Osmani Medical College Hospital Research Articles

Clinico-Demographic characteristics of Patients Presented with exudative Pleural Effusion

Background: Pleural effusion can occur with varied clinical presentations.
 Objective: The purpose of the present study was to see the demographic characteristics and clinical profiles of 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 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 details history of age, sex, socio-economic condition, clinical features were collected from the patients.
 Results: A total of 50 cases were selected consecutively in the study. The mean age of the patients was 44.5±12.86 years. Male to female ratio was 2.1:1. Over half of the patients (54.0%) was poor; 32.0% cases was middle class and 14.0% cases was rich. Low-rade fever (92.0%), cough (86.0%), weight loss (74.0%) and dyspnoea (56.0%) were found as the most common symptoms of exudative pleural effusion.
 Conclusion: In conclusion middle age adult male living in poor socio-sconomic condition are most commonly suffering from exudative pleural effusion.
 Journal of National Institute of Neurosciences Bangladesh, July 2022;8(2):167-170

Assessment of Flap Viability and Post-operative Hand Function After Resurfacing of Acute Soft Tissue Injury onthe Palm of Hand byGroin Flap and Reverse Pedicled RadialForearm Flap

Background: Many flaps have been described and used for coverage of various soft tissue defects of hand, which can be regional or distant. Objective: In this study main goal is to evaluate the assessment of flap viability and post-operative hand function by Total Active Motion (TAM) and Hand grip strength. Method: This was a comparative observational study, conducted at department of Orthopaedic Surgery and Burn and Plastic surgery in Sylhet MAG Osmani Medical College Hospital (SOMCH) from January 2018 to October, 2019. A total of 16 patients with acute hand injury or pathology in the palm which may create surgical wound, admitted in the study place during the study period were the study population. Where those who had Acute wound in palm with exposed tendon, nerve and bones or degloving hand injury were included in the study. Patient were divided into two group namely Group-A and Group-B. Patient chosen for groin flap were allocated in group-A and for reverse pedicled radial forearm flap were in group-B. Results: During the study, complete flap survival was 100% in both group A and B. At all the follow-ups hand grip strength was more in group B and the difference was statistically significant (p<0.05, obtained by unpaired t-test). At final follow-up (12 weeks) hand grip strength was 22.38 (SD±5.26) kg in Group A and 30.13 (SD±10.15) kg in Group B.There is no(0.0%) excellent result of index and middle finger in group A patient compared to 3 (37.5%) and 6 (75.0%) patients respectively in group B. Ingroup A3 patient had excellent outcome in ring fingercompared to 7 (87.5%) patients in group B. Majority (87.5%) patient‘s little finger was excellent in group A and 8(100.0%) in group B.The difference of index finger and middle finger were statistically significant between groups (p<0.05 obtained by Fisher Exact test). Conclusion: From this study we can say that, both the handgrip strength and TAM score was better in patients who underwent radial forearm flap and the difference was statistically significant (p<0.05). It is concluded that reverse pedicled radial forearm flap has better outcome regarding flap viability and post-operative hand function than groin flap.

Clinical Presentation and Management of Breast Lump in Sylhet M.A.G Osmani Medical College and Hospital- A Study of 100 Cases

A breast lump is a growth of tissue that develops within breast. A breast lump is often interchangeably described as a mass, swelling, thickness or fullness. The present cross sectional study was to find the clinical presentation and management of breast lump patient. The study was conducted in the Department of Sylhet MAG Osmani Medical College Hospital between July 2017 to December 2019. The patients who presenting with breast lump were study population and patient with male breast lump and breast abscess were excluded from the study. The mean ages at diagnosis, menarche and menopause were 39.1±15.6, 12.4±1.1, 41.9±10.5 years respectively. The average time lapsed between marriage and 1st child birth was 4.6±2.2 years. Out of 100 patient majorities (84%) patients were married, 8% had family history of breast cancer, 9% had history of taking oral contraceptives. All of the patients complained of swelling in the breast, thirty-four patients complained pain in the breast, twenty-four discharge from the nipple and seven patients complained fever. Half of the patients’ had location of swelling in upper outer quadrant of breast. The mean size of swelling was 4.0±1.5 cm and the lowest and highest size of swelling was 1 cm and 10 cm respectively. Fifty-four percent of patient had firm swelling, forty-one percent had hard and five percent had soft swelling. Two percent had fluctuation in the swelling. Four percent ulceration of breast, two percent peau-d-orange, six percent with fixity of skin and two percent fixity to the underlying structures. Regarding lymph node status twenty-two percent had axillary and four percent had supraclavicular lymphadenopathy. Regarding characteristics of nipple thirteen percent patient had tender nipple followed by eight percent had retracted, four percent had ulcerated and only two percent had protruded nipple. Nearly forty percent patients had blood stained discharge. Out of hundred patients four percent had a history of jaundice, ........

