Mymensingh Medical College Hospital Research Articles

Morbidities and Mortalities among Infant of Diabetic Mother in a Newly Established Scabu of a Tertiary Care Hospital, Bangladesh

Introduction: Diabetes mellitus has long been associated with perinatal morbidity and mortality. It complicates 2% to 3% of all pregnancies; 90% of these cases present with gestational diabetes mellitus. In our population Gestational diabetes mellitus develops among 6.7% of all pregnancies. Macrosomia (28%), hypocalcaemia (22%), hyperbillirubinaemia (19%), polycythemia (34%), perinatal asphyxia, birth injury and congenital anomaly (6-9%) are the complications of infant of diabetic mother (IDM).Materials and Methods: This prospective observational study was done in the newly established Special Care Neonatal Unit (SCANU) to determine the morbidities and mortalities among IDM babies admitted in to Mymensingh Medical College Hospital (MMCH), Bangladesh from January to March 2015. A total 50 IDM patients who admitted during this period were recruited in the study irrespective of their gestational age, birth weight, pattern and duration of maternal diabetes.Results: Male and female patients were 29 (58%) and 21 (42%). Caesarian and vaginal delivery were 43 and seven cases. Gestational and pre-gestational diabetes mothers were 35 (70%) and 15 (30%) respectively. The important morbidities in order of frequency were found perinatal asphyxia (50%), macrosomia (48%), neonatal jaundice (44%), hypoglycaemia (40%), hypocalcaemia (36%), polycythemia (28%), CHD (20%), neonatal sepsis (20%), birth trauma (12%), TTN (6%), RDS (6%), GIT problem (2%) respectively. Mortality was recorded in three patients. Conclusion: Our observations show the high prevalence of IDM (24/1000 live birth) and their various complications. Mortality and morbidity is a bit higher in IDM. Our health policy maker should give adequate emphasis on management of IDM babies.J Nepal Paediatr Soc 2015;35(3):253-256

Aerobic Bacterial Pattern in Puerperal Sepsis

Puerperal sepsis is an important cause of maternal morbidity and mortality in developing countries. This study was undertaken to isolate and identify the Aerobic bacterial agents of Puerperal sepsis among the patients admitted in Mymensingh Medical College Hospital during the period from July, 2006 to June, 2007. Endocervical swabs/secretions were collected from 50 cases of Puerperal sepsis and were cultured aerobically. Out of 50 samples, 42 (84%) yielded growth in cultures. Among 42 culture positive cases, 20 (40%) were Aerobic organisms and 22 (44%) were mixed, i.e., Aerobic and Anaerobic bacteria. The isolated Aerobic organisms were Staphylococcus aureus (26, 61.90%), Escherichia coli (6, 14.28%), Staphylococcus epidermidis (5, 11.90%), Streptococcus pyogenes (3, 7.14%) and Enterococcus faecalis (2, 4.76%). The organisms were identified by standard biochemical tests. All isolates of S.aureus and S. epidermidis were sensitive to Cephalexin and Vancomycin. Similarly all the strains of E. coli were sensitive to Gentamicin, Amikacin, Ciprofloxacin and Cephalexin. All the strains of S. pyogenes were sensitive to Amoxicillin and all the isolates of Enterococcus were sensitive to Amoxicillin and Cephalexin.Bangladesh J Med Microbiol 2008; 02 (01): 22-27DOI:http://dx.doi.org/10.3329/bjmm.v2i1.21785

Emerging Antimicrobial Resistance amongst Common Bacterial Pathogens in Mymensingh Medical College Hospital

Antimicrobial resistance has been coming up as one of the challenging business for treating domiciliary and nosocomial infections. The present study compared rate of resistance towards different commonly used antibiotics for common bacterial pathogens isolated during 2001 to 2003. Regarding Escherichia coli, mentionable increase (p<0.01) of resistance was noted against ceftazidime (47% to 77%) and ceftriaxone (43% to 71%). Imipenem (2% to 1%) and pefloxacin (40% to 17%) showed decreased trend. For Staphylococcus aureus, marked increase in resistance was shown against almost all antibiotics except co-trimoxazole (55% to 57%). Mentionable increase in resistance (p<0.05 and p<0.001, respectively) was noted against ciprofloxacin (17% to 43%) and ceftriaxone (28% to 83%). Although, oxacillin resistance increased from 22% to 42% but no resistance against vancomycin was noted during this period. Strains of Pseudomonas species showed increase (p<0.05) in resistance against ciprofloxacin (47% to 71%), ceftriaxone (50% to 74%) and ceftazidime (39% to 58%). Carbenicillin showed decreased resistance (92% to 50%) and none of the strains was found resistant to imipenem. Emphasis was given towards judicial use of antibiotics by followig local antibiogram.Bangladesh J Med Microbiol 2007; 01 (01): 04-09

