Rangpur Medical College Hospital Research Articles

An Analysis of Hospitalized Burn Injuries in a Burn Care Unit of Northern Bangladesh

Introduction: Burn injuries remain a significant public health issue, especially in low- and middle-income countries where comprehensive data is scarce. This study provides a detailed analysis of burn injuries in Northern Bangladesh, focusing on epidemiological characteristics and factors influencing burn severity and incidents. Methods: This retrospective study analyzed 477 cases of acute, unintentional burns recorded between January 2022 and December 2022 at the Rangpur Medical College Hospital's Burn and Plastic Surgery unit. Data on demographics, burn types, etiology, and severity were collected from hospital registers. Statistical analysis, including chi-square tests and logistic regression, was used to identify predictors of burn severity. Result: Of the 477 documented cases, females represented 62.05% (296 cases) and males 37.95% (181 cases). Flame burns predominated, comprising 70% of incidents, significantly impacting females engaged in cooking activities. The data revealed a distinct seasonal trend with a significant peak in January, where 40% (191 cases) of annual burn incidents occurred due to campfire exposure. The analysis further demonstrated that burns covering more than 30% of total body surface area (TBSA) were significantly associated with higher morbidity and mortality, with third-degree burns occurring in 92.9% of females compared to 55.8% of males. Logistic regression identified age (OR = 1.28, CI [1.13-2.71]), gender (OR = 1.75, CI [1.11-1.47]), and the cause of ignition (OR = 0.56, CI [0.41-0.76]) as significant predictors of burn severity. Conclusion: The findings emphasize the need for targeted interventions to address the high incidence of burns among young to middle-aged women, particularly through safer cooking practices and awareness campaigns. Additionally, public health strategies should consider seasonal risks and promote safer heating methods during colder months. This study underlines critical areas for intervention and highlights the importance of culturally tailored public health strategies to reduce burn injuries in Northern Bangladesh.

Sociodemographic and Clinical Characteristics of Persons with Epilepsy Attending an Epilepsy Clinic of a Tertiary Hospital in Bangladesh

Background: Epilepsy is a common neurological disorder found in all societies. It is seen that the relative frequency of various clinically important characteristics is different in persons with epilepsy (PWE) living in different geographical areas. The purpose of this study was to describe the sociodemographic and clinical characteristics of a cohort of patients with epilepsy from an Epilepsy Clinic of a tertiary hospital in Bangladesh. Methods: This cross-sectional study was conducted in the Department of Neurology at Rangpur Medical College Hospital, Rangpur, Bangladesh, from July 2022 to June 2023. The patients were recruited from the epilepsy clinic. A structured questionnaire was designed to collect relevant information by interviewing the consecutive PWEs. Results: A total of 252 PWEs were recruited, of which 134(53.2%) were male. Most [200(79.4%)] of them were young (age group 0 to 29 years) and had generalized seizures 147(58.3%). The median age of the 1st seizure was 11 years (range 0.5-73.0), and the median duration of epilepsy was 5.0(0-35) years in the present study. EEG, CT scan, and MRI could be done in 200(79.4%), 128(50.8%), and 68(27%, respectively. Among them, 24.2%(61), 10.7%(27), and 11.1%(28) patients had different types of abnormalities on EEG, CT scan, and MRI, respectively. A family history of seizures was present in 20(7.9%) patients. Sixteen patients(6.3%) were not getting any AEDs, 63.1% and 30.6% were on single and multiple AEDs, respectively. Sixty-five (25.8%) patients reported stopping the drug without any medical consultation. Forgetfulness was the most reported (21, 33.8%) reason for stopping drugs, followed by the misconception that the disease was cured (14, 21.5%), lack of time to buy pills (12, 18.5%), and no money to buy (9, 13.8%). Seventy-seven reported having two or more continuous seizures despite taking AEDs regularly. Conclusions: Present study documented some treatment gap and non-adherence to medication in PWE. PWE should be adequately advised about the disease and the effects of drug non-compliance. J Rang Med Col. March 2024; Vol. 9, No. 1: 44-49

Surgical Management and Short-Term Outcome of Patients with Posterior Fossa Tumor in All Age Groups: Our Perspective

Background: Different types of brain tumor can occur in the region of posterior fossa. Ependymoma, medulloblastoma and pilocytic astrocytoma occur mostly in children and rarely in adults. Brain metastases in adults are the most common malignancies at this site. Other tumors that occur in the posterior fossa are meningioma, schwannoma, hemangioblastoma, brain stem glioma and epidermoid tumors. Posterior fossa tumor has different treatment approaches and prognosis. So, an accurate diagnosis, surgical approaches, complication analysis and outcome assessment are mandatory. Objective: To evaluate the clinical aspects, surgical approach, role of preoperative shunt, post-operative complications, and short-term outcome of patients with posterior fossa tumor in different age groups. Methods: This cross-sectional observational study included 36 patients with posterior fossa tumors that were admitted and operated in the Neurosurgery Department of Rangpur Medical College Hospital between the period of November 2018 and June 2022. In each patient clinically diagnosis was confirmed by MRI of Brain with contrast followed by histopathology. Results: Out of 36 patients, 23(63.9%) patients were male and 13(36.1%) were female. Mean age was 18.01±13.95 SD years (minimum 6 months and maximum 45 years), more common in pediatric age group (36.1% <10 years and 25% between 11-20 years). Common presentations were headache (91.6%), vomiting (83.3%) and ataxia (72.2%). Medulloblastoma (27.8%) and ependymoma (25%) were common histological types. Surgical outcome was excellent in 17 cases (47.2%), while poor in 5.6% and 19.4% patients died. There was no statistically significant association of surgical outcome with age (p=0.148) and sex (p=0.170). Suboccipital craniotomy was superior to other surgical procedures in terms of patient’s outcome (p=0.031). Ependymomas and Astrocytomas had better outcome (p=0.014). Conclusions: Surgical outcome is related to the operative approach and histology of the tumor in this study, but no significant association of patient’s outcome with age, sex and preoperative procedure. J Rang Med Col. March 2024; Vol. 9, No. 1: 3-9

