Osmani Medical College Hospital Research Articles

Port-site infiltration of bupivacaine in reduction of postoperative pain after laparoscopic cholecystectomy

Background: Port site pain remains prevalent complaint of early postoperative period after laparoscopic cholecystectomy. Objectives: to see the analgesic efficacy of port-site infiltration of bupivacaine in laparoscopic cholecystectomy. Methodology: This randomized controlled clinical trial was conducted in the Department of Surgery, Sylhet MAG Osmani Medical College Hospital, Sylhet from September 2017 to March 2018. Sixty patients underwent laparoscopic cholecystectomy were randomized into experimental group and control group by odd and even number respectively. Infiltration of 0.5% bupivacaine was at port sites subcutaneously in experimental group and none in control group. Postoperative pain intensity was measured using Numeric Rating Scale (NRS) at 6, 12, 24 and 48 hours. Results: Pain score was lesser in experimental group compared to control group at 6, 12, 24 and 48 hours (p< 0.001). The amount of opioid analgesic needed (p=0.006) and hospital stay (p=0.048) were significantly lesser in experimental group. Less frequent nausea/vomiting (p=0.034) and bladder dysfunction (p=0.012) were in experimental group. Conclusion: Port-site infiltration of bupivacaine is effective in reduction of postoperative pain in laparoscopic cholecystectomy.

Clinical and Bacteriological Profile of UTI Patients in Medicine Department in a Teaching Hospital of Bangladesh

Introduction: Urinary tract infections (UTIs) encompass a wide array of infections, accounting for a vast number of community as well as hospital acquired infections. This study was undertaken to evaluate the clinical presentations and bacteriological profile of UTI patients in indoor setting.&#x0D; Methods: This 6 months cross-sectional study enrolled 100 patients admitted in Medicine department of Sylhet MAG Osmani Medical College Hospital with symptoms and signs of UTI subsequently confirmed by compatible investigations including urine culture.&#x0D; Results: Among 100 patients of UTI, maximum were females (67%) and the male female ratio was 0.49: 1. The most common age group was 46–60 years (34%). Majority (68%) of the patients had upper UTI while lower UTI constitutes 32%.66% of the patients had complicated while 34% have uncomplicated UTI.18% of the patients had recurrent UTI. Most of the patients had fever (55%), followed by loin pain (37%) as their presenting symptoms. The most common risk factor was loss of host defense 38% (diabetes mellitus/ use of immunosuppressive drugs).Out of 100, 60 urine samples were positive for pathogenic organisms. Escherichia coli was isolated in 41 (68.3%) of the positive samples, followed by Klebsiella sp 13 (21.6%), Pseudomonas sp 3 (5%) Proteus sp 2 (3.3%) Staph. Aureus 1(1.66%).&#x0D; Conclusion: The most common clinical presentations of UTI in admitted UTI patients are fever and loin pain. Diabetes mellitus is the most important risk factor. Mainly Gram negative bacilli were found to be responsible for UTI and most frequent isolated bacteria was E-coli.&#x0D; J Bangladesh Coll Phys Surg 2021; 39(2): 106-113

A Comparative Study on Serum Magnesium in Pre-eclampsia and Non Pregnant Women

Introduction: There are many Hypertensive disorders in pregnancy like preeclampsia, eclampsia etc. Pre-eclampsia is the most common medical complication of pregnancy associated with increased maternal and infant mortality and morbidity. Some studies have implicated that low serum calcium levels may have a role in pre-eclampsia but other studies failed to find relation between low levels of these trace elements and pre-eclampsia.&#x0D; Materials and Methods: This cross sectional study was carried out in the Department of Biochemistry, Sylhet MAG Osmani Medical College in collaboration with the Department of Obstetrics and Gynaecology, Sylhet MAG Osmani Medical College Hospital during the period from January 2016 to December 2016. This Study was occured in among 31 pre-eclampsia patients, aged 20 to 40 years, and gestational age ranges from 20 to 40 weeks and 31 age matched normotensive non-pregnant women having no proteinuria. Serum magnesium was measured by Colorimetric method.&#x0D; Results: The mean serum magnesium level was 3.24 (±1.42) mg/dl in pre–eclampsia and was 3.30 (±1.5) mg/dl in normal women. The mean serum magnesium level did not differ significantly between the subjects of pre–eclampsia and normal women (t=0; p&lt;.05).&#x0D; Conclusion: The means of both data sets are equal. So we can conclude that there is no significant difference between them.&#x0D; Medicine Today 2021 Vol.33(1): 58-60

Outcome of Dynamic Condylar Screw with Plate versus Distal Femoral Lock Compression Plate Fixation in Fracture of Distal Femur