Acute kidney injury is a common complication after acute stroke in Mymensingh Medical College Hospital

Stroke represents a continuously evolving medical and social problem, being the third leading cause of death after heart disease and cancer in developed countries. Acute kidney injury (AKI) may develop as a possible complication after acute stroke. Insufficient care of acute stroke patients is an important factor behind it. It may be associated with a significant burden of morbidity and mortality. This cross sectional observational study was conducted in Mymensingh Medical College & Hospital, Mymensingh from July 2012 to June 2014. A total of 240 patients with newly detected acute stroke confirmed by CT scan of brain were included in this study. According to this study, 15.42% of acute stroke patients developed AKI. Majority (54.05%) of the AKI patients were in >60 years age group. 17.93 % of male patients developed AKI and 11.58% of female patients developed AKI. So, AKI was a common complication after acute stroke. Early diagnosis and management of AKI may be an important part of management of these stroke patients.Bangladesh Med J. 2015 May; 44 (2): 82-86

Implication of risk factors for coronary heart disease

A Case Control study was carried out to identify the risk factors of Coronary Heart Disease (CHD) at Mymensingh Medical College Hospital. As many as 96 patients were selected purposively as cases who were admitted with CHD at Coronary Care Unit, whereas an equal number of age, sex and religion matched controls were selected from patients admitted into Medicine Units during the study period. Data were collected by using pretested interview schedule after obtaining informed verbal consent. The mean age of the cases and controls, were 58.88 years with a Standard Deviation of 10.52 years. A highest number of cases and controls (87-90.62%) were males, while the rest 9 (9.38%) were females. Among cases 27 (28.13%) were illiterate, while of controls, 36 (37.50%) were illiterate. The association of smoking with the development of Coronary Heart Disease was statistically significant (P<O.05) with an odds ratio of 2.07. Family history of CHD had a very high statistical significance (p<0.001) with odds ratio 3.53. High statistical significance (p<0.01) was also observed between Diabetes Mellitus and Coronary Heart Disease with an odds ratio of 3.34. Coronary Heart Disease can be prevented through primordial prevention by hindering the development of baneful behaviours like habit of smoking, chewing betel leaf, use of tobacco and jarda, having fatty diet like meat.Bang Med J (Khulna) 2015; 48 : 28-31

Maternal Outcome in Ruptured Uterus: A Review of 72 Cases

This descriptive type of cross-sectional study of 72 cases of uterine rupture was conducted over 1 year (from September 2006 to August 2007) in the department of Obstetrics and Gynaecology, Mymensingh Medical College Hospital, Bangladesh to evaluate the maternal outcome of different types of surgery, to assess the maternal mortality and maternal morbidity. All cases of ruptured uterus which were received & treated and did not die within 30 minutes of admission are included in the study. Data were collected by preformed data collection sheet. The results showed that the common age groups were between 20-30 years in 31(68.00%) cases. Among all ruptured cases, 6 cases (8.33%) were Primigravida, 52 cases (72.22%) were between gravida 2nd to 4th and 14 cases (19.44%) were gravida 5th or above. Among all cases, 66 cases (91.66%) required blood transfusion; Subtotal hysterectomy was done in 36 cases (50.00%), total hysterectomy in 4 cases (5.56%), and repair of the rent in 32 cases (44.44%). Associated operations were done along with repair or hysterectomy in 13 (18.05%) cases. Postoperative complications were found in 23 (31.94%) cases. The shortest stay was 8 days & the longest stay was 62 days. The hospital staying was about 2 weeks in 48(66.70%) cases. Among 10 death cases (13.90%) maximum patient died within first 5 hours. The causes of maternal death were due to septicemia, renal failure and shock in 20%, 30% and 50% respectfully.
 CBMJ 2016 January: Vol. 05 No. 01 P: 20-26