Bacteriological Trends of Chronic Mucosal Otitis Media in a Tertiary Care Hospital in the Northern Region of Bangladesh

Background: Chronic otitis media (COM) is a disease of multiple etiology caused by bacteria and its importance lies in its chronicity and awful complications. The microbiological study shows the growth of a lot of organisms, frequently multiple and those differ based on geographical variation, patient population, climate, and many other factors. Objective: To evaluate current bacteriological trends of ear infections in patients with chronic otitis media which will be beneficial for appropriate treatment as well as for reducing complications. The study also focuses on rapid diagnosis by exploring other factors like age and sex-wise distribution, socioeconomic status, distribution of patients according to the type of dwelling, and bathing habits of patients. Methods: This cross-sectional, observational study was conducted in the Department of ENT and Head-Neck Surgery, Rangpur Medical College Hospital in Rangpur, a northern district of Bangladesh, over 6 months on a total of 80 patients who had attended outpatient and inpatient departments. Aural swab was taken from the discharging ears which were inoculated on blood agar and MacConkey’s agar media. The organism pattern was then tabled based on the culture reports. Results: The most common bacteria causing COM was Pseudomonas aeruginosa in (45.0%) followed by Staph. aureus (27.5%), mixed isolates in 8.75%, E. coli in 5%, Proteus in 3.75%, S. pneumoniae in 2.5%, and Klebsiella in 1.25%. Conclusion: The study proved to be useful for clinicians in management of COM and its complications. Early and effective microbiological diagnosis and intervention is the best solution. From this study, it is observed that Pseudomonas aeruginosa is the commonest pathogen for bacterial ear disease followed by S. Aureus. Mugda Med Coll J. 2023; 6(2): 83-87

Impact of Gestational and Pre-Gestational Diabetes on Maternal Complications and Fetal Outcomes: A Comparative Observational Study at Rangpur Medical College Hospital

Introduction: Diabetes in pregnancy, including gestational and pre-gestational diabetes, presents significant risks to both maternal and fetal health. Understanding the impact of these conditions on pregnancy outcomes is crucial for developing effective management strategies.
 Methods: This observational comparative study involved 300 pregnant women at Rangpur Medical College Hospital, divided into three groups: pre-gestational diabetic (Group A), gestational diabetic (Group B), and non-diabetic control (Group C). Data on socio-demographic characteristics, obstetric profiles, mode of delivery, maternal complications, and fetal outcomes were collected and analyzed.
 Result: The study meticulously analyzed socio-demographic characteristics, revealing no significant differences across the groups. In obstetric profiles, Group A (Pre-Gestational Diabetic) had a notably lower mean gestational age at delivery (36.06 ± 2.71 weeks) compared to Group B (Gestational Diabetic) and Group C (Control), with mean ages of 37.34± 1.12 and 38.46±1.13 weeks, respectively. Maternal complications were significantly higher in Group A at 47%, compared to 25% in Group B and 12% in Group C. Fetal outcomes showed marked variations: Group A had 95% stable births, 5% stillbirths, and 60% of neonates with Apgar scores ≤7 at 5 minutes. In contrast, Group B had 96% stable births, 4% stillbirths, and 27% of neonates with Apgar scores ≤7, while Group C reported 100% stable births and 11% with Apgar scores ≤7. Birth weight distribution indicated 24% of neonates in Group A weighed <2 kg, compared to 5% in Group B and 4% in Group C. NICU admissions were highest in Group A (44%), followed by Group B (29%) and Group C (11%). Perinatal complications like birth asphyxia (38% in Group A, 16% in Group B, 6% in Group C), hypoglycemia (22% in Group A, 10% in Group B, 4% in Group C), and hyperbilirubinemia (16% in Group A, 12% in Group B, 0% in Group C) were also significantly higher in diabetic groups.
 Conclusion: The presence of gestational or pre-gestational diabetes in mothers significantly impacts fetal outcomes and increases the risk of maternal complications. This study highlights the need for specialized care and vigilant monitoring in pregnancies complicated by diabetes to improve health outcomes for mothers and babies.