Introduction: The dynamic compression screw with plate implant used to treat fractures of the distal femur. The distal femoral lock compression plate fixation is designed as an alternative surgical option to treat these fractures. The objective of this study was to assess the comparative endurance of both devices. The objective of the study is to compare the outcome of DF-LCP and DCS fixation in distal femoral fractures.&#x0D; Materials and Methods: This prospective comparative study was conducted in the Department of Orthopaedics, Sylhet MAG Osmani Medical College Hospital, Sylhet between January 2011 and December 2012. Thirty patients with AO type 33-B and 33-C fracture were selected and were divided randomly into group-A and group-B by odd and even number. Dynamic condylar screw (DCS) fixation was used in group-A and distal femoral locking compression plate (DF-LCP) fixation in group-B.&#x0D; Results: DCS group [9 male, 6 female; mean age, 44.9 ± 12.9 years] and DF-LCP group [10 male, 5 female; mean age, 42.6 ± 15.7) years] were similar in age (p=0.660) and sex (p=0.705). The total operation (minutes) [92.3 ± 7.5 versus 90.4 ± 6.9; p=0.484], length of postoperative hospital stay (days) [6.0 ± 0.9 versus 5.9 ± 0.9; p=0.695] and union time (weeks) [20.6 ± 5.0 versus 18.7 ±3.3 weeks; p=0.238] did not differ significantly between two groups. Total complications [6 (40.0%) versus 4 (26.7%); p=0.439] was also similar in both groups. Functional outcome was excellent in 13.3%, good in 33.3%, fair in 33.3% and poor in 20.0% cases in DCS group; while excellent in 53.3%, good in 20.0% fair in 6.7% and poor in 20.0% of cases in DF-LCP group; different was not significant (p=0.080).&#x0D; Conclusion: Dynamic condylar screw with plate and distal femoral locking compression plate fixation are equally effective for achieving satisfactory union and functional outcome in AO type 33-B, 33-C fracture distal femur.&#x0D; Medicine Today 2021 Vol.33(1): 45-49

A Comparative Study of Rotaviral Antigen Detection by ELISA and ICT in Children below Five Years with Acute Diarrhoea in A Tertiary Care Hospital

Rotavirus is responsible for acute severe watery diarrhoea in young children. Early and rapid detection of rotavirus infection can help to reduce inappropriate administration of antibiotics and has future positive impact on prevention of drug resistance. This cross-sectional study was designed to determine the role of rotaviral antigen detection by ICT from stool sample of acute diarrhoeal children below five years admitted in Sylhet MAG Osmani Medical College Hospital, Sylhet and was carried out in the department of microbiology in collaboration with the department of paediatrics during the period from 1st January to 31st December, 2018. Total 184 children of under five years of age with acute watery diarrhoea were enrolled in this study. Rotaviral antigen was detected by ELISA (Enzyme Linked Immunosorbent Assay) and ICT (Immunochromatographic test) from stool samples. Out of 184 stool samples, rotaviral antigen was found positive in 84 and 86 cases by ICT and ELISA methods, respectively. ICT showed sensitivity of 90.70% and specificity of 93.88% when compared with ELISA. The rotavirus infection was found highest in male children (61.90%) and in age group of 7 to 12 months (51.89%). Considering the importance of rotaviral diarrhoea, rapid detection of rotavirus infection by ICT is essentially needed and should be practiced routinely as it is relatively reliable, easy to perform and cost-effective. It is particularly important in Bangladesh, where diarrhoea is still contributing a significant proportion of mortality and morbidity in under five children.&#x0D; Bangladesh Med J. 2020 Jan; 49 (1): 14-18

Anatomical Variation of Recurrent Laryngeal Nerve with Inferior Thyroid Artery: A Cross Sectional Study in Bangladeshi People

Background: Recurrent laryngeal nerve is varied anatomically with inferior thyroid artery.&#x0D; Objective: The purpose of the present study was to observe the anatomical variation of recurrent laryngeal nerve with inferior thyroid artery among Bangladeshi people. &#x0D; Methodology: This comparative cross-sectional study was conducted in the Department of Otolaryngology and Head-Neck surgery at Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh from January 2004 to December 2004 for a period of one (01) year. Patients whose recurrent laryngeal nerve was identified during thyroidectomy due to various pathological conditions of thyroid gland were selected as group I. Again, the dead body which were undergone dissection were designated as group II. All the patients whose recurrent laryngeal nerve and inferior thyroid artery were identified during total, near total, sub-total, hemithyroidectomised or lobectomised were included in this study.&#x0D; Result: A total number of 32 patients were recruited for this study. On the left side nerve was found anteriorly in 2(10.53%), in between in 4(21.05%) and posteriorly in 13(68.42%). On the right side-nerve was found anteriorly in 7(30.43%), in between in 6(26.09%) and posteriorly in 10(43.48%). In this series nerve was seen posterior relation more than other two relations and anterior relation more on right side whereas posterior relation on left side, anterior relation more than in between relation on right side but reverse on left side. In group II On the left side nerve was found anteriorly in 2(6.25%), in between in 6(18.75%) and posteriorly in 24(75%). On the right side-nerve was found anteriorly in 8(25%), in between in 9(28.12%), and posteriorly in 10(46.88%).&#x0D; Conclusion: In conclusion each recurrent laryngeal nerve lies posterior to the inferior thyroid artery in the majority of the occasions whereas the nerve lies anterior to the branches of the inferior thyroid artery less commonly except right side of both study group.&#x0D; Journal of Science Foundation, January 2020;18(1):7-12

