Osmani Medical College Hospital Research Articles

Comparison between Split Dose and Single Dose Bowel Laxatives for Preparation of Colonoscopy in Patients with Bangladeshi Diets: A Randomized Clinical Trial

Introduction: Colonoscopy is an important diagnostic tool for colonic disease and its efficacy and safety have been correlated with adequate bowel preparation. This study compared the efficacy and tolerability of single-dose and split-dose sodium picosulfate lavage as a colon cleansing agent for colonoscopy preparation. Methods: This randomized clinical trial was conducted at the Department of Gastroenterology in Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh from June 2021 to May 2022.A total of 110 patients were selected by randomized sampling technique who underwent elective colonoscopy and were divided into split-dose (n=57) and single-dose (n=53) laxative groups. Bowel preparation was assessed by the Ottawa Bowel Preparation Scale (OBPS) and data were analyzed by SPSS 24.0. Result: The mean age of the patients was 47.4±17.7(SD) years in split-dose and 47.6±15.9 (SD) years in single-dose group. Both groups were statistically similar in terms of socio-demographic profile, medical history, clinical manifestation, and indication of colonoscopy (p>0.05). The mean of total OBPS score (4.39±2.0 vs 5.56±2.2, p=0.004) and caecal intubation time (6.60±3 vs 7.74±2.5, p=0.035) was lower significantly in split-dose than the single-dose group. However, colonoscopy findings, adverse events, and patient compliance were similar between groups (p>0.05). Conclusion: Split-dose is superior to single-dose bowel laxatives for colonoscopy preparation in terms of better mucosal cleanliness and lower caecal intubation time. However, further randomized controlled trial is recommended. J Bangladesh Coll Phys Surg 2024; 42: 329-335

Endoscopic Findings of a Patient Having Cholelithasis in SOMCH, Sylhet, Bangladesh

Introduction: Cholelithiasis is one of the most frequently encountered disease and one of the major causes of abdominal morbidity throughout world [1]. Cholelithiasis is one of the most common and costly of all digestive diseases. Common causes of upper abdominal symptoms are peptic ulcer, acute and chronic gastritis and gallstones. Objective: To assess the endoscopic findings of a patient having cholelithasis in SOMCH. Methods: This was Retrospective Hospital based study conducted at Department of Surgery, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh from January to December 2022 were (One hundred patients were included). All patients underwent OGD after being diagnosed as having cholelithiasis proved by Endoscopic. All patients above 18 years of age presenting with upper abdominal pain, dyspepsia with or without jaundice diagnosed ultrasonically as cholelithiasis and choledocholithiasis with cholelithiasis were included in the study and patients managed conservatively, patients with primary choledocholithiasis and with asymptomatic gallstones were excluded from the study. Results: Out of 100 subjects evaluated during the study period, 58 were females and 42 males. The most common age group affected was between 31-50 years (65%), followed by less than 30 years of age being 18% and more than 50 years being 17%. It should also be noted the higher rate of incidence (65%) in the age group of 31-50 years. Associated symptoms with cholelithiasis were pain in abdomen, which was observed in all the patients (100%). Of these, 74 patients (74%) presented with chronic upper abdominal pain and 26 patients (26%) presented with acute upper abdominal pain. Remaining 56% of the subjects had positive endoscopic findings. Endoscopic findings were positive in 56 had hiatus hernia, duodinitis, duodenal ulcer or other positive findings. Among patients with positive findings 14 had both oeophagitis as well as gastritis while 12 had both gastritis as well as gastric ulcer. All the 56 patients (100%) underwent surgery. Forty patients (71.4%) underwent laparoscopic cholecystectomy, 14 (25.0%) open cholecystectomy and 2 cholecystostomy for empyema gall bladder. Of the 56 patients 40 patients (71.4%) patient had chronic cholecystitis, 9 patients (16.07%) had acute cholecystitis, 4 patients (7.14%) had carcinoma gall bladder, 2 (3.57%) had xanthogranulomatous cholecystitis and 1(1.78%) had cholesterolosis of gallbladder. Of the 4 patients diagnosed of carcinoma gallbladder, 1 patient had carcinoma confined to muscularis mucosa with negative margins and no metastasis, hence no further surgical management was advised and the rest of the 3 patients had either metastasis or positive margins which were managed as per standard guidelines. Conclusion: Cholelithiasis is commonly seen in females in 4th and 5th decade mainly presenting with abdominal pain and dyspepsia. Endoscopy the most common finding was gastritis, oesophagitis and gastric ulcer in decreasing order. There was no hiatus hernia, duodinitis or duodenal ulcer in our study. Patients presenting with dyspepsia and gall-stones in rural setup should be directly treated surgically. Multiple gallstones are common and Laparoscopic cholecystectomy offers best surgical management with 6.57% of conversion rate to open cholecystectomy, with lesser complications.