Comparison of the Outcomes of Treatment on Comminuted Distal Radius Intraarticular Fracture by Volar Locking Plate Fixation and External Fixator

Introduction: Intra-articular fractures of the distal radius represent high-energy, complex, unstable injuries. An anatomical reduction of the joint surface with rigid fixation is the main goal in the treatment of intra-articular distal radial fractures, but the optimal method of treatment remains controversial. The treatment strategies to achieve anatomical reduction for intra-articular fractures and possible surgical treatment methods are external fixation and open reduction and internal fixation (ORIF) by volar locking plate has become increasingly popular. This study aimed to analyze a comparison of the outcomes of treatment on comminuted distal radius intraarticular fracture by volar locking plate fixation and external fixator. Methods: This cross-sectional comparative study was conducted in the Department of Orthopedics, Sylhet M A G Osmani Medical College Hospital, Sylhet during the period from 1st July 2014 to 30th June 2016. A total of 24 cases of a distal radial comminuted intra-articular fracture. They were divided by random allocation into group-A and group B each comprising 12 patients. Every odd number of patients was taken as group-A and an even number of patients was taken as group B. The patients of group-A were treated with a volar locking plate and patients of group B were treated with an external fixator. Result: The age of the patients ranged from 21 to 50 years with a mean age of 33.7 (SD 9.4) years in group-A; while it was 25 to 60 years and 37.1 (SD 9.2) years respectively in group B. Outcome was measured using Quick DASH score and it was significantly lower in group-A than that of group-B [16.9 (SD 1.1) versus 21.5 (SD 4.5); t=-3.428; p<0.01). The outcome was also measured using O’Brien scoring system. The recorded Green O’Brien scoring score was significantly higher in group-A than that of group B [86.7 (SD 6.9) versus 77.9 (SD 10.3); t=2.446; p<0.05). There were 4 (33.3%) excellent, 7 (58.3%) good, and 1 (8.3%) fair in group-A; whereas ....

Depressive Disorders among Patients in Chronic Obstructive Pulmonary Disease

Background: COPD patients suffer from limitations of activities, loss of independence, decreased social functioning and quality of life. Commonly associated co-morbid conditions include cardiovascular disease, the metabolic syndrome, osteoporosis, depression, lung and other cancer. Objective: To evaluate depressive disorders in chronic obstructive pulmonary disease (COPD) patients. Material and Methods: This study was a cross sectional and comparative study conducted in the department of Psychiatry in collaboration with the department of respiratory medicine, Sylhet M.A.G. Osmani Medical College Hospital, Sylhet, Bangladesh during the period from July 2014 to June 2015 with a view to evaluate depressive disorders among patients in COPD. For this purpose 96 respondents of COPD patients were selected fulfilling the inclusion and exclusion criteria and categorized as COPD group (group-A). Results: Depressive disorders were present in 39 (42.9%) patients of smoker and 2 (40.0%) patients of non-smoker. Depressive disorders were present in 17 (50.0%) patients on steroid and 24 (38.7%) patients not on steroid. Though steroid intake increased the rate of depressive disorders in COPD but did not reach the level of significance. The rate of depressive disorders increased with duration of COPD but did not reach the level of significance (χ2=2.931; p=0.231). Conclusion: A liaison between medicine and psychiatry practice is essential for early detection and treatment of depression in patients suffering from COPD.

