Red Crescent Medical College Hospital Research Articles

Early outcome of Lichtenstein technique for complete variety of inguinal hernia repair in a tertiary care hospital

Background: Inguinal hernia repair is very common in day to day general surgical practice. Result of surgical repair is often satisfactory but recurrences following surgery are troublesome both for the surgeon and the patient. Lichtenstein technique is now the most widely performed technique in groin hernia repair.
 Objective: The aim of this study was to assess short term outcome of complete variety of inguinal hernia repair by Lichtenstein technique.
 Methodology: This was a prospective observational study in which 30 complete variety of inguinal hernia repairs were performed by Lichtenstein technique between January 2014 and December 2017 by same surgical team in surgery department, Holy Family Red Crescent Medical College Hospital (HFRCMCH). Patients were scheduled for follow up visits at the end of first week, third month and sixth month after operation in out-patient department. The main outcome measures were postoperative complications, early recurrence, groin pain.
 Result: In this study age of the patients ranged from 30 years to 78 years, the mean age was 51.93 (±SD 10.12) years. Most of the hernia were of indirect type 18(60%) followed by direct type 9(30%). In indirect type (55.6%) of the hernias was right sided and the rest (44.4%) were left sided. On an average each operation lasted for 1.18 hours and oral feeding started 12.69 hours after the operation, Postoperative mean hospital stay that was 2.27 days. Postoperative complications were 2(6.7%) had a prolonged recovery and presented with abdominal distention after operation and 3(10%) patients developed postoperative urinary retention. Scrotal haematoma formation was observed in 2(6.7%) cases and other post-operative complications were local haematoma or seroma formation in incision site, periincisional skin echymosis, postoperative pyrexia, superficial wound infection and post-operative pain were found in 1 (3.3%) cases. Regarding outcome no recurrence or mesh rejection or mesh infection were observed within short time postoperative follow up period.
 Conclusion: In this study no recurrence or mesh rejection or mesh infection were observed within short time postoperative follow up period and patient's compliance was good with minimum morbidity. Therefore, Lichtenstein's technique of inguinal hernia repair considered as a safe and effective procedure.
 Northern International Medical College Journal Vol.10 (2) Jan 2019: 389-392

Early Outcome of Lichtenstein Technique for Inguinal Hernia Repair in Tertiary Care Hospital

Background: Inguinal hernia repair are very common in day to day general surgical practice. Results of surgical repair are often satisfactory but recurrences following surgery is troublesome both for surgeon and patient. Lichtenstein technique is now the most widely performed technique in groin hernia repair. The aim of this study was to assess short term outcome of inguinal hernia repair by Lichtenstein technique.
 Methods and materials: In this prospective study, 30 inguinal hernia repairs were performed by Lichtenstein technique between January 2015 and December 2017 in surgery department of Holy Family Red Crescent Medical College Hospital. Patients were scheduled for follow up visits at 1st week, three months and six months in out- patient department. The main outcome measure was early recurrence, groin pain and other complications.
 Results: In this study age of the patients ranged from 30 years to 78 years, The mean age was 51.93 (±SD 10.12) years. Regarding personal habit, more than half of the patients of inguinal hernia were found to be non-smoker and about 37% of the patients were current smokers. Most of the hernia were of indirect type (18/30) followed by direct type (9/30). In indirect type 55.6% of the hernias were in the right side and the rest were in left side. On an average each operation lasted for 1.18 hours and oral feeding started 12.69 hours after the operation. Two patients (6.7%) had a prolonged recovery and presented with abdominal distention after operation. Postoperative hospital stay that was 2.27 days. 6 (20%) patients developed postoperative urinary retention. Scrotal haematoma formation was observed in 5(17%) cases and local haematoma or seroma formation in incision site was reported in 4 (13%) cases. In 6 patients (20%) we used suction drain tube at tissue plane where mesh was placed for draining of blood or seroma and that drain tube was removed 2nd or 3rd postoperative period. Periincisional skin echymosis, abdominal distension and superficial wound infection, postoperative pyrexia were the other complications reported. No recurrence or mesh rejection or mesh infection were observed within short time postoperative follow up period.
 Conclusion: Lichtenstein technique is easy to learn, simple to perform and very rationale to perform and recurrence rate is low. Multi-centre studies with larger sample and longer duration of study and more sound study design could bring more insight regarding this issue.
 Anwer Khan Modern Medical College Journal Vol. 10, No. 1: Jan 2019, P 62-69

