Salimullah Medical College Mitford Hospital Research Articles

Bowel preparation for colonoscopy with Mannitol and Sodium Phosphate: A randomized controlled study

Background: The aim and objective of this study was to compare the effectiveness between mannitol and sodium phosphate as a colonoscopic bowel cleansing agent conducted in the department of Gastroenterology of Sir Salimullah Medical College Mitford Hospital. Methods: In this cross-sectional study, a total number of 108 cases were randomly selected, who underwent colonoscopy from November 2019 to June 2020 in the department of Gastroenterology of Sir Salimullah Medical College and Mitford Hospital. The patients were divided into two groups based on received bowel preparations agent, either mannitol (Group MN) or sodium phosphate (group NaP). Results: Out of 108 patients 57 received mannitol and 51 received sodium phosphate. Thirty-two males and twenty-two females received mannitol, while 28 males and 23 females received sodium phosphate. Excellent bowel preparation was observed in 32(55%) cases of MN group and 26(45%) cases of group NaP. No statistically significant difference between two groups by Chi-square (X2) test (p=0.793). Conclusion: This cross-sectional, randomized study did not show any significant statistical difference between the two agents regarding effectiveness of bowel preparation. So, both mannitol and sodium phosphate are almost equally effective in achieving excellent or good quality of bowel preparation. Bangladesh J Medicine 2022; 33: 263-268

A Comparison between Skin Stapler and Polypropylene Sutures in Closing Laparotomy Wounds: A Study of 100 Cases

Objective: Healing of laparotomy wounds is associated with number of factors. The aim of the study was to compare skin stapler and polypropylene sutures in closing laparotomy wounds. Materials and method: This randomized controlled trial study was conducted at the Department of Surgery, Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh. The study duration was 6 months, from July 2010 to December 2010. A total of 100 participants were included in the study, divide in two equal groups of 50 participants. The first group received interrupted suture with 2/0 polypropylene. The other group received skin staples. Results: The mean time for closure with suture and staple were 3.7±SD and 22.5±SD cm/min respectively (p- value<0.05). Rate of wound closure was calculated in cm per minute and materials were compared statistically in pairs by t- test. Wounds were closed five times faster with staples then suture (p<0.001). In relation to post-operative infection, 17 (34%) cases developed wound infection in sutured group and 15 (30%) patients in stapled group. Most of the infection occurred in the emergency contaminated cases. There was no significant association between wound infections and method of skin closure (p> 0.05, chi square= 3.15). Conclusions: Staples were well-liked by operators and resulted in substantial and worthwhile savings in time for wound closure.

Comparative Study between Initial Positive and Negative Preoperative Urine Culture for Postoperative Fever in PCNL Patients

Background: The exact mechanism of fever after PCNL has not been established.2. This research studied the frequency of post-PCNL fever and UTI in both initial preoperative positive and negative urine culture group of patients. Objectives: To compare the frequency of post PCNL fever and UTI in initial positive and negative preoperative urine culture patients. Method: This was a prospective observational study on a total sixty patients who underwent single PCNL at the Department of Urology, Sir Salimullah Medical College Mitford Hospital, Dhaka and National Institute of Kidney Diseases and Urology, Dhaka from March 2013 to October 2014.There were two groups of patients, Group-I, with initial positive preoperative urine culture and another Group-II with initial negative preoperative urine culture. But the operation deferred until the positive urine culture became negative. Both groups received prophylactic antibiotic. Results: The frequency of fever and UTI after PCNL was 53.33% in Group-I (n=30) but only 23.33% was found in Group-II (n=30).Significant correlations were observed between post-PCNL fever with initial positive preoperative urine culture group (p=0.017), female sex (p=0.02), prolong hospital stay (p=0.018). Conclusion: The frequency of postoperative fever and UTI is more than two times in preoperative positive urine culture patients than culture negative patients. Risk of post- PCNL fever increased in patients who had initial positive preoperative urine culture. Bangladesh J. Urol. 2021; 24(1): 25-32

Postoperative pain relief in pediatric surgery patients: Effect of intravenous paracetamol in comparison with diclofenac suppository

