Dhaka Medical College Hospital Research Articles

Outcome of Early Oral Feeding after Primary Repair of Traumatic Intestinal Injury: Prospective Observation in a Tertiary Hospital in Bangladesh

Introduction: A period of starvation is common practice after intestinal anastomosis. Starved patient became malnourished and underwent catabolic state, impairing the host immune response and thus increasing the risk of postoperative infections thereby long hospital stay. Objective: To observe the outcome of early oral feeding in patients having primary repair of traumatic intestinal injury and to assess its beneficial effect. Methods: This prospective observational study was conducted on 80 patients who underwent urgent intestinal resection with or without covering stoma in the Department of Casualty Surgery at Dhaka Medical College Hospital. Results: Early oral feeding is safe in the recently performed anastomosis even in emergency situations as there were no cases of clinical anastomotic dehiscence and no increase in morbidity. Among 80 patients 58(72.5%) patients had no complaints; rest 22(27.5%) patients had complication. Wound infection seen in 14(17.5%) patients among them 8(10%) patients had burst abdomen and 1(1.25%) patient had intraabdominal abscess. 14(17.5%) patients had chest infection. 10(12.5%) patients complained nausea and among them 8(10%) patients suffered from few episodes of vomiting. 1(1.25%) patient had diarrhoea. Abdominal distension was seen in 9(11.25%) patients. Hospital stay was significantly shorter in with a mean length of stay (9 ± 1) days. No hospital readmission rate was recorded. Conclusion: Early postoperative feeding is timely, safe and tolerable after emergency intestinal resection anastomosis without raised morbidity and mortality and has a considerable reduction in hospital stay with its physical, psychological and fiscal benefits. JAFMC Bangladesh. Vol 18, No 1 (June) 2022: 75-79

Clinical Staging for Accurate Preoperative Clinical Assessment of Patients with Nasopharyngeal Angiofibroma

Background: The location of the tumor and its accompanying symptoms, which include substantial epistaxis and nasal obstruction, cause the Nasopharyngeal Angiofibroma, a histologically and physiologically benign tumor with aggressive activity. Methods: The Otolaryngology & Head Neck Surgery division at Bangabandhu Shiekh Mujib Medical University, Dhaka Medical College Hospital, and Shaheed Suhrawardy Medical College Hospital in Dhaka carried out this retrospective cross-sectional study. The research was done in 2012, from February to November. 30 people made up the study's entire sample size. Result: The majority of individuals (54%) who have nasopharyngeal angiofibroma are between the ages of 16 and 20. People living in rural area (53.33%) are more sufferers from nasopharyngeal angiofibroma. The majority of patients have similar symptoms such epistaxis, nasal blockage, nasal discharge, anemia, and masses in the nasal cavity. Maximum (90%) has varying degree anaemia at presentation. All patient has soft tissue mass in Nasopharynx, half of the patient has pterygopalatine fossa extension at presentation. Maximum (56.66 %) patient admitted with stage II nasopharyngeal angiofibroma. Conclusion: It is necessary to acquire preoperative clinical staging and imaging parameters from data of one of the largest NA case series.

Socio-demographic Characteristics of Patients with Nasopharyngeal Angiofibroma: A Cross-sectional Observational Study in BSMMU, Bangladesh

Background: A rare head and neck tumor that makes up about 0.5% of all head and neck neoplasms is the nasopharyngeal angiofibroma. They are benign, non-encapsulated, highly vascular tumors with a high incidence of persistence and recurrence from a histological standpoint, but they are also locally invasive tumors. Methods: This retrospective cross-sectional study was conducted by the Otolaryngology & Head Neck Surgery division at Bangabandhu Shiekh Mujib Medical University, Dhaka Medical College Hospital, and Shaheed Suhrawardy Medical College Hospital in Dhaka. The study was conducted from February through November of 2012. The total sample size for the study was 30. Result: The majority of individuals (54%) who have nasopharyngeal angiofibroma are between the ages of 16 and 20. The middle class people (40%) are more sufferers from nasopharyngeal angiofibroma. People living in rural area (53.33%) are more sufferers from nasopharyngeal angiofibroma. The majority of patients have similar symptoms such epistaxis, nasal blockage, nasal discharge, anemia, and masses in the nasal cavity. Conclusion: It is hypothesized that the affected patients' socioeconomic status and geographic location may have an impact on the biologic behavior of nasopharyngeal angiofibroma.

