Mymensingh Medical College Research Articles

Serum Magnesium concentration in normal and preeclamptic pregnancy: A tertiary center experience

Preeclampsia and maternal mortality are more prevalent in underdeveloped nations. Preeclampsia has an estimated 16% incidence rate in Bangladesh, which is extremely high. One of the body's major macronutrients is magnesium. It also serves a multitude of enzymes as a cofactor. This cross-sectional study was done in the department of Biochemistry of Mymensingh Medical College, Mymensingh, from July 2016 to June 2017. This study involved a total of 100 individuals, where 50 preeclamptic patients and 50 healthy pregnant women served as the case and control groups, respectively. The results were shown as mean ±SD. For both the case and control groups, the mean ±SD of serum magnesium levels were 1.75 ±0.22 mg/dl and 1.63 ±0.21, respectively. Comparison of the mean ±SD of serum magnesium in the case and control groups revealed a highly significant difference (P<0.001). Students' unpaired ‘t’ test was used to compute the statistical difference. Mediscope 2024;11(2): 73-76

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 ......

Exploring the Potential of Turmeric as a Natural Antibacterial Agent: In Vitro Evaluation of Crude Paste and Aqueous Extract

Background: There is growing concern in the use of natural antimicrobial compounds due to the emergence of antibiotic resistance. One such contender is turmeric (Curcuma longa), an herb known for its usage in medicine for centuries; nowadays, however, its prospects in pharmacology are being actively discussed. Since access and utilization of modern health care is scarce in Bangladesh, such natural cures are worth researching. Objective: To assess the in vitro antibacterial activity of turmeric’s crude paste and aqueous extract against Staphylococcus aureus and Escherichia coli. Methods: The study was carried out in the Department of Pharmacology with the collaboration of Department of Microbiology, Mymensingh Medical College, Bangladesh, over a period of one year from July 2010 to June 2011, and it consisted of three experiments: Effects of crude turmeric paste incorporated in nutrient agar media, Minimum Inhibitory Concentration of Aqueous Turmeric Extract and Amikacin by broth dilution method, and Subculture method to confirm bactericidal effect. Results: CTP demonstrated effective growth of S. aureus at 10% concentration and E. coli at 30% concentration. The MIC of ATE was found to be 800 μg/ml for S. aureus and 2000 μg/ml for E. coli. The MIC for amikacin was 10 μg/ml for both organisms. These effects have been further substantiated in subculture studies regarding their bactericidal properties. Conclusion: From the findings of the current study, it is evident that both turmeric and its crude paste had profound antibacterial effects against S. aureus and E. coli, though the effect of crude paste was observed to be stronger than that of the aqueous extract. Although not as strong as Amikacin, its organic nature and possibility of side effects make it worth pursuing. Hence, this work adds to the literature on the fact that turmeric has health benefits as highlighted by traditional medical practice and points to the need to find new natural sources of .............

Study of Number of Cotyledons of Placenta in Different Gestational Age Groups of Healthy Pregnant Mother of Bangladesh

<i>Introduction</i>: The placenta has drawn attention as an important indicator of intrauterine condition of fetus and maternal diseases. The study of number of cotyledons of placenta in different gestational age groups of healthy pregnant mother of Bangladesh is cross sectional descriptive study. <i>Aim of the study</i>: The aim of the study was to study the variation of number of cotyledons of placenta in deferent state of gestational ages of healthy pregnant mother. <i>Methods</i>: This cross sectional descriptive study was conducted in the Department of Anatomy, Mymensingh Medical College, Mymensingh, from January 2018 to December 2018. This study was performed on 80 human placentae. <i>Result</i>: The mean (± SD) number of cotyledon of the placenta was 18.56 (±2.15) in group A, 21.21 (±3.11) in group B and 23.75 (±3.45) in group C. The mean number of cotyledon of the placenta was maximum in group C (23.75) and was minimum in group A (18.56). It was also observed that the mean number of cotyledon of the placenta increased with gestational age. The mean difference of the number of placental cotyledons between groups A and C was statistically moderately significant (p < 0.05) but between A and B and B and C was statistically non-significant (p > 0.05). <i>Conclusion</i>: The placental examination becomes important as it will help in understanding the specific etiologies of adverse outcome. This study has shown that the mean number of cotyledon of the placenta increased with gestational age.

