Enam Medical College Hospital Research Articles

Perinatal Outcome and Preventable Causes of Morbidity and Mortality in Eclampsia: A Cross-Sectional Observational Study in a Tertiary Hospital in Bangladesh

Background: Eclampsia poses a substantial threat to perinatal health in developing countries, with Bangladesh experiencing a notable impact on infant well-being. This cross-sectional observational study, conducted at Enam Medical College Hospital, Savar, Dhaka, aimed to investigate perinatal outcomes in eclampsia patients and identify preventable causes of perinatal mortality and morbidity associated with this condition. The study period spanned from June 2015 to July 2017, with a focus on understanding the specific factors contributing to adverse perinatal events in this population. Methods: A total of 155 eclampsia patients were enrolled in the study, resulting in the delivery of 161 babies, including six sets of twins. The study employed a comprehensive observational approach, assessing maternal and fetal conditions to analyze their correlation with perinatal outcomes. Data collection and analysis were conducted in the Department of Obstetrics and Gynaecology at the tertiary hospital, employing standard protocols and statistical methods to derive meaningful insights. Results: The study revealed a perinatal death rate of 27.32%, with stillbirth accounting for 15.52% and early neonatal death for 11.80%. In contrast, 84.47% of babies were born healthy. Among live-born neonates, 27.94% experienced jaundice, while 30.88% had no complications. Prematurity emerged as a significant contributor to perinatal loss in eclampsia cases. The findings underscore the critical role of early referral of eclampsia patients, the implementation of timely resuscitative measures, and improved neonatal care as potential avenues to enhance perinatal outcomes. Conclusion: In conclusion, this study highlights the importance of addressing stillbirth as a predominant component of perinatal death in eclampsia cases. Prematurity was identified as a key factor contributing to adverse perinatal outcomes. Early referral of eclampsia patients and the implementation of resuscitative measures, coupled with enhanced neonatal care, are crucial interventions that can potentially mitigate perinatal morbidity and mortality associated with eclampsia in the context of a tertiary hospital setting in Bangladesh. These findings provide valuable insights for healthcare practitioners and policymakers to guide strategies aimed at improving perinatal outcomes in similar healthcare settings.

Priming Factors Related to Burn Injury among People in Bangladesh

Abstract Background Burns cause the most severe injuries and are a major public health concern worldwide. It is common in third-world countries and it greatly increases mortality and illness there. Because of the long period of time spent in the hospital and the effort required to recover from a burn, it is one of the most costly injuries to treat. Objectives The aim of this study was to identify the priming factors related to burn injury among people in Bangladesh. Materials and Methods The study design was cross-sectional. Total 121 samples were selected conveniently for the study and the study was conducted in several hospital settings in Chittagong, Savar and Dhaka city like Chittagong Medical College Hospital, Enam Medical College Hospital, and Sheikh Hasina Burn Hospital. Data was collected by using a self-administered questionnaire. Statistical Analysis Descriptive and inferential statistics (chi-squared test) were used for data analysis that focused through tables. Results On average, people were 22.43 (14.399) years old. Of the total of 121 patients, 48.1% were female (n = 58) and 52.1% were male (n = 63). Among the participants, 56.2% (n = 68) were hurt accidentally, 33.9% (n = 41) were injured on the job, 2.5% (n = 3) were harmed intentionally, and 7.4% (n = 9) were injured while preparing food. In case of occurrence, 37.2% (n = 45) were burned by fire, 38.8% (n = 47) were electrical burn and 23.9% (n = 29) were chemical or scald type burn. Conclusions Most burn injuries are accidental, such as cooking fires, hot water, electric lines, and acid throwing that are significantly considered as the priming factors of burn injury among people in Bangladesh. The lack of awareness and ignorance causes these accidents and insufficient training causes most the electrical burns.

