Dhaka Medical College Hospital Research Articles

Toxicities Associated With Dose-Adjusted Epoch-R Compared With R-Chop as Frontline Therapy for Diffuse Large B-Cell Lymphoma: A Study Conducted in a Tertiary Level Hospital of Bangladesh

Background: Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma (NHL). This is a heterogeneous group of hematological malignancy of large B lymphocytes with a diffuse growth pattern. Managing DLBCL is challenging because of the biological and clinical heterogeneity of the disease and toxicities during treatment. Methods: This quasi experimental study was conducted at DMCH Hematology department from January 2018 to June 2019 including nineteen, newly diagnosed diffuse large B cell lymphoma with stage I to IV A/B cases. Protocol was approved by ethical review committee (ERC) of Dhaka Medical College Hospital(DMCH). Patients fulfilling the inclusion criteria were enrolled using convenient purposive sampling and then allotted any one of the two regimen groups. Results: Total nineteen (19) DLBCL cases were enrolled for this study and divided into two groups as arm A treated with RCHOP(10 cases) and arm B treated with RDA- EPOCH (9 cases) . Mean age of all patients was 41 years (range 16 to 60 Y). Among them majority (13/69%) of the patients were below 50 years of age and M: F ratio was 2:1.102 cycles of chemotherapy were administered among 20 patients. In R-CHOP group of patients, Grade 1-2 Anemia was found in 14 cycles (28.0%). In R-DA-EPOCH group Grade 1-2 Anemia was found in 14 cycles (31.1%). Grade 3-4 thrombocytopenia was found in 6 cycles (12%) in R-CHOP group. On the other hand, Grade 3-4 thrombocytopenia was found in 4(8.89%) patients in R-DA-EPOCH group. There were 4 episodes of neutropenic fever (8% of cycles) in R-CHOP group and 3 episodes (6.7% of cycles) in R-DA-EPOCH group. 8 out of 10 patients suffered from grade 1-2 anemia in R-CHOP group and 8 out of 9 patients suffered from grade 1-2 anemia. 2 out of 9 patients suffered from grade 3-4 thrombocytopenia in RDA- EPOCH group. Grade 3-4 hemorrhage occurred in 1(10%) patient in R-CHOP group and 2 (22.2%) patients in R-DA-EPOCH group. Mucocitis (grade 1-2) was found in 5 patients (50%) in R-CHOP group and 8 cycles (88.8%) in R-DA-EPOCH group which was not statistically significant. Diarrhea (grade 1- 2) was found in 2 patients (20%) in R-CHOP group and 5 patients (55.5%) in R-DA-EPOCH group. Neuropathy was found in 3 patients (30%) in R-CHOP group and 1 patient (11.1%) in R-DA-EPOCH group. Febrile neutropenia was found in 4 patients (40%) in R-CHOP group and 3 patients (33.3%) in R-DA-EPOCH group. Conclusion: From the result of this study it can be concluded that, Overall incidence of grade 3-4 anemia, thrombocytopenia and diarrhea was more in R-DA- EPOCH group and neuropathy was more common in R-CHOP group. Bangladesh J Medicine 2022; 33: 161-167

Clinical Utility of Urinary β2 Microglobulin in Detection of Early Nephropathy in type 2 Diabetes Mellitus Patients

Background: Diabetic nephropathy is a kidney disease associated with long-standing hyperglycemia. The main features of diabetic nephropathy include nephrotic syndrome with excessive filtration of protein into the urine (proteinuria), high blood pressure (hypertension), and progressive impairment of kidney function. Objective: To find out the clinical utility of urinary β2 microglobulin in the detection of early nephropathy in type 2 diabetes mellitus patients. Methods: This cross-sectional study was conducted in the Department of Nephrology, Dhaka Medical College Hospital, over a period of one year from January 2017 to December 2017. 50 type 2 diabetes mellitus patients as the case group and age sex-matched 50 healthy participants as the control group was included in this study as the study population. Socio-demographic, family history, history of patients, and epidemiological data were recorded. A clinical examination investigation was done for all the study population. The urinary β2 microglobulin (β2m) level was assayed using the beta- 2- macroglobulin ELISA kit, EIA 3609. Statistical analysis was done by the Statistical Package for Social Science (SPSS-22). The confidence interval was considered at the 95% level. The sensitivity and specificity of urinary β2m were calculated in detecting early DN. P-value <0.05 was considered statistically significant. Result: Mean age of the case group was 50.08±12.06 years and the control group was 46.54±9.89 years. Female was predominant in both case and control group. Hypertension, anemia, diabetic nephropathy, and diabetic peripheral neuropathy were found in 24(48%), 17(34%0, 14(28%), and 11(22%) cases. Urinary ACR was found significantly higher in the case group than that of the control group (183.32±164.11 mg/gm vs 13.60±4.40 mg/gm). Similarly, urinary β2 microglobulin was found significantly higher in the case group than in the control group (0.50±0.22 µgm/ml vs 0.14±0.05 µgm/ml). Among early nephropathy patients .....