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.

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

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.

Study of Serum Creatinine in Female Type 2 Diabetes Mellitus Patients

Diabetes mellitus is a chronic illness that affects millions of individuals worldwide. In the present study serum creatinine was estimated in female type 2 diabetes to observe the frequency of increase serum creatinine level in these patients. A cross-sectional, descriptive study was carried out in the Department of Physiology, Mymensingh Medical College, Bangladesh, between July 2016 and June 2017. A total of 210 subjects were selected and were grouped as: control group (group I) having 70 healthy female of reproductive age (21-45 years) and study group (group II), which was again subdivided to group IIA (70 diabetic female of reproductive age (21-45 years) and group IIB (70 diabetic female of post-menopausal age, 45-70 years). Laboratory analysis of serum creatinine was done by enzymatic colorimetric method. A comparison in serum creatinine concentration was done in between group I and group II and in between Group IIA and Group IIB. The results were calculated and analyzed by using SPSS. For statistical analysis students unpaired ‘t’ test was performed. Our study revealed that serum creatinine was increased among females of the study group and the result was statistically significant. In the control group serum creatinine was within the normal physiological range. CBMJ 2024 July: vol. 13 no. 02 P: 198-202

Analysis of Shape of Lingula in Dry Adult Human Mandible in a Bangladeshi Population

The lingula is an important anatomical landmark used in oral and dental surgeries and to block the inferior alveolar nerve. Our study aims to analyze different types of lingula found in mandibles of Bangladeshi individuals. This cross-sectional, descriptive study was done on 150 fully ossified dry human mandibles in the Department of Anatomy, Mymensingh Medical College, Mymensingh, Bangladesh between July 2019 and June 2020. A non-random purposive sampling technique was adopted. The lingula was classified into four types: triangular, truncated, nodular and assimilated. The triangular shape was most commonly found (67%), followed by truncated (19.33%), nodular (9.66%) and assimilated (4%). On right side of the mandible, the triangular shape was present in 61.33% samples and on left side, in 59.33% samples. Truncated shape was found 25.33% on right side and 26.66% on left. Nodular shape was present in 10% on right side and 9.33% on left. Assimilated shape was observed in 3.33% on right side and 4.66% on left. Knowledge of various morphological shapes helps dental and maxillofacial surgeons to preserve important structures like inferior alveolar nerve and vessels during surgical interventions of mandible. Our data is expected to increase the information pool, which will be useful for further anthropological studies. CBMJ 2024 July: vol. 13 no. 02 P: 223-226

Cadaver Study on Variation of Nutrient Foramina of Adult Human Humeri in Bangladeshi Population

The nutrient foramen is an opening in the bone shaft which allows passage to the blood vessels of the modularly cavity of a bone for its nourishment and growth. Nutrient artery is the major source of blood supply to bone and it plays an important role in healing of fracture and trauma and is also important for bone grafting. This cross-sectional, descriptive cadaver based study aims to determine the presence, direction, common location, position and number of nutrient foramen of adult human humerus in a Bangladeshi population. One hundred samples (43 on right and 57 on left) were selected through the purposive sampling technique which was carried out in the Department of Anatomy, Mymensingh Medical College, Bangladesh, from July 2021 to June 2022. Any damaged, unossified bones or fractured bones were excluded. The presence of nutrient foramina was observed in the shaft of the humeri. Data were recorded and tabulated to analyze using Microsoft Excel and SPSS software. Nutrient foramina was found in all the samples on both sides. So nutrient foramina present on the right side was 100% and on the left side was 100%. The direction of nutrient foramina towards the elbow joint was found in all the samples of both sides. Among 43 right humeri, 37(75.51%) have single-nutrient foramen and 06(24.49%) have double-nutrient foramina. Among 57 left humeri, 53(92.98%) have single nutrient foramen, 03(5.27%) have double nutrient foramina and 01(1.75%) has triple nutrient foramina. In case of location of nutrient foramina, among 49 right nutrient foramina, 45(91.84%) were found on the anteromedial surface, 02(4.08%) were found on the anterolateral surface and 02(4.08%) were on the posterior surface of the shaft of the humerus. In case of 62 left nutrient foramina, 57(91.94%) were found on the anteromedial surface and 05(8.06%) were found on the posterior surface of the shaft of the humerus. In case of position of nutrient foramina, among 49 right nutrient foramina, 01(2.04%) was found on the upper third, 46(93.88%) on the middle third and 02(4.08%) on the lower third of the shaft of the humerus. In case of 62 left nutrient foramina, 01(1.60%) was on the upper third, 57(91.95%) were on the middle third and 04(6.45%) were on the lower third of the shaft of the humerus. CBMJ 2024 July: vol. 13 no. 02 P: 176-182

