Mymensingh Medical College Hospital Research Articles

Exploring the Relationship between Vitamin D Deficiency and Disease Activity in Rheumatoid Arthritis Patients

Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease marked by inflammation, pain, and joint damage. Vitamin D deficiency worsens inflammation and increases RA disease activity. Aim of the study: This study aimed to explore the relationship between Vitamin D deficiency and disease activity in rheumatoid arthritis patients. Methods: This cross-sectional study was conducted in the Department of Medicine, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2003 to December 2003. The study included 100 rheumatoid arthritis patients, divided into two groups- Group A: 50 patients with normal Vitamin D level and Group B: 50 patients with Vitamin D deficiency. Result: No significant difference was found between the groups in demographic characteristics. Group B exhibited significantly greater disease severity compared to Group A. The Disease Activity Score (DAS28) was higher in Group B (4.2 ± 1.3) than in Group A (2.8 ± 1.1), with a p-value < 0.001. CRP levels were also elevated in Group B (12.4 ± 3.5 mg/L vs. 5.3 ± 2.1 mg/L; p < 0.001). Group B had more swollen joints (6.2 vs. 3.5) and tender joints (7.3 vs. 4.1), with p < 0.001. ESR levels were higher in Group B (38.7 vs. 22.4 mm/h; p < 0.001). Negative correlations were found between Vitamin D levels and DAS28 (r = -0.48), CRP (r = -0.51), and ESR (r = -0.52). Conclusion: This study concludes that Vitamin D deficiency is significantly associated with increased disease activity, inflammation, and joint involvement in rheumatoid arthritis patients.

Comparison of Outcomes of Bell’s Palsy Patients Treated with Steroid and Steroid with Antiviral Drug in a Tertiary Care Hospital

Background: Bell’s palsy is the most common acute mononeuropathy associated with idiopathic unilateral facial weakness, characterized by facial asymmetry. Though steroids have effectiveness in managing Bell’s palsy, the use of antiviral is still debatable. Objective: To compare the outcome of Bell’s palsy with treatment by steroid versus combination of steroid and antiviral drugs. Methodology: A prospective analytical study was performed on 84 patients with acute Bell’s palsy attending at Neurology outpatient department of Mymensingh Medical College Hospital from July 2014 to June 2016. The patients were divided into two groups purposively after initial assessment as per House-Brackmann grading system (HBS). Group-I patients were treated with oral prednisolone and oral valacyclovir and Group-II patients were treated with oral prednisolone only. Both groups received facial exercises as per demonstration and proper eye care throughout the study period. Follow-up was done after 2 weeks, 4 weeks and 3 months for collection of data about recovery according to reassessment. Results: The analysis revealed that recovery rates at all 3 follow-ups were higher in the combination group than that of the prednisolone-only group [29(67.44%) versus 18 (43.90%) at 2nd week follow-up, 35(81.39%) versus 25(60.97%) at 4th week follow up and 40 (93.02%) versus 30(73.17%) at 3rd month follow-up]. Moreover, the expected recovery rate was higher in severe Bell’s palsy patients in the combination group than in steroid-alone group (22, 88.0% complete recovery versus 13, 54.17% complete recovery at the end of 3 months of treatment) [p=0.034]. haemorrhagic shock, spinal cord damage, septic shock and crush syndrome. Conclusion: The study showed antiviral (valacyclovir) plus steroid (prednisolone) to be more effective than steroid (prednisolone) alone in the treatment of Bell’s palsy. Moreover, outcome was more favorable in combination groups presenting with severe disease. Lessen their severity. Journal of Monno Medical College December, 2023; 9 (2):58-62