Walk for life ‐ the National Clubfoot Project of Bangladesh: the four‐year outcomes of 150 congenital clubfoot cases following Ponseti method

BackgroundCongenital clubfoot deformity can cause significant disability, and if left untreated, may further impoverish those in developing countries, like Bangladesh. The Ponseti method has been strategically introduced in Bangladesh by a non-government organisation, Walk For Life (WFL). WFL has provided free treatment for over 17,500 Bangladeshi children with clubfeet since 2009, sustained by local ownership, and international support. This study assesses the 4-year results in children for whom treatment began before the age of 3 years.MethodsA centrally located WFL clinic at Mymensingh Medical College Hospital (MMCH), representative of the larger WFL clinics, which treats >100 cases annually, was reviewed. In 2015, 99 of the 147 eligible subjects who had begun treatment in 2011 were available for follow up. Specific assessment tools enabled evaluation of parent satisfaction, gait function, and relapse cases.ResultsResults for 99/147 cases were returned after four years: 72 males, 27 females. Typical clubfeet comprised 98/99 of cases, and 55/99 were bilateral. The tenotomy rate was 80 %. Brace use after 3 months was 90 %, at 12 months was 65 %, and at 4 years post treatment was 40 %. Functionally, 98/99 of children could walk and run (99 %). Relapsing deformity was found in 13 %. Relapse severity varied: eight were flexible and partial, five were rigid. Half of the children lost to follow were due to changed phone numbers. While parents were very happy with their child’s feet (97 %), a materials cost of 3000 Taka ($US40) was deemed unaffordable by 60 %.ConclusionsThe 4-year outcomes after Ponseti treatment for clubfoot deformity, showed that 99 % of children available for follow up, were walking independently. The relapse rate was low. Parent satisfaction was high, but those whose children required further treatment were less satisfied.

CT-Scan Findings of Hepatic Mass Patients Attending at a Tertiary Care Hospital in Bangladesh

Background: CT-scan is a very useful diagnostic tool for the detection of hepatic mass. Objective: The present study was undertaken to determine the CT-scan findings of benign and malignant hepatic mass patients. Methodology: This was a cross sectional study conducted in Radiology and Imaging Department at Mymensingh Medical College Hospital (MMCH), Mymensingh; Dhaka Medical College Hospital (DMCH), Dhaka and Banghabandhu Sheikh Mujib Medical University (BSMMU), Dhaka with the collaboration of Pathology Department of the same institute for histopathological confirmation. This study was carried out from January 2006 to December 2007 for a period of 2 years. The patients who were clinically suspected of having hepatic mass attended in the Radiology and Imaging Department in the above mentioned institutes were included as study population. All the CT-scan findings were recorded. Result: A total number of 50 patients were enrolled for this study. CT-scan was done among 40 males and 10 females with a mean age of 51.28 years old. Hypodensity was found in 17 (60.7%) and 18 (81.8%) cases in malignant and benign hepatic lesions respectively. Ill-defined margin was detected in 12 (42.9%) and 6 (27.3%) cases respectively. Calcification was present on 11 (39.3%) malignant lesion and 6 (27.3%) benign lesions. Pressure effect on biliary apparatus was found in 11 (39.3%) malignant lesions and 1 (4.5%) benign lesions (p < 0.05). Lymphadenopathy was found in 10 (35.7%) malignant lesions and 1 (4.5%) benign lesions (p < 0.05). Conclusion: In conclusion, CT-scan findings of malignant and benign hepatic mass show hypodensity with more contrast enhancement in malignant lesions with more calcification in malignant lesion; however, significant difference is detected in pressure effect on biliary apparatus and lymphadenopathy.