Relation between Water Source and Rotaviral infection: An Observational Study

Fecal pollution of water is a major concern in river based countries as it is associated with transmition of the pathogens. Rotavirus is one of them which is the major cause of acute severe dehydrating diarrhoea in children below five years. This cross-sectional observational study was designed to determine the association of contaminated water source with Rotaviral infection among under five children admitted in the Department of Paediatrics, Sylhet MAG Osmani Medical College Hospital, Sylhet and was carried out in the Department of Microbiology during the period from 1st January to 31st December, 2018. Total 184 under five children with acute watery diarrhoea were enrolled in this study by convenient sampling. Stool samples were obtained and assayed for rotavirus antigens by enzyme linked immunosorbent assay (ELISA). Rotaviral antigen was found positive in 86 cases. The Rotavirus infection was found highest in age group of 7 to 12 months (50.56%) and in male (59.30%) children. It was found significantly higher in patients from lower socio-economic condition (64.00%), in rural area (48.75%) and those who consumed unboiled pond water (94.44%). It was found higher among those children who were not exclusively breastfed (83.87%). Bottle feeding, lower educational level of mother and improper hand washing may serve as predisposing factors of rotavirus disease in these children. Using of contaminated drinking and household water has an important relation with Rotaviral infection. Ignorance of using boiled water can play a significant role for increased prevalence of Rotaviral diarrhoea.

Effect of vitamin D and calcium alone or in combination in the treatment of nutritional rickets

Background: Nutritional rickets has emerged as a public health problem in Bangladesh during the past two decades, with up to 8% of children being clinically affected in some areas. Insufficiency of vitamin D and dietary calcium is thought to be the underlying cause. Vitamin D administered with or without calcium is commonly regarded as the mainstay of treatment. Calcium alone or in combination with vitamin D has also been used in the treatment of nutritional rickets. So this study was done to assess the effects of vitamin D, calcium or combination of vitamin D and calcium for the treatment of nutritional rickets in Bangladeshi children.&#x0D; Methods: This open labeled randomized comparative study was done in the Department of Paediatrics, Sylhet MAG Osmani Medical College Hospital from July 1, 2010 to June 30, 2012 A total 48 rickets patient was enrolled in this study. After selection of cases patients were divided in to three groups by lottery method. Group A received single i/m dose of vitamin D 4,00,000 IU (2,00,000 IU in each buttock), Group B received calcium (750 mg per day) for 6 weeks and Group C received both calcium (750 mg per day) for 6 weeks and single i/m dose of vitamin D 4,00,000 IU (2,00,000 IU in each buttock). Response was evaluated by serum alkaline phosphatase level and using 10-point radiographic score developed by Thacher and colleagues at baseline, 6 weeks, and 12 weeks.&#x0D; Results: Mean age of the study participants was 35.83 months. Male to female ratio was 2:1. The radiographic score was significantly improved in first and second follow up (p&lt;0.001) in all groups. But there was significant difference of improvement in Group C than Group A and Group B. In Group C, the percent reduction from base to first follow up was 80.05±7.04 and 90.65±3 in second follow up which showed quick improvement in combination therapy. Serum alkaline phosphatase also significantly reduced in all three groups.&#x0D; Conclusion: Combination use of vitamin D and calcium in the treatment of nutritional rickets is more effective than prescribing either vitamin D or calcium alone.&#x0D; Birdem Med J 2021; 11(1): 39-46

Correlation Between Vitamin D3 and Fasting Blood Sugar in Type 2 Diabetes Mellitus Patients and Normal Individuals in a Bangladeshi Population

