Shaheed Suhrawardy Medical College Hospital Research Articles

Outcome of Myringoplasty with Temporal Fascia and With Sliced Tragal Cartilage Graft-A Comparative Study

Introduction: Myringoplasty is the surgical procedure to repair tympanic membrane perforations and thereby improving hearing, providing a dry ear, and reducing susceptibility to infections. Although there are many kinds of techniques and graft materials used, no methods have proven indisputably superior to the other. Therefore, to find out the outcome of myringoplasty using temporal fascia and sliced tragal cartilage in chronic inactive mucosal otitis media was set as an objective of the study. Materials and Methods: This cross-sectional observational study was conducted at the department of Otolaryngology & Head-Neck surgery, Shaheed Suhrawardy Medical College Hospital (ShSMCH) for six months from July 2018 to December 2018, after acceptance of the protocol and approval from IRB. Patients attending in the ShSMCH with complaints of chronic inactive mucosal otitis media were approached for inclusion of the study and final selection were done in according to the selection criteria. Ethical issues were ensured properly throughout the study period and inclusion was confirmed following signing written informed consent. All patients were randomly allocated into two groups where one group were received myringoplasty with temporalis fascia graft and another group received sliced tragal cartilage. Total 50 patients (25 patients in each group) were included, and they were subjected to details history taking, physical examination and necessary investigations. The researcher conducted all the interview and collected data were recorded into a case record form for each patient. Data analysis was done by SPSS 17. Results: Of total, 50 study population, mean age of the 32.30±10.93 SD (years) with 58% male and 42% females respectively. No significant age and gender difference is noted across the group (p>0.05). Patients having temporal fascia graft had significantly higher proportion of graft uptake in comparison to patients having sliced tragal graft (p<0.05). Both groups of the patient improve significantly in term of hearing after operation (p<0.05 in each group) but comparison in between groups showed that the improvement was significantly higher in temporal fascia graft group (p<0.001). Conclusion: Myringoplasty with temporal fascia graft could be a better option than sliced tragal cartilage graft in our population. However, further larger study with longer follow up is necessary to finalize the comment. Medicine Today 2023 Vol.36 (1): 50-54

Detection of tetracycline and ampicillin resistant E. coli and Salmonella species from hospital wastewater

Escherichia coli (E. coli) and Salmonella spp. were found in hospital wastewater. The highest (E = (6.2 ± 1.8) x 109; S = (4.3 ± 2.2) x 109) and lowest (E = (1.4 ± 1.2) x 109; S = (1.1 ± 1.8) x 109) Total Viable Count (TVC) were in Shaheed Suhrawardy Medical College Hospital (SSMCH) and National Institute of Ophthalmology Hospital (NIOH), respectively. The overall occurrence of E. coli and Salmonella spp. was 80% and 87%, respectively, with 100% occurrence in SSMCH and National Institute of Cardiovascular Diseases Hospital (NICVDH) for Salmonella spp. (p ≤ 0.036). Prevalence of E. coli was low (72%) in winter (November - February). Both types of bacteria were resistant to Tetracycline whereas and 97.5% of E coli were resistant to ampicillin. Gentamycin was more effective than other antibiotics. Rational use of antibiotics is suggested, and hospital management practice should be followed as defined by the Joint Commission International for Hospital Accreditation.
 Bang. vet. 2023. Vol. 40, No. 1 – 2, 16 – 24

Outpatient Service Provision In Tertiary Hospital During Covid-19 Pandemic

Background: The COVID-19 pandemic was a challenge for healthcare professionals globally. The outpatient department is an important part of the hospital. Service providers were facing tremendous difficulties and challenges due to sudden thrust of the pandemic. Despite these challenges service providers had to give service during COVID-19 pandemic. The purpose of this study to assess the state of outpatient service in tertiary hospital during COVID-19 pandemic.
 Methods: This cross-sectional study was conducted among conveniently selected 203 service providers including 156 doctors and 47 nurses. Data were collected through face-to-face interview using semi-structured questionnaire and observation checklist. The study was conducted at medicine, surgery, paediatric and family planning outpatient department of Shaheed Suhrawardy Medical College Hospital, Dhaka Medical College Hospital, and Bangabandhu Sheikh Mujib Medical University during the period from January to December 2021.
 Results: Among 203 service providers, 76.8% were doctors and 23.2% were nurses. All health services were available during COVID-19 pandemic in outpatient departments (OPDs) of the selected hospitals. At outpatient department there was separate entry-exit door, thermal scan was available at entry point, Patients and visitors are restricted. Number of patients were decrease in outpatient department. Among the three hospitals facility of flu-corner and triage in the OPD of ShSMCH. For the DMCH and BSMMU, flu-corner and triage center were situated at other premises of the hospitals. Outdoor surgery, vaccination service and shishu bikash kendro were open during COVID-19 pandemic. About 80.8% respondents mentioned about availability of adequate amount of personal protective equipment, 42.9% respondents mentioned about proper ventilation, 57.1% respondents said had not. About 32.5% respondent said about availability of N-95 mask and 57.6% said had not. Among the respondents 67.0% said they maintained physical distance during consult with the patients. 57.6% respondents said about lack of manpower. 61.6% respondents said about felt anxiety and high-risk during service.
 Conclusion: For more improvement of outpatient service during COVID-19 pandemic, the authority should pay special attention, to increase manpower, arrange frequent training for service providers.
 JOPSOM 2021; 41(2):20-27