Study of Polycystic Ovaries (PCO) in Mymensingh Medical College Hospital, Bangladesh

Background information: Polycystic ovaries (PCO) and their clinical expression (polycystic ovary syndrome) are conditions characterized by menstrual abnormality, clinical and biochemical features of hyperandrogenism. It is the killer of womanhood. Woman of any ethnic background can present with PCOS.Objectives: To find out demographic characteristics such as age, BMI, clinical presentations like hirsutism, menstrual cycle pattern and fertility status and the hormonal changes like LH/FSH ratio and serum testosterone level.Study design: A descriptive cross sectional study for 1 year from December 2009 to November 2010.Study setting: Outdoor Department of obstetrics and gynaecology and center for Nuclear Medicine and Ultrasonography (CNMU) Mymensingh Medical College Hospital, Mymensingh.Result: Total 55 patients were evaluated. Most common age was 20-29 years (72.7%) with mean age 23.55 years and mean BMI 27.12 kg/m2. Clinical presentations were in this study hirsutism in 36.4%, irregular menstrual cycle in 63.6% and subfertility in 56.3%. Laboratory findings revealed testosterone level was more than normal range in 58% case, LH/FSH ratio was increased (more than 1:1) in 58.2% cases, 26 cases had both increased testosterone level and increased LH/FSH ratio. 17cases had testosterone level within normal range and LH/FSH ratio less than 1:1.Conclusion: There are significant relationship between irregular menstrual cycle pattern and hormonal changes such as testosterone level and LH/FSH ratio. There are also significant relationship between BMI and hirsutism with increased testosterone level.J Bangladesh Coll Phys Surg 2014; 32: 142-148

Nebulization by Isotonic Magnesium Sulphate Solution with Salbutamol Provide Early and Better Response as Compared to Conventional Approach (Salbutamol Plus Normal Saline) in Acute Exacerbation of Asthma in Children.

Asthma attacks are serious respiratory problem that can be lethal when not treated appropriately. Till today the main stay of therapy is short acting ß2-agonist. Unfortunately in acute asthma episodes this is not enough to relieve the bronchospasm and reduce dyspnea. The shortcoming of ß2-agonist therapy has resulted in the use of a variety of other treatment in the management of acute asthma. The use of magnesium sulphate is one of the recent treatment options. This study was done to compare the efficacy of nebulized salbutamol with magnesium sulphate versus salbutamol with normal saline in the treatment of acute exacerbation of asthma in children. This randomized controlled trial was carried out among 60 patients with acute exacerbation of bronchial asthma fulfilling the inclusion criteria, admitted in the department of Paediatrics, Mymensingh Medical College Hospital over a period of one year from January 2009 to December 2009. They were distributed randomly, 30 patients received nebulized salbutamol (0.15mg/kg; minimum dose 2.5mg) with 2.0 ml of isotonic magnesium sulphate solution and another 30 patients received the same dose of salbutamol with 2.0 ml of normal saline on 3 occasions at 20 minute intervals. With single dose of nebulization in the magnesium sulphate with salbutamol group, by 20 minute almost all 26 (86.7%) patients achieved at least 60% of predicted PEFR. Within 20 minute from control group none could achieve 60% of predicted PEFR. After second dose of nebulization control group started achieving 60% of predicted value. Regarding response criteria, with second dose of nebulization, at 40 minute 16 (53.3%) patient from magnesium sulphate with salbutamol group showed good response (PEFR&gt;70% predicted). But within the first 40 minutes, none could show good response in control group. With 3rd dose of nebulization all from magnesium sulphate group showed good response but even at 60 minute, 5 (16.7%) patients in control group failed to be included as good responder. In conclusion, nebulization by isotonic magnesium sulphate solution with salbutamol provide early and better response as compared to conventional approach (salbutamol plus normal saline) in acute exacerbation of asthma in children.Faridpur Med. Coll. J. 2014;9(2): 61-67

Comparative Study of Cytology and Histopathology of Cervical Lesion in VIA Positive Patients in Mymensingh

Cervical cancer is the second most frequent type of cancer and leading cause of mortality among women worldwide. More than eighty eight percent deaths from cervical cancer occur in developing countries and by 2030, it will be at least ninety eight percent. In developed countries, the cases and deaths have declined markedly due to their extensive screening programs. The present study was undertaken to assess precancerous and cancerous cervical lesion by cytology and their comparison with histopathology in VIA positive cases. This descriptive, cross-sectional type of observational study was carried out in the Department of Pathology, Mymensingh Medical College in collaboration with the Department of Gynecology and Obstetrics, Mymensingh Medical College Hospital, during the period of July 2012 to June 2013. Study was carried out among 160 VIA positive patients and selected by non-random judgment sampling from the colposcopy clinic. Histological findings revealed that the most common age group affected by different types of cervical lesions is 30 – 39 years. It also revealed that squamous cell carcinoma (SCC) was very much common in age group 40-49 years. The statistical value of accuracy, sensitivity and specificity of Pap smear cytology test and histopathology yielded some important directives. The sensitivity values of Pap smear cytology was found 87.50%. The accuracy of the Pap smears in this study was 88.13%. The present study show significant relationship between cytological test with histopathological diagnosis. However cytology testing is not suitable as a single test. In conclusion, it can be stated that combination of cytology (Pap smear) and histopathology would ultimately be more useful.&#x0D; CBMJ 2015 July: Vol. 04 No. 02 P: 35-40