Evaluation of Laparoscopy in Diagnosis of Female Infertility in Females- A Retrospective Study

Introduction: Infertility, one of the most common conditions confronting gynecologists, is defined as inability to conceive after 1 year of regular unprotected sexual intercourse. Infertility is a problem of global proportion. In recent years, laparoscopy has been considered as important tool in diagnosis and treatment of infertility. Objective: To detect the diagnostic efficacy of laparoscopy in uterine, tubal and ovarian pathologies. Material and Methods: This was a retrospective study carried out in Department of Obstetrics and Gynaecology, Dhaka Medical College Hospital, Dhaka, Bangladesh from July to December 2022 in collaboration with Department of Radiodiagnosis & Department of Pathology. Study included sixty one cases of both primary and secondary infertility in women. We included only those infertile ladies whose husbands showed normal semen analysis. A detailed clinical history especially marital and obstetric history of the patients was taken. Through gynaecological examination was done and all necessary investigations (baseline endocrinal investigations, post coital study, cervical mucus study, ovulation study, post menstrual HSG) were done before laparoscopic examination. Written consent form was taken from all the patients. Results: Among 61 patients, 39 (63.9%) belonged to primary infertility and 22 (36.1%) were of secondary infertility. In primary (58.9%) and secondary infertility (59.1%) maximum number of patient belonged to age group of 21-25 years followed by 21-25 years age group in primary infertility and 31-36 years age group in secondary infertility. Peritubal or peri-ovarian adhesions were present in 15 cases of primary infertility and 5 cases of secondary infertility. Thirty four patients (56.67%) had normal ovaries. Conclusion: Due to safety and cost effectiveness, laparoscopy is considered as important diagnostic tool for evaluation of cause of infertility in women and for effective treatment decisions.

Management of medical store in a tertiary level public hospital in Dhaka city

Cross-sectional descriptive study at Dhaka Medical College Hospital from January to December 2013. This study evaluated the medical supply chain in a Dhaka public tertiary hospital. Respondents were hospital shop employees who kept data on medicine procurement, storage, and distribution. 51-59-year-olds made up 36.6% of respondents. 68.3% of the store's workforce were pharmacists. 82.9% of respondents have a diploma or degree. 70% of personnel lacked retail management training. The investigated store had no AC or chiller. Store had a fridge. The pharmacy's drug procurement and selection committee was present. More than half (55%) of drugs were purchased using open tender. Direct purchases made up 30%, donations 13%, and other methods 2%. The store has an expiration-date section. The store contains updated volatile drug storage, safety stock, a stock ledger, vouchers, and invoicing. The shop had no electronic ledger. Lack of space, shelves, a damp or cracked wall, and a refrigerator were issues. Labor was scarce. Shop managers say improve quality management. During the drug receiving procedure, analytical testing ensures preservation and efficacy. Store management in our nation can be improved by giving refresher training on regulations and legislation and maintaining an electronic ledger via a database system.

Changes in severity of clinical pattern of dengue infection and its management: a cross-sectional study a tertiary care hospital

Background: Dengue fever is a debilitating viral disease, transmitted by mosquitoes, and causes sudden fever, and acute pain in the joints. Aedes Aegyptus mosquitos are responsible for dengue fever. More than 500,000 people are affected by dengue fever each year. In Bangladesh, over 15,000 cases of dengue are reported each year. It is high time to take some measures to control this viral disease. The aim of the study was to investigate the clinical manifestation of dengue fever in tertiary care hospitals.Methods: It is a prospective cross-sectional study that was carried out in the pediatric department of Dhaka medical college hospital (DMCH) over one year and was conducted with 106 patients.Results: The finding had females dominant over males. Minimum and maximum ages were 1 and 14 respectively. All patients (106, 100%) had fever. Around one-third of the patients (34,32%) had headaches. Patients had experienced rash and vomiting. The Tourniquet test came out positive for about one-fifth of the patients (21, 19.8%). About half of the study population (50, 47.2%) had dengue fever, around two-fifth of the patients (44, 41.5%) experienced dengue hemorrhagic fever (DHF) and only 12 patients (12, 11.3%) were diagnosed with dengue shock syndrome (DSS). The majority of the patients (102, 96.22%) were given isotonic fluid. Ns1 antigen for dengue 65 cases and IgM & IgG for dengue 32 cases were positive.Conclusions: Dengue is a rapidly emerging pandemic disease in many parts of the world, especially in Bangladesh. There is no accurate treatment to treat dengue patients. However, more illness and death could be prevented if countries regularly monitor the circulation of viruses in the mosquitos and take control measures before there are consequential outbreaks.