Small Intestinal Bacterial Overgrowth among Patients with Cirrhosis

Introduction: Acute chronic liver failure, spontaneous bacterial peritonitis, hepatic encephalopathy, and hepatorenal syndrome are a few of the grave complications of liver cirrhosis that may result in death. For years, small-intestinal bacterial overgrowth (SIBO) has been considered a predisposing factor for these complications in cirrhotic patients. However, data regarding SIBO in cirrhosis patients remain less focused in our country. Therefore, the study was designed to evaluate the risk of SIBO in patients with liver cirrhosis attending a tertiary care hospital, in Bangladesh. The aim of the study was to find out the association of small intestinal bacterial overgrowth (SIBO) with cirrhosis. Methods: This case-control study was carried out in the departments of Gastroenterology and Department of Hepatology, Dhaka medical college hospital during the period from September 2018 to October 2019 with a total of 136 patients equally divided into case and control groups. The case group consisted of patients with cirrhosis, while the control group comprised of healthy age-matched volunteers. Result: Among SIBO positive cases and control most common age group was 41-50 years of age. The majority were males observed in both the case (83.3%) and the control (66.7%) groups. The risk of SIBO was more in the cirrhotic patient as the odds ratio was > 1(OR= 7.8) with 95% CI 2.18-27.96. Overall frequency of SIBO was more among patients with higher CTP score {CTP-B (72.2%), CTP-C (27.8%)} with a p-value <0.05. Conclusion: Cirrhosis is associated with small intestinal bacterial overgrowth (SIBO). The frequency of SIBO also increases in cirrhotic patients with higher CTP scores.

Role of Glucose Variability in the Diagnosis of Septic Patients

Background: Glucose variability is an indicator and independent predictors of mortality and severity of sepsis in critically septic patients of intensive care unit. Objectives: This study evaluated the relationship of glucose variability in critically ill septic patients in relation with serum lactate. Method: It is a prospective observational study was conducted in the Intensive Care Unit (ICU) in Department of Anesthesia, Pain, Palliative Care and Intensive Care, Dhaka Medical College hospital, Dhaka over a period of one year in between 1st January- 31st December, 2015. Total 51 septic adult patients were included in the study according to the selection criteria. In this study, 8 consecutive capillary blood samples were taken with a periodic interval of 3 hours starting from admission. Mean and standard deviation (SD) blood glucose were computed to see the glucose variability and agreement done with serum lactate and severity of sepsis. All collected data were registered documented and analyzed in the statistical program Statistical Package for Social Science (SPSS) version 20.0. Result: Among total 51 patients, 52.9% study cases were of 4th decade with a mean age of 46±12 years had a mild female predominance. Glycemic variability was taken as >2SD. High glycemic variability observed in 70.6% cases. Good agreement observed in glucose variability with serum lactate by Kappa Statistics. Conclusion: Glucose variability shows the prediction of sepsis and it could be used as a useful alternative tool to predict sepsis and severity of sepsis. Bangladesh Crit Care J March 2022; 10 (1): 10-14

Evaluation of the Causes of Resistant Hypertension in Non-dialysis Chronic Kidney Disease Patients

Background: In Chronic Kidney disease (CKD), resistant hypertension (RH) is a common condition due to a combination of factors including sodium retention, increased activity of the renin-angiotensin system, and enhanced activity of the sympathetic nervous system. The aim of the study was to determine the causes of resistant hypertension in non-dialysis Chronic Kidney Disease Patients. Methods: This descriptive cross-sectional study was conducted in the department of Nephrology & Internal Medicine of Dhaka Medical College Hospital from 18th January 2016 to 20th may 2016. Patients aged above 18 years admitted with resistant RH and CKD were enrolled in the study after fulfilling the inclusion and exclusion criteria. The study involved 50 CKD patients who had RH. Purposive consecutive type of sampling technique was applied for sample collection. Detail socio-demographic data were collected and recorded in a predesigned questionnaire. Clinical examination and relevant investigations were done. Data was analysed with SPSS version 22.0. P value of <0.05 was considered significant. Result: Maximum number of patients 23(46.0%) were between 46-60 years age group, mean age of the patient was 53.17 ± 8.42 years. Male: female ratio was 1.63:1. Study showed that frequency of RH and CKD gradually increased with age. In case of both sexes, 46-60 years age group showed the highest incidence for CKD. The mean systolic and diastolic blood pressures (BP) were 133.04 ± 12.91 mmHg and 81.07 ± 6.41 mmHg respectively. Those with diabetes mellitus, obesity (BMI > 27.5 kg/m2) and those who were older than 55 years were significantly higher in the RHT group than in the non-RHT group. Conclusion: RH in CKD patients was significantly associated with the presence of obesity, diabetes mellitus and increased age. These factors should always be kept in mind while treating HTN in CKD patients. Bangladesh Crit Care J March 2022; 10 (1): 19-25