Comparison of Atorvastatin Alone and its Combination with Ezetimibe among Mixed Hyperlipidemic Patients

Background: Lowering the lipid levels remains the basis of recent medical therapy for preventing cardiovascular events. Statin treatment to attain target low-density lipoprotein cholesterol (LDL-C) levels is still associated with residual risk. Objective: To compare the efficacy of Atorvastatin and Atorvastatin combined with Ezetimibe among mixed hyperlipidemic patients. Methodology: This was a prospective interventional study among the 58 diagnosed mixed hyperlipidemic patients in the outpatient department (OPD) of the Department of Cardiology at the Sylhet MAG Osmani Medical College Hospital during February to November, 2023. Patients were divided into two groups. Group I had a combination of Atorvastatin 10mg and Ezetimibe 10mg, whereas Group II took Tab. Atorvastatin 20mg once daily at night for 12 weeks. Results: After 12 weeks of treatment, a comparison of lipid profile changes between the combination therapy group and the Atorvastatin group revealed a significant reduction (p<0.05) in total cholesterol (35.7% vs. 30.1%), triglycerides (30.6% vs. 16%), and LDL-C (47.5% vs. 40.1%). In the combination therapy group, ALT levels increased by 4.6%, compared to a 3.8% increase with Atorvastatin treatment alone. Combination therapy led to a 2.07% elevation in CK levels, while the Atorvastatin treatment group showed a 1.9% increase in CK values. The differences in HDL-C, ALT, and CK levels between the two groups were not statistically significant (p>0.05). Conclusion: The study revealed that combination therapy of Atorvastatin with Ezetimibe is more effective in reducing LDL-C, TG, and total cholesterol in patients with mixed hyperlipidemia compared to Atorvastatin alone. Journal of Monno Medical College June, 2024; 10 (1):23-29

Rational Use of Proton Pump Inhibitors among Patients Admitted in a Tertiary Care Hospital

Background: The prevalent usage of proton pump inhibitors (PPIs) is a testament to the effectiveness of this class of medications, but it also introduces risk associated with inappropriate prescriptive and consumptive practices. Because of the negative effect of incorrect usage and overdose of PPIs, it is very important for physicians to only prescribe these drugs when needed. However, recent studies showed some concerns about long-term PPIs consumption. The rational prescription of medications is vital to ensuring the optimal use of medical resources, providing effective therapy and minimizing adverse drug reactions. Methods: This observational study was conducted in the department of Pharmacology and therapeutics, Sylhet M.A.G. Osmani medical college, Sylhet, in collaboration with the department of Medicine, Surgery, Gastroenterology, Obstetrics and gynaecology, Sylhet M.A.G. Osmani medical college hospital, Sylhet, from July 2022 to June 2023. The sample size for this study was 600. Usage of PPIs was considered to be appropriate on the basis NICE guidelines and recommendations by Scarpignato et al. (2016) committees on behalf of three Italian scientific societies. Result: For 600 PPIs prescriptions, total 705 case sheets were reviewed. The mean age of the study patients was 42.94±17.16 years. Female were found more 359(59.8%) than male 241(40.2%). Out of 600 patients, based on the indications of PPI usage, 287 (47.8%) of prescriptions were found appropriate, whereas inappropriate prescriptions were found in 313 (52.2%) cases. Out of 287 patients who were prescribed PPIs in an appropriate indication, 175 (61%) patients were given PPIs in an appropriate dose, whereas inappropriate dose was found in 112 (39%) of patients. Again, among 175 patients who were prescribed PPIs for appropriate dose, 24 (13.7%) patients were given PPIs in an appropriate frequency, whereas inappropriate frequency was found in 151 (86.3%) of patients. Finally, 24/600 (4%) patients were prescribed in an appropriate indication with an appropriate dose and frequency, whereas inappropriate prescription were found in 576/600 (96%) patients. PPIs were used as prophylaxis for NSAIDs in highest number 147(51.2%) of patients. Oral was the most common 348(58%) route of prescribing PPIs. Omeprazole was the highest 577(96.2%) prescribed PPIs. Conclusion: Based on this study result, it could be concluded that in most of the patients PPIs prescriptions were not following appropriate indications, dose and frequency recommended by reference guidelines. Like any other drugs, PPIs should be prescribed for a clear indication, the minimum dose needed for the expected effect and medication halted when no longer necessary upon re-evaluation.