Background: Pain is a major problem regarding quality of life in children undergoing surgicaloperation.Pain assessment is the most important and critical component of pain management. Oral andrectal paracetamol formulations are associated with a slower onset of action and more variableanalgesic activity than IV acetaminophen, making them less useful in preoperative and acute caresettings. Objective: To find out the effect of intravenous paracetamol in releiving postoperative pain in pediatricpatients. Settings and study design: This randomized clinical trial study was conducted in theAnaesthesiology department of Sir Salimullah Medical College Mitford Hospital,Dhaka fromFebruary' 2014 to August' 2014. A total of 100 cases were taken, they were randomly divided into twogroups in which one group received intravenous paracetamol and another group received diclofenacsuppository for the same operation performed on them, age of the children were between 4-12 years, andall were ASA grade I. Pain relief was assessed with VAS score from 30 minutes after surgery up to 6hours with regular follow up and comparison made between the two groups. Results: In this study, comparisons by mean visual analog scale between intravenous paracetamolwith diclofenac suppository groups were done. VAS score showed both analgesic reduces pain, butdiclofenac suppository was found better post operative pain reliever than intravenous paracetamolwithin observed 30 min to 2 hours. However observed after 6 hours, diclofenac suppository group issignificantly better than intravenous paracetamol group in relieving post operative pain by measuringVAS. Conclusion: Our study showed that diclofenac suppository is more effective than IV paracetamol inrelieving postoperative pain. However paracetamol is definitely a viable alternative to the NSA IDs,especially because of the lower incidence of adverse effects, and should be the preferred choice inhigh-risk patients. It may be appropriate to combine paracetamol with NSAIDs,but future studies arerequired especially after major surgery. JBSA 2022; 35 (2) : 37-42

Level of Serum Parathyroid, Calcium, Phosphate and Vitamin D and Their Correlation In Occurrence of Mineral Bone Disorder In Ckd Patient Admitted in Adult Medicine Ward Of a Tertiary Hospital in Bangladesh

Background: Chronic kidney disease (CKD) is a global health problem associated with increased risks of morbidity, premature mortality, and/or decreased quality of life. CKD is usually asymptomatic until progressive damage occurs and produce multiple symptoms and signs. Progressive loss of kidney function in CKD leads to reduced production of 1-á-(OH) 2-D3 (1, 25-dihydroxyvitamin D; calcitriol) and abnormal mineral homeostasis. The aim of the study was planned to assess the mineral and bone disorder in CKD patients admitted in a tertiary care hospital. Methods: A Cross sectional observational study was performed at a tertiary care centre. 100 cases of diagnosed Chronic Kidney Disease patients in indoor of department of Nephrology and Medicine of Sir Salimullah Medical College Mitford hospital from March 2018 to August 2018 were included in this study. Results: Majority of the patients (60%) were of age between 46 and 65 years. 31% of the study population were older than 65 years. 72% of the study population were male and 28% were female. Diabetic nephropathy was the leading cause of CKD, affecting 36% of the study population. Hypertension was the likely cause in 26% of the subjects. Obstructive uropathy and chronic glomerulonephritis affected 7% and 5% of the subjects respectively. There was one (1%) patient with ADPKD, and in 25% of the cases no causative factor was identified. Most (40%) of the study subjects were in the stage 3 of CKD. 34% & 26% of the patients were in the stage 5 & 4 respectively. We did not find any patient with normal vitamin D level. 10% of the patients were in the insufficient range and 90% of the study subjects were deficient in vitamin D. Hyperparathyroidism was prevalent in 75% of the study subjects. 79% of the patients had elevated serum phosphate levels. Hypocalcemia was found in 49% of the patients. 33% of the patients had hyperkalemia during admission. Hyperphosphatasia was prevalent in 39% of the study subjects. However, bone fraction of the ALP was not tested. Among stages 3B, 4 and 5 CKD patients, there were 2% patients in each group that were insufficient in vitamin D. Majority (32% in stage 5, 24% each in stages 3B and 4) were deficient in vitamin D. Deficiency was also prevalent in earlier stages of CKD (10% patients in stage 3A). The difference was statistically significant, that is, the later the stage of CKD the greater the prevalence of vitamin D deficiency was. All the patients in stage 5 and 4 (34% and 26% respectively) had hyperparathyroidism. 0% and 15% of the patients in stages 3A and 3B respectively had hyperparathyroidism. The difference between groups was statistically significant. Serum calcium level correlated well with the stage of CKD. Most of the patients in stage 5 were hypocalcemic (32 among 34). Among the 39% of the total study population with hyperphosphatasia, 24%, 9% and 6% were in stages 5, 4 & 3B respectively. Which were statistically significant. 49% pf the patients had hyperparathyroidism with hypocalcemia, 26% of the patients had hyperparathyroidism and normal serum calcium levels. None of the patients had hypocalcemia and normal PTH level. Among the 90 patients with deficient vitamin D levels, 46 had hypocalcemia also. 70 patients with deficient vitamin D level also had high PTH level. The difference between groups which was statistically significant. Conclusion: MBD is a common complication in our CKD patients. Raised PTH, low 25(OH) D, and raised phosphorus levels were the most prevalent markers. Majority of our patients presented, or were referred late. Clinical features of MBD in CKD were poor guides to the presence of MBD in our pre-dialysis patients. Bangladesh J Medicine 2022; 33: 145-153

