Enam Medical College Research Articles

Clinical and Endoscopic Profile of Patients with Upper Gastro-Intestinal Bleeding (UGIB)

Background: Upper gastro-intestinal bleeding (UGIB) is a cause of significant morbidity and mortality. Prevalence as well as mortality is higher in elderly persons above sixty years because of increasing use of nonsteroidal anti-inflammatory drugs and associated comorbidity. Conventionally upper GI bleeding is divided as variceal and nonvariceal sources and the treatment protocol varies accordingly. There are limited data regarding UGIB in our country.
 Objective: This observational study was designed to delineate the clinical and endoscopic profile of patients with UGIB in our country.
 Materials and Methods: This prospective observational study was done in the Department of Gastroenterology in Enam Medical College & Hospital during the period of 2014–2017. Patients with UGIB were followed until discharge or death. Patients were subjected to upper GI endoscopy, preferably within the first 24 hours. Clinical and endoscopic data of 131 patients were compiled and analyzed in this study. The data were analysed using SPSS version 21.0.
 Results: Among the 131 final participants 101 were male and 30 were female. Mean age of the patients was 43.65 ± 18.63 years. Patients mostly presented with both haematemesis and melaena (66, 50.4% patients), 33.6% with haematemesis only, and 16% patients with melaena only. The most common endoscopic finding was duodenal and or gastric ulcer (57); next common lesions were gastric/duodenal erosions (23), oesophageal varices (13), oesophageal erosions/ulcers (10), corrosive burn (10) and carcinoma (7). Forty patients had history of NSAID intake and gastric/duodenal ulcer and/erosions were the most frequent lesions among them (27). One patient with oesophageal varices died due to rebleeding.
 Conclusion: In our study peptic ulcer-related bleeding is the most common cause of UGIB. A significant proportion of UGIB is due to corrosive burn (harpic) emphasizing the need for public awareness. Mortality was due to rebleeding.
 J Enam Med Col 2019; 9(2): 78-83

Role of Resistance Index in Differentiation of Benign and Malignant Breast Masses Compared with Histopathological Diagnosis

Background: Breast tumor remains a worldwide public health problem for women. Linear array sonography is currently one of the main diagnostic methods for detecting breast lumps. Duplex color Doppler sonography has been helpful to distinguish malignant from benign breast disease and also to predict the disease prognosis.
 Objectives: The purpose of this study was to evaluate the role of spectral Doppler as a method to measure the vascular resistance index in differential diagnosis between the benign and malignant breast neoplasm.
 Materials and Methods: This cross-sectional study was carried out in department of Radiology & Imaging of Enam Medical College & Hospital during January 2015 to December 2017. Sonography was done in 153 women having breast lumps. Among them histopathology was done in 105 cases. Ultrasonographic findings and histopathological report analyses were done using SPSS 13.0.
 Results: The study was done in 105 women with mean age 31.6 ± 4.5 years. On ultrasonogram, lesions were diagnosed as benign in 65 (62%) cases and malignant in 40 (38%) cases. Out of sonographically diagnosed 65 benign lesions having peripheral vascularity and decreased RI, 63 (97%) were proved benign histopathologically. With these criteria for diagnosis of benign lesion, sensitivity was 94%, specificity 92%, positive predictive value 95%, negative predictive value 89% and accuracy 93%. Sonographically 40 lesions were diagnosed as malignant. Among them 37 (92.5%) cases were proven malignant histopathologically and showed central vascularity and increased RI having sensitivity of 92%, specificity 94%, positive predictive value 89%, negative predictive value 95% and accuracy 93%.
 Conclusion: The analysis of vascular resistance index combined with findings on grayscale sonographic images correlates well with histopathological reports and can be of great assistance in the assessment of breast masses with high sensitivity and specificity.
 J Enam Med Col 2019; 9(2): 97-103

