Family Red Crescent Medical College Research Articles

Evaluation of Various Indications of Total Abdominal Hysterectomy in Holy Family Red Crescent Medical College Hospital for Last 20 Months

Background: Total Abdominal Hysterectomy (TAH) is a common surgical procedure for treating various gynecological conditions. This study aims to evaluate the demographic characteristics, comorbidities, and clinical indications for TAH at Holy Family Red Crescent Medical College Hospital, Dhaka, Bangladesh. Methods: This retrospective study included all TAH cases performed from January 2018 to August 2019. Data on patient age, comorbidities (hypertension and diabetes), and indications for TAH were collected from hospital records. Descriptive statistics were used to analyze the data. Results: A total of 320 TAH cases were reviewed. The most common age group was 41-50 years (43.13%), followed by patients aged ≤40 years (31.56%). Hypertension was present in 36.25% of the patients, and diabetes was observed in 30.94%. The most frequent indication for TAH was fibroid uterus (55.63%), followed by adenomyosis (18.75%) and post-menopausal bleeding (14.38%). Other indications included ovarian cysts (5.63%), endometrial hyperplasia (5.00%), and pelvic mass (6.25%). Conclusion: The findings highlight uterine fibroids, adenomyosis, and post-menopausal bleeding as the primary indications for TAH, with a significant prevalence of hypertension and diabetes among the patients. Effective management strategies for these conditions and considerations of comorbidities are crucial in optimizing surgical outcomes. Further research into minimally invasive techniques may enhance patient care in gynecological surgery.

Colposcopic Detection of CIN in Patients with Clinically Abnormal Cervix at a Tertiary Care Center in Bangladesh

Background: Cervical cancer poses a significant public health challenge globally, especially in regions like Bangladesh where access to effective screening programs is limited. Early detection and management of cervical intraepithelial neoplasia (CIN) play crucial roles in preventing the progression to cervical cancer. This study investigates the diagnostic accuracy of colposcopy, compared with histopathological findings, in detecting various grades of CIN and cervical cancer. Methods: This retrospective observational study reviewed hospital records of 200 VIA-positive cases from January 2021 to December 2023 at the Obstetrics and Gynecology Department of Holy Family Red Crescent Medical College Hospital Dhaka, Bangladesh. Colposcopic examinations were conducted, followed by histopathological evaluations of biopsied tissues to confirm the presence and grade of CIN. Data on demographic characteristics, clinical findings, and outcomes were analyzed using descriptive statistics. Result: Of the participants, 44% had normal colposcopic findings, while the prevalence of CIN I, CIN II, CIN III, and cervical cancer was 22.5%, 17%, 11%, and 4%, respectively. Histopathological correlation confirmed 46% as normal, with discrepancies noted in higher-grade lesion diagnosis. The study highlighted the high sensitivity but variable specificity of colposcopy in detecting and grading cervical lesions. Conclusion: Colposcopy serves as a valuable diagnostic tool in the early detection of cervical abnormalities. However, discrepancies in lesion grading underscore the need for integrating colposcopy with histopathological evaluations to enhance diagnostic accuracy and optimize patient management.

Assessment of Contraceptive Usage Patterns and Associated Factors among Women in Bangladesh: A Hospital-Based Observational Study

Background: The use of contraceptives is crucial in managing family size, improving maternal health, and enhancing socio-economic development. Despite progress in promoting contraceptive use, challenges persist in countries like Bangladesh, where socio-cultural dynamics can affect the uptake and usage patterns. This study aimed to assess contraceptive usage patterns and associated factors among women attending a hospital in Bangladesh. Material & Methods: This prospective observational study was conducted at the Outpatient Department of Obstetrics and Gynecology, Holy Family Red Crescent Medical College Hospital, Dhaka, Bangladesh, from January 2021 to December 2022. The study included 150 women of reproductive age (18-45 years) who visited the hospital for gynecological problems or regular check-ups. Data was collected through structured interviews using validated questionnaires assessing knowledge and usage of contraceptive methods. Descriptive statistics and Chi-square tests were used for data analysis. Results: Among the participants, 66.00% reported regular contraceptive use, 10.67% reported irregular usage, and 23.33% stated they were not using contraception. Oral contraceptive pills were the most common method (43.48%). There was a significant association between contraceptive usage patterns and education level, age group, marital status, and number of children. In contrast, residence did not significantly associate with contraceptive practice. Conclusion: Despite high awareness levels, there exists a gap between knowledge and consistent contraceptive use. Education level, age, marital status, and number of children significantly influence contraceptive usage patterns. This study highlights the importance of integrating these socio-demographic factors in the planning and implementation of family planning policies to promote effective contraceptive use in Bangladesh. Future research should investigate the reasons behind irregular or non-use of contraceptives among informed women and devise strategies to bridge the knowledge-practice gap.