Cross-Sectional Comparative study to find out the efficacy of Probiotic in case of children of Acute watery diarrhea(AWD)

Objectives: Diarrhea is a diseases with high fatality rate and having a significant impact on the health and well being of children. In addition to ORS, effectiveness of zinc is already established. Use of probiotic in AWD is a new era of treatment. The aim of this study was to compare the effectiveness of zinc-probiotics combination therapy to zinc monotherapy in reducing the severity of AWD. Method: This was a cross-sectional compative study which was conducted from july 1,2019 to june 30, 2020 in the department of Pharmacology and Therapeutics at Sylhet M.A.G Osmani medical college Hospital. Total number of 128 patients with acute watery diarrhea ages between 6 months to 5 years were enrolled those who were fulfilled the selection criteria. Participants were subsequently randomized into two group. Group A were treated with Zinc(2mg/kg/day in two divided dose for 14 days), Probiotic(1capsule mixed with 1 tsf of water two times a day for 5 days) and Group B were treated with Zinc(2mg/kg/day in two divided dose for 14 days). Sufficient amount of ORS(Oral rehydration Solution) were supplied to the patients according to their requirement .Patients were followed up for changes of consistency of diarrhea, severity of diarrhea (both frequency and duration),duration of hospital stay for 7 days. Result: The Study covered, in Group A 57.81% male and 42.19% female where as in Group B 51.56% male and 48.44% female. Stool consistency have improved in Group A then Group B (liquid stool 3.13% versus on day 2 (p<0.001).Frequency of stool passing became less than two on third day in Zinc Group A and on fifth day in Group B. Based on the Vesikari severity scoring system, the score became below one on fifth day in Group A and on sixth day in Group B. In Vesikari severity score grading system, all the patients of Zinc + Probiotic Groups became mild on fifth day and of Zinc only Group on sixth day of treatment. Mean duration of hospital stay was significantly (p = <0.001) less in Zinc + Probiotic Group (3.36±0.545 days) than Zinc only Group (4.38±0.63 days).

Correlation between Serum Ferritin and Thyroid Hormones Level in Children with Thalassemia

Background: Thalassemia is a group of hereditary blood disorder characterized by reduced or absent globin chain synthesis resulting in transfusion dependent anaemia and iron overload. Due to regular blood transfusion and inadequate chelation therapy patient develop multiorgan dysfunction. Objectives: To find any correlation between serum ferritin and thyroid hormones level in children with transfusion dependent thalassemia. Methods: This cross-sectional study was carried out in the department of Paediatrics and department of Medicine, Sylhet MAG Osmani Medical College Hospital between June, 2021 to May, 2022, on one hundred children with transfusion dependent thalassemia who were on more than 12 times blood transfusion but did not take any chelation therapy and whose serum ferritin level were > 1000 ng/ml. Assessment of their thyroid hormones level and statistically its correlation with serum ferritin were done. Result: A total of 53 (53%) male and 47 (47%) female were included in this study. The mean age of the patients was 9.47 ±3.63 years. Mean serum ferritin was 1980±1126.19 ng/ml, mean serum TSH was 3.55±2.08 µIU/ml, mean serum free T4 was 1.10±0.18 ng/ml, mean serum free T3 was 3.64±0.37 pg/ml. Subclinical hypothyroidism and euthyroid were found in 20 patients (20%) and 80 patients (80%) respectively. No overt hypothyroidism or hyperthyroidism were found. Mean serum ferritin in subclinical hypothyroid and euthyroid were 2407±995.37 ng/ml and 1875.59±1131.18 ng/ml respectively which difference was statistically significant (P value <0.05). Scattered diagram was done and it showed linear correlation between serum ferritin and serum TSH of subclinical hypothyroid group. No linear correlation was found between serum ferritin and F.T3 and F.T4 on scattered diagram. Positive (Pearson) correlation was found between serum ferritin and serum TSH of subclinical hypothyroid group and strong positive (Pearson) correlation (r=0.74, P=0.02) was found between them. Conclusion: This study showed that good percentages of children with transfusion dependent thalassemia are suffering from subclinical hypothyroidism. There is positive correlation between serum ferritin level and subclinical hypothyroidism.

Comparative Outcomes of Propranolol Monotherapy and Combined Therapy with Intralesional Triamcinolone in Infantile Hemangioma

Background: Infantile Hemangiomas (IHs) are the most common vascular tumors of infancy. Oral propranolol has achieved great success in treating IHs since 2008. Recently combined oral propranolol with intralesional injection of Triamcinolone acetonide is the effective method of treatment for infantile Hemangioma with minimal adverse effects. Objectives: To observe the outcome of Propranolol monotherapy and combined therapy with intralesional Triamcinolone in Infantile Hemangioma. Materials and Methods: This prospective study was carried out in the Department of Pediatric Surgery, Sylhet MAG Osmani Medical College Hospital, Sylhet, during the period from January 2018 to December 2019. It included 42 infantile hemangioma patients divided into two groups: Group A (21) treated with oral propranolol, and Group B (21) treated with oral propranolol plus intralesional triamcinolone acetonide. Patients were followed up at regular intervals for 6 months. Results: The data of two groups of patients with IH were compared in the study. The demographic variables, including median age, sex, size, type, and site of IH, were comparable between the two groups. This showed that pre-treatment complications were slightly higher in Group B but not significantly different. Superior size reduction was observed in Group B (71.4% vs. 38.1%), though the difference was not significant statistically. Group B had excellent color regression, which was significantly higher compared to the other group (90.5% vs. 9.5%, p < 0.001). The mean treatment cost was higher in Group B, which was 187.86. taka compared to 124.76. taka in Group A (P value was <0.001). In summary, Group B had better color regression of the pinprick but at a higher cost of treatment as compared to Group A, and other parameters were almost equal in both groups. Conclusion: Combined propranolol and intralesional Triamcinolone is more effective compared to propranolol alone in the treatment of IHs.

