Sir Salimullah Medical College Mitford Research Articles

QTc dispersion as a predictor of coronary artery disease severity in Bangladeshi patients with chronic coronary syndromes

Background: Coronary artery disease (CAD) is a leading global and national health burden. Accurate assessment of CAD severity is crucial for effective management. QTc dispersion, a simple electrocardiographic parameter, has been explored as a potential predictor of CAD. This study aimed to evaluate the association between QTc dispersion and coronary angiographic severity in Bangladeshi patients with chronic coronary syndromes (CCS). Methods: A cross-sectional study was conducted on 92 CCS patients undergoing coronary angiography at Sir Salimullah Medical College Mitford Hospital, Dhaka, from November 2020 to October 2021. Patients were divided into two groups based on QTc dispersion (≥50 ms or <50 ms). Coronary angiographic severity was assessed using the Gensini score. Results: Patients with increased QTc dispersion (Group B) had a significantly higher mean age, were predominantly male, and exhibited significantly higher Gensini scores compared to those with normal QTc dispersion (Group A). A strong positive correlation was observed between QTc dispersion and Gensini score (r=0.742, p<0.001). Conclusion: Our findings suggest that QTc dispersion is a significant predictor of CAD severity in Bangladeshi patients with CCS. Incorporating QTc dispersion into routine clinical practice may aid in risk stratification and the development of personalized treatment strategies for these patients.

The Outcome of Early Oral Feeding Following Elective Gastrointestinal Surgery.

Background Early oral feeding (EOF) after gastrointestinal (GI) surgery is an optimistic way to speed up recovery and shorten hospital stays, but its full effects remain unexplored. Aim This study aims to evaluate the outcomes of EOF in patients having elective gastrointestinal surgery. Methods This open-level, prospective randomized controlled trial was conducted in the Department of Surgeryat Sir Salimullah Medical College Mitford Hospital, Dhaka, from March 2022 to February 2023. A total of 50 patients were enrolled and divided into two groups: early oral feeding (EOF) and traditional postoperative oral feeding (TOF), both before and after 48 hours of surgery, using a systematicrandom sampling technique. Informed written consent was taken from the patients. The patients were monitored on days 1, 3, 5, 7, 14, and 28 following surgeries. Postoperative complications, the duration for nasogastric tube (NGT) removal (days), the early recovery of bowel motility, and the length of the hospital stay (days) were noted. Results In this study, both EOF and TOF groups were found indifferent in terms of age distribution, gender ratio, or body mass index (BMI). However, significant differences emerged in postoperative outcomes. The TOF group experienced a significantly longer duration for nasogastric tube (NGT) removal and the initiation of oral feeding compared to the EOF group (P-value < 0.001). Complication rates, including nausea, vomiting, ileus, anastomotic leakage, wound infection, and pneumonia, did not exhibit statistically significant differences between the groups (P-value > 0.05). Moreover, the EOF group demonstrated an early recovery of bowel motility after surgeryand shorter hospital stays compared to the TOF group (P-value < 0.05). Conclusion Starting oral feeding earlier does not increase complications.However, it does speed up recovery and shorten hospital stays.

Impairment of Renal Function in Perinatal Asphyxia with Hypoxic Ischemic Encephalopathy in Term Neonates

Background: Perinatal asphyxia is a major cause of neonatal morbidity and mortality worldwide including in Bangladesh. It causes damage to almost every tissue and organ of the body. In kidneys, renal insufficiency may occur promptly even within 24 hours of asphyxia. So, renal function assessment is essential for accurate management of metabolic derangement in neonates as prolonged hypoxic ischemic episode can lead to irreversible cortical necrosis with onset of acute renal failure.Objectives: To find out renal impairment and to measure serum creatinine, serum electrolyte and eGFR, Also to compare biochemical parameters level and determine the frequency of AKI among the asphyxiated neonates with HIE.Materials and Methods: This cross-sectional study was conducted in the neonatal care unit of Sir Salimullah Medical College Mitford Hospital, Dhaka. A total of 70 term neonates suffered from perinatal asphyxia with different stages of Hypoxic ischaemic encephalopathy. A ‘p’ value &lt;0.05 was considered as statistically significant.Results: Among 70 term neonates having HIE, it was observed that 62.9% neonates had moderate birth asphyxia followed by mild (28.6%) and severe (8.6%). Newborns with SGA (71.4%) had more renal impairment than AGA. Among biochemical variables Blood urea and serum creatinine were high and eGFR was low in stage Π. Among electrolytes, hyponatremia was present in 24.3% of cases and more in stage Π, and hyperkalemia was present in 21.4% of cases and more in stage Ш. AKI was found in 18.6% of cases, Risk (stage 1) was 77%, Injury (stage Π) was 15.3% and Failure (stage 3) was 7.7 %.Conclusion: Renal impairment was found in 18.5% of term asphyxiated neonates with HIE according to pRIFLE and AKIN criteria and Biochemical parameters showed no significant changes between different stages of HIE. KYAMC Journal Volume: 14, No: 04, January 2024: 198-205.