Analysis of Vesicovaginal Fistulas in Sylhet MAG Osmani Medical Hospital: A Two Years Study

Background: Vesico-vaginal fistula (VVF) is still a persisting scourge in the developing countries with devastating medical and social consequences. These consequences were studied among patients presenting with vesico- vaginal fistula in Sylhet MAG Osmani Medical College Hospital, Sylhet. Objectives: To analyzethe vesico-vaginal fistula patients during the 2 years period. Materials and Methods: This was a descriptive and cross-sectional study conducted in the Department of Obstetrics and Gynaecology, Sylhet M.A.G. Osmani Medical College Hospital, Sylhet from May 2008 to April 2010 (2 years).Fifty-three hospitalized patients with vesico-vaginal fistula were selected by Inclusion and exclusion criteria, undergoing repair operation irrespective of age. After selection of the patients informed written consent was taken. Each patient was interviewed using the semi-structured questionnaire containing socio- demographic and other relevant information like age, occupation, education of the patient and her husband, age at marriage, age at 1* child birth, monthly income and detailed history of the delivery. Type of fistula and related examination of the fistula was also done and noted. Type of repair of vesico-vaginal fistula, postoperative complications and outcome was recorded in the same manner. Results: The mean age of the patients with vesico-vaginal fistula was 30.5 years (SD± 8.5; range, 18 to 52). Majority (73.6%) were between 21 to 40 years; and 52.8% patients were primipara, 81.1% patients were illiterate and 69.8%patientswere from lower social class. The aetiology of fistula were obstructed labour 49.1%, emergency lower segment caesarean section 37.7%, destructive delivery 11.3% and caesarean hysterectomy 1.9%.The repair operation was done of all patients in this series through vaginal approach. Repair was done first time in 83% and rest had history of failed repair. Postoperative complications were catheter block and urine leakage in 37.7% and urinary tract infection in 11.3% patients. Successful outcome was found in 79.2% cases. Causes of failure were severe scaring 36.5% difficult operation, catheter block and others each constituted 18.2% and large fistula 1.9%. Conclusion: Young primi are the victims of vesico-vaginal fistula, obstetric causes add up to form a major share of the etiology of vesico-vaginal fistula. Proper perinatal management is most important to reduce obs fistula formation.

Indications of Peripartum Hysterectomy

Introduction: Peripartum hysterectomy has to be done repeatedly as the last resort in saving a woman's existence. Currently, several drugs and surgical techniques have been established for the management of postpartum haemorrhages. The foremost indication for peripartum hysterectomy is severe uterine haemorrhage that cannot be controlled by conservative methods. Objectives: This study intended to find out the indication and frequency of peripartum hysterectomy in MAG Osmani Medical College Hospital, Sylhet. Methods: This prospective cross-sectional study on 100 cases of peripartum hysterectomy was carried out at the Department of Obstetrics & Gynaecology at Sylhet M.A.G Osmani Medical College Hospital, Sylhet from January 2004 to June 2005. Verbal consent was taken before recruiting the study population. Data was compiled and analysed manually. Result: The commonest age group involved in peripartum hysterectomy was 31-35 years (38,38.0%). The incidence of peripartum hysterectomy was 0.70%. Rupture uterus (76%) was the most common cause. Other causes are uterine atony (12%), Placenta praevia (2%), placenta accreta (2%) & sepsis in 6% of cases. Maximum patients (82,82.0%) did not get any antenatal care. Of those who got antenatal care, eighteen patients (18,18.0%) were irregularly booked. Conclusion: Emergency peripartum hysterectomy is a vital lifesaving technique and remains to have a high incidence in our community. The choice to implement an emergency peripartum hysterectomy is usually obscure as the obstetrician's paramount wish is to preserve the uterus for future childbearing.

