Faridpur Medical College Hospital Research Articles

Association of Admission CRP Level with Short Term Outcome in Patients with Acute Ischemic Stroke

Acute ischemic stroke is very common in Bangladesh and one of the most common causes of physical disability and death. This study was performed to determine the prognostic value of CRP measured in the very early phase of ischemic stroke for short term functional outcome of patients with acute ischemic stroke. This observational study was carried out in the departments of Medicine and Neurology of Faridpur Medical College Hospital, Faridpur from July 2012 to December 2012. Total 100 patients of acute ischemic stroke were recruited in this study. Blood sample was collected for CRP level during the time of admission. In this study 26% of patients were in low CRP group (CRP <3 mg/L), 34% of patients were in medium CRP group (CRP 3-9.9 mg/L), 40% of patients were in high CRP group (CRP ≥10 mg/L). According to modified Rankin Scale (mRS) scoring system the high CRP group having a 44% risk for a poor outcome (mRS ≥3 ) vs 27% for the low CRP group ( p = 0.01). According to Barthel Index (BI) scoring system the high CRP group having a 45% risk for a poor outcome (BI <95) vs. 25% for the low CRP group (p = 0.002). Z test of proportion revealed significant association between high CRP level and poor short-term outcome of patients with acute ischemic stroke. Bangabandhu Sheikh Mujib Med. Coll. J. 2024;3(1):12-15

Hyperbilirubinemia is a Predictor of Gangrenous or Perforated Appendicitis

Introduction: Acute appendicitis is the most common acute abdominal condition that requires surgical intervention in childhood. Patients with complicated appendicitis (CA) were reported to have elevated serum bilirubin or reduced serum sodium levels in several studies. Aim of the study: The purpose of this study was to establish the role of hyperbilirubinemia as a predictive parameter for the prediction of either acute, or gangrenous/perforated appendicitis. Methods: The present descriptive type observational study was accomplished in Department of Surgery, Faridpur Medical College Hospital, Bangladesh. Medical files of the patients, who underwent appendectomies between July 2015 and January 2016, were evaluated. Age, gender, preoperative white blood cell count (WBC), neutrophil count (NEU), neutrophil percentage (NEU %), C-reactive protein (CRP), total/ direct/indirect bilirubin levels, and preoperative presentation & severity, complication of disease, outcome and postoperative hospital stay findings were recorded. The Fisher’s exact, Pearson’s χ2, ANOVA, and Kreskas–Wallis tests while logistic regression for multivariate analysis was performed. P value < 0.05 was accepted as statistically significant\ for this study. Result: 50 patients of more than 15 years old participated in this study. Histopathological examinations revealed normal appendix in 11 (22%) patients, non-complicated acute appendicitis in 18 (36%), and appendiceal gangrene/perforation in 21 (42 %) patients. WBC, NEU, NEU%, and CRP levels were found significantly elevated in cases of acute and gangrenous/perforated appendicitis (p < 0.01). Total and direct bilirubin levels were also significantly higher in patients with acute and gangrenous/perforated appendicitis (p < 0.01). Multivariate analysis, higher levels of CRP were associated with 14 times, elevated total bilirubin levels were associated with five times, and elevated direct bilirubin levels were associated with 36 times greater risk ........

Outcome of Placenta Percreta Management by Planned Peripartum Hysterectomy in a Tertiary Level Hospital

The incidence of placenta accreta spectrum is gradually increasing due to increased rate of caesarean sections (CS). Due to torrential haemorrhage, placenta percreta is one of the main reasons for emergency peripartum hysterectomies and mostly results in subsequent maternal mortalities and morbidities. In such cases, caesarean hysterectomy leaving the placenta in situ without any separation of placenta is preferred. We observed the outcome of such patients managed with planned caesarean hysterectomy. This cross-sectional observational study was conducted at the Department of Obstetrics, Faridpur Medical College Hospital, Bangladesh. A total of 14 patients who underwent planned caesarean hysterectomy due to placenta percreta were studied. We performed delivery of the baby through upper segment transverse incision without placental separation. The umbilical cord was ligated leaving the placenta in the uterine cavity and cut margins of the uterus was closed with few interrupted sutures and then hysterectomy was performed. Among 14 cases, the mean age was 30 years, mean gestational age at the time of delivery was 36 weeks, and all had a history of one or more CS. Before operation, mean Hb% was 8.9 g/dl. A mean of 1.5 units pre-operative and 1.2 units post-operative blood transfusions was needed. Post-operative mean Hb% was 10.5 gm/dl. Half of the women were discharged on their 3rd post-operative day. None of them had serious pre- and post-operative complications. In light of our findings, we recommend managing placenta percreta by planned caesarean hysterectomy with the placenta left in situ to minimise blood loss and subsequent maternal mortality and morbidity.
 Bangabandhu Sheikh Mujib Med. Coll. J. 2022;1(2):80-84