Impact of Gestational Diabetes and Pre-existing Diabetes in Fetal Outcome among Pregnancy Cases of Rangpur

Introduction: Diabetes in pregnancy, including gestational and pre-gestational diabetes, presents significant risks to both maternal and fetal health. Understanding the impact of these conditions on pregnancy outcomes is crucial for developing effective management strategies.
 Methods: This observational comparative study involved 300 pregnant women at Rangpur Medical College Hospital, divided into three groups: pre-gestational diabetic (Group A), gestational diabetic (Group B), and non-diabetic control (Group C). Data on socio-demographic characteristics, obstetric profiles, mode of delivery, maternal complications, and fetal outcomes were collected and analyzed.
 Result: The study meticulously analyzed socio-demographic characteristics, revealing no significant differences across the groups. In obstetric profiles, Group A (Pre-Gestational Diabetic) had a notably lower mean gestational age at delivery (36.06 ± 2.71 weeks) compared to Group B (Gestational Diabetic) and Group C (Control), with mean ages of 37.34± 1.12 and 38.46±1.13 weeks, respectively. Maternal complications were significantly higher in Group A at 47%, compared to 25% in Group B and 12% in Group C. Fetal outcomes showed marked variations: Group A had 95% stable births, 5% stillbirths, and 60% of neonates with Apgar scores ≤7 at 5 minutes. In contrast, Group B had 96% stable births, 4% stillbirths, and 27% of neonates with Apgar scores ≤7, while Group C reported 100% stable births and 11% with Apgar scores ≤7. Birth weight distribution indicated 24% of neonates in Group A weighed <2 kg, compared to 5% in Group B and 4% in Group C. NICU admissions were highest in Group A (44%), followed by Group B (29%) and Group C (11%). Perinatal complications like birth asphyxia (38% in Group A, 16% in Group B, 6% in Group C), hypoglycemia (22% in Group A, 10% in Group B, 4% in Group C), and hyperbilirubinemia (16% in Group A, 12% in Group B, 0% in Group C) were also significantly higher in diabetic groups.
 Conclusion: The presence of gestational or pre-gestational diabetes in mothers significantly impacts fetal outcomes and increases the risk of maternal complications. This study highlights the need for specialized care and vigilant monitoring in pregnancies complicated by diabetes to improve health outcomes for mothers and babies.

To Identify Common Risk Factors Associated with IUFD in Rangpur Medical College Hospital, Rangpur, Bangladesh

Introduction: Intra uterine fetal death is always an unacceptable event not only by the expecting mother and family but also by the obstetrician. Both the woman & the obstetrician become desperate to know the cause of IUFD & its prevention in future pregnancy. In more than 50% cases causes of fetal death cannot be determined. Objective: To identify common risk factors associated with IUFD. Methods: It was a cross sectional study was conducted in the department of Obstetrics & Gynaecology, Rangpur Medical College Hospital, Rangpur over the period of 6 months dated from July 2017 to December 2017. Sample size: 50 cases. All pregnant woman after 28 weeks of gestational age who were admitted in antenatal ward of the Gynae & Obstetric department of Rangpur Medical College Hospital, Rangpur. During the study period all the patients with IUFD & Fetuses who does not show any signs of births were the study population of this study. Result: Total 50 patients included in your study. Table-I shows that most of the women with IUFD cases fall in the age group of 20-30years 76% and 72% of women had primary level of education. Most of the patient 70%were from middle class. All were housewife. Majority (88%) were from rural area. Majority 52% were primigravida, 50% were>36weeks of gestational age, history of abortion were in 14% cases & IUFD in 04% cases. None of the patient took regular antenatal care, most of the Patient (72%) took irregular ANC, and 28% of patient did not take any ANC. Hypertensive disorder was the major risk factors 34% which include chr. HTN. 08%, preeclampsia 10% & eclampsia 16%, Other risk factors were PROM 16%, Prolong labor and obstructed labour 12%, GDM 06%, Rupture uterus with previous C/S 10%, Placental factor 08%, Cord prolapse 06%, Severe IUGR 04%, no risk factors found in 04% cases. 72% of the cases had mild anaemia, 60% were normotensive & 40% had high blood pressure, Scar tenderness were found in 20% cases who had H/O C/S. the patient 58% had Hb% 08-10gm/dl, all were Rh+ve mother, PPBS raised in 06% cases. In USG liquor volume normal 20%, mild to moderate oligohydramnios in 44%, moderate to severe oligohydramnios in 20% & severe oligohydramnios in 16% cases. Shows vaginal delivery had occurred in 86% cases. 14% need operative intervention among which 10% laparotomy were due to rupture uterus & 04% LSCS were due to scar tenderness. Maternal outcome in 84% cases were uneventful. Wound infection occured in 12% cases & Puerperial sepsis occurred in 04% cases. Conclusions: PIH, PROM were leading causes of IUFD. Majority of women who had IUFD were emergency admission who had not received adequate antenatal care. A significant proportion of IUFD is preventable by health education to patients and community for regular antenatal care, about warning signs during antenatal period, hospital delivery and early referral.