The Effect of Self-Medication with NSAIDs on GIT in Orthopaedic Patients

Self-medication is a gradually increasing entity in a healthcare system. It leads patients towards greater independence in taking decisions about management of minor illnesses. It ensures access to medication and limits delayed diagnosis, worsening of disease evolution, the cost burden of drugs in comparison to prescribed drug. The aim of the study was to evaluate the prevalence of the use of NSAIDs as in the form of analgesics for self-medication with their associated risks especially GIT symptoms. This cross-sectional study was done at Holy Family Red Crescent Medical College Hospital, Dhaka, July 2018 to December 2018 for 6 months among the patients who registered to visit Orthopaedic OPD for their musridoskeletal problems. A pretested and validated questionnaire was used to collect data. There were 97% response rate recorded. The study included 571 randomly selected patient aged between 20 to75 years, of which 55.3% were from urban areas versus 44.7% from rural areas, females being dominant (69.32%). The drugs which was surveyed, were used by 84.8% of the study population, in most cases the administration being made without prior professional advice. Of the 331 participants prom urban areas, 89% used the self-medication, compared with 58.31% in rural areas. Paracetamol (46.34%), followed by Ketorolac (24.47%) and Diclofenac (22.7%) are among the most widely used analgesics, both in urban and rural areas. The most frequent symptoms that required self-medication were: low back pain (urban and rural are), neck pain (predominantly urban) and knee joint pain (predominantly rural areas). Misuse of analgesics and anti-inflammatory drugs, both in urban and rural areas is a burning issue. The growing economy improvised urban and rural people to avail the medications without knowing the risks. Close monitoring, a multilevel venture between all concerned -patients, physicians and pharmacists to provide the supervised education and appropriate information on safe self-medication for the accomplishment of national goals, are suggested plan of action. It will maximize the benefit and minimize the risks.

Oral Prednisolone Treatment of Sudden Sensory Neural Hearing Loss: 16 A Three Year Retrospective Analysis

Sudden Sensory Neural Hearing Loss (SSNHL) is a serious medical condition and requires prompt medical attention. The study was done to estimate the effect of different protocols of oral Prednisolone plus high dose vitamin B-complex and vitamin BI, 132. Be in patients with unilateral SSNHL who have failed to respond to treatment. A retrospective study was done from January 2015 to January 2018 at the outdoor patient department of Holy Family Red Crescent Medical College Hospital, Dhaka among 75 randomly selected patients with a mean age of 46.32 years (range 25-69 years). with the preselected criteria. Each of the patient received one of the four standard oral Prednisolone dosing protocols along with high dose of vitamin B-complex and BI, 132, Be orally 20mg four times for a total dose of 80mg daily for one week, Group A, n=18; orally 20 mg three times, for a total dose of 60mg daily for one week Group B, n=18; orally 20mg two times for a total dose of 40mg daily for one week Group C, n=18; orally 10mg three times for a total dose of 30mg daily for one week. Group a n=18. All the doses were then tapered for next 5 days. Patient characteristics and pharmacological effects were compared among the 4 groups. The mean age, average duration of symptoms from onset to treatment, and degree of hearing loss were analyzed by means oft-test Treatment effects were analyzed by means of Chi-square test. P<0.05 was considered significant. Improvement of hearing was assessed by pure tone audiogram. The total effective rate was 88.89% 83.33%, 77.78% 66.67% for each treatment protocol, respectively, with no significant statistical difference between them (p00.05). The results suggest that a total dose of 80 mg is the most appropriate protocol. Prednisolone significantly improves the prognosis of SSNHL. Further multicenter studies are needed to determine the more standard treatment protocol.