Effects of Exposure of Cement Dust on Platelet Count in Workers of a Cement Mill

Introduction: Cement dust is emitted during the different steps of cement production. This dust is composed of chemical components that may have unfavourable effects on the haematological system. The workers in these factories are exposed daily to this toxic dust. Those exposed to the cement dust may suffer from changes in platelet count and eventually suffer from damaging effects on the cardiovascular system. Objective: Assess the effects of cement dust on platelet count of cement mill workers. Materials and Methods: Conduction of this cross sectional study took place in the Department of Physiology, Dhaka Medical College, Dhaka between July 2017 to June 2018. After fulfilling the ethical consideration, 46 apparently healthy male cement mill workers, working for 2 or more years in a cement mill , with range of age of 20 to 50 years (study group) and 46 BMI, age and socioeconomic condition matched apparently healthy male subjects from Dhaka city were control group. The platelet count was estimated using automated haematology analyzer in Dhaka Medical College Hospital, Dhaka. Data was collected in a pre-designed structured questionnaire form. Unpaired Student’s ‘t’ test and Pearson’s correlation coefficient test were performed for statistical analysis. Results: In this study, the platelet count was significantly (p < 0.05) higher than those of control group. The platelet count was directly related with duration of cement dust exposure. Conclusions: This study concludes that the cement dust has harmful effect on the platelet count and the duration of exposure to cement dust also has an effect on this parameter. Medicine Today 2022 Vol.34(1): 44-46

Early Postoperative Complications and Mortality in Patients Undergoing Colorectal Cancer Surgery, Co-Relation with Nutritional Status, Stage of Disease and Presentation

Background: Early postoperative outcome of colorectal cancer being worsen by various factors like advanced disease stage, emergency presentation, poor nutritional status of the patient etc. To aim of this study was to evaluate the relationship between nutritional status, disease stage, its presentation with short term outcome like mortality and morbidity after colorectal cancer surgery. Methods: A total 44 number of colorectal cancer patients enrolled in this observational study. These patients underwent colorectal cancer surgery in different surgery unit of Dhaka Medical College hospital and Bangabandhu Sheikh Mujib Medical University, Dhaka were enrolled during the period of March 2014 to march 2015.Patients who developed early postoperative morbidity or mortality were compared with those who followed a healthy course after surgery in relation to nutritional status, disease stage and presentation. Total sample were divided into Group A, who developed postoperative complications and Group B, where patients had uneventful outcome. Results: Among 44 patients, in hospital death rate found nil and the overall postoperative morbidity rate was 34%. Most of the patients (33/44) was with normal BMI (17-24.9). Histopathologically found adenocarcinaoma and 56% was found TNM stage. Early postoperative outcome was significantly associated with preoperative hypoalbuminemia (16/36), medium to high risk of malnutrition (22/44), immediate surgery for acute disease state (2/15). Conclusion: In colorectal cancer, malnourished, high risk of malnutrition, hypoalbuminemia significantly contributes to postoperative mortality, morbidity and length of total hospital stay. Hypoalbuminemia serves as an excellent assessment tool and preoperative predictor of postoperative outcomes.

A Comparative Study between Fresh and Stored Platelet Concentrate after Transfusion in same ALL patients in a Tertiary Hospital

Background: Platelet transfusion is needed for the treatment of ALL children. Researchers have shown that transfusion of stored platelet concentrates (up to 5days) is as effective as fresh platelet concentrates (24 hours). Objectives: The present study was conducted to access the comparison between fresh and stored platelet concentrate after transfusion in same all patients in a tertiary hospital. Materials and methods: The study was a cross-sectional descriptive study which was conducted in department of Clinical Pathology, Paediatric Haemato-Oncology and transfusion Medicine BSMMU, and Department of Haematology and Paediatric Haemato-Oncology in Dhaka Medical College Hospital. Over a period of March 2010 to February 2011.The sample size was 81. A data sheet with two parts (Part A and Part B) was designed with a view to collect data from the patient to be enrolled in the study .The data were analyzed using the SPSS version 25.0. Results: Out of 81 patients fresh platelet concentrates (FPC) or day-0 platelets were transfused in 47 acute Lymphoblastic leukaemia (ALL) children. Stored platelet concentrates (day 1-5) were transfused in 34 children. In 27cases both fresh and stored platelet concentrates were transfused. Corrected count increment at 1 hour (CCI 1h) in FPC and SPC were 20.5 and 18.9 respectively. Mean corrected count increment at 24 hour (CCI 24h) FPC and SPC were 15.5 and 13.8 respectively. There were no significant differences between FPC and SPC P>0.05. Conclusions: It was observed that 1-5 day's stored platelet-rich-plasma platelet concentrate (PRP-PC) was as effective as fresh PC to obtain acceptable platelet increment in childhood acute lymphoblastic leukemia. Furthermore, corrected count increment and percentage platelet recovery are important tools to evaluate platelet refractoriness.