Outcomes of Laparoscopic Cholecystectomy in Elderly Patients

Background: Laparoscopic cholecystectomy (LC) is the standard treatment for both symptomatic gallstones and acute cholecystitis. Laparoscopic cholecystectomy is the surgical procedure to remove the gallbladder. While historically challenging in cases of acute cholecystitis, advancements in laparoscopic techniques have made it a viable and preferred treatment option for this condition. Objective: Our study’s objective was to evaluate the efficacy of LC in elderly individuals. Methods: This prospective observational study was conducted at the general surgical department of Mymensingh Medical College Hospital from January 2023 to December 2023. A total number of 70 elderly patients who had acute cholecystitis (symptomatic gallstone disease) were included in this study. Based on physical examination, general conditions, laboratory investigation, and radiographic results, gallstone disease was diagnosed. All cases provided a signed, informed consent form. The research was done after approval of the ethical committee. Results: Among the 70 patients the majority of patients (87.14%) fall within the 60-69 years age range. A smaller proportion of older patients: A smaller percentage (12.86%) of patients are aged 70 years or older. The majority of the patients (68.30%) were male and (32.70%) were female. Hypertension is the most prevalent comorbidity among the patients, approximately 15.6% of the patients. Diabetes mellitus follows as the second most common comorbidity, with 11.1% of patients Cardiac disease is the third most frequent comorbidity, present in 6.7% of the patients. Peripheral vascular disease is the least common comorbidity among those presented, affecting 4.4% of the patients. Regarding the symptoms and clinical presentation, patients exhibited a variety of the usual gallbladder disease symptoms, including epigastric pain (51.30%), fatty food intolerance (37.14%), nausea and vomiting (24.29%), Murphy’s sign (14.29%), biliary colic (32.86%), right upper ......

Predictors of Morbidity and Mortality of Gastrointestinal Perforation in Children

Background: Gastrointestinal perforation is a common surgical problem in paediatric surgical ward in our country. It carries a high morbidity and mortality in children. The predictors of postoperative morbidity and mortality are still not well established. Objectives: The objective of this study was to identify the predictors of morbidity and mortality following surgery for gastrointestinal perforation in children. Methods: This was a single centre cross sectional type of descriptive observational study carried out in the Department of Paediatric Surgery, Mymensingh Medical College Hospital with 16-month duration from 1st January, 2017 to April 30, 2018, in children aged from 2-12 years. Predictors related to postoperative morbidity and mortality were investigated. Results: A total of 40 patients were selected for this study with mean age of 8.92±2.61 years. Male: female was 1.5:1. Analysis indicated that factors associated with postoperative morbidity and mortality were low BMI, poor nutritional status, low serum total protein and albumin, delay in seeking treatment and contaminated peritoneal collection. Appendicular perforation was the highest number perforation in 23(57.5%) patients. Ileal perforation was the second highest number 8(20%). Appendectomy was the highest surgical procedure 21(52.5%), followed by resection-anastomosis and wound excision & repair 3(7.5%) each. Serum total protein and albumin were below normal limit among 15(37.5%) and 35(87.5%) patients respectively. 13(32.5%) patients received treatment 72 hours after onset of symptom and 18(45%) patients undergone operation within 24-48 hours of admission. Postoperative complications developed in 30 patients. Among them SSI were in 20(66.66%), SIRS in 9(30%) and leakage of repair in 1(3.33%) patient. Mortality rate was 5%. Conclusion: Poor nutritional status, low total serum protein and albumin, delay in initiation of treatment, and contaminated peritoneal fluid are the predictors of morbidity and mortality of gastrointestinal perforation in children.

Maternal Status during and after Labor Beyond 28 Weeks of Gestation at a Tertiary Hospital

Background: The journey of pregnancy and childbirth embodies a critical period in a woman's life, impacting both maternal and child well-being. Understanding maternal status during and after labor beyond 28 weeks of gestation holds significant clinical relevance, given its implications for obstetric management and outcomes. Objective: This study aimed to assess maternal status during and after labor beyond 28 weeks of gestation at a tertiary hospital. Methods: A cross-sectional descriptive observational study was conducted at Mymensingh Medical College Hospital from March 2019 to August 2019. The study included pregnant women with fetal malpresentation from 28 to 42 weeks of gestation admitted to the labor and antenatal ward. A total of 50 participants were purposively sampled. Data were collected using a structured questionnaire and analyzed using SPSS version 16. Ethical approval was obtained, and informed consent was obtained from all participants. Results: The study revealed a diverse age distribution among mothers, with the majority falling within the 26-30 age bracket (40.0%). Parity distribution showed a significant proportion of mothers with four or more children (40.0%). Prolonged labor emerged as the most common complication (6.0%), followed by obstructed labor (4.0%). Maximum vaginal deliveries occurred at 28-31 weeks of gestation, while cesarean sections were predominant at or above 36 weeks. Cesarean section exhibited the highest survival frequency (100%), followed by vaginal delivery (90%) and assisted breech delivery (80%). Postpartum hemorrhage was the most common maternal morbidity (6.0%). Conclusion: In conclusion, our study sheds light on maternal demographics, labor complications, delivery modes, and perinatal outcomes at a tertiary hospital. The age distribution revealed diversity, with most mothers aged 26-30. Many were multiparous, underscoring the importance of obstetric history. Prolonged labor was predominant, emphasizing the need for vigilant monitoring. Cesarean sections were common after 36 weeks, ensuring higher survival rates. Despite benefits, postpartum hemorrhage posed a significant concern. This highlights the necessity for comprehensive obstetric care to improve maternal and neonatal outcomes. Further research is imperative to refine maternal-fetal care in tertiary settings.