Nutritional Status of School Age Children Attending OPD of Selected Hospitals

School-age is the vital growing phase of a child. Primary school age is a progressive period of physical growth and mental development of the child. Health issues because of poor nutrition in elementary schoolage children are among the foremost common causes of a low level of school enrolment, high absenteeism, early dropout and unsatisfactory classroom performance. Growth monitoring is a global tool to evaluate nutritional status, health and development of individual children, and the overall nutritional status and health ofpopulations. To find out the nutritional status of schoolage children and to signify nutritional deficiencies, a cross-sectional study was undertaken among the 222 registered school age childrenat the OPD of two selected urban and rural hospitalof Bangladesh — Holy Family Red Crescent Medical College Hospital, Dhaka and Dhamrai Upaxilla Health Complex, Savar, Dhaka. The data was collected from the parents or attendant accompanying them by non-probability purposive sampling method through semi-structured questionnaire by face to face interview. The children between 5 to 15 years were recruitedaccording to inclusion and exclusion criteria. The age group of 8-10 years constituted the highest portion (31.5%) of the respondents. The mean ± SD age of the childrenwas 9.8 ± 7.27 years. Most of the childrenwere Muslims (94.6%). About 62% of them were boys and 38% were girls. Most of the children's mothers completed theirprimary education (37.4%). The percentage of the illiterate father was 17.12% Majority of the mothers were labourers (41.32%) and most of the fathers were farmers (31.08%). Most of the respondents had monthly family income Tk 10000-30000 (43%).44% had low birth weight and about 89% of them were vaccinated following a regular schedule The mean weight of childrenwas 22.63 ±4.65 kg and height were 120.92 ± 6.54cm. According to BM1 classification, there were 58% normal, 35% undernourished and 7 % obese/overweight. The health and nutrition status of children is one of the crucial elements in the assessment of the quality of life of the people To prevent nutritional problems and their consequences early diagnosis is necessary. So, it is important to raise awareness regarding the special nutritional needs of the school-age children and regularly monitor and assess the nutritional status of them.

Hyperemesis Graviderum: An observational study and outcome at a tertiary teaching hospital in Dhaka city

Hyperemesis graviderum is a complication of pregnancy that can lead to severe maternal nutritional deprivation. About 0.14% -1.3% of pregnant women sufferedfrom hyperemesis graviderum. Women with hyperemesis grmidanan causing loss of greater than 5% of their pre-pregnancy weight. And has been linked to fetal growth restriction, wernickes encephalopathy resulting in fetal death in 40% of cases . Ilyperemesis graviderzaninterfire there working life, it is important to know the outcome of hyperemesis graviderum on fetus and mother. A tertiary level hospital based prospective study was conducted on woman suffering from Hyperemesis graviderum and attended in OPD and 1F'D of Holy Family Red Crescent Medical College Hospital, Bangladesh to asses the adverse outcome of Hyperemesis Graviderum on .mother and baby and identifies its determinants. The mean age of the study group was 26.2513.25 years. Regarding parity, 54.0% patients were found primipara and 46.0% patients found multipara. The majority of the subjects (66%) were normal weight, 18% patients had overweight by BM1 (body mass index) 12% patients were underweight and 4% patients were obese. Distribution of the study subjects according to educational status, it was found that 32% were primary, 44% patients were high school, 12% patients were SSC, 8% patients were HSC and 4% patients were graduate and above. Out of 50 cases, 64% were housewife, 18% patients were service, 4% patients were business and 10% patients were student. Majority of patients (70%) had positive family history of hyperemsisgravidenn. Study showed 46% respondent started vomiting within 6-10 gestational weeks, 30% started vomiting more than 10 gestational weeks and 24% started vomiting within 1-5 gestational weeks. Maximum subjects (78%) needed home treatment and 22% patients were hospitalization. Most of the patients (68.0%) hemoglobin level 6- 10mg/d 1 . Maximum were rhesus positive blood group. Most of the patients 98% had normal serum creatinine level, 86% patients had normal serum electrolytes, 94% patients had normal urine R/M/E, 78% patients had normal RS'S level, 100% patients of hyperemesis gravidunn patients ultrasonography reports in pregnancy was normal. Among 50 patients, 4% patients had abortion history, 2% cases had IUD, 44% patients had IUGR and 10% patients had AGA in pre-term pregnancy. Out of 23 term pregnancy, 24% cases had 1UGR and 22% cases had AGA. Two percent neonatal death after delivery. hyperemesis Graviderum is related to maternal age, parity, education level, body mass index, occupation of the patients, education level, family history of hyperemesis graviderum and adverse outcome on mother and baby.