Comparing Predictive power of CT-scan Findings among the Malignant Hepatic Mass patients

Background: CT-scan is useful for the detection of hepatic mass. Objective: The purpose of the present study was to see the predictive values of CT scan in the diagnosis of malignant hepatic mass. Methodology: This cross sectional study was carried out in the Department of Radiology and Imaging at Mymensingh Medical College Hospital (MMCH), Mymensingh, Banghabandhu Sheikh Mujib Medical University (BSMMU), Dhaka and Dhaka Medical College Hospital (DMCH), Dhaka during the period of 1st January 2006 to 31st December 2007. Patients admitted in the Department of Medicine and Department of Hepatobiliary of MMCH, BSMMU, and DMCH with the clinical diagnosis of fever, abdominal pain, anorexia, nausea/vomiting, loss of appetite, jaundice, weight loss and ascites were selected as study population. CT scan and histopathology were performed to all the patients. Result: A total number of 50 patients were recruited for this study.. The sensitivity for multiplicity was 71.4%, specificity was 63.6%, accuracy was 68%, PPV was 71.4% and NPV was 63.6%. The sensitivity for hypodensity as a sign of malignancy was 60.7%, specificity was 18.2%, accuracy was 42.0%, PPV was 48.6% and NPV was 26.7%. The sensitivity, specificity, PPV, NPV and accuracy of contrast enhancement were 100.0%, 22.7%, 62.2%, 100.0% and 66.0% respectively. Again the sensitivity, specificity, PPV, NPV and accuracy of detection of pressure effect on biliary apparatus by CT-scan were 100.0%, 22.7%, 62.2%, 100.0% and 66.0% respectively. Again the sensitivity, specificity, PPV, NPV and accuracy of detection of Lymphadenopathy by CT-scan were 35.7%, 95.5%, 90.9%, 53.8% and 62.0% respectively. The sensitivity, specificity, PPV, NPV and accuracy of detection of Portal vein invasion by CT-scan were 14.3%, 100.0%, 100.0%, 47.8% and 52.0% respectively. The sensitivity, specificity, PPV, NPV and accuracy of detection of hepatic vein invasion by CT-scan were 10.7%, 100.0%, 100.0%, 46.8% and 50.0% respectively. The sensitivity, specificity, PPV, NPV and accuracy of detection of inferior vena cava (IVC) invasion by CT-scan were 7.1%, 100.0%, 100.0%, 45.8% and 48.0% respectively. Conclusion: CT is a useful diagnostic tool for the detection of malignant hepatic masses.Journal of Science Foundation, 2014;12(1):2-6

Test Accuracy of CT-Scan for the Detection of Malignant Liver Mass

Background: Detection of malignant liver mass is very important for the treatment modalities. Objective: The purpose of the present study was to establish the usefulness of CT scan in the diagnosis of malignant hepatic mass. Methodology: This cross sectional study was carried out in the Department of Radiology and Imaging at Mymensingh Medical College Hospital (MMCH), Mymensingh, Banghabandhu Sheikh Mujib Medical University (BSMMU), Dhaka and Dhaka Medical College Hospital (DMCH), Dhaka during the period of 1st January 2006 to 31st December 2007. Patients admitted in the Department of Medicine and Department of Hepatobiliary of MMCH, BSMMU, and DMCH with the clinical diagnosis of fever, abdominal pain, anorexia, nausea/vomiting, loss of appetite, jaundice, weight loss and ascites were selected as study population. CT scan and histopathology were performed to all the patients. Result: A total number of 50 patients were recruited for this study. Mean age of all patients was 51.28 ± 14 years with a range of 17 year to 78 years. Among all patients 28 had multiple lesion, of them 71.4% was malignant and 28.6% was benign. On the other side 22 patients had solitary lesion, of them 36.4% was malignant and 63.6% was benign (p < 0.05). Sensitivity of CT to diagnose malignant lesion was 96.4%, specificity 86.4%, accuracy 92%, positive predictive value 90% and negative predictive value 95%. Conclusion: CT is a useful diagnostic tool for the detection of malignant hepatic masses.

