Dhaka Medical College Hospital Research Articles

Correlation of Caval Index and Central Venous Pressure in Non-ventilated Critically ill Patients

Background: Determination of intravascular volume status can sometimes be challenging part of critically ill patient’s management in ICU. Invasive haemodynamic monitoring of central venous pressure is a useful guide in directing early resuscitative efforts and assist in reducing the morbidity and mortality of ICU patients with severe sepsis/septic shock. Obtaining invasive hemodynamic monitoring can lead to complications and time consuming. Sonographic measurement of the inferior vena cava (IVC) diameter and IVC collapsibility, termed the caval index is a non-invasive method of estimating the fluid status in critically ill patients. The study was designed to see the correlation between caval index and central venous pressure (CVP) in non-ventilated critically ill patients. Objectives: The aim of the study was to evaluate the correlation of caval index and central venous pressure in non-ventilated critically ill patients. Methods: It was a hospital based descriptive type of cross-sectional study, carried out in the ICU at the Department of Anaesthesia, Analgesia, Palliative & Intensive Care Medicine, Dhaka Medical College Hospital, Dhaka from the period of May 2017 to October 2018. A total number of 86 patients were enrolled in this study. Study subjects were patients (age >18 years) with critically-ill non-ventilated and whom central venous catheter inserted for CVP monitoring. Central venous pressure was measured first by CVP manometer. Then IVC diameter and caval index were measured with curvilinear probe of the Sonosite ultrasound device. The correlation of CVP and CI was calculated. Statistical analyses of the results were obtained by using window-based Microsoft Excel and Statistical Packages for Social Sciences (SPSS-24). Results: In this study, according to CVP 33.7% (29) of patients were hypovolemic with mean (±SD) CVP 5.3±1.2 cm H20, euvolemic were 38.3% (33) with mean (±SD) CVP 10.6±1.7 cm H20 and hypervolemic were 27.9% (24) with mean±SD CVP 16.1±1.5 cm H20. Mean caval index (CI) (%) mean (±SD) was found 57.1±7.23 in hypovolemic patients, 39.5±2.65 in euvolemic & hypervolemic patients. So, the result shows >50 % CI is associated with CVP < 8 mm of Hg and < 50% CI is associated with CVP > 8 mm of Hg. Pearsons correlation coefficient test used to assess the strength and nature of correlation between two variables. There was a statistically significant correlation between the mean CVP and the caval index (p < 0.001). So findings revealed that there is an inverse relationship between the caval index and CVP. Conclusion: The caval index had acceptable correlation with CVP at the level of IVC entry into the right atrium. It was concluded that there is an inverse relationship of CVP with the caval index. Bangladesh Crit Care J March 2024; 12 (1): 29-34

Prevalence of Ear and Nasal Diseases in Bangladeshi Patients

Background: The magnitude of health problems related to ear and nose in Bangladesh has not been estimated in a larger scale and very little is known about the prevalence and types of ENT diseases. Commonest cause of hearing impairment in our country is middle ear infection. Conductive type of deafness mostly occurs due to otitis media with or without its complications. Goal of primary health eare services is to achieve "Sound hearing by 2030" will never be achieved if we could not find out possible association of middle ear disease with other health conditions. Objective: To determine the prevalence of ear and nasal diseases in Bangladeshi patients. Methods: Two hundred patients complaining of middle ear discharge and or nasal symptoms were included in this study, to see the association of COM with nasal disorders. This cross sectional study was conducted in Dhaka Medical College Hospital from July 2012 to June 2014.Sample was taken by purposive sampling. Sample was divided into four groups as exposed and diseased, exposed and not diseased, not exposed diseased and not exposed and not diseased. Results: Two hundred patients were studied in the department of ENT and Head Neck Surgery of Dhaka Medical College Hospital complaining of either COM or Sinonasal disease. Among them 107 were female and 93 were male and male female ratio was 1:1.15. On analyzing age distribution it was ranging from 10 years to 50 years with mean age 30±7.86% clustering around 25 years. This study revealed that 65 % of COM is in the age group of 10-30 years. Conclusion: A study on the prevalence of the Ear Nose throat and Head and Neck diseases in developing country like Bangladesh can provide basic data which can be relevant and beneficial to the development of medical ENT curriculum in the regional setup and subsequent medical practice.