Ondansetron as Prophylactic against Hypotension and Bradycardia Following Spinal Anaesthesia in Elective Caesarean Section: a Case Control Study

Introduction: Hypotension and bradycardia following the administration of spinal anesthesia for cesarean section are very common and bear profound detrimental effects both on mother and baby. In our country, a significant proportion of patients undergo cesarean section delivery. Considering the workload and the socio-economic condition it is often a bad headache for our anesthesiologists to combat post-spinal hypotension. Vasopressor drugs have been widely used to prevent and treat maternal hypotension during cesarean section under spinal anesthesia. A combination of preloading and using vasopressor has maximum efficacy in preventing spinal-induced hypotension but with compromising with some detrimental adverse effects of vasopressor. Amongst vasopressors, ephedrine is widely used but studies found that a higher bolus dose is often required to prevent hypotension and bradycardia. Aim of the study: To find out the efficacy of ondansetron to prevent haemodynamic derrangement in cesarean section under spinal anaesthesia. Methods: This Prospective Randomized Double-Blind Comparative study was conducted at the Department of Anesthesiology and ICU, Dhaka Medical College Hospital, Dhaka, Bangladesh. The study duration was ten months, from March 2015 to January 2016. A total of 120 participants were randomly included in this study.Each participant was included either into “Group A (n=60)” or “Group B (n=60)” by using fixed number card sampling as mentioned earlier. Group B had been considered as control group in the study, Participants of group A received intravenous ondansetron (0.1 mg/kg body weight) and group B received ephedrine (0.5 mg/kg body weight). Result: The majority of the participants (58.33%) from both groups were from the age group of 26-30 years. Parity distribution revealed that 59.17% (n=71) patients were multigravida while 40.33% (n=49) were primi. In total, 80.33% of the participants had ASA I physical status, and 19.17% had ASA II. All patients .......

Clinical Significance of Modified Greab Score in Patients of Intra Ventricular Hemorrhage when Treating with External Ventricular Drainage

Background: There is no consensus in the literature on the effects of the development of hydrocephalus on survival and disability after intracerebral hemorrhage (ICH) and the benefits of external ventricular drainage (EVD). Some studies showed good outcomes whereas some showed poor outcomes after insertion of EVD in patients with spontaneous intraventricular hemorrhage with hydrocephalus. Objective: This study is planned to describe the role of external ventricular drainage in treating patients with spontaneous, either primary or secondary, intraventricular hemorrhage with hydrocephalus. Method: A hospital-based prospective interventional study was conducted in the Department of Neurosurgery of Dhaka Medical College Hospital, which is a tertiary level hospital, from April 2016 to September 2017. A total of 42 patients of spontaneous intraventricular hemorrhage, either primary or secondary, with hydrocephalus were selected for this study. Glasgow Coma Scale score for level of consciousness and Modified GRAEB score for severity of ventricular hemorrhage were recorded preoperatively. All the collected data were entered into IBM SPSS software, Version 22.0. Correlations were determined by linear regression analysis. Results: Among 42 patients, the age range was 26-75 years with a mean age of 65.2±10.87 years. Male were 26(61.9%) and females were 16(38.1%). The male-Female ratio was 1.625:1. A total of 9(21.42%) patients had a primary intraventricular hemorrhage and the rest of 33(78.58%) had an intraventricular hemorrhage. Preoperative GCS ranged from 4 to13 with a mean value of 7.14 ± SD 1.995. Modified GRA Escoresre was ranged from 5 to 19 with the mean 8.85± SD 0.7693. The difference in GCS at 24 hours was ranged from a minimum of 3 to a maximum of +10 with an increase of +1.67± SD 2.09. Collected CSF volumes at 24 hours were ranged from a minimum of 50 to a maximum of 480 ml with a mean of 338 of 0.33 ml ±SD 113.329. Total 5 patients died within 30 days. ...........