The Role of Courtyard to Improve the Physical Environment of Inpatient Wards: A Case Study of Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh

This research investigates the role of a courtyard to improve the physical environment of inpatient wards at Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh. The objective is to investigate the luminous, thermal and acoustic conditions and identify if courtyard has improved the ward’s physical environment. Both qualitative and quantitative survey have been conducted to measure the light, temperature, humidity, ventilation and sound among experimental group (wards beside courtyard) and control group (wards away from courtyard); and interviews from patients to get their experiences. The findings demonstrate that the presence of the courtyard positively influences wards’ physical environment. Patients also express higher levels of satisfaction with the courtyard. The wards beside courtyards have a higher level of light, ventilation rate and lower level of sound rate and the wards away from courtyard have a lower level of light, ventilation rate and higher level of sound rate. The outcome underscores the importance of incorporating nature into healthcare facilities and provide valuable insights for healthcare authorities to create patient-centered and sustainable healing environments in hospitals in context of Bangladesh.

Motivation and Job Performance among Nurses at Public Hospital in Bangladesh

Background: The performance of nurses plays a crucial role in achieving positive outcomes for healthcare organizations. Performance is directly related to motivation; as higher motivation leads to better performance. Motivated nurses tend to have a strong sense of organizational belonging, resulting in improved work quality, increased productivity, and enhanced job performance. Objective: The study aims to examine the relationship between motivation and job performance among nurses at public hospital in Bangladesh. Methods: A descriptive correlational study was conducted at Shaheed Suhrawardy Medical College Hospital. A total of 112 nurses were selected using a convenience sampling technique. Data were collected from February 2023 to March 2023 using a structured questionnaire. The instrument consisted of three parts: Part I, the Socio-Demographic Questionnaire (SCQ-10); Part II, the Nurses' Motivation Measurement Questionnaire (NMMQ-32); and Part III, the Nursing Job Performance Related Questionnaire (NJPQ-52). Descriptive and inferential statistics were used to analyze the data. Results: The average age of the participants was 37.3 years (SD = 57.102). Among them, 94.6% were female, 97.3% were married, and 75% identified themselves as Muslims. The mean score of motivation was 3.43 (SD = 0.660), indicating that nurses were motivated. The mean score of job performance was 2.78 (SD = 0.640), indicating that nurses had good job performance. The results also showed that more than half of the nurses expressed dissatisfaction with their remuneration. There was a significant positive correlation between motivation and job performance (r = 0.725, p = 0.000). Conclusion: The present study found that motivation and job performance strongly correlate with each other. Although the participants were motivated and had a good performance, there is still a lack of a fair performance evaluation system and proper resources for better job performance. Based on these findings, the researchers recommended that further study be conducted with a larger sample size and in multiple healthcare settings to allow the generalizability of the findings and provide a more diverse and comprehensive understanding of the relationship between motivation and job performance.

Maternal Cardiac Functional and Structural Changes in Preeclampsia: an Echocardiographic Study

Background & objective: Preeclampsia is a pregnancy-induced multi-organ syndrome of acute cardiovascular manifestations with significant short and long-term sequelae. However, there is a relative lack of knowledge with respect to cardiac functional and structural changes in women with preeclampsia Therapeutic interventions used in the management of preeclampsia may cause iatrogenic adverse consequences due to this lack of knowledge. The present study was therefore designed to evaluate the echocardiographic changes in cardiac structural and functional indices in pregnant women with PE. Methods: This cross-sectional study was carried out in the Department of Obstetrics and Gynaecology Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka Medical College Hospital (DMCH), and Shaheed Suhrawardy Medical College Hospital (SSMCH) in collaboration with National Institute of Cardiovascular Diseases (NICVD), Dhaka over a period of one year from July 2013 to June 2014. A total of 30 single-tone pregnant women of 20-40 weeks gestation with preeclampsia were taken as cases. An equal number of gestationally-matched healthy pregnant (HP) women of similar age cohorts having no history of preexisting hypertension were included as controls. Preeclampsia was defined as SBP ≥140and/or DBP ≥ 90 mmHg after 20 weeks gestation in a woman with previously normal blood pressure and with proteinuria≥1 + in the dipstick test. Pregnant women with systolic and diastolic blood pressures within the normal range (< 140mmHg and > 90 mmHg respectively), trace or absence of proteinuria by dipstick test were defined as controls. All thesubjects were investigated with ECG, standard two-dimensional, M-mode, and Doppler transthoracic echocardiography. The cardiac functional and structural changes were measured in terms of interventricular septal thickness (IVSTd),posterior wall thickness (PWTd), left ventricular internal diameter at the end of diastole (LVIDd), ejection fraction (EF), transmitral velocity (MV E/A ratio), MV deceleration time (MV DecT). Result: Half of the women with preeclampsia were primigravidae and there was no association between gravidity and the occurrence of preeclampsia. Prepregnancy overweight or obesity (in terms of BMI) was found to be strongly associated with preeclampsia. One in 10 PE women had a previous history of preeclampsia as opposed to none in the HP women. A substantial proportion (56.7%) of PE women had a family history of hypertension in comparison to healthy pregnant women (16.3%). The women with PE had significantly higher SBP, DBP, & MAP than the HP women. Parameters of diastolic dysfunction, like mitral E/A ratio was reduced and deceleration time was prolonged in PE with diastolic dysfunction (mean E/A ratio < 0.73 and mean DceT >178 ms respectively) than those in PE with normal diastolic function (mean E/A ratio 1.2 and mean DceT 192.4 ms respectively) healthy pregnant women (mean E/A ratio 1.3 and mean DecT 186.5 ms respectively). Over one-third (36.7%) of women with PE met the criteria of diastolic dysfunction compared to none in healthy pregnant women. The LVH appears to be a frequent occurrence in pregnancies complicated by preeclampsia (43.3%) as compared to none in healthy pregnant women. In the present study, the systolic function was assessed with the help of EF, which was well-preserved both in PE and HP with no significant intergroup difference. Conclusion: Preeclampsia is associated with left ventricular diastolic dysfunction and hypertrophy preserving the systolic function. These structural and functional changes are primarily adaptive in nature for maintaining cardiac systolic function. Ibrahim Card Med J 2022; 12 (2): 32-39