Role of Ultrasonography in the Diagnosis of Acute Appendicitis

Introduction: Acute appendicitis is still prevalent as a major surgical emergency. Due to the fast progress of the ailment, surgery is often the most sensible approach to manage it. But any surgery comes with its fair share of risk. If the diagnosis of the disease can be made more accurate prior to surgery, the error rate of negative appendectomy can be greatly reduced. Aim of the study: The aim of the study was to evaluate the role of ultrasonography in the diagnosing acute appendicitis. Methods: This prospective cross-sectional study was conducted at the Department of Surgery, Faridpur Medical College Hospital, Faridpur, Bangladesh. The study duration was 6 months, from November 2013 to April 2014. A total of 100 cases were selected from those admitted to the emergency department of the study hospital with pain in the right lower quadrant of the abdomen for the purpose of this study. Result: Among the 100 participants of the study, histopathological diagnosis showed that 86% were acute appendicitis cases and 14% had normal appendicitis. Gender or age had no significant association with histopathological diagnosis, but male prevalence was observed in the study, with a high prevalence of young adults. The original site of pain was periumbilical pain shifted to the right iliac fossa for half the participants. Pain duration was between 18-24 hours for 36% of the cases. All participants presented with pain, fever, anorexia, and nausea had a high prevalence among participants. The sensitivity and specificity of high-resolution ultra-sonogram were 84.9% and 85.7% respectively. Conclusion: Appendicitis is a disease of the young, and can occur in participants of both genders. Histopathological diagnosis has no significant association with patient age or gender. Ultra-sonogram has high sensitivity and specificity ratio in diagnosing acute appendicitis and also has a high positive predictive value but low negative predictive value.