A Study of the Efficacy of Doxycycline plus Trifarotene in the Treatment of Moderate to Severe Acne Vulgaris

Introduction: Acne is a common cutaneous disease affecting the pilosebaceous apparatus, in which there is hyperkeratinization, excessive sebum production, follicular colonization with Propionibacteriun acnes & inflammation. It manifests as comedones, papules, pustules, nodules & cysts on the face, neck, and trunk. Epidemiologic studies indicate acne affects approximately 9.4% of the global population, ranking it as the eighth most prevalent disease worldwide. It is a common skin condition of the face and trunk that negatively impacts the quality of life. Objectives: We evaluated the efficacy of oral doxycycline in combination with topical trifarotene in the treatment of moderate to severe acne vulgaris. Methods: This was an interventional study for 12-week duration to see the treatment outcome in moderate & severe acne patients. This study was carried out at the Dept. of Dermatology & Venereology, Enam medical college Hospital, Savar, Dhaka, Bangladesh from January 2022 to September 2022. We evaluated a new therapeutic regimen: Doxycycline 100 mg (Oral) once daily during dinner with food and enough water,21 days / month, for three consecutive months along with topical Trifarotene 0.005%w/w once daily at night after proper cleansing for the same duration. Acne severity was graded using Investigator Global Acne Assessment Scale (IGAS). Results: A total of 96 patients with moderate to severe acne were treated & among them 85 completed this study. Out of these 85, 15 are males & 70 are females. There was a marked improvement in IGAS with marked reduction in the number of inflammatory and non-inflammatory lesions between the beginning of the study and through follow up visits. Clinical response to Doxycycline Plus Trifarotene was excellent in 15%, good in 68%, moderate in 14% and mild in 3% and satisfaction to treatment was 22% very satisfied, 60% satisfied and 17% somewhat satisfied. Side effects were low and only 2.1% of cases had mild irritation. ........

Outcome of Dutasteride 0.5mg in Androgenic Alopecia

Introduction: Androgenetic alopecia (AGA) is an androgen-mediated condition that is characterized by a progressive decline in visible scalp hair density. Genetically predisposed hair follicles are the target of dihydrotestosterone (DHT), which leads to the progressive miniaturization of hair follicles and hair thinning. Dutasteride inhibits conversion of testosterone to dihydrotestosterone, which significantly improves hair growth. Objective: To assess the outcome of dutasteride in androgenic alopecia. Methods: This study was carried out at Dermatology and Venereology Department, Enam Medical College Hospital, Savar, Dhaka, Bangladesh from January2022 to July 2022. From the outpatient clinic fifty (50) patients were recruited who fulfilled the inclusion and exclusion criteria. Dermatologist observe every patients hair changes before, during &after treatment with dutasteride for 24 week. Results: Out Of the 50 patients, 60% patients were female. 40% patients noticed hair loss first at the age of 16-25 years of their lifetime. 44% patients had this disease from 1 to 6 months duration. After 6 months of therapy with dutasteride 0.5mg 20% patients were improved markedly, followed by 24% improved moderately, 16% improved mild. Besides that, six months after dutasteride treatment, there was significant improvement in both hair density and thickness. And during treatment libido decreased in 24% cases and ejaculatory disorder seen in 14% cases. After 6 months therapy in patients where 20% improved markedly, followed by 24% improved moderately, 16% improved mild. Conclusion: It is concluded that dutasteride at a dosage of 0.5 mg/d clinically improve hair growth after six months of therapy in patients with AGA but there was a higher prevalence of sexual dysfunction. Large number of studies are required to recommend dutasteride 0.5 mg/d as the alternative therapeutic option for AGA.

Maternal and Perinatal Outcome in Placenta Previa: One Year Study in Enam Medical College Hospital

Introduction: Placenta previa is a key risk factor for obstetric hemorrhage particularly occurs in women with a previous uterine scar. It can be defined as an embedding of the placenta in the lower uterine segment, overlying or approaching the internal cervical os. One-third of all cases of APH caused due to placenta previa. Aim of the study: To assess the maternal complications and perinatal outcomes of patients with placenta previa by analyzing its obstetrical factors. Methods: This study is a cross-sectional observational study conducted at the Department of Obstetrics and Gynae, in Enam Medical College and Hospital, Savar, Bangladesh. The study was conducted for the duration of 1 year between January 21 to December 21. The sample size for this study was 109. Result: The most respondents 81(74.3%) were from the age group 25-29 years, 17(16%) were booked and 92(84%) were unbooked. 27(25%) were primi and 82(75%) were multi-para. Pain abdomen was present in only 2(1.8%) cases and absent in most 107(98.2%) cases. LSCS was done in 79(72%) patients and vaginal delivery was done in 30(28%) cases. Type 2b in most of the cases 50(45.9%). Blood transfusion was needed in 20(18.3%) and post hemorrhage was seen in 12(11%). APGAR at birth was 8-10 in 69(63.35) cases, 5-7 in 27(24.8%) cases and <5 in 13(11.9%) cases. Conclusion: Placenta previa is the main cause of maternal and perinatal morbidity and mortality. Maternal and fetal outcome can be improved by regular antenatal check-up, early diagnosis of case. Management should be done in tertiary care center with neonatal management facility.