A study of Serodiagnostic Challenges in Enteric Fever Cases Presenting as Co-infection with Dengue and Malaria

Enteric fever, Dengue and malaria still remain diseases of public health importance in the tropics. The aim of the study to see the serodiagnostic challenges in enteric fever cases presenting as co-infection with dengue and malaria. The cross sectional study was conducted in the department of Medicine and Department of Microbiology, Holy Family Red Crescent Medical College Hospital, from July 2016 to June 2017. Febrile patients attending the outpatient department or admitted to hospitals attached to Holy Family Red Crescent Medical College Hospital suspected to have signs and symptoms clinically suggestive of typhoid, malaria and/or dengue were initially enrolled. Seropositivity of typhoid-dengue it was observed that 55 (55.0%) patients had dengue IgM+typhoid, 27 (27.0%) had dengue IgG+typhoid, 10(10.0%) had dengue IgM+IgG+typhoid and 08(8.0%) were negative. Seropositivity of typhoid-malaria of the patients, it was observed that p. falciparum+typhoid was found in 33 (33.0%), p. vivax+typhoid was 22 (22.0%) and negative was 45 (45.0%). Male patients while co-infection with typhoid fever observed more than in female population. In the present study Seropositivity of typhoid-dengue fever is high of co-infections are common than typhoid-malaria, hence it should be properly diagnosed and timely medication should be provided to reduce complications and get proper treatment.

Evaluation of 200 Cases of Caesarean Section to Find Out Post Operative Urinary Tract Infection

The incidence of caesarian section varies from hospital to hospital and from communii), to community. Endometritis, post surgical infection, mastitis, genital tract infection, perineal cellulites, respiratory complication from anaesthesia, retained product of conception, urinary tract infection and septic pelvic phlebitis are the post partum infection. To find out urinary tract infection in caesarean section. This prospective cohort study was conducted in the Department of Gynae and Obstetrics, Holy Family Red Crescent Medical College Hospital from August 2003 to January 2004 over a period of six months. Two hundred pregnant patients age between 15 to 42 years, both primi & multipary, pre term, term and post term cases were included in this study. Patients having fever prior to caesarean section were excluded from this study. Out of 200 caesarean section cases history of previous caesarean section (33.5%), Fetal distress (31%), preeclampsia (9.5%), cephalopelvic disproportion (8%), placenta praevia (6.5%) obstructed labour (4.5%), bad obstetric history (3.5%), early rupture of membrane (3.5%). Term delivery was 77%, preterm was 16.5% and post term was 6.5% in this study. 43.0% cases was primi para and 56.5% was multipara. 22 (11.0%) cases of study population had a history of UTI during pregnancy and only 29 (14.5%) cases developed urinary tract infection. Out of 29 cases only 3 (13.6) cases had a history of urinary tract infection during pregnancy. But there was no wound infection after caesarean section in this study. Urinary tract infection is probably due to improper aseptic precaution during catheterization. Organism isolated from urine were pseudomonas (44.8%), Klebsilla (24.1 %), E.coli (20.7%), proteus (10.3%). In this study, 29 (14.5%) cases developed UTI following caesarean section and only 3 03.6%) cases had a history of UTI during pregnancy.