Evaluation of Retained Placenta: A Study in a District Hospital

Introduction: The placenta is an organ that is attached to the uterine wall and connects the fetus with the mother through the umbilical cord. The placenta is said to be retained when it is not expelled out even half an hour after the birth of the baby. The study aimed to evaluate the retention of the placenta. Methods: This was a cross-sectional study was conducted at the Department of Obstetrics & Gynecology , Faridpur Medical College Hospital, Faridpur from June 2016 to November 2016. The sample was taken purposively and the sample size was 110. Patients were diagnosed with a case of 'retained placenta' through proper history, and clinical examination. Written informed consent was taken from every patient or their relatives. The information was collected in a preformed data collection sheet. Observation and results of the study and statistical analysis were presented in tables. Data were analyzed by using the computer-based program Statistical Package for Social Science (SPSS) software for windows. Result: Out of 110 study subjects about 58.18% were found in the age group of 21-30 years and 20% were found in the age group of 20 years. The age of the patients ranges from 18 to 40 years. Among 110 study subjects, 64.55% were from lower socioeconomic status, 27.27% were from middle socioeconomic status and only 8.18% belonged to affluent socioeconomic status. The majority (74.54%) of cases were delivered at home and 25.46% of cases were delivered at different levels of hospitals (among them 1.82% of cases occurred in the institute where the study was done). Among them 20% were para- 1, 54.54% were para-2-4 and 25.46% of respondents were para ≥ 5. The majority (60%) of study subjects were admitted between 3 to 8 hours after developing retained placenta, followed by 18.19% who came within 2 hours. Regarding the clinical presentation, 69.09% of study subjects presented with anemia of varying degrees, 24.53% presented with shock, 5.45% presented with sepsis, and only 0.93% (one patient) presented with acute renal failure. Concerning predisposing factors of retained placenta, 25.46% of study subjects were grand multipara, 11.82% had H/O MR or D & C, 10.90% with prolonged labor, 10.90% respondents had IUD, 10% with past H/O retained placenta, 8.20% had preterm labor, 2.72% had H/O LUCS/ other uterine surgery and 20% were without any predisposing factors. Among the respondents, 27.27% of study subjects presented with genital tract trauma, 5.45% with sepsis, 5.45% with acute renal failure, 0.91% with DIC, 0.91% with uterine prolapse 64.55% with no associated conditions/complications. Among the total study population, 58.18% of retained placenta cases required manual removal under G/A, and 41.82% were managed by manual removal of the placenta under deep sedation. Out of 110 respondents, 21.82% of cases of retained placenta did not require any blood transfusion, 58.18% received 1-2 units and 20% received 3 or more units of blood transfusion. During management, 13.63% of study subjects developed uterine atony, 0.91% developed uterine inversion, 2.73% were complicated by uterine perforation, 0.91% were complicated by anesthetic hazard; 81.82% had no complication during management. Out of 110, 18.18% of study subjects experienced various complications. Among them 9.10% were managed by intrauterine balloon tamponade,2.73% required hysterectomy, and 6.37% were managed by other measures. 70% of respondents stayed in the hospital for 1-3 days, 26.36% for 4 to 7 days, and 3.64% stayed more than 7 days before discharge. Regarding the outcome of retained placenta among study subjects, 80.91% improved and discharged, 10% had severe anemia and required subsequent blood transfusion, 6.36% developed an infection, 0.91% developed acute renal failure and 2 patients died (one due to DIC and another patient due to irreversible shock). Conclusion: The retained placenta is an obstetric emergency. Rapid recognition and treatments are essential because heavy blood loss with coagulation problems remains the lethal factor in this disease. Rapid control of hemorrhage should be the first initiative. Active management of the third stage of labor lowers the danger by a significant percentage.

Acute Coronary Syndrome among Patients with Chest Pain: Prevalence and Common Cardiovascular Risk Factors

Background: Chest pain not yet diagnosed), has been introduced in order to describe the subset of patients without coronary ischemic etiology of their chest pain. Chest pain is one of the common reason and Acute coronary syndrome is an important cause of chest pain. Objective: To assess the Prevalence of Acute Coronary Syndrome among Patients Presenting with Chest Pain and its association with common cardiovascular risk factors. Methods: This was an observational study conducted at Faridpur Medical College Hospital, Faridpur, Bangladesh from January to June 2022 enrolling 224 participants consecutively. Participants were interviewed focusing history of hypertension, diabetes, smoking and nature of chest pain. The diagnosis of participants whether it was acute coronary syndrome or not were recorded. Prevalence of acute coronary syndrome was calculated. Linear regression analysis was done to see the correlation with tested variables. Results: Out of 224 participants, 150 (66.96%) were male. Hypertension was present in 84 (37.5%), diabetes in 60 (26.78%) and 52 (23.21%) were smoker. Mean age was 51.82±14.24 years. Seventy-five (66.96%) were male. Forty-two (37.5%) were hypertensive, 60 (26.78%) were diabetes and 52 (23.21%) were smoker. Fifty-six (50%) had nonspecific chest pain, 70 (31.25%) had atypical chest pain and 42 (18.75%) had typical chest pain. Among the participants 76 (33.93%) had acute coronary syndrome. Acute coronary syndrome showed positive correlation with age, gender, nature of chest pain, hypertension and smoking. Conclusion: Acute coronary pattern was one of the common cause of casket pain among actors visiting exigency of a tertiary cardiac centre. We set up positive correlation of age, gender, nature of casket pain, hypertension and smoking with opinion of ACS. Cases with these threat factors need strong dubitation of ACS and prompt work up when they present with casket pain so that they can get proper operation on time.