Retrospective Study of Ligature Material on Suicidal Hanging

Background: Hanging is one of the most common methods of suicide. It is always suicidal unless otherwise proved. Recent evidence showed that the incidence of suicide by hanging has increased especially among young adults. Ligature material plays an important role in leading investigation in hanging. The ligature material depends on its accessibility and availability. Various ligature materials are being used like nylon rope, cotton rope, wire, synthetic saree, lungi etc.
 Objective: Present study is a humble effort to find out the choice of ligature material used by the victim at Dhaka Medical College.
 Materials and methods: A retrospective study was conducted at the mortuary of Forensic medicine department, Dhaka Medical College Hospital, Dhaka, Bangladesh from July 2017 to December 2018. During this period data were collected from 112 cases of medicolegal autopsies by purposive sampling.
 Result: A total of 112 medicolegal autopsies were analyzed. In this hanging death, the most common ligature material used was rope in 58% of cases followed by dupatta (13%), lungi (11%) and saree (9%). Electric wire and kamiz were other ligature material used for hanging. The consistency of ligature material observed was hard (71%) & width is narrow width is (71%). Majority of cases (71%) were observed is male. Complete hanging was seen in 67% of cases & among them 85% cases are atypical hanging.
 Conclusion: Hanging is always suicidal unless otherwise proved. It is the form of painless violent asphyxia death that is widely practiced method of suicide. The most used ligature material is rope. Rope is chosen as ligature material due to its availability and accessibility. Young people in the justice system may need personal and psychological support to reduce the incidence of suicide.
 Eastern Med Coll J. Jan 2023; 8 (1) 12-14

Outcome of diffuse large B-cell lymphoma patients treated with different chemotherapeutic regimens (R-DA-EPOCH vs R-CHOP)

Background: Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous group of hematological malignancy of large B lymphocytes with a diffuse growth pattern. It is the most common type of adult non-Hodgkin lymphoma (NHL), making up to 30-40% of NHL. Although DLBCL is potentially curable, it remains a challenging lymphoma to manage because of the biological and clinical heterogeneity of the disease.Aim of the study was to compare the outcome of different chemotherapeutic regimens in newly diagnosed DLBCL patients.
 Methods: This quasi-experimental study was conducted at Department ofHematology,Dhaka Medical College Hospital(DMCH) from January 2018 to June 2019 including nineteen newly diagnosed DLBCL with stage I to IV A/B cases. Protocol was approved by ethical review committee (ERC) of DMCH. Patients aged e”18 years and < 65 years were enrolled for this study and were divided into two groups as arm A treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, prednisone (R-CHOP) (10 cases) and arm B treated with rituximab plus dose adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin (R-DA-EPOCH)(9 cases).
 Results: Mean age of all patients was 41 years (range 16 to 60 years). Majority (69%) of the patients were below 50 years of age and M: F ratio was 2:1.Seventy percent of patients had Ann Arbor stage III or IV disease in R-CHOP arm and 67% in R-DA-EPOCH arm although international prognostic index (IPI) score was variable (0-4). Raised serum lactate dehydrogenase (LDH) was observed in 70% and 89% of R-CHOP and R-DA-EPOCH arms respectively. Almost 50% of patients were germinal-center B-cell-like (GCB) diffuse large B-cell lymphoma (DLBCL) in each arm.In arm A, out of ten patients, five (50%) achieved complete remission (CR), one (10%) achieved partial response(PR), three (30%) had progressive disease (PD) and overall response (OR) rate was 60%. In arm B, out of nine patients, five (56%) achieved CR, two (22%) had progressive disease (PD) and two (22%) patients died. In subgroup analysis of outcome of GCB group, there was equal CR rate in both arms(60%, p=0.57), whereas in non-GCB arm, CR was found 40% vs. 50% in R-CHOP vs. R-DA-EPOCH arm respectively (p=0.89).
 Conclusion: From the result of this study it can be concluded that, there was no statistically significant difference in respect of outcome of chemotherapy among patients treated with R-DA-EPOCH and R-CHOP.
 BIRDEM Med J 2022; 12(3): 188-194

