Rajshahi Medical College Hospital Research Articles

Frequency of lymph node metastasis in differentiated thyroid carcinoma

Background: Although lymphatic metastasis does not affect overall survival for patients with differentiated thyroid carcinoma, locoregional control can be improved with cervical lymphadenectomy. The major morbidity of neck dissection (ND) for the management of regional metastasis is spinal accessory (CN XI) dysfunction. To avoid this complication, some surgeon advocates limited ND. This study aimed to analyze the frequency of lymph node metastasis in differentiated carcinoma of the thyroid. Methods: This cross-sectional observational study was conducted at the Department of Otolaryngology, Rajshahi Medical College Hospital, Rajshahi, and Department of Otolaryngology, Bangabandhu Sheikh Mujib Medical University (BSMMU), from July 2011 to Jun 2012. A total of 40 patients were selected as study subjects by simple random sampling technique. A descriptive analysis of data was carried out by using a statistical package for social science (SPSS) 22.0 for Windows. Results: In this study, a majority 35 (87.5%) of the patients suffered from papillary carcinoma, followed by 5 (12.5%) follicular carcinoma It was found that 18 (51.43%) patients had lymph node metastasis from papillary carcinoma of the thyroid. 10 (55.56%), and 4 (22.22%) patients had right and left-sided lymph node involvement respectively. Bilateral involvement was found in 4 (22.22%) patients. The predominant site of metastasis was level-III (77.3%) followed by level-VI (63.64%) nodal metastasis. Conclusions: This study concludes that metastasis in differentiated thyroid carcinoma is common. Lymph node metastasis is more common in papillary carcinoma than follicular carcinoma.

Comparison on Efficacy between Itraconazole and Terbinafine in the Treatment of Cutaneous Dermatophytosis

The increasing burden of dermatophytosis has been observed all over the world. The vast numbers of hidden and undiagnosed cases remain untreated and these patients act as reservoirs and reinfect their surroundings, contributing to communal infection, a significant threat to the community. This randomized clinical trial was conducted to compare efficacy & safety between Itraconazole and Terbinafine in the treatment of cutaneous dermatophytosis, in the Department of Pharmacology and Therapeutics at Rajshahi Medical College, Rajshahi in collaboration with department of Dermatology & Venereology at Rajshahi Medical College Hospital, Rajshahi and Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2021 to June 2022. The study was conducted after obtaining ethical clearance from the Institutional Review Board (IRB) of Rajshahi Medical College and consent from the patients. Based on predefined eligibility criteria, a total number of 180 patients with dermatophytosis were included in the study. The study population was divided into two groups (Group-A and Group-B) on the basis of drug allocation. In Group-A, 90 patients were treated with Itraconazole at a dose of 5 mg/kg/day (study group) and in Group-B 90 patients were treated with Terbinafine at a dose of 3–6 mg/kg/day (control group) for 6 weeks. Erythema, scaling and pruritus were measured initially at baseline and again at the end of the 3rd and 6th week of drug administration. The overall reduction of mean erythema, scaling and pruritus from baseline to the 2nd follow-up of drug administration was more in Itraconazole group than Terbinafine group and it was statistically significant (p < 0.001, p=0.003 and p=0.001, respectively). The cure rate was 62.20% in Itraconazole group and 28.90% in Terbinafine group. Two weeks after cure, the relapse rates were 8.93% and 30.77%, respectively in the Itraconazole and Terbinafine groups. The findings of the study showed that Itraconazole is a better antifungal drug in comparison to Terbinafine (p < 0.05).