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

Electrolyte Disturbances in Acute Exacerbation of COPD

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 and it is associated with significant electrolyte disturbances.
 Objectives: The main objective of this study was to determine the prevalence of electrolyte disturbances in patients with acute exacerbation of COPD and to determine possible effects of these electrolyte disorders.
 Materials and Methods: This observational prospective study was carried out in the Department of Pulmonology, Enam Medical College & Hospital from 1st January to 31st December 2017. Sixty patients with acute exacerbation of COPD were included. Serum electrolytes and arterial blood gases were measured.
 Results: Low level of serum sodium (131 ± 5.66 mEq/L) and potassium (3.20 ± 0.44 mEq/L) were found in subjects with acute exacerbation of COPD. In patients with respiratory failure Na+ and K+ levels were even lower.
 Conclusion: Serum electrolytes in acute exacerbation of COPD patients should be monitored routinely and should be corrected early to avoid poor outcomes.
 J Enam Med Col 2019; 9(1): 25-29

USG-Guided Percutaneous Aspiration: an Effective Way for Managing Appendicular Abscess

Background: During last 2−3 decades image-guided drainage procedures have been developed complementing modern surgical drainage techniques. The development of interventional radiological procedure has made percutaneous puncture and drainage of abdominal fluid collection possible. Image-guided percutaneous drainage of appendicular abscess has become well-established because of its proven safety and efficacy.
 Objectives: To evaluate the safety and feasibility of USG-guided percutaneous aspiration for draining appendicular abscess with special attention to the need for conversion and to see the nature of complications after draining of abscess.
 Materials and Methods: Between May 2013 to May 2014, 25 cases of appendicular abscess were selected from the admitted patients (surgery department) in Enam Medical College & Hospital who underwent USG-guided percutaneous aspiration. Procedure was performed mostly under local anaesthesia. Patients were followed up for 6 months. Interval appendicectomy was not performed routinely.
 Results: USG-guided aspiration was successful in 23 (92%) patients and in 2 (8%) patients procedure failed. Single attempt was successful in 21 (84%) cases and 4 (16%) patients needed double attempt for draining appendicular abscess. In 23 (92%) patients, PCA was done under local anaesthesia and two (8%) patients needed general anaesthesia. Complications developed in 4 (16%) patients. Four (16%) patients needed follow-up USG. Average hospital stay was 5 days (2−8 days) and average duration of using I/V antibiotic was 3.5 days (2−5 days).
 Conclusion: USG-guided percutaneous aspiration is an easy and safe method for draining appendicular abscess with minimum procedural complications.
 J Enam Med Col 2019; 9(1): 41-45

Endoscopic Retrograde Cholangiopancreatography (ERCP) Experience in a Tertiary Level Hospital in Bangladesh

Background: Although endoscopic retrograde cholangiopancreatography (ERCP) was first described as a diagnostic technique, now-a-days we mainly do ERCP with a therapeutic intent for management of various biliary and pancreatic diseases.
 Objectives: This study intends to find out the diagnosis obtained by ERCP procedure and the therapeutic interventions done for appropriate cases in a tertiary level hospital in Bangladesh.
 Materials and Methods: This prospective observational study was performed in the Department of Gastroenterology in Enam Medical College & Hospital over a period from June 2014 to October 2016. Eighty patients, aged 15–70 years, were selected only for therapeutic ERCP. They were diagnosed and selected after taking history, physical examination and appropriate investigations. ERCP was done under short-term general anesthesia or deep sedation by using propofol or fentanyl. Results are shown in tables.
 Results: Majority of the cases were choledocholithiasis (53.75%) followed by cholangiocarcinoma (11.25%), ampullary carcinoma (8.75%), carcinoma of the gall bladder (6.25%), biliary ascariasis (6.25%), biliary stricture (5%), papillary stenosis (5%), chronic pancreatitis (2.5%) and sludge in the CBD (1.25%). Types of therapeutic intervention depended on diagnosis. Papillotomy with stone removal was done in patients with choledocholithiasis. Papillotomy with stenting was done in the patients with cholangiocarcinoma, ampullary carcinoma, gall bladder carcinoma, biliary stricture and paillary stenosis. Papillotomy with worm extraction was done in cases of biliary ascariasis. Papillotomy with clearing of sludge was done for sludge in the CBD and only papillotomy was done in two patients of chronic pancreatitis.
 Conclusion: In this study we found that choledocholithiasis and biliary tract malignancy were the two major ERCP findings. Therapeutic interventions were done according to diagnosis. The most common therapeutic intervention was papillotomy with stone removal. Next common intervention was papillotomy with stenting.
 J Enam Med Col 2019; 9(1): 9-15