Clinical Profile and In-hospital Outcome of Acute Household Substances Poisoning in a Tertiary Care Hospital

Background: Poisoning is an acute medical emergency. Among the thousands of harmless products available for household, very few are hazardous. Still, self-poisoning with these substances is one of the commonest mode of poisoning. This study was carried out to get information related to clinical profile and inhospital outcome of household substances poisoning in a particular area of Bangladesh. Methods: This cross-sectional type of descriptive study was carried out in the department of Medicine, Sylhet M.A.G. Osmani Medical College Hospital, Sylhet, Bangladesh during the period of June 2022 to November 2022.Purposive convenient sampling was applied to recruit sample from study population. Calculated sample size was 64. Detailed history including nature of poisoning (unintentional/ intentional), route of poisoning, type of poison, symptoms and signs with relevant laboratory findings were documented in a structured data collection sheet through interview from the patient or their guardians after obtaining informed written consent. In-hospital outcome in terms of survival (discharged, discharge without advice/absconded) and mortality were recorded.Results:Among 64 participants majority 65.63% (n=42) were female and most 56.25% (n=36) were of 18-20 years age group.Regarding educational status 96.87 %(n=62) participants were educated. All of the poisoning were intentional and by oral route. Harpic was the most common agents 59.38% (n=38) used by the victims.Vomiting was the most common 81.25% (n=52) symptomand oral ulcer was the commonest 40.63% (n=26) sign. No significant abnormality of vital signs and laboratory investigations were found. Majority of the respondents 43.75 % (n=28) stayed 2 days in hospital for treatment purpose. Total 85.94% (n=55) respondents were discharged with advice and 14.06% (n=9) respondents left hospital without medical advice. No death was documented in this study. Conclusion: Young teenaged female patients were the majority of victims in our study reflecting the degree of powerlessness and hopelessness of young, educated people with unemployment and difficulties in coping with life stressors. Bangladesh J Medicine 2024; 35: 70-75

Efficacy of Doxylamine and Pyridoxine during Pregnancy Induced Nausea and Vomiting

Introduction: Nausea and vomiting in pregnancy (NVP) is the most common medical condition of pregnancy causes a significant clinical, psychological and economic burden. Therefore, it is very important to treat this condition appropriately and effectively. The combination of Doxylamine and Pyridoxine is recommended as first-line therapy for nausea and vomiting in pregnancy. Objectives: To observe the therapeutic efficacy of combined Doxylamine and Pyridoxine for treatment of nausea and vomiting in pregnancy. Materials and Methods: An observational study was conducted on patients with nausea and vomiting in pregnancy attended the Model Family planning clinic in the Department of Obstetrics and Gynaecology, Sylhet MAG Osmani Medical College Hospital, Sylhet during the period from January 2019 to December 2019. A total 90 patients with clinically meaningful nausea vomiting (Pregnancy-Unique Quantification of Emesis [PUQE] score > 6) were selected and given 2-4 tablets each containing combined Doxylamine succinate 10 mg and Pyridoxine hydrochloride 10 mg based on a pre-specified titration protocol response to symptoms by respective physician and PUQE score was recorded in all participants before initiation of treatment and at 8th day and 15th day of treatment. In course of follow up period 7 patients were dropped out and finally 83 patients were analyzed in this study. Result: The mean PUQE score was decreased from 10.27 ± 1.76 to 7.94 ± 1.75 at 8th day and to 5.35 ± 1.47 at 15th day of treatment was significant (p<0.001). The percentage reduction of PUQE score was 23.14% at 8th day and 46.91% at 15th day of treatment. The difference was significant (p<0.001). Conclusion: Combined Doxylamine-Pyridoxine is effective and well tolerated in the treatment of nausea and vomiting in pregnancy (NVP). Medicine Today 2023 Vol.36 (1): 26-30

The use of arthroscopy in diagnosing and treating sports-related cartilage lesions

