Shaheed Ziaur Rahman Medical College Research Articles

Clinical Presentations of Ovarian Tumor: A Cross-Sectional Study in a Tertiary Care Hospital

Background: In gynecological practice, ovarian cystic tumors are prevalent. Pathologists may have a hard time determining the cause of certain symptoms. To better understand ovarian cystic tumor's clinical and histological characteristics, this study was conducted. Methods: Between June 2021 and July 2022, 120 women admitted in Department of Gynecology and Obstetrics, Shaheed Ziaur Rahman Medical College and Hospital, Bogura in Bangladesh were recruited purposively for a cross sectional study as per inclusion criteria. The study included all individuals who had ovarian cysts that had been detected clinically and radiologically, with histological confirmation. A variety of information was examined, including the subjects' age, clinical symptoms, parity, laterality, and histopathology. SPSS 26 was used to analyze the data. Results: The data came from 120 women who had ovarian cysts removed over the time frame of the research. Pain in the lower abdomen was the most prevalent clinical symptom. In all, there were 10 (8.5 percent) instances of malignancy, 4 (3.5 percent) cases that were intermediate grade or border line, and 104 (86.6 percent) cases that were benign in nature. There were 4% cases of ovarian metastases. The most prevalent histological diagnosis was mature cystic teratoma (27 percent). Serous cystadenoma was the second most prevalent kind of cyst (20 percent). Conclusion: The histology of ovarian lesions is quite diverse. If a tough case requires immunohistochemistry, the diagnosis may be determined on the basis of regular gross and histological examinations.

Postoperative Outcome of Abdominal Surgery in Obese Patients

Introduction: Obesity is a major health problem in western society with rapidly increasing prevalence in most countries. The healthcare burden of obesity is far reaching but many of the consequences are yet to be fully understood. While there is a perception that obesity negatively impacts on outcomes following abdominal surgery there is conflicting evidence for this. Aims: To identify the complications of post-operative obese patients. Methods: Between 1st September, 2016 and 28th February, 2017, patients undergoing GIT, Hepatobilliary and Urological surgery at Shaheed Ziaur Rahman Medical College Hospital in Bogura, Bangladesh were enrolled. Following informed consent, BMI was assessed. High risk patients and complications were identified according to established criteria. Patients were grouped according to BMI categories as Normal, overweight, Obese grade-I and Obese grade-II. A Cost analysis was performed on all patients treated at Shaheed Ziaur Rahman Medical College Hospital using a SQL database. The cost of treatment was analysed with respect to the same BMI catagories. Results: A literature review found evidence of increased risk of wound infection, anastomotic leak, and pulmonary and thrombo-embolic risk. There was mixed evidence or no evidence that obesity increases cardiac risk, sepsis, overall morbidity and mortality or overall cost. A cohort of 100 patients was analysed. Diabetes was more common with increased BMI (p=0.017). Other categories of operative risk were not different. There was no difference in overall morbidity (p=0.903). Obese patients were more expensive than normal weight patients ($9587 versus $5,786(p<0.05)). Conclusion: This study demonstrates that obesity, measured by BMI is associated with more severe morbidity. I have also demonstrated that excess body fat as measured by BMI is associated with a significantly increased cost of treatment (36%) for patients undergoing major abdominal surgery.

Etiological Factors and Outcome of Ureterovaginal Fistula: A Study in Tertiary Care Hospitals

Background: Ureterovaginal fistula is a communication between the distal ureter and the vagina. It is a rare but a relatively frequent complication of pelvic surgery. The etiological factors are very important in the treatment procedure of ureterovaginal fistula. We have very few data regarding this issue. Aim of the study: The aim of this study was to assess the etiological factors and outcome of ureterovaginal fistula in women. Methods: This was an observational study and it was conducted in Shaheed Ziaur Rahman medical College Hospital (SZMCH), Bogura, Bangladesh, during the period from May 2016 to December 2018. This study was approved by the ethical committee of the mentioned hospital. In total 48 women with ureterovaginal fistula at the center were included as the study population on the basis of non-probability purposive sampling. The investigative procedures, etiology, clinical presentation and outcomes were recorded. All the data were collected, processed, analyzed and disseminated by MS Office and SPSS version 20 as per need. Result: In analyzing the etiological factors among participants we found that, among the patients of post-hysterectomy 16.67%, 14.58%, 25% and 4.17% were with abdominal hysterectomy for fibroids, abdominal hysterectomy for malignancy, cesarean hysterectomy and rupture uterus with SVD (Spontaneous vaginal delivery). In analyzing the final outcomes among the participants we found most of the patients (n=40; 83%) healed and continent. Then 13% healed with residual incontinence and the rest 4% patients healed ureterovaginal fistula with residual vesicocervicovaginal fistula. Conclusion: In this study the emergency cesarean section was found to be commonest etiological factor and the use of abdominopelvic ultrasound was found to be effective in the confirmation of diagnosis and identifying the affected ureter. Well planned hysterectomy for benign and malignant uterine pathologies may reduce the frequencies of ureterovaginal fistula. Bangladesh J. Urol. 2021; 24(1): 72-76