Efficacy of Bedside Index for Severity In Acute Pancreatitis (Bisap) Score As Predictor of In-Hospital Outcome in Acute Pancreatitis

Background: Acute pancreatitis is a potentially life-threatening condition characterized by inflammation of the pancreas. Early identification of patients at risk of severe disease is crucial for devising appropriate management strategies and improving outcomes. The aim of the study was to investigate the efficacy of BISAP score as predictor of in-hospital outcome in patients with acute pancreatitis. Methods: This was a longitudinal study conducted in Department of Medicine, Sir Salimullah Medical College Mitford Hospital, Dhaka from January 2023 to December 2023. After ethical approval, a total 107 subjects were included in this study based on inclusion and exclusion criteria. Severity of the disease was assessed by BISAP score. Theoutcome determinants were length of hospital stay, complete recovery, partial recovery with complication, transfer to ICU and mortality. Chi Square test, Binominal Regression analysis and Receiver operator characteristic (ROC) curve analysis were performed as applicable. p value &lt;0.05 was considered as the level of significance. Results: The mean BISAP score among 107 study participants was 2.00 ± 0.76. Patients with BISAP score ³3 had significantly increased odds of prolonged hospital stay (OR: 11.226; 95% CI: 2.985- 42.222; p&lt;0.001), higher rate of partial recovery with complications (OR: 7.302; 95.325% CI: -20.997; p&lt;0.001). &lt;0.001), and greater likelihood of intensive care unit (ICU) transfer (OR: 1.136; 95% CI: 0.968-1.333; p=0.004). A BISAP score cutoff value of ³3 was associated with increased length of hospital stay (sensitivity 91.3%, specificity 97.6%, AUC=0.945), partial recovery with complications (sensitivity 83.3%, specificity 96.4%, AUC=0.899), and ICU transfer (sensitivity 75%, specificity 80.6%, AUC=0.778).Conclusion: It can be concluded that increased BISAP score can be served as an independent predictor of in-hospital in patients with acute pancreatitis (AP). Bangladesh J Medicine 2024; 35: 88-92

Clinical epidemiology of cardiovascular disease in advanced chronic kidney disease prior to dialysis to a tertiary care centre in Bangladesh

Background: Patients with advanced CKD stages exhibit a markedly elevated risk of cardiovascular disease. Patients with chronic kidney disease (CKD) exhibit an elevated cardiovascular risk manifesting as coronary artery disease, heart failure, arrhythmias, and sudden cardiac death .The main objective of this study was to observe the clinical epidemiology of cardiovascular disease in advanced stages of CKD prior to dialysis to a tertiary care centre in Bangladesh. Methods: This was a cross-sectional observational study on 150 cases of diagnosed advanced stages (4&amp;5) of CKD patients in the indoor Department of Medicine of Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh from July 2022to January2023 for 6 months. Data was analyzed SPSS 25. Results: Out of the total group, 62.0% are male, 38.0% are female, and the average (mean) age of the entire group was 55.2 ±10.3. Patients are compared in terms of their relative percentages and the associated cardiovascular disease (CVD) risk, with the hypothesis that lower hemoglobin levels (&lt;9 mg/dL), common in advanced CKD, may be associated with higher CVD risk. A statistically significant P-value (0.036) indicates a significant association between lower hemoglobin levels and increased risk of CVD. Hypertension is the most common risk factor in both stages showing (80%) in stage 4 and 86.6% in Stage -5 of CKD respectively that increasing prevalence as stages of CKD increases . Other factors like diabetes 50.6%) and 53.3% , dyslipidemia 61.3% and 66.7% , and family history of cardiovascular disease (CVD) 40% and 46.6% also in prevalence from Stage 4 to Stage 5. However, the differences in the prevalence of these risk factors between the two stages are not statistically significant, as indicated by the P-values. The prevalence of Congestive Heart Failure rises from 44% in Stage 4 to 52% in Stage 5, and a similar trend is observed in Coronary Artery Disease from 40% in Stage 4 to 48% in Stage 5 and for other diseases, albeit with lesser increments. The provided pvalues, which assess statistical significance, indicate that the differences in disease prevalence between the two stages are not statistically significant, suggesting that the progression from Stage 4 to Stage 5. Conclusion: This study stated that increased prevalence and progression of cardiovascular risks in advanced CKD stages. Bangladesh J Medicine 2024; 35: 96-100