Effect of Zinc Supplementation on Duration of Hospital Stay in Childhood Pneumonia

Background: Pneumonia is one of the major causes of death in children younger than age five, especially in developing countries. Supplementation with zinc is effective in the treatment and prevention of childhood pneumonia.
 Objective: To assess the duration of hospitalization after zinc supplementation in childhood pneumonia.
 Materials and Methods: This randomized double blind controlled trial was conducted in the Department of Pediatrics, Sylhet MAG Osmani Medical College Hospital, Sylhet during the period from 1st July 2013 to 30th June 2015. A total of 120 patients with severe pneumonia in hospitalized children fulfilling inclusion and exclusion criteria were enrolled by systematic random sampling. Group allocation of Group-A and Group-B was done by lottery method each consisting of 60 and 60 patients. Identically small packets that contained 10mg zinc sulphate powder or 10 mg placebo powder were coded as A and B by guide.
 Results: Time for normalization of all parameters (clinical recovery) in placebo group and zinc group was 127.12±24.58 hours and 111.23±35.47 hours respectively which were statistically significant (p<0.05). All patients of both groups were discharged. The mean duration of hospital stay was found to be 6.78±0.42 days in placebo group and 5.42±0.81 days in zinc group. Mean duration of hospital stay was significantly less in zinc group in comparison to placebo (p<0.05).
 Conclusion: Supplementation of zinc therapy in childhood pneumonia causes early clinical recovery and less duration of hospital stay in comparison to the non-zinc therapy group.
 Eastern Med Coll J. Jan 2023; 8 (1) 15-18

Association between Prenatal Maternal Tobacco Use and Intrauterine Growth Restriction: A Case-Control Study

Introduction: Intrauterine growth restriction (IUGR) refers to the poor growth of a baby while in the mother’s womb during pregnancy. More than 9% of women smoke tobacco and one-third of women consume smokeless tobacco in developing countries. The intent of the study was to examine the effect on fetal intrauterine growth retardation using maternal tobacco. Methods: This convenient case-control study was conducted with 75 cases and 150 suitably matched controls enrolled in the Department of Pediatrics at Sylhet MAG Osmani Medical College Hospital for about 12 months. Ethical considerations were undertaken before the enrollment of patients. Data were analyzed using SPSS software. Result: ST user mothers of IUGR infants used jarda or gul as smokeless tobacco about 5 times a day and smoker mothers smoked about 5 sticks a day. Maternal tobacco use had a higher (6.9 times) risk of having IUGR babies compared to the non-tobacco user. Conclusion: This study observed that maternal total tobacco use showed a risk of having IUGR infants more than 6.9 times in contrast to non-tobacco user.

Lumbar Interverterbral Disc Prolapse (PLID) Surgery under SAB

Background: The type of surgery performed on the spine encompasses operations for trauma, deformity, and myelopathy. The complexity of procedures is continuing to increase and older patients with significant co-morbidities are being offered ever more major procedures for which they would have previously not been considered. Developing areas include surgery for degenerative scoliosis and an increase in operations performed on the anterior lumbar spine Spinal anaesthesia for Lumbar Interverterbral Disc Prolapse (PLID) surgery is becoming increasingly more popular because this anaesthetic technique allows the patient to comfortable self-position and avoid neurological injury that may occur with prone positioning under general anaesthesia. PLID surgery is also a comparatively cost effective surgical procedure. Aim of the study: The aim of the study was to observe the extent of surgical options as per pathological outcome in terms of postoperative pain, immediate functional recovery and patient’s satisfaction for undergoing PLID surgery under spinal anaesthesia. Methods: This observation study was conducted in the department of Neuro surgery Sylhet MAG Osmani Medical College Hospital in association with Central Hospital Limited Sylhet from January 2007 to July 2019. A total of 4000 healthy cooperative patients with ASA I-III grading, undergoing Lumbar Interverterbral Disc Prolapse (PLID) surgery at single level to two levels also recurrent cases operative maximum twice previously were selected as study population. A comprehensive perioperative was carried out documenting per operative events anaesthetic complications, pace of physiological and functional recovery and patient’s satisfaction. Variables were recorded as pain level using a visual analogue scale (VAS) at 1, 6, 12 & 24 hours; patients level of satisfaction during the stay on the ward using verbal rating scale (VER); during of surgery; per amount of blood loss. Data were analyzed by SPSS version 19.0. Results: Among 4000 participants, man was 2416(60.4%) and female 1684 (39.6%). In incidence of PLID surgery 36-45 years age group was almost fifty percent 49.42%. In level of PLID L3/4 was highest 39.0%. Regarding of per operative blood, new was 3337(84.18%) & mean value was 47.65(±9.14) and recurrent 633(15.82%) & mean value was 55.60(±13.80). In duration of surgery the mean of new was 22.51(±3.67)& recurrent 26.72(±5.78). Regarding per operative complications, hypertension was highest 1440(36.0%) followed by hypotension 992(24.4%) & nausea/vomiting 960(24.0%).Average hospital stay was 36 to 48 hours. Conclusion:As our results correspond to the others available studies it is clear that, spinal anaethesia can be definitely used for doing at least 2 levels of PLID surgery as it is also more cost effective and patient need to stay minimum in time duration. Bang. J Neurosurgery 2022; 11(2): 75-79