Keystone flap: Suitable option for coverage of soft tissue defect over Tendo Achilles following open repair

Introduction: Wound complications are not uncommon following operative Tendo Achilles repair. Patients presented in Plastic surgery department with soft tissue defect on Tendo achilles region with exposed Tendon. The paucity of tissue and poor blood circulation are main challenges for the reconstructive surgeon. The study aimed to evaluate the Keystone flap for soft tissue coverage of defects following Tendo achilles repair. Methods: This prospective study was conducted on January 2021 to December 2022 in Plastic surgery department of Rajshahi Medical College Hospital and all 12 cases were done by single surgeon. All patients had history of repair for ruptured Tendo Achilles and were presented with defect over Tendo achilles near or at its insertion, where the defect length was larger than width. Keystone flap type IIA was done for each defect. Results: Mean age of the study patients was 43.42 ±9.79 years. The highest dimension of wound was 36.80 (8 X 4.6) cm2 and flap was 66 (10 X 6.6) cm2. The range of advancement of flap was 3- 4.6 cm (mean: 3.43 ±0.54 cm) in transverse axis of leg. Mean duration of operative time was 53.58± 10.06 minutes. Follow up period was 3 months to measure outcome the flap. Conclusion: The keystone flap has high survivability rate with low complications rate providing with good functional outcome of joint. So, keystone flap is a suitable option for coverage of soft tissue defects following operative Tendo Achilles repair. J Bangladesh Coll Phys Surg 2024; 42: 155-160

Immediate Prognosis of Hepatic Encephalopathy in a Tertiary Hospital

Background: Hepatic encephalopathy (HE) is a significant neuropsychiatric complication of liver disease, causing substantial global morbidity and mortality. Advances in our understanding of HE pathogenesis have led to the development of new management strategies. Documenting the disease profile, precipitating factors, and prognostic indicators is crucial, given the need to widely apply these new strategies. Objectives: This study aims to assess the immediate prognosis, identify presenting features, and categorize patients based on the Child-Pugh Class at Rajshahi Medical College Hospital. Materials and Methods: This cross-sectional descriptive study conducted in the Department of Medicine at Rajshahi Medical College Hospital from January to December 2010 aimed to assess the immediate prognosis of HE, determine its presenting features, and categorize study subjects based on the Child-Pugh Class. Sixty-six patients with chronic liver disease and HE were included in the study. Comprehensive data were collected through detailed history-taking, physical examinations, and investigations that adhered to the inclusion criteria. Results: The study cohort included 42 male and 24 female patients, with the majority (69.7%) falling within the age group of 30-60 years, with a mean age of 47.29 (±13.5). Most patients presented with grade II HE (40.9%). Hepatitis B, C, or both were positive in 63.6% of cases. Confusion was the most common presenting feature due to encephalopathy (53.0%). A majority of patients (62%) were in Child Class C. Electrolyte imbalance (54.4%), and constipation (34.8%) were the most common precipitating factors. 74.2% of patients survived, while 25.8% succumbed to the condition. Conclusion: Hepatic encephalopathy is a well-recognized complication of chronic liver disease, predominantly presenting with mental confusion. Despite many patients presenting with severe encephalopathy (Child Class C), the immediate survival rate was deemed satisfactory. The study underscores the importance of early hospitalization, identification of precipitating factors, and timely treatment in improving outcomes for this fatal condition.

Feto-Maternal Outcome in Preeclampsia and its Association with Maternal Body Mass Index (BMI) in a Tertiary Care Hospital in Rajshahi

Background: Obesity is associated with profound metabolic and physiological changes and an established risk factor for the adverse feto-maternal outcome for pregnant women. As the prevalence of obesity increasing day by day among pregnant women and there is a scarcity of related studies in Bangladesh context, this study aimed to find out the fetomaternal outcome in preeclamptic women and its association with maternal body mass index (BMI) in a tertiary care hospital in Rajshahi. Objectives: The aim of the study was to associate the fetomaternal outcome in preeclampsia and its association with maternal body mass index (BMI) in a tertiary care hospital in Rajshahi. Methods: This cross-sectional type of analytical study was conducted in the Department of Obstetrics & Gynaecology, Rajshahi Medical College Hospital (RMCH). Singleton pregnant women with preeclampsia who delivered a baby in this Hospital were approached for this study. After ethical clearance, a total of 120 patients were taken as study samples according to selection criteria. Informed written consent was obtained from each patient. All patients were subjected to detailed history taking and thorough physical examination. A structured questionnaire was designed including all the variables of interest. Data were collected through direct interview of the patients at the respective departments by the researcher. Collected data were checked, edited and analyzed using the SPSS-24. Results: The observed maternal outcome was PIH (33%), Gestational diabetes mellitus (20%), Caesarean section (46.7%), prolonged labour (13.3%), wound infection (5%) and 5% had postpartum hemorrhage (5%). PIH, Gestational diabetes mellitus and Caesarean section were significantly higher among overweight or obese patients with preeclampsia (p<.05). So, association of maternal BMI with PIH, gestational diabetes mellitus and Caesarean section was significant (P<.05) but not significant in prolonged labour, wound infection, postpartum .....