Pattern of Gynaecological Malignancies in a Tertiary Care Hospital

Background: Gynaecological malignancies are the second most common cancer of females after cancer breast. Gynaecological malignancies contribute significantly to cancer burden and have a higher rate of mortality and morbidity. Carcinoma cervix is the commonest gynaecological malignancy in developing countries while in developed countries, ovarian cancer is the commonest. Comprehensive statistics on gynecologic malignancies reported from Bangladesh are deficient. This study was performed to ascertain the profile of gynecologic cancers reported at our center regarding demography, the frequency of involvement at various sites, clinical presentation, incidence, histologic subtypes and stage at presentation. Methods: This is a retrospective study where the records of the Departments of Gynecology and Pathology at Enam Medical College & Hospital, Dhaka, Bangladesh were retrospectively reviewed to identify all cases of Gynecologic malignancies and to determine the pattern of gynaecological malignancies identified between January 2015 and December, 2018. Results: Cervical cancer (53%) was the most common gynaecological malignancy, followed by ovarian cancer (29%), uterine cancer (8%), vulvar cancer (5%) and gestational trophoblastic neoplasm (GTN 5%). In the case of cervical and ovarian cancer the most common age group was 41 - 50 years and gestational trophoblastic neoplasm (GTN). The majority of patients presented at the ages of 31 - 40 years while uterine cancer presented in the elderly (>60 years). Among the patients studied 88% were multiparous. Of the cervical cancer cases, 96.22% was squamous cell carcinoma and commonest presenting complains were contact bleeding (33.96%) and excessive and irregular menstruation (26.41%). Among ovarian tumor cases 69% had epithelial while 31% had non-epithelial cancer and predo&

Management of OPC and Carbamate Poisoning in Intensive Care Unit of Enam Medical College & Hospital, Savar, Dhaka

Background: Bangladesh is an agriculture-dependent country. Organophosphorus insecticides are widely used for the better outcome of cultivation. It is used for suicidal purpose due to its easy availability all over the country. Worldwide, acute pesticide poisoning is causing major health problems with high mortality in developing countries.Objective: The objective of our study was to establish that early management of acute poisoning with organophosphorus and carbamate in ICU along with ventilatory support in severe respiratory distress reduces the mortality rate.Materials and Methods: This study was conducted in the Department of Anesthesiology & ICU in Enam Medical College & Hospital, Savar, Dhaka from January 2013 to December 2015. Total 84 patients with acute poisoning cases were selected. The diagnosis was confirmed by the history of ingestion of insecticides, observing clinical signs and symptoms and presence of foul smelling of poisonous agent. Management included supportive care, intubation, artificial ventilation in selective cases, administration of antidotes as loading and maintenance dose for atropinization with atropine and pralidoxime, antibiotics, anti-ulcerant, anticonvulsant, inotropic support (in severe hypotension) along with other symptomatic treatment. After stabilization, decontamination was started with removal of contaminated clothes, thorough wash with soap and water, irrigation of eyes with water and normal saline. Gastric lavage was given within 2 to 3 hours of ingestion of poison.Results: Acute poisoning was observed more in male (60.71%) than in female (39.29%) and in age group of 21–40 years (60.71%). Suicidal attempt was present in 97.61% cases and causes of suicidal poisoning were familial disharmony (76.19%), financial loss (14.28%) and failure in examination (9.52%). Organophosphate group poison ingestion was in 77.38% cases and carbamate group poison in 21.43% and both agents in 1.19% cases. Ventilatory support was given in 48.80% cases and 78.05% patients were successfully extubated from mechanical ventilator. Mean duration of ventilatory support was 2–14 days. Out of 84 patients, 75 (89.28%) survived and 9 (10.72%) patients expired. Fifty two (61.91%) patients were discharged within 4–6 days, 16 (19.04%) within 2–3 days, and 7 (8.33%) patients were discharged within 7–14 days.Conclusion: Early ICU admission and appropriate management of patients after ingestion of poisonous agent results in reduced morbidity and mortality.J Enam Med Col 2018; 8(3): 144-152