Background: Sports-related cartilage lesions pose challenges for athletes. Cartilage, vital for smooth joint movement, can be damaged. Arthroscopy, a minimally invasive procedure, allows precise diagnosis and treatment of joint issues, offering quicker recovery and minimal scarring, enhancing orthopedic interventions. This study aimed to assess the use of arthroscopy in diagnosing and treating sports-related cartilage lesions. Methods: This prospective observational study was conducted at the department of orthopaedics and traumatology, Life Line Hospital Moulovibazar, Mount Adora Hospital Sylhet, MAG Osmani Medical College Hospital Sylhet, Bangladesh from January 2022 to December 2023. As the study subjects, a total of 58 patients with non-surgically treated acute or chronic sports-related cartilage lesions were enrolled by using a purposive sampling technique. After 6 months, a follow-up report was recorded. Data were analyzed by using Microsoft Office tools. Results: In this study, 72% of participants underwent cuff repair, with the remaining 28% opting for loop repair. The arthroscopic assessment revealed anterior medial cartilage lesions in 34% and anterior lateral lesions in 28%. Posterior medial, posterior lateral, and mid-talus dome cartilage lesions were observed in 17%, 5%, and 16%, respectively. Capsule repair was employed in 86% of cases. Significant improvement in hip range of motion, as well as radiological parameters like lateral center-edge angle, alpha angle (anteroposterior), and alpha angle (Dunn), was observed 6 months postoperatively (p<0.001). Conclusions: In detecting and treating sports-related cartilage lesions, arthroscopy is an effective method. This minimally invasive less painful treatment approach contributes to faster rehabilitation and a quicker return to normal activities.

Use of ‘Diarrhea Stool Card’ in acute diarrhea management in under 5 Years children in resource constraints country

BackgroundAntibiotics are often overused in the management of diarrhea, despite few indications. Lack of confidence regarding the causative organism and limited access to diagnostic facilities contribute to the misuse of antibiotics in acute watery diarrhea (AWD). ObjectiveThe present study aims to assess the variation in diarrhea management before and after implementing the 'Diarrhea Stool Card'. MethodsThis cross-sectional retro-prospective study was conducted at the Department of Pediatrics, Sylhet M. A. G Osmani Medical College Hospital, Bangladesh, from June 2022 to March 2023. It included all children less than 5 years who were admitted into the inpatient department with acute diarrhea. During the prospective phase of the study, all doctors working in the diarrhea unit were oriented first how to utilize the ‘Diarrhea Stool Card’ for assuming the causative organism of diarrhea and to decide whether antibiotic will be given or not. Previous data regarding use of antibiotic in the same diarrheal unit by same doctors were collected retrospectively and compared with prospective data. The study analyzed the data and compared antibiotic prescription rates before the introduction of the 'Diarrhea Stool Card'. ResultsA total of 368 patients were analyzed, among them 177 children were included during the prospective part of the study period and 191 were included from the hospital record as the retrospective sample. Socio-demographic factors of studied populations were analyzed only for prospective samples. Before using the 'Diarrhea Stool Card’, antibiotics were used in 59% (112) of AWD cases. By using the 'Diarrhea stool card' antibiotic prescription declined to 20.8%, (p- 0.0001). ConclusionAntibiotic misuse can be significantly reduced by using a ‘Diarrhea Stool Card’, which can provide confidence to the attending physician in managing diarrhea, especially in low-resource country like Bangladesh.

Circadian Variation of Stroke in a Tertiary Level Hospital

Introduction: Stroke, a primary global health concern, is the fifth leading cause of death in Bangladesh, with a prevalence of 0.3%. While 85% of stroke cases globally are cerebral infarctions, Asian countries exhibit stroke patients on average 15 years younger than developed countries. Survival studies reveal strokes exceeding coronary events in hypertensive patients. Observational data suggests circadian, circaseptan, and circannual variations in stroke occurrence, with a morning peak. Circadian rhythm in ischemic stroke is higher in the early morning. Thrombotic strokes, influenced by platelet aggregation and fibrinolysis, often occur in the morning. Haemorrhagic strokes result from blood vessel ruptures. Population-specific circadian patterns remain unconfirmed.
 Aim of the Study: The study aims to find out the relation of circadian variation of stroke.
 Methods: This cross-sectional study, conducted at Sylhet MAG Osmani Medical College Hospital, Bangladesh, analyzed 100 stroke patients over six months. Ethical approval was obtained, and informed consent was taken. Inclusion criteria covered patients with clinical and imaging stroke diagnoses, while exclusion criteria excluded transient ischemic attack, previous stroke, head injury history, and refusal to participate. Stroke onset time was categorized into four six-hour intervals. Demographic data, risk factors, and comorbidities were recorded, and brain CT scans were performed. Data analysis used SPSS version 22, employing descriptive statistics, Chi-square Test, and Student's t-test. Significance was set at p<0.05. Results were presented in tables.
 Results: The study involves 100 participants, primarily aged 60-70 (50%), predominantly male (76%), residing 62% in urban and 38% in rural areas. Occupationally, 35% are businessmen, 24% are housewives, and 15% are service holders and laborers. Smoking status shows 58% smokers. Stroke types include 57% ischemic strokes and 39% hemorrhagic strokes. Hypertension (72%) is the significant risk factor. Stroke symptoms predominantly occur between 06:01 and 12:00 (46%). These insights comprehensively understand the study population's demographics, lifestyle, and clinical characteristics.
 Conclusion: The study established circadian patterns in stroke onset, with the highest frequency between 06:00-12:00 and the lowest between 18:01-24:00. Ischemic stroke was the most common subtype, followed by hemorrhagic stroke and fewer subarachnoid hemorrhages. Managing blood pressure and coagulation during peak onset times could aid stroke prevention, but further extensive studies are needed for validation.

