College Hospital Research Articles

Pattern, Interventions and Outcome of Post-Dural Puncture Headache Among Obstetric Patients in Ibadan

Background: Post-dural puncture headache (PDPH) is a complication of dura mater puncture. PDPH poses a problem in postpartum women; hence, there is a need to identify and promptly treat it using highly effective, non-invasive techniques that can be easily implemented in low-resource settings to reduce the burden and associated morbidity. Objective: To examine the interventions and outcomes of PDPH among women who had a subarachnoid block for obstetric indications at the University College Hospital, Ibadan. Methods: A prospective, cross-sectional study was conducted among women with a subarachnoid block for obstetric indications. A semi-structured interviewer-administered data collection form was used to assess pain at the onset of the headache and followed up to 72 hours post-treatment. Results: This study evaluated 26 pregnant women with PDPH. Most respondents (18; 69.2%) were ≥30 years old, had a normal BMI of 11 (42.3%), and 26.9% of the women had a prior history of PDPH. Subarachnoid block was performed by a registrar in 24 (92.3%) women. The majority (22; 84.6%) had only one attempt at dural puncture, all in a sitting position with the 25G-sized spinal needle in 96.2%. The headache was incapacitating in 9 (34.6%) cases and got worse in the upright position in 23 (88.5%) women. Conclusion: PDPH is a notorious morbidity in parturients, and steps should be taken to minimise the duration and effects of the condition. Prevention, prompt identification, diagnosis, and proactive treatment are desirable.

Incidence of cutaneous Leishmaniasis in humans during the COVID-19 pandemic in Baluchistan Province, Pakistan.

Cutaneous leishmaniasis (CL) is one of the neglected tropical diseases that affects impoverished communities throughout the world. In Pakistan CL is an endemic disease. This study aimed to determine the incidence of CL infection in the Baluchistan province of Pakistan from January 2020 to March 2022 during the COVID-19 pandemic. A total of 1047 clinically suspected cases of CL from Bolan Medical College Hospital, Quetta, were followed up in the study. The data regarding the epidemiological characterstics, pathological information, and treatment of patients was collected. Out of 1047 probable cases of CL, 594 (56.73%) cases were found to be positive for CL. Females had the highest infection rate, with the majority of reported cases being in the 0-9-year age group. Most CL cases were reported in April in the year 2020, with a few cases reported in June. But in the year 2021, the highest number of cases were reported in December. The number of overall cases has gradually increased in the year 2022, most likely because of the reduction in COVID-19 pandemic restrictions. The p value for the positive as compared to suspected cases in the years 2020, 2021, and 2022 was calculated as 0.8925, 0.8763, and 0.8535 respectively. Further epidemiological studies and health education campaigns are recommended to increase public awareness. It is strongly advised that local, provincial, and national health authorities establish and maintain effective leishmaniasis surveillance systems to promptly identify disease outbreaks and implement timely control measures.

Pattern of Bowel Injury and the Outcome of their Management in Blunt Abdominal Trauma in a Tertiary Care Hospital

Background: Blunt abdominal injury is common in trauma patients. Evaluation of patients who have sustained blunt abdominal trauma may pose a formidable problem and significant intra abdominal injury is one of the most difficult problems faced by emergency doctors and surgeons in the management of trauma. Traumatic bowel injury is one of the curable traumatic conditions. An accurate and timely diagnosis and treatment giving an excellent outcome in most cases. A delay in diagnosis is associated with significant morbidity and mortality. Objectives: To determine the pattern of bowel injury from blunt abdominal trauma, and outcome of their management of the patient after surgery in a tertiary care hospital. Methods: It was an observational study carried out in the department of surgery, Shaheed Ziaur Rahman Medical College Hospital, Bogura from April '2020 to September '2020. Thereafter, they were scrutinized according to eligibility criteria and 50 patients were finalized. Patients with a history of bowel injury are managed with blunt abdominal trauma after proper counseling, results were tabulated and analyzed. Results: A total of 50 patients were enrolled comprising 42(84%) males and 8(16%) females and male-female ration 21:4. Out of 50 patients, most of 18(35%) patients had 31-40 years age group. The mean age was 33.9±7.2 years. Maximum patients reported within 1-6 hours 28(56%) and next group within about 1 hours 11(22%). The average time lapsed was 5.79 hours. 18(36%) patients had concomitant injuries, like 1(2%) patient had a head injury, 8(16%) had pelvic fracture, 4(8%) patients had long bone fracture, 3(6%) patients had soft tissue injury and 2(4%) patients had blunt chest injury. Features of peritonitis were present at initial evaluation 42(84%) patients abdominal pain and features of paralytic ileus 21(42%). 28(56%) cases sustained injury from motor vehicle accident as passenger. Sites of bowel injury were: duodenum 3(6%), jejunum 24(48%), ileum 8(16%), large gut 8(16%), both small and large gut 2(4%). Conclusion: Traumatic bowel injury is one of the commonest traumatic conditions that are encountered in hospitals, namely in the department of surgery. The management of traumatic bowel injury has a fairly good prognosis in developed countries. The outcome is not as good as expected in the third world countries, like our country, due to certain prevailing adverse conditions. The injury in the small bowel is associated with more morbidity than that in the large bowel injury.