Short Term Hospital Outcome of Intracerebral Hemorrhage on The Basis of Admission Serum Calcium Level

(1) Background: Spontaneous intracerebral haemorrhage (ICH) accounts for approximately 15% of all strokes and is a leading cause of disability, with a one-month mortality rate of 40%. Whereas factors predicting short-term mortality are well known, data regarding long-term outcome are scarce and imprecise. Only a few studies revealed association of serum calcium level with outcome of stroke particularly ischaemic stroke but data regarding intracerebral hemorrhage is very limited. Therefore, to reveal the short-term hospital outcome of intracerebral hemorrhage patient on the basis of admission serum calcium level is the objective of the study. Methods: This study was a hospital based observational study and conducted at the Department of Neurology, Neurosurgery and Medicine in Dhaka Medical College Hospital. People who were suffering from intracerebral haemorrhage and were admitted in the department of Neurology, Neurosurgery and Medicine were approached for inclusion in the study according to inclusion and exclusion criteria. Ethical issues were ensured properly. After written informed consent history and physical examination were done. Diagnosis was confirmed by researcher with the aid of CT scan. Total 365 consecutive samples were collected and incompletion of data was considered exclusion of the study. Following radiological confirmation blood were drawn to measure serum calcium level with maintaining all aseptic precautions. For analysis patients’ corrected serum calcium level were divided into three tertiles: T1 = <2.20 mmol/l, T2 = 2.20 to 2.40 mmol/l and T3 = >2.40 mmol/l. The principal investigator interviewed each patient individually and in case of unconscious patient; history was collected from attendant of the patient. All these were registered, documented and analyzed in the statistical program Statistical Package for Social Science (SPSS) version 20.0. Results: Out of a total of 365 patients, Mean age of the population was 58.43(±12.33).................

Clinical Pattern and Outcome of Neonates with Surgical Problems in Dhaka Medical College Hospital

Background: Although the global number of newborn deaths declined from 5 million (1990) to 2.4 million (2020), children face the greatest risk of death within their first 28 days of life. Dhaka Medical College Hospital (DMCH) is the biggest tertiary hospital in Bangladesh serving all incoming patients free of cost. Objectives: We studied here the clinical patterns and outcomes of neonatal surgeries in DMCH from July 2014 to June 2016. Materials and Methods: This prospective descriptive study included 500 neonates with surgical problems who had attended from July 2014 to June 2016. Data were collected at admission and thereafter by predesigned data collection sheet. Results: Male female ratio was 1.5: 1. Majority of the neonates (346) presented during the first week of life (69.2%). Presented within 1 hour to 28 days (mean 7.1 days ± SD 8.8), weighing 1.5 - 5.0 kilogram (mean 2.6 in kg ± SD 0.5). Surgical indications in order of sequences were Neonatal Intestinal Obstruction (NIO), gastroschisis, omphalocele, abscess/cellulitis, hydronephrosis, congenital diaphragmatic hernia, Tracheo esophageal atresia or fistula (TEF), bladder exstrophy, malignancy, Infantile Hypertrophic Pyloric Stenosis (IHPS), cloacal exstrophy, neonatal injury, patent urachus, prune belly syndrome, amniotic band syndrome. NIO was in the form of Anorectal Malformations (ARM), Hirschsprung disease, septicemia, intestinal atresia, meconium ileus, volvulus neonatorum, multiple congenital anomalies, obstructed inguinal hernia. Total 384 patients were managed surgically. 125 (25.0%). 33 (6.6%) died preoperatively and 92 (18.4%) died postoperatively. Conclusion: Early diagnosis, resuscitation, skilled staff, ICU facilities etc. are crucial for the best outcomes of neonatal surgical problems. KYAMC Journal Vol. 13, No. 02, July 2022: 86-93

Comparison between Lingual Mucosal Graft Urethroplasty and Buccal Mucosal Graft Urethroplasty in The Management of Anterior Urethral Stricture.