Background and Aims: Controversies prevail on association of vitamin D level and type 2 diabetes mellitus. The present study aims to compare serum 25-hydroxycholecalciferol (vitamin D3) level and fasting blood glucose in type 2 diabetes mellitus patients and healthy subjects and evaluate their association in both groups.&#x0D; Methods: This cross-sectional, observational study was done in Department of Biochemistry, Sylhet MAG Osmani Medical College, Bangladesh, between July 2015 and June 2016. The patients were selected from medicine out-patients departments (MOPD) of Sylhet MAG Osmani Medical College Hospital and Sylhet Diabetic Hospital, Bangladesh. A total of 135 study subjects were selected following convenient consecutive sampling technique. They grouped into case (Group A) i.e. 65 patients having type 2 diabetes mellitus, and control (Group B), i.e. 70 patients apparently healthy subjects (non-diabetic). Initial evaluation of the patients done by history and clinical examination was recorded in the preformed data collection sheet. Fasting blood glucose was measured by enzymatic method, while serum 25-hydroxycholecalciferol (vitamin D3) was measured by radioimmunoassay (RIA).&#x0D; Results: The mean age of 42.02±3.29 years in case (Group A); while 41.35±3.97 years in control (Group B). There were 33 male (50.76%) and 32 (49.23%) female in group A, while 35 (50%) male and 35 (50%) female in group B. No significant age difference was observed between the groups (p=0.284). Serum 25-hydroxycholecalciferol in cases (Group A) was 55.73±9.02 ng/ml and in controls (Group B) 53.77±10.86 ng/ ml (p=0.255). Fasting blood glucose was 161.98±62.47 mg/dl in cases (Group A) and 86.92±15.74 mg/dl in controls (Group B) (p&lt;0.001). No correlation was found between serum 25-hydroxycholecalciferol and fasting blood glucose in any group: in type 2 diabetic patients (case group) (r=0.010, p=0.943), in healthy controls (r=0.186, p=0.122), and all study subjects together (r=0.095, p=0.268).&#x0D; Conclusions: Our data suggest that serum 25-hydroxycholecalciferol (vitamin D3) was within optimum level in both type 2 diabetic patients and healthy individuals. However, no correlation was found between serum 25-hydroxycholecalciferol and fasting blood glucose in any group.

Eswl for Upper Ureteric Stone With and Without JJ Stent-A Comparative Study

Objective: To find out the outcome of stenting before ESWL in the management of upper ureteric stone.&#x0D; Methods and materials: This prospective comparative study was conducted in the department of urology, Sylhet Osmani Medical College Hospital from January 2011 to June 2012. Sixty two patients with upper ureteric stone, aged between 18 to 60 years irrespective of sex, unilateral radio opaque upper ureteric stone of greatest diameter 2cm, patients with normal renal function and negative urine culture and were agreed to participate in the study were selected. Selected 62 patients with upper ureteric stones were divided randomly into group-A and group-B each consisting 31 patients. The patients of group-A were treated with ESWL with a JJ stent and that of group-B without JJ stent. In the patients selected for JJ placement, a 5 fr JJ stent was placed under regional anaesthesia before ESWL. Siemens Lithotripsy ESWL machine was used to impart shock waves and 3500 shockwaves was given in a session. Both the groups were compared for stone clearance, ureteric colic, steinstrasse, fever, lower urinary tract symptoms (LUTS), number of ESWL sessions. Data were processed and analyzed using software SPSS.&#x0D; Results: The number ESWL session in stented group [single session 10 (32.3%) and multiple sessions 21 (67.7%)] and in non-stented group [single session 9 (29.0%) and multiple sessions 22 (71.0%)] was similar in both groups (p&gt;0.05) Stones were cleared in 23 (74.2%) patients in stented group and 25 (80.6%) patients in non-stented group. Difference was not statistically significant (p&gt;0.05). Ureteric colic was significantly fewer in stented group than that of non-stented group [4 (12.9%) vs 11 (35.5%); p&lt;0.05] but surapubic pain was significantly more in stented group than that of non-stented group [13 (41.9%) vs 5 (16.1%); p&lt;0.05]; while steinstrasse [3 (9.7%) vs 5 (16.1%); p&gt;0.05] and fever [5 (16.1%) vs 2 (6.5%); p&gt;0.05] did not differ statistically significant between groups. Lower urinary tract symptoms such as urinary frequency [15 (48.4%) vs 3 (9.7%); p&lt;0.01]; urgency [17 (54.8%) vs 5 (16.1%); p&lt;0.01] and dysuria [19 (61.3%) vs 6 (19.4%); p&lt;0.01] were significantly more in stented group than that of non-stented group; but gross haematuria [21 (67.7%) vs 15 (48.4%); p&gt;0.05] were more in stented group.&#x0D; Conclusion: ESWL is an effective and reasonable initial therapy in the management of upper ureteric stones measuring &lt;2 cm. Pre-ESWL ureteric stenting provides no additional benefit over non-stented ESWL in their management. Moreover, stents are associated with signiûcant patient discomfort and morbidity.&#x0D; Bangladesh Journal of Urology, Vol. 16, No. 1, Jan 2014 p.17-22

Validation of Bangla generalized anxiety disorder 7 scale among general population