Knowledge, Attitude and Practice of Prevention of Thalassaemia of the Parents of Children with Thalassaemia attending in a Tertiary Care Hospital in Bangladesh

Introduction: Inherited disorder of Hemoglobin is widely distributed throughout the world. Among them, Thalassaemia is a common disorder with widespread geographical distribution. Objectives: The objective of the study was to determine the level of knowledge, attitude and practice of thalassaemia prevention among parents of children with Thalassaemia. Methodology: This was a descriptive cross sectional study. This study was conducted in inpatient and outpatient department of paediatrics, Rajshahi Medical College Hospital over a period of July 2020 to June 2021. 45 parents of children with thalassaemia were purposively selected as study subjects. Informed written consent were obtained from the parents before enrollment in the study. Data were collected on variables of interest. All the findings were recorded and analyzed. Statistical analysis were done using statistical package for social science (SPSS) software version 21. Result: Total 45 parents of children with thalassaemia were enrolled in the study. Among the informants, 73.3% (total 33) were mother and 26.6% (total 12) were father. 77.7% (total 35) children were from rural areas and 22.22% (total 10) were from urban areas. All the study population received knowledge about thalassaemia from the physicians. Knowledge of the parents about the disease, its treatment options and methods of its prevention were assessed by likert scale questionnaire. 22.22% parents had adequate knowledge , 64.44% had average knowledge and 13.33% had inadequate knowledge about the disease. 60% parents had adequate knowledge 31.11% had average knowledge and 8.89% had inadequate knowledge about prevention of thalassaemia. Attitude of all the parents (100%) were positive. Conclusion: Most of the parents have adequate knowledge and positive attitude for thalassaemia prevention and they can serve as resource for spreading awareness about thalassaemia in community. J Bangladesh Coll Phys Surg 2024; 42: 6-11

Characteristics and Outcomes of SARS-Cov-2 Positive Pregnant Women Admitted to a Dedicated COVID ICU in RMCH, Bangladesh: An Observational Study

Characteristics and Outcomes of SARS-Cov-2 Positive Pregnant Women Admitted to a Dedicated COVID ICU in RMCH, Bangladesh: An Observational Study

Assessment the Ability of Free/Total Ratio of Serum PSA in Diagnosing Prostate Cancer and Benign Prostatic Hyperplasia