Foreign Bodies in Ear and Upper Aero-digestive Tract in Tertiary Level Hospital

Background: Foreign Bodies (FBs) are the commonest emergencies in Otorhinolaryngology. The most common incidences arein nasal cavity, ears and oropharynx. The most commonly swallowed foreign bodies in children are coins. It was aimed todescribe the nature, types, and location of FB impaction in addition to procedure of anesthesia & management of patients as well. Methods: All patients with history and clinical features of foreign body in otorhinolaryngology in both sexes during the 6months study period constituted the study population. This was a descriptive type of cross-sectional study done in a tertiarylevel hospital (Faridpur Medical College Hospital, Faridpur, Bangladesh). Results: The study was included 58 patients aged 6 months to 72 years were seen (mean: 22.46 years) with 33 males and 25females and a male: female ratio of 1.4: 1. Most common site of impaction were nasal cavity 19 cases (52.6%) then ear 13 cases(22.4%), hypopharynx 9 cases (8.6%),oropharynx 6 cases(10.3%), esophagus 5 cases (8.6%), soft tissue neck 4 cases (6.9%)and larynx 2 cases (3.4%). In this study most common FB was Fish bone 8(13.79%) then coin 5(8.62%). Most of the oro-pharyngeal FBs and nasal FBs were removed directly 33 (56.90%) by naked eye with forceps or FB hook. Only 2 cases (3.40%)nasal FBs were removed by endoscope. Esophagoscopy was done in 14 cases (24.1%).Foreign body soft tissue neck wasremoved with external approach in 4 patients (6.9%).Only in 3 cases microscope was needed to remove foreign body from ear(5.3%).Only in 2 cases (3.4%) laryngoscopy was needed to remove foreign body. FBs from nose & oropharynx mostlyremoved without anaesthesia 25(43.10%) though some FBs from nose & oro-pharynx were removed under local anaesthesiaby using 10% Xylocaine spray. Conclusion: The study findings felt the need for parental health education on object placements, and a high index of suspicionamong practitioners to facilitate early referral and avoid preventable complications.

Prevalence of Major Non- Communicable Diseases in a Tertiary Care Hospital

Background: Non-communicable diseases (NCDs) are increasing trend globally and account for the majority of all new cases of morbidity and mortality. Previously, its prevalence was more in developed countries, but now it is increasing in low income settings. Early diagnosis, treatment and preventive measures will reduce the mortality, morbidity, and financial burden on families and community.
 Objectives: The study was carried out in a tertiary care hospital to explore the incidence of common NCDs and whether there was differentiation in ages, sexes and residences among hospitalized patients.
 Methods: A descriptive cross sectional type of observational study was done in a tertiary care hospital, Bangabandhu Sheikh Mujib Medical College Hospital (former Faridpur Medical College Hospital), Faridpur, Bangladesh from January 2019 to July 2019 for a period of 7 months. Patients were selected randomly in different adult medicine wards, including all sexes, races, and residences. Common NCDs included were cardiovascular diseases like hypertension (HTN), ischemic heart disease (IHD) and stroke; chronic respiratory diseases like COPD and asthma; diabetes mellitus (DM) and malignancy.
 Result: A total of 1119 patients were hospitalized for different reasons; among them, 891 patients were diagnosed as NCDs (79.62%). In this study, male patients were more than females (63.41% vs. 36.59%), common age groups between 46 and 60 (33%) and the next age groups between 31 and 45 (26.26%); the mean age was 41.51. Younger people aged 60 years are affected more than the elderly. Rural patients were more than urban (64.54% vs. 35.46%). Common NCDs were stroke (25.58%), hypertension (18.40%), diabetes (12.0%), ischemic heart disease (9.20%), chronic respiratory diseases (6.95%), malignancy (3.36%) and other less common non-communicable diseases (24.47%).
 Conclusion: Globally, the world is facing a growing burden of NCDs and it is a great challenge to face this upcoming situation. Measure should be taken, that how can we reduce the incidences, morbidity and mortality of those devastating diseases by prevention of their risk factors and early treatment.
 CBMJ 2021 January: vol. 10 no. 02 P: 80-84