Anxiety disorder is the most prevalent mental disorder in Bangladesh according to the estimation of World Health Organization (WHO). Among the anxiety disorders, generalized anxiety disorder (GAD) is most common and morbid one. The generalized anxiety disorder (GAD) 7 scale is widely used, highly sensitive and reliable scale to screen GAD and other anxiety disorder for both primary and clinical settings. Because of scarcity of properly validated Bangla version of GAD 7 screening tool among the general population, this study was aimed to develop such a version. This validation study was conducted in cross-sectional design from September, 2016 to August, 2018 in the department of psychiatry, Sylhet MAG Osmani Medical College Hospital, Sylhet. Adaptation was done as per Beaton et al., 2000 criteria. Total 61 patient aged e”18 years diagnosed as GAD by applying SCID CV and 65 age and sex matched healthy volunteer was taken as sample by purposively. Data was collected by administering written questioner with Bangla version of GAD 7 scale and Depression Anxiety Stress Scale (DASS) 21 Bangla. Convergent validity and discriminant validity was explored using DASS 21 Bangla scale. Data was analyzed using SPSS version 25. The result showed that, the Cronbach’s alpha value was excellent (0.90), test-retest and intra-class correlation was also good. Unidimensionality was confirmed, a cut-off point of 9 showed adequate value of sensitivity (85%) and specificity (80%) with area under curve being statistically significant (AUC=0.893-0.973). The scale showed good correlation with DASS 21 anxiety (0.637, p&lt;0.001) and stress subscale (0.576, p&lt;0.001). The metric properties of GAD 7 Bangla, its comparison with DASS 21 Bangla confirmed its cultural adaptation and validation. It would be helpful to identify the GAD in all age range of Bangla speaking people. Bang J Psychiatry 2020; 34(1):3-8

Relation between plasma lipids and relapse of idiopathic nephrotic syndrome in children

Background: Nephrotic syndrome (NS) is one of the most common renal diseases in children. It is a chronicchildhood disorder with a course of relapse and remission. Hyperlipidemia is a constant feature (95% cases)of minimal change nephrotic syndrome (MCNS) having serum cholesterol &gt;250 mg/dl. Both increased synthesisand decreased clearance of lipoproteins may contribute to the hyperlipoproteinemia which frequently complicatesthe NS. Persistent hyperlipidemia can lead to relapse of NS which is a potential risk factor for progression ofglomerular injury. Persistent hyperlipidemia and frequent relapse of NS are further responsible forcardiovascular disease and progressive glomerular damage leading to renal failure. This study was done todetermine relationship between plasma lipids and relapse of idiopathic NS in children.&#x0D; Methods: This prospective study was carried out from July 2015 to June 2017 at the Department of Paediatricsin Sylhet MAG Osmani Medical College Hospital. Patients with the diagnosis of NS fulfilling the inclusioncriteria were included in this study purposively. A total of 50 children were included into this study. Theprimary end point was to determine plasma lipids level in children having idiopathic NS at acute phase, inremission and at 6 months after completion of treatment. The secondary end point was to evaluate the relationshipbetween persistent hyperlipidemia in remission phase and relapse of NS.&#x0D; Results: Among 50 children with clinical diagnosis of NS, 35 were first episode and 15 were in relapse cases.Among the first episode NS cases serum lipids level were decreased significantly during remission but HDLwas increased, whereas in relapse cases even during remission serum lipids level were significantly higher.After six months of follow up, out of 50 patients 28 patients had persistent remission and 22 patients hadrelapsed. The relationship between plasma lipids level and the incidence of relapse showed that acute lipidfraction levels were not risk factor in relapsing NS. Only the triglyceride level during remission was a riskfactor in relapsing NS (p&lt;0.035) with OR 5.4 and 95% CI [1.06, 25.4].&#x0D; Conclusion: Persistent hypertriglyceridemia and hypercholesterolemia in remission phase is a risk factor forrelapse of idiopathic NS in children.&#x0D; Birdem Med J 2020; 10(2): 97-102

Body Mass Index and Waist Hip Ratio a Predictor of Hypertension of Adolescent Boys and Girls in a Metropolitan City in Bangladesh