Background: The Prostate gland is the male secondary sexual organ most commonly affected by benign or malignant neoplasm. Prostate cancer (Ca-P) is one of the most commonly diagnosed cancers in men and is now the third commonest cause of cancer death in western countries.The aim of the study was to evaluate the use of serum prostate-specific antigen levels in differentiating prostate cancer from benign prostatic hyperplasia. Methods:The present study is a cross-sectional observational study.The study was conducted at the outpatient department and indoor patients at the department of Urology, Rajshahi Medical College Hospital (RMCH), Rajshahi, and different private clinic in Rajshahi City during the period from July 2019 to June 2020.The study population included male patients above 50 years of age, who attended in the department of Urology, Rajshahi Medical College Hospital (RMCH), Rajshahi, and different private clinic in Rajshahi City complaining of irritative or obstructive lower urinary tract symptoms (LUTS) suspected as clinically prostate cancer or benign prostatic hyperplasia (BPHStatistical analysis of the results was obtained by using window-based computer software devised with Statistical Packages for Social Sciences (SPSS-24). Results: The age distribution of the prostatic carcinoma and BPH patients. Prostatic carcinoma was observed to be significantly higher from 80 years onwards, while BPH was common between 60 - 80 years (p = 0.00001). Table 10shows the validity or accuracy of the free/total ratio of serum PSA as a diagnostic test in differentiating prostatic carcinoma from BPH in patientswith total PSA levels between 4-10ng/ml. The percentage of false positives was significantly higher when total PSA ratio was used to diagnose the disease compared to when free to total PSA was used as a diagnostic tool (p<0.000001). The overall accuracy of total PSA was also significantly lower (61.45%) than that of free/total PSA (91.67%) (p< 0.011526). Conclusion: Free and total prostate specific antigen (PSA) is increased significantly in carcinoma prostate than benign prostatic hyperplasia but free/total ratio of serum prostate- specific antigen level significantly decreases in prostatic carcinoma than benign prostatic hyperplasia. TAJ 2023; 36: No-2: 215-230

Proportion of Low Birth weight and Associated Maternal Risk Factors in a Developing Country, Bangladesh

Introduction: Though the health situation of Bangladesh has been improved substantially over the years, the low birth weight (LBW) rate is still pretty high. LBW has been associated with high probability of infection, malnutrition, mental deficiencies and behavioural and learning problem in later life. The principle focus of this study was to ascertain the proportion of LBW and its associated maternal risk factors identification. Materials & methods: It was a cross-sectional type of descriptive study done at two tertiary level hospitals – Rajshahi Medical College Hospital and Islami Bank Medical College Hospital. A total of 270 mothers were interviewed within 1 month of their delivery. The purposively selected participants were asked about their socio-demographic characters and other associated factors related to birth of the babies. Weights of the babies at birth were documented from hospital records. Result: Proportion of LBW was found 28.1% with no significant sex variation. Majority of the LBW babies were found in mothers of 15-20 years of age group. Mothers’ educational qualifications, occupations, early age pregnancy and type of pregnancy were associated significantly for LBW. Less than 37 weeks of gestational age of baby, home delivery, NVD were also significant risk factors of LBW. Residence and sex of neonate were not significantly associated with LBW. Conclusion: Proportion of LBW in tertiary care hospitals were found 28.1%. Early maternal pregnancy, lower gestational age, higher parity, NVD and home delivery played an important role in the incidence of LBW. TAJ 2023; 36: No-2: 207-214

Fungal Agents Causing Chronic Otitis Externa with Their Antimicrobial Susceptibility Pattern at RMCH

Fungal Agents Causing Chronic Otitis Externa with Their Antimicrobial Susceptibility Pattern at RMCH

Correlation with serum Lactate dehydrogenase level and Hematological parameters before and after induction of remission in childhood Acute lymphoblastic leukemia- A prospective study

The relationship between serum LDH (lactate dehydrogenase) and the course of neoplasia had been well established in different studies. It might be a promising tool as assessing serum is easy, readily available and cheap in the prognosis of childhood Acute Lymphoblastic Leukemia (ALL). This study is aimed to evaluate the role of serum LDH before and after induction of remission in childhood ALL. This study was conducted at the Department of Pediatrics, Rajshahi Medical College Hospital, and Rajshahi for a period of two years. Total 30 children aged from 1-12 years newly diagnosed cases of ALL were included. Each patient underwent clinical evaluation and relevant investigations. All information was recorded in a separate case record form. Collected data were analyzed using the statistical software SPSS 23. Mean age of the studied children was 5.03±3.17 years. Male children were 66.7% and female children were 33.3%. Mean value of serum LDH was significantly lower at 29th days of induction of remission compared to the value before chemotherapy (432.40±310.52 U/L vs. 829.10±345.58 U/L, p<0.05). Mean peripheral blast cell also reduced after chemotherapy (30.03±16.41% Vs. 0.37±0.96%). Pearson correlation model showed strong positive correlation between LDH level and bone marrow blast cell at both before and after chemotherapy (r> +0.75, p<0.001). This study observed significant reduction of LDH after chemotherapy and positive linear relation with peripheral blast cells. TAJ 2023; 36: No-2: 83-92