Evaluation of Fetomaternal Outcome in Expectant and Active Management of Term Prelabour Rupture of Membranes

Background: PROM is a complex condition with multifactorial etiology, including factors like multigravida, low socioeconomic status, concomitant infections, late symptom presentation, and a history of preterm PROM. Conventional management strategies include expectant management, waiting for spontaneous labor, and active management, involving induction with oxytocin or prostaglandins. Objectives: This prospective cross- sectional observational study aimed to evaluate fetomaternal outcomes in both expectant and active management of term PROM. Methods: Conducted at the Obstetrics and Gynecology Department of Rangpur Medical College Hospital, the study included 50 pregnant women with a history of PROM, gestational age ≥37 weeks, and spontaneous membrane rupture. Data were collected from March to September 2019 using purposive sampling. Demographic information was recorded, and clinical examinations were performed. Data were processed, analyzed, and compared between active management (Group-A) and expectant management (Group-B). Results: The study population's age ranged from 17 to 35 years, with a majority aged 20-25 years (42.0%). Most patients were from urban areas (52.0%), with 52% belonging to a socioeconomically disadvantaged class. Group-A, which underwent active management, showed a significantly higher rate of delivery within 12 hours (80.0%) compared to Group-B (48%). Both groups had similar induction-to-delivery intervals. Vaginal deliveries were more frequent in Group-A (84% vs. 64%), while Group-B had a higher rate of C-sections due to fetal distress. Group-B experienced more maternal complications, including puerperal sepsis, wound infections, and postpartum hemorrhage. Neonatal outcomes were better in Group-A, with higher Apgar scores at both 1 and 5 minutes. Conclusion: Active management was associated with better outcomes in term PROM cases compared to expectant management. Early antenatal diagnosis and risk factor identification are essential tools.....

Socio-demographic Status and Psychiatric Morbidity of Suicide Attempters in a Tertiary Care Hospital of Bangladesh

Background: Suicide is a worldwide growing but neglected problem crossing culture, geographies, religious, social and economic boundaries. Suicide is a perplexing phenomenon of taking one’s own life. As versatile human beings are, reasons behind suicide attempts are also unique. There is paucity of study on the clinical characteristics of these patients from a psychosocial and psychiatric point in Bangladesh. Objective: The study was aimed to assess the socio-demographic profile and psychiatric morbidity in attempted suicide patients. Methods: This cross-sectional observational study was carried out for 4 months (May’2017-September’2017) at the Rangpur Medical College Hospital, Rangpur, Bangladesh. ). A total of 101 patients were purposively selected from the patients with suicidal attempt from different departments of the hospital (Medicine, Surgery, Head-Neck & Otorhinolaryngology). Informed written consent was obtained from all patients. The interview was conducted once the patient was considered fit for a psychosocial assessment using a semi-structured questionnaire and clinical interviews. Diagnosis was made according to DSM-IV. Data was entered and analyzed using SPSS version 24 and results were expressed as proportions and percentages. Results: The majority of suicide attempts seen are in socio-economically-deprived young persons. Majority were <20 years age (41.59%), Female (53.47%), Unmarried (51.49%), Rural dwellers(72.28%), students (38.62%) and 58% attempts were impulsive. 63% without any prior suicidal thoughts, 56% resorted to poisoning, 49% attempted due to domestic quarrel, 65% suffered from a psychiatric disorder and major depressive disorder (18%) was found to be one of the commonest diagnosed disorders. Conclusion: Psychiatric disorders and their co morbidities are common in suicide attempt patients which calls for implementation of hospital guidelines for routine psychiatric and psychosocial assessments. J Rang Med Col. September 2023; Vol. 8, No. 2: 7-13

Socio-demographic Characteristics and Histopathological Type of Colorectal Cancer in the Northern Part of Bangladesh

Background: Colorectal cancer is one of the most common causes of death among patients. This study aimed to see the pattern of colorectal cancer from 2018 to 2021 and to explore its association with age and sex, its site of occurrence, histopathological types & its incidence in different regions of the Rangpur division. Methods: This cross-sectional study was carried out in the Department of Radiotherapy, Rangpur Medical College Hospital, Rangpur, Bangladesh. All data regarding 434(7.5%) colo-rectal cancers out of 5782(100%) patients were collected from 2018 to 2021. Each of the 434 colorectal cancer patients was interviewed and examined thoroughly before data collection. Age, sex, previous & current data of all patients were recorded properly during the study. Result: The study showed out of 436 colo-rectal cancers 266(61.3%) were male and 168(38.7%) female with a male-female ratio of 1.58:1. Highest incidence of cancer was in the age group 41-60 years (194,44.7%). Out of 436 cancers 219(50.4%) found in rectum, 29(6.6%) in sigmoid colon and 186(42.8%) in other parts of colon. The most common histopathological type was adenocarcinoma 415(95.62%). Among eight districts of the Rangpur division highest incidence of colorectal cancer was found in Rangpur 194(44.7%) followed by Nilphamari 64(14.7%), Gaibandha 44(10.1%), Kurigragm 40(9.2%), Dinajpur 35(8.06%), Lalmonirhat 34(7.9%), Panchagarh 12(2.7%) and Thakurgaon 11(2.5%). Conclusion: The incidence of colorectal cancer is higher in males than females. Highest incidence of colorectal cancer in the age group of 41-60 years. Adenocarcinoma is the most common histopathological type of colorectal cancer in both males and females. Incidence of the colo-rectal cancer in the Rangpur district is higher than in other districts of Rangpur division. J Rang Med Col. September 2023; Vol. 8, No. 2: 44-47