Pattern of Thyroid Swelling – A Histopathological Study

Background: This is a cross sectional study. The purpose of the study was to determine the histopathological pattern in Thyroid swellings. The study was done in the department of Otolaryngology and Head-Neck Surgery, Sir Salimullah Medical College Mitford Hospital, Dhaka from December 2015 to December 2016. Fifty patients of Thyroid swelling were studied by detailed history, clinical examination, thyroid hormone assay, ultrasonography, Thyroid scan, FNAC and Histopathological examination.
 Results: In this study it was found that Goitre is predominant in female. Among the 50 cases nodular colloid goitre was found in 25 cases in FNAC suspicious cell for malignancy in 2 cases, follicular neoplasm in 11 cases & malignancy in 11 cases. Histopathology reports were obtained in all cases. Histopatholgical findings of the swelling shows that 42.0% of the swelling are Nodular colloidal goiter and 24.0% tumor are follicular adenoma and thyroiditis was found in 8 % cases. Among malignancy papillary carcinoma was in 20% cases while folicullar carcinoma and medullary carcinoma was 4% and 2% respectively. No case of anaplastic carcinoma and lymphoma was found. Proportion of papillary carcinoma was highest in the age group 30 years and below and proportion of follicular carcinoma was highest in age group above 50 years patients while nodular colloidal goiter was highest in age group 31 to 50 years patients.Thyroiditis was highest in the age group 31 to 50 year’s patients and follicular adenoma was highest in the age group above 50 years patients. Proportion of follicular carcinoma (25.0%) and medullary carcinoma (12.5%) was higher in male patients than female. On the other hand proportion of nodular colloidal goiter (40.5%), thyroiditis (9.5%), papillary carcinoma (21.4%) and follicular adenoma (26.2%) was higher in female patients than male.
 Conclusion: Clinical evaluation of goiter should be thorough, and use all means especially histopathologic study of the specimens to arrive at a definitive diagnosis as thyroid carcinoma is not uncommon.
 Sir Salimullah Med Coll J 2022; 30: 75-82

A Quasi Experiment on Outcome of Mirabegron and Solifenacin in the Treatment of Primary Over Active Bladder in A Tertiary Hospital in Dhaka, Bangladesh

Background: Overactive bladder (OAB) syndrome is a common symptom complex that affects millions of people worldwide, with an increasing prevalence with increased age in primary overactive bladder.
 Objective: The study was done to find out the efficacy and outcome of Mirabegron and solifenacin on primary overactive bladder.
 Methodology : This study was a quasi-experimental study conducted on 100 study population (Group A-50 Group B-50) in Urology Outpatient Department, Sir Salimullah Medical College Mitford Hospital, Dhaka from July 2017 to December 2018. Study population were total 100 men and women aged at least 18 & up to 60 years (Group A -50 and Group B-50) with persistent primary overactive bladder (OAB) symptoms for 3 months or more were enrolled in this study. Patients were eligible for the study who were able to give a written informed consent before starting the intervention & was also able to complete a voiding diary. Patients were recruited at the urology outpatient department, SSMCMH, Dhaka and were selected by the following inclusion and exclusion criteria. A data sheet was completed for each patient which included particulars of the patient, history, examination findings and baseline investigations. Half of the patients were enrolled in each group. Mirabegron group was experimental group and Solifenacin group was control group. Cases of Mirabegron group was given once daily dose of Mirabegron 25 mg and Solifenacin group was also given single dose of Solifenacin succinate 5 mg, at for 12 weeks.
 Result: The result of age distribution of the study patients belonged to age 31-40 years in group A (Mirabegron 25 mg) 21(42.0%) and 16(32.0%) in group B (Solifenacin 5 mg). The mean voided volume of each micturation at 12 week of treatment was more increased in group A (Mirabegron 25 mg) than group B (Solifenacin 5 mg). The mean change in micturition frequency per 24 hours, episodes of urgency per 24 hours, urge incontinence episodes per 24 hours and nocturia episodes per 24 hours were statistically significant (p<0.05) between group A (Mirabegron 25 mg) and group B (Solifenacin 5 mg).
 Conclusion The study shows that Mirabegron is more effective than Solifenacin in the treatment of primary over active bladder and can be used in without organic and pathological diseases of urinary bladder
 Sir Salimullah Med Coll J 2022; 30: 55-60