Background: Urethral stricture is a chronic and common urological problem in Bangladesh and its management poses a big challenge to urologists. Surgical treatment of urethral stricture diseases is a continuously evolving process, and the superiority of one technique over another has yet to be clearly demonstrated. Urethrotomy is the most commonly used technique but long term results are not satisfactory. Long penile urethral strictures are best treated by substitution urethroplasty. The ideal graft material for substitution urethroplasty is constantly evolving. Buccal mucosa produces excellent result but is associated with many long term donor site complications. Lingual mucosa is an alternative donor site for graft urethroplasty and achieved good functional and aesthetic results. Materials & Methods: A hospital based prospective study was conducted in the department of urology, Dhaka Medical College Hospital from July 2016 to March 2017. Total 40 patients were included in this study. They were divided in two groups, group 1 was treated by lingual mucosal graft and group 2 was treated by buccal mucosal graft. All patients were followed up for six months noting pre and post-operative maximum urine flow rate (Qmax), voiding time and complications at both urethroplasty and donor site. Results: There were no significant differences in overall operative success rate between two groups of patients. But complications at donor site were higher in group 2 patients. Conclusion: Lingual mucosal graft urethroplasty may be preferred to buccal mucosa in anterior urethral stricture as it is easy to harvest and is associated with less short and long term donor site complications without significant difference in operative success rate. KYAMC Journal Vol. 13, No. 02, July 2022: 108-114

Pattern of Antenatal Care Received by Working Mothers and Their Pregnancy Outcome

Background: Now a days, women are joining almost in every sector of the workforce. In view of these changes, it is necessary to find out whether the health of the working mother or their progeny has been consequently compromised. Objectives: To identify the utilization pattern of Antenatal Care (ANC) received by working mothers and their pregnancy outcome. Materials & Methods: A cross-sectional study was conducted on 242 admitted working mothers with a history of recent delivery in Dhaka Medical College Hospital (DMCH), Dhaka from January 2013 to December 2013. Results: Majority (61.2%) of the mothers was in the age group of 20-30 years with an average income 4885.95 Tk. Two fifth (42.1%) of them were garment workers. Only one-third (33.9%) mother received regular ANC. Majority (79.3) of them received their ANC from doctors and rest of them from Non-Government Organizations (NGO) workers (11.6%), nurses (2.5%) and health assistant (1.7%). Mothers with a history of irregular ANC showed almost 5 times more likely to develop anemia than the mothers with history of regular ANC (p < 0.001). Mean level of birth weight was highest among regularly ANC taking group found in one-way ANOVA (F = 7.24, P<0.05). Conclusion: As ANC has direct effect on a mother’s health and pregnancy outcome employers should have ANC policy for their women workers. KYAMC Journal Vol. 13, No. 02, July 2022: 86-80

Detection of Helicobacter pylori and its Antimicrobial Susceptibility Pattern from Gastric Biopsy Specimens

Background: Early detection of Helicobacter pylori (H. pylori) infection is essential for its treatment. Resistance to amoxicillin, clarithromycin and metronidazole has been on the increase in many countries. Phenotypic resistance is correlated with treatment failure. So, there is an urgent need to explore sensitivity of other antibiotics, such as levofloxacin to combat H. pylori infection. Objective: The study was aimed to detect H. pylori from gastric biopsy samples and its susceptibility profile to commonly used antimicrobial drugs. Methods: Gastroduodenal biopsy specimens were collected from 143 adult dyspeptic patients during March 2018-February, 2019, who attended the outpatient department of gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU) and Dhaka Medical College Hospital (DMCH), for endoscopy. H. pylori was identified by rapid urease test (RUT), ureC gene PCR, histological staining (Giemsa) and culture. From culture isolates antimicrobial susceptibility of clarithromycin, levofloxacin, amoxicillin and metronidazole were detected by disk diffusion method. Results: The highest rate of H. pylori infection was found in the age group between 41-50 years (25.5%). According to case definition, H. pylori positive cases were 47 (32.9%) and H. pylori negative cases were 96 (67.1%). Thirty five H. pylori positive samples were subjected to culture and only 10 (28.6%) were positive. Among 10 culture positive H. pylori isolates, clarithromycin exhibited 20% resistance, levofloxacin 30%, metronidazole 30% and no resistance found to amoxicillin. Conclusion: PCR based assays can be an alternative rapid approach for the detection of H. pylori. In this study, levofloxacin showed high resistance, a further larger study is required to confirm this finding. Bangladesh Med Res Counc Bull 2022; 48(1): 3-9