Prescription Pattern of Different Groups of Antibiotics at Out Patient Department of a Tertiary Medical College Hospital in Dhaka City

Background: Drugs prescription pattern is very important at outpatient department in the tertiary care hospital. Objective: The purpose of the present study was to evaluate the distribution of patients and antibiotic prescribing trends in OPD of a Tertiary Medical College hospital. Methodology: This cross-sectional study was undertaken in the medicine, surgery, gynaecology & obstetrics and paediatrics Out Patient Department of Shaheed Suhrawardy Medical college hospital, Dhaka. The duration of the study period was 5 weeks (25th March, 2017 to 29th April, 2017). The study was designed to obtain information regarding prescribing pattern of drugs by physicians and also to analyze basal information of the prescription. The prescription were observed from the hospital’s OPD and few prescriptions were from each unit. Results: A total 320 prescription were observed from the hospital’s OPD where 80 prescriptions were from each unit. The mean age of the patients was 24.50±14.976 years. The most commonly prescribed antibiotics at medicine OPD was Cephalosporin which was 19(51.4%) cases followed by others antibiotics and azithromycin which was 9(24.3%) cases and 8(21.6%) cases respectively. In surgery OPD, the most commonly used antibiotics were flucloxacillin and cephalosporin which was 66(82.5%) cases and 24(30.0%) cases respectively. In Gynae & obstetrics OPD, the most commonly prescribed antibiotics were quinolones as well as other groups of antibiotics which were 23(46.0%) cases and 27(54.0%) cases respectively. Conclusion: In conclusion most commonly used antibiotic are Cephalosporin, azithromycin and Flucloxacillin in different OPD of the hospital. Journal of National Institute of Neurosciences Bangladesh, January 2023;9(1):54-58

Pycnodysostosis: Report of A Rare Case

A 20-year old male patient reported in the outpatient department of Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh, with the complaints of body aches along with pain in the upper and lower limbs for several years. He also gave history of previous hospitalization for the same reason. He also had complaints of failure to thrive in his adolescence. However, he was treated as a case of polyarthritis in his previous admission in the district hospital. On clinical examination, he was found to have short stature, low-weight, peculiar face, prominent forehead, receding jaw and partial dysplasia of the terminal phalanges. He was sent for radiological investigations in the Department of Radiology & Imaging of the same hospital. Plain radiograph of his skull showed brachycephaly with wide sutures and persistent fontanelles with sclerotic changes in the base of skull and orbital rims. The angle of the mandible was obtuse, and the maxilla was found hypoplastic. Lumbar region showed ‘spool-shaped’ vertebral bodies with quite prominent anterior defects; bones had sclerotic changes. Both hands had acro-osteolysis of distal phalanges of thumb, index, middle and ring fingers (both right and left sides) along with irregular distal fragments; bones were sclerotic, too. Those features were consistent with pycnodysostosis. The patient was kept admitted into the hospital and treated accordingly. After obtaining a written informed consent, he was presented as a special case in clinical seminar.
 Mugda Med Coll J. 2022; 5(2): 110-113

Evaluation of Ophthalmoscopic Findings in Type 2 Diabetic Patients at a Tertiary Level Hospital