Pattern of ENT Emergencies in Tertiary Level Hospital

Background: Emergencies in ENT practice has a wide spectrum and management of each condition requires specialized skills. Crucial decisions are necessary to save patients life in hurried situations.
 Objectives: This study is carried out with an objective to find out pattern of ENT emergencies in tertiary level hospital.
 Methods: This is a cross sectional study was done in two major tertiary level hospitals (Dhaka Medical College Hospital, Sir Salimullah Medical College Mitford Hospital) of Dhaka, Bangladesh. This study was conducted in a period of six months and took into account all inpatient and outpatient emergencies in this period. These included 496 patients either admitted as emergency or took emergency treatment without admission from department of ENT and Head-Neck surgery of two tertiary level hospitals.
 Results: 496 patients of between age ranges 2 months-80 years with a mean age 26.3 years were included. Male female ratio was 1.9:1.55.65% patients are from rural area. The total throat related cases were maximum (40.52%) in comparison to ear (32.26%) and nose (27.22%). Inflammatory condition in pharynx (46.27%) is the most common among throat related emergencies, followed by foreign body in throat (32.26%). Fish bone impaction is the most common (33.36%) emergencies among foreign body in throat. Foreign body in throat was mostly seen in 0 to 10 age group. Acute upper respiratory tract infection is the highest (27.96%) among the pharyngeal emergencies. Laryngeal emergencies with stridor were most common (47.62%) among laryngeal, tracheal and bronchial emergencies other than foreign body. Among the otological emergencies external ear emergencies other than foreign body (40%) was most common. Vegetables foreign body in the ear was most common (40%) among the foreign body in ear. Foreign body in ear mostly found in 0 to 10 age group. Traumatic injury to external ear is the most common (18.75%) among external ear emergencies other than foreign body. Among the sinonasal emergencies epistaxis was most common (39.26%). Most of the cases were managed surgically (71.97%) 87.5% cases were recovered from emergencies with overall mortality of (1.21%).
 Conclusion: Epistaxis emerged as the leading cause of ENT emergencies followed by foreign body in ENT region. Most of the ENT emergencies were managed surgically under local anaesthesia. So, presence of otolaryngological department in thana and district level hospital could avoid unnecessary referral.
 Sir Salimullah Med Coll J 2022; 30: 67-74

Solid Tumor in Children: A Single Centre Experience

Introduction: Now a days, number of childhood tumors are gradually increasing throughout the world. But in Bangladesh we have no actual tumor register. In this study we just try to find out the demographic presentation of solid tumor in a tertiary care center of Dhaka city.
 Methods and materials: it is a retrospective descriptive type of observational study. Study was held in department of pediatric surgery, Sir Salimullah medical college Mitford hospital Dhaka from January 2016 to December 2020.
 Results: total number of the patients were 37. Male 15 and female 22. Male female ratio is 1:1.7. Age range of the patients from 9 days to 13 years. Mean age 135.83 days. Among 37 patients, 29 had malignant tumors and rest of 8 patients had benign tumor. Ovarian tumors were highest, 10. Then nephroblastoma 9, neuroblastoma 7, non Hodgkin lymphoma 3, sacrococcygeal teratoma 3, adrenal benign tumor 1, soft tissue sarcoma in pelvis 1, rhabdomyosarcoma of urinary bladder1, rectal carcinoma 1 and rhabdomyosarcoma of lower limb 1 accordingly. Most of the patients were went through surgery first then sent for chemotherapy according to histology.
 Conclusion: In spite of a tertiary medical care center in Dhaka city, our number of patient is not satisfactory. Lack of proper awareness in public, lots of patient did not reach to proper center, those who attained hospital, may lost. And our poor record keeping system is also responsible for adequate informations.
 Sir Salimullah Med Coll J 2021; 29(2): 117-120