Association of Deviated Nasal Septum with Chronic otitis Media

Background: The existence of a pathophysiologic connection between nose and rniddle ear is widely accepted so that chronic purulent middle ear disease (CPMED) could be expected to be usually associated with chronic nasal disease or impaired function. Nevertheless such association is less frequently observed in clinical practice than one could expect, possibly because of inadequate evaluation of nasal function. Objective: To observe the association of deviated nasal septum with COM Methods: Two hundred patients complaining of middle ear discharge and or nasal symptoms were included in this study, to see the association of COM with nasal disorders. This cross sectional study was conducted in Dhaka Medical College Hospital from July 2012 to June 2014.Sample was taken by purposive sampling. Sample was divided into four groups as exposed and diseased, exposed and not diseased, not exposed diseased and not exposed and not diseased. Results: Along with DNS age, sex, smoking and abusing of nasal drug were compared. Number of patients with septal deviation with a convexity to the same side as affected ear in COM was compared with Chi-square test. Septal deviation founded more frequently on the same side of ear pathology (p<00l), Therefore, septal deviations must be carefully investigated during the management patients with COM. Conclusion: Septal deviations must be carefully investigated during the preoperative assessment of patients with COM. Along with DNS age, sex, smoking and abusing of nasal drugs were evaluated. Smoking was found to be associated with the development of COM.

Experience of pediatric palliative care among children with cancer in a tertiary care hospital in Bangladesh

Background: Palliative care is a holistic approach which can improve patients and their family’s quality of life through the prevention and relief of physical symptoms as well as support for emotional, social and spiritual suffering. Despite the substantial need for palliative care there is very limited access in Bangladesh, with only a few palliative care services focused on children including several hospital-based services as well as home and hospice-based services, within the capital city of Dhaka. The aim of the study was to evaluate the effect of pediatric palliative care on quality of life in children with cancer. Methods: This was an institutional based descriptive study conducted in the department of pediatric hematology and oncology and pediatric palliative care unit, Dhaka medical college hospital, Dhaka, from May to August 2023. A total of thirty child and parent pairs were taken as the study population according to inclusion and exclusion criteria. Outcome was evaluated by the CPOS-2 questionnaires for symptom and Lanskys performance status scale for assessment of activity level. Results: The median age of the children were 5.7 years where 70.0% were male. The duration of disease of the patients was up to 6 months in 63.3% cases. One third of the patients had ALL, 13.3% had NHL, and 10.0% had Ewing sarcoma while another 10.0% having neuroblastoma. Conclusions: There is significant improvement in the quality of life of pediatric cancer patients and their parents, as well as the enhanced performance status of patients with cancer after receiving pediatric palliative care.

Role of Ultrasound Guided Pneumatic Reduction of Intussusception in Children Under 3 Years with Early Presentation

Background: Intussusception remains the most common cause of intestinal obstruction in children under 3 years of age. Objective: To evaluate the role of ultrasound guided pneumatic reduction of intussusception in children under 3 years with early presentation. Methods: This prospective interventional study was carried out at the Department of Pediatric Surgery in Dhaka Medical College Hospital, Dhaka from July, 2020 to June, 2022 for a period of 24 months. A total number of 22 patients with intussusception scheduled for Ultrasound Guided Pneumatic Reduction procedure to reduce intussusception were enrolled for this study after fulfilling the selection criteria. After Ultrasound Guided Pneumatic Reduction, patients were evaluated with duration of reduction, hospital stay and mass existence. Results: The mean age of the patients was 1.28 ± 0.83 years, ranging from 4 months to 3 years. Of them, 54.5% were below or equal to 1 year and the rest, 45.5% were above 1 year. All patients had abdominal pain and 86.4% palpable abdominal mass. Most of the mass situated at right hypochondrium (59.1%). The mean duration of reduction was 6.45 ± 1.29 minutes, ranging from 4 to 8 minutes. The mean duration of hospitalization was 15.90 ± 1.57 hours, ranging from 14 to 18 hours. In 9.1% of cases, the mass remained after the procedure. Conclusion: Intussusception can be effectively treated using pneumatic reduction, which is also quicker, less messy, and risk-free.