Efficacy and Safety of Laparoscopic Appendectomy for Complicated Appendicitis in Children in Tertiary Care Hospital

Laparoscopic appendectomy for uncomplicated appendicitis is associated with good outcomes but the role of laparoscopy in complicated appendicitis is more controversial because of high incidence of infectious complications. The aim of this current study is to evaluate the efficacy and safety of laparoscopic appendectomy in complicated appendicitis in children. This interventional study was carried out during the period from January 2015 to May 2018 in Holy Family Red Crescent Medical College Hospital. The study included 43 patients, age ranges from 3 years to 15 years who underwent laparoscopic appendectomy for complicated acute appendicitis. The following variables were analyzed : age, sex, operative findings, operative time, return of bowel function, resumption of oral feeds, length of hospital stay, postoperative complications such as deur, wound infection and intraabdominal abscess etc. The mean age of studied cases was 7.1 years. In 41 patients (95.3%) the procedure was completed laparoscopically. Two (4.7%) patients required conversion to open appendectomy. The operative time was 83.5+,25.8 minutes. Two patients (4.6%) had post-operative ileus. Four patients (9.7%) developed superficial wound infection. Three patients (7.3%) developed infra-abdominal collections. One (2.4%) patients were readmitted because of recurrent abdominal pain One patients (2.4%) developed postoperative pyrexia due to pneumonitis and Three patients (7.3) developed gastroenteritis. The mean length of hospital stay was 5.8±2.1 days. No mortality was recorded.Laparoscopic appendectomy can be the first choice for cases of complicated appendicitis in children. It is a feasible, safe procedure and is associated with acceptable post-operative morbidity with rapid recovery and better cosmetic results.

Ectopic pregnancy: Interventional Outcome at Tertiary Hospital

The aim of this study is to determine the incidence and to evaluate and analyse the clinical presentation, risk factor and treatment of ectopic pregnancy in Holy Family Red Crescent Medical College Hospital, Dhaka. A prospective study was conducted in Department of Obstetrics and Gynaecology from August 2016 to December 2017. The study subjects included 50 women diagnosed with ectopic pregnancy (EP) to receive the treatment of medical and surgical procedure. In this study group the incidence was 4.7% among total gynecological admitted patient (2017) and the risk were within the age group 27-35 years. Majority of patients were having triad of symptom such as abdominal pain, secondary amenorrhoea and vaginal bleeding. Past NO abortion and abdomino-pelvic surgery were 66%. The commonest modality of treatment was Laparotomy (41 of 50, 86%), others were conservative with Inj. Methotrexate, failed conservative followed by Laparotomy (4%) and Laparoscopy (2%). EP is a common and life threatening entity. Women with infertility and past abdomino-pelvic surgery, MR, abortion are particularly at risk. Early diagnosis and intervention can reduce the mortality and morbidity of women having EP.

Biochemical Profile and Degree of Liver Involvement in Dengue Fever

Dengue disease has emerged globally as the most frequent and medically relevant viral infection transmitted by mosquito bite. Acute hepatitis is a manifestation of dengue virus infection. This study shows the impact of dengue on liver function was studied by biochemical tests on 80 patients out of them 53 male (age 42±12 yrs) and 27 female (age 39±13 yrs). The patients were diagnosed as dengue fever and were admitted in Holy Family Red Crescent Medical college Hospital from June 2014 to December 2016. All the patient were diagnosed by anti-dengue IgM positive by ELISA method. Abnormal level of aspartate aminotransferase (ASV, alanine aminotransferase (ALT), bilirubin, alkaline Phosphatase (Alp), gamma-glutamyl transferase (G-GT) and albumin and urinary albumin were observed in 82.5%, 82.5%, 47.5%, 38.75%, 71.25% ,66.25% and, 76.25% of the patients respectively. It is concluded that dengue fever may cause hepatic injury and transaminase elevation similar to that in patients with conventional viral hepatitis. In epidemic or endemic areas, dengue fever should be considered in the differential diagnosis of acute hepatitis.