Comparative Effectiveness of Drugs in the Treatment of Primary Headache

Introduction: Primary headache disorder, characterized by recurrent headache is the most prevalent disease leading to widespread ill health and impaired quality of life. Headache is one of the most common cause of patient attending neurology clinic. Amitriptyline, flunarizine and topiramate are common drugs in the treatment of primary headache. Objective: To compare the efficacy of drugs namely Amitriptyline, flunarizine and topiramate in the treatment of primary headache. Methods and Materials: This is the retrospective data analysis study was contacted at Dept. Of Neurology, Enam Medical College Hospital, Savar, Dhaka, Bangladesh from March to June 2022. Data analysis of primary headache patients treated with amitriptyline, flunarizine and topiramate. On their first, second and third subsequent visits, Headache Impact Test 6 Scoring was done by a medical person. Patients were treated clinically. After the third follow up data were analyzed using SPSS version 20.0. Categorical variables were compared by chi-square test, paired sample t-test, ANOVA test and Welch test. Results: A total of 121 patient data was analyzed. Most patients were between 16 to 40 years of age (54.34%) followed by 41-60 years of age (33.80%) with minimum age of 16 years and maximum age of 60 years respectively. Among the patients in the study group, the majority were female (85%). All three medications: amitriptyline, flunarizine and topiramate were able to significantly lower Headache impact test -17.23 ± 6.643, -14.06 ± 7.155, -15.82 ± 5.907 respectively (P-<0.001). Amitriptyline was found to be better than other two drugs in reducing Headache Impact Test. Conclusion: Primary headache is a common presentation in neurological OPD. Female between ages 16-60 years had more primary headache. Amitriptyline, flunarizine and topiramate all are effective in the treatment of primary headache. Though tension type of headache is the most common type of headache, amitriptyline seems to be equally effective in treatment with other primary headaches.

HsCRP (High-Sensitivity C - reactive protein) and its Association with Short Term Prognosis Following Ischaemic Stroke

Introduction: Stroke is a major cerebrovascular disease is one of the most common Neurological diseases. It is the second leading cause of death worldwide. Cerebrovascular disease threatening human health and life with high morbidity, disability and mortality. Major risk factors of ischaemic strokes are hypertension, diabetes, and dyslipidaemia. High sensitivity C-reactive protein (HsCRP) is an inflammatory marker which appears to be a strong predictor of risk factor and prognostic marker of Ischaemic stroke. Objective: To find the acute course of HsCRP and its association with short term prognosis following Ischaemic stroke. Methods: A Cross sectional observational study at Dept. of Neurology, Enam Medical College Hospital, Savar, Dhaka, Bangladesh From March 2020 to April 2021. Total number of subjects in this study were 101 with power 80% (persons aged 30 years & above; both male and female). Both sexes and their plasma high sensitivity C-reactive protein (HsCRP) level was measured within 48 hours of admission and on the 5th day after admission. Results: The study showed that the level of HsCRP did not change significantly when measured within 48 hours of onset of Ischaemic stroke and on 5th day after stroke (p=0.335) - the prognosis and severity remained same when followed for 5 days. It, also, showed that the level of CRP ≥ 3 within 48 hours of admission is associated with increased severity and mortality of stroke (Z=14.4; p<0.0001). Conclusion: HsCRP level provides rapid and reliable information regarding severity & prognosis in patients with Ischaemic stroke. The level of HsCRP does not change significantly when measured within 48 hours of onset of Ischaemic stroke and on 5th day after stroke. Also, the level of CRP on 5th day was same as within 48 hours of stroke - the prognosis and severity remained same. If confirmed by larger, longitudinal studies this association may be used as a tool to assess the severity and prognosis in a patient with Ischaemic strokes.