Pattern of Ocular Morbidity among Children Referred Ophthalmology Dept. at Mugda Medical College Hospital, Mugda, Dhaka, Bangladesh

Pattern of Ocular Morbidity among Children Referred Ophthalmology Dept. at Mugda Medical College Hospital, Mugda, Dhaka, Bangladesh

Patient with Diabetic Foot Ulcer Admitted in Surgery Ward; Risk Factors, Associations and Grades of Presentation

Background: The management of chronic diabetic foot ulcers (DFU) poses a great challenge to the treating physician and surgeon. The aim of this study was to identify the risk factors, clinical presentation, and outcomes associated with chronic DFU. Objective: To determine the various risk factors for diabetic foot ulcers and study their associations. To study the grades of diabetic foot ulcers at presentation. Method: Purposive sampling. This study was done in the Surgery department of Shaheed Ziaur Rahman Medical College Hospital (SZMCH), Bogura for period of twelve (12) months. 100 cases were selected after informed consent. Study group (A) comprises of 50 cases of type 2 diabetes with diabetic foot ulcer and control group (B) comprises of 50 cases of age and gender matched type 2 diabetics without foot ulcers. Patients having serious systemic illness, type I diabetics and non-diabetic patients presenting with foot ulcer were excluded. Age, gender, duration of diabetes, duration of ulcer, glycemic control, presence of neuropathy and vascular disease were documented. Grading and Staging of ulcer was done according to New University of Texas Diabetic Wound Classification. Various risk factors were compared between the two groups. Data analyzed via SPSS version 17 with significant p-value < 0.05. Results: Among 100 cases (64 % males & 36 % females); mean age was 58.50 ± 9.8 (group A) versus 50.40 ± 10.5 (group B). Mean duration of diabetes was longer in group A (10.49 ± 7.06 years) vs. group B (8.34 ± 4.83 years) (p = 0.019). Glycemic control was poor in group A (72 %) vs. group B (56 %) (p = 0.045). There was significantly more peripheral vascular disease in group A (50 %) vs. group B (32 %) (p= 0.005). Sensory neuropathy was more in group A (90 %) vs. group B (38 %) (p < 0.0001). Grade-I ulcer was present in 16 % cases, Grade-II in 38 % and Grade-III in 46 %. Conclusion: Neuropathy carries highest risk for diabetic foot ulcer, followed by peripheral vascular disease and poor glycemic control. Therefore, diabetic patient must be educated about these risk factors, foot care and self-examination and to have regular screening by clinician. Appropriate glycemic control and timely medical and surgical intervention may reduce morbidity in diabetics.

Threads of Vulnerability: A Cross-sectional Study on Factors Associated with Suicide and Self-harm in Pakistan

Background: Globally, over a million people commit suicide every year. Although suicide rates are more in high-income countries, many countries do not report suicide cases regularly to the World Health Organization (WHO). Therefore, this study aimed to determine the factors associated with suicide and self-harm in Pakistan. Method: This cross-sectional study was conducted at Peoples Medical College Hospital (PMCH) in Shaheed Benazirabad, Sindh, Pakistan, from July to December 2019. A total of 131 cases of suicide/self-harm were included using a convenience sampling technique. Data were collected on a predesigned questionnaire consisting of 14 close-ended questions. A chi-square test was used to determine the association between different categorical variables. Results: The majority of the subjects were males (53.4%), young adults aged between 16 and 30 years (69.5%), single (51.9%), and uneducated (57.3%). More than half (51.9%) of the subjects who attempted suicide or self-harm were unemployed. There was a significant association between education level (c2 =13.149, P = 0.001) and age groups (c2 = 15.554, P = 0.001) with health outcomes (suicide or self-harm) only. Moreover, gender (c2 = 20.776, P = 0.004), marital status (c2 = 69.047, P < 0.001), level of education (c2 = 63.144, P < 0.001), age groups (c2 = 69.848, P < 0.001), and employment status (c2 = 28.677, P = 0.012) were also associated with the reasons of suicide and self-harm. Conclusion: Our study concluded that mostly single, unemployed males with low literacy and with marital and family issues are determined as factors associated with a high risk of self-harm and suicide.