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.

Correlation of Gestational Age with Anterior-Posterior Thigh Diameter Measured by Two-Dimensional Sonography

Background: Anterior-posterior thigh diameter measurement via two-dimensional sonography (2D-US) correlates with fetal gestational age and reflects the growth and development of fetal thigh muscles and bones. This measurement, alongside estimated gestational age, offers valuable insights into fetal well-being and growth during pregnancy. This study aimed to evaluate the correlation of gestational age with anterior-posterior thigh diameter measured by two-dimensional sonography and estimated gestational age. Methods: This cross-sectional study was conducted at the Department of Radiology and Imaging, Mymensingh Medical College &amp; Hospital, Mymensingh, Bangladesh from January 2010 to January 2012. As the study subjects, a total of 250 healthy women between the 24th and 38th weeks of normal pregnancy were enrolled by using a purposive sampling technique. For data analysis, SPSS version 23.0 was used. Results: The mean age of the participants was 24.79 ± 4.71 years with a range from 18 to 35 years. More than one-third (34.0%) of the women were in the age range of 21-25 years. The mean gestational age of all participants was 30.93 ± 4.32 weeks. Primigravida accounted for more than half (56.4%) of them. A statistically significant positive correlation was observed between fetal anterior-posterior thigh diameter and gestational age (p&lt;0.001. Conclusion: There is a statistically significant positive correlation between fetal anterior-posterior thigh diameter and gestational age.

Correlation of Estimated Gestational Age with the Anterior-Posterior Thigh Diameter and Other Parameters of Fetal Biometry

Background: Accurate gestational age estimation is vital for tracking pregnancy, identifying growth issues, and guiding clinical decisions. Including anterior-posterior thigh diameter (APTD) in fetal biometry enhances fetal health assessment. Correlating EGA with APTD and other biometry parameters is crucial for evaluating fetal growth and development. This study aimed to evaluate the correlation of estimated gestational age with the anterior-posterior thigh diameter and other parameters of fetal biometry. Methods: This cross-sectional study was conducted at the Department of Radiology and Imaging, Mymensingh Medical College &amp; Hospital, Mymensingh, Bangladesh, from January 2010 to January 2012. A total of 250 healthy women between the 24th and 38th weeks of normal pregnancy were enrolled using a purposive sampling technique. Data analysis was performed using SPSS version 23.0. Results: More than one-third (34.0%) of participants were aged 21-25 years. The mean gestational age was 30.93 ± 4.32 weeks, and over half (56.4%) were primigravida. Significant positive correlations were found between fetal anterior-posterior thigh diameter and gestational age (r=1.0; p&lt;0.001), bi-parietal diameter (r=0.856; p&lt;0.001), head circumference (r=0.962; p&lt;0.001), abdominal circumference (r=0.972; p&lt;0.001), and femur length (r=0.948; p&lt;0.001). Conclusion: The fetal anterior-posterior thigh diameter shows significant positive correlations with several parameters, including gestational age, biparietal diameter, head circumference, abdominal circumference, and femur length in this study.

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.