Background: The associations between elevated blood pressure and overweight increasing now a days. Over the last few decades the prevalence of elevated blood pressure also increased in children due to increasing pediatric overweight because of changing dietary habits, changing pattern of life style.&#x0D; Objective: To see the body mass index and waist hip ratio a predictor of hypertension of adolescent boys and girls in a metropolitan city in Bangladesh.&#x0D; Methods and Materials: This cross-sectional– descriptive study was conducted in the department of Pediatrics, Sylhet M.A.G. Osmani Medical College Hospital, Sylhet during the period from January 2014 to June 2014. Adolescent boys and girls in Sylhet Metropolitan City were included according to inclusion and exclusion criteria. Inclusion criteria were children aged 12-16 years in Sylhet Metropolitan City. Children aged under 12 or above 16 years and with any systemic disorder were excluded.&#x0D; Results: This study showed that 56.4% adolescents were male and 43.6% were female with ratio of male: female = 1.3:1 and their average age was 14±2 yrs. Average height of male was 154.82±49.08 cm and female was 148.42±38.09 cm. Average weight of male was 49.12±10.49 kg and that of female was 44.48±12.08 kg .Prevalence of hypertension in adolescent boys and girls of Sylhet city was 0.70% and there was a significant relationship of hypertension with the obesity. Among 7 (seven) hypertensive children, 3(42.8%) were overweight and 3(42.8%) obese (p=0.001). While waist hip ratio among those, 2(28.6%) were excellent and 5(71.4%) were average; was not significant (p=0.745) among the hypertensive adolescents.&#x0D; Conclusion: Prevalence of hypertension in apparently healthy adolescent child of Sylhet city was 0.70% and had a strong relationship with high body mass index&#x0D; J Bangladesh Coll Phys Surg 2020; 38(3): 110-115

An Observational Study to Assess Outcome of NSTEMI Patients with Raised Serum Uric Acid Level in a Tertiary Care Hospital of Bangladesh

Background: Non-ST segment elevation myocardial infarction (NSTEMI) is the commonest form of ACS and a leading global cause of premature morbidity and mortality. Evidences link serum uric acid with short and long-term major adverse outcomes (MACE) in patients with NSTEMI. Objective: To see in-hospital outcome of NSTEMI patients with raised serum uric acid level. Methodology: This cross-sectional observational study was conducted in the Department of Cardiology, Sylhet MAG Osmani Medical College Hospital, Sylhet during the period from July, 2017 to June, 2019. Fifty NSTEMI patients with raised serum uric acid (&gt;7mg/dl in male; &gt;6mg/dl in female) level (Group A) and fifty NSTEMI patients with normal serum uric acid level (group B) admitted within 24 hours of symptom onset were consequently enrolled. In-hospital complications and mortality were recorded while continuing standard treatment for the event. Results: The mean age was 60.82 (SD 9.62) years in group A and 49.90 (SD 10.40) years in group B. The mean age of the patients of group A was significantly higher than patients of Group B (p&lt;0.001). Male preponderance was in both groups (84.0% versus 80.0%; p=0.603). Diabetes mellitus (52.0% versus 22.0%; p=0.002), hypertension (78.0% versus 52.0%; p=0.039) and dyslipidaemia (48.0% versus 12.0%; p&lt;0.001) were more frequent in group A than that of group B. But smoking status (70.0% versus 66.0%; p=0.668), family history of CAD (10.0% versus 26.0%; p=0.476) did not differ significantly. Killip class did not differ significantly between group A and group B (p=0.127). In-hospital mortality was 5 (10.0%) patients in group A and 2 (4.0%) patients in group B; did not reach the level of significance (p&gt;0.05) and complications such as post MI angina, cardiogenic shock, acute left ventricular failure, re-infarction, sinus tachycardia, sinus bradycardia, atrial flutter, atrial fibrillation, bundle branch block, ventricular tachycardia, ventricular fibrillation did not differ significantly between the two groups (p&gt;0.05). Conclusion: There is no significant difference between in-hospital outcome (mortality and complications) of NSTEMI patients with raised and normal serum uric acid level.

Comparison of depressive disorders between the mothers of children with and without autism spectrum disorder

Autism spectrum disorder (ASD) is a neuro-developmental disorder and a lifelong condition which has considerable impact on parents. Various psychiatric conditions are common in mothers of ASD children including depression, anxiety, low self-esteem, feeling of social isolation and high social anxiety. The objective of the study was to evaluate the presence of depression in mothers of ASD children in comparison with mothers of normally developing children. This was a cross-sectional, comparative and analytical study carried out in the outpatient department of Psychiatry in collaboration with the Shishu Bikash Kendro of Sylhet MAG Osmani Medical College Hospital Sylhet, Bangladesh during the period from 1st January 2015 to 31st December 2015. A total of 75 mothers of ASD children were selected by convenient sampling technique and grouped as group A. Another 75 age matched mothers of normally developing children were recruited and grouped as group B. Depression was assessed primarily by using the Beck Depression Inventory (BDI). Those who scored 10 or above points, were evaluated further by mental state examination and DSM 5 criteria. The results showed that, depressive disorder was present in 31 (41.3%) mothers of ASD children and 12 (16.0%) mothers of normally developing children. Significantly higher rate of depressive disorder was present in mothers of ASD children than that of mothers of normally developing children (p=0.001). These findings concluded that the proportion of depressive disorders was higher and statistically significant.&#x0D; Bang J Psychiatry December 2017; 31(2): 32-37

Association of COPD with osteoporosis in male smokers: A case control study in a tertiary medical college hospital in Bangladesh.