Evaluation of Various Indications of Total Abdominal Hysterectomy in Holy Family Red Crescent Medical College Hospital for Last 20 Months

Background: Total Abdominal Hysterectomy (TAH) is a common surgical procedure for treating various gynecological conditions. This study aims to evaluate the demographic characteristics, comorbidities, and clinical indications for TAH at Holy Family Red Crescent Medical College Hospital, Dhaka, Bangladesh. Methods: This retrospective study included all TAH cases performed from January 2018 to August 2019. Data on patient age, comorbidities (hypertension and diabetes), and indications for TAH were collected from hospital records. Descriptive statistics were used to analyze the data. Results: A total of 320 TAH cases were reviewed. The most common age group was 41-50 years (43.13%), followed by patients aged ≤40 years (31.56%). Hypertension was present in 36.25% of the patients, and diabetes was observed in 30.94%. The most frequent indication for TAH was fibroid uterus (55.63%), followed by adenomyosis (18.75%) and post-menopausal bleeding (14.38%). Other indications included ovarian cysts (5.63%), endometrial hyperplasia (5.00%), and pelvic mass (6.25%). Conclusion: The findings highlight uterine fibroids, adenomyosis, and post-menopausal bleeding as the primary indications for TAH, with a significant prevalence of hypertension and diabetes among the patients. Effective management strategies for these conditions and considerations of comorbidities are crucial in optimizing surgical outcomes. Further research into minimally invasive techniques may enhance patient care in gynecological surgery.

Venous resection increases risk of chyle leak after total pancreatectomy for pancreatic tumors

BackgroundExisting research on chyle leak (CL) after pancreatic surgery is mostly focused on pancreaticoduodenectomy and lacks investigation on total pancreatectomy (TP). This study aimed to explore potential risk factors of CL and develop a predictive model for patients with pancreatic tumor undergoing TP.MethodsThis retrospective study enrolled 90 consecutive patients undergoing TP from January 2015 to December 2023 at Peking Union Medical College Hospital. According to the inclusion criteria, 79 patients were finally included in the following analysis. The LASSO regression and multivariate logistic regression analysis were performed to identify risk factors associated with CL and construct a predictive nomogram. Then, the ROC analysis, calibration curve, decision curve analysis (DCA), and clinical impact curve (CIC) were performed to assess its discrimination, accuracy, and efficacy. Due to the small sample size, we adopted the bootstrap resampling method with 500 repetitions for validation. Lastly, we plotted and analyzed the trend of postoperative drainage volume in CL patients.ResultsWe revealed that venous resection (OR = 4.352, 95%CI 1.404–14.04, P = 0.011) was an independent risk factor for CL after TP. Prolonged operation time (OR = 1.473, 95%CI 1.015–2.237, P = 0.052) was also associated with an increased incidence of CL. We included these two factors in our prediction model. The area under the curve (AUC) was 0.752 (95%CI 0.622–0.874) after bootstrap. The calibration curve, DCA and CIC showed great accuracy and clinical benefit of our nomogram. In patients with CL, the mean drainage volume was significantly higher in venous resection group and grade B CL group.ConclusionVenous resection was an independent risk factor for chyle leak after TP. Patients undergoing vascular resection during TP should be alert for the occurrence of CL after surgery. We then constructed a nomogram consisted of venous resection and operation time to predict the odds of CL in patients undergoing TP.