Outcome of Perforator Based VY Advancement Fasciocutaneous Flap for Sacral Pressure Sore Reconstruction

Background: Pressure sores are an ancient medical problem; were even found in autopsies of Egyptian mummies. Sacral pressure sore is more common among paraplegic and bedridden patients. The principle of treatment is excision of all dead & devitalized tissue including scars, underlying bursa, and the involved bone, followed by durable coverage with Flap. Various flaps have been used to reconstruct the pressure sore, including Fasciocutaneous flaps, muscle flaps and free flaps. Among various local flaps, perforators based V-Y advancement fasciocutaneous flap is a reasonable and flexible option with good outcomes for sacral pressure sores reconstruction. Objectives: The purpose of this study was to evaluate the outcome of perforator based V-Y advancement fasciocutaneous flap for sacral pressure sores reconstruction concerning the sociodemographic characteristics of the patients, defect size, and outcome of surgery. Methods: This was a prospective observational study, conducted in the Burn & Plastic Surgery department of Rangpur Medical College Hospital, Rangpur over a period of three years from August 2018 to September 2021 through purposive sampling. Patients of all ages and sexes having grade IV sacral pressure sores were included in this study. In all cases, perforator- based V-Y advancement fasciocutaneous flaps were used. Surgical technique, patient demographics, and outcome were evaluated. Results: A total of 30 patients were operated on. The age range was 18 – 65 years, among them 43.33% of patients were in the age range of 31 – 40 years. 80% of patients in this series were male. Traumatic paraplegia was the main cause of sacral pressure sore, and it was 70%. This study showed that in context to the length and breadth of the wound, a majority (30%) of the patients had a wound dimension of 71–90cm2. The smallest wound dimension was (5x6) = 30cm2 and largest wound dimension was (10x16) = 160cm2. Twenty-one sores that ranged from 6cm to 10cm were reconstructed with unilateral flaps and 09 sores that ranged from 11cm to 16cm were reconstructed with bilateral flaps. In this study, 06 (20%) patients had complications and all were managed conservatively. Three patients had infections and were treated according to the culture sensitivity report. Two patients had marginal flap necrosis at the vertical limb of Y which healed conservatively. One patient developed a seroma due to a blockage of the drain tube, which was resolved spontaneously. There was no flap loss in our study. The average follow-up period was one year. No recurrence of pressure sore during this period. Conclusion: The simplicity of the surgical procedure, minimum or no morbidity in the donor area, and satisfactory outcome in terms of recurrence make this a reasonable option for the reconstruction of the sacral pressure sore. J Rang Med Col. September 2023; Vol. 8, No. 2: 20-24

Accuracy of Johnson's Formula for Estimating Fetal Weight Compared to Actual Birth Weight: A Study of 600 Cases in Rangpur Medical College

Introduction: The estimation of fetal weight during pregnancy has a significant impact on the survival of newborns and some immediate and late sequelae of the life of newborns. Estimation of fetal weight also plays a paramount role in determining time, mode, and place of delivery. There are many methods to estimate fetal weight like the palpation method, fundal height measurement, and radio frequency volume reduction. Johnson's method is one of the clinical methods that require no expense and is easier to estimate the precise birth weight and fetal weight. This study aimed to analyze the accuracy of the Johnsons formula for estimating fetal weight compared to actual birth weight. Methods: This cross-sectional prospective study took place in the Gynecology and Obstetrics Department of Rangpur Medical College Hospital, Rangpur, between May 2015 to October 2015, six (06) months after approval. The sample size was 600 as per inclusion criteria. Data were collected through face-to-face interviews with the women by using a pre- design questionnaire after proper counseling and informed written consent. The purposive sampling method was used in the study. Data processing was consisting of registration schedule, editing, computerization, preparation of dummy table, analyzing & matching of data. Statistical analysis was carried out by using the Statistical Package for Social Sciences version 16.0 for Windows. The mean values were calculated for continuous variables. The quantitative observations were indicated by frequencies and percentages. Paired t-test was used for continuous variables. Pearson's correlation coefficients were used to test the relationship between the groups. P values <0.05 was considered statistically significant. Result: The mean age was found 24.5±5.1 years with a range from 18 to 38 years. The mean symphysio fundal height was found 32.4±2.0 cm with a range from 28 to 36 cm. The mean estimated fetal weight was found 3205.2±287.9 grams with a range from 2635 to 3875 grams. The mean actual birth weight after delivery was found 3019.0±359.0 grams with a range from 2200 to 3800 grams. The difference was statistically significant (p<0.05) between the two groups. A positive significant correlation (r=0.929; p=0.001) was found between actual birth weight and estimated fetal weight by Johnson's formula. A positive significant correlation (r=0.517; p=0.001) was found between actual birth weight and symphysio fundal height. A positive significant correlation (r=0.129; p=0.002) was also found between the actual birth weight neonate and the BMI of the mother. Conclusion: Antenatal and intranatal fetal weight can be estimated with reasonable accuracy, clinically using Johnson's formula. Ultrasound is not available in remote areas where Johnson's formula is easy and simple to calculate and can be included in the training program of medical and paramedical staff and birth attendants.