Outcomes of Fetal Malpresentation Beyond 28 Weeks of Gestation at a Tertiary-Level Hospital

Background: The term malpresentation encompasses any fetal presentation other than vertex, including breech, face, brow, shoulder, and compound presentations. Both fetal and maternal factors contribute to the occurrence of malpresentation. Objective: To determine the outcomes of fetal malpresentation beyond 28 weeks of gestation at a tertiary-level hospital. Material and Methods: It was a cross sectional descriptive type of observational study carried out in the Department of Obstetrics & Gynaecolgy, Mymensingh Medical College Hospital, Mymensingh during the period of March 2019 to August 2019.Structured questionnaire including history and physical examination of pregnant women were included in data collection sheet-and analysis was done by computer software SPSS version 20. Results: This study shows majority of the women 20(40%) were in the age group of 26-30 years. The average age was 29.9 years. The common fetal malpresentation was breech presentation 35(70%) followed by5(10%) was brow presentation, 5(10%) was shoulder presentation and 3(6%) was compound presentation and maximum seen in multiparity 20(40%) Regarding mode of delivery, 15(30%) delivered vaginally and 35(70%) had to do caesarean section. 13(26%) women suffered from complication during labour. Most common fetal morbidity were birth asphyxia 10(20%) and perinatal mortality was 2(4%). Conclusion: It was observed that major fetal morbidities were low birth weight, birth asphyxia and perinatal infection. Majority patients were delivered by caesarean section. Identification of the cases that require caesarean section, and allowing appropriate and safe trial of labour and vaginal delivery (if no contraindication) require clinical experience and technical skill. The obstetricians should acquire and maintain such knowledge through clinical exposure and attending obstetric emergency skill courses.

Patterns of Childhood Solid Malignant Tumours in Paediatric Surgery Department of Mymensingh Medical College Hospital

Patterns of Childhood Solid Malignant Tumours in Paediatric Surgery Department of Mymensingh Medical College Hospital

Evaluation of the Patients with Placenta Praevia in Mymensingh Medical College Hospital, Bangladesh

Placenta praevia is a life-threatening condition both for mother and foetus and defines high risk pregnancy. A cross-sectional, observational study was conducted from July to December of 2021 in the Department of Obstetrics & Gynaecology of Mymensingh Medical College Hospital, Mymensingh, Bangladesh, to assess the relationship between previous Caesarean scar and subsequent development of placenta praevia. A total of 48 women of placenta parevia were taken in this study as diagnosed through ultrasonogram. In age distribution of these patients, peak incidence was found in the 26-35 years age group (54.10%) and the oldest was at her 42 years. Most of the patients (35.41%) did not take any antenatal check-up before their admission into hospital. The majority patients (64.58%) had history of previous Caesarean scar than vaginal delivery (35.41%) and previous two scars (51.61%) were most common. Ultrasonographically, partial variety was more (29.10%) common than others. Most pregnancies were (78.08%) delivered abdominally. In fetal outcome, 22.91% of babies were premature but did not need any NICU support, whereas 22.83% needed admission into NICU. Primary postpartum haemorrhage was the most common among complications (37.50%). This study suggests identifying the risk factors for placenta praevia. Early diagnosis, creating awareness and organizing a strong supportive surgical skilled team are needed to reduce maternal and foetal morbidity and mortality in such cases. CBMJ 2024 July: vol. 13 no. 02 P: 135-140

Biofilm formation, agr typing and antibiotic resistance pattern in methicillin-resistant Staphylococcus aureus isolated from hospital environments.