Association of iron deficiency anemia with acute bronchiolitis in children below 2 years of age

Background: Bronchiolitis is the leading cause of respiratory distress in small children and one of the main causes of hospitalization in children &lt;2 years of age. Anemia is also identified as a risk factor for lower respiratory tract infection. Iron deficiency is considered the most common cause of anemia in developing countries. As anemia is highly prevalent in children of our country, this study was undertaken to evaluate whether iron deficiency anemia is associated with acute bronchiolitis. Method: This Cross-Sectional Analytical study was carried out in the Department of Paediatrics, Sir Salimullah Medical College Mitford Hospital (SSMCMH), Dhaka, during the period of December 2021 to November 2022 after obtaining ethical approval to explore the association between iron deficiency anemia and bronchiolitis. Hemoglobin level, RBC indices, TWBC count, serum iron, TIBC level, Transferrin saturation, and PBF were investigated and compared in all children with bronchiolitis and control. For this purpose, a total number of 71 patients were enrolled in the study and among them, 35 children with bronchiolitis were considered as cases, and 36 healthy children without bronchiolitis were considered as control, who were matched with age. After taking written informed consent from parents/legal guardians, a detailed history and thorough clinical examination and laboratory investigations were carried out on each child. Data were recorded in separate case record form and analyzed by SPSS version 23.0. Results: The mean age was found 12.1±6.7 months in cases and 14.1±6.9 months in controls. Male participants (47, 66.2%) were the predominant group in the study and female participants were (24, 33.8%). Exclusive breastfeeding was found in 10 (28.6%) cases and 25 (71.4%) controls. There was a statistically significant difference in Hb (gm/dl), MCV (fl), S.Iron (µg/dl), Transferrin Saturation (%) and RDW-CV (%) between cases and controls (p&lt;0.05). Among 35 cases, 25 (67.6%) had Iron Deficiency Anemia and statistical difference between the case and control was significant (p=0.001) with an odds ratio of 5.0. Conclusion: Iron deficiency anemia has a significant association with bronchiolitis. A larger and more extensive study was recommended.

Comparison of Serum IgE Level between Initial Attack and Relapse Cases of Idiopathic Nephrotic Syndrome in Children

Background: Nephrotic Syndrome (NS) is a common and recurrent glomerular disease in childhood. Although the exact etiology of NS is not fully known, it is believed that immune system plays a pivotal role in its pathogenesis. Studies have been reported a strong association between NS and increased level of serum immunoglobulin E (IgE). In addition, children with recurrent NS, the IgE level significantly increases, and there is a higher relapse rate.&#x0D; Objective: The aim of the study was to determine the difference of Serum IgE level between initial attack and relapse cases of idiopathic Nephrotic Syndrome in children.&#x0D; Methodology: A cross sectional analytical study has been conducted on 35 initial attack and 35 relapse cases of idiopathic Nephrotic Syndrome children admitted in the Department of paediatrics, Sir Salimullah Medical College Mitford Hospital (SSMCMH), Dhaka from May 2021 to April 2022. Study subjects were enrolled by purposive sampling after confirming the diagnosis and fulfilling the inclusion and exclusion criteria. Informed written consent was taken from each patient's legal guardian before enrollment. A detailed history and thorough physical examination was done in each patient on admission. With all aseptic precaution five ml of venous blood was collected and sent for serum albumin, serum cholesterol and serum IgE level measurement. Data were analyzed using the statistical package for social sciences (SPSS) version 23.0. Independent sample t test or Mann-whitney test was used to compare data between groups. P value of less than 0.05 was considered as significant.&#x0D; Results: The mean age of the studied samples was 3.86 (ranging from 2 to 6 years). Moreover, among the studied sample male was a little bit greater than female. A significant prevalence of relapse cases were found among the children with middle income family status (P&lt;0.05).Spot urine protein and creatinine ratio and serum cholesterol level was significantly higher in patients experience relapse attack (P&lt;0.05). However, serum albumin level was quite similar in both cases. The mean serum IgE of patients experiencing relapse attack was 985.11+433.65 which was significantly higher than patients experiencing initial attack 470.48+227.35 (P&lt;0.001). &#x0D; Conclusion: This study showed that serum IgE levels are higher in relapse cases of Nephrotic Syndrome than that of initial attack. Furthermore, serum IgE is more in frequent relapse as compared to infrequent relapse. Serum IgE levels have a positive correlation with disease activity and relapse of Nephrotic Syndrome.