Evaluation of Complication of Repeat Cesarean Section: A Study of 100 Patients in a Tertiary Care Hospital in Bangladesh

Background: Worldwide, caesarean section (CS) is one of the most commonly performed obstetric procedures. Maternal mortality and morbidities associated with repeat caesarean section is an important health problem in global perspective that needs to be addressed. Objectives: To evaluate the complications of repeat caesarean section. Materials and Method: This cross-sectional descriptive study was conducted in the department of Obstetrics & Gynaecology, Rangpur medical college hospital, Rangpur from July ’18 to June ‘20 after acceptance and ethical clearance of the protocol. During data collection total admitted patient were 2123 out of which 446 caesarean section was done among them 100 patients of my study population were selected by fulfilling inclusion and exclusion criteria. After full explanation, informing the details of the purpose of the study informed written consent was obtained from the study subjects/ or her legal gardian. After Meticulous history taking thorough physical examination was done on every patient and available investigations according to the need of management was done in the hospital. Per operative and postoperative complications were noted. Information’s were collected in predesigned questionnaire and presented in tabulated form and that was finally was analyzed with the help of computer program SPSS (Statistical Package for Social Science) version 23. Result: Total patient admitted during my data collection were 2123 and of them 446 caesarean sections were done and repeat caesarean sections were 100. The incidence of repeat caesarean section was 22.42%. 35% respondents were between >25-30 years of age. Average gestational age was >36 – 40 weeks. Emergency caesarean section was done in 79% cases and elective in 21% cases. 68% patients had adhesion, 38% had uterine atonicity, 26% had injury to the surrounding structure, placenta previa was found in 7% cases and morbid adhesion of placenta was found in 3% cases. Additional procedures like blood transfusion needed in 34% cases, adhesiolysis performed in 21% cases, ICU admission needed in 16% cases, caesarean hysterectomy performed in 11% cases and B-Lynch suture in 8% cases. Among the postoperative complications wound infection occurred in 20% cases, PPH in 13% cases, UTI in 9% cases, paralytic ileus in 4% cases and postpartum psychosis in 3% cases. Maternal mortality was found in only 3% cases. Conclusion: Repeat caesarean section is associated with increased number of intraoperative and postoperative complications like adhesion, placenta previa, morbid adherent placenta, PPH, wound infection thus increasing maternal morbidity. So, the best way to reduce these morbidity and mortality by reducing primary caesarean section rates by taking judicious decision and indications should be appropriate and C/S should be done by well-trained doctors and specialists in well-equipped centre.

Role of Serum CA 125 Level in the Diagnosis of Pulmonary Tuberculosis

Background: Pulmonary tuberculosis (PTB) persists as a great public health problem in Bangladesh. Although many diagnostic tools are invented but the diagnosis continues to rely on smear microscopy, culture and chest radiography. Other non-conventional approaches include detection of immunological response and the search for biochemical markers. Cancer Antigen 125 (CA-125) was considered a promising one and have been reported in few instances. Methods: This study was a hospital based cross-sectional analytical study conducted at department of Medicine in Rangpur Medical college Hospital, Bangladesh for 24-months following approval of the protocol. Total 100 people with pulmonary tuberculosis either smear positive or smear negative gene X pert positive were selected and analysed in this study. Written informed consent were taken from all subjects. After taking written consent from each patient, detailed clinical history, physical examination and relevant investigations including serum CA 125 level were done for every patient. Reflection of CA 125 positivity were calculated on the basis of smear positive and smear negative gene X pert MTB/RIF positive pulmonary tuberculosis. Collected data were noted down in separate case record form. After removing consistency and compilation, final data analysis was done in the statistical program Statistical Package for Social Science (SPSS) version 23.0.P-value of <0.05 was considered to indicate statistical significance. Results: Of total 100 patients, mean age was 36.68 ± 12.57 SD (years) with slight male predominance with Male female ratio was 2.13:1. Overall elevated CA-125 was found in 88% cases with mean value 90.82 ± 74.28 IU/mL. Mean level of CA- 125 among sputum smear positive cases 74.69±49.51 IU/mL (37-153 IU/mL). Among 50 smear negative gene Xpert positive cases, 24% had serum CA-125 level <35 IU/mL (19.73±11.86 IU/mL) and rest 76% had e”35 IU/mL (134.51±86.74 IU/mL). Smear negative & gene Xpert positive cases has statistically significant higher level of CA-125 cases in comparison to smear positive cases (P-value <0.05). Conclusion: More than two thirds of the pulmonary tuberculosis patients had higher level CA-125 and smear negative-Xpert positive cases had significantly higher level than smear positive cases. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 206