Colposcopic Findings for Detecting Pre-invasive Lesion of Cervix Among Visually Inspected Acetic Acid Positive Cases

Background: Cervical cancer-a preventable disease, is the second most commonly diagnosed cancer among women of developing countries. Paps smear is the gold standard screening method worldwide. But a low-cost test, visual inspection of cervix with acetic acid (VIA) has been emerged as an alternative for use in lowresource settings. VIA is simple and easy to perform by auxiliary health professionals. Colposcopy is an essential procedure in the evaluation of screen positive cervix though it requires considerable training and experience. Objective: The objective of this study was to evaluate the VIA positive cases by colposcopy, colposcopy guided biopsy and histopathological examination. Methods: This was a cross sectional observational study conducted among 100 VIA positive cases attended at GOPD of Dhaka Medical College Hospital from July 2014 to December 2014. Colposcopy was performed in all VIA positive cases. Subsequent biopsy and histopathological examinations were done for those with colposcopic abnormal findings. Results: The mean age of the study population was 37.9±9.3 years. Among VIA positive cases 66.0% had complaints of whitish vaginal discharge. Among the study population, colposcopically 46.0% had healthy cervix (normal) and 54.0% had abnormal findings. Colposcopy guided biopsy was taken from those with abnormal findings. Histopathological findings were normal in 38.9% cases, chronic cervicitis in 20.37% cases, squamous cell metaplasia in 3.7% cases, CIN I in 16.7%, CIN II in11.11%, CIN III in 5.6% and 3.7% cases were carcinoma cervix. True positive value was 20, false positive value 34 and positive predictive value of colposcopy was 37.03%. Conclusion: This study concluded that VIA is effective in detection of CIN and invasive carcinoma of cervix. It also suggests the role of colposcopy in the evaluation of CIN and other cervical diseases in screen positive cases. VIA can be used as a screening tool in low and middle income countries like Bangladesh, not only in rural areas and small health centres, but also in hospitals, cancer institutes, and other health facilities with better resources. Bangladesh Med Res Counc Bull 2022; 48(1): 27-32

Tension Free Vaginal Tape (TVT) for Stress Urinary Incontinence - Our Experiences

Introduction: There are large numbers of adult women with troublesome urine leakage have a “stress component” to their incontinence. One common procedure to treat stress incontinence is Transvaginal Tape (TVT). In this procedure a small piece of mesh is used to support urethra. This helps to keep urine from escaping uncontrollably. This study aims at finding the outcome of TVT for treating women with SUI. Methods: We performed a prospective type of experimental study of 15 patients of 38 to 55 years old with SUI, for which they underwent TVT at Urology department, DhakaMedicalCollege hospital, from January 2014 to June 2020. Patients were selected as per selection criteria; detailed history and pre-operative investigations were done and all the women were counseled about the procedure and possible complications .We performed TVT procedure in dorsal lithotomy position under spinal anesthesia. First and second follow up was done at 6th and 12th weeks respectively. In each follow up in addition to routine checkup pad test was done, patients were asked of any urinary complain of LUTS. Result: Of the 15 patients there were no major intra-operative complications; only one woman was found to have mild bladder erosion which was treated by post-operative 14 days catheterization. Average blood loss was less than 60 ml. All the patients urinated without any complication. None required surgical re-intervention. Only one patient aged 50 years and diabetic did not improved after surgery even in 2nd follow up. Success rate was 93%. Median time to return to full domestic activities was about 4 weeks. Conclusion: TVT is safe and effective procedure for female stress urinary incontinence with an enduring, high success rate with minimal complications. Bangladesh J. Urol. 2021; 24(2): 170-174

Comparative Study on Cancer Yielding Rate Between sextant vs Ten Cores TRUS Biopsy