Mode of Presentation of Liver Cirrhosis: A Study in a Tertiary Level Hospital

Liver cirrhosis is an important cause of death and disability globally. This cross-sectional study was carried out in Faridpur Medical College Hospital from November 2018 to April 2019 to see the patterns of clinical presentations and associated factors among admitted liver cirrhosis patients. A total of 89 patients were included. Data were collected by detailed history from patients or their relatives followed by thorough physical examination as well as diagnostic evaluation; then those were checked, verified for consistency and edited for result. Among total respondents, the majority were male (69.7%) with a male to female ratio of 1:0.44. Age of patients ranged between 22-106 years with mean age of 52.33 year. The patients predominantly presented with ascites (49.4%), gastrointestinal bleeding (27%), peripheral edema (24.7%), and encephalopathy (21.3%). The in-hospital case fatality rate was 11.2% and the patients presented with decreased urinary output, peripheral edema and encephalopathy had statistically significant death rate. The results of the study highlighted that the patients with liver cirrhosis mostly present with features of decompensation and there is a statistically significant relation with some of these clinical presentations with in-hospital mortality. Faridpur Med. Coll. J. 2021;16(1):39-41

Oral Nifedipine versus Intravenous Labetalol for Acute Blood Pressure Control in Severe Hypertension of Pregnancy: A Study at Faridpur Medical College Hospital

The first line antihypertensive treatment for severe hypertension of pregnancy includes labetalol, hydralazine, or nifedipine. Rapid but safe blood pressure control allows the definitive treatment, the delivery of baby to be carried out with minimal delay and good maternal and fetal outcomes. This non-randomized clinical trial was performed in Faridpur Medical College Hospital to compare the effectiveness and tolerability of oral nifedipine and intravenous labetalol in the acute control of severe hypertension of pregnancy. Total 50 admitted pregnant women with a viable fetus (>_ 24 weeks of gestation) having severe hypertension were allocated into two groups, Group A: 25 patients receiving oral nifedipine (10 mg), Group B: 25 patients receiving injectable labetalol (with incremental doses: 20, 40, 80mg). Up to 5 doses were tried for each drug at 15 minutes interval until target blood pressure (<_150/100 mmHg) was achieved. Baseline characteristics like mean age, mean weight, heart rate, systolic and diastolic pressures were similar in both labetalol and nifedipine groups. The average time required to achieve target blood pressure was 30.33 ± 10.44 minutes for labetalol and 25.63 ± 10.12 minutes for nifedipine (p=0.9129). Feto-maternal outcomes and adverse drug related effects were similar among the two groups. Both intravenous labetalol and oral nifedipine were found to be equally effective and well tolerated. Nifedipine may be preferable as it is a simple, flat dose schedule and an oral regimen. Faridpur Med. Coll. J. 2021;16(1):25-29

Pattern of Complementary Feeding Practices among Mothers Attending at a Tertiary Level Hospital in Bangladesh

Optimal growth and development of a child depends mostly on proper breastfeeding and complementary feeding practices. However, many children yet suffer from malnutrition and the recommended practices of complementary feeding have yet not been established among the majority of the population. In this observational study, we looked for the causes behind the improper complementary feeding practices among the mothers attending the outdoor and indoor units of the Department of Pediatrics, Faridpur Medical College Hospital, Faridpur, Bangladesh, from January 2018 to January 2019. A total of 447 mothers were interviewed regarding their complementary feeding practices and data were analyzed to find out the demographic and social influences. The majority of the respondents were between the age group of 21-25 years (54%). Thirty five percent were illiterate, 60% were from the rural area, 78% were housewives, 64% came from a nuclear family, and 87% had a monthly family income of 5000-20000. Most of the deliveries were conducted at home (58%) and the most common source of feeding related information was healthcare workers (66%). Only 41% of the mothers started complementary feeding at the age of 6 months. The most common complementary food was Suji, 60% of them lacked the knowledge of food preparation and 35% of them practice forceful feeding to the children. The promotion of proper complementary feeding needs to be ensured to achieve the children's catch-up growth and development. Faridpur Med. Coll. J. 2021;16(1):30-33