Comparison of Efficacy and Outcome of Primary Percutaneous Coronary Intervention to Pharmacoinvasive Strategy in Management of ST-Segment Elevation Myocardial Infarction

Introduction: Primary percutaneous coronary intervention (PPCI) is the best reperfusion option in ST-segment elevation myocardial infarction (STEMI) when performed timely but PPCI is not universally available. Hence, Pharmacoinvasive (PhI) reperfusion strategy is recommended for STEMI patients. However, there are very few studies in Bangladesh for the comparison of efficacy and outcome of PPCI and PhI Strategy. The aim of this study is to compare the efficacy and outcome of PPCI and PhI strategies in patients of Bangladesh. Methodology and Materials: This was a prospective observational comparative study. A total of 783 acute STEMI patients were included in Enam Medical College Hospital, Savar, Dhaka, Bangladesh during December-2015 to April-2019. Among them, 103 patients underwent Primary PCI and 184 patients underwent PhI strategy. Data were collected prospectively using a standardized case report form. Chai-squared tests were done to compare the ratio of the frequency of the groups and t-tests were done to compare the mean of the groups with 95% CI where pResults: Among the studied patients, access site complications in PPCI were hematoma, occlusion and pseudo-aneurysm being observed 03(2.91%), 05(4.85) and (0%), whereas, in PhI strategy were 09(4.89%), 08(4.34%), and 02(1.08%) respectively (P>0.05). In hospital, primary composite cardiovascular outcome of death, reinfarction, stroke and CHF were noted insignificant in both the strategies (p>0.05). On follow-up at 01 month, 06 month and 12 month, the composite cardiovascular outcome of death, reinfarction, stroke and CHF) were 03(3.84%), 04(5.12%), and 05(6.41%), in PPCI and 04(2.81%), 09(6.33%), and 07(4.92%) respectively in PhI strategy (P>0.05). Conclusion: Similar clinical, in hospital, and followed up outcomes were found when comparing the efficacy and safety Primary PCI to PhI Strategy in patients with STEMI who were eligible for reperfusion. So, both Primary PCI and Pharmacoinvasive strategies are safe and effective in management of patients with STEMI.

Study on Diagnostic Evaluation of Pancytopenic Patients

Introduction: Pancytopenia is a common hematological problem with an extensive differential diagnosis and is a challenging problem to the treating physician. Bone marrow aspiration and biopsy is an important diagnostic test for patient management. The objective of this study is to find out the incidence various causes of pancytopenia in patients attending to the Enam medical college hospital in savar.
 Materials and Methods: This prospective observational study was done in the department of haematology, Enam Medical College Hospital (EMCH) from July 2012 to June 2019.
 Results: In our study out of 66 patients, 36 (54.55%) were male, 30 (45.45%) were female and male to female ratio were 1.2:1.Generalized weakness 47 (71.21%) and fever 23 (34.85%) were the most common presenting symptoms followed by bleeding 17 (25.76%), weight loss 6 (12.12%), bodyache 6 (9.09%). Most common clinical findings were anemia 57 (86.36%) and bone tenderness 22 (33.33%). Other physical findings were purpura/brusing 13 (19.70%), splenomegaly 10 (15.15%), lymphadenopathy 4 (6.06%) and hepatomegaly 3 (4.55%). Hematological malignancy 29 (43.94%) and hypoplastic marrow 26 (39.39%) were the most common bone marrow finding of pancytopenic patients followed by megaloblastic anaemia 4 (6.06%), leishmaniasias 5 (7.58), and erythroid hyperplasia 2 (3.03%). Acute myeloid leukaemia was the common haematological malignancy 16 (24.24%), others were acute lymphoblastic leukaemia 5 (7.58%). Myelodysplastic syndrome 3 (4.55%), multiple myeloma 4 (6.06%), chronic myelogenous leukaemia in blastic crisis 1 (1.52%).
 Conclusion: So we concluded that complete workup is essential for all cases of pancytopenia to find out the treatable cases and to reduce the motality and morbidity in serious diseases.
 Medicine Today 2020 Vol.32(1): 58-61