Parameters Requiring Blood Transfusions in Epistaxis : A cohort study

The retrospective cohort study was done to analyze the characteristics of patients who needed a blood transfusion due to epistaxis-caused anemia and to define potential risk factors. A total cohort of 330 epistaxis patients, prospectively included between March 2007 and April 2008 at the ENT departments of the Holy Family Red Crescent Medical College Hospital Dhaka, Taqwah specialized Hospital, Dhaka & Insaf Barakah Kidney Hospital Dhaka, was evaluated concerning the need for blood transfusions. The clinical charts and medical histories of these patients were evaluated. Common parameters that increase the riskfor severe anemia due to epistaxis. Twelve patients required blood transfusions due to their medical condition. 22.7% suffered from traumatic nosebleeds. Another 27.3% had a known medical condition with an increased bleeding tendency. These proportions were significantly higher than in the group of patients without need of blood transfusion. The odds ratio for receiving a blood transfusion was 14.0 in patients with hematologic disorders, 4.3 in traumatic epistaxis and 7.7 in posterior bleeders. The transfusion-dependent epistaxis patients suffered significantly more often from severe posterior nosebleeds with the need for a surgical therapeutic approach. Patients with severe nosebleeds either from the posterior part of the nose or with known hematologic disorders or traumatic epistaxis should be closely monitored by blood parameter analyses to evaluate the indication for blood transfusion.

Antibiotics in ICU : The Challenges of Use, Cost and Response in a Tertiary Care Hospital

Antibiotic resistance can lead to increased morbidity, mortality, length of hospital stay, and health care expenditures. The study is designed to observe the challenges of antibiotic consumption, related costs and their resistance pattern in critically ill patients. The study was conducted in ICU from July to December 2016, in Holy Family Red Crescent Medical College Hospital The demographic data, antibiotic sensitivity report, the administration of different classes of antibiotics as well as individual drugs and their costs were recorded. In 216 patients, meropenem was the most commonly prescribed antibiotic followed by levofloxacin and ceftriaxone. Meropenem with one or more class of antibiotics had the higher cost (1985/-and 2800/- BDT/ per day) per patient. Though the cephalosporins are the initial choice as the safest, cheaper antibiotics in developed countries, but high rate of resistance was observed in this ICU. The overall sterilization and strict control of nosocomial infections may play vital role in overcoming the challenges. Use of local antibiogram, narrow spectrum antibiotics, infectious disease specialist consultation, and restricted authorization to prescribe antibiotics can effectively shift the antibiotic sensitivity and minimize the cost in ICU stay.

Clinico-pathological Correlation with Liver Enzymes in Dengue Infection

Dengue infection is a major vector borne disease. The classical signs and symptoms include high fever, severe headache, chill, and rash. Atypical manifestations of dengue infection with hepatic involvement are frequently reported, ranging from mild elevations of liver enzymes to acute liver failure. Analysis of 110 serologically confirmed cases of dengue infection in Holy Family Red Crescent Medical College hospital a tertiary care hospital was done. Patients with normal aminotransferase levels were categorized into Grade A, patients with at least one of the enzymes raised above normal but less than 3 times were categorized into Grade B, those with at least one of the enzymes elevated more than 3 times but less than 10 times were graded as C, and those with elevations more than 10 times as Grade D. 83.7% patients had alterations of transaminase levels, with 45.5% categorized into grade b, 30.9% into grade C, and 7.3% into grade D or acute hepatitis (P value 0.224). Rise of aspartate aminotransferase (AS7) levels were higher compared to the levels of alanine aminotransferase (AL7). Liver damage with alteration of aminotransferases is a common manifestation of dengue infection and also valuable markers for monitoring these patients.