Hepatitis B Screening Program for patients attending out-patient department (OPD) at Sir Salimullah Medical College Mitford Hospital, Dhaka – An Observational Study

Background: Hepatitis B (HBV) is a major cause of chronic hepatitis, cirrhosis of liver and hepatocellular carcinoma in Bangladesh. It is also the most common cause of death from liver disease in the country. The prevalence of hepatitis B is 5-6% in the general population. So the present status of the virus is considered as an important public health concern of Bangladesh. Objectives: To investigate hepatitis B prevalence among the persons attending the OPD and to increase awareness about hepatitis B. Materials and methods: A cross-sectional observational study was carried out the at the Department of Hepatology, Sir Salimullah Medical College Mitford Hospital, Dhaka on March 17&amp;18, 2022 at Special Treatment Campaign on the occasion of celebration of the birth anniversary of the Father of Nation, Bangabandhu Sheikh Mujibur Rahman. A total of 190 people of both sexes from 18 years to 50 years of age group were enrolled in the study. These people were unaware of whether they were carrying hepatitis B virus or also was not aware of whether they are suffering from any kind of liver disease. Informed consent was taken and a pre-designed structured questionnaire was used. Screening was done by HBsAg detection using rapid diagnostic kit. Result: The mean age of respondents was 35.95±6.42 years with a male to female ratio of 0.83. Most of the respondents were married (72.63%) and Muslim (87.37%). Among them 47.36% of the respondents were service holders. Only 17.89% had a previous history of some types of hepatitis. 25.26% of respondents had history of different types of surgical procedure. 8 (4.2%) participants were found positive for HBsAg on the screening test in our study. Conclusion: This study shows 4.2 % of participants were screening positive among the respondents. This correlate with the intermediate prevalence of hepatitis B in Bangladesh as stated in World Health Organization data. Screening program increases knowledge and awareness among the population and thereby increase treatment seeking, which ultimately reduce incidence of disease and complications as well as death. Sir Salimullah Med Coll J 2023; 31: 3-8

A Study of LDL Status of Stroke Patient Admitted in Tertiary Care Hospital

Background: Stroke is the leading cause of morbidity globally and the second most frequent cause of mortality after ischemic heart disease. Previous findings regarding the relationship between lipids and stroke were debatable. Objective: To observe LDL status of stroke patients in tertiary care hospital. Method: This cross-sectional observational study was conducted in the Medicine Unit of Sir Salimullah Medical College Mitford Hospital, Dhaka from August 2011 to January 2012. A total of 104 patients of any sexes who were clinically present with features of stroke and then confirmed on CT scan were included. Patients were randomly enrolled according to the selection criteria. Data were collected using a structured questionnaire. Patients demographic profile, co-morbidities, history of TIA, and lipid profile were collected and recorded. Data were presented as frequency with percentage in case of categorical data and mean and standard deviation in case of numerical data. The Chi- Square test and unpaired t test was used to analyze categorical and numerical data respectively. A value of p &lt;0.5 was considered statistically significant. Statistical software SPSS was used for data analysis. Result: The average age was 62.12±11.65 years. The majority of patients (61.5%) were men, while 38.5% were women. Out of 104 patients, 57.7% had high blood pressure, 33.7% had diabetes, 22.1% had IHD, and 26.0% had had a stroke or TIA in the past. 21.2% of the patients used smokeless tobacco, and about 41.3% smoked cigarettes. 73.1 percent of the patients had ischaemic strokes, and the remaining 26.9 percent had hemorrhagic strokes. It was found that dyslipidaemia was more frequently linked to ischaemic stroke than hemorrhagic stroke. Nearly 78.8% of stroke victims had high LDL levels, 44.2% had low HDL levels, 57.7% had high cholesterol, and 57.7% had high triglyceride levels. Patients who had ischaemic strokes were found to have higher levels of LDL than patients who had hemorrhagic strokes, but the difference was not statistically significant. Conclusion: Elevated LDL cholesterol was found higher in ischemic stroke patients than hemorrhagic stroke patients but there was no significant difference. Sir Salimullah Med Coll J 2023; 31: 53-59

Association of Neonatal AKI with Gestational Age and Birth Weight in Tertiary Care Hospitals of Dhaka City, Bangladesh