Male Breast Cancer - A Case Report

Male breast cancer is a rare cancer that forms in the breast tissue of men. Though breast cancer is most commonly thought of as a disease that affects women, it does occurs in men. Male breast cancer is most common in older men, in between ages 60 and 70, though it can rarely occur under age 35. Common predisposing causes that raise odds for male breast cancer includes-breast cancer in a first degree relatives, history of radiation exposure to chest, enlarged breast (gynaecomastia) because of excess endogenous or exogenous estrogens, obesity, mutation of BRCA2 gene (common), cirrhosis of liver, history of some drugs intake, alcoholism, klinefelter’s syndrome, diseases of the testicles such as mumps orchitis or orchidectomy, prostate cancer or may be idiopathic. Here we present a case of older aged man who reported with a lump and itching of the left breast for one year in OPD of a general clinic in Munshigonj. The patient was referred to the unit-1, department of surgery, Sir Salimullah Medical College Mitford Hospital where clinical diagnosis was carcinoma of left breast.
 Sir Salimullah Med Coll J 2021; 29(2): 166-168

Comparative Evaluation of Quantitative Protein Measurement of 12-Hour and 24-hour Urine Sample for the Diagnosis of Nephrotic Syndrome and their Correlation with Spot Urinary Protein Creatinine Ratio

Background: The amount of protein excretion is a reflection of disease activity in Nephrotic Syndrome. 24-hour urine collection has remained as the method of choice to quantify proteinuria. An alternative method for quantitative evaluation of proteinuria is measuring the ratio of protein or albumin to creatinine in an untimed ‘‘spot’’ urine specimen.
 Objective: To compare 12-hour versus 24-hour proteinuria in nephrotic syndrome and its correlation to spot urinary protein creatinine ratio.
 Materials & Methods: A comparative cross-sectional study was conducted in the Department of Pediatrics, Sir Salimullah Medical College Mitford Hospital (SSMC & MH), Dhaka over a period from September 2016 to June 2017. All the babies developing 1st attack of Nephrotic Syndrome and meeting the clinical criteria were included in the study. Complete history was taken from accompanying attendants. Thorough clinical examinations and relevant laboratory investigations (12- hour day urinary protein, 12-hour night urinary protein, 24-hour urinary total protein, S. Albumin, S. Cholesterol, Urinary spot Protein Creatinine ratio) were done. All the information was recorded in the fixed protocol. Collected data were classified, edited, coded and entered into computer for statistical analyses.
 Results: Out of 50 cases, the mean age was found 58.3±29.0 months. 12-hour day urinary protein was found 2.02±0.167 gm/m2/12 hours, mean; 12-hour night urinary protein was found 2.12±2.18 gm/m2/12 hours, mean; 24-hour urinary total protein was found 4.10±3.32 gm/m2/24 hours. The mean spot urinary protein creatinine ratio was found 12.58±7.21 with range from 2.02 to 29.85. There was no statistically significant difference between 12- hour day sample and 12-hour night sample. There was also no significant difference between 12-hour day & night sample with 24-hour sample. Results of all 03 samples were comparable to urinary protein creatinine ratio.
 Conclusion: This study reveals no statistically significant difference in quantitative estimation of 12-hour day and night protein with 24-hour urinary total protein. The 12- hour day and night protein and urinary total protein were comparable with each other and also with urinary spot protein creatinine ratio.So 12-hour day or night urinary total protein may be a diagnostic tool for nephrotic syndrome.
 Sir Salimullah Med Coll J 2021; 29(2): 105-111

Colonoscopy Screening Recommended as Earlier or Better an Investigation of Choice for Colorectal Symptoms

Background: Colonoscopic techniques have expanded the role of colonoscopy beyond conventional screening, surveillance, and diagnosis to various complex therapeutic and interventional utilities in colorectal diseases.
 Objective : (i) To determine the incidence of colorectal cancer in early and late onset. (ii) To determine the incidence in age cohort (iii) To compare clinico-epidemiological features in early and late onset (iv) To bring forth any discrepancies.
 Methods: It was prospective study conducted in Department of Colorectal Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), and Sir Salimullah Medical College Mitford Hospital, Dhaka total 200 cases were included in this study during the period January 2017 to June 2019.
 Results : Study shows out of 200 respondent 0.5% were under 31-40 years age, 4.5% were between 41-50, and 5.5% were above 50 years. Out of 200 respondent 8% were male in malignancy and 17.5% are benign and 3% were female in malignancy and 14% are benign. Male female ratio was 1.7:1 in malignancy. The most common clinical presentation were per-rectal bleeding (64%), then anaemia/weakness (46%), alteration of bowel habit (36%), pain (10.5%) and obstruction (3.5%).
 Conclusion: It concluded that proper equipment (colonoscope) and educated personnel, we can introduce colonoscopy as the mandatory screening method of examination, particularly for vulnerable groups.
 Sir Salimullah Med Coll J 2021; 29(2): 132-135