Biofilm development significantly enhances the virulence of methicillin-resistant Staphylococcus aureus (MRSA), leading to severe infections and decreased susceptibility to antibiotics, especially in strains associated with hospital environments. This study examined the occurrence of MRSA, their ability to form biofilms, agr typing, and the antibiotic resistance profiles of biofilm-forming MRSA strains isolated from environmental surfaces at Mymensingh Medical College Hospital (MMCH). From 120 swab samples, 86 (71.67%) tested positive for S. aureus. MRSA was identified in 86 isolates using the disk diffusion technique, and by polymerase chain reaction (PCR), 56 (65.1%) isolates were confirmed to carry the mecA gene. The Crystal Violet Microtiter Plate (CVMP) test revealed that 80.35% (45 isolates) were biofilm-forming and 19.6% (11 isolates) were non-biofilm-forming. Out of 45 biofilm producer isolates 37.5% and 42.9% isolates exhibited strong and intermediate biofilm-forming characteristics, respectively. Molecular analysis revealed that 17.78% of MRSA isolates carried at least one gene related to biofilm formation, specifically icaA, icaB, and icaD genes were discovered in 13.33%, 8.89%, 6.67% of the MRSA isolates, respectively. In agr typing, the most prevalent group was agr I (71.11%), followed by group III (17.78%) and group II (11.11%). Group IV was not detected. The distribution of agr gene groups showed a significant difference among biofilm-forming isolates (p < 0.05). In agr group I, 18.75% of isolates carried the icaA gene, 12.5% carried the icaB gene, and 9.37% carried the icaD gene. Biofilm-forming genes were not detected in any of the isolates from agr groups II or III. There are no statistically significant differences between agr groups and the presence of these genes (p > 0.05). Antibiotic resistance varied significantly among agr groups, with agr group I displaying the highest resistance, agr group II, and agr group III exhibiting the least resistance (p < 0.05). Seventy-three (73.3%) of the isolates were multi-drug resistant, with agr group I displaying nineteen MDR patterns. The occurrence of MRSA in hospital environments and their capacity to form biofilm raises concerns for public health. These findings support the importance of further research focused on agr quorum sensing systems as a basis for developing novel antibacterial agents.

The Outcome of a Single Stage Repair for Proximal Hypospadias in Otherwise Healthy Child at Mymensingh Medical College Hospital

Hypospadias is a birth defect that involves the development of a penile urethra that opens on the ventral side of the penis. Proximal hypospadias is one of the most severe forms of hypospadias that is generally associated with chordee. Hypospadias surgery, especially in the proximal location, is challenging, and many operations have been proposed, including one-stage and two-stage operations. Objectives: The aim of the study was to evaluate the success rate and safety of a single-stage surgery in children with proximal hypospadias and to determine the complications. Materials and Methods: This interventional study was conducted on forty patients, aged between one and twelve years, who had proximal hypospadias and were admitted to Mymensingh Medical College Hospital between January 2014 and April 2015. A one-step operation with tabularized incised plate urethroplasty (TIPU) was done. Patients’ demographic data, intraoperative details, and postoperative outcomes were recorded within 3 months after the operation. Results: The common age at surgery was 2-4 years, and they were 40% of the total patients. There was Haematoma in 5% of cases, a devitalized skin flap in 7.5% of cases, and stent blockage in 10% of cases during the immediate postoperative period. In our 3-month follow-up, all the patients had conical glans and cylindrical penises. Meatal stenosis and narrow stream were noted in 5 percent of patients but were relieved with meatal dilatation. Urethrocutaneous fistulas remained patients in 7.5% of cases. Conclusion: TIPU repair of proximal hypospadias is safe, effective, yields good results, and has low risks of complications in otherwise healthy children. It is a less risky and more viable method that helps to exclude extra steps in the process.

The Association between Platelet Lymphocyte Ratio and In-Hospital Outcomes in Patients with First Attack of Acute ST-elevation Myocardial Infraction following Thrombolysis with Streptokinase in a Tertiary Care Hospital