Blood Stream Infection: Identification & Antibiotic Sensitivity Pattern of Microorganisms in a Tertiary Care Hospital in Dhaka City

Background: Blood stream infections are an important cause of mortality & morbidity in all age group worldwide. Aim & Objective: The aim of this study was to perform bacteriological analysis and assess antibiotic sensitivity patterns of isolates from bloodstream infections in a tertiary care hospital in Dhaka city. Material & methods: The study is a retrospective observational analysis of blood culture isolates received in the Department of Microbiology, Holy Family Red Crescent Medical College & Hospital from January to December, 2021. A total sample size was 2371, out of them positive aerobic bacterial growth was observed in 85 (3.58%) isolates. Sampling technique was used to collect data from the laboratory records and written consent was taken from concerned authority collected data were compiled and analyzed with the help of SPSS version 20. All samples were collected in BacT/ ALERT 3D 60 aerobic bottles irrespective to antibiotics administration. One to five (1-5) ml blood for children and 5-10 ml blood for adult were collected respectively. Samples were incubated in the automated BacT/ ALERT 3D. Subculture was done on blood agar, chocolate agar media & MacConkey’s agar media. Identification of organisms by Gram stain & biochemical tests were done as per the standard methods. Negative signal blood culture bottles were kept in machine for up to 5 days. No mixed cultures (the association of two microorganisms) were identified. All the isolates were tested for their antimicrobial susceptibility pattern by Kirby-Bauer’s disk diffusion technique according to the Clinical and Laboratory standards institute guideline. Results: Overall, 45/874 (5.14%) positive blood cultures were isolated from adult followed by neonate 31/709(4.37%), children 6/390(1.54%) & infant 3/398(0.75%). Bacteremia was more or less equal in both sexes, female 44 (51.77%) & male 41(48.23%). Trend of pathogens recover in highest in November 13(15.29%). The most common organism isolated was Staph. aureus 26(30.58%) followed by Klebsiella species 15(17.64%), Acinetobacter species 13(15.29%), Pseudomonas species 11(12.94%), Salmonella Typhi 10(11.76%) and E. coli 10(11.76%). In Staph. aureus, linezolid and vancomycin were 100% sensitive. In Klebsiella spp. meropenem was 87% & in E. coli 80% sensitive. In Acinetobacter spp. amoxicillin/ clavanic acid 85% & colistin 70% sensitive. In Pseudomonas spp., meropenem and piperacillin tazobactum 100% sensitive followed by ciprofloxacin 82%, ceftazidime 82% & amikacin 81.8% sensitive. In Salmonella Typhi, ceftriaxone was 100% sensitive. Conclusion: Drug resistant bacteria are increasing over the years, so, antibiotic policy which formulates according to local sensitivity pattern will be implemented effectively. Bangladesh Journal of Medical Education Vol.14(2) July 2023: 84-91

Clinical Presentation of Dengue Fever among Bangladeshi Children: A Study of 100 Cases

Background: Dengue is a common tropical disease in Bangladesh. It is prevalent in our country during and just after the rainy season. The symptoms and signs are similar to many other diseases. Objective: The objective of the study is to observe the pattern of dengue fever in this institution for better care of the patients and also comparing with follow-up studies. Methodology: This cross-sectional study was conducted in the Department of Pediatrics at Holy Family Red Crescent Medical College Hospital, Dhaka, Bangladesh from May 2019 to August 2019. A total number of 100 patients were enrolled for this study. They were selected form the inpatient admission. Results: Most commonly children from the 5 to 10 years’ age group were affected with slight preponderance of girls. 90% patients presented with fever with chills and rigor. About 38.18 % children had uncomplicated dengue fever. Most common bleeding manifestation was melena (12.0%). About 21 patients had associated rickettsia infections. About 11 patients developed shock after admission only 22 patients had respiratory distress and 15 patients had pleural effusion. Six patients had neurological symptoms. Conclusions: Classical DF is most common form of the disease. This is followed by other two manifestations. Bangladesh Journal of Infectious Diseases, June 2022;9(1):25-30

The Effects Between Spinal and General Anesthesia for Pre-Eclamptic Mothers Underwent Caesarean Delivery in a Tertiary Care Hospital- A Comparative Study