Clinicopathological Study of Sinonasal Malignancy-Experience in a Tertiary Level Hospital in Bangladesh

Objectives: To assess the clinical presentation and histopathological types and extensions of the disease at the time of presentation.
 Methods: Cross sectional observational study of 40 patients with sinonasal malignancy from the department of otolaryngology and Head neck surgery, Sylhet MAG Osmani Medical College Hospital, Sylhet Bangladesh, period from May 2019 to April 2020. The patients were examined after admission into hospital pre-operatively and in the postoperative period. The surgical specimens were sent for Histopathology.
 Results: Majority patients were at 4th to 6th decade where male outnumbered the female with male female ratio was 3.4:1. Out of 40 patients, the majority of patients complaints of nasal obstruction followed by nasal discharge, facial pain, facial swelling and headache. About the site of the lesion maximum patients having the lesion in Maxillary sinus (60%) followed by nasal cavity (15%) multiple sinuses (12.5%) involvement in Ethmoidal sinus (10%) lateral wall of nose (2.5%)
 Conclusion: Sinonasal Malignancy is usually a disease of middle age and elderly people. Most of the patients (in this study 65% patients come at T3 & T4 stage) presented late with multiple symptoms.
 Bangladesh J Otorhinolaryngol 2022; 28(1): 37-42

Psychiatric morbidity among the patients of first ever ischemic stroke

Ischemic stroke is one of the leading causes of mortality and morbidity worldwide and third common cause of death in developed countries which consumes annually a great cost, directly or indirectly and stroke produces a wide range of psychiatric disorders. This was a cross sectional study, conducted in the department of Psychiatry, Sylhet MAG Osmani Medical College Hospital, Sylhet during the period from 1 July 2013 to 30 June 2014 to evaluate the psychiatric morbidity among the patients of first ever ischemic stroke. For this purpose, 66 ischemic stroke patients of first attack between 2 weeks to 2 years of stroke, aged above 18 years irrespective of sex and 66 accompanying healthy persons of the patients and other patients without any kind of stroke matching age and sex fulfilling inclusion and exclusion criteria were taken in Group[1]A and Group-B respectively. Psychiatric assessment was done using General Health Questionnaire (GHQ12) as a screening tool and all GHQ12 positive cases were evaluated using mental state examination. Diagnoses of psychiatric disorders of all respondents were confirmed by psychiatrist according to Diagnostic and statistical manual of mental disorders (DSM) 5 criteria. Ethical issues were maintained properly and an informed written consent was taken from every patient. After collecting data, editing was done manually and was analyzed with statistical package for social sciences (SPSS) version 21. The result showed that, the mean age of the respondents was 57.6 (SD±5.5) years which was almost identical to control group (p=0.130). Most (87.9%) of the patient were below the age of 65 years. Co-morbid psychiatric disorder was found in (34.8%) patients with ischemic stroke and (13.6%) control subjects (p=0.004). The most common psychiatric disorder was generalized anxiety disorder (13.6%) and major depressive disorder (21.2%) in ischemic stroke group. The results of this study suggested that, a significant number of patients with ischemic stroke were suffering from psychiatric disorders than the age and sex matched control. Bang J Psychiatry 2022;36(1):11-17