Chronic obstructive pulmonary disease (COPD) may increase the risk of osteoporosis and resulting fractures can contribute to disability and mortality of patients. We intended to evaluate the frequency of osteoporosis in male smokers with and without COPD and study whether any correlation existed between osteoporosis and COPD. This case-control study was carried out in the Department of Medicine, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh between July 2013 and June 2015. Seventy four male smokers with COPD and 66 age-matched male smokers without COPD were enrolled. All individuals underwent Bone Mass Densitometry (BMD) by Dual-Energy X-Ray Absorptiometry (DEXA). COPD and non-COPD groups did not differ regarding age and smoking pack-years. Osteoporosis at femoral neck (48.6% versus 16.7%; p< 0.001) and lumbar spine (68.9% versus 37.9%; p< 0.01) was significantly higher in COPD compared to controls. Osteopenia did not differ significantly. Patients with COPD were 4.5times more likely to develop osteoporosis than controls after adjusting age, smoking-pack years and BMI (adjusted OR = 4.5; 95% CI = 1.8-11.5). Osteoporosis is more frequent in male smokers with COPD compared to smokers without COPD. COPD is a risk factor of osteoporosis independent of age, smoking and BMI.

Outcome of Early Laparoscopic Cholecystectomy in Acute Calculus Cholecystitis

Background: : The surgical management of patients presenting with acute calculus cholecystitis remains controversial.&#x0D; Objective: The aim of this study was to evaluate the safety and feasibility of early laparoscopic cholecystectomy for acute calculus cholecystitis and to document the outcome of early laparoscopic cholecystectomy.&#x0D; Methodology: This observational comparative study was carried out in the Department of General Surgery of Sylhet MAG Osmani Medical College Hospital, Sylhet from July 2006 to June 2008, a period of 24 months. The study group enrolled 101 patients of both sexes who underwent laparoscopic cholecystectomy surgery and divided into two groups. 51 patients with a diagnosis of acute calculus cholecystitis were assigned randomly to early laparoscopic cholecystectomy within 72 h of admission (early group, n=51) or to initial conservative treatment followed by elective laparoscopic cholecystectomy, 6 to 12 weeks later (elective group, n=50).&#x0D; Results: There was no significant difference in operation times (early, 81.98 vs elective, 79.96), conversion rates (early, 5.88% vs elective 10%) or postoperative complications (early 31,4% vs elective,24%).However, during early laparoscopic cholecystectomy distended gallbladder containing infected bile was more in 41 patients (80.01%) while 04 patients (09%) and 03 patients (7.20%) in elective laparoscopic cholecystectomy (p&gt;0.05) and significantly (p&lt;0.05) more modification in operative techniques in early group than elective group. In addition, early group had shorte hospital stay (8.37 vs 12.62 days0 and lower treatment cost (5243.13 vs 7327) which were statistically significant (p&lt;0.05).&#x0D; Conclusion: In conclusion laparoscopic cholecystectomy during the early admission with acute calculus cholecystitis can be performed safely and successfully. Earlier surgery has a beneficial impact for patients and the National Health Service.&#x0D; Journal of National Institute of Neurosciences Bangladesh, 2019;5(2): 161-166

Comparative Study of Rivastigmine and Donepezil on Cognitive Function in Mild to Moderate Dementia

Background: Rivastigmine and donepezil are both increase attention and working memory functioning.&#x0D; Objective: The purpose of the present study was to observe and compare the efficacy and safety of rivastigmine and donepezil in mild to moderate dementia.&#x0D; Methodology: This observational study was conducted on patients with mild to moderate dementia attended in the Out-patient Departments of Neurology, Medicine and Psychiatry, Sylhet MAG Osmani Medical College Hospital, Bangladesh during the period from July 2017 to June 2018. Patients with mild to moderate dementia were selected of which group A was treated with rivastigmineand group B was treated with donepezil by respective physician and Mini-Mental State Examination (MMSE) was recorded in all participants before initiation of treatment and at 4th week and at 12th week of treatment.&#x0D; Result: A total of 230 patients with mild to moderate dementia were selected of which 115 were treated with rivastigmine (Group-A) and another 115 were treated with donepezil (Group-B). In course of follow up period 11 patients from group A and 13 patients from group B were dropped out. Finally 104 patients of group-A and 102 patients of group-B were accounted as study subjects for statistical analysis. Out of 230 patients the mean age was 64.89 ± 6.82 years and 63.67 ± 7.02 in group-A and group-B respectively (p=0.204). Vascular dementia was 60(57.7%) patients and Probable Alzheimer Disease was in 44 (42.3%) patients in Rivastigmine treated group. It was 47 (46.1%) and 55 (53.9%) respectively in Donepezil treated group (p=0.095).The mean duration of dementia was 18.53 ± 9.25 months in group-A and 20.82 ± 11.38 months in group-B (p=0.114).The changes of mean MMSE score from 14.39 ± 2.95 at baseline to 16.37 ± 3.21 at 4th week and to 16.37 ± 3.21 at 12th week in Rivastigmine treated group (p&lt;0.001). It was 15.05 ± 3.49, 15.84 ± 3.86 and 19.19 ± 4.38 respectively in Donepezil treated group at the 12th week (p&lt;0.001). The percentage increment of MMSE score from baseline was 14.29% at 4th week and 41.43% at 12th week of treatment in rivastigmine treated group (p&lt;0.001). It was 6.29% and 30.86% in donepezil treated group (p&lt;0.001). When percentage increment of MMSE score were compared between two treatment group, there were significantly higher percentage increment of MMSE score in rivastigmine treated group compared to donepezil treated group estimated at 4th week (p&lt;0.001) and at 12th week of treatment (p=0.001).&#x0D; Conclusion: Treatment with rivastigmine and donepezil increases cognitive function by measurement of MMSE in patients with mild to moderate dementia.&#x0D; Journal of National Institute of Neurosciences Bangladesh, 2019;5(1): 8-12