Introduction: Platelet Lymphocyte ratio (PLR) has been found to be a good predictor of future adverse cardiovascular outcomes in patients with ST-segment elevation myocardial infarction (STEMI). Aim: Investigation was done in the aim to detect the role of Platelet Lymphocyte ratio (PLR) in predicting in-hospital adverse cardiac events in patients with STEMI thrombolysed with streptokinase in a tertiary care hospital. Methods: This cross sectional descriptive study carried out in the Department of Cardiology, Mymensingh Medical College Hospital, Mymensingh for fifteen-month duration from January, 2018 to March, 2019, in STEMI patients, who were thrombolysed with inj. Streptokinase (STK) had blood samples at admission, analyzed complete blood counts for PLR calculation. They were grouped into two, low and high PLR, taking 150 as cut-off. Chi square test was used to compare rate of adverse events and death in hospital stay. Logistic regression analysis was used to estimate predictive ability of PLR for in-hospital cardiac events. Results: A total of 79 patients among 217 patients had complications. Patients in high PLR group had higher rate of complications (63.6% vs. 21.4%, p &lt;0.001) in hospital than those in low PLR group. Arrhythmias (13.0% vs. 5.0%, p &lt;0.036), Heart failure (45.5% vs. 15.0%, p=0.001), Cardiogenic shock (10.4% vs.3.6%, p &lt;0.001), Death (9.1% vs. 6.4%, p=0.473), occurred more in high PLR group. Mean PLR was significantly different between Group-I and Group-II (96.21±27.79 vs. 233.21±88.20, p&lt;0.001). Multivariate regression analysis showed PLR an independent predictor of in-hospital adverse cardiac events (at 10% level of significance, p = 0.001). Conclusion: High admission PLR is an independent predictor for in-hospital adverse cardiac events in patients hospitalized for STEMI thrombolysed with streptokinase.

Assessment the Incidence of Inferior Wall Myocardial Infarction, its Association with Right Ventricular Infarction and Function and its Clinical Outcome

Introduction: Myocardial infarction is one of the most common diagnoses in hospitalized patients. Myocardial infarction was previously thought to be a disease of mainly the left ventricle. Right ventricular infarction was just a pathological entity. Myocardial infarction may go undetected or may lead to catastrophic events leading to sudden cardiac death or causing severe hemodynamic derangements. Objective: To find out the Assessment the incidence of Inferior Wall Myocardial Infarction, its association with right ventricular infarction and function and its clinical outcome. Methods: The hospital based observational cross-sectional study was contacted at Department of Cardiology, Mymensingh Medical College Hospital, Bangladesh from 1st January 2022 to 30th January 2024. Conducted in intensive care unit, on an in-patient basis, consist of 50 cases of inferior wall MI. In patients with RVMI, the hospital death is high and major complications are greater. Right ventricular infarction leads to hemodynamic instability, atrio-ventricular conduction blocks, and in-hospital mortality in patients with inferior wall myocardial infarction. Results: Out of the total 150 cases of acute MI were included. The incidence of IMI among all the cases of AMI was 33.3%. In our study group of IMI RVI incidence was 30%. So, the incidence of RVI in all cases of AMI was 10%. There is a significant association between IWMI and RVMI and RVMI is seen in about 20% of cases and most common complication encountered was hypotension followed by complete heart block. The mean age of participants was 58.33 and maximum number of patients was in the age group of 40-60 (43%) and consists of 80% males and 20% females. Among them 51.4% was hypertensive, 22.8% were diabetic, 74.3% smokers, 11.42% were alcoholics. In this study 58.33% of patients with RVMI and 2% of patients without RVMI were presented with hypotension at the time of admission. Complete heart block seen in 13.33% of IWMI patients and Hypotension seen in 20% IWMI patients RVMI group. Right ventricular myocardial infarction seen in 20% of IWMI cases and TR is seen 66% of patients of IWMI with RVMI and 4% of patients of IWMI without RVMI. Conclusion: The incidence of mortality and complications can be reduced only when we are fully aware of the diagnosis and the complications that can occur in RVI. So, in all cases of IMI, RVI should be looked for by using simple and specific investigation like RPLs of ECG. Involvement of the right ventricle in inferior wall myocardial infarction significantly affects the mortality and morbidity and complications.

#330 Pattern of short-term outcomes of renal function in postpartum acute kidney injury patients: a single-center study in Bangladesh