Comparison of Intra-Operative and Post-Operative Complications between Non-Descent Vaginal Hysterectomy and Total Abdominal Hysterectomy

Background: Hysterectomy is one of the most common surgical procedures performed by the gynaecologists and can be done through abdominal and vaginal routes. Vaginal hysterectomy technique has been introduced and performed centuries back, but is less popular due to lack of experience and misconception that the abdominal route is easier and safer. Worldwide gynaecologists continue to use abdominal route for hysterectomy that could be performed vaginally which is less invasive and has minimal complications.Objective: To compare the complications during intra-operative and post-operative period between vaginal hysterectomy and abdominal hysterectomy in non-descent uterus.Materials and Methods: This prospective randomised study was performed in Enam Medical College & Hospital, Savar, Dhaka during a period of one year. Sixty consecutive patients requiring hysterectomy for benign diseases were included in this study. Group A (n=30) underwent vaginal hysterectomy (non-descent vaginal hysterectomy) and were compared with Group B (n=30) who underwent abdominal hysterectomy. The primary outcome measures were operative time, intra-operative blood loss, post-operative complications like wound infection, febrile morbidity, post-operative systemic infection and hospital stay. Secondary outcome measures were conversion of vaginal to abdominal route and re-laparotomy. Data were collected in structured questionnaire and analysed by computer using R programming version 3.4.3.Results: Baseline characteristics were similar in two groups. There were no intra-operative complications in either group. Intra-operative blood loss was significantly more in Group B than in Group A. The overall complication rate was significantly higher with abdominal hysterectomy with a rate of 56.67% against 30% for vaginal hysterectomy. Wound infection (23.33%) was significantly higher in Group B as compared to Group A (0%). Post-operative hospital stay was significantly higher in Group B (7.03 days) than in Group A (4.57 days).Conclusion: Considering intra-operative blood loss, post-operative complications and hospital stay, vaginal route was found safer than abdominal route in this study.J Enam Med Col 2018; 8(3): 128-134

A Clinical and Laboratory Profile of Multiple Myeloma

Background: Myeloma, the most common malignant disease of bone, is incurable and occurring with increasing frequency in elderly population. Typical clinical features are weakness, fatigability, bone pain, anemia, renal insufficiency and hypercalcemia. Incidental discovery on comprehensive laboratory panels is common. Serum or urine protein electrophoresis or immunofixation and bone marrow aspirate analysis help the diagnosis of multiple myeloma.Objective: The aim of this study was to define and evaluate the clinico-laboratory features of newly diagnosed adult multiple myeloma (MM) patients in the context of Bangladesh.Materials and Methods: This study was carried out in two centers, from October 2005 to January 2010 in Bangabandhu Sheikh Mujib Medical University (BSMMU) and July 2012 to June 2017 in Enam Medical College and Hospital (EMCH). Thirty two diagnosed valid cases of multiple myeloma were included in this study. Clinical history, physical and relevant laboratory findings were carefully recorded and analyzed.Results: In this study among 32 patients, 29 were males and 3 were females with mean age 51.94 ± 10.09 years. The common complaints were bone pain, weakness and fatigue. The common clinical findings were bone tenderness, pallor and high ESR (ESR of all the study patients was more than 100 mm in 1st hour). Hemoglobin level was <8.5 gm/dL in 13 patients, serum creatinine ≥2 mg/dL in seven patients, serum albumin <30 mg/L in 14 patients and serum β2 microglobulin >5.5 mg/L in 15 patients. Three patients were hypercalcemic. Lytic lesions were the most common radiological finding in the study.Conclusion: This study showed that multiple myeloma is a disease of the middle and elderly aged population with male preponderance, with high male female ratio. Multivenued studies are needed to view the real picture of multiple myeloma in the context of Bangladesh.J Enam Med Col 2018; 8(3): 159-164