Similarities between Preexplorative Diagnosis and Perexplorative Findings of Intestinal Obstruction Patients in Two Tertiary Care Hospitals in Bangladesh

Background: Intestinal obstruction is a common surgical problem that surgeons face in clinical practice. Still intestinal obstruction is a major problem in medical college hospitals in Bangladesh. Causes of intestinal obstruction remain same as earlier. There is lack of statistical data in our country. So, this study will be helpful in various aspect of management of intestinal obstruction patients by providing data.
 Objective: To find out similarities between preoperative diagnosis with actual peroperative findings of intestinal obstruction.
 Materials and Methods: This cross-sectional study was conducted from April 2013 to April 2014 at Enam Medical College Hospital and Dhaka Medical College Hospital. Two hundred patients were selected by purposive sampling of diagnosed cases of intestinal obstruction.
 Results: Among the subjects male were 124 (62%) and female were 76 (38%). Mean age was 34.56 ± 9.13 years. The maximum respondents were from 21–30 years age group (54%) followed by 31–40 years (18%) age group. Chronic intestinal obstruction was present in 53% cases and acute intestinal obstruction in 47% cases. The clinical profile showed that all patients had abdominal pain followed by vomiting (78%). The preoperative diagnosis of intestinal obstruction was neoplastic obstruction (24%) followed by obstructed hernia (22.5%). The highest similarities (100%) were observed in case of volvulus and ileosigmoid knotting. Obstructed hernia had the highest accuracy (97.7%) followed by neoplastic obstruction (91.66%). Maximum patients (13.5%) suffered from wound infection followed by burst abdomen (3%).
 Conclusion: The preoperative diagnoses are very much similar to peroperative findings. The clinical parameters and other mandatory diagnostic tools commonly used in tertiary level hospitals in our country showed diagnostic accuracy in diagnosis of intestinal obstruction.
 J Enam Med Col 2019; 9(3): 155-159

Characterization of extended spectrum β-Lactamase producing bactieria isolated from urinary tract infections

Background: A unique challenge for clinical microbiologists, clinicians, infection control professionals is to deal with extended-spectrum β-lactamase (ESBL) producing pathogens. The study was aims to isolate ESBL producing bacteria from urine samples of Urinary Tract Infection (UTI)-patients and to analyses their phenotypic and genotypic characteristics.
 Methods: A total of 90 urine samples from UTI patients were collected from Enam Medical College Hospital and Gonoshastha Medical College Hospital, Savar, Dhaka, Bangladesh; between May-2012 to August-2012. A total 75gram negative isolates were retrieved and screened for ESBL production by the Double Disk Diffusion Synergy Test (DDST). Isolates with ESBL phenotype were further characterised by antibiotic susceptibility testing, PCR and sequencing of β-lactamase genes.
 Results: Cultural and biochemical assay combined with 16S rRNA gene based phylogenetic identification confirmed that Escherichia spp. were predominant pathogens associate with UTI (41%), and the rest were distributed within the genus Enterobacter spp. 26%, Klebsiella spp. 21% , and Pseudomonas spp.10%. Total 31 isolates were phenotypically confirmed as ESBLs through DDST. The multidrug resistant (MDR) and ESBL producing bacteria showed high resistance to cefotaxime (96%), cefixime (90%) and imipenem (32%). PCR reaction was carried out targeting the genes blaTEM, blaCTX. Dominant ESBL class was CTX-M (65%) followed by TEM (52%). All ESBL isolates except 7 possesses multiple plasmids indicating possibility of both chromosomal and plasmid inheritance of ESBLs.
 Conclusions: This study shows a high prevalence of ESBL producing MDR in UTI patients among these two hospitals of Bangladesh indicating the necessity of alternative therapeutic intervention.
 Bangladesh Med Res Counc Bull 2019; 45: 23-33

Diagnostic Role of Bone Marrow Examination in Detecting Haematological and Nonhaematological Disorders