Psychiatric Morbidity Among the Patients of First Ever Ischaemic Stroke

AimsTo evaluate psychiatric morbidity among the patients of first ever ischemic strokeMethodsThis sectional comparative study was carried out in the Department of Psychiatry, Sylhet MAG Osmani Medical College Hospital, Sylhet during the period from 1st July 2013 to 30th June 2014. Sixty six ischaemic stroke patients of first attack between 2 weeks to 2 years of stroke, aged above 18 years irrespective of sex and 66 accompanying healthy person of the patients and other patients without any kind of stroke matching age and sex fulfilling inclusion and exclusion criteria were taken in Group-A and Group-B respectively. Diagnosis of ischaemic stroke was made in these patients by the consultant neurologists reviewing the history, clinical examination and accompanying investigations reports specially CT scan of brain. Psychiatric assessment was done using General Health Questionnaire (GHQ12) as screening tool. All GHQ12 positive cases were evaluated using mental state examination and recorded in a MSE sheet. Diagnosis of psychiatric disorders of all respondents was confirmed by psychiatrist according to DSM-5 criteria.ResultsThe patients with ischaemic stroke and control subjects were similar in age [57.6 (SD ± 5.5) years vs 57.1 (SD ± 4.5) years; p > 0.130] and sex [48 (72.7%) male and 18 (27.3%) female vs 45 (68.2%) male and 21 (31.8%) female; p = 0.567]. Comorbid psychiatric disorder was found in 23 (34.8%) patients of ischaemic stroke and 9 (13.6%) control subjects. The comorbid psychiatric disorder was significantly higher in patients of ischaemic stroke than that of control g subjects (p = 0.004). Comorbid specific psychiatric disorders were generalized anxiety disorder in 9 (13.6%) and major depressive disorder in 14 (21.2%) in stroke group; while comorbid specific psychiatric disorders were generalized anxiety disorder in 2 (3.0%) and major depressive disorder in 7 (10.6%) respondents in control group (p < 0.013).ConclusionComorbid psychiatric disorders are quite common among patients with first ever ischaemic stroke in the form of major depressive disorder and generalized anxiety disorder. Therefore, attention should be paid to the anxiety and depressive symptoms in stroke units and try to relieve the patients’ emotional stress and personal suffering, which could improve their neurological outcome.

An Observational Study on Idiopathic Intracranial Hypertension (IIH) in a Tertiary Care Hospital in Bangladesh

Background: Among the risk factors of cardiovascular diseases, hypertension is one of the major reason. Intracranial hypertension (IIH) is a pressure buildup around the brain. It can happen unexpectedly, as a result of a severe head injury, stroke, or brain abscess could be occurred. It could also be a chronic, long-term condition, known as IIH. It results in the signs and symptoms of a brain tumor. Which is also known as benign intracranial hypertension. Cerebrospinal fluid, or CSF, is the fluid that surrounds the spinal cord and brain. CSF can accumulate if too much fluid is produced or not enough is reabsorbed. This can induce symptoms similar to a brain tumor. Intracranial Hypertension can be classified into three categories, they are Acute, Chronic and Idiopathic. IIH is recognized when the increased intracranial pressure cannot be explained by any other underlying cause.Aim: The aim of the study was to observe idiopathic intracranial hypertension patients in a select tertiary care hospital of Bangladesh.Methods:This cross-sectional observational study was conducted at the Department of Neurosurgery, Sylhet M. A. G. Osmani Medical College Hospital, Sylhet, Bangladesh. The study duration was from January 2012 to December 2020. A total number of 47 participants had been recruited as study population.Results:Male: female ratio was 1:10.75, and 91% of the total participants were female. 40.43% of the participants were aged between 21-30 years. 46.81% were overweight and 34.04% were obese. Most common symptom was nausea, followed by visual impairment and double vision.Conclusion:The prevalence of Idiopathic Intracranial Hypertension is much higher among the female. Female and high BMI are significant risk factors of IIH. It is more prevalent among young adults, and results on various vision related symptoms.