Background: Preeclampsia is a multisystem disorder characterized by new onset of hypertension systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg and proteinuria >300 mg/24 h arising after 20 weeks of gestation in a previously normotensive woman and associated with significant maternal and neonatal morbidity and mortality worldwide. Women with preeclampsia have an increased rate of cesarean section consequent upon the high incidence of intrauterine growth restriction, fetal distress, and prematurity. The aim of this study was to determine and compare maternal & neonatal outcome among pre-eclamptic women following caesarian delivery under general and spinal anesthesia. Material & Methods: This was a comparative observational study and was conducted in the Department of Anesthesiology of Holy Family red crescent Medical College Hospital, Dhaka, Bangladesh during the period from February,2020 to February,2023. In this study we included 250 preeclamptic women undergoing cesarean delivery. The patients were randomly divided into two groups – GA group (Patients who were given general anesthesia) & SA group (Patients who were given spinal anesthesia). Results: In total 250 patients from both the groups completed the study. In our study we found majority (44.8%) of our patients were aged 28-32 years. The mean age was 27.13 ± 3.76 years. Majority (62.8% ) of our patients were cases of emergency caesarean delivery & 37.2% were elective caesarean delivery classes. Most of the students (41.2%) used magnesium sulfate. Intraoperative systolic BP, diastolic BP was significantly lower in SA group than GA group. We found headache, vomiting, fever and wound gaping, postpartum hemorrhage & lower respiratory tract infection was significantly higher in GA group. On contrary, hypotension & pulmonary edema was higher in SA group. Apgar score at 1st, 5th & 10th minutes was significantly higher in GA group than SA group. In GA group, neonatal mortality at 48 h was 10.4% whereas it was 4.8% in SA group. Conclusion: In our study, we found intra-operative blood pressure and pulse rate was observed significantly higher in GA group than SA. Severe preeclamptic mothers receiving general anesthesia and their babies required more critical care support. Maternal as well as neonatal mortality was significantly higher with general anesthesia. Therefore, spinal anesthesia is a safer alternative to general anesthesia among women with severe preeclampsia following caesarean delivery with less postoperative morbidity and mortality.

A Comparative Analysis Between Spinal and General Anesthesia for Orthopedic Surgery

Background: Many surgeries can be performed with spinal anesthesia (SA) or general anesthesia (GA). However, there are only limited and confounding data available regarding costs and anesthesia-related times. Hip or knee replacement are common orthopedic surgeries that can be performed using SA or GA without differences regarding mortality or morbidity. Observational studies have suggested that spinal anesthesia may be associated with lower risks of death, delirium and major medical complications and with shorter lengths of stay in the hospital than general anesthesia. The aim of this study was to assess and compare the effects of spinal versus general anesthesia on postoperative outcomes in patients undergoing orthopedic surgery. Material & Methods: This was a comparative observational study and was conducted in the Department of Anesthesiology of Holy Family red crescent Medical College Hospital, Dhaka, Bangladesh during the period from March,2021 to March,2023. In this study we included 200 patients undergoing orthopedic surgery. The patients were randomly divided into two groups – Group A (Patients who were given general anesthesia) & Group B (Patients who were given spinal anesthesia). Results: In total 200 patients from both the groups completed the study. In our study we found majority (44.5%) of our patients were aged 60-69 years and most of our patients were female (56%) compared to male (44%).The mean age of our patients was 61.73 ± 7.92 years. The mean BMI was 31.67±3.24 kg/m.2Among all patients ,48% had mild systemic disease and followed by 31.5% had severe systemic disease. Majority (43.5%) of our patients had hypertension, 31% had diabetes. Vomiting was found 47% in group A on contrary only 23% had vomiting in spinal group. We found the mean anesthesia induction time was significantly higher in spinal group. Anesthesia time was lower in spinal group while PACU time was higher in group B. Time duration of surgery was significantly lower in spinal group. After 24 hours, spinal group showed less pain score than general anesthesia group. Conclusion: In our study, we found that SA is associated with less fixed and variable costs and lower postoperative pain scores during the stay in the PACU. Therefore, SA is a more reasonable alternative to GA in the immediate postoperative period for patients undergoing hip or knee replacement. When compared to general anaesthesia, spinal anaesthesia provides better operating circumstances, better postoperative pain control, and faster postoperative recovery.

The Impact of Overactive Bladder on Quality of Life Affecting Physical Life, Social Life and Psychological Health among Women

Introduction: Overactive bladder (OAB) has profound impacts on the quality of life (QoL) in women, affecting their physical, social, and psychological well-being. However, comprehensive studies on the impacts of OAB among women in Bangladesh, a low-middle income country with unique cultural, social, and economic contexts, remain scarce. Methods: This prospective observational study, conducted at the Department of Obstetrics and Gynecology, Holy Family Red Crescent Medical College Hospital, Dhaka, Bangladesh, from January 2021 to December 2022, included 120 women visiting the study hospital with complaints of urinary leakage. Participants were surveyed on the prevalence and severity of OAB symptoms and their impact on physical life, social life, and psychological health. The Overactive Bladder Symptom Score (OABSS) and the King's Health Questionnaire (KHQ) were used to assess symptom severity and impact on quality of life, respectively. Result: The study found that OAB symptoms were prevalent among the participants, with 50.00% reporting urinary urgency, 40.00% reporting frequency of urination, 30.00% reporting nocturia, and 20.00% reporting incontinence. The severity of OAB symptoms varied, with 40.00% having a mild OABSS score, 50.00% having a moderate OABSS score, and 10.00% having a severe OABSS score. Conclusion: OAB significantly impacts the QoL of women in Bangladesh. This study underscores the need for comprehensive, multi- dimensional approaches to manage OAB, emphasizing the necessity for mental health support. It contributes to the limited literature on OAB's impact in low and middle-income countries, highlighting the need for further research and public health initiatives to improve the management and treatment of OAB in these contexts.