Outcome of paraquat poisoning patients admitted in a tertiary hospital in Bangladesh

Background: Paraquat Poisoning is not unknown in clinical practice. However, the data from our country is scanty. Therefore, to find the outcome of paraquat poisoning in a tertiary level hospital was the objective of this study. Methods: The study was a longitudinal descriptive study and conducted at department of Medicine, Rajshahi Medical College Hospital. Patients of paraquat poisoning were approached for inclusion. Informed written consent was taken from the patients and/or attendants. Data were collected by face-to-face interview by the researcher with an aid of a semi-structured questionnaire. All available investigation reports, follow up notes, discharge papers and death certificates were scrutinized. A total 30 patients were included in this study. Results: Total 30 subjects were interviewed. Mean age was 25.33±8.86 (SD) years with female to male ratio-2:1.Majority were from rural area (90%). About 94% consumed with an intention of suicide. Most of the patients had renal impairment (53.3%) and hepatic impairment (50%) as complication. 63.3% patients reached to hospital >12 hours after ingestion of poison and 36.7% reached within 12 hours. Of all, 33.3% (n=10) patients survived. Possible cause of death were Multi organ failure (MOF) (40.0%), Acute renal failure (25.0%), ARDS (15.0%) and Hepatic failure (20.0%). However, overall outcome is not dependent with to time reaching hospital after poisoning but with amount of poison ingested (p<0.05). Conclusion: About 67% patients died following ingestion of the paraquat poisoning and it is not dependant with the time required to reach the hospital rather to the amount of poison ingested. TAJ 2023; 36: No-2: 35-46

Coronary Angiographic Characteristic of Coronary Artery Disease of Young Adults Under Age Forty Years Compare to Those Over Age Forty

This study aimed to compare the coronary angiographic characteristics of coronary artery disease in young adults (≤40 years) and older adults (>40 years). This was a retrospective analytic study. The study was conducted at the Department of Cardiology, Rajshahi Medical College Hospital. 100 patients with coronary artery disease were included in this study. Among the 100 patients, 50% were in the ≤40 years’ group (group A) and 50% were in the >40 years’ group (group B). Coronary angiographic characteristics were analyzed for each group. Coronary artery disease was present in 72% of group A and 84% of group B. In group A, single vessel disease (SVD) was the most common pattern (38%, p=0.001), while in group B, double vessel disease (DVD) (36%, p=0.043), triple vessel disease (TVD) (26%, p=0.033), and left main vessel disease (LM) (8%, p=0.035) were more prevalent. Left ventricular dysfunction with hypokinesia was observed in the majority of patients. The left anterior descending (LAD) artery was most commonly involved in both groups, primarily in the mid and proximal segments. The right coronary artery (RCA) was the next commonly affected artery, with differences in involvement site between the two groups. This study highlights that SVD is more common among young adults, whereas DVD, TVD, and LM diseases are more prevalent in older individuals. Older age groups exhibited a higher prevalence of diabetes mellitus, while smoking, dyslipidemia, and hypertension were common risk factors for coronary artery disease in both age groups. TAJ 2023; 36: No-2: 01-09

Risk Factors of Community Acquired Pneumonia among Under Five Children in a Tertiary Level Hospital in Rajshahi