Knowledge, Attitude and Practice of Female Nurses on Complementary Feeding in a Tertiary level Hospital of Bangladesh

Introduction: Inadequate knowledge on nutritious foods and feeding practices are determinant of malnutrition rather than lack of food. Health professionals particularly nurses pass long contact time with the mothers, so positive attitude among them can be used in motivating mothers for infant and young child feeding. There is little data available in this regard, therefore evaluation of nurses’ knowledge, attitude and practice on complementary feeding is very important. This study was conducted among the female nurses in a tertiary level hospital of Bangladesh to find out the knowledge, attitude and practice of complementary feeding to their own under-2 children. Methods: The descriptive study was carried out at Dhaka Medical College Hospital between September 2014 and August 2015. Total 95 nurses having children from 6 months up to 2 years of age were enrolled as sample. Results: It showed that 63.1% of the nurses had good understanding on complementary feeding. But 46.3% of them did not know the duration correctly and 27.4% considered infant formula as the complementary food. Almost all had the positive attitude but 28.4% stated that distraction during feeding is needed. Among the respondents, 97% strongly agreed about the importance of complementary feeding but 67.4% of the nurses introduced complementary food before 6 months of age. Only 58.9% of them continued breast feeding up to 2 years. Conclusion: The study reflects that although most of the nurses have adequate knowledge and positive attitude towards complementary feeding but deviation was noted in timely Introduction of complementary food and use of feeding bottle. This indicates clear disparity between knowledge and practice of the female nurses. J Bangladesh Coll Phys Surg 2022; 40: 87-92

Recovery of Children from Acute Lower Respiratory Tract Infection(Pneumonia and Bronchiolitis) : In a tertiary Care Hospital

Backgrounds: Children are mostly the victims of pneumonia and bronchiolitis for which they are often hospitalized. Acute respiratory infection(ARI)results in 1.9 million deaths per year in developing countries(Taneja et. al 2009). It is important to know the recovery time of individual acute lower respiratory tract infection (ALRTIs) like pneumonia and bronchiolitis for better understanding the clinical feature and outcome. Knowing the length of stay (LOS) in case of ALRTI has not yet been worked out and studied well.
 Objective: To determine the recovery of different clinical features Length of hospital Stay and outcome of two common LRTIs viz pneumonia and bronchiolitis.
 Methods: A cross-sectional analytical study was done in department of pediatrics of Dhaka Medical College Hospital during the from October 2013 to September 2014. Cases were selected according to selection criteria. Pneumonia was diagnosed on the basis of fever, cough, breathing difficulty, and found chest indrawing, fast breathing, and bronchial breath sound or crackles on examination and consolidation or patchy opacity in chest X-ray and bronchiolitis on the basis of presence of runny nose followed by cough, breathing difficulty and wheeze on auscultation in a child below 2 yrs. Cases of pneumonia were treated with standard protocol of WHO and cases of bronchiolitis were treated with national guideline. The cases were followed up 12 hourly for 8 days using case collection sheet by monitoring 17 clinical features.
 Results : There were 54 cases of pneumonia and 54 cases of bronchiolitis. Baseline selected clinical-sociodemographic parameters of both the cases were similar in terms of sociodemographic status and some clinical features. The following clinical features were similar in both groups viz. cough(100% vs 100%) breathing difficulty (100%vs 100%), feeding difficulty (92.6%vs96.3%), chest indrawing(92.6%vs 96.3%).The dissimilar clinical features were fever (100%vs77.8%, p<0.001), runny nose (40.7%vs 100%, p<0.001%) sleeping difficulty (92.6% vs 77.8% p<0.03) wheeze (29.6% vs 100%, p<0.001) crackles(100% vs 18.5%, p<0.001). Dynamics of improvement in clinical features:Significant number of cases of pneumonia did not improve from breathing difficulty (40.7%) , feeding difficulty(40.7%), restlessness(16.7%), sleeping difficulty(76.9%), chest indrawing (63%), documented fever(54%) within 3 days, but more than 90% cases of bronchiolitis recovered from above mentioned clinical features. (P<0.001). Social smile returned to only 68% in case of pneumonia but 100% cases of bronchiolitis(p<0.001) with in 4 days.
 Conclusion: This study was concluded that almost 89% cases of pneumonia and 100% cases of bronchiolitis recovered. Length of hospital stay(LOS) was 5.8±2.1 days in pneumonia and LOS was 3.2±0.7 in bronchiolitis. Mortality was higher in cases pneumonia (3.7%) than cases of Bronchiolitis(0.0%).
 Sir Salimullah Med Coll J 2021; 29(2): 124-131

Detection of Quinolone Resistance Qnr Genes and its Association with Extended Spectrum Β-Lactamase and Carbapenemase Genes in Qnr Positive Enterobacteriaceae in a Tertiary Hospital in Bangladesh