The Benefit and Risk of Combined Epidural and General Anesthesia for Laparoscopic Surgery

Introduction: Laparoscopic surgery, also known as minimally invasive surgery, is a modern surgical technique that allows surgeons to perform operations using small incisions instead of the larger incisions required for open surgery. Combined epidural and general anesthesia for laparoscopic surgery is an anesthesia technique that merges the benefits of both general and epidural anesthesia to achieve improved patient outcomes. Aim of the Study: The aim of this study was to assess the benefit and risk of combined epidural and general anesthesia for laparoscopic surgery. Methods: This cross-sectional study was conducted in Department of Anesthesiology, Holy Family Red Crescent Medical College and Hospital, Dhaka, Bangladesh, during the period from January 2021 to January 2023. Total 300 patients undergoing laparoscopic surgery were in this study. All the patients were divided into two groups: Group A consist of 150 patients operated with only general anesthesia and Group B consist of 150 patients operated with combined epidural and general anesthesia. Result: In this study, no demographic characteristics were statistically significant (P>0.05). The operation time was significantly (p≤ 0.05) higher in group B compared to group A. The duration of anesthesia was also significantly (p≤ 0.05) higher in group B compared to group A. For systolic arterial pressure, no significant differences were found between the two groups at any time point. Similarly, for heart rate, only the difference after anesthesia was significant, with a p-value of 0.0457. For diastolic arterial pressure, the only significant difference was found after anesthesia, with a p-value of <0.0001. Group A had a mean VAS score of 2.8 (SD±1.5), while Group B had a mean VAS score of 1.5 (SD±1.4). The pain score was statistically (p<0.0001) lower in group B. Group A had a mean recovery time of 21.5 minutes with a SD of 8.2, and Group B had a mean recovery time of 15.5 minutes with a SD of 6.8. The recovery ......

A Comparative Study of Propofol and Sevoflurane for General Anesthesia in Laparoscopic Appendectomy

Introduction: Anesthesia plays a vital role in the success of surgical procedures, with the choice of anesthetic agents influencing patient recovery and postoperative complications. Propofol and sevoflurane are two commonly used anesthetic agents, each with distinct properties and implications on patient outcomes. The primary objective of this study was to compare the effects of propofol and sevoflurane on intraoperative hemodynamic parameters, recovery profiles, and postoperative complications in patients undergoing laparoscopic appendectomy. Methods: This prospective randomized trial was conducted over 2 years at Holy Family Red Crescent Medical College Hospital, Dhaka, Bangladesh, and included 180 laparoscopic appendectomy cases. Participants were randomized into two groups: 90 receiving propofol and 90 receiving sevoflurane for general anesthesia. The study received ethical approval from the hospital's review committee. Result: The mean age of patients in the Propofol group was 59.5 years (SD=2.6), while in the Sevoflurane group, it was 56.3 years (SD=7.9). Intraoperative heart rate and recovery profiles showed statistically significant differences between the two groups (p<0.05). The time to eye opening was 6.8 minutes (SD=1.5) for Propofol and 7.4 minutes (SD=1.7) for Sevoflurane. Postoperative complications were significantly higher in the Sevoflurane group: pain (35.56% vs. 24.44%), nausea and vomiting (27.78% vs. 16.67%), and analgesic requirements (44.44% vs. 30.00%). Conclusion: The findings of this study suggest that propofol may be a more favorable anesthetic agent compared to sevoflurane in laparoscopic appendectomy procedures. Propofol demonstrated better intraoperative heart rate control, faster recovery profiles, and reduced postoperative complications, potentially enhancing overall patient outcomes and satisfaction.

Electrolyte Imbalance Among Bangladeshi Patients With COVID-19.