Introduction: Community acquired pneumonia (CAP) top the list of causes of under five children mortality in the world. Proper assessment of these risk factors and controlling them may help decrease the morbidity and mortality in under-five children suffering from CAP in Bangladesh and thereby help in improving the quality of life of our future generation. Objective: To assess the risk factors of CAP among under five children ( 2-59 months ) in a tertiary level hospital in Rajshahi. Materials and methods: This is a case control study which was carried out in the department of Pediatrics and EPI center of Rajshahi Medical College Hospital, RMCH from January 2017 to December 2018 to determine the risk factors of CAP among under five children. For this study, total 246 children, aged 2 months to 59 months, were selected by purposive sampling technique. 123 were cases who were taken from indoor and 123 were healthy controls who were taken from out patients department & EPI centre. After taking written consent from guardians, history was taken and physical examination was done. All informations were recorded in a predesigned data sheet. Chi-square test and odds ratio were used to demonstrate level of significance. Results: Among 246 children greater number of patients of both group were male and came from rural area. Cases were predominant under 12 months and came from lower socioechonomic status. A statistically significant association was found between social class and CAP (<0.001), father’s literacy was inversely related to CAP (p value <0.001). Types of housing, ventilation of living room , overcrowding, types of fuel and cookers used for cooking, parental smoking , malnutrition, history of diarrhea and presence of anemia , prematurity and low birth weight were significantly associated with CAP ( p value <0.05) . Conclusion: Proper assessment of these risk factors and controlling them may help decrease the morbidity and mortality in under-five children suffering from CAP in Bangladesh and thereby help in improving the quality of life of our future generation. TAJ 2023; 36: No-2: 145-153

FGFR1 Gene Expression and its Relationship with Sociodemographic and Clinicopathological Indices in Oral Squamous Cell Carcinoma

Introduction: A better prognosis has resulted from the use of molecular techniques in cancer diagnosis. The FGFR family of genes is one of the major gene families involved in the carcinogenic pathways of different malignancies. Tumorigenesis, uncontrolled cell proliferation, and a number of pathologic diseases are linked to improper FGFR activation. The family of genes known as FGFRs encodes cell surface membrane receptors with tyrosine kinases.The development of oral squamous cell carcinoma (OSCC) may be significantly influenced by fibroblast growth factor receptor 1 (FGFR1). Analyzing these elements' expression patterns may provide fresh perspectives on illness management strategies including genetic mediated target therapy. Objectives: In order to improve care and prevent future difficulties from oral squamous cell carcinoma (OSCC), the current study sought to assess the expression of FGFR1 genes in OSCC tumors as a result of the discovery of biomarkers and early diagnosis. Methods:In order to assess the expression of FGFR1 genes in 16 OSCC samples, 16 normal specimens from the same sample, free from cancer margin and 4 control samples from other patient free from cancer, the Oral and Maxillofacial Surgery DepartmentatDental Unit of Rajshahi Medical College Hospital was collected. Trizol and the appropriate kits were used for RNA extraction and cDNA synthesis. Real-time PCR was used to assess the FGFR1 gene's expression following the construction of a specific primer set in order to find and validate molecular biomarkers. The data is analyzed using the ANOVA and independent t-test. Statistics were shown to be significant when P<0.05. Results:According to the findings, there are notable variations in the expression of the FGFR1 gene between tumor and normal or control tissues (P < 0.001). Patients over 60 are more likely to have OSCC, and the majority of them smoke 8. Retromolar trigon 8 is the most frequent location, and the majority of them are in stages III and IV. The FGFR1 gene expression does not significantly differ according on a patient's age, gender, religion and behavior, including whether they smoke, drink, or chew paan. It also does not differ depending on the tumor's location, stages and grade. Conclusions: The FGFR1 gene was often expressed differently in cancerous and control tissues, confirming the gene's involvement in OSCC. The expression of FGFR1 is not correlated with factors such as gender, age, history of smoking, alcohol intake, chewing paan, tumor site, degree of differentiation, or TNM stage. The current investigation demonstrated the critical function of the investigated gene in the diagnosis of OSCC. To verify this, though, more research is required. TAJ 2023; 36: No-2: 155-162

Detection of Salmonella species by Automated Blood Culture Method in Suspected Cases of Enteric Fever