Effect of Perioperative Allogeneic Blood Transfusion in Causing Surgical Site Infection in Elective Gastrointestinal Surgeries: A Comparative Study among the Pediatric Population in A Tertiary Care Hospital of Bangladesh

Background: Allogeneic blood transfusion (ABT) has been reported as a major risk factor for surgical site infection (SSI) in patients undergoing elective gastrointestinal surgery. Objective: To find out whether perioperative allogeneic blood transfusion is a significant risk factor for surgical site infection in children undergoing elective gastrointestinal surgery. Methods: This prospective observational study was carried out at the Department of Pediatric Surgery in Dhaka Medical College Hospital, Dhaka, from January, 2021, to June, 2022, for a period of 18 months. According to CDC standards, patients who underwent elective gastrointestinal surgical procedure or clean-contaminated surgical wound (class II) were chosen as the study population. Total 256 patients were divided into two groups according to the blood transfusion as transfused and non-transfused group. Preoperative and postoperative day 1 CBC were done to observe the lymphocyte count. Blood transfusions were recorded during the perioperative period. After surgery, patients were followed up to check for surgical site infection and anastomotic leakage. Pus or wound swab for C/S was done in all the patients who developed SSI. The duration of the hospital stay after surgery was also noted. Results: Most of the study subjects in both the groups were ≤5 years(p=0.095). Males were predominant than females in both groups (p=0.014). Infection was found significantly higher among the transfused group (34.6%) than non-transfused group (14.6%) (p=0.001). In both the groups common infection was superficial SSI (12.0% in transfused group and 6.5% in non-transfused group). Among the infections, bacterial growth was 39.1% in Group A and 38.9% in Group B (p>0.786). Postoperative duration of hospital stay was 10.56 ± 4.05 days and 8.47 ± 2.67 days in Group A and Group B respectively (p<0.001). Mean lymphocyte count in Group A and group B was (2353.9±1647.7 vs 3792.5±1455.9; p<0.001). Conclusion: Allogeneic blood ........

Evaluation of Outcomes of Subcutaneous Negative Suction Drain in Emergency Laparotomy in Children with Peritonitis

Background: Emergency laparotomy for peritonitis is associated with the highest rates of infective complication, especially surgical site infection (SSI) and it's linked to higher morbidity, mortality, and healthcare costs. Aim of the Study: The aim of this study was to evaluate the outcome of subcutaneous negative suction drain in emergency laparotomy in children with peritonitis. Methodology: This prospective interventional study was conducted in the Department of Pediatric Surgery, Dhaka Medical College Hospital, Dhaka from January, 2020 to December 2021 over a period of two years. A total of 64 patients who underwent emergency laparotomy with features of peritonitis were enrolled in this study as per selection criteria. They were divided into two groups equally. Subcutaneous negative suction drain was used in Group A patients, and in Group B patient’s standard of care was provided. Patients were followed up to 30thpostoperative day. Outcome was evaluated by superficial surgical site infection (s-SSI), wound dehiscence, secondary suturing and duration of hospital stay. Superficial surgical site infection(s-SSI) assessed by CDC criteria of surgical site infection on 3rd, 5th, 7th, 14th& 30thpostoperative day. Microsoft Excel was used for data analysis. Results: Mean age of the study populations in Group A was 8.41 ± 2.27 years and Group B was 8.95 ± 2.27 years. Male were predominant than female in both the two groups. s-SSI was observed significantly(p=0.016) lower in Group A (9.4%) than Group B (34.4%). Culture & sensitivity growth was observed significantly(p=0.020) lower in Group A (6.3%) than Group B (28.1%). Wound dehiscence was (9.4%) in Group A and (28.1%) in Group B. Secondary suturing was (3.1%) and (15.6%) in Group A and Group B respectively. Duration of hospital stay was found significantly (p=0.011) lesser in Group A than Group B (6.68 ± 2.14 vs 8.50 ± 3.29) days. Conclusion: Subcutaneous negative suction drain reduces the post-operative superficial ..

Comparative Demographic and Clinical Profile of Preeclamptic and Normal Pregnant Women in the Third Trimester