Demographic Study on Enteric Fever: A Single Centre Experiences

Background: Typhoid fever, caused by Salmonella typhi and Salmonella paratyphi, infects various organs after entering the bloodstream. It typically presents with headache, fever, splenomegaly, abdominal pain, and leucopenia, among other symptoms. Globally, it affects 11-21 million people annually, causing 120,000-160,000 deaths, with Southeast Asia being the most impacted region. Improved water, sanitation, and hygiene (WASH) practices are crucial for prevention, alongside targeted public health strategies in endemic regions like Bangladesh. Aim of the study: The study aims to identify demographic risk factors associated with typhoid fever in Bangladesh. Methods: This cross-sectional observational study was conducted at the Department of Medicine, North Bengal Medical College Hospital, Sirajganj, Bangladesh, over 12 months. We included 72 patients presenting with fever, headache, and abdominal pain, with positive blood culture reports for Salmonella typhi and Salmonella paratyphi, aged 18 years and above, who provided informed consent. Excluded were patients on antibiotics and those with multiple blood culture samples. A short questionnaire, validated through a pilot study, captured demographic and clinical data. Result: Mostly 76.39% of participants were aged 18-45. Males comprised 58.33% of participants, and females 41.67%. Occupationally, 48.61% were civil servants, 16.67% housewives, 13.89% students, 12.50% businessmen, and 8.33% farmers. Socio-economically, 16.67% were upper class, 37.50% middle class, and 45.83% lower class. Urban residents made up 40.28% and rural residents 59.72%. All participants had a fever, with other symptoms including headache (69.44%), abdominal pain (48.61%), vomiting (20.83%), coated tongue (27.78%), and constipation (61.11%). Conclusion: This study examines factors influencing enteric fever in Bangladesh, noting higher prevalence among males aged 18-45 due to occupational risks. Lower socio-economic status and rural living also increase risk, highlighting healthcare disparities. Common symptoms included fever, headache, and abdominal pain. Improving sanitation and targeting high-risk groups can reduce incidence.

Effects of tumor location and mismatch repair on clinicopathological features and survival for non-metastatic colon cancer: A retrospective, single center, cohort study

Objective: To analyze the differences in clinicopathological features of colon cancers and survival between patients with right- versus left-sided colon cancers. Methods: This was a retrospective cohort study. Information on patients with colon cancer from January 2016 to August 2020 was collected from the prospective registry database at Peking Union Medical College Hospital . Primary tumors located in the cecum, ascending colon, and proximal two-thirds of the transverse colon were defined as right-sided colon cancers (RCCs), whereas primary tumors located in the distal third of the transverse colon, descending colon, or sigmoid colon were defined as left-sided colon cancers (LCCs). Clinicopathological features were compared using the χ2 test or Mann-Whitney U test. Survival was estimated by Kaplan-Meier curves and the log-rank test. Factors that differed significantly between the two groups were identified by multivariate survival analyses performed with the Cox proportional hazards function. One propensity score matching was performed to eliminate the effects of confounding factors. Results: The study cohort comprised 856 patients, with TNM Stage I disease, 391 (45.7%) with Stage II, and 336 (39.3%) with Stage III, including 442 (51.6%) with LCC and 414 (48.4%) with RCC and 129 (15.1%). Defective mismatch repair (dMMR) was identified in 139 patients (16.2%). Compared with RCC, the proportion of men (274/442 [62.0%] vs. 224/414 [54.1%], χ2=5.462, P=0.019), body mass index (24.2 [21.9, 26.6] kg/m2 vs. 23.2 [21.3, 25.5] kg/m2, U=78,789.0, P<0.001), and well/moderately differentiated cancer (412/442 [93.2%] vs. 344/414 [83.1%], χ2=22.266, P<0.001) were higher in the LCC than the RCC group. In contrast, the proportion of dMMR (40/442 [9.0%] vs. 99/414 [23.9%], χ2=34.721, P<0.001) and combined vascular invasion (106/442[24.0%] vs. 125/414[30.2%], χ2=4.186, P=0.041) were lower in the LCC than RCC group. The median follow-up time for all patients was 48 (range 33, 59) months. The log-rank test revealed no significant differences in disease-free survival (DFS) (P=0.668) or overall survival (OS) (P=0.828) between patients with LCC versus RCC. Cox proportional hazards model showed that dMMR was significantly associated with a longer DFS (HR=0.419, 95%CI: 0.204‒0.862, P=0.018), whereas a higher proportion of T3-4 (HR=2.178, 95%CI: 1.089‒4.359, P=0.028), N+ (HR=2.126, 95%CI: 1.443‒3.133, P<0.001), and perineural invasion (HR=1.835, 95%CI: 1.115‒3.020, P=0.017) were associated with poor DFS. Tumor location was not associated with DFS or OS (all P>0.05). Subsequent analysis showed that RCC patients with dMMR had longer DFS than did RCC patients with pMMR (HR=0.338, 95%CI: 0.146‒0.786, P=0.012). However, the difference in OS between the two groups was not statistically significant (HR=0.340, 95%CI:0.103‒1.119, P=0.076). After propensity score matching for independent risk factors for DFS, the log-rank test revealed no significant differences in DFS (P=0.343) or OS (P=0.658) between patients with LCC versus RCC, whereas patient with dMMR had better DFS (P=0.047) and OS (P=0.040) than did patients with pMMR. Conclusions: Tumor location is associated with differences in clinicopathological features; however, this has no impact on survival. dMMR status is significantly associated with longer survival: this association may be stronger in RCC patients.