“Pattern of Disease among the Patients Suffering from Otitis Externa in ENT Outpatient Department at Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh”

Introduction: Otitis externa is a common otologic problem affecting between 5% -20% of patients seen in an otolaryngological practice in the tropical and subtropical regions of the world, a general practitioner can expect to see 16 new cases per year. Objective: To assess the pattern of disease among the patients suffering from otitis externa in ENT outpatient department at shaheed ziaur rahman medical college hospital, bogura, Bangladesh. Materials and Methods: This prospective study was carried out on the patients suffering from aural symptoms suggestive of otitis externa in ENT outpatient department of Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh. Among 202 patients (222 affected ears) with the aural symptoms suggestive of otitis externa and 111 healthy control (222 ears), from January 2019 to December 2020. We also included age and sex matched 111 healthy individuals to serve as control, which provided total 222 control units. The patients having symptoms suggestive of otitis externa were randomly selected from the ENT outpatient department of SZRMCH. Results: Our study maximum 71(35.1%) patients were in the 21 -30 years age group followed by 47 (23.2%) were in the 11 -20 years age group. 30 (14.8%) patients were within 31 - 40 years. 18 (8.9%) patients were within both 41 -50 years and > 60 years of age groups. Out of the total 202 patients 113 (55.9%) patients were male and remaining 89 (44.0%) were female. The male -female ratio was 1.3:1. Shows that 106 (52%) patients were smoker and 96 (48%) patients were non-smoker. Maximum number of 169(76.1%) cases were acute otitis externa, which had been suffering for less than two months. Rest 53(23.8%) were chronic cases suffering for more than two months. Most of the ears had multiple complains of which commonest was itching in 203 (91.4%) affected ears, followed by earache in 177(79.7%) ears, sense of blocked ear in 132 (59.4%) ears, discharge in 114 (51.3%) ears, deafness in 26 (11.7%) ears and tinnitus in 17 (7.6%) affected ears. From the results of microscopic examination and culture of ear swab we detected pure bacterial growth in 48 (21.6%) acute cases and 10 (4.5%) chronic cases, pure fungal growth in 74 (33.3%) acute cases and 22 (9.9%) chronic cases, mixed bacterial and fungal growth in 16 (7.2%) acute cases and 10 (4.5%) chronic cases, no growth or contamination in 32 (14.4%) acute cases and 10 (4.5%) cases. Most of the ears were affected by fungal infection accounting 49.0% (109 cases), followed by bacterial infection in 31.9% ears. Out of 71 cases of otitis externa caused by bacteria 29 (40.8%) were due to Pseudomonas aeroginosa, 26 (36.6%) were due to Staphylococcus aureus, 10 (14.0%) were due to E.coli and 6 (8.4%) were due to Proteus mirabilis. Among the culture positive ears 13 (38.2%) were due to Aspergillus, 9 (26.4%) were due to Candida, 6 (17.6%) Penicillium, 3 (8.8%) Mucor and 3 (8.8%) were due to other fungal strains. The microbiological and culture finding of ear swabs among the healthy population of bacterial isolates of which 10 (16.6%) were Staphylococcus aureus, 26 (43.3%) were Staphylococcus epidermidis, 8 (13.3%) were Diphtheroids, 7 (11.6%) were E. coll. 3 (5.0%) were Proteus and 6 (10.0%) were Pseudomonas aeroginosa. Conclusion: From this study it is also evident that although bacteria could be detected from control cases but the isolation of fungus were negligible. Most of the bacteria were normal commensal. Whereas in diseased ear presence of fungus in the ear canal was highly significant, which signifies the prerequisite of an altered aural flora and fauna for the development of fungal infection.