Correlation Between Magnitude of ST Segment Elevation and the Proximal Right Coronary Artery Lesion in Acute Inferior Myocardial Infarction

Introduction: The determination of the probable site of occlusion within RCA in acute inferior MI is very important because proximal occlusions are likely to cause greater myocardial damage and an early invasive strategy may be planned in such cases. Furthermore, identification of infarct-related artery and its site in acute inferior myocardial infarction not only guide decision regarding the urgency of revascularization but also guide to avoid therapy that may adversely affect the outcome. Objective: To predict the site of lesion in right coronary artery in acute inferior myocardial infarction by the magnitude of ST segment elevation in inferior leads (II, III and aVF). Methodology: This cross-sectional study was conducted in the Department of Cardiology, Sylhet MAG Osmani Medical College Hospital, from January 2014 to December 2015. A total of 50 consecutive patients with inferior MI who present within 12 hours of symptom onset and received fibrinolytic therapy were selected according to inclusion and exclusion criteria. Using 12-lead ECG, height of ST segment elevation in leads II, III and aVF were measured & coronary angiography(CAG) was performed during index hospital period .CAG which showed culprit lesion in RCA were only taken for the study. The sum of STsegment elevation in inferior leads were then correlated with the proximal lesion in RCA. Results: The age of the patients ranged from 31 to 70 years with the mean age of 51.1 (SD 9.2) years. Majorities (88%) of the patients were male and ratio of male to female was 7.33:1.Out of 50 patients, 26(52%) had the lesion in proximal, 19 (38%) in mid and 05 (10%) in distal RCA. Patients with proximal RCA lesion showed a mean ST segment elevation of 12.5(SD 1.07) mm, with mid RCA lesion 8.5 (SD 0.80) mm and distal RCA lesion 6.5(SD 0.42) mm. There was a positive correlation of sum of ST segment elevation in inferior leads II, III and aVF to the proximal lesion in RCA (r=0.923, P < 0.05). Conclusion: From the study it is concluded that the magnitude of ST segment elevation in inferior leads (II,III, aVF) can predict site of lesion in RCA in acute inferior wall myocardial infarction; the greater the sum of the height of ST segment elevation in inferior leads, the higher is the probability of lying the lesion in proximal right coronary artery. Bangladesh Heart Journal 2024; 39(1): 44-48

Relationship between Etiology and Radiological Findings in Case of Moderate and Severe Head Injury Patients.

Introduction: Traumatic brain injury (TBI) or head injury is one of the leading causes of mortality and disability in the world. The common causes of TBI are usually motor vehicle accident, fall and physical assault. Methodology: This was a prospective cohort study to find out the relationship between etiology and the radiological findings in moderate and severe head injury patients. The places of the study were the Neurosurgery department of Sylhet M A G Osmani Medical College Hospital, Sylhet Women’s Medical College Hospital (SWMCH) and King Faisal Hospital (KFH), Taif, KSA. The Sample size was 104. The study period was 3 years (July 2021 to December 2022). On the basis of radiological findings, the participants were divided into three groups or arms. The different arms were diffused traumatic brain injury (arm-1), focal traumatic brain injury (arm-2) and both (diffused and traumatic) types traumatic brain injury (arm-3). Results: Mean age was significantly higher in female (51.83%). Overall mean age was 40.28 year. Highest frequency (23%) was in the below 20-year age group followed by the 41-50-year age group (20.2%). Road traffic accident (RTA) was the commonest (63.5%) etiology followed by fall (21.2%). At the end of 1 month 68.3% of participants showed improvement. Conclusion: Post head injury disability is a huge psychological and financial burden for any nation or family. RTA contributes the major risk for the moderate and severe head injury

Comparison of in Hospital Complications and Mortality between Diabetic and Non-Diabetic Patients Admitted with Acute Anterior MI