Endoscopic Sinus Surgery in the Management of Inflammatory Sinonasal Disease

Background: Inflammation of the nose and paranasal sinus is a clinical problem frequently encountered in the practice of otolaryngology in our country. Endoscopic sinus surgery is a minimally invasive technique for the evaluation and treatment of inflammatory sinonasal disease. Endoscopic sinus surgery is used to restore sinus ventilation and normal function of sinuses.Objectives: To see the outcome of endoscopic sinus surgery associated with inflammatory sinonasal diseases.Materials and Methods: It is a prospective observational study carried out in ENT &amp;Head Neck Surgery of Shaheed Suhrawardy Medical College Hospital Dhaka from April 2016 to September 2016.Fifty(50) patients were enrolled in this study. Data was collected by Structural Questionnaire.Result: The majority of patients were 21-30years age group. The mean age group was 35.32 years, Male: male-to-female ratio was 1.3:1. The Majority of cases were antrochoanal polyps followed by an ethmoidal polyp, chronic maxillary sinusitis, and fungal rhinosinusitis. The majority of patients came with nasal obstruction and nasal discharge. Polyp was found in the majority of cases. A major complication was found in hemorrhage. Symptomatic improvement was found following endoscopic sinus surgery. KYAMC Journal Volume: 14, No: 04, January 2024: 226-233.

Assessment of Factors and Level of Patient Satisfaction in Out-patient Department of a Private Hospital

Background: Measurement of patient satisfaction in the outpatient department (OPD) of a hospital can be used to evaluate and redesign the process of caregiving and to improve the quality of services. Sometimes study findings depend on the setting.Objectives: a) To identify the factors associated with the patient's experience, and satisfaction about health care services of Out-patient department(OPD) of Khwaja Yunus Ali Medical College Hospital receives multidisciplinary health services. b) To measure the satisfaction level regarding doctors, health assistance, and other auxiliary staff working in OPD to help patients.Materials and Methods: A cross-sectional study was conducted among 914 patients of age ranging from 1 to 80 years selected randomly from OPD between January 2021 and May 2021. A self-designed semi-structured questionnaire was developed to assess patients' satisfaction with health care services. Statistical analysis was done by online computer software.Results: Overall 92.23 % of the patients were satisfied with the behaviour of the doctors and 75.93 % were satisfied with the services of other staff, and the remaining 7.77% were unsatisfied with doctors' behaviour and 24 % with other staff services respectively.Conclusions: The percentages of unsatisfied patients were deficient. Various deficiencies should always be covered by the hospital administration that will turn into a good result of improvement in the hospital services for more satisfaction of the patients. KYAMC Journal Volume: 14, No: 04, January 2024: 234-239.

Analysis of adverse late-term pregnancy outcomes after cervical cold knife conization

Objective: To investigate the effects of cervical cold knife conization (CKC) on preterm delivery, other pregnancy complications and neonatal outcomes, and explore the relationship between preterm delivery risk and the depth and volume of conization. Methods: The clinical data and pregnancy outcomes of 272 women who underwent CKC in Peking Union Medical College Hospital from January 2002 to March 2018 (conization group) and 1 647 pregnant women who gave birth in Peking Union Medical College Hospital during January to December 2019 (control group) were collected. The preterm delivery, premature rupture of membranes, other pregnancy complications and neonatal outcomes of the two groups were compared, and the relationship between the depth and volume of conization and the risk of preterm delivery in postoperative singleton pregnancy was analyzed. Results: (1) There were no significant differences between the two groups in delivery age, parity, proportion of singleton pregnancy, proportion of assisted reproductive technology (all P>0.05). (2) The rate of preterm delivery in the conization group was significantly higher than that in the control group [14.8% (39/264) vs 5.7% (91/1 589); χ2=28.397, P<0.001]. There were still significant differences in preterm delivery rates between the two groups at <34 weeks and 34-37 weeks (all P<0.01). There was no significant difference in the incidence of premature rupture of membrane between the two groups [23.5% (62/264) vs 23.4% (372/1 589); χ2=0.001, P=0.979], but the incidence of preterm premature rupture of membrane in the conization group was significantly higher than that in the control group [11.4% (30/264) vs 2.2% (35/1 589); χ2=56.132, P<0.001]. (3) The rate of cesarean section in the conization group was higher than that in the control group [59.6% (162/272) vs 38.8% (639/1 647); χ2=41.377, P<0.001]. The birth weight of preterm infants in the conization group was significantly higher than that in the control group [(2 409±680) vs (2 150±684) g; t=2.184, P=0.030]. However, there were no statistically significant differences in the incidence of gestational diabetes mellitus, hypertensive disorders in pregnancy, the birth weight of full-term infants, incidence of small for gestational age infant and neonatal intensive care unit admission rate between the two groups (all P>0.05). (4) The preterm delivery rates of coning depth >15 mm, cone size ≥2 cm3 and cone size <2 cm3 were higher than that in the control group (all P<0.05). When the coning depth ≤15 mm, the preterm delivery rate in the conization group was higher than that in the control group, but there was no significant difference (P=0.620). The rate of preterm delivery of pregnant women with coning depth >15 mm was significantly higher than those with coning depth ≤15 mm (RR=3.084, 95%CI: 1.474-6.453; P=0.001). There was no significant difference in the preterm delivery rate between pregnant women with cone size >2 cm3 and those with cone size ≥2 cm3 (RR=1.700, 95%CI: 0.935-3.092; P=0.077). Conclusion: The risk of preterm delivery and preterm premature rupture of membranes in subsequent pregnancies are increased after cervical CKC, and the risk of preterm delivery is positively correlated with the depth of cervical coning.