Background: Acute kidney injury (AKI) is common in neonatal intensive care unit (NICU) and also in general neonatal ward (GNW) of two tertiary care hospitals (Dhaka Medical College and Sir Salimullah Medical College Mitford Hospital). Association of neonatal AKI with different birth weights (low birth weight, very low birth weight, extreme low birth weight) and gestational age (both term and preterm) has greater impact on AKI. Early detection and immediate management is life saving. Methodology: This prospective observational study carried out in NICU and GNW of DMCH &amp; SSMC Mitoford Hospital over a period of one year to find out the AKI cases within the first 28 days of life. Blood sample collected by plane test tube and send to the laboratory and serum creatinine levels were estimated by auto analyzer (PICTUS-400). AKI was leveled when serum creatinine &gt;1.5 times of medium values. Those AKI patients were evaluated in relation with gestational age &amp; birth weight. After counselling and taking informed written consent from legal guardians, three hundred neonates were enrolled in this study by purposive sampling. The data were collected in a pre-structured questionnaire and analysis by SPSS 22 software. Results: A total of 300 neonates were included in this study. Mean age of the neonates were 5.71±6.70 days (age range 1-28 days). Male were predominant (59.4%). Male and female ratio was 1.46:1. AKI developed in 23.7% neonates. Among them 53.5% was appropriate for gestational age (AGA), 36.6% had LBW and 9.9% had VLBW. Among preterm, term and post term 24.4%, 22.0% and 75.0% developed AKI respectively. Neonatal AKI also associated mostly with perinatal asphyxia (43.8%) and neonatal sepsis (35.21%). Conclusion: AKI developed in 23.7% neonates. AKI prevalence is same in gestational age and birth weight. Sir Salimullah Med Coll J 2023; 31: 73-78

Maternal and Perinatal Outcomes in Women with Preeclampsia: A Case-Control Study in a Tertiary Care Hospital, Dhaka, Bangladesh

Introduction: Preeclampsia is an advanced objection characterized by the new start of hypertension and proteinuria or the new start of hypertension and important end-organ dysfunction with or without proteinuria in the last half of the prenatal period or post-delivery. Long-term, patients with preeclampsia are at enhanced risk for developing cardiovascular and renal disease. The aim of the study was to evaluate the maternal and perinatal outcomes in women suffering from preeclampsia. Methods: A case-control study was carried out in the Department of Obstetrics and Gynecology, Sir Salimullah Medical College Mitford Hospital, Dhaka from July 2020 to June 2021. A total number of one hundred twelve pregnant women (N=112), were enrolled in the study and fifty-six (n=56) were included as preeclampsia (Cases) and another fifty-six (n=56) were enrolled as normotensives (Controls). Data were collected using the predesigned semi-structured questionnaire. Verbal consent was taken before recruiting the study population. Completed data forms were reviewed, edited, and processed for computer data entry. The data analysis was performed using Statistical Package for the Social Sciences (SPSS) Version 25.0. Result: Respondents' mean age was 27.35 ± 4.85 (case) &amp; 26.46 ± 4.86(control) years. Maximum study subjects had only primary education. The majority of the respondents were homemakers in all groups. Respondents' mean gestational age was 36.28 ± 2.12 (case) &amp; 36.57 ± 1.82 (control) weeks respectively and was significant in both case and control groups (p=.001). There was no statistical difference according to gravida found between the cases and controls. Based on maternal outcomes, delivery by cesarean section was greater in cases than in controls (p&lt;0.001), &amp;eclampsia (p&lt;0.001) and PPH (p=0.002) were significantly lower in controls than cases. Based on the neonatal outcome, birth weight was significantly lower in cases than in controls (p=0.020), and stillbirth was significantly lower in controls than cases (p=0.042). Conclusion: Preeclampsia may be linked to complications with the placenta initially in the pregnancy. A very little amount of maternal complications and fetal complications rose in this current analysis and the result of the findings was satisfactory.

Pathophysiological Effect of Enlarged Adenoid on Middle Ear in Children

Objective: To identify the incidence of otitis media with effusion (OME) in children with enlarged adenoid. Methodology: This is a cross sectional observational study was carried out at Department of Otolaryngology and Head Neck surgery of Sir Salimullah Medical College Mitford Hospital, Dhaka from July 2014 to June 2016. One Hundred and Fifty (150) children with enlarged adenoid were included in this study. All patients were subjected for history, local physical examination, evaluation of adenoid size by X ray of nasopharynx lateral view. Pure tone audiometry &amp; tympanometry were done in all patients. Informations were recorded in a specially designed data collection sheet. Result: Among 150 children with enlarged adenoid 30(20%) patient had OME, majority of patients (60%) were age group 7-9 years. Male were predominant (60%) than female (40%). Among 150 patients grade- I was 16%, grade II- was 26%, grade-III was 54% and grade IV was 4%.According to the grading of enlarged adenoid cases , grade I, grade II , grade III and grade IV had 8.33%,15.38% ,23.46% and 50% cases had OME respectively. Hearing loss was in 33(22%) children. According to tympanometry, type A curve was in 118(78.67%) children, type B 26(17.33%) and type C 6(4%) children. Conclusion: Enlarged adenoid is associated with otitis media with effusion. Incidence of Otitis media with effusion increases with the proportion of severity of nasopharyngeal obstruction by enlarged adenoid. Bangladesh J Otorhinolaryngol 2023; 29(1): 11-16