Short-term of mortality in acute stroke patients

Background: Stroke is a major cause of disability and death. A significant number of patients with acute stroke dies within 30 days of developing stroke. The aim of the study was to determine the short-termmortality (within 30 days) in acute stroke patients. Methods: This was a cross-sectional study, carried out in the Department of Medicine of Rangpur Medical College Hospital. Date was collected for 6 months (from January to June). Results: During the study period, we studied of 248 acute stroke patients, among them 110 were hemorrhagic and 138 were ischemic. Mean age of the patients were 56.02 years in hemorrhagic stroke and 61.26 years in ischemic stroke. In case of hemorrhagic stroke, short term mortality was 45.5% (50), among them in hospital death was 88% (44) and majority of the deaths occurred with in the first 7 days. Mortality was significantly higher among patients with larger hematomas (>60 cm3) compared to subjects with smaller hematomas (<30 cm3). Short term mortality was 18.1% in ischemic stroke. Infarction size more than 10 mm2, total anterior circulation syndrome (TACS) and GCS less than 10 at presentation were significantly associated with short term mortality. Conclusion: Short-term mortality was high in acute hemorrhagic stroke than acute ischemic stroke. In hemorrhagic stroke larger hematoma, GCS at presentation, ventricular extension and in case of ischemic stroke size of the infarction, arterial territory involvement and GCS were predictor of mortality. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 205

Associated Risk Factors and Outcomes of Resection Surgery of Colorectal Cancer: A Single Center Study in Bangladesh

Background: One of the most common cancers in the world is c1olorectal cancer. Surgery is the sole curative option, and post-operative morbidity and mortality should be kept to a minimum to enhance results. Of course, the whole surgical and medical team is extremely frustrated when post-operative complications finally result in patient death. Because colon cancer patients tend to be older, it is to be expected that a growing percentage of patients have co-morbidity, making any procedure riskier. Patients may lose their lives even after successful surgery as a result of co-morbidity-related consequences. The main method of therapy for colorectal cancer is still surgery. However, the procedure entails a high risk of morbidity and death and uses a substantial amount of medical resources. Postoperative complications are common in patients who have had colorectal surgery, and they put them at increased risk for morbidity, mortality, poor oncologic outcomes, and a reduced quality of life. Objective: To find out associated risk factors of the patients related to colorectal cancer and the outcome of resection surgery of colorectal cancer. Materials and Methods: After receiving ethical permission, the department of surgery at Rangpur Medical College Hospital carried out this longitudinal form of descriptive study between July 2019 and June 2020. After explaining the nature and goal of the study to the participants, signed informed permission was acquired. A pre-made questionnaire was used to interview a total of 33 patients. Each patient had a complete physical examination, a careful history review, and any necessary investigations. Based on pre-existing co-morbidities, surgical technique, and associated complications, 30-day postoperative mortality and morbidity were assessed. The case questionnaire contained the collected data. ANOVA, Fisher exact, and the appropriate statistical tests (Chi-square) were run. Software called SPSS (version 22.0) was used to examine the data.

Sensitivity, Specificity, Predictive Values and Accuracy of clinical diagnosis of Acute Stroke

Background: Stroke is a leading cause of death and disability globally and particularly in low and middle-income countries, and the burden is increasing. To prevent complications and permanent defects in stroke, early diagnosis is the key that can easily obtained by a CT scan of brain. However, quick access to CT scanning is not available in every country and hospital specially in Bangladesh, various clinical findings especially neurological signs and symptoms and risk factors differentiation are helpful in differentiating the types of stroke. Objective: This study aimed to see the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of clinical diagnosis in the detection of stroke subtype. Methods: This hospital based cross-sectional comparative study was conducted in Department of Medicine, Rangpur medical college hospital, Rangpur, Bangladesh from January 2010 to December 2011 on three hundred (300) suspected acute stroke patients selected by purposive sampling technique. The clinical diagnosis of type of stroke was made on the basis of mode of presentation, risk factors and signs and confirmed by CT scan of brain within 1 week of attack. Then the clinical diagnosis was compared with the results of CT scan. Statistical analyses related with this study were performed by using of SPSS-19 package program. Results: Among the 300 patients, 73(24.3%) patients were clinically diagnosed as hemorrhagic stroke and 227(75.6%) patients were as infarctive stroke. Out of 73 clinically diagnosed haemorrhagic stroke patients, CT scan revealed that 61 (83.6%) patients had intracerebral hemorrhage, 5 (6.8%) had infarct. And out of 133 diagnosed ischemic stroke patients, CT scan revealed that 203 (89.4%) patients had infarction, 6 (2.6%) had intracerebral hemorrhage. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of clinical diagnosis of hemorrhagic stroke were 91.0%, 94.8%, 83.6%, 97.4% and 94.0% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of clinical diagnosis of infarctive stroke were 97.6%, 73.9%, 89.4%, 92.2% and 90.3% respectively. Conclusion: CT scan of brain remains the gold standard for differential diagnosis, but the availability of CT scan is not always feasible, and it is virtually impossible to submit all stroke patients to CT scan. Adequate knowledge on risk factors, clinical features and initial investigations may contribute to such a differentiation of cerebral infarction from intracerebral hemorrhage with high accuracy where rapid access to Computed Tomography (CT) is lacking. J Rang Med Col. March 2023; Vol. 8, No. 2:33-39

Randomized Control Trial of 3% Nebulized Hypertonic Saline in Reducing the Length of Hospital Stay in Children with Bronchiolitis