Background: Preeclampsia is a pregnancy-specific, multi-system disorder characterized by elevated blood pressure and proteinuria after 20 weeks of gestation. Its exact etiology remains unknown, and globally, it stands as a prominent cause of maternal and infant morbidity and mortality. This study aimed to assess the comparative demographic and clinical profile of preeclamptic and normal pregnant women in the third trimester. Methods: This case-control study took place in Bangabandhu Sheikh Mujib Medical University Hospital and Dhaka Medical College Hospital, Dhaka, Bangladesh, spanning from July 2011 to June 2012. The study enrolled 100 pregnant women, with 50 cases diagnosed with preeclampsia and 50 controls representing normal pregnant women. Data analysis was conducted using SPSS version 23.0. Results: The mean ages of cases (25.8 ± 4.4 years) and controls (27.1 ± 3.1 years) were similar (P=0.177). A predominant proportion of cases (74%) and controls (66%) belonged to a lower social class (P=0.383). BMI assessment showed no significant difference (P= 0.645). Most participants in both groups were preterm (P=0.235) and primigravida (P= 0.422). The case group exhibited significantly higher mean serum ferritin than the control group (P<0.001). Hemoglobin and hematocrit levels showed no significant differences (P=0.761 and P=0.231, respectively). Elevated serum ferritin (>20 ng/ml) was prevalent in 76% of cases and 44% of controls (P=0.001). The odds of elevated serum ferritin in preeclampsia were approximately 4 times higher than in normal pregnancies (95% CI=1.7–9.5). Variations in serum ferritin levels across gestational ages are illustrated. Conclusion: The study found no significant correlation between preeclamptic and normal pregnant women's demographic and clinical status in the third trimester, except for serum ferritin levels. Further research is needed to obtain a clearer understanding of these relationships.

Did the COVID-19 pandemic affect levels of burnout, anxiety and depression among doctors and nurses in Bangladesh? A cross-sectional survey study

IntroductionCOVID-19 has caused severe disruption to clinical services in Bangladesh but the extent of this, and the impact on healthcare professionals is unclear. We aimed to assess the perceived levels...

Association of Heart Failure Admission with Age, Sex, Risk Factors and Co-Morbidities in Tertiary Care Hospital in Bangladesh

Background: Heart failure is a significant medical and societal concern worldwide. It continues to be a major source of morbidity and mortality and causes a significant and rising cost on the health care system. There is a seasonal fluctuation in the number of people who are admitted to hospitals for heart failure, with winter seeing the highest rate. Objective: To assess the seasonal variation of heart failure admission with age, sex, risk factors and co-morbidities in tertiary care hospital in Bangladesh. Materials and Methods: This cross-sectional study was carried out among the patients hospitalized with heart failure at the Department of Cardiology, Dhaka Medical College Hospital (DMCH), Dhaka, between April 2015 and March 2016. The history, clinical characteristics, and investigational data were used to diagnosis the patients. Statistical tests were used to examine the impact of seasonal fluctuation on patients admitted with heart failure. Results: In the age range of 41 to 60 years, 302 patients with heart failure at the highest level (51.7%) were hospitalized. Heart failure admission patients were 2.8 times more likely to be male than female, with a mean age of 55.18±12.42 years. Heart failure patients in the age ranges of 20 to 40, 41 to 60, and 61 to 80 years were hospitalized more frequently in the winter and post-monsoon. Seasons and gender had a statistically significant relationship (p=0.030). Smoking is the greatest risk factor compared to other risk factors in all seasons, and all risk factors were more prevalent in the winter than they were in other seasons. Conclusion: This study may help improve the healthcare system and alter how easily accessible hospital resources such as emergency rooms are throughout the winter. More information regarding the heart failure events that occur throughout the winter should be made available to patients and general practitioners.

Prevalence of Heart Failure Patients Admitted in the Winter and Other Seasons in a Tertiary Care Hospital Bangladesh

Background: As a leading global cause of death and disability, heart failure places a significant strain on the healthcare system. It has been observed that in some countries, there is a seasonal increase in the number of people admitted to hospitals with heart failure during winter. However, there is a dearth of population-based statistics for Southeast Asia and Bangladesh. with regards to this subject. Objective: To determine the number of patients with heart failure admitted during the winter and other seasons in Bangladesh's tertiary care hospitals. Materials and Methods: This study used a cross-sectional, observational design. The study was carried out at the Cardiology Department of Dhaka Medical College Hospital (DMCH). The research took place over the course of a year, from April 2015 to March 2016. Patients with heart failure who are admitted to the DMCH's Cardiology Department constitute the study population. This study made use of a systematic sampling strategy. All 584 patients who visited the hospital's cardiology department were counted. Patients' demographics, medical histories, symptoms, and test results were recorded on a standard data collection form. The statistical software package SPSS 22.0 was used to analyze the data (Statistical Package for Social Science). Results: Heart failure patients were most prevalent in the 41 to 60 age group, with 74.3% being men and 25.7% being women. The winter season saw the largest number of patient admissions (n=207, 35.5%). Compared to other seasons, the winter had higher concentrations of all risk variables. It is statistically significant, with the exception of thyroid issues and dyslipidemia (p-values of <0.222, <0.001, <0.001, <0.001, and <0.006). Conclusion: General practitioners might learn how to handle heart failure patients' responses to the cold and hone their abilities in this area. This research may also be useful for modifying the wintertime accessibility of hospital resources like emergency rooms.