Handgrip Strength in Patients With Type 2 Diabetes Mellitus

Background: Handgrip strength can be used to determine an individual's muscular strength objectively. It is a valid indicator of the disability index. Type 2 diabetes mellitus has a negative impact on skeletal muscles and handgrip strength. The goal of this study was to compare type 2 diabetic patients' handgrip strength to that of apparently healthy non-diabetic individuals. Materials and Method: This cross-sectional study was carried out in the Department of Physiology, Sylhet M.A.G Osmani Medical College in collaboration with Outpatient Department of Endocrinology, Sylhet M.A.G Osmani Medical College Hospital and Outpatient Department of Sylhet Diabetic Hospital during the period from January 2017 to December 2017. A total of 100 type 2 diabetic patients who had been diagnosed for at least 5 years were selected, as well as 100 age and sex matched apparently healthy non-diabetic controls. The Jamar Hydraulic Hand Dynamometer was used to measure the handgrip strength of all subjects. All the collected data were compiled and analyzed using the Statistical Package for Social Science (SPSS) Version 22.0. Results: The mean handgrip strength of the diabetics (60.62 ± 18.98 lb) was significantly lower than non-diabetics (74.80 ± 21.61 lb) (p<0.001). A significant negative correlation was found between handgrip strength and duration of diabetes (r=–0.270, p=0.007). Conclusion: Handgrip strength is lowered in patients with type 2 diabetes compared to the non-diabetic group and correlates negatively with diabetes duration. Reduced handgrip strength may lead to the development of impairment in the future, resulting in decreased productivity.

Subtype and severity of stroke at presentation in subjects with and without type 2 diabetes

Background: Although diabetes is a strong risk factor for stroke, it is still unclear whether stroke subtype and severity at presentation are different in patients with and without diabetes. Objective: The objective of the study was to identify the subtype and severity of stroke at presentation in diabetic versus nondiabetic subjects in our population. Methods: This cross-sectional comparative study was conducted in the Departments of Neurology and Medicine, Sylhet MAG Osmani Medical College Hospital, Sylhet, from July 2011 to December 2011. Forty-seven stroke patients with diabetes and 47 nondiabetic patients with stroke were included in the study. Results: The mean age of the patients of the diabetic group was lower than the nondiabetic group (60.4 [standard deviation (SD) ± 10.5] vs. 65.4 [SD ± 10.3], P< 0.05), but there was no sex difference between the two groups. Hypertension and stroke severity was more in diabetics (Scandinavian Stroke Scale: 21.2 vs. 28.1, P< 0.001). Ischemic stroke was significantly more in the diabetic group than that of the nondiabetic group (83.0% vs. 59.6%, P< 0.01). Subtypes of hemorrhagic stroke and ischemic stroke were almost similar in both the diabetic and nondiabetic groups. Conclusion: Stroke in diabetic patients is different from stroke in nondiabetic patients in several aspects. The diabetic stroke patient is younger, ischemic stroke and stroke severity is more, but hemorrhagic stroke is less in diabetic individuals.

Efficacy and Safety of Gabapentine and Duloxetine in Diabetic Peripheral Neuropathic Pain

Introduction: Diabetic peripheral neuropathy (DPNP) is not uncommon now a days. As the pathophysiology is not completely understood, symptoms relief is still the main goal of treatment. Gabapentine and Duloxetine are being using around the world for this purpose. But clinical data regarding its efficacy and safety are not sufficiently available. Materials and Methods: This prospective comparative clinical study conducted in Sylhet MAG Osmani Medical College and Sylhet Diabetic Hospital, Bangladesh from January 2013 to December 2013. Diagnosis of DPNP confirmed by Michigan Neuropathy Screening Instrument (MNSI) and Douleur Neuropathic en-4 (DN4). Patients were treated by Gabapentine (Group-A) and Duloxetine (Group-B); and followed up at 4th, 8th and 12th week of treatment using 11-point numerical pain rating scale (NRS), clinical global impression of change (CGIC) score and patient’s global impression of change (PGIC) score. Results: A total of 72 patients with DPNP were recruited. Final comparison was done in 64 patients – 33 in Group-A and 31 in Group-B. Changes in NRS (p = &lt;0.001), CGIC (p = &lt;0.001) and PGIC (p = &lt;0.001) were statistically significant during the course of treatment. However, inter-group variation of NRS, CGIC and PGIC were not statistically significant at the beginning and 4th, 8th and 12th week of treatment. Insignificant adverse effects were noted between the groups in this study except constipation (p = 0.022) and nausea-vomiting (p = 0.01) of Duloxetine taking group. Conclusion: Gabapentine and Duloxetine are equally effective in the treatment of DPNP with good safety profile. Medicine Today 2021 Vol.33(2): 108-113