Diabetes mellitus (DM) is a global burden of disease. Long standing disease causes macrovascular and microvascular complications. Diabetic retinopathy (DR) is the most common microvascular complication of diabetes and it remains a leading cause of blindness and visual impairment in the working-age population in both developing and developed world. Patients with diabetes often developed other ophthalmic complications, such as corneal abnormalities, glaucoma, iris neovascularization, cataracts, and maculopathy. The study was carried out to evaluate the ophthalmoscopic changes in type-2 diabetes mellitus (T2DM) patients. This hospital based cross-sectional study was conducted in the department of Medicine, Shaheed Suhrawardy Medical College Hospital, Dhaka, from September 2018 to March 2019. Patients with T2DM attended at the department of medicine within the mentioned period were enrolled after fulfilling the selection criteria. Patients with dense, lentalopacities and other media opacities which prevented posterior segment examination were excluded from the study. Sample was selected by purposive sampling method. Detail demographic data were collected from the patients and recorded in structured case report form. Clinical examination and relevant investigations were done meticulously. Then pupil was dilated and ophthalmoscopic examination was done. Among the 50 diabetic patient’s male was 54%, middle aged (49-60 years) was 54% and sedentary workers was 84.0% with a positive family history of DM was 56.0%. Most of the patients were known hypertensive (64.0%) at the time of enrolment and almost all (94.0%) were taking antihypertensive drug. Retinal photography was performed in all patients and retinopathy was detected in 29 (58%) patients. Fundoscopic findings revealed that cotton-wool spots detected in 32.0% patients, Flame-shaped hemorrhages was 16.0% patients; Arteriovenous nipping was is 18.0% patients and opticdisc swelling (Papilloedema) in 26.0% patients. In this study 21 (42%) patients had normal fundoscopic findings. Retinopathy was more common in smoker (70.0%). Uncontrolled and long-standing diabetes and high HbA1c was major risk factors for the development of retinopathy (P < 0.001). In conclusion, diabetic retinopathy is more common in male smoker with uncontrolled and long-standing diabetic patients. T2DM is a major cause of blindness as it affects microvasculature of retina. Bangladesh Med J. 2021 Sept; 51(1): 33-40

Assessment of radiation level and potential risk to public living around major hospitals in central and western Bangladesh

Human beings are continuously bathed in radiation coming from natural and artificial sources. Although the use of radiation in medical applications is beneficial to patients, it also contributes significantly to the health hazard for radiation workers and the public if radiation-generating equipment and radioactive sources are not handled properly. 96% dose contributed from medical uses of ionizing radiation in the US population among man-made sources as per NCRP Report No. 160. There is no extensive study conducted on the large hospitals in Bangladesh following the In-Situ method. We used a real-time digital portable radiation monitor with Garmin eTrex Global Positioning System at 320 monitoring points for radiation monitoring and positioning around the ten largest hospitals in central & western Bangladesh from September to November 2021. The mean radiation dose rates around Bangabandhu Sheikh Mujib Medical University, Dhaka Medical College Hospital, Evercare Hospital, Khulna Medical College Hospital, Mitford Hospital, National Institute of Cancer Research Hospital, Popular Hospital, Rajshahi Medical College Hospital, Shaheed Suhrawardy Medical College Hospital, and Square Hospitals were measured as 0.145 ± 0.012 μSv/h, 0.135 ± 0.009 μSv/h, 0.148 ± 0.008 μSv/h, 0.139 ± 0.01 μSv/h, 0.133 ± 0.007 μSv/h, 0.153 ± 0.011 μSv/h, 0.144 ± 0.012 μSv/h, 0.137 ± 0.008 μSv/h, 0.145 ± 0.01 μSv/h, and 0.153 ± 0.009 μSv/h, respectively. The mean excess lifetime cancer risk (ELCR) of the public who lives nearby the hospital's boundary was estimated at 1.05 × 10−3, 0.983 × 10−3, 1.071 × 10−3, 1.004 × 10−3, 0.964 × 10−3, 1.084 × 10−3, 1.043 × 10−3,0.996 × 10−3, 1.051 × 10−3 & 1.112 × 10−3 respectively. ELCR in most of the locations around the ten largest hospitals in central & western Bangladesh is higher than the global average value. Radiation monitoring is significant for minimizing the public's radiation risk and keeping hospital environments as radiation-free as possible.