Acute Acalculous Cholecystitis in Dengue Fever with Raised Transaminase

Background: Dengue fever is a viral fever classically characterized by high-grade temperature, headache, ocular pain, sternal pain, muscle and joint pain, nausea, vomiting and sometimes rash. Apart from above stated clinical features, there may be hepatitis, ascites, cholecystitis, pleural effusion, etc. which are confirmed by investigations.Objective: To establish the fact that acute acalculous cholecystitis is not uncommon in dengue fever. Raised transaminases are good indicators for further investigation and to find out the prognosis and management of acute acalculous cholecystitis in dengue fever.Materials and Methods: A total of 100 patients with confirmed dengue fever who were admitted to Khwaja Yunus Ali Medical College Hospital, were selected randomly for one month. Among them, 44 patients had undergone for ultrasound of the whole abdomen because of nausea, vomiting, abdominal pain and raised transaminases. Results: Acute acalculous cholecystitis was detected in 20 patients (20%) with confirmed dengue fever. These patients with acute acalculous cholecystitis were treated conservatively and they recovered completely without any surgical intervention.Conclusion: In dengue fever unlike acute pancreatitis or encephalitis, acute acalculous cholecystitis is not uncommon and it is self-limiting and resolved by conservative management. KYAMC Journal Volume: 14, No: 04, January 2024: 190-193.

The Partograph: A Practical Guide for Preventing Prolonged Labour

Background: The partograph, a graphic recording of labour and features in the mother and foetus has been used since 1970 to detect labour that is not progressing normally. The partograph serves early warning system and assist in early decision of transfer, augmentation and termination of labour. It also increases the quality and regularity of observing mother and foetus in labour. Objectives: The study aimed to evaluate effect of using partograph on the management and outcome of labour. Materials and Methods: It was a prospective cross-sectional observational study conducted in the Department of Obstetrics and Gynaecology at Sher-E-Bangla Medical College Hospital, Barishal; Bangladesh over one (1) year from January 2017 to December 2017. A total 280 patients were enrolled in this study. Plotting on the partograph was started at cervical dilation of 4 cm on alert line. Results: The mean age of the participants was 23.4 ±4 years and mean gestational age was 38.3 ±1.74 weeks and 45% were primigravida. The mean Apgar score of the newborn after 5 minutes was 9.3 ±0.7. The mean duration for delivery on active labour was 4.3 ±2.5 hours in primigravida and 3.4 ±2.3 hours in multipara.Conclusion: The proper use of partographs and the application of the right decision at the right time can be achieved the best for maternal and neonatal outcomes. KYAMC Journal Volume: 14, No: 04, January 2024: 215-219.

Correlation between motor function and health-related quality of life in early to mid-stage patients with Parkinson disease: a cross-sectional observational study.