Introduction: Bone marrow study has wide application in clinical medicine. It is important test not only for diagnosis of haematological diseases but also for various systemic illnesses. The aim of this study is to determine the indications, the spectrum of haemotological and non haematological disorders diagnosed by using this procedure.
 Materials & Methods: It was a prospective study comprising 152 patients who underwent bone marrow examination for evaluation of haematological and nonhaematological disorders in the Department of Haematology, Enam Medical College Hospital during the period of 2012 to 2017.
 Results: In our study male to female ratio was 1.6:1 and common age group was >45years (n-65, 42.76%). Most common indications for bone marrow examination were pancytopenia (26.97%, n-41) and diagnosis of leukaemia/myeloproliferative neoplasm (25.66%, n-38). 90.13% (n-137) marrows were pathological. Non-malignant conditions were 40.79% (n-62) and malignant conditions were 49.43% (n-75). Non malignant haematological condition were 33.55% (n-51), malignant haematological conditions were 47.37% (n-72). Most common nonmalignant haematological conditions were aplastic anaemia (15.13%, n-23) and immune thrombocytopenic purpura (9.87%, n-15). Visceral leishmaniasis was found 3.29% (n-5). Acute myelogenous leukaemia (14.47%, n-22) and multiple myloma (11.18%, n-17) were the most common malignant haematological condition. Secondary deposit was found 1.97% (n-3).
 Conclusion: Bone marrow examination is a simple invasive procedure for diagnosis of both haematological and nonhaematological diseases when routine investigations failed to reach the final diagnosis.
 Medicine Today 2019 Vol.31(1): 15-18

Pattern of Sputum Bacteriology in Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Background: Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality worldwide. Acute exacerbation is an acute and sustained worsening of a patient’s condition from a stable state (beyond normal day-to-day variations) and it is caused in majority by infectious agents, particularly bacteria.Objectives: The aim of this study was to find out the pattern of sputum bacteriology and antibiotic sensitivity in patients admitted into respiratory ward of Enam Medical College Hospital (EMCH) with acute exacerbation of COPD (AECOPD).Materials and Methods: This study included 60 patients who presented with acute exacerbation of COPD. The patients were classified into several groups according to different variables, such as age, pack years, severity, O2 saturation on admission, sputum type. Bacteriological investigations were performed for all patients and included gram staining together with culture and sensitivity testing of all sputum samples.Results: Klebsiella pneumoniae was the most common isolate in patients with COPD exacerbations admitted into the respiratory ward of Enam Medical College & Hospital followed by Staphylococcus aureus and Streptococcus pneumoniae. Three cases of Pseudomonus aeruginosa were detected. Gentamicin and meropenem were the most sensitive antibiotics in all patient groups in the ward. Majority of Klebsiella pneumoniae, Streptococcus pneumoniae and Staphylococcus aureus were sensitive to ceftriaxone, levofloxacin and moxifloxacin.Conclusion: This study reveals that gentamicin, ceftriaxone and moxifloxacin can be the drugs of choice in treating AECOPD in our setting.J Enam Med Col 2018; 8(2): 80-84

Bacterial Aetiology and Antibiotic Resistance Pattern of Community-Acquired Urinary Tract Infections in Children in a Tertiary Care Hospital in Bangladesh

Background: Urinary tract infections (UTIs) in children are among the most common bacterial infections. Community-acquired urinary tract infections (CAUTI) are often treated empirically with broad-spectrum antibiotics. Pattern of aetiologic agents and their antibiotic sensitivity may vary according to geographical and regional location. So, knowledge of antibiotic resistance trends is important for improving evidence-based recommendations for empirical treatment of UTIs.Objectives: To determine the common bacterial aetiologies of CAUTIs and their antibiotic resistance patterns in a tertiary care hospital, Savar.Materials and Methods: This cross-sectional descriptive study was conducted at Enam Medical College Hospital, Savar from May 2016 to April 2017. We collected clean-catch mid-stream urine samples from 257 patients having clinical diagnosis of UTI and submitted to the clinical microbiology laboratory for culture and sensitivity.Results: A total of 120 (46.7%) samples were positive for bacterial growth. Escherichia coli (79%) was the most common pathogen, followed by Klebsiella spp. (14%). Bacterial isolates showed high prevalence of resistance to multiple antibiotics. Resistance against amoxicillin/clavulanic acid, co-trimoxazole and ciprofloxacin was higher compared to newer quinolones and aminoglycosides.Conclusion: Esch. coli and Klebsiella spp. were the predominant bacterial pathogens. The resistance pattern to commonly prescribed antibiotics was quite high and alarming.J Enam Med Col 2017; 7(3): 134-139