The Adverse Effects of Carbetocin Administration in the Third Stage of Labor

Introduction: The pharmacologic agents currently used routinely to prevent postpartum hemorrhage are mainly oxytocin, syntometrine (a combination of oxytocin and ergometrine), and carbetocin. Syntometrine is associated with a statistically significant reduction in the risk of postpartum hemorrhage when compared with oxytocin alone. So, this study aimed to assess the adverse effects of carbetocin administration in the third stage of labor. This study aimed to analyze the adverse effects of carbetocin administration in the third stage of labor. Methods: This cross-sectional observational study was conducted at the Department of Obstetrics and Gynaecology, Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh. The study period was from May 2016 to October 2016. 100 women undergoing normal vaginal delivery were the study subject. A convenient sampling technique was used in this study. Necessary data was collected in the data collection sheet. Women received a bolus of 100 microgram carbetocin IV at delivery of the anterior shoulder. A standardized deliver mat (Quaiyum's mat) was used before placental removal for measuring blood loss. Statistical analysis was carried out by using the Statistical Package for Social Sciences version 19.0 for Windows (SPSS Inc., Chicago, Illinois, USA). The mean values were calculated by frequencies and percentages. Result: In this study, the majority (54, 54.0%) of patients belonged to age 20-25 years, followed by (30, 30.0%) >25 years. It was observed that the majority 93(93.0%) patients had regular menstrual history. Concerning the clinical indices, anaemia was found 69(69.0%), jaundice 08(8.0%) and edema 24(24.0%). Additional uterotonices was used in 15(15.0%) and blood transfusion 07(7.0%) patients. Mean blood loss before the use of the weight of Q-mat was found 74.81±1.23 gram, mean blood loss after the use of the weight of Q-mat was 246.28±99.98 gram, and mean net blood loss was 141.61±59.93 gram. Majority 61(61.0%) babies had birth weight ≥2.5 kg. Majority 68(68.0%) patients had Hb% <10.5. The mean Hb% before delivery was 10.3±0.47 gm/dl with a range from 9.40 to 11.20 gm/dl The mean birth weight was found 2.57±0.41 kg with a range from 2.3 to 3.10 kg. Conclusion: Carbetocin appears to be an effective new drug in the active management of third-stage labor. Carbetocin has associated with a lower risk of various adverse effects and preventing postpartum hemorrhage in women undergoing vaginal delivery.

Breast feeding Status of Infants Born in a Baby Friendly Hospital Up to 180 days of life

Background : Initiation of breast-feeding (BF) within 1 hour after birth has been associated with reduced neonatal mortality. Baby Friendly Hospital Initiative has profound effects on appropriate practice of BF and thus helps to reduce infant mortality and morbidity.
 Objective : This study was conducted in the Department of Gynae and Obstetrics and Department of Paediatrics of Shaheed Suhrawardy Medical College Hospital (ShMCH), Dhaka, to observe the rate of exclusive breast feeding and home-based compliance.
 Methodology : Hundred (100) term babies of normal birth weight irrespective of sex, born in ShSMCH by normal vaginal delivery (NVD) or caesarian section were included. Data was collected from the mother with a pretested questionnaire at the postnatal period, at 6th week, 14th week and 6th month (180 days) of age.
 Result : The mean age of studied newborn (100) was 20±19.5 hours. All the infants started breast feeding after birth and among them 56% initiated with in 1 hour. Difficulty in breast feeding was found in 36(36.0%) infants, which was resolved mostly (94%) by nurse. Exclusive breastfeeding (EBF) was found in 100% of infants during discharge from hospital. During 1st and 2nd follow up we found 95 (95.0%) and 89 (89.0%) infants respectively were exclusively breastfed. In 3rd follow up at completed 6th month (180 days) 78 (78.0%) infants were exclusively breast fed. In our study 5 (5%) and 6 (6%) infants received supplementary food in 1st follow up and in 2nd follow up respectively. In the last follow up the number were 11 (11%) and the total number was 22 (22%).
 Conclusion : Exclusive breast feeding up to completion of 6 months (180 days) was found in 78.0% of infants. Maternal and relative’s misperception of baby’s crying due to insufficient breast milk and joining to job outside home were the causes of introduction of formula milk in the 1st, 2nd and 3rd visit respectively.
 Northern International Medical College Journal Vol. 12 No.2 Jan 2021, Page 530-534

A Prospective Study of Post-operative Complications Following Stapled Haemorrhoidectomy

Introduction: Haemorrhoids is one of the most common anorectal disorders. Stapled haemorrhoidectomy (SH) is newly developed method for the surgical management of Haemorrhoids. Objective: To evalute postoperative complications followed by Stapled haemorrhoidectomy. Methods: A prospective observational study was conducted among the patients with haemorroid those who got admitted in different surgery units in the department of surgery in Shaheed Suhrawardy Medical College Hospital, Dhaka from 01 December 2015 to 31 May 2016. A total of 60 patients were selected following convenient sampling technique. Data were collected by face to face interview using a structured questionnaire and check list. All completed questionnaires were validated manually and data were analyzed by using descriptive and inferential statistics with SPSS 19.0. Results: In this study, immediate complications (first week) were: bleeding (8.3%), urinary retention (5.0%), moderate pain (5.0%), pruritus (5.0%) and submucosal abscess (1.7%). The most common complication after 1 week was mild pain (8.3%), stenosis (5%), flatus incontinence, recurrence of hemorrhoids in 3.3% and bleeding was (3.3%). Recurrent hemorrhoids were treated by ligation in 40% and by Milligan-Morgan procedure in 32%. Anal stenoses were treated by dilatation in 55% and by anoplasty in 45%. It was revealed from study that among the patients treated with SH 21.6% had immediate complications followed by 24.3% had late complications. Conclusion: Prevention is the best treatment of haemorrhoids. Stapled haemorrhoidectomy is safe with many short-term benefits like less post-operative pain, early return from hospital and early return to their normal activities. Like other modalities it is also associated with a long-term risk of hemorrhoid recurrence and the symptom    of prolapse. However, this method is well accepted and comfortable for the patients.  JAFMC Bangladesh. Vol 18, No 2 (December) 2022: 57-60