Bacteriological Study and Antibacterial Susceptibility in Ludwig’s Angina in a Tertiary Level Hospital in Dhaka, Bangladesh

Background: The knowledge of the local pattern of infection and antibacterial sensitivity in Ludwig’s angina is essential to enable efficacious treatment for it. Objective: To find out the pattern of bacteria responsible for developing Ludwig’s angina and their antibacterial susceptibility. Methods: It is a prospective, observational type of study carried out in the Department of Otolaryngology & Head-Neck Surgery, Dhaka Medical College Hospital, Dhaka, and the Department of Clinical Microbiology, ICDDR, B, Dhaka, Bangladesh, between April and September of 2016. A total of 100 patients were included in this study. Results: This study was done among 100 patients. In this study, 42 cases (42%) were in the 31-45 years age group. The male patients were 60 (60%) and females were 40 (40%). Majority of patients 70(70%) came from poor class family with educational level up to HSC (75%), maximum 35(35%) patients use meswak to clean teeth, 70 (70%) patients came from rural area, 70 (70%) patients had dental infection, 25 (25%) patients had diabetes mellitus, all the cases (100%) presented with swelling in the floor of the mouth and neck, pain and tenderness and fever. The major complication was necrotizing fasciitis 8 (8%), 36 (36%) patients were discharged within 1-2 weeks after treatment, Streptococcus 40 (40%) was the most common organism and the most effective antibiotic was Ceftriaxone (65%). Conclusion: The most frequently isolated organism in Ludwig’s angina is Streptococcus and sensitivity results showed a majority of isolates are susceptible to Ceftriaxone. Mugda Med Coll J. 2023; 6(2): 71-76

ঢাকা মেডিকেল কলেজ হাসপাতালের μমবর্ধমান উন্নয়ন ও বিকাশ (১৯৪৬-১৯৭১)

Dhaka Medical College Hospital started its Journey in a part of East Bengal and Assam Province Secretariat building built in 1904. The hospital was established on July 16, 1946 through a government order. Initially the hospital was not equipped with all the medical facilities and modern equipment. Within about one and a half year, all the internal departments of the hospital started functioning. However, it was not until the late forties and mid-fifties that the hospital started all kinds of initiatives related to the medical system. Modern treatment started in this hospital in the fifties but not all the complex diseases were treated. Similarly, various departments were under the process of modernization. Through this article, the history of the establishment of western medical system in East Bengal and Present Bangladesh will be known. Basically, the doctors of this hospital and the students who passed from Dhaka Medical College Started providing the first advanced Western medical services. Primary sources have been relied upon in writing the essay. Because no researcher has previously studied on this topic. In this case, data has been collected from the documents preserved from Bangladesh National Archives, especially ‘A’ Proceedings, ‘B’ Proceedings, Government Reports and Minutes, Assembly Proceedings, Gazetteers, Gazettes and old Newspapers.

Evaluation the role of supplementation of oral zinc on systolic and diastolic blood pressure in type 2 diabetic patients

Background: Zinc is an important trace element and a potent antioxidant. Its deficiency causes a common comorbidity with numerous chronic diseases including hypertension and diabetes mellitus, associated with development and progression of various complications. Objective: The present study has been undertaken to evaluate the effects of zinc supplementation on blood pressure in type 2 diabetic patients. Methods: This prospective interventional study was conducted in the Department of Physiology, Dhaka Medical College, Dhaka between January 2016 to December 2016. In this study, a total number of 46 diagnosed type 2 diabetic patients of both sexes were selected with age ranging from 40 to 55 years. Among them, 26 type 2 diabetic patients with supplementation of oral zinc (40mg/day) for 12 weeks were considered as study group (Group B). Another 25 age matched type 2 diabetic patients without supplementation of oral zinc were considered as control group (Group A) for comparison. All subjects were selected from Outpatient Department of Endocrinology, Dhaka Medical College Hospital, Dhaka on the basis of inclusion and exclusion criteria. Their blood pressure (BP) was measured and serum zinc level was estimated by Spectrophotometric method accordingly. These parameters were studied 2 times in all subjects of control and study groups i.e. at the beginning of study (base line) and after 12 weeks of study period. Data were collected in pre-designed structured questionnaire form by the researcher herself. For statistical analysis, paired Student’s ‘t’ test and unpaired Student’s ‘t’ test were performed as applicable using SPSS for windows version 22.0. Results: In this study, after zinc supplementation resulted in a significant (p<0.001) decrease in both systolic and diastolic blood pressure in study group but there was no significant change observed in control group. Conclusions: After analyzing the results of the study, it can be concluded that oral zinc supplementation can be useful for improving blood pressure in type 2 diabetic patients. Central Medical College Journal Vol 7 No 1 January 2023 Page: 41-46