Role of Serum CYFRA 21-1 in the Diagnosis of Primary Lung Cancer

Majority of the lung cancer occurs in developing countries. In case of Bangladesh it's a burden for health in both serest. A definitive diagnosis of lung cancer can help the surgeons and physicians for making decisions about the plan of treatment. The rapidity of diagnosis also alleviates the patient's anxiety whether the lesion is nonmalignant or malignant Several studies proposed the role of CYFRA 21-1 level in diagnosis of lung cancer and its better management. To find the sensitive, feasible and cost effective test for detection of lung cancer and to evaluate the CYFRA 21-1 with their histopathological findings. This case control study was carried out in the department of Medicine of National Institute of Diseases of the Chest and Hospital (NIDCH) Dhaka and Enam Medical College Hospital, Savar, Dhaka during the period from January 2017 to September 2017. We included a total of 80 subjects among them 40 diagnosed cases of lung cancer and 40 controls with diseases other than lung cancer. The mean normal (< 3.5) serum CYFRA 21-1 level was (Mean *SD) 1.10 t 1.5 with ranging from 0.87 ng /ml — 1.5 ng lint Normal level of CYFRA 21-1 was found in all 40 (100%) of controls. The mean of high (> 3.5) serum CYFRA 21-1 level was (Mean +-SD) 18.20 ± 13.63 with rangingfrom 6.9 ng hnl — 49.30 ng/ml. High level of CYFRA 21-1 level was found in maximum 35(87.5%) cases. High (> 3.5 rig/m1) serum CYFRA 21-1 level was found maximum in squamous cell carcinoma (20), next adenocarcinoma (15). Among 40 cases diagnosed as malignant by histopathology, serum CYFRA 21-1 level was compared with histopathological findings. The sensitivity of serum CYFRA 21-1 level in case of squamous cell carcinoma, adenocarcinoma and combined were 90.90%, 83.33% and 87.5% respectively. The sensitivity and accuracy of serum CYFRA 21-1 for squamous cell carcinoma was more than that of adenocarcinoma. So serum CYFRA 21-1 level was highly sensitive for squamous cell carcinoma.

A 16-Year-Old Lady with Transformer Oil Poisoning in Intensive Care Unit of Enam Medical College Hospital

Transformer oil is one kind of highly refined oil which is used as coolant and heat exchanger in different electronic equipments. Poisoning with this oil is a rare type of chemical poisoning as it is not easily available for household purpose. The main constituent of transformer oil is polychlorinated biphenyl (PCB) which is responsible for producing toxicity in humans. Chronic exposure with PCB may cause some toxicity such as hepatotoxicity and neurotoxicity. Here we present a case of acute toxicity with transformer oil of a rural woman in Bangladesh who ingested this oil as suicidal attempt. She was managed efficiently through conservative treatment along with artificial ventilation.J Enam Med Col 2016; 6(2): 110-113

Tragedy in Savar: Management of Victims in Enam Medical College Hospital

Background: Rana Plaza collapse is the worst and deadliest man-made industrial disaster in the history of garment sector in the world. Around 1200 people died and thousands more were injured. Most of the victims of the disaster were treated in Enam Medical College Hospital (EMCH). We conducted this study to give an overview on the disaster victims and services provided by EMCH. Objective: The study was done to observe the length of time between accident and admission in EMCH, length of time between admission and discharge, to observe the numbers, types and sites of injuries to the victims, medical measures given to the victims and finally to observe the status of the victims at the time of discharge. Materials and Methods: This descriptive type of observational study was carried out among the victims of Rana Plaza tragedy during the period of May to October 2013. All admitted patients in EMCH were included in the study. Purposive nonprobability sampling technique was applied in this research work. Data were collected from the hospital record. After collection, data were manually compiled, edited and analyzed. Results: Among 621 victims treated in different wards, 276 (44.45%) were admitted to the hospital on the day of accident. Among the admitted patients, 255 (41.06%) stayed in the hospital for 1--3 days,133 (21.42%) for 4--7 days and 88 (14.17%) for more than 10 days. Fracture and dislocation were present in 32.70% patients, lacerated injury in 18.20%, abrasion in 15.78%, bruise in 13.53%, incised wound in 15.45% and punctured wound in 4.34% patients. Single injury was present in 56.68% and rest had multiple injuries. Lower limbs were the most (33.01%) affected part of the body followed by head and neck (22.06%), upper limbs (18.52%), thorax (17.55%) and abdomen (8.86%). Two hundred seventy two patients (43.80%) were improved after treatment and 56 (9.02%) were fully cured; 23.83% of the victims were referred to higher medical centers for special measures. Conclusion: The collapse of Rana Plaza has fueled a greater call for reform and safety in garment industry. At the same time, all health care centers should adopt a broad-based approach to disaster-preparedness by providing a framework to ensure a well-coordinated response to mass casualty event. DOI: http://dx.doi.org/10.3329/jemc.v4i1.18066 J Enam Med Col 2014; 4(1): 31-35