Perinatal Outcome in Preterm Caesarean Section at a Teaching Hospital in Bangladesh

Background: Preterm caesarean section gives different perinatal outcomes.
 Objective: The purpose of the present study was to observe the different perinatal outcomes among the pregnant women with preterm caesarean section.
 Methodology: This prospective cohort study was conducted in the Department of Obstetric & Gynaecology at Shaheed Ziaur Rahman Medical College Hospital, Bogra, Bangladesh from January 2007 to December 2007 for a period of one year. Women with the gestational age between 32 to 36 completed weeks who were selected for delivery by caesarean section were selected as study population. Most of the pregnant women were brought to the hospital with poor condition. Actually the patients were managed on emergency basis. With the improvement of general condition of the patients, in consultation with anaesthetic department and paediatric department patients were managed accordingly and the perinatal outcomes were recorded.
 Result: A total number of 100 pregnant women were recruited for this study. In this study most of the pregnant women were in the age group of 15 to 25 years which was 60(60.0%) cases. Birth weight below 1.5 kg was in 15.0% cases. However, 72.0% babies had shown APGAR score within 4 to 7 at 5 minute. APGAR score more than 7 was present in 18.0% babies. In this study incidence of other diseases associated with prematurity was in 39(39.0%) cases and perinatal asphyxia was in 25(25.0%) cases. Among the women undergone preterm caesarean sections about 92(92.0%) cases were giving live birth and 8(8.0%) cases were reported still birth; however, subsequent neonatal death occurred in 27(27.0%) cases.
 Conclusion: In conclusion most common perinatal outcomes of preterm caesarean section is live birth with prematurity and perinatal asphyxia.
 Journal of National Institute of Neurosciences Bangladesh, July 2021, Vol. 7, No. 2, pp. 169-172

Study on the Etiology of the Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Among the Hospital Admitted Patient

Background: The syndrome of inappropriate antidiuretic hormone (SIADH) is a clinical illness that increases antidiuretic hormone (ADH) production or activity due to different disease processes. Normal release of ADH, or arginine vasopressin (AVP), occurs in the posterior lobe of the pituitary gland. SIADH, a hemodynamic disturbance, does not cause secretion of ADH. It is mediated through no osmotic receptors, resulting in water retention and dilutional hyponatremia. Materials methods: This was a cross-sectional observational study carried out by the Department of Medicine, Shaheed Ziaur Rahman Medical College Hospital, Bogura. Total 100 consecutive patients had hyponatremia due to SIADH. All patients were interviewed using standardized questionnaires. Data were analyzed using the statistical packages for social sciences (SPSS) for windows version 16. Results: Most of the patients (42%) in the study were older people >60 years. The average age was 60.69 years. The male-female ratio was 1.43.1. The symptoms of hyponatremia were fever (32%), headache (34%), weakness (40%). confusion (48%), convulsion (19%) and coma (52%). Of them, 34% were hypertensive, and 51% of patients had a Glasgow coma scale of 3/15. It was observed that the most common etiology of SIADH was hemorrhagic stroke (46%) then ischemic (41%). Among the hemorrhagic strokes, 40% were intracerebral, 4% were subarachnoid hemorrhage, and 2% were brain stem hemorrhage. Another etiology was meningitis (4%). Encephalitis (4%). Pneumonia (3%) and pulmonary tuberculosis (2%). Serum Na+ <120 mmol/L was seen in 38% patients. Total plasma osmolality was 260.40±8.51 (mmol/Kg), urinary Na+ was 13465±55.81 mmol/L, urinary osmolality was 408.05±157.02 mmol/L. S. creatinine was 1.06±1.02 m/dl, and S. uric acid was 3.35±0.75 mg/dl. Conclusions: The most common symptoms were Coma, confusion, weakness, headache, fever, and convulsion by hemorrhagic stroke and ischemic stroke. Meningitis, encephalitis, pneumonia, and pulmon

Outcomes of Total Knee Replacement: A Prospective Observational Study in Bangladesh