Background: Bronchiolitis is the most common cause of lower respiratory tract infections within the first 2 years of life. Despite tantalizing efforts, an effective optimized treatment for bronchiolitis still remains elusive. Nebulized hypertonic saline may improve clinical severity scores and reduce length of hospital stay among infants with non-severe acute bronchiolitis. Objective: The objective of this study was to evaluate efficacy of 3% hypertonic saline in reducing the length of hospital stay in children with bronchiolitis. Method: This randomized control trial was conducted in the department of Paediatrics, Rangpur Medical College Hospital between July 2018 to June 2020. After acceptance and ethical clearance, 72 infants and young children fulfilling the selection criteria were enrolled into this study. Children were randomly divided into two groups, designed as group–A and group–B. Patients in group A were nebulized with 3% hypertonic saline and group B with normal saline. Patients in each group were nebulized three times 8 hourly during hospital stay. Each group received the same standard supportive measures. Data was analyzed through SPSS (version 23.0) software using chi-square test, student t' test, where applicable. Statistical significance was set as 0.05 level. Results: Among the 72 children, 72.22% (26/36) of group A and 58.33% (21/36) of group B were male, with a male female ratio of 1.88:1. Mean age of the children of group A (7.5±1.94 months) was significantly higher than that of group B (5.8±2.01 months) (p=0.032). Baseline clinical characteristics were almost similar, except oxygen saturation (p<0.001) between the two groups. 88.9% (32/36) patients of group A and 41.7% (15/36) from group B recovered and were discharged within 72 hours. After 72 hours, 11.1% (4/36) from group A and 58.3% (21/36) from group B recovered and were discharged (p<0.001). Mean length of hospital stay was shorter in the hypertonic saline group (2.28 ± 0.45 days) than that in the normal saline group (3.72 ±0.45 days). Conclusion: The length of hospital stay was effectively reduced by 3% nebulized hypertonic saline in children with bronchiolitis. J Rang Med Col. March 2023; Vol. 8, No. 2:40-43

Assessment of Bacteriological Pattern and Antimicrobial Susceptibility in Deep Neck Space Abscess

Background: Deep neck abscess is a common clinical entity in developing countries like ours. Despite the widespread use of antibiotics, deep neck infections do not disappear and remain one of the most difficult emergencies encountered in daily clinical practice. The extent and severity of the illness could become life-threatening. Therefore, coping with deep neck abscess remain a challenge to otolaryngologists. This study aimed to analyze the bacteriological pattern and antimicrobial susceptibility in deep neck space abscesses. Material Methods: It was a cross-sectional observational study. 50 patients with deep neck space abscesses fulfilling the inclusion and exclusion criteria admitted to the department of ENT Head Neck Surgery, Rangpur Medical College Hospital, Rangpur, from 1st July 2017 to 30th December 2017 were enrolled in this study. Pus from deep neck space abscess was collected by either aspiration or incision and drainage with proper aseptic measure and sent by sterile test tube to microbiology department immediately. Data were collected by detailed history taking and clinical examination investigations with informed written consent and analyzed by SPSS (version 20). Results: In this study most commonly involved deep neck spaces were Submandibular (38%), Peritonsillar (32%), Retropharyngeal (14%), and parapharyngeal (8%) spaces. Streptococcus viridans was the most prominent organism 14 (28%) followed by Klebsiella pneumonia 9(18%) and Staph. aureus 4 (8%). The most effective antibiotic was Ceftriaxone 34(79%) followed by Cefuroxime 30 (70%) and Erythromycin 23(54%). Aerobic organisms were highly sensitive to Cefuroxime (83%) and Ceftriaxone (83%) followed by Erythromycin (48%). Anaerobic organisms were sensitive to Clindamycin (100%), Metronidazole (100%), and Erythromycin (100%) followed by Ceftriaxone (75%). Conclusion: The most frequently isolated organism in deep neck space abscesses were Streptococcus viridans and Staphylococcus aureus and sensitivity results showed the majority of isolates are susceptible to Ceftriaxone and Cefuroxime.

Assessment of Foot Ulcer and Peripheral Neuropathy in Diabetic Patients

Background: One of the most common complications of diabetes mellitus in lower extremity is the diabetic foot ulcer. There are numerous risk factors, among those peripheral neuropathy is the most important risk factor for diabetic foot ulceration. Objectives: To assess the diabetic foot ulcer, probable risk factors and the relationship of diabetic foot ulcer with peripheral Neuropathy. Materials and methods: This cross sectional study was done in the department of General Surgery, Rangpur Medical College Hospital, Rangpur, Bangladesh between May, 2015 to November 2015. 50 patients with diabetic foot ulcer were selected by purposive sampling method. Results: In this study, 60% of patients were above 60 years of age. 82% of patients were male and 18% were female. All patients were with uncontrolled diabetes mellitus and 80% of patients had blood glucose level between 11-20 mmol/L. HbA1c level found >7 in 68% of patients. 72% patients had history of trauma. 66% of the patients were smoker. None of the patients was alcoholic. Peripheral arterial disease was present in 24% patients. 72% patients had peripheral neuropathy. Conclusion: This study may help to raise the awareness among patients and professionals, ultimately which will help to take initiatives for early diagnosis and treatment of high risk patients. KYAMC Journal Vol. 13, No. 04, January 2023: 214-217