Accuracy of transient elastography in Identifying fibrosis among patients with Chronic hepatitis b: a cross-sectional Observational study

Background: Hepatitis B virus (HBV) infection is a significant global public health problem, affecting millions of people worldwide. Liver biopsy is the gold standard for assessing fibrosis but is invasive and carries post-procedural risks. Noninvasive tests to evaluate liver fibrosis are needed, and transient elastography is one such method. This cross-sectional observational study aimed to assess the accuracy of transient elastography in identifying fibrosis among patients with chronic hepatitis B.&#x0D; Methods: The study was conducted at the Department of Medicine and Hepatology, Sir Salimullah Medical College Mitford Hospital, Dhaka. The study subjects were patients diagnosed with chronic hepatitis B infection, both outpatient and inpatient cases. Data were collected from 25 patients using convenient and purposive sampling techniques. Demographic data, clinical examination, and relevant investigations were recorded in a structured case report form. Data were processed, registered, edited, computerized, and analyzed.&#x0D; Results: The study included 25 patients with a mean age of 26.8±6.5 years, predominantly male (80%). All patients were HBsAg positive, 12.0% were HBeAg positive, and 56.0% were antiHBe positive. The mean HBV DNA PCR was 1516293.4±7475976.3 IU/ml. The mean ALT level was 45.4±13.8 U/L. The mean liver stiffness measurement (LSM) was 7.5±2.3 kPa, with 64.0% of patients showing fibrosis stage F0-F1. The mean periportal +/- bridging necrosis was 2.92±1.58, intralobular degeneration and focal were 1.16±0.55, portal inflammation was 2.52±0.87, histological activity index was 6.6±2.2, and fibrosis score was 1.44±1.04. Positive correlations were observed between LSM and histological activity index (r=0.239; p=0.251) and between LSM and fibrosis score (r=0.107; p=0.612).&#x0D; Conclusion: Our study demonstrates that transient elastography provides a non-invasive, easy, and cost-effective method for identifying fibrosis in chronic hepatitis B patients, serving as a potential alternative to liver biopsy.&#x0D; Bangladesh J Medicine 2023; 34(3): 199-205

Serum Cholinesterase Level in Patients with Cirrhosis of Liver and Its Correlation with the Severity of the Disease

Background: Serum cholinesterase mainly comes from the liver, a sensitive indicator of the synthetic capacity of the liver. It can be used as a prognostic marker for cirrhosis.&#x0D; Objectives: To measure the serum cholinesterase level in cirrhotic patients and to correlate its level with the severity of the disease as per the Child-Pugh score.&#x0D; Methodology: This cross-sectional study was conducted in the Department of Gastroenterology, Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh, from January 2018 to December 2018. Fifty adult patients with cirrhosis of the liver were enrolled. Fifty healthy individuals were also taken to compare serum cholinesterase levels. Cirrhotic patients were grouped strictly into A, B, and C classes, as per the Child-Pugh score. Serum cholinesterase level was measured in all participants. The correlation between cholinesterase level and the severity of the disease was analyzed.&#x0D; Result: Mean age of the patients was 47.42 ± 12.40 years and 47.22 ± 11.99 years in cirrhotic patients and healthy group, respectively. The number of patients in the Child-Pugh A, B, and C subgroups was 12 (24%), 20 (40%), and 18 (36%), respectively. The mean serum cholinesterase level was 2938 ± 1561 U/L in cirrhotic patients and 9036 ± 2024 U/L in the healthy group. Serum cholinesterase level in different Child-Pugh class was 4740 ± 1046 U/l (Child A), 3157 ± 1161 U/l (Child B), and 1493 ± 500 U/l (Child C). Serum Cholinesterase was positively correlated with serum albumin and negatively correlated with bilirubin, prothrombin time, and INR. A negative correlation was found between serum Cholinesterase level and the severity of the disease.&#x0D; Conclusion: Serum cholinesterase level was low in cirrhotic patients, and its level was inversely correlated with the severity of the disease. Thus it can be used as a prognostic marker of cirrhosis. However, further study with a large sample size could explain this more precisely.&#x0D; TAJ 2022; 36: No-1: 33-40

Serum adiponectin profile in obese Bangladeshi children attending an obesity clinic