Postpartum Acute Kidney Injury - a Study at Faridpur Medical College Hospital

Postpartum Acute Kidney Injury (AKI) is one of the serious complications of pregnancy and is associated with high mortality and morbidity. Although Postpartum AKI has decreased markedly in developed countries in the last 50 years, but it is a challenging health problem in pregnant women, specially in the developing countries like Bangladesh. Aim of this study was to determine the contributing factors and outcome of postpartum AKI. This observational study was conducted in the department of nephrology, Faridpur Medical College Hospital from January 2018 to December 2019. During that study period thirty two patients with postpartum AKI were admitted in the above mentioned department. Demographic, clinical and laboratory data of those patients were recorded. Mean age of patients was 25.3 ± 4.2 years, and the 72% patients underwent cesarean section. Oliguria was the main presentation (91%). Puerperal sepsis (38%), postpartum hemorrhage (22%), and Eclampsia (16%) were the common contributing factors. Hemodialysis was required for most of the patients (75%). Therefore early diagnosis, identification and treatment of cause, timely initiation of renal replacement therapy is mandatory. Faridpur Med. Coll. J. 2020;15(2): 62-64

An Experience of 436 COVID-19 Patients in Bangladesh

SARS-CoV-2 corona virus infection (COVID-19) is a public health emergency of international concern causing many deaths. The aim of this study was to assess demography, clinical presentation, blood group, disease severity and outcome of COVID-19 infected patients in Bangladesh. This is a cross sectional, observational study of 436 COVID- 19 infected patients, confirmed by RT-PCR assay's on nasopharyngeal swab specimens, presented at Faridpur Medical College Hospital and Kurmitola General Hospital during the month of May to September, 2020. Data were collected in a preformed data sheet and analyzed for variables included demography, source of infection, spreading within family, clinical features, blood group, disease severity and outcome. Study showed mean age 41.27±16.65 years with slight male predominance (1.87:1), most were service holder (47%), source of infection was unknown (40%), from infected family members (35%) and working place (23%). In 44% cases, family members of infected index cases were unaffected. Common co-morbidities were Diabetes Mellitus (19.7%) and Hypertension (19%). Blood group of most (41.29%) was B positive. Disease spectrum ranged from asymptomatic (15%), mild (53%), moderate (19%) and severe (13%) disease. Common presenting symptoms were fever (72.2%), cough (42.9%) dyspnoea (29.6%), myalgia (22.9%), anorexia (17.9%), fatigue (17.4%), diarrhea (13.5%), headache (12.4%) and anosmia (12.4%). Majority (75.2%) had nonspecific (fever, mayalgia, fatigue) symptoms and in 16.28% cases it was the only presentation. Respiratory (61.9%) and GI (28.4%) symptoms presented either concomitantly or with nonspecific symptoms (55%). Majority (95%) of patients recovered and only 5% died. Faridpur Med. Coll. J. Jan 2020;15(2): 53-57

C-reactive protein as a Predictor of Early Outcome Following Acute Myocardial Infarction

Background: Acute myocardial infarction (AMI) which constitutes STEMI & NSTEMI triggers an inflammatory reaction, which plays an important role in myocardial injury. An inflammatory marker such as C - reactive protein (CRP) reflects the extent of myocardial necrosis.Circulatory levels of Creactive protein (CRP) may be an independent risk factor for cardiovascular disease.
 Methods: An observational study was carried out in the department of Medicine and department of Cardiology of Faridpur Medical CollegeHospital, Faridpur from May 2012 to October 2012. One Hundred Patients were selected consecutively from acute Myocardial Infarction patients admitted in the department of medicine and Department of Cardiology of Faridpur Medical College Hospital. The sample was selected purposively. Quantitative value of CRP was done on first day of admission. Z test of proportion was done to analyze the data. Level of significance was < 0.05.
 Results: In this study, 84% of AMI had CRP level >6 mg/dl.86% patients had STEMI, and 14% patients had NSTEMI. Out of 86 patients with STEMI, 72 patients (83.72%) & out of 14 patients with NSTEMI, 12 patients (85.71%) had high CRP. Out of 72 STEMI patients with high CRP level, 22 patients (30.55%) & 6 patients (8.33%) were expired. Out of 12 NSTEMI patients with high CRP level, 2 patients (16.67%) developed left ventricular failure&no one was expired. STEMI was associated with worst outcome 30.55% vs 16.67% left ventricular failure and 8.33% vs 0% mortality rate.
 Conclusions: High CRP is a predictor of adverse early outcome in patients with acute coronary syndromes
 Bangladesh J Medicine July 2021; 32(2) : 95-98