World-wide, total knee replacement (TKR) is a standard and definitive treatment option following failed adequate non-operative management of knee. After completing total knee replacement for the patients, it is necessary to assess the clinical and functional outcomes of the procedure. We have very few research-based information outcomes of total knee replacement. Aim of the study: The aim of to this study was to assess the clinical and functional outcomes of total knee replacement in patients with knee osteoarthritis. Methods: This prospective observational study was conducted in the Department of Orthopedics, Shaheed Ziaur Rahman Medical College, Bogura, Bangladesh during the period from March 2019 to December 2019. In total 37 patients with knee osteoarthritis attended and selected for total knee replacement in the mentioned hospital, maintained proper documentations were finalized as the study subjects. The outcomes of the patients were measured in terms of treatment excellent and good rate, incidence rate of complications, KSS, Hss, VAS and NRS scores. All data were processed, analyzed and disseminated by using MS Office and SPSS version 22 as per need. Results: In this study, the mean (±SD) Hss scores of pre and post TKR among the participants were 56.06±4.17 and 89.83±6.76 respectively. The mean (±SD) KSS scores of pre and post TKR among the participants were 54.17±5.27 and 85.79±8.32 respectively. The mean (±SD) VAS scores of pre and post TKR among the participants were 5.54±1.11 and 1.17±0.23 respectively. The mean (±SD) NRS scores of pre and post TKR among the participants were 5.44±1.05 and 1.25±0.33 respectively. In comparing all the scores between pre and post stages the P values were ‘<0.0001’. In analyzing the final outcomes among the participants, we observed that, 27.03%, 45.95%, 21.62% and 5.41% participants got ‘Excellent’, ‘Good’, ‘Acceptable’ and ‘Poor’ results respectively. Conclusion: Total knee replacement (TKR) significantly relieves pain of patients with knee osteoarthritis and ensures improves knee joint function with fewer complications. Considering the prompt healing, less complication and effectiveness of total knee replacement method physicians can take TKR as a prominent treatment option for the knee arthritis patients.

Proportion of Gestational Diabetes Mellitus among the Pregnant Mothers and Their Socio-Demographic Characteristics Attending ANC Corner at ShaheedZiaur Rahman Medical College Hospital, Bogura

Background: The proportion of Diabetes is becoming more aggregate around the universe, and it is linked to both genetic and environmental causes. Because of the rising prevalence of type 2 diabetes among young people, the number of pregnancies with this problem has increased. Objectives: The aim of the study was to assess the proportion of Gestational Diabetes Mellitus (GDM) among the pregnant mothers and their socio-demographic characteristics.

Factors associated with low back pain in adult: a study in a tertiary care hospital of Bangladesh

Background: Low back pain (LBP) is a very common health problem in humans that may cause disability and can affect work performance and well-being. It can be acute, subacute, or chronic in condition. Although several risk factors of LBP have already been identified like occupational posture, age, depressive moods, body height, or obesity we have not enough research-based data regarding this issue. Aim of the study: The aim of this study was to evaluate the risk factors associated with low back pain in adults. Methods: This cross-sectional observational study was conducted in the Department of Physical Medicine &amp; Rehabilitation, Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh during the period from July 2019 to December 2020. In total 57 confirmed LBP patients were enrolled as the case group patients and 30 healthy people were included as the control group participants in this study. All the clinical data regarding LBP were collected by using a predesigned questioner. Data were processed analyzed and disseminated by MS Office and SPSS programs as per need. Results: In analyzing the risk factors of low back pain among the participants we observed, 47% of case group participants were used to remain in a sitting position for 0-1 hours per day whereas it was found among 67% in the control group. Moreover, in the case group, 14% of participants used to remain in a sitting position for more than 6 hours per day which was only 7% in the control group. Besides age (p=0.004) among several possible risk factors, in this study, we found a significant correlation of low back pain in the duration of sitting position between the case and control groups, where the p-value was 0.006. Conclusion: Continuation of a long time sitting position is a harmful thing for the human musculoskeletal system. Now a day the lifestyle factors should be assessed with more attention for detecting the basic etiology of low back pain.

“An Assessment of Surgical Management of Tibial Plateau Fracture”