Background and objective: Childhood obesity plays major role in the pathogenesis of various cardiovascular and metabolic diseases. Serum adiponectin has been found to be associated with several cardiometabolic risk factors. The study investigated the serum adiponectin levels and its relationship with obesity and cardiometabolic risk factors in Bangladeshi obese children. Material and methods: Overweight or obese children, between 6-18 years of age, attending the obesity clinic of the Department of Endocrinology, BSMMU were enrolled. Waist circumference (WC) and blood pressure (BP) were measured and blood samples were taken for estimation of glucose, insulin, lipid profile and adiponectin. Fasting plasma glucose (FPG), serum insulin and lipid profile were estimated by automated analyzer. Insulin resistance (HOMA-IR) was calculated from fasting insulin and fasting plasma glucose values. Serum adiponectin (total) was measured by ELISA method using DRG ELISA kit, Germany. Results:A total of 78 overweight or obese children of 6-18-year of age were enrolled. The mean (±SD) age of the study population was 12.22 ± 2.56 years and the mean BMI was 28.79 ± 4.54 kg/m2. Mean (±SD) serum adiponectin was 36.93 ± 17.85 µg/ml in 78 overweight/obese children. One way ANOVA showed no significant (P= 0.582) difference of adiponectin levels among children with overweight and different grades of obesity. There was no significant correlation between adiponectin and measures of generalized (r=0.035, p=0.763) or central (r=0.098, p=0.392) obesity. Also, no significant correlation was found between serum adiponectin level and any of cardiovascular risk factors of obesity or metabolic health. Conclusion: The study showed high serum adiponectin level in obese Bangladeshi children. Also, no association was found between serum adiponectin levels with grades of obesity and cardiometabolic risk factors among obese children of Bangladesh. IMC J Med Sci. 2023; 17(2):009. DOI: https://doi.org/10.55010/imcjms.17.019 *Correspondence: Palash Chandra Sutradhar, Department of Medicine, Sir Salimullah Medical College Mitford Hospital, Kotwali, Dhaka-1000, Bangladesh. Email: palashdmc@gmail.com

Association of 99MTC- Hmpao Spect Measured Regional Cerebral Blood Flow And Serum Vitamin D Level With Clinical Staging of Parkinson’s Disease

Background: Parkinson’s disease (PD) is the most common neurodegenerative movement disorder. Diagnosis of PD can be made through Single-photon emission computed tomography (SPECT). Vitamin D deficiency has recently been proposed as a potential risk factor for PD. This study aimed to evaluate the association of 99mTc- HMPAO SPECT image findings and vitamin D status with clinical staging of PD. Methods: This cross-sectional study was conducted in Department of Neurology, Sir Salimullah Medical College Mitford Hospital for a period of 12 months. Total 66 diagnosed PD patients were included after taking informed written consent. Detailed demographic history and neurological examination were done. The severity of PD was assessed using the modified Hoehn and Yahr (H &amp; Y) scale. Serum 25-Hydroxyvitamin D level was measured for each participant. 99mTc- HMPAO SPECT imaging was done at Institute of Nuclear Medicine and Allied Sciences. Results: The mean age of the studied respondents was 71±8.72 (SD) years wherein maximum were male (59.1%) and aged above 70 years. The most common symptoms among the patients were tremor (78.8%) and bradykinesia (75.5%).The mean duration of PD was 5.74±2.22 (SD) years. Majority of the patients were diagnosed to have stage-2 (30.3%) followed by stage-2.5 (24.2%), stage-3 (16.7%), stage-4 (7.6%), stage-1 (4.5%), and stage-5 (3%). As the clinical stage of PD advanced from stages 1-5, the HMPAO uptake reduced significantly in the basal ganglia (p=0.006) .Vitamin-D level decreased significantly as the disease severity progress from stage-1 (27.8 ng/ml) to stage-5 (19.5 ng/ml) (p-value=0.008). Conclusion: Serum Vitamin-D level was inversely associated to severity of PD and decreased regional cerebral blood flow in basal ganglia in advanced stages of PD patients. However, further larger study is recommended. Bangladesh J Medicine 2023; 34(2): 112-120

Assessment of Health Performance and Outcome with Disease Profile among Paediatrics Population of a Non COVID Tertiary Care Hospital in Bangladesh in COVID Era