Evaluation of Short-Term Complications of PPIUCD

Background: Postpartum intrauterine contraceptives device (PPIUCD) offers an effective means of providing contraceptive services to women in countries with high rates of unmet needs for family planning services. Scientific literature estimating the long-term retention rates is scarce. The complications following PPIUCD insertion at the three follow-up visits. The PPIUCD can be placed immediately following delivery of the placenta, during cesarean section or within 48 hours following childbirth. Objectives: The aim of the study was to assess the evaluation of short-term complications of Post-Partum Intrauterine Contraceptive Device (PPIUCD). Methods: This is a prospective observational study was conducted at Department of Obstetrics and Gynecology, Dhaka Medical College Hospital (DMCH). 360 eligible postpartum women were counselled for PPIUCD insertion. These women were also interviewed for their reasons for accepting and rejecting PPIUCD. After consent, Cu-T 380A insertion was done. Follow-up was done at 6 weeks or when reported with any complaint. Results: PPIUCD implantation was performed on 48 (13.3%) of 360 eligible counseled postpartum patients. Acceptance of PPIUCD was higher in the age range of 25 - 30 years (43.75%), women from middle socioeconomic status (58.3%), those with family support (75%), those who had previously had PPIUCD health counselling (70.8%), and multipara (68.75%). Missing thread (8.3%), lower abdomen pain (6.25%), and irregular per vaginal bleeding (4.2%) were the most prevalent problems. There was 86% continuation of IUCD, 8% discontinuance, 6% expulsion, and no occurrence of unintended pregnancy. Conclusion: The awareness about availability of PPIUCD is quite low because it is recently introduced in the family planning methods. The most common reason for refusal is disagreement between the husband and his family. Acceptance can be increased further by disseminating information and providing proper counseling in antenatal clinics.

Electrophysiological Evaluation of Common Peroneal Nerve in Chronic Cigarette Smokers.

Background: Researchers have identified multiple negative health effects of smoking on the respiratory and cardiovascular systems. It was recently reported that substances in cigarette smoke also have pathological effects on peripheral nerves, which causes neuronal impairment. The common peroneal nerve conduction study is an essential electrodiagnostic test of the lower limb for the detection of peripheral motor nerve dysfunction.Objectives: To assess the potential influence of smoking on the electrophysiological status of common peroneal nerve in young male chronic cigarette smokers.Materials and Methods: This case-control study was conducted in the Department of Physiology, Sir Salimullah Medical College, Dhaka, from July 2017 to June 2018, including thirty male cigarette smokers aged 25 to 40 years. For comparison, another thirty age and BMI-matched healthy male non-smoker subjects were selected in the control group. The electrophysiological parameters (distal latency, amplitude, and motor nerve conduction velocity) of the left common peroneal nerve were evaluated by standard methods in the Department of Neurology, Dhaka Medical College Hospital. For the statistical analysis, an independent t-test was performed.Result: In this study, the mean distal latency of the common peroneal nerve was slightly prolonged, while the mean amplitude was slightly reduced in smokers. However, these changes were not statistically significant. However, the motor nerve conduction velocity was significantly (p ˂ 0.05) slower in cigarette smokers compared to non-smokers.Conclusion: Chronic cigarette smoking causes significant impairment of common peroneal motor nerve conduction, while it does not affect the amplitude in young individuals. KYAMC Journal Volume: 14, No: 03, October 2023: 111-115.