Development and evaluation of a mobile application for case management of small and sick newborns in Bangladesh

BackgroundIn low-income settings, community health workers (CHWs) are frequently the first point of contact for newborns. Mobile technology may aid health workers in classifying illness and providing referral and management guidance for newborn care. This study evaluates the potential for mobile health technology to improve diagnosis and case management of newborns in Bangladesh.MethodsA mobile application based on Bangladesh’s Comprehensive Newborn Care Package national guidelines (mCNCP) was developed to aid CHWs in identifying and managing small and sick infants. After a 2-day training, CHWs assessed newborns at Sylhet Osmani Medical College Hospital and in the Projahnmo research site (Sylhet, Bangladesh) using either mCNCP or a comparable paper form (pCNCP), similar to standard IMCI-formatted paper forms. CHWs were randomized to conduct a block of ~ 6 newborn assessments starting with either mCNCP or pCNCP, then switched to the alternate method. Physicians using mCNCP served as gold standard assessors. CHW performance with mCNCP and pCNCP were compared using chi-squared tests of independence for equality of proportions, and logistic regressions clustered by CHW.ResultsTwo hundred seven total CHW assessments were completed on 101 enrolled infants. mCNCP assessments were more often fully completed and completed faster than pCNCP assessments (100% vs 23.8%, p < 0.001; 17.5 vs 23.6 min; p < 0.001). mCNCP facilitated calculations of respiratory rate, temperature, and gestational age. CHWs using mCNCP were more likely to identify small newborns (Odds Ratio (OR): 20.8, Confidence Interval (CI): (7.1, 60.8), p < 0.001), and to correctly classify 7 out of 16 newborn conditions evaluated, including severe weight loss (OR: 13.1, CI: (4.6, 37.5), p < 0.001), poor movement (OR: 6.6, CI: (2.3, 19.3), p = 0.001), hypothermia (OR: 14.9, CI: (2.7, 82.2), p = 0.002), and feeding intolerance (OR: 2.1, CI: (1.3, 3.3), p = 0.003). CHWs with mCNCP were more likely to provide counseling as needed on 4 out of 7 case management recommendations evaluated, including kangaroo mother care.ConclusionsCHWs in rural Bangladesh with limited experience using tablets successfully used a mobile application for neonatal assessment after a two-day training. mCNCP may aid frontline health workers in Bangladesh to improve completion of neonatal assessment, classification of illnesses, and adherence to neonatal management guidelines.

Evaluation of Risk Factors Associated with Rotaviral Diarrhoea among Under Five Children in Sylhet Region of Bangladesh

Retrovirus is the major cause of acute severe diarrhea in under five children and contributing 10,000 to 27000 deaths each year in Bangladesh. This cross-sectional study was designed to determine the risk factors associated with Rotaviral among under five children admitted in the Department of Paediatrics, Sylhet MAG Osmani Medical College Hospital, Sylhet and was carried out in the Department of Microbiology during the period from 1st January to 31st December, 2018. Total 184 under five children with acute watery diarrhoea were enrolled in this study by convenient sampling. Stool samples were obtained and assayed for rotavirus antigens by enzyme linked immunosorbent assay (ELISA). Rotaviral antigen was found positive in 86 cases.The Rotavirus infection was found highest in age group of 7 to 12 months (50.56%) and in male (59.30%) children. It was found significantly higher in patients from lower socio-economic condition (64.00%), those who were from rural area (48.75%) and children who were not exclusively breastfed (83.87%). Bottle feeding, lower educational level of mother and overweight of children may serve as predisposing factors of rotavirus disease in these children.&#x0D; Bangladesh Med J. 2019 May; 48 (2): 32-37