Antibiotics in ICU : The Challenges of Use, Cost and Response in a Tertiary Care Hospital

Antibiotic resistance can lead to increased morbidity, mortality, length of hospital stay, and health care expenditures. The study is designed to observe the challenges of antibiotic consumption, related costs and their resistance pattern in critically ill patients. The study was conducted in ICU from July to December 2016, in Holy Family Red Crescent Medical College Hospital The demographic data, antibiotic sensitivity report, the administration ofdifferent classes of antibiotics as well as individual drugs and their costs were recorded. In 216 patients, meropenem was the most commonly prescribed antibiotic followed by levofloxacin and ceftriaxone. Meropenem with one or more class of antibiotics had the higher cost (1985/-and 2800/- BDT/ per day) per patient. Though the cephalosporins are the initial choice as the safest, cheaper antibiotics in developed countries, but high rate of resistance was observed in this ICU. The overall sterilization and strict control of nosocomial infections may play vital role in overcoming the challenges. Use of local antibiogram, narrow spectrum antibiotics, infectious disease specialist consultation, and restricted authorization to prescribe antibiotics can effectively shift the antibiotic sensitivity and minimize the cost in ICU stay.

Antimicrobial Resistance Pattern of Bacterial Isolates from Intensive Care Unit of a Tertiary Care Hospital in Bangladesh

Infections with resistant strain are one of the leading causes of morbidity and mortality in hospitalized patients especially the critically ill patients in intensive care unit (ICU). The present study was conducted to know the changing pattern of antibiotic resistance of the common isolates from blood, urine, respiratory secretions and pus/ wound swab of patients admitted in ICU at Holy Family Red Crescent Medical College hospital over a two years period from January 2012 to December 2013. A total of 1282 samples were analyzed. Out of which 301 (23.5%) samples were positive for growth of organisms. The predominant isolates were E.coli (28%), Klebsiella (27%), Acinetobacter (17.3%), Pseudomonas (9.6%), Staphylococcus aureus (5.3%) & candida (6%). Majority isolates were resistant to Cephalosporin and Amoxycillin, (>70-90%). Carbapenem were still highly active against E.coli. However, Klebsiella, Pseudomonas and Acinetobacter were showing alarming resistance (55-60%) towards those drugs. Aminoglycosides resistance has also increased for Pseudomonas and Klebsiella. The percentage of Cloxacillin resistant for staphylococcus was near about 40%. The most active drug against Pseudomonas was piperacillin/Tazobactam. The positive result from this study was that organisms showed decreased resistance towards Tetracycline, Cotrimoxazole and Ciprofloxacin. The sensitivity of Nitrofurantoin for urinary isolates was good. Regular surveillance of antibiotic susceptibility pattern & judicious use of antibiotics is very important for reducing the infection rate and antimicrobial resistance.Bangladesh J Med Microbiol 2014; 08 (01): 07-11

Typhoidal Salmonaelle in Holy Family Red Crescent Medical College Hospital, Dhaka, Bangladesh

Enteric fever is still an important public health problem in many developing countries like Bangladesh. A changing antibiotic susceptibility pattern of Salmonella typhi and Salmonella paratyphi A and emergence of multidrug resistance has increased to a greater concern. The present study was undertaken to find out the rate of isolation of Salmonella from Blood samples and to compare the changing patterns of drug resistance at Holy Family Hospital and Medical College and Hospital over a two year study period from January 2013 to December 2014. During the period January 2013 to December 2013, total 31 Salmonella were isolated (14% of blood isolates) in which Salmonella typhi were 27 and Salmonella paratyphi were 4. Again, during the period January 2014 to December 2014, total 27 Salmonella were isolated (10% of blood isolates) in which Salmonella typhi were 23 and Salmonella paratyphi were 4. The rate of isolation of S. typhi was noted higher among pediatric group when compared to adult group in both study periods. The sensitivity of cotrimoxazole and chloramphenicol was increased which were (80-88)% & (79-93)% respectively in 2 year study period. Nalidixic acid resistant Salmonella typhi(NARST) was 88-89% and all of NARST showing good sensitivity to ciprofloxacin. In our study period, Azythromycin resistance rate is increasing from 30-35%. All the isolates were fully susceptible to 3rd generation of cephalosporin in both study periods. The rate of Multi drug resistant(MDR) was (6.5- 7.4)%; which was low in 2 year period. The policy of empirical treatment of enteric fever needs to be rationalized and newer generation antibiotics should be restricted only for multi-resistant cases of enteric fever.

Study of Extra intestinal E.coli and their resistant pattern in a tertiary care hospital of Bangladesh.