Background: Fractures around the knee joint especially tibial plateau fracture are very crucial for surgical management. Low and high-energy tibial plateau fractures usually result from axial loading in combination with valgus stress forces, present a variety of soft tissue and bony injuries that can produce permanent disabilities. Since there are various modalities for fixation of these fractures with satisfactory results, but there is no general consensus as to which modality is the best in terms of functional outcome. Aim of the study: The aim of this study was to assess the functional outcome of surgical management of tibial plateau fractures. Methods: This prospective observational study was conducted in the Department of Orthopedics, Shaheed Ziaur Rahman Medical College, Bogura, Bangladesh during the period from January 2020 to December 2020. In total 28 patients of several age groups with tibial plateau fractures attended to the mentioned hospital during the first six months of the study were selected as the study population. Gustilo Anderson Grade I fractures of tibial plateau presenting in patients requiring open or closed reduction and internal fixation to restore the articular anatomy were finalized for this study. All data were processed, analyzed and disseminated by MS Office and SPSS program as per need. Result: In this study, for most of the cases the treatment duration was &lt; 10 days which was among 75%. As complication ‘knee stiffness’ was found among the highest number of patients which was in 10.71%. The average duration of hospitalization of the participants was 7.5 days (range 4-8 days). In this study, we found satisfactory outcome in 25 patients which was 89% and not satisfactory in 3 patients which was 11% among all the participants. Finally, the end result as per Rasmussen’s criteria was ‘Excellent’ in 15 (53.57%), ‘Good’ in 10 (35.71%), fair in 2 (7.14%) and poor in 1 (3.57%) patient. Conclusion: In this current study we found satisfactory o

To Evaluate The Clinical Aspects, And The Prognostic Factors Of Morbidity And Mortality Of Eclampsia

Introduction: Pre-eclampsia is a leading cause of maternal morbidity and mortality. Substandard care is often present and many deaths are preventable. Eclampsia, a major neurological complication of pre-eclampsia, is defined by a convulsive manifestation and/or conscious-ness disorder occurring in a preeclampsia context and cannot be at-tributed to a pre-existing neurological problem. Objective: To Evaluate the Clinical Aspects, And the Prognostic Factors Of Morbidity and Mortality Of Eclampsia. Materials and Methods: This is a retrospective, descriptive and analytical study of all patients admitted for eclampsia from April 2020 to March 2021 in the multipurpose intensive care unit of the anesthesiology Dept. Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh. The diagnosis of eclampsia was based on the occurrence of peripartum seizures in a woman whose history and examination revealed no other cause for the convulsion. We studied the clinical, therapeutic, evolutionary and prognostic factors of morbidity and mortality. Results: We collected 45 cases of eclampsia for 2502 deliveries in the study (incidence of 1.8%). The average age of the patients was 22.23 years. Primiparity was found in 25 patients (55.5%). Antenatal consultations were effective in 4 patients (8.8%). Conscious-ness was clear at admission in 38 patients (84.4%) and for one patient a Glasgow score <8 was reported (1.96%). Severe hypertension was observed in 27.4% of cases. A ventilation intubation of 03 days was required in one patient in 1.9% of cases. Caesarean was the mode of delivery in 56.8% of cases and vaginal delivery was performed in 43%of cases. General anesthesia was doing in 18 patients (72%) and spinal anesthesia was performed in 7 patients (28%). Maternal complications were represented by: Postpartum acute renal failure (13.3%), Hellp syndrome (11.1%), and coagulopathy (16.6%). Prematurity was found in 12 neonates (13.3%), perinatal mortality was 9.1% and the maternal mortality rate was 4.4%. Conclusion: Eclampsia is still responsible for high maternal and infant mortality. The association of two or even more serious factors is very important in this mortality.

An Investigation of the Effect of Age, Severity of Hypertension and Duration of Hypertension for Erectile Dysfunction

Introduction: Hypertension (HTN) is one of the most common diseases of the cardiovascular system. It is an increasingly important medical and public health problem. Hypertension is regarded as an indicator for erectile dysfunction. That is why problems with erectile function are an important concern in the treatment of hypertension. Objective: To investigate the frequency and severity of erectile dysfunction among hypertensive and normotensive married men attending a tertiary care hospital of Bangladesh. Material &amp; Methods: It was a cross sectional comparative study. The study was done at Shaheed Ziaur Rahman Medical College, Bogura, Bangladesh in the department of Medicine from July 2019 to January 2021. A total of 150 patients were selected as a study population. Purposive sampling was applied to collect the sample as per inclusion and exclusion criteria. The participants who were excluded from the study declined to give their consent, didn’t complete the questionnaire and there was difficulties in fulfilling the inclusion and exclusion criteria. After collecting the data, it was checked and rechecked for omission, inconsistencies and improbabilities. Data analysis was performed by Statistical Package for Social Science (SPSS), version-22. Results: Analysis was done with the data of 150 cases. Out of the total 150 cases 75 were hypertensive and 75 were normotensive. The respondents were further sub grouped into an age matched manner. The predominant respondent age group was 40 to 49 years which included 42 in normotensive group and 42 in hypertensive group. The age range of the normotensive was 33-55 years in the study population and the mean age of them was (42.65 ± 5.53) years. On spot measurement of blood pressure 26 patients were found in an uncontrolled state of BP. Fifteen (15) subjects was in grade I and 11 subjects were in grade II. Among them 53.3% of grade 1 had ED and 90.9% with grade II suffered from ED. None was found in the range of grade III or ....