Diagnosis of Anorectal Tuberculosis by Polymerase Chain Reaction, GeneXpert And Histopathogenesis in Anal Fistula Patients

Background: Association of tuberculosis (TB) with anal fistulas can make its treatment quite difficult. The main challenge is timely detection of TB in anal fistulas and its proper management. There is little data available on diagnosis and management of TB in anal fistulas.
 Objective: To detect TB in fistula-in-ano patients were analyzed in different methods utilized. Methods: It was a prospective study conducted in Department of Colorectal Surgery, Bangabandhu Sheikh Mujib Medical University and Department of Surgery & Pathology, Sir Salimullah Medical College Mitford Hospital, Dhaka. Total 258 cases were included in this study during the period January 2018 to December 2020.The sampling was done for tissue (fistula tract lining) and pus (when available). The detection rate of various tests to detect TB and prevalence rate of TB in simple vs complex fistulae were studied.
 Results: This study shows 84.1% were non TB fistula and 15.9% were TB fistula. Majority were male between non TB fistula and TB fistula which was 87.1% and 85.4% respectively. TB fistulas were more complex than non-tuberculous fistulas (68.3% vs 44.2%) respectively. TB was detected in (7.4%) samples tested by PCR-tissue, 23.6% samples tested by PCR-pus, (1.6%) samples tested with HPE-tissue and 0.8% samples tested by GeneXpert.
 Conclusion: This study shows the detection of TB by polymerase chain-reaction was higher than by histopathology and GeneXpert. Amongst polymerase chain-reaction, pus had a higher detection rate than tissue. TB fistulas were more complex than non-tuberculous fistulas but aggressive diagnosis and meticulous treatment led to comparable overall success rates in both groups.
 Sir Salimullah Med Coll J 2021; 29(2): 121-123

Carbetocin versus Oxytocin in the Prevention of Postpartum Haemorrhage after Caesarean Section

Background: postpartum haemorrhage is one of the major contributors to maternal mortality and morbidity worldwide. There are many pharmacological options for the management of postpartum hemorrhage, oxytocin being the first line choice of treatment.Carbetocin, a long acting oxytocin agonist, appears to be a promising agent for the prevention of PPH. This comparative study was between Carbetocin Versus Oxytocin for the Prevention of Postpartum Haemorrhage in Caesarean Section
 Objective: To determine the safety and effectiveness of carbetocin and oxytocin for the prevention of post-partum haemorrhage in caesarean section.
 Methods: Randomized controlled clinical trial was done in the department of Obstetrics and Gynaecology of Sir Salimullah Medical College Mitford Hospital, Dhaka, between February to July 2015. Study population were 64 pregnant women admitted for delivery and underwent caesarean section, who were randomly selected. Women in the intervention group (group I) received injection carbetocin a bolus of 100 mgm IV; women in the standard treatment group (group II) received 10 IU of oxytocin in IV.Both administered immediately after chiidbirth.This trial was registered in SSMC MH with reference no-SSMC/2014/76.
 Result: Difference of mean age,mean gestational age and indication of C/S were not statistically significant between two groups.Regarding haemodynamic effect,both drugs were almost similar.There was no significant difference in per-operetive blood loss,uterine tone, level of uterine fundus, urine output in urobag and hemoglobin level. Need for additional oxytocics required 0(0.0%) vs 5(16.7%) patients in group I and group II respectively and was found statistically significant.Blood transfusion needed was 0(0.0%) vs 3(10.0%) patients and primary PPH 0(0.0%) vs 3(9.4%),though both were not statistically significant. No significant difference regarding side effects and total expense was found.
 Conclusion: Administration of single bolus dose of carbetocin (100 μgIV) after delivery of the baby in caesarean section immediately reduces the need for additional oxytocics, occurrence of primary PPH and further blood transfusion. Side effects are mild and similar in both the groups.
 Bangladesh J Obstet Gynaecol, 2020; Vol. 35(2): 63-67

Pattern and aetiological factors of surgical site infection among patients undergone surgery in a tertiary care hospital