Abstract Background and Aims Postpartum acute kidney injury (PPAKI) is a formidable health problem in pregnant woman especially in developing country. Monitoring outcomes like serum creatinine levels and glomerular filtration rates is vital. Understanding these short-term results is crucial for timely interventions and better patient care, improving prognosis in this critical condition. The aim of the study was to assess the short-term outcomes of renal function in postpartum acute kidney injury patients. Method This prospective observational study was conducted at Mymensingh Medical College Hospital in Bangladesh between March 2020 and April 2021. The study enrolled 153 postpartum acute kidney injury (AKI) patients from the Departments of Nephrology and Departments of Obstetrics &amp; Gynaecology using purposive sampling. Data on patient demographics, etiology, and presentation were collected. Statistical analysis was performed using SPSS version 23.0 and a p- value of &amp;lt;0.05 was considered statistically significant. Results After three months, among 153 postpartum acute kidney injury (PPAKI) patients, 77.8% of the patients fully recovered, 5.2% of the patients developed chronic kidney disease. Dialysis was required in 24.2% of the patients, among them 2.2% remained on dialysis. Sadly, 15.7% didn't survive, that highlight the severity of postpartum acute kidney injury. Mortality rates didn't significantly differ between vaginal delivery (14.9%) and cesarean section (16.0%) groups (p=0.488). Both groups show positive outcomes, with 75.5% of vaginal delivery and 79.2% of cesarean section patients achieving full recovery. Blood urea also significantly decreased from 128.51 ± 39.59 to 101.65 ± 55.57 mg/dl during this period Conclusion Most postpartum acute kidney injury patients show promising recovery, but some still grapple with persistent renal impairment. Tragically, mortality rates underscore the severity of this condition. Importantly, survival rates don't significantly differ between vaginal delivery and cesarean section patients, emphasizing timely interventions.

Characterization of β-lactamase and virulence genes in Pseudomonas aeruginosa isolated from clinical, environmental and poultry sources in Bangladesh.

The emergence and spread of multidrug-resistant pathogens like Pseudomonas aeruginosa are major concerns for public health worldwide. This study aimed to assess the prevalence of P. aeruginosa in clinical, environmental, and poultry sources in Bangladesh, along with their antibiotic susceptibility and the profiling of β-lactamase and virulence genes using standard molecular and microbiology techniques. We collected 110 samples from five different locations, viz., BAU residential area (BAURA; n = 15), BAU Healthcare Center (BAUHCC; n = 20), BAU Veterinary Teaching Hospital (BAUVTH; n = 22), Poultry Market (PM; n = 30) and Mymensingh Medical College Hospital (MCCH; n = 23). After overnight enrichment in nutrient broth, 89 probable Pseudomonas isolates (80.90%) were screened through selective culture, gram-staining and biochemical tests. Using genus- and species-specific PCR, we confirmed 22 isolates (20.0%) as P. aeruginosa from these samples. Antibiogram profiling revealed that 100.0% P. aeruginosa isolates (n = 22) were multidrug-resistant isolates, showing resistance against Doripenem, Penicillin, Ceftazidime, Cefepime, and Imipenem. Furthermore, resistance to aztreonam was observed in 95.45% isolates. However, P. aeruginosa isolates showed a varying degree of sensitivity against Amikacin, Gentamicin, and Ciprofloxacin. The blaTEM gene was detected in 86.0% isolates, while blaCMY, blaSHV and blaOXA, were detected in 27.0%, 18.0% and 5.0% of the P. aeruginosa isolates, respectively. The algD gene was detected in 32.0% isolates, whereas lasB and exoA genes were identified in 9.0% and 5.0% P. aeruginosa isolates. However, none of the P. aeruginosa isolates harbored exoS gene. Hence, this study provides valuable and novel insights on the resistance and virulence of circulating P. aeruginosa within the clinical, environmental, and poultry environments of Bangladesh. These findings are crucial for understanding the emergence of β-lactamase resistance in P. aeruginosa, highlighting its usefulness in the treatment and control of P. aeruginosa infections in both human and animal populations.

Trans-Abdominal Ultrasonographic Evaluation of Molar Pregnancy

Background: Molar pregnancy is the most common benign from of gestational trophoblastic neoplasm. Molar pregnancy has distinction histologic characteristics a custic or grape like degeneration of chorionic villi, absent or inadequate vascularization of chorionic villi and abnormal proliferation of placental trophoblast. Objective: To assess the role of ultrasonography (UCG) in the evaluation of molar pregnancy. Method: This cross sectional study was carried out on consecutively selected 40 patient out of 45 patient who were suspected to suffering from molar pregnancy. This study was take place Mymensingh Medical College Hospital from those who were attended the department for ultrasonography for suspicious features of gestational trophoblastic diseases. Result: Among the 40 patients in this study 9 were 15-20 years of age, total 24 were between 20-35 years of age and 7 patients were 35-45 years of age. The range of age was 15 to 45 years. Conclusion: In conclusion ultrasonography can be accepted as an initial imaging modality in the evaluation of gestational trophoblastic diseases.