Background: Multidrug resistance in Enterobacteriaceae including resistance to quinolone is dramatically increasing day by day. Widespread use of quinolones against Enterobacteriaceae has contributed to the rise of drug resistance. Resistance to quinolone is generally due to chromosomal mutations in genes coding for the target molecules of these agents, namely the DNA gyrase and topoisomerase IV enzymes. Recently, a multiresistance plasmid is discovered that encodes transferable resistance to quinolones; its prevalence is increasing gradually throughout the world. Plasmids have a crucial role in the dissemination of drug resistance genes like plasmid mediated quinolone resistant (PMQR) genes, extended-spectrum β-lactamase (ESBL) genes and carbapenemase genes. Objective: To detect the prevalence of quinolone resistance Qnr genes and its association with extended-spectrum β-lactamase and carbapenemase genes in Qnr positive Enterobacteriaceae. Methods: A prospective cross sectional study was conducted from January 2015 to December 2015 at Dhaka Medical College hospital, Bangladesh. A total of 270 Enterobacteriaceae were isolated from 340 samples collecting from inpatient and outpatient departments of DMCH irrespective of age, sex and antibiotic intake. Qnr determinant screening among ciprofloxacin resistant strains were conducted using PCR amplification. Searching of Extended-spectrum β-lactamase and carbapenemase genes in Qnr positive Enterobacteriaceae were conducted also by using PCR. Results: The Qnr genes were detected in 141 (62.67%) of the 225 quinolone resistant isolates by using PCR. Highest proportion of QnrS (n =84, 59.57%) were detected followed by QnrB (n =70, 49.64%) and QnrA (n =33, 23.40%). In the present study, 48 ESBL producers were identified among 141 Qnr positive strains. Highest proportion of CTX-M-15 (n= 38, 69.09%) were detected followed by TEM (n= 20, 36.36%) and OXA-1 (n= 16, 29.09%). In the present study, 22 carbapenemase producers were .....

Association of Virulence with Antimicrobial Resistance among Klebsiella pneumoniae Isolated from Hospital Settings in Bangladesh

:Introduction:Infections caused by multidrug-resistant (MDR) hypervirulent Klebsiella pneumoniae are difficult to treat and associated with high mortality rates. Hence, this study was conducted to determine the antibiotic resistance pattern along with the distribution of virulence genes among isolated string test positive and negative strains.Materials and Methods:A total of 44 K. pneumoniae strains were isolated following standard microbiological methods from 350 different clinical samples from patients admitted to Dhaka Medical College Hospital, Bangladesh. String test was done to detect the hypermucoid phenotype. Antimicrobial resistance (AMR) pattern was determined by dichlorodiphenyltrichloroethane (except colistin and fosfomycin) among all isolates. Polymerase chain reaction was done to detect the hypervirulence genes (magA, rmpA, rmpA2 iutA, iroN).Results:In this study, 21/44 (47.73%) of the isolated K. pneumoniae were string test positive and distribution of the virulence genes except rmpA2 was higher among them. A total of 15/44 (34.09%) of the isolated K. pneumoniae were MDR, 10/44 (22.73%) were extensively drug resistant, 1/44 (2.27%) was pan drug resistant, and 14/44 (31.82%) were colistin resistant. Isolated organisms were highly resistant to third-generation cephalosporins and most sensitive to fosfomycin in this study. Although all the string test positive strains showed higher resistance rates than the string test negative ones toward most of the tested antibiotics, only the differences of resistance rates to amoxiclav and tigecycline among the two phenotypes were statistically significant.Conclusion:Our findings highlight the importance of surveillance of the AMR pattern of hypervirulent K. pneumoniae in clinical samples. Therefore, a response to check the global dissemination of this hypervirulent K. pneumoniae with resistance determinants is urgently needed.

Evaluation of Drug Prescribing Patterns in Dermatology Outpatient Department of Two Teaching Hospitals in Bangladesh