Introduction Infection with SARS-CoV-2 begins in the lower respiratory tract, but COVID-19 often involves the renal system, resulting in serum electrolyte imbalance. Monitoring serum electrolyte levels and parameters of liver and kidney function is essential to understand disease prognosis. Objectives This study aimed to determine the effect of imbalances in serum electrolytes and other parameters on COVID-19 severity. Material and method This retrospective study comprised 241 patients, ages 14 years and older, including 186 patients who were moderately affected and 55 who were categorized as severely affected by COVID-19. Serum electrolytes (sodium (Na+), potassium (K+), and chloride (Cl-)) and biomarkers of kidney and liver function (creatinine and alanine aminotransferase (ALT)) were measured and correlated with disease severity. This research was conducted among admitted patients of Holy Family Red Crescent Medical College Hospital designated into two groups based on retrospective hospital records. Individuals with moderate illness had evidence of lower respiratory tract infection (cough, cold, breathless, etc.) during clinical assessment or imaging (chest X-ray and computed tomography (CT) scan of the lungs) and have an oxygen saturation by pulse oximetry (SpO2) ≥ 94% on room air at sea level. The severely ill group involved individuals with SpO2 ≤94% on room air at sea level and respiratory rate ≥ 30 breaths/minute, and critically ill patients are those who needed mechanical ventilation or required intensive care unit (ICU) care. This categorization was based on the Coronavirus Disease 2019 (COVID-19) Treatment Guidelines (https://www.covid19treatmentguidelines.nih.gov/about-the-guidelines/whats-new/). Results Average Na+and creatinine increased by 2.30 parts (95% confidence interval (CI) = 0.20, 4.81, P = 0.041) and 0.35 units (95% CI = 0.03, 0.68, P = 0.043) in severe cases compared with moderate cases. Older participants had relatively Na+lowered to -0.06 parts (95% CI = -0.12, -0.001, P = 0.045), significant Cl- reduction by 0.09 units (95% CI = -0.14, -0.04, P = 0.001), and ALT by 0.47 units (95% CI = -0.88, -0.06, P = 0.024), whereas serum creatinine was increased by 0.01 parts (95% CI = 0.001, 0.02, P = 0.024). The creatinine and ALT of COVID-19 participants were significantly higher in males by 0.34 units and 23.2 units, respectively,compared with females. In severe COVID-19 cases compared with moderate cases, the risks of hypernatremia, elevated chloride levels, and elevated serum creatinine levels were increased by 2.83-fold (95% CI = 1.26, 6.36, P = 0.012), 5.37-fold (95% CI = 1.90, 15.3, P = 0.002), and 2.00-fold (95% CI = 1.08, 4.31, P = 0.039), respectively. Conclusion Serum electrolyte and biomarker levels can serve as good indicators of the condition and disease prognosis of patients with COVID-19. Our purpose in this study was to determine the association between serum electrolyte imbalance and disease severity. We collected data from ex post facto hospital records and did not intend to assess the mortality rate. Consequently, this study expects that the prompt diagnosis of electrolyte disparity or disturbance possibly minimizes COVID-19-related morbidity and mortality.

Comparison of the Effects of General Anesthesia & Spinal Anesthesia for Elective Cesarean Section in Diabetic Pregnant Women

Introduction: Caesarean section (CS) is now one of the most commonly performed major operations in pregnant women throughout the world. While regional or general anaesthesia (GA) are both acceptable for caesarean delivery, use of GA has decreased dramatically in the past few decades due to a higher risk of anaesthesia-related maternal mortality. As a consequence, spinal anaesthesia (SA) is now the technique of choice for CS. It has become the preferred anesthetic technique when providing anesthesia for patients undergoing elective cesarean section as the risk of maternal and fetal complications associated with spinal anesthesia is less than with general anesthesia. Aim of the study: The aim of this study was to compare the effects of general & spinal anesthesia for elective cesarean section in diabetic pregnant women. Methods: This was a comparative observational study and was conducted in the Department of Anaesthesiology of Holy Family Red Crescent Medical College Hospital, Dhaka, Bangladesh during the period from January,2022 to December,2020.In our study we included 120 pregnant women with diabetes who were given spinal and general anesthesia during C-section surgery. Our patients were equally divided into two groups – i) Group A (Patients were given general anesthesia) & ii) Group B (Patients were given spinal anesthesia). Result: In total 120 patients from both the groups completed the study. In our study we found the mean age and BMI was 34.48± 11.79 years & 38.48± 14.89 kg/m2 respectively. Among all patients 16%, 58% & 27 % patients had Type 1, Type 2 & gestational diabetes respectively. The mean blood glucose level was significantly lower in SA (80.9 ±17.7) compared to GA (121.1± 17.4) after one hour of surgery. The mean of mother’s perioperative difference was significantly lower in SA (4.0 ± 0.19) compared to GA (9.4 ± 0.21). Conclusion: In our study, we found that general anaesthetic had a substantially higher influence on blood glucose concentrations ..