Evaluation of the effectiveness of the combination of doxycycline and trifarotene for managing acne vulgaris of moderate to severe severity: a study in a tertiary care hospital

Background: Acne vulgaris (AV), affecting diverse skin types, prompts a uniform therapeutic approach, with options ranging from topical to systemic treatments. Trifarotene, a fourth-generation topical retinoid, offers precise skin-specific effects, especially in facial and truncal acne treatment. The study aimed to evaluate the effectiveness of the combination of doxycycline and trifarotene for managing AV of moderate to severe severity. Methods: At Mymensingh medical college hospital, the study enrolled 100 individuals to evaluate a new treatment for moderate AV from Jan-Jun 2023. Treatment comprised oral doxycycline (100 mg) and topical trifarotene (0.005% w/w) over 2 months, following a stratified randomization process. Evaluation criteria included clinical scores, lesion counts, and safety parameters, analyzed using SPSS v20. Results: Study on doxycycline and trifarotene for moderate to severe acne shows promising results. Participants, mainly aged 15-25 exhibit diverse demographics and balanced gender ratio. Significant improvement on investigator's global assessment (IGA) scale is noted, with 35% experiencing notable progress at 9-10 weeks, alongside reduction in Propionibacterium acnes growth and positive patient feedback with 36% reporting 'good' response. Conclusions: The study on doxycycline and trifarotene for moderate acne exhibits robust methodology with adherence to established practices and stratified randomization. Results, assessed via IGA, demonstrate promising efficacy and safety, providing insights for diverse skin types' acne management enhancement.

Bacterial Isolates from Diabetic Foot Ulcer with Antibiotic Sensitivity Pattern

A cross-sectional, descriptive study was carried out in the Department of Surgery, Mymensingh Medical College Hospital, Mymensingh, Bangladesh, between October 2014 and September 2015, to determine the microbiological profile and antibiotic susceptibility patterns of organisms isolated from diabetic foot ulcer. A total of 130 patients of diabetic foot ulcer were included in the study according to inclusion and exclusion criteria. Samples of pus were collected from those patients and sent for culture and sensitivity tests. Out of 130 cases, the highest number of patients 55(42.4%) were in 50-59 years age group. The mean age was 60.1±9.8 years. Most of the patients (70%) were male. 90(69.2%) samples yielded growth, while 40(30.8%) did not show any bacterial growth. Out of those 90 samples with growths, 112 bacteria were isolated. Of them, 59(52.7%) organisms were gram-positive, while 28(25%) were gram-negative and 25(22.3%) organisms were both gram-positive and gram-negative. Out of 59 gram-positive isolates, 35(59.3%) were S. aureus, 18(30.5%) were Enterococci, and 6(10.2%) were Streptococci. In 28 gram-negative isolates, 15(53.7%) were E. coli, 6(21.4%) were Pseudomonas, 4(14.2%) were klebsiella, and 3(10.7%) were proteus. Regarding antibiotic sensitivity, all gram-positive bacteria (100%) were sensitive to vancomycin. S. aureus was 80% sensitive to ceftriaxone, 71.4% to flucloxacillin, 65.7% to clavulanic acid, 54.2% to ampicillin, 48.5% to amoxicillin, and 28.5% to cotrimoxazole. Enterococci spp. was 61.1% sensitive to ceftriaxone, 33.3% to clavulanic acid, (27.7%) to ampicillin, and 16.6% to both amoxicillin and cotrimoxazole. Streptococcus spp. showed 83.3% sensitivity to ceftriaxone, 66.6% to flucloxacillin, 33.3% to clavulanic acid, and 16.6% to cotrimoxazole. Among gram-negative bacteria, E. coli was found to be sensitive to imipenem (100%), ceftriaxone (86%), amikacin (100%), cefuroxime (73.3%), ampicillin (33.3%), ciprofloxacin (60%), and gentamycin (60%). Pseudomonas was found to be sensitive to imipenem (50%), ceftriaxone (66.6%), amikacin (83.3%), and cefuroxime (66.6%). Klebsiella was found to be sensitive to imipenem (100%), ceftriaxone (75%), amikacin (75%), cefuroxime (50%), and ciprofloxacin (25%). Proteus was found to be sensitive to imipenem (100%), ceftriaxone (66.6%), amikacin (66.6%), cefuroxime (33.3%), ciprofloxacin (66.6%), and gentamycin (66.6%). CBMJ 2024 January: vol. 13 no. 01 P: 89-94