Non-viral Microbial Keratitis in a Tertiary Care Hospital in Bangladesh

Introduction: Microbial keratitis is a serious ocular infectious disease that can lead to significant visual loss and ophthalmic morbidity. Objectives were to see the profile of non-viral microbial keratitis in a tertiary care hospital in Bangladesh. Materials and Methods: This cross-sectional study was conducted in the Department of Ophthalmology, Sylhet MAG Osmani Medical College Hospital, Sylhet between January 2015 and December 2016. Results: The mean age of the patients was 46.7 ± 16.5 years with male preponderance (54.4%). The most common predisposing factors were trauma (66.7%), and chronic dacryocystitis (25.6%). Fungal growth was more frequent compared to bacterial growth 70 (77.7%) versus 30 (33.3%), p&lt;0.01). Gram positive organisms were Staphylococcus epidermidis (11.1%), Staphylococcus aureus (3.3%); gram negative organisms were Pseudomonas aeruginosa (12.2%), Klebsiella species (3.3%) and Escherichia coli (3.3%). Aspergillus species (71.4%) was the commonest fungus. Others were Penicillium species (7.1%), Fusarium species (8.6%), Mucor (10.0%) and Rhizopus (2.9%). Conclusion: Fungi are more frequent cause of non-viral keratitis. Watering, redness, pain or burning sensation, corneal opacity and dimness of vision are clinical profiles of non-viral microbial keratitis. Medicine Today 2021 Vol.33(2): 133-137

Obstetric Haemorrhage Related Maternal Mortality: A Two-Year Experience at a Teaching Hospital in Bangladesh

Background: Bangladesh is one of the developing countries where the maternal mortality is extraordinarily high.&#x0D; Objectives: This study was conducted to find out the number and cause of obstetric haemorrhage related maternal death.&#x0D; Methodology: This retrospective study was conducted in the department of obstetrics &amp; gynaecology at M.A.G Osmani Medical College Hospital, Sylhet, Bangladesh from January 2006 to December 2007. From all maternal deaths related to pregnancy occurred in that period, only death due to obstetric hemorrhage were enrolled. Thereafter, the records of hemorrhage related death patients were scrutinized and data were collected from death register. All necessary information was collected in a pre-designed clinical data sheet and analyzed.&#x0D; Results: Among all deaths in obstetric unit, maternal mortality due to obstetric haemorrhage was 32.09%. The deaths were common among multipara (3-4) in 26-30 years age group. Most of them were from lower socio-economic condition having no or irregular antenatal checkup. Among the causes of obstetric haemorrhage, PPH was the commonest. Atonic uterus was the main cause of PPH. Injudicious use of oxytocin and obstructed labour were the common cause of rupture of uterus. Although the causes of haemorrhage were different, most of the patients died due to haemorrhagic shock.&#x0D; Conclusion: This study helps to detect the magnitude of problem and major causes of maternal deaths specially haemorrhage related maternal deaths.&#x0D; Journal of Current and Advance Medical Research, July 2021;8(2):90-94

Incidence of surgical site infections after emergency laparotomy for perforation peritonitis

Background: Generalized peritonitis as a result of gastrointestinal perforation is a common surgical emergency and one of important morbidity is surgical site infection (SSI). Objectives: to evaluate the incidence of SSI after emergency laparotomy for perforation peritonitis. Methodology: A prospective interventional study was conducted in the Department of Surgery, Sylhet MAG Osmani Medical College Hospital, Sylhet from December 2019 to November 2020. Ninety patients who underwent emergency laparotomy for perforation peritonitis aged 18 years or above were included. After laparotomy standard closure technique was applied in all cases and subcutaneous closed suction drain was given in 43 cases. Results: The mean age of the patients was 32.59 ± 11.88 years, 58.9% of patients were in 21-40 years and male preponderance (66.7%). Peritonitis was most commonly due to peptic ulcer perforation (38.7%) followed by burst appendix (27.8%). Incidence of SSI was 26.7%. Subcutaneous closed suction drain was used in 47.8% of cases and its use reduced the incidence of SSI [OR=0.344 (95% CI=0.126-0.937) χ2=4.543; p=0.033]. Conclusion: Perforation peritonitis is associated with higher incidence of SSI and subcutaneous closed suction drain is effective in reducing the chances of SSI.