Clinical Profile and Ultrasonographic Evaluation of Brain in Perinatal Asphyxia

This descriptive cross sectional study was carried out in the department of paediatrics, Mymensingh Medical College Hospital from March 2006 to December 2006. This study was performed on 100 consecutive asphyxiated newborns who were admitted in Mymensingh Medical College Hospital during the study period. Among them, 50 babies were preterm and 50 babies were full term with moderate to severe perinatal asphyxia. Full term (&gt;37 weeks of gestation) and preterm (&lt;37 weeks of gestation) newborn babies with perinatal asphyxia was taken as case in inclusion criteria. Among the preterm babies, highest number 23(46%) were in the age group o/ 34-36 weeks of gestational age and among the term babies, highest number 24(48%) were in the age group of 39-40 weeks of gestational age. This study shows that 39% mothers had prolong obstructed labour, 21% had premature rupture membrane and 17% had pre-eclamptic toxaemia during pregnancy,. Convulsion 66%, poor primitive reflexes 52%, cyanosis 49% pallor 32%, respiratory distress 32% and apnoic spells 26% were the common presentations of asphyxiated babies. Out of 50 preterm asphyxiated newborn, one showed periventricular leukomalacia, two IVH and two ventricular dilatation. In the present study abnormal sonogram were detected in ten term babies. Two cases showed features of cerebral oedema and eight cases showed mild to moderate ventriculomegaly together with several subcortical cystic lesions of varying size. In case of comparison, eight cases had ventricular dilatation in term babies while 2 cases had in preterm babies. None of the term babies had ventricular haemorrhage but 2 had in preterm babies. Only, one preterm baby had periventricular leukomalacia but none among the term babies. There were 2 cases of cerebral oedema in term babies but none in preterm babies. Thus ultrasonography helps early recognition of intracranial abnormalities in asphyxiated newborns. So prognosis may be assessed, complication may be anticipated and appropriate management plan can be designed. DOI: http://dx.doi.org/10.3329/bmj.v41i3.18956 Bangladesh Medical Journal 2012 Vol.41(3): 33-37

Isolation and Characterization of Bacterial Species from Enteric Fever Suspected Human Cases of Mymensingh Medical College Hospital

A total of 17 stool samples were collected from enteric fever suspected patients of Mymensingh Medical College Hospital, Mymensingh, Bangladesh. Results of morphological, biochemical examinations and pathogenicity test revealed Escherichia coli (47%), Klebsiella spp. (41%), Citrobacter spp. (29%). In cultural examination, all Escherichia coli showed metallic sheen on EMB agar, Klebsiella spp. showed moist shiny mucoid colonies and Citrobacter spp. showed large convex colorless dwarf colonies on MacConkey agar. In biochemical examination, all the isolates fermented five basic sugars with the production of acid and gas where the Citrobacter spp. were late lactose fermenter. Escherichia coli was indole and MR positive but V-P negative, Klebsiella spp. were V-P positive but MR and Indole negative and Citrobacter spp. were MR positive but V-P and Indole negative. All isolated bacterial species were sensitive to ciprofloxacin but resistant to amoxicillin. Salmonella typhi or Salmonella paratyphi organisms were not present in the stool samples examined. This may be due to collection of samples from patient having antibiotic therapy with Ceftriaxone through intravenous route for 3 days prior to collection of samples. From this study, it may be concluded that Escherichia coli, Kelbsiella spp. and Citrobacter spp. may be commonly present in enteric fever suspected patients or they may produce enteric fever like symptoms in human.DOI: http://dx.doi.org/10.3329/pa.v20i1-2.16857 Progress. Agric. 20(1 &amp; 2): 85 – 92, 2009