Maternal and Fetal Outcome between Dated and Post-dated Pregnancy: A Comparative Study Conducted in a Tertiary Care Hospital

This prospective observational comparative study was conducted in department of Obstetrics and Gynaecology (OBGyn) of Shaheed Suhrawardy Medical College Hospital (ShSMCH), Dhaka. It was carried out from April 2019 to September 2019. The objectives was to compare the feto-maternal outcome of postdated pregnancy (40+1- 41+6 weeks) with pregnancy at term(37-40 weeks). Pregnant women admitted in ShSMCH with or without labour pain were considered as study population. Following ethical clearance from the local ethical committee and written informed consent, 59 cases of post-dated pregnancy (case) and 59 cases of term pregnancy (control) were included inthis study. Cases and control were selected by random sampling method according to inclusion and exclusion criteria. Inclusion criteria were: 1) Patients who have excellent EDD(dated by early ultrasonogram) , 2) Patients having regular menstrual cycle prior to present pregnancy and can remember exact LMP, 3) Postdated pregnancy as case and pregnancy at term as control. Exclusion criteria were: 1) Patients with eclampsia, systemic hypertension, heart disease, diabetes mellitus and renal disease, 2) Patients with multiple gestation and any congenital anomaly, 3) Pregnancy occurred during lactational amenorrhoea, 4) Pregnancy with veneral disease, 5) pregnancy with blood group incompatibility. Data were collected with a pre-designed structured questionnaire. A full assessment were done by history[age, occupation, menstrual and obstetric history, medical, surgical and family history, antenatal care(ANC)], physical examination (general, abdominal and vaginal) and ultrasonogram (USG) to assess gestational age and liquor volume. After proper counselling, induction of labour given to patients without labour pain and fetal distress. Mode of delivery, post-delivery maternal and fetal outcome and complication were recorded.This study showed that maximum number of patients in term pregnancy (control) belonged to age group (21-30 years) [control 71.2%, case 62.7%] and in post-dated pregnancy (case) belonged to >30 years [control 15.5%, case 23.7%]. In both groups, maximum number of women were housewives, control 48(81.4%), case 46(78%) and service-holder 11(18.6%) in control, 13 (22%) in case. In control group 36 (61%) were primi-gravida and 23 (39%) were multi-gravida. In case group 29(49.2%) were primi-gravida, 30(50.8%) multi-gravida. Family history of post-dated pregnancy were present in 14(23.7%) of control group and 13(22%) of case group. Most of the women of both control (93.2%) and case (89.8%) received regular ANC. Large fetus were seen in 6(10.2%) of control and 9(15.3%) of case group. Vertex was common presenting feature in both control (94.9%) and case (88.1%). Liquor volume was adequate in maximum number of women of both control (69.5%) and case (62.7%) group. Uterine irritability was present in 16(27.1%) of control and 17 (28.8%) of case group. Associated complication, such as CPD and elderly primi were present in 10 (16.9%) of control and 9 (15.3%) of case group. Induction of labour was required in 33(55.9%)of control and 41 (69.5%) of case group. Normal vaginal delivery was achieved in 41 (69.5%) of control and in 33 (55.9%) of case group women. LSCS required in 18 (30.5%) of control and 25 (42.4%) of case group women. Cause of LSCS is fetal distressin (54.5%) of control and (42.4%) of case group. Post-operative complication were more in case (16.9%), versus (3.4%) in control. Fetal complication were more in case group (22%), versus control (6.8%) regarding birth asphyxia, RDS, neonatal jaundice, neonatal septicemia, meconium aspiration syndrome, macrosomia and neonatal death. So this study showed that maternal and fetal perinatal morbidiy were quite high in post-dated pregnancy. There is scope for further improvement of clinical care practices of post-dated pregnant womenwith acceptable maternal and fetal outcome. J Shaheed Suhrawardy Med Coll 2021; 13(2): 130-136

A Cross-Sectional Study on Factors Related to Status of Meconium Stained Liquor Labour Patients Attended at Tertiary Level Hospital in Dhaka, Bangladesh

Background: Meconium-stained liquor during labor is a common almost daily encountered problem. Objective: The purpose of the study was to find out factors related to meconium-stained liquor affecting during labor. Methodology: This is a cross-sectional, hospital-based observational study conducted in the Department of Obs & Gyne, Shaheed Suhrawardy Medical College Hospital, Dhaka. The cases with single, term pregnancy with cephalic presentation presented with meconium-stained liquor was selected. All the cases willingly participated in this study. Data collection and fetal assessment was conducted in the labor room. The meconium-stained liquor was clinically and completely in a structured questionnaire according to the events that happened pre and post-delivery including neonatal outcome data. Data was analyzed by computer using the SPSS program (Statistical Package of Social Sciences), version-22, and p value <0.05 considered as statistically significant. Result: The mean age of the study group was 32.3±6.4 years. The Level of education of the study population, illiterate 12.0%, primary school 21.0%, majority SSC 33.0%, HSC 20.0% and graduation 14.0% and the occupation of the study patients mostly housewife 65.0%, least service.10.0%, business 14.0% and other professions 11.0% and mean gestational week was 40.12±1.43. Conclusion: The meconium-stained liquor labour is a serious condition and related with some factors which can be addressed by these factors and the safety of maternal and fetal outcomes. J Shaheed Suhrawardy Med Coll 2021; 13(2): 109-112