Background: Skin diseases are common and cause a huge burden globally. Bangladesh is known to have a high prevalence of skin diseases. Considering the economic burden of the skin diseases treatment and its high prevalence, it is important to study the drug prescribing patterns in skin diseases.
 Objective: To evaluate the prescribing pattern of drug according to World Health Organization (WHO) prescribing indicators among the patients attending Dermatology outpatient department in two teaching hospitals.
 Materials and method: A cross sectional descriptive study was conducted in outpatient department of Dermatology in Dhaka Medical College Hospital (DMCH) and Sir Salimullah Medical College & Mitford Hospital (SSMC & MH) from July 2015 to June 2016. A total number of 600 prescriptions (300 from each hospital) were enrolled in the study. The general information and data were collected in the questionnaire and subjected to evaluation using WHO prescribing indicators.
 Results: The average number of drugs per prescription was 2.41 in DMCH and 2.38 in SSMC & MH. Only 23.72% drugs in DMCH and 27.79% drugs in SSMC & MH were prescribed by generic name. The percentage of prescriptions with antibiotics was 46% in DMCH and 45.66% in SSMC & MH. The percentage of prescriptions with an injection encountered was 0.67% and 0.33% in DMCH and SSMC & MH respectively. This study also revealed that, the percentage of drugs prescribed from the Essential Drug List (EDL) of Bangladesh was 56% in DMCH and 57.68% in SSMC & MH.
 Conclusion: There is need to emphasize to keep the average number of drugs as low as possible and encourage prescribing by generic name and from Essential Drug List (EDL).
 Delta Med Col J. Jul 2020 8(1): 9-14

The Relationship between Hormonal Contraceptives and Metabolic Syndrome

Background: Metabolic syndrome (MS) in women using hormonal contraceptives (HCs) are common health hazards all over the world than that of contraceptives non users. Objective: To observe the relationship of hormonal contraceptives with metabolic syndrome. Method: This cross-sectional study was carried out in the Department of Physiology, Dhaka Medical College Hospital, Dhaka, during the period from January to 31 December, 2011. Two hundred women age ranged 20-35 years using hormonal contraceptives were included in this study group. The study group was subdivided into oral contraceptive users (Group B) and injectable contraceptive users (Group C). All the women using hormonal contraceptive were selected from Model clinic and Medicine ward in DMC and also from different areas of Dhaka city. Results: In this study, the BMI value in both oral and injectable contraceptives users were significantly (P<0.001) higher than that of contraceptive non users. Within the study groups, the BMI in oral and injectable contraceptives users for 1-5 years were significantly lower (P<0.001) than that of oral contraceptive users for 6-10 years. The waist circumference (WC) in all oral and injectable contraceptives users for 1-5 years and 6-10 years were significantly (P<0.001) higher than that of contraceptive non users. Conclusion: Percentage of distribution of subjects having metabolic syndrome was higher in women using hormonal contraceptives and increase duration of hormonal contraceptives use progressively increase the level of parameters of metabolic syndrome. So, it may be concluded that women using hormonal contraceptives are more prone to develop metabolic syndrome.

Clinico-Pathological Outcome of Induced Abortion among the Patient Admitted in DMCH

Background: Abortion is defined as the loss or termination of a pregnancy before 20 weeks of gestation or when the fetus weighs less than 500 g. Induced abortion is defined as the use of medications or surgical intervention to stop pregnancy after implantation but before the embryo or fetus has become independently viable. The purposeful termination of a pregnancy, known as induced abortion, is one of the most common gynecological treatments. In this study, attempts have been made to show the clinical presentation, management, and outcome of patients. Aim of the study: The study aimed to assess the outcome of a patient after induced abortion. Methods: It was a prospective observational study. The study was conducted at the Department of obstetrics and gynecology, Dhaka Medical College Hospital, Dhaka, Bangladesh during May-Oct'2007 from all induced abortion cases admitted in different maternity units, 80 cases are randomly selected for the study. Proper ethical consent was taken from the concerns. All necessary investigation was done, and necessary pieces of information were noted in a preformed data collection sheet. Finally, the results were analyzed and presented in different tables using a computer and the SPSS database. Result: In this study, it has been seen that around 45.5% of gynecology patients are of abortion, and the incidence of induced abortion was 16% among all gynecological admission. The majority of abortion cases (58.75%.) were conducted by untrained persons. Among the patients, 8.75% had adequate knowledge about MR, while 51.25% had unreliable or incorrect information regarding MR. 55% of cases had used contraceptives. A total of 76.25% of patients got admission within 1 month of their complications. Among all cases, 92.5% were improved while the death rate was 7.5%. Amongst 23 specimens of high vaginal swab culture 15 (65.22%) patients showed growth of Escherichia coli, 3 (13.5%) of staphylococcus, 3 (13.5%) of pseudomonas, 1 (4.34%) of protus, 1 (4.34%) of klebsiella. Conclusion: All this can be reduced by improving socioeconomic condition, educational status, popularizing family planning, and modernization of existing laws in relation to abortion.