Surgical site infections (SSIs) are the second most common nosocomial (hospital-acquired) infections after urinary tract infections. Despite recent advances in aseptic techniques, till now SSI has been considered as a major source of morbidity and mortality in developing countries and continued to represent about one fifth of all healthcare-associated infections. This cross-sectional study was conducted to analyze the pattern & aetiological factors of SSI among patients undergoing surgery at Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh involving 160 admitted patients during the study period. Of all SSIs, 73.0% were superficial and 27.0% were deep infections. Among the risk factors, Hypertension (29.4%), Diabetes Mellitus (24.4%), old age (>60 yr) [19.4%], anaemia (28.7%), and below average nutrition (13.8%) were the most common and had statistically significant relation with SSIs (p<.05). Moreover, incidence of SSIs was significantly higher in patients who required more duration of operation. The most common organism involved in SSI was S. aureas (42.4%), followed by E. coli (27.3%), P. aeruginosa (12.1%), bacteroids (12.1%) and Klebsiella spp. (6.1%). However, Meropenem was the most sensitive drug followed by Ceftriaxone according to culture and sensitivity screening. Gentamycin was 100% sensitive for gram-negative organism only. The incidence of SSIs are about one fifth of the post-surgical cases, where Staphylococcus aureus was the most prevalent organism. Meropenem and Gentamicin were the two most sensitive drugs against infections. BSMMU J 2021; 14(3): 50-56

Comparison of Body Mass Index with Modified Subjective Global Assessment for Detection of Malnutrition Among Patients Under Maintenance Hemodialysis: A Multi-Center Cross-Sectional Study

Background: Patients under maintenance hemodialysis are at increased risk of malnutrition, causing from multitude of factors. Present study aims to assess the prevalence of malnutrition among maintenance hemodialysis patients using both modified subjective global assessment score and body mass index, compare them and assess the sensitivity and specificity of body mass index for detecting malnutrition, along with determining a new cutoff value for BMI that better represent the maintenance hemodialysis patient’s nutritional status. Methods: This was a cross-sectional study conducted in the hemodialysis unit of Bangabandhu Sheikh Mujib Medical University, Sir Salimullah Medical College Mitford Hospital, BIRDEM General Hospital and National Institute of Kidney Diseases & Urology; among 80 adult CKD patients who were on regular (≥2 sessions per week) maintenance hemodialysis for more than 3 months without any acute infection, during the period of July 2016 to June 2017. Nutritional assessment was done for each patient using modified SGA score along with BMI. Sensitivity analysis of WHO recommended cutoff value for BMI was done among the study population using modified SGA score as gold standard test for detection of malnutrition among the respondents. ROC curve was used to estimate the best fitting cutoff value of BMI that showed highest sensitivity, specificity and accuracy for detracting malnutrition among maintenance hemodialysis patients. Results: The study participants were predominantly male (66.3%) and from age group 45 to 59 years (36.3%). Modified SGA score detected 90.0% of the study population as malnourished. WHO recommended 18.5 kg/m2 cutoff value was also used to detect malnutrition among study population and 13.8% were found to be malnourished, with a sensitivity and specificity of 12.5% and 75.0% respectively. Accuracy was found to be 18.8%. Using ROC curve, 23.1 kg/m2 was found to be the best fitting cutoff value of BMI for the study population to detect malnutrition. With a sensitivity of 47.2%, specificity of 37.5% and accuracy of 46.3%. Conclusion: BMI showed low sensitivity for detecting malnutrition among patients under maintenance hemodialysis, compared to modified SGA score and should be avoided as a screening tool, but 23.1 kg/m2 cutoff value for BMI showed potential to be used as an easy to use and quick tool for detecting malnutrition among such patients. Further study with larger sample size could shed more light on this. JOPSOM 2021; 40(1): 14-21

Liver Function Derangement and Bleeding Morbidity in Dengue Fever and Dengue Haemorrhagic Fever in a tertiary Hospital in Bangladesh