Effectiveness of Magnesium Sulphatein Term Neonate with Perinatal Asphyxia: A Study in Faridpurmedical College Hospital, Faridpur, Bangladesh

Effectiveness of Magnesium Sulphatein Term Neonate with Perinatal Asphyxia: A Study in Faridpurmedical College Hospital, Faridpur, Bangladesh

Pattern of Serum Electrolytes Imbalance among Patients with Acute Exacerbation of COPD Admitted in a Tertiary Level Hospital

Chronic Obstructive Pulmonary Disease (COPD) is a progressive disease and there is not yet a cure. Not only in Bangladesh but also worldwide the incidence of COPD is increasing. The disease is associated with some metabolic derangement such as electrolytes imbalance. Those factors further worsen the disease course. As a result COPD related morbidity, mortality and cost to health systems are also increasing. This cross-sectional observational study was conducted in Faridpur Medical College Hospital (FMCH) over 6 months among 100 patients who were admitted with acute exacerbation of COPD. The mean age was (58.13 ± 9.96) years. In this study serum electrolytes were found below the normal range in 68 (68%) cases and within normal range in 32(32%) cases. Isolated hyponatremia was observed in 36(53%) and 15(22%) had isolated hypokalaemia. Both hyponatremia and hypokalaemia was found in 17(25%) cases. The mean serum sodium level was (133.82±2.52) mmol/l. Among patients with isolated hyponatremia, 24(67%) had mild hyponatremia and 12(33%) got moderate hyponatremia. Again the mean serum potassium was (3.45±0.23) mmol/l. Among patients with isolated hypokalaemia, 10(67%) had mild hypokalaemia and 5(33%) had moderate hypokalaemia. Both hyponatremia and hypokalaemia was observed in one fourth of total electrolytes depleted cases and all were within the mild range. No patient had severe hyponatremia or hypokalaemia. Faridpur Med. Coll. J. Jan 2020;15(1): 24-27

Antimicrobial Resistance Situation in SCANU of Faridpur Medical College Hospital, a Tertiary Level Hospital in Bangladesh

Considering the high risk of neonatal sepsis in low and middle-income countries, empirical antibiotic therapy is commonly employed in most cases to clinically suspected septic neonates without the aid of culture and antibiotic sensitivity report. Increasing antimicrobial resistance is posing a threat to these practices and urges the obligation for understanding the causative organisms and their changing resistance pattern at the local level. Aim of this study was to identify the pathogens responsible for neonatal sepsis and understand their current antimicrobial resistance pattern. This prospective study was undertaken in the Special Care Newborn Unit of the Faridpur Medical College Hospital from October 2017 to November 2018. Venous blood culture and antimicrobial susceptibility of 56 suspected neonatal sepsis cases were studied. Among the 56 clinically suspected cases 86% had culture positive isolates in the specimen. Predominant isolates were Klebsiella (42%) and coagulase-negative staphylococci (25%). Of all the identified bacteria, 88% were resistant to >_ 3 classes of antibiotics. Eighty-five percent of Klebsiella isolates were found to be carbapenem-resistant along with 100% of E. coli isolates and 95% of Klebsiella isolates had possible extended spectrum b -lactamase production. Seventy-five percent of Acinetobacter isolates were multidrug-resistant and 100% of coagulase-negative staphylococci were methicillin resistant. The array of causative organisms and their increasing resistance to commonly practiced antibiotics are alarming. It is urgent to develop strategies focusing on all healthcare levels to cease the spread of antimicrobial resistance in an effort to reduce the burden of neonatal sepsis. Faridpur Med. Coll. J. Jan 2020;15(1): 28-33

Incidence and Risk Factors of Neonatal Hypoglycemia During the First 48 Hours of Life in a Tertiary Level Hospital