Background: Enteric fever caused by Salmonella species is a systemic febrile illness that can be fatal since its characterization in 1880. Enteric fever may remain asymptomatic carrier and sometimes fatal that it can be difficult to diagnose based on symptoms alone because they are similar to those of other febrile disorders. In developing countries, enteric fever is common global health problem due to poor standard of personal hygiene, contaminated food, inadequate safe water and sanitation. Methods: This is a cross-sectional study that was conducted in the Microbiology Department of Rajshahi Medical College Hospital for one year from January 2021 to December 2021 to identify Salmonella species by Automated Blood Culture (Fastidious Antibiotic Neutralization method) followed by subculture in MacConkey’s agar, Xylose lysine deoxycholate agar, and Salmonella Shigella agar media in suspected enteric fever cases. This study included suspected cases of enteric fever as determined by the physician who fulfilled the inclusion and exclusion criteria. Results: Among 127 suspected cases of enteric fever 64(50.39%) culture positive bacteria isolated by automated blood culture (FAN) method and out of that Salmonella species 38 (59.37%) and others bacteria 26(40.63%) following subculture in MacConkey’s agar, Xylose lysine deoxycholate agar and Salmonella Shigella agar media. Regarding gender, the majorities (61.4%) of culture-positive patients were male, and the majority (65.35%) came from rural areas. Conclusion: Especially for patients who have received antibiotics, we propose that the automated blood culture approach followed by subculture could be employed as a novel diagnostic method for typhoid fever. TAJ 2023; 36: No-2: 71-76

Clinical and Radiological Correlation of Ameloblastoma among the patients attending in the Oral & Maxillofacial Surgery Department of Rajshahi Medical College Hospital

Objectives: The cause of this observation turned into a change to evaluate the clinical and radiological abilities of 35 intraosseous ameloblastomas. Study design: Data regarding the patients' time, sex, tumour locations, and surgical remedy history, just like the radiographic findings and the type of recurrences, had been analyzed. Results: The patient ranged from 10 to 69 years (mean, 27.8 years). 19 (54.29%) of the 35 topics were males, and 16 (45.71%) were females. 33 (94.29%) of the 35 ameloblastomas had been located in the mandible. The swelling turned into changed into the maximum now no longer; uncommon vicinity symptom and changed right into an expert via way of 13(37.14%) patients. Radiographically, 22 (62.85%) of the 35 tumours had been unilocular with a well-demarcated border. Of the final 13 instances, 10 had been multilocular and 3 had been of cleaning soap bubble appearance. 16 instances of ameloblastoma had advanced in a cyst. The not unusual place recurrence charge turned into changed to 20%, and the commonplace vicinity age of the affected person at recurrence was modified to 26.4 years. Conclusion: When the assessment of ameloblastoma in greater younger humans stays unsure after medical and radiologic examination, a biopsy is necessary. Follow-up at normal durations after surgical operation is likewise recommended. TAJ 2023; 36: No-2: 77-82

Magnitude of Pneumonia and Bronchiolitis and Their Treatment Modalities Practiced in Under Five Children Attending a Tertiary Care Hospital

Background: Pneumonia is the leading cause of death globally among children younger than five years of age. Acute bronchiolitis is also a major public health problem throughout the world. Many children with pneumonia and bronchiolitis are not properly diagnosed, and overuse of antibiotics has led to increasing drug resistance. Objectives: To determine the magnitude of pneumonia and bronchiolitis and to study their treatment modalities practiced in under five children. Methods: This cross-sectional observational study was carried out in the Pediatric inpatient department and outpatient department of Rajshahi Medical college Hospital from October 2015 to March 2016. Total 373 cases between 1 month to 59 months of age with acute respiratory infection who fulfilled the inclusion criteria were enrolled in the study. The inclusion criteria were any child between 1 month to 59 months of age presented with respiratory symptoms including cough/runny nose or breathing difficulty as complained by the caregivers or having chest in-drawing. Detailed information was obtained through structured questionnaire and then analyzed. Results: In this study majority of the children 223 (59.78%) were under 12 months of age. There were 234 (62.73%) male and 139 (37.27%) female cases, male to female ratio being 1.68:1. Among studied children 217 (58.18%) were urban dwellers and 156 (41.82%) were from rural areas and majority of the children 268 (71.85%) came from lower socioeconomic strata. Out of 373 cases, pneumonia was diagnosed in 131(35.12%) cases, bronchiolitis in 88 (23.60%) cases and other acute respiratory tract infections in 154 (41.28%) cases. Most common antibiotic used for the treatment of both pneumonia and bronchiolitis was ceftriaxone in 34.35% and 25% cases respectively followed by other antibiotics and medications. Conclusion: It is concluded that pneumonia was found in 35.12% cases and bronchiolitis in 23.60% cases among the under five children attending a tertiary care hospital with acute respiratory infection. Majority were under 12 months of age, male children, residing in urban areas and coming from lower socioeconomic status. Ceftriaxone was the commonest antibiotic used in the treatment of both pneumonia and bronchiolitis. TAJ 2023; 36: No-2: 163-170