The Risk Factors in Patients of Myocardial Infarction: An Observational Study

Background: Acute myocardial infarction is a condition where the blood flow to the heart muscle is blocked, leading to the death of heart tissue. It is a major cause of heart failure and fatalities worldwide. Objective: To assess risk factors in MI patients and determine clinical criteria for patients with MI. Methods: This cross-sectional observational study was done from January 2023 to June 2023 at the Mymensingh Medical College Hospital, Mymensingh, Bangladesh. A total of 100 people were observed in this study. Results: Our study showed that a maximum of 32 individuals aged 50-59 suffered from acute myocardial infarction. Most were male (74%) and Muslim (93%). 83% had hypertension, 78% had diabetes mellitus, and 77% were smokers. Different types of MI were identified, with anterolateral MI being the most common (25 patients). Conclusion: Several risk factors increase the chance of developing acute myocardial infarction, including family history, sedentary lifestyle, unhealthy diet, smoking, lack of exercise, and certain health conditions like diabetes, hypertension, dyslipidemia, SLE, vasculitis, or obesity.

The Clinical Profile and Hospital-based Outcome of Acute Myocardial Infarction in Elderly Patients More than 60 Years and Patients Younger than 60 Years: A Comparative Study

Background: Acute myocardial infarction refers to a pathological state characterized by the obstruction of blood supply to the myocardium, resulting in the subsequent necrosis of cardiac tissue. It constitutes a significant etiological factor contributing to the development of heart failure and global mortality rates. Objective: The purpose of this study was to conduct a comparative analysis of the clinical characteristics of acute myocardial infarction in old and young individuals who sought medical attention at a tertiary care hospital. Methods: This cross-sectional observational study was done from January 2023 to June 2023 at the Mymensingh Medical College Hospital, Mymensingh, Bangladesh. A total of 100 people were observed in this study. Result: We have two age groups: under 60 (60%) and over 60 (40%). We name them A and B. Group A patients are 86.7% male and 13.3% female. Group A patients are 88.3% Muslim and 7% Hindu. This patient group includes 30% service workers and 20% businesses. The remaining 28.3% were patients from diverse jobs and 1.7% were farmers. With 55% male and 45% female Muslim patients, Group B includes domestic workers (45%) and businessmen (22.5%). Service workers 17%, farmers 2.5%, and other patients 12.5%. Group A had 85% chest pain, 46.7% dyspnea, 90% palpitations, and 86.7% nausea and vomiting. Ischemic chest pain, dyspnea, palpitations, nausea, and vomiting affected 87.5% of Group B.Top MI risk factors. Group A had dyslipidemia (95%), family history of MI (93.3%), sedentary lifestyle (91.7%), smoking (88.3%), hypertension (86.7%), and diabetes (78.3%). The sedentary lifestyle, 100% family history of ischemic heart disease, 97.5% dyslipidemia, and 77.5% diabetes and hypertension characterized Group B. Lastly, our study reports patients' average pulse and blood pressure. In Group A, the average pulse was 81.73 ± 14.60, systolic blood pressure was 129.50 ± 20.28 mmHg, and diastolic blood pressure was 89.41 ± 12.35. Group B had an .......

Associations between ECG Changes and Echocardiographic Findings in Patients with Acute Non-ST Elevation Myocardial Infarction

Background: STEMI shows specific ECG changes due to sudden coronary blockage, but NSTEMI has varied ECG characteristics, including ST depressions and T wave inversions. Echocardiography, especially tissue Doppler imaging and speckle tracking, is crucial for diagnosing and predicting outcomes in acute coronary syndrome. The study aims to correlate ECG changes with echocardiographic findings in NSTEMI, offering potential diagnostic insights. Objective: The study aims to connect ECG alterations with echocardiographic findings in NSTEMI patients. Methods and Materials: This cross-sectional study took place from January to June 2023 at a Mymensingh Medical College Hospital, Mymensingh, Bangladesh. The research included 109 NSTEMI patients, both with and without cardiac history. Inclusion criteria were age above 30 and ischemic type of chest pain. Results: Out of 109 admitted patients, 67.4% were male and 6.4% were female. The average age was 54.34 ± 2.31 years, and prevalent conditions included 7.3% with diabetes, 11% with dyslipidemia, and 0.9% with edema, while 73% had a family history of ischemia. Conclusion: There were inconsistencies between the ECG and Echo in identifying the site of the infraction in the MI patients. Pulmonary hypertension, infection, ischemic stroke, and inferonasal regional wall motion abnormalities. Maximum no association was found in ECG changes and echocardiographic findings with acute non-ST elevation myocardial infarction.