Cough Variant Asthma in Medical Outpatient Department of a Tertiary Care Hospital in Bangladesh

Background: Cough variant asthma (CVA) is a subset of asthma where the only symptom is chronic persistent cough. Many cases go unrecognized due to lack of proper evaluation. Response to asthma medication with features supportive of airway hypersensitivity helps in management of this disease. Objective: To find out the proportion of cough variant asthma among the patients attending medicine outpatient department of Enam Medical College, Savar, Dhaka. Materials and Methods: This cross sectional study was conducted in Enam Medical College Hospital, Savar, Dhaka over a period of two years from July 2009 to July 2011. Cough variant asthma was diagnosed mainly on clinical ground as chronic cough without wheezing, fever, weight loss, shortness of breath or sputum or any other apparent cause that persisted for more than eight weeks with absolutely normal physical examination of chest, normal chest radiography and blood count except raised eosinophil count and IgE level. Patients who met these criteria were given 2 weeks course of inhaler beclomethasone propionate and were assessed for improvement. Those who improved after steroid inhalation were categorised as having cough variant asthma. Results: Out of purposively selected 148 patients complaining only of chronic dry cough for more than eight weeks, 92 patients met the primary selection criteria for cough variant asthma. These 92 patients were given 2 weeks trial of 250 ìgm beclomethasone inhalation twice daily. Seventy nine patients reported almost complete recovery from chronic cough after 2 weeks and were categorized as having CVA. Thirteen patients did not improve and were not categorized as CVA. Conclusion: These findings suggest that cough variant asthma is the most common among the patients with chronic cough not due to any apparent cause. The efficacy of inhaled corticosteroid suggests that early intervention is effective in the treatment of this disease. DOI: http://dx.doi.org/10.3329/jemc.v3i1.13871 J Enam Med Col 2013; 3(1): 29-31

Ice-on-Eyes Test in the Diagnosis of Myasthenia Gravis

Myasthenia gravis is the most frequent autoimmune neuromuscular transmission disorder with incidence of 2-20 patients per million. Its pathophysiology is autoimmune, with acetylcholine receptor auto antibodies damaging the post-synaptic fold at the muscle membrane. The diagnostic confirmation of myasthenia gravis is often challenging. Ice-oneyes test can be used to diagnose this disease for its simplicity, safety and cost-effectiveness. Here we report a case of myasthenia gravis in Enam Medical College Hospital, Savar, Dhaka where ice-on-eyes test was done with improvement of ptosis of the patient. Aim of this case report is to make aware our physicians to apply this simple bed side test instead of common traditional edrophonium (tensilon test) test for confirmation of the diagnosis of ocular myasthenia gravis. DOI: http://dx.doi.org/10.3329/jemc.v2i2.12845 J Enam Med Col 2012; 2(2): 92-93

Cat Scratch Disease

We report a case of cat scratch disease in a young boy who presented in the outpatient department of Enam Medical College Hospital, Savar, Dhaka with history of cat scratch and regional painful lymphadenopathy. The diagnosis was made on the basis of history, physical examination and common investigations including lymph node aspiration cytology DOI: http://dx.doi.org/10.3329/jemc.v2i1.11928 J Enam Med Col 2012; 2(1): 40-42