Negative Impact of COVID 19 on Physical, Mental and Socio-Economic Condition among General Patients

Covid-19 is the name of a serious pandemics in the current world. Although this disease is responsible for very limited symptoms and complications like severe acute respiratory syndrome, fever, headache, diarrhea, malaise and weakness but its probability of affecting more people is very high. For this reason, its psychological and socio-economic impact demanded more attention of the world community. We have very limited research-based information regarding this issue. The aim of this study was to evaluate the negative impact of Covid 19 on physical, mental and socio-economic condition among general non-Covid patients. This was a prospective survey-based study which was conducted in the Department of Medicine, Shaheed Ziaur Rahman Medical College, Bogura, Bangladesh during the period from July 2020 to December 2020. In total 128 patients with several health problems, physically or virtually attended the OPD of the mentioned hospital were enrolled as the study population. A pre-designed questionnaire was used in patent data collection. All data were processed, analyzed and disseminated by MS Office and SPSS version as per need. In analyzing the negative impact on physical health of participants we observed, 10.94%, 8.59%, 7.03%, 5.47% and 3.13% patients were with feeling of physical fatigue, gaining extra body-weight, insomnia, general weakness and having chronic disease respectively. In this current study, in analyzing the negative impact on mental health of participants we observed feeling of suffocation, feeling of exhausted, fear of falling ill and anxiety about future were found as some major negative mental impacts of Covid 19 on the respondents which was among 11.72%, 10.94%, 8.59% and 7.81% participants respectively. As negative impact on social life of participants due to Covid 19 continuing remote socialization, intolerance to others, random commitment violation and ended social life were found among 8.59%, 3.91%, 3.13% and 1.56% participants ...............

Quality of Life Assessment after Canal Wall Down Mastoidectomy: Our Experiences in Shaheed Ziaur Rahman Medical College Hospital, Bogura

Objective: To determine subjective outcomes after cholesteatoma surgery.&#x0D; Design: Cross sectional observational study&#x0D; Methods: Study place: Shaheed Ziaur Rahman Medical college Hospital (SZMCH), Bogura, Bangladesh&#x0D; Study population: Chronic otitis media (COM) with extensive cholesteatoma. Interventions: Canal wall down mastoidectomy for cholesteatoma.&#x0D; Main Outcome Measures: In this study, the Chronic Ear Survey (CES) was provided to all patients preoperatively and one year after surgery. The preoperative and postoperative score differences were analyzed. We also assessed correlations between chronic ear survey scores and air conduction threshold.&#x0D; Results: Seventy six patients were enrolled in our study &amp; marked improvements were found in total CES score &amp; all subscale scores postoperatively (P value: 0.00). The total CES score and symptom subscale scores were observed greater improvement (P value: 0.00).Significant negative linear correlations were observed among total CES scores, symptom subscale scores and air conduction thresholds (P&lt;.05).&#x0D; Conclusion: The present study suggests that canal wall down mastoidectomy (CWDM) provides a significant improvement in the post-operative Quality of life (QoL) &amp;b there is a significant association between subjective outcomes &amp;the objective audiometric results.&#x0D; Bangladesh J Otorhinolaryngol; April 2021; 27(1): 52-58

Indications of Preterm Caesarean Section: Experience of 100 Cases at a Tertiary Care Hospital in Bangladesh

Background: Preterm caesarean section is performed for different indication among the pregnant women.&#x0D; Objective: The purpose of the present study was to find out the indications of preterm caesarean section among pregnant women.&#x0D; Methodology: This cross sectional study was conducted in the Department of Obstetric &amp; Gynaecology at Shaheed Ziaur Rahman Medical College Hospital, Bogra, Bangladesh from January 2007 to December 2007 for a period of one year. Women with the gestational age between 32 to 36 completed weeks who were selected for delivery by Caesarean section were selected as study population. All the women of study were assessed on the basis of detailed history, clinical examination, gestational period, history of premature rupture of membranes, any vaginal bleeding and fetal condition.&#x0D; Result: A total number of 100 pregnant women were recruited for this study. In this study most of the pregnant women were in the age group of15 to 20 years which was 40(40.0%) cases followed by the age group of 21 to 25 years which were 20(20.0%) cases. About 43(43.0%) cases were complicated with pregnancy induced hypertension. Almost all of them had indication for immediate caesarean section. Among the group incidence of eclampsia was high which was in 23(23.0%) cases; however, preeclampsia was found in 20(20.0%) cases. Ante partum haemorrhage was reported in 10(10.0%) cases. Pregnant women with premature rupture of membrane (PROM) was found in 14(14.0%) cases; furthermore, PROM with Chorioamnionitis was detected in 5(5.0%) cases. Preterm labour with history of previous caesarean section was given by 5(5.0%) women.&#x0D; Conclusion: In conclusion eclampsia and preeclampsia are the most common indication for preterm caesarean section followed by premature rupture of membrane.&#x0D; Journal of Current and Advance Medical Research, January 2021;8(1):44-48