Background: Myocardial infarction (MI) or acute myocardial infarction (AMI), commonly known as a heart attack, occurs when blood flow stops to a part of the heart causing damage to the heart muscle. The most common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck, or jaw. Objective: To see the comparison in hospital complications and mortality between diabetic and non-diabetic patients of acute anterior MI. Methodology: This cross-sectional observational study was conducted in the Department of Cardiology, Sylhet MAG Osmani Medical College Hospital, Sylhet over a period of two years from July 2015 to June 2017. A total of 100 acute anterior MI patients (50 diabetic and 50 non diabetic) were included in this study. Acute anterior MI patients admitted after 6 hours of symptom onset or who did not receive streptokinase were excluded. Results: Male predominance was obvious in both groups [40 (80%) versus 42 (84%); p>0.05] in diabetic and non-diabetic group respectively. Mean age was 53.34 ± 11.32 and 54.84 ± 14.12 years in diabetic and non-diabetic groups respectively. Dyslipidemia [6 (12%) versus 6 (12%); p >0.05], Smoking [32 (64%) versus 34 (68%); p >0.05] and Family history of cardiovascular disease [6 (12%) versus 4 (8%); p >0.05] were similar among diabetic and non-diabetic respectively. Hypertension was found more among non-diabetic [27 (54%) versus 19 (38%); p>0.05] but difference was not statistically significant. Diabetic group had more acute MR [2 (4%) versus 0 (0%); p>0.05] but was not significant. Death was more in diabetic group than that of non-diabetic group [7 (14%) versus 3 (6%); p>0.05] but it was statistically not significant. Conclusion: Post MI angina was higher in diabetic than non-diabetic patients. Mechanical complications were also more in diabetic patients. However rate of reinfarction was higher among non-diabetic than that in diabetic patients. Mortality rate was higher in diabetic than that in non-diabetic patients. So, it may be concluded from the present study that in-hospital complications and mortality of acute anterior myocardial infarction are comparatively more in diabetic patients than in non-diabetic patients.

Different Infective and Non-Infective Etiology of Exudative Pleural Fluid Effusion: Experience of 50 Cases in Bangladesh

Background: Several diseases are responsible for the causation of exudative pleural fluid effusion among patients. Objective: The purpose of the present study was to identify the etiologies of exudative pleural fluid effusion. Methodology: This cross-sectional study was carried out at medicine indoor department of Sylhet MAG Osmani Medical College Hospital, Sylhet over a period of six month from October 2009 to March 2010. Patients who were admitted with pleural effusion were selected as the study population. Pleural fluid was collected by a physician. The laboratory tests were performed in the Department of Laboratory medicine of the Hospital. The different etiologies were determined by the different diagnostic tests. Results: A total of 50 cases were selected consecutively in the study. Out of 50 patients, 28.0% was in the range of 41 to 50 years followed by 26.0% between 31 to 40 years. Tuberculosis was the most common cause of exudative pleural effusion and among 50 cases of effusion 30 were due to tuberculosis (60%). Malignancy was found as the 2nd common cause of exudative pleural effusion (24.0%). Pneumonia was found as the 3rd common cause of exudative pleural effusion (10.0%). Conclusion: In conclusion tuberculosis is the most common cause of exudative pleural effusion followed by malignancy. Bangladesh Journal of Medical Microbiology, January 2023;17(1):10-14

Outcome of Transvaginal Local Repair of Vesicovaginal Fistula

Background: Vesicovaginal fistula (VVF) is a significant cause of physical & psychological disability with social stigmatization especially in low- and middle-income countries. Over 80% of such cases result from neglected prolonged and obstructed labour. Objective: The purpose of the study was to observe the outcome of transvaginal local repair of vesicovaginal fistula (VVF). Methods: This descriptive study was carried out at the Department of Obstetrics & Gynaecology, Sylhet M.A.G. Osmani Medical College Hospital, Bangladesh, from July 2007 to June 2008, on 50 patients of vesicovaginal fistula. We included women who were suffering from VVF and who were operated before and diagnosed as a failed repair of VVF. We excluded those patients who had VVF with associated problem like rectovaginal fistula (RVF), any repair through transabdominal route and unwilling to take part in this study. Before surgery, each woman was assessed by medical and surgical history, examination and necessary investigations. Typically, regional anesthesia was utilized for the fistula surgery. However, general anesthesia was given when required. During surgery, transvaginal approach was taken for repair. The vagina was packed for haemostasis. Vaginal pack was removed after 1-2 days depending on instruction of the surgeon. Repacking of vagina was also done sometimes when there was some leaking during post-operative period. Few patients developed severe constipation post operatively. Results: The participants aged between 16 and 70 years. Among them, majority of the patient belongs to the age 31-35 years (26%) followed by 2nd common group 26-30 years of age (20%) and 3rd one in between 21-25 years of age (16%). Among them 44% patients were primipara and 22% patients were grand multipara. The mobilization during operation was excellent in 30%, satisfactory 64% cases and not enough in 6% cases. After mobilization fistula closed in double layer in 10% and in single layer 90% cases, labial fat graft was given 38% and peritoneal graft was given in 2% cases. During operation bleeding was minimum in 92% cases and in 34% cases catheter was block, urine leakage occurred in 30% cases. Among all patients 14% suffered from fever postoperatively. There was vaginal discharge in 10% cases and UTI in 12%cases which was evidenced by urine culture. Operation was fully successful in 60 percent cases, urethral incontinence in 22% cases & failed in 18% women. Conclusion: In this study, majority of the transvaginal local repair of VVF operations were successful; however, few difficult cases were observed. Mugda Med Coll J. 2023; 6(1): 25-29