Background: The standard sextant biopsy protocol misses about 15% of cancer when compared with results obtained from a more extensive biopsy procedure. The number of systematic biopsies has increased over the years, with 10–12 cores currently accepted as the minimum standard. Objectives: To compare the detection rate of carcinoma prostate through standard sextant biopsy and extended 10-core biopsy in Bangladeshi male subjects. Methods: This prospective experimental study was conducted in the Department of Urology of Dhaka Medical College Hospital, Dhaka from January 2007 to May 2008 including a total of 69 male patients aged over 56 years having normal digital rectal examination (DRE) findings with serum PSA level of 4 ng/mL or greater or having abnormal findings on DRE irrespective of serum PSA level. The subjects underwent transrectal ultrasound (TRUS) and biopsies were taken systematically. Biopsy results were interpreted according to different sextant biopsy protocols and also following extended 10-core biopsy protocol. Data collection sheet containing the selected points were filled up. Data were analysed using SPSS version 12. The test statistic used to analyse the data were descriptive statistics and McNemar’s test. The level of significance was set at 0.05 and p <0.005 was considered significant. Result: Out of the total 69 subjects, 29 (42%) were diagnosed to have prostate cancer following biopsy. In the standard mid lobar sextant protocol the cancer detection was lowest (79.3%) while it was highest (89.7%) when lateral zone biopsy was performed. The extended 10-core biopsy regimen had higher cancer detection rate than any of the standard sextant protocols and it was 96.6%. The difference in the cancer detection rates between the two schemes was statistically significant (p <0.001). Conclusion: The sextant biopsy is inadequate in detecting carcinoma prostate and extended 10-core biopsy protocol including the apex, midlobar mid gland, lateral mid gland and lateral base with more extensive sampling of the lateral aspects of the prostate is superior. Bangladesh J. Urol. 2021; 24(2): 214-219

Clinical Profile of Patients Admitted to the PICU in a Tertiary Care Teaching Hospital in Bangladesh

Background: Care of critically ill children remains one of the most demanding and challenging aspects in the field of pediatrics. PICU aims at promoting early intervention with an objective of achieving good results and better prognosis. This study was undertaken to know about the clinical profile and outcome of patients admitted in pediatric ICU in a tertiary care teaching Hospital. Objective: To find out the Clinical profile of patients admitted to the PICU of a tertiary care teaching hospital in Bangladesh. Methods: This is a hospital based, retrospective, descriptive study, done on patients admitted to pediatric ICU of Dhaka medical College Hospital from October 2019 -June 2022 (2 years and 9 months). Results: Total 437 patients were admitted in pediatric ICU. According to the age distribution of patients, most 172(39.36%) respondents were aged <1 year. The mean age was 3.55±3.52 years SD. There was a male preponderance 299(68%), females were 138(32%). Patients from rural area were 308(70%) and 129(30%) from urban area. Clinical profile showed that meningoencephalitis was the most common diagnosis 85(19.45%) for admission in PICU. This was followed by pneumonia 75(17.16%), septicemia 39(8.92%), and neurosurgical patient 34(7.78%). Although few percentages, some other diseases were significantly important like GBS, AGN, hepatic encephalopathies, accidental emergencies, Dengue shock syndrome, needed PICU support. The outcome revealed, overall mortality was 92(21.05%), 330(75.52%) were discharged, 9(2.06%) patients went against medical advice, 6(1.37%) patients were referred for specific comorbidities. Use of inotropes, need for mechanical ventilation, and presence of co morbid illness and low level of Glasgow coma scale less than seven were independent predictors of mortality. Conclusions: Mortality is moderate in our PICU. We conclude that a well-equipped intensive care unit with modern and innovative intensive care and appropriate training greatly ..........

A Study of Thrombocytopenia in Chronic Liver Disease and Its Correlation with Development of Esophageal Varices