Job Satisfaction of the Senior Staff Nurses at Rajshahi Medical College Hospital

Background: Job satisfaction among healthcare professionals, particularly senior staff nurses, is essential for maintaining high-quality patient care. The study aims to assess the job satisfaction of senior staff nurses at Rajshahi Medical College Hospital. Method: A descriptive cross-sectional study was select 50 senior staff nurses working in various units at RMCH. Semi-structured interviews were conducted with the selected participants, taking place in private rooms during different shifts. Data collection spanned from November 2014 to April 2015 and covered 40 wards under 7 selected units. Demographic data, including age, gender, religion, educational qualifications, and years of service, were collected from the participants. Job satisfaction-related questions were explored, encompassing aspects such as training, promotion, rewards, job-related factors, feelings towards the job, and overall job experience. Results: The surveyed senior staff nurses were predominantly female (90%), aged 40-49 years (54%). Education levels varied: 68% held nursing diplomas, 24% had B.Sc. in nursing degrees, and 8% possessed MPH qualifications. The majority (34%) had 11-15 years of service, with a minority (4%) having over 25 years. Job Satisfaction Factors: Key job satisfaction drivers included training for skill improvement (80%), promotion opportunities (12%), and recognition through rewards (8%). A significant 92% reported high job satisfaction. Personal motivation (10%), financial incentives (40%), and a desire to help others (50%) played vital roles. Most found their work fulfilling, with 70% stating it fulfilled their desire to assist patients, describing their experiences as rewarding. Conclusion: This study underscores the importance of addressing key determinants of job satisfaction, such as training, promotion, and rewards, to maintain a high level of job satisfaction among senior staff nurses at RMCH. Improving job satisfaction can contribute to a more motivated and effective healthcare workforce, ultimately enhancing patient care.

Dengue Encephalitis with ‘Double Doughnut Sign’ – A Rare Case Report

Dengue fever is one of the most common arboviral infections, and it is the world’s fastest-spreading tropical illness. According to the World Health Organization, fifty million cases of clinical dengue infections occur each year, posing a significant public health hazard, primarily in Southeast Asia and the Western Pacific. The clinical spectrum of dengue fever ranges from asymptomatic infection to dengue shock syndrome. Although dengue virus is non-neurotropic virus, there is increasing evidence for dengue viral neurotropism suggesting there may be an element of direct viral encephalitis. Encephalopathy has been thought to result from the multisystem derangement that occurs in severe dengue, with liver failure, shock and coagulopathy causing a cerebral insult. Dengue encephalitis is a rare disease. We report dengue encephalitis in a 55-year-old female, admitted in Rajshahi Medical College Hospital, Rajshahi, Bangladesh who presented with fever, vomiting, and altered level of consciousness. Her serum dengue NS1 was positive. MRI of brain showed hyperintensity in both basal ganglia & cerebellar region, which is identical to “Double Doughnut sign” found specifically in dengue encephalitis. J Bangladesh Coll Phys Surg 2023; 41: 96-98