Transvaginal Colour Doppler Ultrasound Study of Uterine Tumours with Histopathological Correlation

A cross-sectional study was conducted in the Department of Radiology & Imaging, in collaboration with the Department of Obstetrics & Gynaecology, in Dhaka Medical College Hospital and Bangabandhu Sheikh Mujib Medical University Hospital, Dhaka, Bangladesh, between July 2010 and March 2012, to evaluate the diagnostic usefulness of transvaginal color doppler ultrasonography (TVCDU) in differentiating benign and malignant uterine tumours. A total of fifty women, diagnosed as having uterine tumours both clinically and using ultrasound, participated in the study. They were evaluated preoperatively using TVCDU. All the study participants underwent surgical operation and resected specimens were sent for histopathological examination. Histopathology reports were correlated with the of colour Doppler findings. The mean age of the patients was 47.72±8.79 years. Major complaints were menorrhagia (58%), dysmenorrhoea (50%) and lump in the lower abdomen (48%). Neovascularization was found in 16(32%) cases. The mean resistance index and pulsatility index were much lower in malignant tumours than that of the benign counterpart (0.35±0.03 vs. 0.67±0.01 and 0.65±0.14 vs. 1.35±0.11 respectively); the difference was statistically significant (P<0.001). The sensitivity, specificity, positive and negative predictive values of TVCDU were found 86.7%, 97.14%, 92.85% and 94.4% respectively. Overall diagnostic accuracy was 94%. To summarize, blood flow characteristics of benign and malignant uterine tumours, as evident on color Doppler imaging, have distinct diagnostic value. Hence, transvaginal colour Doppler ultrasound examination can be used as an easily available, efficient, and non-invasive diagnostic modality in differentiation of uterine tumours, which can be histologically confirmed later.
 CBMJ 2021 January: vol. 10 no. 02 P: 105-110

Effects of Multiple Pregnancies on Mother and Foetus

Background: The incidence of multiple pregnancies is on rising due to a variety of reasons like increased use of assisted reproductive techniques and an increasing number of women having a pregnancy at an advanced age. A mother with twin pregnancy needs to be taken under the special care category. Objectives: We are intended to observe the effects associated with twin or higher-order pregnancy. Materials and Methods: This is a descriptive type of cross-sectional observational study conducted in the Department of Gynae and Obstetrics, Bangabandhu Sheik Mujib Medical University and Dhaka medical college hospital over a period of six months from 1st July to 31st December 2014. Total fifty patients were included in the study. Inclusion criteria were pregnant women who would be admitted with multiple pregnancies in BSMMU & DMCH. Results: Average age of the responding patients was 24.54 years with standard deviation of ±3.93. Forty-two (84%) patients had ANC. Maximum (34%) patients had no complication, 8(16%) patients had GDM, 8(16%) patients had Preterm labor (PTL), 12 (24%) patients had Preeclampsia and only 5(10%) patients had PROM. Maximum (50%) babies had no significant fetal outcome, 30% babies had low birth weight, 16% babies were very low birth weight and 4(8%) patients had fetal demise. Conclusion: Now a days the incidence of multiple pregnancies is increasing due to ART. Multiple pregnancies are high-risk pregnancies with more complications in comparison to a single pregnancy. Our study reveals that nearly half of the cases had no maternal or fetal complication, Commonest maternal complications were preterm labor, Premature rupture of membranes (PROM), preeclampsia, and fetal outcomes were premature and low birthweight babies. KYAMC Journal. 2022;12(04): 196-199

Types and Distribution of Fetal Congenital Anomaly and their Maternal Characteristics in High Risk Pregnancy Unit of Dhaka Medical College Hospital, Bangladesh

Introduction: Congenital anomaly is one of the important causes of perinatal mortality and morbidity. Proper information regarding its prevalence, distribution as well as risk factors can help policy makers to take appropriate steps for prevention. Materials and Methods: A hospital record based observational study was done in Obstetric department of Dhaka Medical College Hospital, Bangladesh during the year of 2020. The aim of the study is to evaluate the pattern of anomaly found in admitted patients in Maternal Fetal Medicine unit, along with the maternal demographic profile and associated diseases. After taking ethical clearance and permission from department detailed information was collected and analysis was done. Results: In the year 2020 total 6012 delivery was occurred and 4.42% of them were anomalous baby. The maternal characteristics showed that mean maternal age was 26.24(±5.25) years. 20.7% of mother had previous history of abortion, 7.7% has previous perinatal death and 3.3% have previous anomalous baby. 5.49% mother had Diabetic disorders and 4.39% had congenital heart disease. Associated poly hydramnios was found in 17.7% and oligohydramnios was found in 12.1% of cases. The distribution pattern of anomalies according to system involved showed that 41.7% was Central Nervous System anomaly, 8.7% was Renal anomaly, 6.5% was Musculoskeletal anomaly, 4.4% was Gastrointestinal anomaly,6.6% had body wall defect , 10.9 % was Non immune Hydrops, 3.3% was Syndromic baby and 13.1% had multiple congenital anomaly. Conclusion: It is a tertiary hospital based study. So it may not reflect the actual picture of population. So community based study is needed for further advancement.