Background: The aim and objective of this study was to evaluate relationship of platelet count and esophageal varices in chronic liver disease (CLD) admitted in the medicine unit and gastroenterology department of Dhaka Medical College Hospital. Methods: In this cross-sectional study, a total number of 100 randomly selected, clinically diagnosed patients of chronic liver disease were studied from June 2010 to November 2010 (6 months). All patients were assessed as per Child-Pugh class and had full blood count, HBsAg, Anti-HCV antibodies by ELISA, abdominal ultrasound and Endoscopy of upper gastrointestinal tract. Patients were divided into Group A (Platelet count <1,50,000) and Group B (platelet count>1,50,000). Result: 73 male (73%) and 27 female patients (27%) with age range of 16 to 75 years were evaluated. 24% patient were in between 45-55 years age group. 63% patient fall in child Pugh class A group, 32% fall in child Pugh class B &5% fall in child Pugh class C. Esophageal varices were present in 32 patients (32%) and absent in 68 patients (68%). Group A had 31 patients (31% of the total) with 26 patients (83.87%) having esophageal varices. Group B had 69 patients (69% of the total) with 6 patients (8.70%) having esophageal varices. Sensitivity of thrombocytopenia as a marker of esophageal varices was 81.25% and specificity 92.64%, positive predictive value 83.87% and negative predictive value 91.3% and Odds ratio was 54.6. P value is <0.001. Conclusion: In this study, It was attempted to find out the relationship between thrombocytopenia and esophageal varices in CLD. In Group A that is platelet count <1,50,000, the incidence of EV was more than Group B (platelet count >1,50,000). Hence, thrombocytopenia is a good surrogate marker for the presence of esophageal varices in CLD. Bangladesh J Medicine 2022; 33: 247-251

Correlation between Current Histopathological Grading and Anatomical Location of Mucoepidermoid Carcinoma of Salivary Glands

Introduction: Mucoepidermoid carcinoma (MEC) is a kind of salivary cancer with a wide range of biologic activity. Mucoepidermoid tumors are the only kind of cancer where histologic grading and clinical behavior features are linked. Given the relative rarity of this disease, while being the most prevalent of the salivary gland malignancies, this is a common problem in the MEC literature. The aim of the study was to observe the correlation of MEC histopathological grading and anatomical location. Methods: This observational descriptive cross-sectional multi-center study was conducted at the Department of Oral and Maxillofacial Surgery, Dhaka Dental College Hospital, Dhaka, Department of Otolaryngology &Head Neck Surgery, Dhaka Medical College Hospital, Dhaka, and Department of Otolaryngology-Head Neck Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh The study duration was 1.5 years, from July 2011 to December 2012. A total of 20 patients attending the study centers with diagnosed case of mucoepidermoid carcinoma of salivary glands was selected for the study following inclusion and exclusion criteria. Result: 40% of the participants were from the age group of 31-40 years, while another 30% were under the age of 21 years. 70% of the participants were female. Histological grading of the participants revealed 9 low grade, 8 intermediate grade, and 4 high-grade MEC tumor cases. High-grade tumor MEC had an association with increasing age and male gender. The swelling was a common clinical feature among all the participants, whereas ulceration was observed in 75% of high-grade tumor patients. Parotid gland was the most common location at 45%, followed by 30% tumors occurring at the palate. Among the 9 parotid gland carcinomas, 55.6% were from MEC intermediate grade, 33.3% from low grade and the remaining 11.1% from MEC high grade by histological grading. Among the 6 carcinomas of the palate, 50% were low grade, 33.3% were intermediate grade, ..........

Early outcome of total abdominoplasty in thirty cases

Background: Abdominoplasty, a popular cosmetic surgery, has improved in recent years. Kelly helped minimize abdominal fat and skin. Medical institutions are diagnosing and treating obesity at an increasing pace. The research aimed to examine early post-abdominoplasty outcomes.Methods: This prospective observational study was carried out from July 2014 to April 2015. Patients admitted at the plastic surgery department of Dhaka Medical College Hospital and different private hospitals in Dhaka with excess abdominal skin and abdominal wall laxity due to various reasons like previous pregnancy or massive weight reduction were the study population. A total of 30 cases that fulfilled the enrolment criteria were selected from the study population.Results: Most of the patients (26, 86.67%) were female, 76% of them were married. The mean age at the time of operation was 41.3 years. The overall complication rate was 40% with few major complication (4, 13.33%) and the maximum portion was minor (9, 30%). The most frequent was seroma (3, 10%), infection (2, 6.67%), hematoma (2, 6.67%), wound dehiscence (1, 3.33%), partial flap loss (2, 6.67%) and umbilical stenosis (1, 3.33%), epidermolysis (1, 3.33%), deep vein thrombosis (DVT) (1, 3.33%). Patients’ satisfaction was scored as very good (19, 66.3%), good (9, 30%), satisfactory (2, 6%). No patient scored his satisfaction as poor or very poor.Conclusions: Abdominoplasty is safe and comfortable. Patients were happy with the treatment and had improved symptoms with little health hazards. There were mild problems, especially with wound healing. Minor difficulties were simply treated in an office.