A Clinical Study on socio-demographic background in Ruptured Uterus Cases

A study of 72 cases of uterine rupture out of total 5984 deliveries(including 3619 caesarean sections) over 1 year (from Sep. 2006 to Aug 2007) in the dept. of Obstetrics and Gynaecology, Mymensingh Medical College Hospital was reported. This gives an incidence of uterine rupture 1: 83. The results showed that, this was a common obstetric emergency &amp; was a major cause of maternal &amp; foetal deaths. Study showed that, 87.5% came from rural areas where facility was not available, 79% were of poor socio-economic condition .All rupture uterus cases (100%)was house wife. Peak age was between 20-30 years (68%). Among all rupture cases, 72.22% cases were between gravida 2nd to 4th,and 19.44% cases were gravida 5th or above &amp; only 8.33% cases were Primigravida, Most of the patients(56%) were illiterate. 46% of cases had no antenatal checkup during their pregnancies. 51.38% cases labour pain lasting&gt;16 hours. Most of the mishandled cases (66.67%) were exposed to injudicious use of uterotonic drugs before admission. Most of the cases (38.9%) handled by untrained birth attendants. DOI: http://dx.doi.org/10.3329/cbmj.v2i2.16692 Community Based Medical Journal 2013 July: Vol.02 No 02: 9-14

Management of Nonunion of Tibia by Ilizarov Technique

This prospective study was carried out during the period of January 2007 to December 2011 in Mymensingh Medical College Hospital and other private clinics of Mymensingh town to assess the results of Ilizarov technice for nonunion of the tibia. Here total operated patient were 30, of them 24 were male and 6 were female. 10 cases are hypertrophic, 8 cases are atrophic and 12 cases are infected nonunion. In this series age of the patients was 10 ? 60 years. Motor vehicle accident was the commonest cause of fracture found in 66.67% cases. Second most common cause of injury was fall from height. Among 30 patients proximal corticotomy was done in 24 patient and distal corticomy in 2 patient. Union time was 4-12 months. Among 30 patients 27 were united at initial procedure. From nonunited 3 cases again refreshening of the ends along with bone grafting was done and ultimately 2 were united and 1 remains nonunited. In this series limb length discrepancy reduced to maximum 1.5 cm with contralateral limbs. Average total hospital stay was 15 days. Pin site infection and pain were the commonest complications in our study. Close adherences to Ilizarov principles make it now possible to successfully treat a most of orthopaedic conditions that previously were fraught with high morbidity rates and poor results. DOI: http://dx.doi.org/10.3329/cbmj.v2i2.16697 Community Based Medical Journal 2013 July: Vol.02 No 02: 41-45

Double layer versus Single layer Gastro-intestinal anastomosis in gastric cancer surgery in Mymensingh Medical College Hospital

Introduction: In gastric cancer surgery, gastrojejunostomy is one of the most important procedures. Anastomosis between different parts of the stomach and the intestine is a basic technical component in all gastrointestinal procedure. Backgrounds and aims: This study evaluated complications of gastrojejunostomy in gastric cancer surgery with two methods: single-layer and double-layer anastomosis. Materials and methods: This study was carried out in the department of surgery in Mymensingh Medical College Hospital from January 1, 2009 to December 31, 2012. 100 patients with carcinoma stomach who needed gastrojejunostomy were included in this study. These patients with average age of 43.22 years were divided in two groups (50 in each group); single-layer and double-layer anastomosis. In single-layer anastomosis gastrojejunostomy was performed in interrupted method with absorbable suture (2/0 vicryl). Double-layer anastomosis was carried out with continuous suture (2/0 silk, 2/0 catgut). Possible post-operative complications like anastomotic leakage, pelvic abscess, abdominal sepsis, anastomotic stenosis and wound infection were evaluated. Results: In the single-layer group, 4 patients (8%) developed anastomotic leakage, wound infection and only 2 patients (4%) developed abdominal sepsis, pelvic abscess and anastomotic bleeding. No patient developed anastomotic stricture. In double-layer group, 2 (4%) patients developed anastomotic leakage, only 1 (2%) patient had pelvic abscess, abdominal sepsis and anastomotic bleeding but wound infection in 2 (4%) patients. Conclusion: Gastrojejunostomy with single-layer hand-sewn suture technique is safe without serious complications in comparison to double-layer suture technique. More-over operation time is less and cost is less in single-layer method.DOI: http://dx.doi.org/10.3329/cbmj.v2i2.16695 Community Based Medical Journal 2013 July: Vol.02 No 02: 30-34

