febrile illness (AFI) is a prevalent disease in developing countries that is difficult to diagnose due to the diversity of infectious organisms and the poor quality of clinical diagnosis. TaqMan array card (TAC) can detect up to 35 AFI-associated organisms in 1.5 h, addressing diagnostic demands. In this study, we aimed to evaluate the role of TAC in determining the causative organisms in hospitalized AFI patients. The study had a cross-sectional design and enrolled 120 admitted patients with persistent fever for three or more days from the medicine ward of Chittagong Medical College Hospital (CMCH) and Bangladesh Institute of Tropical and Infectious Diseases Hospital (BITID). Blood samples were collected and then subjected to automated BacT/Alert blood culture, microbial culture, TAC assay, and typhoid/paratyphoid test. The total number of study participants was 120, among them 48 (40%) samples showed a positive result in TAC card, 29 (24.16%) were TP positive and nine (7.51%) were culture positive. The number of organisms detected by the TAC card was 13 bacteria, three viruses, one protozoan, and one fungus. The sensitivity and specificity of the TAC assay for different bacterial pathogen compared to blood culture was 44.44%, and 90.99%, respectively. In contrast, the TP test had a sensitivity and specificity of 100% and 80%, respectively, compared to the blood culture test. TAC can be a handful tool for detecting multiple organisms in AFI with high specificity which can facilitate early diagnosis of different pathogens contributing to AFI.

Evaluation of Vacuum Assisted Wound Closure and Conventional Wound Closure In Contaminated Major Surgical Wound

Background: Surgical Site Infections (SSI) increase costs, hospital stay, morbidity, and mortality. Vacuum-Assisted Closures (VAC) system has been gaining popularity recently in managing wounds to reduce SSI. But the current guidelines do not recommend its routine use for surgical wounds. This study aimed to compare the effectiveness and safety of VAC with conventional wound closure techniques for preventing SSIs in the major contaminated surgical wound. Methods and materials: Sixty patients with a contaminated surgical wound from the Department of Surgery and Department of Casualty of Chittagong Medical College Hospital were randomized in a 1:1 ratio to receive either VAC (Using Romovac device) or conventional wound closure. The primary endpoint was the rate of uncomplicated wound healing, defined as a Southampton wound score of <2 at 30 days postoperatively. Secondary outcomes include duration of hospital stay and other complications (Defined by the Clavien-Dindo Classification). The primary analysis was an intention-to-treat analysis performed with a Chi-square test. Results: There were no significant differences in mean age, sex, body mass index, smoking history, wound class, indication for surgery and duration of surgery between the two groups. At 30 days postoperatively, 29 (96.3%) of 30 patients undergoing VAC had uncomplicated wound healing compared to 13 (43.6%) in the conventional closure group (p<0.001). Most patients (26/30, 86.6 %) in the VAC group experienced Clavien-Dindo grade I or II complications. In contrast, in the conventional closure group, 28 (93.3%) patients developed Clavien-Dindo Grade III or IV complications (p<0.001). The mean length of hospital stay was significantly shorter in the VAC group than in the conventional closure group (12.2±3.59 versus 29.07±10.36 days, p<0.001). Conclusion: VAC resulted in favourable wound healing with less complication and shorter hospital stay than the conventional technique for the closure of the contaminated surgical wound. IAHS Medical Journal Vol 5(2), Dec 2022; 6-10

Predicting Role of the Appendicitis Inflammatory Response Score in Diagnosis and Risk Stratification of Acute Appendicitis among Adult Patients

Background: Appendicitis is a global disease. Understanding the global evolution of appendicitis in highly industrialized countries and in newly industrialized countries is necessary for planning healthcare resource utilization. Scoring systems have been designed to aid in the clinical assessment of patients with acute appendicitis. The recently introduced Appendicitis Inflammatory Response (AIR) score was designed to overcome these drawbacks. This simple clinical score can correctly classify the majority of patients with suspected appendicitis. To evaluate the AIR score on patients with suspicion of acute appendicitis and its risk stratification and assess the sensitivity and specificity of the AIR score. Materials and methods: This descriptive of observational study was carried out in the Department of Surgery, Chittagong Medical College Hospital, Chattogram from 21st March to 20th September 2017. Total 100 cases of appendicitis patients were selected after careful history taking, thorough general and local examination and appropriate investigations fulfilling inclusion and exclusion criteria. Results: The present study of 100 selected cases reveals that maximum number of patients (54.0%) were between 15-25 years age group, mean age of appendicitis was 24.5±8.9 years. The sensitivity and Specificity of the Appendicitis Inflammatory Response Score (AIR score) in diagnosis and risk stratification of acute appendicitis was 85.2% and 96.9% respectively. Similarly, the positive predictive value and accuracy rate for the same is 93.5 % and 93.0% respectively. Conclusion: Through associating easily applicable clinical criteria and two simple laboratory tests AIR score help in diagnosis and risk stratification of suspected appendicitis and could guide decision-making to reduce admissions, optimize utility of diagnostic imaging and prevent negative explorations. IAHS Medical Journal Vol 5(2), Dec 2022; 46-51