Study on Impact of Tertiary Care Baby Friendly Hospital on Exclusive Breast Feeding and Child Health

Background: Initiation of breast-feeding within 1hour after birth has been associated with reduced neonatal mortality. Baby Friendly Hospital Initiative has profound effects on appropriate practice of BF and thus helps to reduce infant mortality and morbidity. Objective: This study was conductedin the dept.Gynae & Obs and Dept of Paediatrics of Shaheed Suhrawardy Medical College Hospital,Dhaka, to observe the rates of exclusive breast feeding and child health status after cancelling from Baby Friendly Hospital Methodology: 100 term babies of normal birth weight irrespective of sex, born in Sh.SMCH by NVD or caesarian section were included. Data was collected from the mother with a pretested questionnaire at postnatal period, at 6th week, 14th week & 6th month of age. Result: The mean age of studiednewborn (100) was 20.02±19.54 hours. All the infants started breast feeding after birth and among them fifty six percent initiated with in 1 hour. Fifty five percent mothers were fed breast milk more than 8 times of her baby in last 24 hours. Difficulty in breast feeding was found in 36(36.0%) infants, which was resolved mostly (94%) by nurse. Exclusive breastfeeding was found in 100% of infants during discharge from hospital. In 1st and 2nd follow up 95(95.0%) and 89(89.0%) infants were exclusively breastfed. In 3rd follow up at last week of 6th month 78(78.0%) infants were exclusively breast fed. Five(5%) and six(6%) infants received supplementary food in 1st and 2nd follow up respectively. In last follow up the number were eleven (11%) and the total number was 22(22%).The causes of supplementation were crying of baby due to perceived insufficient breast milk and job of the mother in 1st& 2nd and 3rd visit respectively. Weight was significantly (p<0.05) higher in exclusive breast feeding group than the non EBF group and sickness were also more in non EBF group. Conclusion: Exclusive breast feeding was found in 78.0% of infants upto last week of 6 months. Crying of baby due to perception of insufficient breast milk and joining in outside job of the mother were the causes of introduction of formula milk in the 1st,2nd and 3rd visit respectively. Weight gain and sickness were significantly less in EBF group than in non EBF group. J Shaheed Suhrawardy Med Coll 2021; 13(2): 164-170

Practice of Nurses on Patient Record Management In Tertiary Level Hospitals

Background: Patient record prescribed further state of health of the patient and determines the diagnosis of diseases by exerting the history. The study was conducted to assess the practice of patient record management among nurses in a selected government hospital, Dhaka, Bangladesh. Methods: A descriptive type of cross-sectional study was done among 214 respondents following convenient methods of sampling from Shaheed Suhrawardy Medical College Hospital (ShSMCH), Dhaka, Bangladesh from January to December 2020. Data were collected through face-to-face interview by using a pretested semi-structured questionnaire. Results: The study revealed that about 27% of the respondents were belonging to the 26-30 age groups and the mean ± SD of age was 35.16 ± 6.93. Most of the respondents 48% were diploma in nursing. Out of 214 respondents, the pattern of nursing documentation was always filled up by about 97%, documentation practice was taken manually by 55%, management of missing files was done by 33% of respondents, and confidentiality record kept access for authorized ones was mentioned by 58%. Keeping patient records after death was made by 34.2% of respondents and preservation of medico-legal files was stored on papers narrated by 90% of the respondents. The majority of the respondents 73.4% mentioned inadequate working knowledge as a barrier in medical history training. Conclusion: Practice of Nurses on patient record management may help the authority to identify any error in the patient care, self-evaluation, and assure the quality of care. The study has an immense value if it’s possible to develop the electronic data record-keeping system in every government hospital. JOPSOM 2021; 40(2): 38-43

Socio-Demographic Determinants of Genitourinary Prolapse

Background: Genitourinary prolapse is a common gynecological problem, especially in developing country. Causes and risk factors for uterine prolapse are complex and deeply embedded in the cultural, economic and social conditions of women. Prevalence of depression is higher among women with advanced stages of prolapse. Hence this study aimed to assess the socio-demographic factors among patients with genitourinary prolapse. Methods: A cross-sectional study was conducted from January to December, 2013 among 120 women with genital prolapse who attended at Gynae wards of Dhaka Medical College Hospital, Shaheed Suhrawardy Medical College Hospital, and Mitford Hospital in Dhaka. Women who were admitted with complaints of protruding mass per vagina and diagnosed as case of uterine prolapse were assessed and staged accordingly. A semi-structured questionnaire was used to obtain socio-demographic data and prolapse related data by face to face interview. After collection, data were compiled, summarized, and analyzed using SPSS software. Results: In this study, out of 120 genitourinary prolapsed patients, 31.7% were 40-45 years age group, majority of 79.2 % were illiterate and almost two third had no monthly income. Among all respondents, 64.2 % had more than four children, maximum 96.7% had history of home delivery, and 91.7% history of heavy work during pregnancy or just after delivery. Conclusion: Genitourinary prolapsed patients were illiterate, multipara, economic insolvency, heavy work during pregnancy and home delivery. A holistic management approach is recommended for women having prolapse. JOPSOM 2021; 40(2):26-31