Prevalence of Congenital Heart Disease in Neonate in a Tertiary Level Hospital

Background: Congenital heart disease (CHD) has already been recognized as one of the important cause of neonatal mortality and morbidity. The reported prevalence of CHD in live newborns tends to vary a lot due to various unrecognizable lesions at birth and lack of technical expertise. Methods: A cross sectional study was carried out in the department of Neonatology at Mymensingh Medical College Hospital (MMCH), Bangladesh from January to December 2010 to find prevalence of CHD in neonates. Results: Out of 6560 admitted neonates, 51 were found to have CHD. The prevalence was 7.8/1000 live births. Mean age was 10.2±9.8 days and weight was 2380.5±590.5gms. Respiratory distress was the commonest symptom (71%) followed by cyanosis (26%) and reluctant to feed (24%). Among the CHD Ventricular septal defect (VSD) was the commonest 15/51 and then Atrial septal defect (ASD) 12/51, Patent ductus arteriosus (PDA) 5/51, Transposition of great arteries ( TGA) 4/51, Complex heart disease 4/51 and Tetralogy of Fallot (TOF) 3/51 cases. Some associated non-cardiac anomalies like Down’s syndrome, polydactyly, syndactyly, cleft lip, cleft palate and cataract were found. Risk factors associated with CHD were diabetes mellitus (10%), hypertension (8%) and maternal infection (4%). Among the drugs, anti-pyretic by 20%, anti-emetic by 18%, anti-epileptic by 4%, vitamin-A and hormone each by 2% of mothers respectively. Conclusion: VSD and ASD were the commonest CHD in this study. Thorough clinical examination and proper investigations immediately after admission is essential, which may help us for proper counseling and early intervention. Nepal Journal of Medical Sciences | Volume 02 | Number 02 | July-December 2013 | Page 91-95 DOI: http://dx.doi.org/10.3126/njms.v2i2.8942

Status of Serum bilirubin, Serum Proteins and Prothrombin time in babies with Perinatal Asphyxia

Background and Objectives: Because of hypoxemia, different organ systems of the body are affected in perinatal asphyxia. This study was carried out to see the status of Serum bilirubin, Serum Proteins and Prothrombin time in asphyxiated babies and to know any correlation existing between hepatic dysfunction and the severity of perinatal asphyxia. Methods: A total of 70 full-term asphyxiated newborns (study group) were studied during January ‘2008 to December ‘2008 in the department of Paediatrics, Mymensingh Medical College Hospital. After enrolment these babies were grouped according to Sarnat &amp; Sarnat stages of HIE as stage I, II &amp; III (Sarnat &amp; Sarnat’ 1976). Babies who are small for gestational age, having severe jaundice, sepsis or congenital anomalies of the hepatobiliary system were excluded from the study. A total of 50 healthy newborns were also studied as reference group. Two c.c. of venous blood were taken both from asphyxiated and healthy babies between 2nd and 5th day of life to estimate Total serum bilirubin (TSB), Serum Total protein (STP), Serum Albumin and Prothrombin time (PT). Data were analyzed by computer software SPSS version 15. Unpaired student’s ‘t’ test was used to measure the level of significance and Spearman’s rank correlation was done to see the correlation and at P &lt; 0.05 the results were considered significant. Results: The mean TSB, STP &amp; S. Albumin of asphyxiated babies were 5.52 ± 2.01mg/dl, 55.74 ± 8.84 &amp; 32.60 ± 5.48 g/L respectively and those of normal babies were 4.51 ± 1.19 mg/dl, 66.30 ± 10.36 &amp; 40.90 ± 6.45 g/L respectively and these differences were statistically significant (P &lt; 0.001). On the other hand no significant changes were noted in prothrombin time. The rise of PT showed a significant positive correlation with the severity of perinatal asphyxia. On the other hand STP, S. Albumin &amp; TSB showed no significant correlation. Conclusion: This study concludes that TSB, STP &amp; S. Albumin significantly elevated and this elevation was proportional to the severity of perinatal asphyxia. On the other hand no significant changes were noted in prothrombin time. Recommendation: A large scale multi-centre study is recommended to establish this finding. DOI: http://dx.doi.org/10.3329/jdnmch.v18i2.16022 J. Dhaka National Med. Coll. Hos. 2012; 18 (02): 43-46