E.coli is one of the most important gram negative bacterial pathogen in human and can be subdivided into the following; (i) intestinal non-pathogenic, commensal variants (ii) Intestinal pathogenic isolates and (iii) extra intestinal pathogenic E.colior ExPEC isolates. ExPEC causes the vast majority of urinary tract infections (UTIs), is a leading cause of adult bacteremia and is the second most common cause of neonatal meningitis. The clinical specimens obtained from patients admitted in Holy Family Red Crescent Medical College Hospital (HFRCMCH) from January 2014 to December 2016. All laboratory works were performed in department of microbiology and immunology of HFRCMCH. The infection rate was maximum in urine (89%) followed by blood (5%), pus (5%) and others (1%). Most of the ExPEC were isolated from outdoor department 62.6%. ExPEC displayed higher resistance to many antibiotics like 75% resistant to Ampiciline , 55% resistant to Cotrimazole, 22% resistant to Gentamycin, 17% resistant to Nitrofurantoin, 55% resistant to Ciprofloxacin, 70% resistant to Ceftriaxone, 82% resistant to Cefalexin, 50% resistant to Azithromycin, 10% resistant to Amikacin, 48% resistant to Tetracycline, 7% resistant to Imipenem and 8% resistant to Meropenem. In conclusion, there were high resistant rate to commonly available antibiotics. It seems that appropriate and judicial use of antibiotics may help to control the evolving problem of drug resistance towards ExPEC.
 Bangladesh J Med Microbiol 2017; 11 (1): 10-13

Evaluation of total abdominal hysterectomy over the decade in Holy Family Red Crescent Medical College Hospital - A retrospective observational study

Hysterectomy is the commonest major surgical procedure in Gynaecology & usually performed to improve quality of life rather than to cure life-threatening conditions. The rates differ between countries depending on differences in morbidity, health economical aspects, traditions and attitudes. This retrospective observational study was carried out from 2001-2010 & included all cases of abdominal hysterectomy done for benign and non emergency conditions in the department of Obstetrics & Gynaecology, Holy Family Red Crescent Medical College and Hospital, Dhaka with the intention to assess the proportion and the indications of total abdominal hysterectomy over a 10-year period. Percentage of the total abdominal hysterectomy remained between 50-70% of the total major operations over the decade. Fibroid was found to be the most common indication among the admitted patients (around 36%) with highest percetage in 2006 and 2007 (43% and 46% respectively). Next important indication was dysfunctional uterine bleeding (20%) followed by pelvic inflammatory disease (13%), ovarian mass (5%), endometriosis & adenomyosis (4%) and post menopausal bleeding (2%). The majority of hysterectomies were abdominal and the most common indication was uterine fibroids. The overall rate for hysterectomy remained reasonably stable.Bangladesh Med J. 2015 May; 44 (2): 87-91

Pattern of Analgesic Use in Post-Operative Pain Management in a Tertiary Level Teaching Hospital in Bangladesh

Recent advance in the knowledge of pathophysiology of pain and improvement of analgesic drugs and techniques, little improvement will show in post-operative pain management in LUCS. Like most other postsurgical populations, the new mother needs effective pain relief so that she can mobilise early but she also has the added responsibility of needing to care for her newborn baby. There is no ‘gold standard ’for post-caesarean pain management. This prospective observational study was done to observe the prescribing trend of analgesic used in per and post-operative patients of LUCS of gynae and obstratic department of Holy Family Red Crescent Medical College Hospital. A total of normotensive and non-diabetic 111 patients were included over 6 month period of January 2015 to July 2015. Analgesics prescribed for pain management used from during and after day of operation to 4th post-operative day were recorded. 31.03% patient received pethidine and 21.29% received fentanyl preoperatively, 91.60% patient received pethidine on the day of operation. Diclofenac (78.70%) was most commonly prescribed drug in post-operative days. Seven different strength of pethidine used per-operatively. Ten different combination of analgesics used in patients, among them pethidine and diclofenac combination used in highest cases.