To investigate the correlation between motor function and health-related quality of life (HrQOL) in early to mid-stage patients with Parkinson disease (PwP). This cross-sectional study recruited PwP from April 2020 to December 2023 at the outpatient clinic of Peking Union Medical College Hospital in Beijing, China. The motor symptoms were assessed using Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part 3. Balance function was evaluated using the Berg Balance Scale (BBS), and the risk of fall using Timed Up-and-Go test (TUG), and Five Times Sit-to-Stand test (FTSST). Freezing of gait questionnaire (FOGQ) was used to evaluate the severity of gait. The Intelligent Device for Energy Expenditure and Physical Activity (IDEEA) recorded gait cycle parameters, and the isokinetic dynamometer measured muscle strength. The Parkinson's Disease Questionnaire-39 (PDQ-39) was used to measure HrQOL. All assessments were tested during the on state. Spearman correlation was conducted to evaluate the correlation between motor function and HrQOL. 243 patients with mean age of 69.33 years were enrolled. The PDQ-39 score was strongly correlated with FOG in H&Y stage III (r = 0.653, p < 0.001) and moderately correlated in H&Y stage I (r = 0.471, p < 0.001) and H&Y stage II (r = 0.386, p < 0.001). Furthermore, the FOG was strongly correlated with mobility domain at H&Y stage III (r = 0.694, p < 0.001) and moderately correlated at H&Y stage I (r = 0.431, p < 0.001) and H&Y stage II (r = 0.434, p < 0.001). All motor function scores were correlated with PDQ-39 scores at H&Y stage III (p < 0.05). Motor function correlated with HrQOL in early to mid-stage PwP, and FOG was the main factor, especially affecting mobility, activities of daily life and communication. HrQOL in patients at different disease stages were variously affected by motor function, and HrQOL and multiple dimensions was significantly associated with motor function in patients at H&Y stage III.

Living with axial spondyloarthritis: a cross-sectional survey of patient knowledge and perceptions

Diagnosis and effective treatment of axial spondyloarthritis (AxSpA) are often delayed due to inadequate awareness and poor patient-physician communication. Some AxSpA patients fail to maintain an active lifestyle by exercising regularly, further worsening their disease management. The evolving concept of patient-centred care necessitates better understanding of patient awareness and their needs. We aimed to survey AxSpA patients to reflect on healthcare planning and management perspectives. Our self-administered questionnaire focused on perceptions of AxSpA diagnosis and management, particularly exploring issues of physical activity and active lifestyle. Satisfaction with AxSpA medical care and its accessibility, diagnostic delays, patient-physician communication, and support for disease management were also explored. This offline survey was arranged at the Department of Rheumatology, Immunology, and Internal Medicine of Jagiellonian University Medical College and Krakow University Hospital. We surveyed patients with AxSpA attending outpatient clinics between December 1st, 2023 and April 22nd, 2024. The questionnaire included questions on types of physical activities, barriers to exercising, satisfaction with medical care, patient-physician interactions, diagnostic delays, and use of teleconsultations. A total of 117 patients with AxSpA were enrolled (mean age 41.62 years). The majority (n = 93, 79.5%) were employed. There was a male predominance (69, 59%). The average diagnostic delay was 5.5 years. Notably, 104 (88.9%) responders perceived physical activity as a factor influencing their disease course. However, only 32 (27.35%) managed to exercise regularly (≥ 30 min, 2–3 times a week). The majority (70, 59.83%) were irregularly engaged in some form of physical activity, with 15 (12.8%) not exercising at all, and nearly half (48%) reported at least one barrier to maintaining a physically active lifestyle. Pain (32, 27.35%), fatigue (27, 23.08%), lack of motivation (17, 14.53%), and lack of time (12, 10.26%) were noted as barriers to exercising. The respondents preferred to exercise at home. The survey identified critical areas where patient dissatisfaction or uncertainty were notably prevalent: 38 (32.5%) were uncertain and 35 (30%) were dissatisfied with rehabilitation access. For spa therapy, 63 (53.85%) reported uncertainty and 23 (19.7%) expressed dissatisfaction. Only 48 (41%) were treated by a rehabilitation specialist last year. Only 23% of AxSpA patients took part in teleconsultations last year, and 65% preferred in-person visits. While AxSpA patients recognize the importance of physical activity, significant barriers exist to engaging them regularly in exercising. Addressing these barriers through personalized, motivational, and educational strategies could improve patient outcomes. Improving patient satisfaction with healthcare services, particularly in areas of rehabilitation and physician-patient communication, is crucial for improving the overall care of AxSpA patients.