Outpatient Service Provision In Tertiary Hospital During Covid-19 Pandemic

Background: The COVID-19 pandemic was a challenge for healthcare professionals globally. The outpatient department is an important part of the hospital. Service providers were facing tremendous difficulties and challenges due to sudden thrust of the pandemic. Despite these challenges service providers had to give service during COVID-19 pandemic. The purpose of this study to assess the state of outpatient service in tertiary hospital during COVID-19 pandemic.
 Methods: This cross-sectional study was conducted among conveniently selected 203 service providers including 156 doctors and 47 nurses. Data were collected through face-to-face interview using semi-structured questionnaire and observation checklist. The study was conducted at medicine, surgery, paediatric and family planning outpatient department of Shaheed Suhrawardy Medical College Hospital, Dhaka Medical College Hospital, and Bangabandhu Sheikh Mujib Medical University during the period from January to December 2021.
 Results: Among 203 service providers, 76.8% were doctors and 23.2% were nurses. All health services were available during COVID-19 pandemic in outpatient departments (OPDs) of the selected hospitals. At outpatient department there was separate entry-exit door, thermal scan was available at entry point, Patients and visitors are restricted. Number of patients were decrease in outpatient department. Among the three hospitals facility of flu-corner and triage in the OPD of ShSMCH. For the DMCH and BSMMU, flu-corner and triage center were situated at other premises of the hospitals. Outdoor surgery, vaccination service and shishu bikash kendro were open during COVID-19 pandemic. About 80.8% respondents mentioned about availability of adequate amount of personal protective equipment, 42.9% respondents mentioned about proper ventilation, 57.1% respondents said had not. About 32.5% respondent said about availability of N-95 mask and 57.6% said had not. Among the respondents 67.0% said they maintained physical distance during consult with the patients. 57.6% respondents said about lack of manpower. 61.6% respondents said about felt anxiety and high-risk during service.
 Conclusion: For more improvement of outpatient service during COVID-19 pandemic, the authority should pay special attention, to increase manpower, arrange frequent training for service providers.
 JOPSOM 2021; 41(2):20-27

Comparison of Serum C-Reactive Protein (CRP) Level Between Non-Alcoholic Fatty Liver Disease (NAFLD) Cases and Healthy Adults: A Cross-sectional Analytical Study.

Background: Non-alcoholic fatty liver disease (NAFLD) encompasses the simple steatosis to more progressive steatosis with associated hepatitis, fibrosis and cirrhosis. Though accurate diagnosis of simple fatty liver (SFL) and non-alcoholic steatohepatitis (NASH) can be made by liver biopsy, it is not feasible to be done in all NAFLD patients. Relationship of C-reactive protein (CRP) with NAFLD was well documented in many populations, but comprehensive data is lacking in Bangladeshi people. Method: This case-control study was conducted at the Medicine, Gastroenterology and Hepatology departments in Dhaka Medical College Hospital from March to August 2018 involving 30 patients with NAFLD as case and apparently healthy 30 individuals as control. Abdominal ultrasound to detect fatty liver and serum CRP level estimation by nephelometry were performed for each subject to compare between two groups. Result: Majority of the NAFLD cases and healthy controls were female (70% and 60% respectively). Mean age was 47.53±9.69 year in NAFLD group and 46.03±8.44 year in healthy controls. NAFLD cases had significantly higher mean serum CRP concentration (6.27±1.80) mg/dl than that of healthy controls (3.94±2.16) mg/dl (p<0.001). Overweight/obesity and dyslipidaemia were found as significant risk factors for NAFLD compared to the healthy control group (p<0.05). Conclusion: NAFLD cases had significantly higher CRP than the control group. But, to find out the association of increasing CRP level with the severity of NAFLD and to establish it as a diagnostic tool, further extensive studies are recommended. J MEDICINE 2024; 25: 5-10

Association Between Neutrophil to Lymphocyte Ratio and Severity of Coronary Artery Disease in Acute Myocardial Infarction Patients