Impact of General Anesthesia on Preeclamptic Women in a Tertiary Care Hospital

Background: General anesthesia can be necessary during delivery for women with preeclampsia, a serious pregnancy condition characterized by high blood pressure and organ damage. However, the impact of general anesthesia on pregnant women with preeclampsia is not well understood and studies show conflicting results. The decision to use general anesthesia in such cases should be carefully weighed by the healthcare provider, considering the individual circumstances and potential risks and benefits. Aim of the study: The aim of this study was to assess the impact of general anesthesia on preeclamptic women. Methods: This cross-sectional study was conducted in Department of Anaesthesiology, Holy Family Red Crescent Medical College Hospital, Dhaka, Bangladesh, during the period from January 2022 to January 2023. Total 120 pregnant women with preeclampsia were included in this study. Result: Demographic and clinical data of participants in the general anesthesia group showed a mean maternal age of 24.12 years, 63.3% of whom were primigravida, and a mean weight of 76 kg. Pulse rate decreased from 97.8 before anesthesia to 91.1 after 1 hour, while systolic blood pressure decreased from 152.3 to 135.5 and diastolic blood pressure decreased from 92.5 to 79.4. The mean time from skin incision to delivery was 5.8 minutes and surgery lasted 43.5 minutes. Adverse events included surgical site infections (5.0%), anesthesia complications (7.5%), pulmonary edema (14.2%), and 1 death (0.8%). The mean postoperative pain score was 7.2. In this study, 29.2% patient were admitted to critical care unit. Newborns had a mean systolic arterial pressure of 55 mm Hg, heart rate of 141 beats per minute, and weight of 2.3 kg. Apgar score was below 6 for 20% at 1 minute and 10% at 5 minutes, with 52.5% of newborns admitted to the NICU. Conclusion: The present study provides important insights into the impact of general anesthesia on pregnant women with preeclampsia. While general anesthesia ......

Views of Medical Teachers in Overcoming Problems in Practicing Structured Oral Examination in MBBS Course of Bangladesh

Background: Traditional oral examination is a subjective tool of assessment, day by day which is losing its credibility because lack of its objectivity and impartiality. On the other hand, Structured Oral Examination (SOE) is a modified form of oral examination with some criteria where whole system is structured beforehand by preparing the questions in advance covering the educational objectives, carefully selecting the examiner, equal time allocated for each examinee & concurrent marking for each response. Structured Oral Examination (SOE) may be considered as the appropriate concept to overcome the drawbacks of the traditional oral examination but its implementation is a tedious, keen, time-consuming job. Aim of the Study: The aim of this study- to sought out suggestions of medical teachers in overcoming the problems in practicing SOE. Methods: This descriptive cross sectional qualitative study was conducted in two public and two private medical colleges, namely Dhaka Medical College, Sir Salimullah Medical College, Ibrahim Medical College and Holy Family Red Crescent Medical College in Bangladesh during the period from July 2010-June 2011. The MBBS course was then divided into 3 phases. In total 50 teachers who were conducting Structured Oral Examinations (SOE) for at least last two years in any of selected medical colleges were enrolled as the study subjects. An open-ended questionnaire was used to collect research data. Data were edited after collection. Then the content was analyzed by the researcher and has been presented in a narrative form and also quantification of these data shown separately for convenience. Results: Lack of proper teacher training & motivation, lack of uniformity in examination process in different medical colleges were common problem faced uniformly by all (100%). Inadequate number & remuneration of teachers, undue intervention of authority/political leaders/influential/co-examiner, chance of leakage of ill prepared & inadequate number of questions were other important problems & drawbacks in the opinion of 3/4th (74%) of the respondents. Above-all preparing well-structured SOE question card is a tedious & time-consuming procedure to all (100%) teachers. The ultimate recommendations of our teachers to overcome these were, regular & continuous training of teachers on assessment, central question bank & central monitoring & moderation of question for all medical colleges, appointment of post graduate doctor of same discipline in registrar or in equivalent post who are directly related to teaching & assessment were uniform opinion of all (100%) teachers. Other recommendations include number of competent teachers & remuneration of teachers should be increased - opinion of 3/4th (74%) of the respondents, separate medical education service so only motivated doctors can be selected in teaching profession, enforcing some strict regulatory laws, judicious setup/pairing of examiner, some (20%) open ended questions may be included in all question card for giving extra marks to extra ordinary student or for assessing exact level of learning in case of very poor performed student, rearrangement of subjects in different Phases to overcome time constraint, final examination may be conducted by separate medical college in separate venue. Conclusion: As per the findings of this study we can conclude that, considering the scholar opinion of medical teachers if their recommendations can be implemented, undoubtedly our medical education will progress further by certifying more competent and safer doctor for ourselves and universe.

Medical Termination of Pregnancy up to 28 Weeks -A Tertiary Care Hospital Study in Bangladesh

Background: Early pregnancy failure is a major public health problem throughout the world. It has been estimated that over 10-20% of pregnancies end up in spontaneous abortion and 80% of all these occur before 12 weeks. Mifepristone and Misoprostol are drugs, which are easy to store and require no surgical skills to administer, providing an alternative to surgical intervention that could increase access to abortion care. Objective: The objective of the study was to evaluate the safety, effectiveness, and acceptability of oral mifepristone and misoprostol for the termination of first- trimester pregnancy. The study was carried out in the department of Obstetrics and Gynecology, Holy Family Red Crescent Medical College Hospital, Dhaka, conducted from June 2021 to May 2022. Methods: A total of 80 women participants of reproductive age group with miscarriage at gestational age up to 28 weeks attended the outdoor of Holy Family Red Crescent Medical College Hospital, Dhaka. A complete history was taken from each patients and accompanying attendants. A thorough clinical examination was done. Relevant investigation reports were collected. Patients were given a tablet of Misoprostol on day 1. Mifepristone & Misoprostol, in the divided dose and repeated after 2 weeks & after 2 weeks only misoprostol is given for 3 days as per needed. They were followed up for 1-3 days before discharge. Participants were asked to return to the hospital two weeks later to conform to clinical status. If incomplete termination was determined by clinical exam or by ultrasound in either of the study arm, women were given the option for surgical evacuation or 500 mcg of Misoprostol for additional follow-up 1 week later to see if expulsion would have occurred spontaneously. If, after the second follow-up visit, abortion was not complete, a surgical completion was performed. Results: Patients belonged to the age group 18-25 years. Maximum numbers of cases were multiparous and belonged to 7-8 .........