Lenalidomide and dexamethasone for Rosai-Dorfman disease: a single arm, single center, prospective phase 2 study

Rosai-Dorfman disease (RDD) is a rare heterogeneous histiocytic disorder lacking standardized first-line treatment. This single-center, phase 2 prospective study enrolled 13 newly diagnosed and 10 recurrent RDD patients from June 2021 to March 2023at Peking Union Medical College Hospital (Beijing, China). Lenalidomide 25mg days 1-21 plus dexamethasone 40mg days 1, 8, 15, 22 was administered in 28-day cycles, totaling 12 cycles. The primary endpoint was progression-free survival (PFS). Secondary endpoints were overall response rate (ORR) to lenalidomide and dexamethasone (RD) regimen, toxicity, and overall survival (OS) measured from RD start to death or last follow-up. OS and PFS were estimated according to Kaplan-Meier survival analysis and compared with the log-rank test. For OS and OR rate, 95% confidence limits were obtained using the Clopper-Pearson method, with standard methods used for PFS. p<0.05 was considered statistically significant. The trial was registered with ClinicalTrials.gov (NCT04924647). The median age was 44 years (IQR 35-54). All patients had extranodal RDD. MAPK pathway alterations occurred in 6/18 (33%). Elevated IL-6 and TNF-α were found in 39% (n=9) and 70% (n=16), respectively. All patients received ≥6 cycles (median 12, range 6-12, IQR 10-12). The ORR was 87% (20/23, 95% CI 66%-97%), 30% (n=7) complete remission, 57% (n=13) partial remission). Treatment with RD significantly decreased median serum levels of both IL-6 (from 5.9 (IQR 4.2-8.7) to 2.9 (IQR 2.1-5.9) pg/mL, p=0.031) and TNF-α (from 12.2 (IQR 8.6-17.9) to 8.3 (IQR 6.1-10.5) pg/mL, p=0.0012). With a median 26 months follow-up (range 6-28, IQR 16-28), 4 patients relapsed and none died. Two-year OS and PFS were 100.0% (95% CI 85%-100%) and 69.0% (95% CI 51%-94%), respectively. No grade 3-4 adverse events or discontinuations due to adverse events occurred. Twelve patients (n=12, 52%) had grade 1-2 hematological toxicity. Other toxicities included constipation (n=2, 9%), glucose intolerance (n=2, 9%), edema (n=2, 9%), insomnia (n=1, 4%), and tremor (n=1, 4%). Lenalidomide and dexamethasone regimen is an effective and safe regimen for newly diagnosed and recurrent RDD. National Natural Science Foundation of China, Beijing Natural Science Haidian frontier Foundation Funding, and the National High Level Hospital Clinical Research Funding.

Association of Serum Albumin Level with Wound Healing after Caesarean Section

Background: Hypoalbuminemia, indicative of malnutrition and illness, is associated with a heightened risk of poor post-operative outcomes, particularly impaired wound healing. Pregnancy, characterized by elevated estrogen levels, may further complicate wound healing processes. Objective: To evaluate the association of serum albumin level with wound healing after a caesarean section. Methods: A cohort of 100 pregnant patients undergoing caesarean section at Dhaka Medical College Hospital was included between January and December 2020. Preoperative serum albumin levels were measured, with hypoalbuminemia defined as &lt; 3.5 g/dl. Patients were categorized into groups of hypoalbuminemic (Group I) and normal albuminemic (Group II). Postoperatively, patients were monitored for 60 days to identify surgical site infections and signs of delayed wound healing. Results: The mean preoperative serum albumin level was 2.57±0.35 gm/dl in group I and 4.2±0.4 gm/dl in group II. The difference was statistically significant (p&lt;0.05) between two groups. Out of 19 patients, 9 (47.4%) developed post caesarean wound infection and delayed wound healing in group I. Out of 81 patients, 7(8.6%) developed post caesarean wound infection and delayed wound healing in group II. The difference was statistically significant (p&lt;0.05) with OR=9.51 having 95% CI (2.52-37.32). The number of post-operative days in hospital was 13.11±6.14 in group I and 3.22±1.41 in group II. The difference was statistically significant (p&lt;0.05) between two groups. A subject with serum albumin (&lt;3.5 gm/dl) had 7.626 (95.0% CI 2.324 to 25.02) times increased risk to develop wound infection and delayed wound healing after surgery. Other variables were not significantly associated with delayed wound healing. Conclusion: Hypoalbuminemia is an independent risk factor for the delay in wound healing. Low serum albumin level correlates well with the development of surgical site infection and delayed wound healing contributed to prolonged hospital stay.

Nursing Interventions for the Prevention and Management of Diabetic Foot Ulcers among Patients at Rajshahi Medical College Hospital

Nursing Interventions for the Prevention and Management of Diabetic Foot Ulcers among Patients at Rajshahi Medical College Hospital