Background: Acute myocardial infarction is one of the leading causes of death across the world. Determination of severity is important in patients with acute myocardial infraction for the therapeutic decision making. Neutrophil to Lymphocyte Ratio (NLR) has been proposed as a new prognostic marker in patients with acute MI. Several international studies have found to compare the relation between NLR and severity of coronary artery disease. In these studies, they demonstrated that the NLR is higher in severe CAD. In our country no such study has been done yet to predict the severity of coronary artery disease by estimating NLR in acute MI patients. Moreover, NLR is cheap, easily available, non-invasive and routinely done procedure. Objectives: This study was conducted to find out the association of NLR to severity of CAD in acute MI patients. Methods: This observational cross sectional analytical study was carried out in the Department of Cardiology, Dhaka Medical College Hospital, SSMC and Mitford Hospital and NICVD, Dhaka from March 2021 to February, 2022. Patients with acute MI (STEMI and NSTEMI) were approached for this study according to inclusion and exclusion criteria. They were divided into two groups according to NLR: Group A NLR >2.5 and Group B NLR ≤2.5. Coronary angiogram was done during index hospitalization. The severity of coronary artery disease was assessed by Vessel score and Gensini score. According to Gensini score was non severe (≤50) severe (>50). Results: Among 70 patients in our study 30 (42.8%) were in the high NLR group (Group A) and 40 (57.14%) were in low NLR group (Group B). In group A mean NLR was 5.15 ± 2.21 and in group B mean NLR was 1.65 ± 0.35, this difference was statistically significant. Severe coronary artery disease in terms of vessel score and Gensini score was significantly higher in group A than group B (p value 0.001). We found strong positive correlation between NLR and Gensini score (r= 0.7, p= 0.001), and moderate positive correlation between NLR nad vessel score (r= 0.5, p= 0.001). With the increase of NLR, vessel score and Gensini score increases demonstrating more severe CAD. Simple logistic regression analysis of variables of interest revealed that hypertension (p=0.003), diabetes mellitus (p=0.008), dyslipidaemia (p=0.007), WBC count(p=0.034), Neutrophil count (p=0.000), Lymphocyte count (p=0.000), NLR (p=0.000), LVEF (p=0.001) were independent predictor of severe coronary artery disease with odds ratio (OR) being 5.32, 3.88, 4.42, 1.00, 1.20, 0.834, 2.28, 0.805 respectively. In multivariate logistic regression analysis, after adjustment of confounding, hypertension (p=0.028, OR=5.87) and NLR (P=0.004, OR=1.81) remain independent predictor of severe CAD. In ROC curve analysis, the AUC of NLR for predicting severity of CAD is 0.8 with p value < 0.001, 95% CI (0.78-0.96) and with 75% sensitivity and 86.5% specificity. So, from this study, it is evident that NLR is directly associated with coronary artery disease severity. Conclusion: Increased NLR was associated with angiographically severe coronary artery disease in acute Myocardial Infarction patients, and this association is independent of conventional cardiovascular risk factors. Bangladesh Heart Journal 2024; 39(1): 1-9

Study on Red Cell Indices in Chronic Liver Disease in Tertiary Level Hospital

Background: Chronic liver disease (CLD) in the clinical context is a disease process of the liver that involves a process of progressive destruction and regeneration of the liver parenchyma leading to fibrosis and cirrhosis. Liver diseases are frequently associated with hematological abnormalities. Bleeding and defective blood coagulation contributes to the anemia in CLD patients. Other mechanisms of anemia include aplastic anemia secondary to previous hepatitis, or side effects of treatment of hepatitis with chemotherapeutic agent. Other different factors, such as malabsorption, malnutrition or direct toxic effect also contribute to hematological abnormalities. The examination of complete blood count is common, economically cheap and readily available laboratory procedure. Red cell indices are valuable in the evaluation of morphologic characteristic of anaemias or hematological abnormalities in CLD patients. Objectives: To assess the red cell indices in chronic liver disease patients. Materials & method: This descriptive type of cross-sectional study was conducted in Department of Medicine, Dhaka Medical College Hospital, Dhaka, among 75 cases of Chronic liver disease patients. Samples were selected by purposive sampling technique. Detail demographic data were collected from the patients and recorded in structured case report form. Clinical examination and relevant investigation were done meticulously. Data was processed and analysed with the help of computer program SPSS and Microsoft excel. Quantitative data expressed as mean and standard deviation and qualitative data as frequency and percentage. Results was presented by tabulation and graphical presentation in the form of tables, pie chart, graphs, bar diagrams, histogram & charts etc. Result: Maximum number of patients, 37(49.3%) were between 31-40 years of age with mean age of the patient was 37.58 ± 8.23 years. Out of 75 cases 58(77.0%) patients were male and 17(23.0%) were female. Male-female ratio was 3.34:1. Majority of patients belonged to Child Pugh score B. Prevalence of anaemia was 54(72%) in CLD patients. Microcytic anaemia was predominant and Normocytic anaemia was second most common. Hb concentration & MCV decreases with the severity of Child Pugh score. Abnormalities of red cell indices were positively associated with severity of CLD. Conclusion: Present study concluded that chronic liver diseases are associated with hematological abnormalities. Patients with severe hepatocellular disease develop defects of blood coagulation as a consequence of endothelial dysfunction, thrombocytopenia, deficiencies of coagulation factors and various associated disorders. In overall patients, Child Pugh class C cases had significant low hemoglobin in comparison to rest of group. Assessing the severity and type of anaemia by red cell indices is a useful tool for proper treatment, prognosis in patients of CLD for reducing the mortality and morbidity. J MEDICINE 2024; 25: 41-45