Demographic, Clinicopathological Profile and Outcomes of COVID-19 among Hospital Admitted Children

Background: Although the corona virus disease 2019 (COVID‐19) outbreak is a global public health challenge, clinical patterns of children with COVID‐19 still remain unclear as most studies on COVID- 19 have focused on adults and only a small number of studies included pediatric patients.
 Objective: This study was done to observe the demographic profile, clinical presentation, laboratory finding and outcome of hospital-admitted children diagnosed as COVID-19.
 Method: This was a observational study done in Department of Paediatrics at Holy Family Red Crescent Medical College Hospital, Dhaka, Bangladesh from October 2021 to March 2022 for duration of six month. This study included all admitted children from newborn up to 14 years of age diagnosed with COVID-19 either by RT-PCR or by HRCT scan of the chest.
 Results: Among 35 patients mean age was 48.64 ± 63.10 month and 62.8% were male and 37.1% were female. Most common presentations were fever and cough both were (77.1%) followed by diarrhoea and vomiting which were 37.1% and 28.5% respectively. Leucopenia was noted in 22.8% patients. Chest X-Ray abnormalities were found in 60% of patients, bilateral patchy shadows were most common (24.2%) followed by consolidation (17.1%). 1 patient needed PICU, rest of the 34 (97%) patient in this study were discharged after full recovery.
 Conclusion: Clinical feature of COVID-19 in children differs from adult cases. Although fever and cough are main clinical symptoms, diarrhoea and vomiting are also common presenting symptoms in this study. Biochemical parameters like serum ferritin, D-dimer were also unremarkable and outcome was generally favourable.
 Bangladesh Journal of Infectious Diseases, April 2022;9(Suppl_1): S14-S19

Current Microbial Isolates and Their Antimicrobial Susceptibility Pattern from Wound Infection in a Tertiary Care Hospital

Background: Wound infection is one of the leading cause of mortality and morbidity worldwide. Objectives: To identify the current microbial isolates and their antimicrobial susceptibility pattern from wound infection in a tertiary care hospital in Dhaka city. Materials & Methods: This retrospective study was conducted in the department of Microbiology at Holy Family Red Crescent Medical College Hospital, Dhaka from July 2019 to December 2020 for a period of one and half years. Written consent was taken from corresponding authority. Microsoft Excel software was used for data analysis. A total 134 wound swab / pus were collected from the patients who were visited in outpatient department and were admitted at inpatient department with suspected wound infection. All samples were processed aerobically on Blood agar, MacConkeys agar media and incubated at 370C for 24 hours. Organisms were identified by standard procedures including colony characters, Gram staining and biochemical reactions. Antimicrobial susceptibility testing of all the isolates were performed by Kirby Bauer’s disc diffusion method. Results: A total 134 samples were analyzed. Of them, predominant populations were male 76(56.72%) and remaining were female 58(43.28%). Out of 134 samples 102 (76.11%) was culture positive. Culture positive was observed higher in inpatient department (IPD) 80 (78.43%) than outpatient department (OPD) 22 (21.57%). Majority of isolates were Gram negative bacteria. Among them predominant bacteria was E. coli 26(25.49%) followed by Klebsiella spp. 24(23.53%), Pseudomonas spp. 15(14.71%) & Proteus spp. 04(3.92%). Among the Gram - positive isolates 30(29.41%) was Staph. aureus. E. coli showed higher sensitivity to meropenem 88.46% & gentamicin 80.76%. Other drugs showed sensitivity to amikacin 65.38%, amoxicillin/clavulenic acid 53.84%, tetracycline 46.15%, ceftriaxone & ceftazidime 42.30%, trimethoprime/ sulfamethoxazole 34.61% & cefuroxime 23.07%. In Klebsiella spp. meropenem showed higher sensitivity 79.16% & gentamycin 66.66%. Other drugs like amikacin showed 58.33%, trimethoprime/ sulfamethoxazole 45.83%, ceftazidime & ciprofloxacin 20.83% sensitivity. Low sensitivity 16.66% to amoxicillin/clavulanic acid, cefuroxime, ceftriaxone, & tetracycline was found. Proteus spp. showed 75% sensitivity to meropenem. Cefuroxime, ceftriaxone, ciprofloxacin, ceftazidime, gentamycin, amikacin, trimethoprime/ sulfamethoxazole showed very low sensitivity 25% & amoxycillin/clavulanic acid showed 100% resistance. Pseudomonas spp. showed highest sensitivity 83.33% to piperacillin tazobactum, amikacin & imipenem, 77.77% to meropenem, 66.66% to gentamycin, 61.11% to ciprofloxacin, 50% to ceftazidime & 33.33% to cefepime. All the isolate of Staph. aureus was sensitive to amikacin 90%, amoxyclav 80%, cloxacillin 70%, ciprofloxacin 70%, gentamicin 63.33% & azythromycin showed lower sensitivity 43.33%. Conclusion: Most of the injectable antibiotics showed higher sensitivity which is an alarming sign for the clinician to treat wound infection. Periodic review of the bacteriological profile and antibiotic sensitivity pattern is highly essential. Antibiotic policy & infection control program should be included in every hospital to reduce this drug resistance. J Shaheed Suhrawardy Med Coll 2021; 13(1): 80-85