Background: Dengue is a major international health concern that is prevalent in tropical and sub tropical countries. Study of dengue infection and its Liver complications are scarce from countries like India. This study was done to assess the frequency and spectrum of liver dysfunction and bleeding morbidity in Dengue infection patients. Methods: A Cross sectional prospective observational study was performed in the of Department of Medicine Sir Salimullah Medical College Mitford Hospital. All the inpatients who were diagnosed with dengue infection between July 2015 to July 2016 were included in this study. A total of 70 patients were included in the study. Results: Patients were classified as classical dengue fever (DF) 61.5.% dengue haemorrhagic fever (DHF) 38.5%. The mean age was 28.607±10.45 years in DF group and 26.78±11.78 years in DHF group and male: female ratio was 3:1. Deranged serum glutamic-oxaloacetic transaminase (SGOT) and/or Serum glutamic pyruvic transaminase (SGPT) was present in most of the patients. Elevation of ALT level occured more in DHF group patient (81%) than DF group (46%). Out of 70 patient 28(40%) patient were within normal value. 42 (60%) patient had elevated ALT level which is statistically significant (p value-<0.05)..The degree of rise of SGOT, SGPT,and Bilirubin was significantly more in DHF and DSS, as compared to DF. About bleeding morbidity, purpura was a mentionable finding 29(41%) but gum bleeding 15(21%), echymosis 14(20%), are less in both DF and DHF group. Major bleeding like hematomesis 5 (7%), melaena 4 (5%) and haematuria 1 (1%) also occured in both group of patients. Conclusion: Liver dysfunction in the form of raised SGPT was seen in almost all patients. Preferentially high SGOT may serve as an early indicator of dengue infection while high values of bilirubin, SGOT, SGPT,may be an indicator of severe disease and poor prognosis. Bangladesh J Medicine July 2022; 33(1) : 44-51

Outcome of Preterm Labour in SSMC Mitford Hospital, Dhaka.

Introduction: : Preterm birth as a consequence of preterm labour is the major clinical problem associated with perinatal mortality, serious neonatal morbidity and moderate to severe childhood disability and two-thirds of all perinatal deaths. Moreover, preterm labour comprises a large number of low birth weight babies. Global incidence of preterm labour is 5-10% of all births. The aim of this study was to determine the clinical profile and to find out pregnancy outcomes of preterm labour. Materials & Methods: This cross-sectional study was conducted in Sir Salimullah Medical College Mitford Hospital, Dhaka from January 2005 to December 2005. A total 103 gravid women who got admitted with established premature labour pain were included as study patients. Preterm labour associated with severe pre-eclampsia, eclampsia, antepartum haemorrhage and intrauterine fetal death were excluded. Data were collected in a pre-designed questionnaire and analyzed by SPSS software. Results: Incidence of preterm labour was found 6.3%. Among maternal morbidities, puerperal sepsis found to be highest (14.56%) followed by UTI (7.77%), PPH (6.80%), wound infection (5.83%) and retained placenta (3.88%). This study found perinatal mortality 32.0% and morbidity 49.5% of which RDS contributed highest (24.27%) followed by neonatal jaundice (11.65%), septicemia (8.73%), neonatal convulsion (2.91%) and umbilical sepsis (1.94%). Conclusion: Preterm labor followed by preterm birth significantly contributes to maternal morbidity and perinatal morbidity and mortality. Medicine Today 2021 Vol.33(2): 143-146

Evaluation of Stone Free Rate and Complications of PCNL Using the STONE Nephrolithometry Score: A Study in Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh

Evaluation of Stone Free Rate and Complications of PCNL Using the STONE Nephrolithometry Score: A Study in Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh

Evaluation of Post-Hemithyroidectomy hypothyroidism

Objective: To evaluate the incidence of post-hemithyroidectomy hypothyroidism and identify possible risk factors that indicates which patients require thyroid function monitoring after surgery.
 Methods: A prospective study of patients with benign, non-toxic thyroid disease undergoing hemithyroidectomy between January 2017 and July 2019 in the Department of Otolaryngology and Head-Neck Surgery, Sir Salimullah Medical College Mitford Hospital, Dhaka. All patients were in euthyroid state preoperatively.Thyroid specimens were examined for pathological diagnosis and thyroid function was evaluated again six weeks after surgery.
 Results: All had normal preoperative thyroid function. Six weeks after surgery, 10 (22.22%) of the cases developed hypothyroidism (6.66% overt or symptomatic hypothyroidism and 15.56% subclinical hypothyroidism). The mean preoperative TSH level was significantly higher in the hypothyroid group than in the euthyroid group (2.1±1.1 vs 1.3±0.7mIU/L, p<0.01).Seven of patients with preoperative thyroid stimulating hormone (TSH) level more than or equal to 2 mIU/L developed hypothyroidism in comparison to only 3 of those with preoperative TSH <2 mIU/L (odds ratio 11.3).
 Conclusion: Ten (22.22%) patients in the present study developed hypothyroidism after hemithyroidectomy. Preoperative TSH more than or equal 2 mIU/L, elevation of thyroid antibodies and thyroiditiswarrant post-operative close TSH monitoring. Awareness of such risk factors for post-operative hypothyroidism would improve patients care and reduce complications.
 Bangladesh J Otorhinolaryngol; October 2020; 26(2): 95-101