Dengue epidemic in a non-endemic zone of Bangladesh: Clinical and laboratory profiles of patients.

BackgroundsApproximately, half of the population in the world including tropical and sub-tropical climates region is at risk of dengue. Being an endemic country, Bangladesh has experienced the largest dengue epidemic in 2019. The present study aimed at evaluating the clinical and laboratory profile of dengue patients in northern Bangladesh during the epidemic.MethodsThis cross-sectional study included 319 serologically confirmed dengue patients admitted in Shaheed Ziaur Rahman Medical College Hospital in Bogra district. It is one of the main tertiary care hospitals in northern Bangladesh. Data were collected from July to September 2019. Patients’ clinical and laboratory data were extracted from clinical records. Patients were classified into two classes according to the WHO 2009 dengue classification such as (i) non-severe dengue and (ii) severe dengue. Chi-square test and independent t-test were used in this study.ResultsOf the 319 patients, 94.1% had non-severe dengue and the remaining 5.9% had severe dengue (severe plasma leakage 68.4%, severe organ involvement 68.4%, and severe clinical bleeding 10.5%). Most of the patients were suffering from primary dengue infection. The most common clinical presentation was fever followed by headache and myalgia. Vomiting and abdominal pain were the most prevalent warning signs. The common hematological findings on admission were leukopenia (63.3%), thrombocytopenia (30.4%) and increased hematocrit (26.6%). Raised serum ALT or AST was observed in 14.1% cases whereas raised serum creatinine was observed in 6.6% cases. Signs of plasma leakage (pleural effusion, respiratory distress, and ascites, rise of hematocrit >20% during hospital stay) and hepatic or renal involvement (serum ALT >42UI/L or serum creatinine >1.2 mg/dL) on admission were mostly associated with severe dengue.ConclusionThe study provides clinical evidence on presentation as well as hematological and biochemical profile of dengue patients in northern Bangladesh that should be implicated in effective patient management.

Management and Outcome of Diabetic Foot-A Study of Hundred Case

Background: Diabetes mellitus is a complex metabolic disorder that affect 1-2 percent of the population. It can give rise to many tissue complications among which foot is particularly vulnerable to circulatory and neurological disorder, so that even minor trauma can lead to ulceration and infection.&#x0D; Methods: Between September 2008 and August 2009, 100 patients were undergone treatment for diabetic foot at department of Surgery, Shaheed Ziaur Rahman Medical College Hospital, Bogra. This study included all the cases of diabetic foot irrespective of age, sex and diabetic status.&#x0D; Results: After 12 weeks treatment 84% of patient were completely recovered, 2% developed abscess, 8% developed ulceration and 6% developed gangrene. Mean age of diabetic patients with foot ulcer is 50-60 years. Out of 100 cases 64% male and 36% female. Maximum number of patient (64%) had foot problems after suffering from diabetes mellitus for a period of 6-10 years.&#x0D; Conclusion: The modalities of treatment of diabetic foot should be selected for each type of pathology depending on the pattern of presentations of diabetic foot. Careful selection of treatment modalities can reduce the rate of diabetic foot complications and improve the quality of life of diabetic patients.&#x0D; Journal of Surgical Sciences (2019) Vol. 23 (1) : 25-28

Prevalence of Pregnancy Induced Hypertension among the Pregnant Women: A Study in Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh

Prevalence of Pregnancy Induced Hypertension among the Pregnant Women: A Study in Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh

Clinico-Pathological Study of Juvenile Nasopharyngeal Angiofibroma

Introduction: Anigo-fibroma is vascular swelling arising in the nasopharynx of prepubertal and adolescent males and exhibiting strong tendency to bleed, also termed as nasopharyngeal fibroma or a nasopharyngeal angiofibroma. It accounts for less than 0.5% of all head & neck tumour. It occurs almost exclusively in adolescent male, though rarely found in children and elderly young. It is a rare <1% of head and neck tumors benign mesenchymal neoplasm composed of a vascular proliferation within a cellular, densely collagenizedstroma, typically originating in the nasopharynx, affecting adolescent males. It occurs most often in male adolescents with an average age at diagnosis of 14-16 years. Anyway, there are very few studies, regarding Juvenile Nasopharyngeal Angiofibroma in Bangladrsh and there is not much national data about this issue. Hence, the researcher purposively a total of 30 patients of juvenile nasophryngeal angiofibroma (JNA) included in this study from ENT department of Shaheed Ziaur Rahman Medical College, Bogura, Bangladesh. The aim of this study was to find out the common mode of clinical presentation with their site of extension and different surgical approaches adopted for them. Methods & Materials: This prospective observational study was conducted in the Department of otolaryngology and head, neck surgery of Shaheed Ziaur Rahman Medical College, Bogura, Bangladesh, which is the 2nd generation tertiary level medical service institution during the period from Jan 2017 to Dec 2019. All data were analyzed by using simple statistical data analyzed tools. Result: Almost all the present with recurrent epistaxis 28 (93.33%), following by nasal obstruction 26 (86.66%), nasal discharge 25 (83.33%), facial swelling 10 (33.33%), protrusion of the eyeball 4 (13.33%), aural symptoms 3 (10%) and head-ache 2 (6.66%). Majority of our patient presented with multiple symptoms. Analysis of the finding showed that 100% had nasopharyngeal mass, nasal mass 86.66% palatal bulging 66.66%, swelling of the cheek 33.33%, proptosis 13.33% and headache with blurring of vision 6.66%, these are obtained after thorough clinical examination both local and general. Extension of the tumour assessed on the basis C scan, MRI, as well as observation on the operation showed, nasal cavity 100% and into the pterygopalantine fossa 40%, infratemporal fossa 33.33%, orbit 13.33%, oropharynx 10% maxillary antrum 6.66%, sphenoid sinus 3.33%, ethmoidal sinus 3.33% and 6.66% infra oranial extension. Regarding treatment surgical resection was the most common principal mode of treatment offered to the 93.33% patient but radiotherapy given in 6.66% patient. Conclusion: All young males of this study with nasal obstruction or nose bleed (or both) should be suspected of having juvenile angiofibroma. Angiography to find out feeding vessel to do pre-operative embolization is helpful for surgery. This together with hypotensive anaesthesia and operated by a skilled surgeon having sound knowledge about nasopharynx can lessen the haemorrhage, thereby reduce the mortality and morbidity.

The Efficacy of low: Dose ketamine for prevention of intraoperative nausea and vomiting during caesarean section under spinal anaesthesia: A comparative study

Background: Intraoperative nausea and vomiting affecting women undergoing regional anesthesia for cesarean section is an important clinical problem since these techniques are used widely. There are burdens of literature about intraoperative nausea and vomiting (IONV) and several in parturient and cesarean. However, it needs more attention. Ketamine is a potential drug in this procedure. Objective: The main objective of the study was to evaluate the efficacy of low-dose ketamine for prevention of intraoperative nausea and vomiting in caesarean section under spinal anaesthesia. Methods: This comparative study was conducted in Department of Anaesthesiology and ICU in Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh during the period from January 2019 to December 2019. In total 120 patients were randomly allocated into two equal groups: the ketamine group; in which 0.5 mg/kg was infused intravenously in 20 min and the placebo group; in which normal saline was infused. The two groups were given subarachnoid block with local anaesthetic hyperbaric 0.5% bupivacaine and intrathecal fentanyl. Results: The incidence of intraoperative nausea was 20% and episodes were 38 in total in the ketamine group compared with 38.33% and episodes were 76 in total in the placebo group, which was statistically significant (P value 0.176). Both vomiting episodes and number of patients who required rescue anti-emetics in the ketamine group compared with placebo one (3.33% vs 6.67% and 2 vs 5 respectively) were not statistically significant P values 0.682 and 0.593. Conclusion: In our study, we found the satisfactory efficacy and better compliance from the patient’s front. Ketamine may be used without hesitation for prevention of intraoperative nausea and vomiting in caesarean section under spinal anaesthesia.