Clinical Pattern of Thoracic Spine Pain (TSP)

Thoracic spine pain (TSP) is defined as pain perceived anywhere in the region bounded superiorly by a transverse line through the tip of the spinous process of T1, inferiorly by a transverse line through the tip of the spinous process of T12, and laterally by vertical lines tangential to the most lateral margins of the erector spine muscles. One year prevalence of TSP ranged from 8.3-38.1% in different Asian countries. A longitudinal observational study was conducted to observe the clinical feature, demographic profile and clinical course of patients, with TSP attending at the Department of Physical Medicine and Rehabilitation (PMR) of Shaheed Suhrawardy Medical College Hospital (ShSMCH). Among the 100 study patients mean age ±SD was 34.76±13.26. Highest number of the patients (45%) belong to 16-30 years age group and male-female vatioo was 3:1. Highest frequency in the level of education 28% belonged to higher secondary or diploma. Twenty six percent (26%) patients were housewife, manual labor 20%, students 19%, sedentary worker 15%, manufacturing and industrial worker 8%, health professional 4%, driver 3% and 5% were in others group. Most of them (71%) belong to <12000 taka monthly income group and 91% patients’ lived in urban area. Duration of thoracic spine pain was found acute (6 weeks) 46%, sub-acute (>6-12 weeks) 16% and chronic (>12 weeks) 38%. Upper TSP was found among 51% of the patients. Onset of pain among the patients 66% was gradual. Mild intensity of pain was reported in 54% patients, moderate 44% and severe in only 2% patients and 64% patients had no radiation. Aggravating factors were found in patients with prolong sitting in 42%. More than one third (36%) patients relieving factor were lying, 24% rest, activity 16% and no relieving factors in 24% patients. Morning stiffness and depression was found 20% and 25% patients respectively. Associated conditions were found as diabetes mellitus (DM) 25%, sleep disturbance 16%, dyspepsia 10%, hypertension (HTN) were in 7% patients and 42% patients had no associated condition. Large number of the patients’ was occupational 46%; rest of the factors were MFPS 16%, degenerative 14% (dorsal spondylosis 5%, cervical spondylosis 6% and lumbar spondylosis 3%, Ankylosing Spondylitis (AS) 7% and traumatic were 6%. Pott‘s disease 4% and 7% patients’ cause were others. According to Numeric Rating Scale in the first visit mild causes were in 54% patients, 44% moderate and 2% severe. In the last visit 69% patients were found mild and rest had no pain (p value=0.001). Assessment of joint tenderness in first visit; 56% patients were in grade 1, 20% grade 2 and 3% in grade 3, 21% patients had no tenderness. In the last visit it was found that only 21% patients in grade 1 and rest 79% had no tenderness (p value=0.001). According to Pain Disability Index in the first visit mild disability was found in 67% patients, moderate 31% and 2% had no disability. In the last visit mild were 74% and 26% had no disability (p value=0.001). Teenager, young adults and adults were the most commonly affected patients with TSP with M:F=1.5:1. Most of the patient of upper TSP presented before 6 weeks; common presenting features were gradual onset, pain was constant in nature, mild to moderate in intensity without radiation, aggravated by prolong sitting and leaning forward, relieved by lying and rest, with no depression and significant morning stiffness. Most of the factors were occupational and MFPS. Occupations were commonly housewife and manual labor. They were improved significantly (p value=0.001) with conventional treatment.
 Bangladesh Med J. 2021 Sept; 50(3): 26-35

Clinical Staging for Accurate Preoperative Clinical Assessment of Patients with Nasopharyngeal Angiofibroma

Background: The location of the tumor and its accompanying symptoms, which include substantial epistaxis and nasal obstruction, cause the Nasopharyngeal Angiofibroma, a histologically and physiologically benign tumor with aggressive activity. Methods: The Otolaryngology & Head Neck Surgery division at Bangabandhu Shiekh Mujib Medical University, Dhaka Medical College Hospital, and Shaheed Suhrawardy Medical College Hospital in Dhaka carried out this retrospective cross-sectional study. The research was done in 2012, from February to November. 30 people made up the study's entire sample size. Result: The majority of individuals (54%) who have nasopharyngeal angiofibroma are between the ages of 16 and 20. People living in rural area (53.33%) are more sufferers from nasopharyngeal angiofibroma. The majority of patients have similar symptoms such epistaxis, nasal blockage, nasal discharge, anemia, and masses in the nasal cavity. Maximum (90%) has varying degree anaemia at presentation. All patient has soft tissue mass in Nasopharynx, half of the patient has pterygopalatine fossa extension at presentation. Maximum (56.66 %) patient admitted with stage II nasopharyngeal angiofibroma. Conclusion: It is necessary to acquire preoperative clinical staging and imaging parameters from data of one of the largest NA case series.