Accuracy of High Resolution Sonography in Diagnosis of Fibroadenosis Compared with Histopathological Diagnosis

Background: Fibrocystic breast condition is a common, non-cancerous condition that affects premenopausal woman between 20 and 50 years of age. Because of non-specific nature of clinical presentation, diagnosis is not that easy. Linear array sonography has been helpful for detection of mammary dysplasia.Objective: The purpose of this study was to determine the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of superficial sonography in the diagnosis of chronic cystic mastitis.Materials and Methods: This study was carried out in department of Radiology & Imaging of Enam Medical College and Hospital during June 2013 to October 2017. Sonography was done in 1350 women suspected of having fibrocystic disease. Among them FNAC was done only in 1020 cases. Ultrasonographic findings and histopathological reports were analyzed using SPSS 13.0.Results: According to our study the sensitivity of superficial sonography was 92.4%, specificity 88.8%, positive predictive value 93.8%, negative predictive value 86.4% and accuracy 91% in the diagnosis of fibrocystic changes.Conclusion: With the validity test result, it can be concluded that high frequency sonography provides an accurate diagnosis of fibroadenosis.J Enam Med Col 2018; 8(3): 139-143

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

Assessment of the Cases Undergone Peripartum Hysterectomy in a Tertiary Care Hospital in the Last Three Years

Background: Emergency peripartum hysterectomy (EPH), although rare in modern obstetrics, remains a life-saving procedure in cases of severe hemorrhage. Objective: To assess the incidence, indications, outcomes & complications of peripartum hysterecomty performed in a tertiary care hospital & compare the results with other reports in the literature. Methods: Twenty nine peripartum hysterectomy cases carried out between July 2015 and June 2018 in Enam Medical College & Hospital, Savar, Dhaka were evaluated retrospectively. Maternal characteristics and characteristics of the present pregnancy and delivery, hysterectomy indications, operative complications, postoperative conditions, and maternal and neonatal outcomes were evaluated. Results: Peripartum hysterectomy incidence was found as 7.26 per 1000 deliveries. The most common indication for hysterectomy was placenta previa with morbidly adherent placenta (17/29) followed by post-partum haemorrhage due to uterine atony (6/29) and ruptured uterus (6/29). There were 6 cases of intraoperative bladder injury. We had 5 maternal deaths, 3 of them were due to irreversible shock & 2 due to septicaemia. There were 5 cases of neonatal mortality mostly because of prematurity & asphyxia. All of the placenta previa with placenta accreta cases had at least one previous cesarean section. All 6 ruptured uterus cases had history of previous caesarean section. It was found that blood transfusion was required in all cases. Conclusion: Obstetric hemorrhages are life-threatening clinical conditions & peripartum hysterectomy is a necessary life-saving procedure. Abnormal placentation is the leading cause of emergency peripartum hysterectomy specially in cases with previous cesarean section history.

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.

Identifying predatory or pseudo-journals.

The World Association of Medical Journal Editors (WAME) Board has recently announced the publication of the WAME statement on Identifying Predatory or Pseudo-Journals (posted on February 18, 2017). Members of WAME are permitted to republish the statement in their journals. As Editor-in-Chief and Editor of Journal of Enam Medical College are members of WAME, we are republishing this important paper in Journal of Enam Medical College. J Enam Med Col 2017; 7(2): 62-68

Identifying Predatory or Pseudo-Journals

The World Association of Medical Journal Editors (WAME) Board has recently announced the publication of the WAME statement on Identifying Predatory or Pseudo-Journals (posted on February 18, 2017). Members of WAME are permitted to republish the statement in their journals. As Editor-in-Chief and Editor of Journal of Enam Medical College are members of WAME, we are republishing this important paper in Journal of Enam Medical College.J Enam Med Col 2017; 7(2): 62-68

Identifying Predatory or Pseudo-Journals.