Neonatal hypoglycemia is one of the common metabolic problems causing neonatal mortality and neurodevelopmental impairments. In developing countries, where the classic risk factors for neonatal hypoglycemia prevail; understanding the prevalence and association of hypoglycemia in different settings is essential. Our aim of this study was to identify the incidence and associated risk factors that predicted the occurrence of neonatal hypoglycemia during the first 48 hours of life. This hospital-based prospective case-control study was undertaken in the Department of Pediatrics in Faridpur Medical College Hospital, Bangladesh; from June 1, 2019 to July 31, 2019. Blood glucose levels of all the admitted newborns were noted on two occasions at 24 hours apart. Hypoglycemic neonates were selected as case and 3 euglycemic neonates for each case with similar age and sex were selected as control. Clinical characteristics of the mother and the baby were analyzed statistically in relation to the occurrence of hypoglycemia. We have found the incidence of neonatal hypoglycemia was 17.2%. Prematurity, low birth weight, small and large for gestational age, perinatal asphyxia, hypothermia, and delay in the initiation of breast feeding were significant neonatal factors. Maternal factors such as gestational diabetes mellitus, eclampsia, and fever during delivery had strong association as well. Understanding the incidence and risk factors may help prompt identification of hypoglycemic baby may also help to take early and effective measures to prevent the sequels of neonatal hypoglycemia. Faridpur Med. Coll. J. Jan 2020;15(1): 12-15

Ligation of the Intersphincteric Fistula Tract (LIFT) Technique in the Treatment of Complex Perianal Fistula: Experience of First 50 Cases

Perianal fistula is a common disease and surgery is the only treatment option. Many surgical techniques have been described. Ligation of intersphincteric fistula tract (LIFT) is a sphincter saving surgical technique in which fistula tract is ligated and excised through intersphincteric approach. The aim of study is to present our experience of first 50 LIFT procedures particularly healing rate, recurrence rate and complications from the procedure. This is a prospective observational study started from March 2018 on whom underwent LIFT procedure for primary complex perianal fistula of infective origin at Faridpur Central Hospital and Faridpur Medical College Hospital. In this study, 50 patients (42 male and 8 female) of average age of 39±7.6 years with complex fistula were included. The mean operative time was 34.7±5.67 minutes and most of the fistulas were transsphincteric variety (90%). Median wound healing time was 21.45±6.34 days for intersphincteric wound and 26.78±6.93 days for the external opening of the fistula. Mean follow up period was 10.5 months. Seven patients of our series developed recurrent fistula, making the overall success of 86%. None of the patient in our series developed incontinence. LIFT procedure has the advantage of preservation of anal sphincter, minimal tissue injury, shorter healing time, relatively easy to perform, and high success rate. It's a good choice for treatment of complex perianal fistula. Faridpur Med. Coll. J. Jan 2020;15(1): 3-7

Sociodemographic Status and Pattern of Poisoning in a Tertiary Level Hospital

Poisoning is responsible for a large number of hospital admissions in Bangladesh. Sociodemographic status and pattern of poisoning are changing day by day. That's why poisoning related mortality and morbidity are varying. This study was carried out in the Medicine department of Faridpur Medical College Hospital (FMCH) from January to June 2017, to observe the sociodemographic status, such as age, sex, residence, occupation, level of education of patient, mode and pattern of poisoning. Cases were selected randomly in ward and data were collected in a data sheet with consent. Sample size was 100 and age range was from 15 to 65 years. Among them female were 60(60%). Maximum number (64%) of cases was on age range from 15 to 25 years that comprises 41% female and 23% male. Subsequently second highest number (20%) was on range from 26-35 years. Most of the female (60%) were housewives and maximum (40%) of male were student. Highest number (60%) of patients studied academically below SSC. Regarding mode of poisoning suicidal attempted was highest (85%) and among them about 68% were female. Organophosphorus compound (OPC) was most common (52%) poisoning agent and most of them (67%) were female. Street poisoning was observed in 11(11%) cases and all were male. Subsequently sedative and harpic poisoning occurred in same number (10 in each) of cases. History of gul poisoning was found in 8% cases and most of them were female. Besides them paracetamol, savlon and others poisoning were documented in 4%, 2% and 3% respectively. Faridpur Med. Coll. J. Jan 2020;15(1): 8-11