Association and Outcome of ABO-Rh Blood Group among 294 COVID-19 Patients admitted in A Dedicated Hospital

Aim: The rapid global spread of the novel corona virus SARS-CoV-2 has strained healthcare and testing resources, making the identification and prioritization of individuals most at-risk became a critical challenge. Recent evidence suggests blood type may affect the risk of severe COVID-19.Method: In this cross-sectional observational study, among 1348 admitted patients in Holy Family Red Crescent Medical College who tested positive for RT-PCR, 294 patients were included with known blood type to assess the association between ABO and Rh blood types and demographic profile, co-morbidities, clinical outcomes, and changes in the biomarkers. Result: among 294 patients admitted to the hospital with COVID-19, the mean age was 48 to 49 years. Out of all patients, 211 were male, and 83 were female, with a ratio of 1: 2.54. The highest numbers of patients were between 50-59 years. The highest percentage of diabetic patients were present in the AB blood group (54%), and hypertensive patients in the O and Rh-negative blood group (40.29%, 60%) which were statistically not significant. Other than that, COPD, IHD, and CKD were observed. Symptoms of patients were categorized as inflammatory and neurological. Shortness of breath (52.41%), fever (38.43%), and cough (28.23%) were observed among inflammatory symptoms, which were statistically significant and lethargy (16.25%) was only remarkable neurological involvement. Among all ABO blood groups, 'A' blood group of patients, present with a higher percentage of both inflammatory and neurological symptoms. Among the Rh blood group, Rh-negative patients did not present with diarrhea, sore throat, lethargy, anosmia, and loss of taste. Changes in biomarkers levels were also observed in all blood groups. Conclusion: COVID-19 patients with blood group A or B are at increased risk of disease severity with the highest number of co morbidities and symptoms compared with patients with blood group O or AB.

Histopathological Pattern of Primary Glomerulonephritis - A Single Center Experience

lomerulonephritis is the most common cause of chronic kidney disease in our country like in other developing countries. The incidence and histological pattern of primary GN in our countare is inadequately described. This cross-sectional prospective study was conducted at the nephrology unit in Holy Family Red Crescent Medical College Hospital, a tertiary care teaching hospital in Dhaka, Bangladesh starting from January 2019 - December 2019 including all patients with suspected primary GN who underwent kidney biopsies. Total 35 biopsies were performed. M: F 1.3:1 .Mean age was 33.71+_12.2 yrs. Membranoproliferative GN (34.28%) was the most common cause followed by mesangioproliferative (22.85%), IgA nephropathy (17.14%), membranous (11.42%), FSGS ( 11.42%) and minimal change disease (2.8%). Among 35 cases, 20 had proliferative verity. In immunofluroscence study, 19 had mild to marked deposits of immunoglubulin. 5.71% had post-biopsy complication which was not significant enough. As the sample size was small so needs more studies in large to get the specific epidemiological patterns of primary GN.

Comprehensive Overview of 473 Cases of COVID-19: Outcome Experiences of a Dedicated Hospital in Dhaka, Bangladesh

Aim: The study aimed to observe and compare the demographic, comorbidities, biomarkers in different categories of diagnosed COVID-19 patients admitted to a COVID dedicated tertiary care hospital in the pic time of the pandemic, 2020, at Dhaka, Bangladesh. Methods: This retrospective study was conducted from May to September 2020 in 720 bed Holy Family Red Crescent Medical College Hospital. Four hundred seventy-three patients included in this study, diagnosed by RT-PCR of the nasopharyngeal swab, were divided into four groups. The mild group includes 254 patients, the moderate group has 82 patients, 38 patents in the severe group, and the critical group who were admitted to ICU, 99 patients. Demographic data, available investigation reports of individual patients, obtained from hospital records manually and compared between all four different categories of patients.