The World Association of Medical Journal Editors (WAME) Board has recently announced the publication of the WAME statement on Identifying Predatory or Pseudo-Journals (posted on February 18, 2017). Members of WAME are permitted to republish the statement in their journals. As Editor-in-Chief and Editor of Journal of Enam Medical College are members of WAME, we are republishing this important paper in Journal of Enam Medical College. J Enam Med Col 2017; 7(2): 62-68

Effect of Spinal Anaesthesia in Children of 4-10 Years

Background: Though paediatric spinal anaesthesia has been used since early 20th century in developed countries even in neonates, still it is not common in our country. Spinal anaesthesia can be given in neonates and children for infraumbilical surgeries with an expert and experienced anaesthesiologist.Objective: The objective of this study was to establish spinal anaesthesia as a safe and effective regional anaesthetic procedure in children of 4–10 years.Materials and Methods: The study was done in the Department of Anaesthesiology & Intensive Care Unit of Enam Medical College & Hospital during the period of June 2012 to May 2014. A total of 102 patients aged from 4 to 10 years with American Society of Anaesthesiologists (ASA)-I and II were selected. After proper preoperative anaesthetic evaluation spinal anaesthesia was administered. All patients were premedicated with atropine, preloaded with crystalloid solution and sedated with ketamine 1 mg/kg or midazolam 0.03 mg/kg. 0.5% hyperberic bupivacaine was injected at L4/5 or L5/S1 level with spinocaine needle. After establishment of desired block, surgery was performed. All vital parameters, number of attempts for lumbar puncture, sensory and motor block were monitored and recorded.Results: Almost all patients achieved desired block (T8–T10) within 5 to 10 minutes. The success rate in our study was 96.1% and remaining 3.9% were considered as failure. No remarkable changes were observed in vital parameters after spinal anaesthesia. Lumbar puncture was successful in first attempt in 60 (58.82%) cases and in second attempt in 42 (41.18%) cases. Hypotension occurred in 2%, shivering in 3% and 3% developed restlessness.Conclusion: Spinal anaesthesia produces a reliable, profound and uniformly distributed block with rapid onset, good muscle relaxation, complete control of cardiovascular and stress responses compared with epidural or GA. There is also rapid recovery and minimal complications without special drugs or expensive equipments. However, greater acceptance and experience are still desired for this technique to become more popular.J Enam Med Col 2017; 7(1): 10-14

Assessment of Cranial Sonographic Findings of Hypoxic Ischemic Brain Injury in Perinatal Asphyxia

Background: In perinatal asphyxia, hypoxic ischemic brain injury remains most serious condition causing significant mortality and long term morbidity. Early detection of intracranial changes and its consequences will enhance timely intervention and better out come. Cranial sonography can be done to assess the abnormalities of brain in perinatal asphyxia. Objectives: The objective of this study was to evaluate usefulness of cranial sonography in perinatal asphyxia.Methods: This was an observational study conducted from March 2014 to February 2015 at department of radiology and imaging, Enam Medical College and Hospital. Total 100 neonates with perinatal asphyxia were included in this study. Cranial USG was done in all cases and sonographic abnormalities were evaluated.Result: 56 term (>37 weeks of gestation ) and 44preterm (<37 weeks of gestation ) newborn having birth asphyxia were taken as cases in this study. Common cranial sonographic findings of preterm babies were periventricular leukomalacia 29% (13), germinal matrix hemorrhage 14% (6), Intraventricular hemorrhage 11% (5) cerebral oedema 7% (3) and normal 39% (17). Common cranial USG findings in term babies were cerebral oedema 43% (24), intracerebral hemorrhage 5% (3), Focal cerebral infarct 4% (2), Intraventricular hemorrhage 2% (1) and normal 46% (26).Conclusion: This study found that transcranial sonography is useful to identify the abnormalities in brain of asphyxiated neonate and helps to predict the neurodevelopmental outcome. So proper management plan can be done.J MEDICINE January 2016; 17 (1) : 12-16