Association of Maternal Serum Magnesium Level with Preterm Labour

Background: Preterm labour is a major health problem in obstetrics. The cause of preterm labour is still unknown. The role of magnesium is also not clear. Recently, involvement of magnesium in physiological and pathological process of labour has been clearly demonstrated. Aims and Objectives: To see the association between maternal scrum magnesium level and preterm labour. Materials and Method: This cross-sectional comparative study was conducted in Department of Obstetrics and Gynecology, Sylhet M.A.G. Osmani Medical College Hospital, between January 2017 and December 2018. Thirty-five pregnant women with preterm labour were selected as case and 35 preterm age and gestational age matched pregnant women without having preterm labour were selected as control group. Serum magnesium concentration was measured. Results: The mean age (25.43 ± 4.62 years versus 24.40 ± 3.99 years; p=0.332) and the gestational age (31.31 ± 1.78 weeks versus 31.34 ± 1.84 weeks; p=0.974) did not differ between preterm labour group and control group. Serum magnesium level (mg/dl) was significantly lower in prelabour group compared to control group (0.90 ± 0.37 versus 1.69 ± 0.33; p<0.001). Conclusion: It is strongly suggested that maternal serum magnesium associated with preterm labor of unknown etiology

Clinical Spectrum of Major Infection in Hospitalized Children with Nephrotic Syndrome at a Tertiary Care Hospital

Background : Children with Nephrotic Syndrome (NS) are exposed to multiple infections resulting in significant morbidity and mortality. Besides being a common cause of mortality, infections may also be responsible for a poor response to steroid therapy or induce relapse in a child with Nephrotic Syndrome.
 Aims: To assess the clinical spectrum of major infection in hospitalized children with Nephrotic Syndrome.
 Materials and Methods: This hospital based cross-sectional study was done in the Department of Paediatrics, Sylhet M A G Osmani Medical College Hospital, Sylhet, Bangladesh. In this study, sample size was 44 diagnosed cases of Nephrotic Syndrome with infection. After taking consent, detailed history and thorough physical examination were done in each patient. All data were collected in a preformed questioner and finally collected data were expressed in tabulated form.
 Results: In our study total 44 children with Nephrotic Syndrome were enrolled with the mean age of 5.98 ± 2.93 years and most of the childhood Nephrotic Syndrome was aged between 2 to 8 years (75.0%); 23 (52.3%) patients were male, and 21 (47.7%) patients were female with a ratio of male to female of 1.1:1. The common clinical symptoms of major infection were fever (79.5%) and cough (70.5%). Other clinical presentations were throat pain (18.2%), abdominal pain (15.9%), runny nose (11.4%), burning micturition (9.1%), respiratory distress (6.8%), vomiting (4.5%) and leg pain (4.5%). Relapse of Nephrotic Syndrome was found in 33 (75.0%) cases. The most common major infection was pneumonia (50.0%), followed by urinary tract infection (20.5%), Upper respiratory tract infection (15.9%), pneumonia with UTI (6.8%), cellulitis (4.5%) and pneumonia with UTI with spontaneous bacterial peritonitis (2.3%). The most common isolated organisms in urine were Escherichia coli (27.3%), followed by Klebsiella pneumoniae (2.3%).
 Conclusion: The common symptoms of major infection in Nephrotic Syndrome are fever and cough. The most common major infection was pneumonia and urinary tract infection.
 Northern International Medical College Journal Vol. 12 No.2 Jan 2021, Page 544-547

On Examination and Radiological Findings of Tubercular and Malignant Pleural Fluid Collected from Patients Presented with Exudative Pleural Effusion

Background: The on examination and radiological findings of tubercular and malignant pleural fluid may vary among patients with exudative pleural effusion. Objective: The purpose of the present study was to assess the on examination and radiological findings of tubercular and malignant pleural fluid collected from patients presented with exudative pleural effusion. Methodology: This cross-sectional study was carried out at medicine indoor department of Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh from October 2009 to March 2010. Patients who were admitted with pleural effusion were selected as the study population. Pleural fluid was collected and laboratory tests were performed in the Department of Laboratory Medicine of the Hospital. The clinical features and haematological findings of tubercular and malignant pleural fluid were assessed. Results: A total of 50 cases were selected consecutively in the study. Among 30 tuberculars pleural effusion, chest movement and expansion decreased in 26 cases. However, in 12 malignant pleural effusion cases, most of the patients’ chest movement and expansion were found diminished which was in 9 cases. Radiological findings showed that more than half (54.0%) of the patients had right sided pleural effusion. Conclusion: In conclusion chest movement and expansion as well as vocal resonance are decreased in both tubercular and malignant pleural effusion patients with absent of breath sound. Journal of Current and Advance Medical Research, July 2022;9(2):74-78