Background: Hospital based data of diseases profile are reflection of community at large. Being in COVID pandemic era, knowledge of disease pattern and outcome in children is crucial for proper resource allocation and health care planning. Performance evaluation of each hospital has become central to the concept of quality improvement. Objective: to evaluate disease pattern and outcome of a non COVID hospital in COVID era. Methodology: This retrospective descriptive study was conducted in pediatric unit (1 months to 14 year) of Sir Salimullah Medical College Mitford Hospital from January, 2021 to December, 2021. Medical records were reviewed and analyzed for age, gender, disease, duration of hospital stay, bed occupancy rate and outcome. Results: Total 4346 patients were admitted of which male is 68%. Most admission was in between 1 month to 12 months of age which is 48.5%. Bronchopneumonia, Dengue and Bronchiolitis became the top 3 cause of admission. 70% patients stayed less than 7 days. 2% patients were referred of which maximum were later diagnosed as COVID-19 patients. Bed Occupancy rate was 138% and Bed Turn Over rate was 72.4 patients/bed/year. Mortality rate was 1.6%. Conclusion: To achieve SDG 3 goal by 2030, assessment of hospital performance as well as disease profile of each hospital is needed for proper resource allocation and community improvement. Sir Salimullah Med Coll J 2022; 30: 168-174

Evaluation of Blood Requisition Forms Submitted to Transfusion Medicine Department of a Tertiary Care Hospital in Dhaka, Bangladesh

Introduction: Blood requisition form (BRF) analysis is one of the most efficient and effective approaches to assess and monitor rational use of blood and its product. BRF is the first line of communication between the clinicians and transfusion medicine specialists which helps to recognize and evaluate inappropriate use of blood. This issue is frequently underrated by the clinicians which results in increased risk of inappropriate transfusion. The current study is aimed to examine the pattern of completion of blood requisition forms and to ensure safe blood transfusion. Materials and methods: This cross sectional prospective study was conducted from January 2020 to December 2021, at the Department of Transfusion Medicine, Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh. A total of 32,133 blood requisition forms that were submitted during the study period were compiled and reviewed anonymously. The data were analyzed using Microsoft Excel. Results: During the study period, a total of 32,133 Blood requisition forms were analyzed. Only 15.2% of these forms were duly completed. Rest of the forms had one or more important parameters left blank. The most common incomplete BRF items were the clinical history or differential diagnosis of the patient (52.66%), presumed date and time of transfusion (95.19%), previous transfusion history (95.9%), and referring doctor’s name and designation (88%). Blood requests were more for females (52.02%) than males (47.98%) during the period. Requisitions were more for adults (90%) than pediatric patients. Conclusion: The current study provides evidence that the rate of completion of BRFs is not satisfactory. The request forms evaluated were not covering acceptable demographic and clinical data of the patients. Both the Hospital Transfusion Committee (HTC) and the Department of Transfusion Medicine can help to improve and standardize transfusion practice by working together. Sir Salimullah Med Coll J 2022; 30: 142-147

Comparison of Outcome of Unilateral Modified Bladder Neck Incision and Tamsulosin Therapy in the Treatment of Primary Bladder Neck Obstruction in Young Men

Background: Primary bladder neck obstruction (PBNO) is a condition in which the bladder neck does not open appropriately or completely during voiding. Symptoms caused by primary bladder neck obstruction includes storage symptoms (Frequency, Urgency, Urge incontinence, nocturia) and voiding Symptoms (Poor urinary stream, hesitancy, incomplete emptying of bladder). Objective: To compare outcome of unilateral modified bladder neck incision with tamsulosin therapy in primary bladder neck obstruction in young men. Materials and Methods: This hospital based quasi-experimental study was conducted in the department of urology, Sir Salimullah Medical College Mitford Hospital. Patients with the diagnosis of primary bladder neck obstruction included in this study. Total 44 cases were included. Among them 18 were treated with unilateral modified BNI (Group A) and 26 were treated with tamsulosin therapy (Group B). Results: The mean age was found 31.11±4.77 years in group A and 34.15±5.42 years in group B. At 3rd and 6th month mean uroflowmetry (Qmax) was statistically significant (p&lt;0.05) when compared between two groups. However, in group A and group B uroflowmetry (Qmax) was significantly increased when compared initial vs 3rd month and initial vs 6th month respectively. The study observed that after 3rd month following the treatment the retrograde ejaculation was not found in group A and 1(3.8%) found in group B. At 6th month retrograde ejaculation was not also found in group A and found 2(7.7%) in group B. At 3rd and 6th month retrograde ejaculation was not statistically significant (p&gt;0.05). Conclusion: The outcome of unilateral modified BNI is better than tamsulosin therapy. All others adverse effect of both medical and surgical treatment was mild and transient that was acceptable in clinical practice. Sir Salimullah Med Coll J 2022; 30: 155-160

Impact of Peroperative Intravenous Lidocaine on Postoperative Analgesia in Laparoscopic Cholecystectomy

The present study was undertaken to evaluate the outcome of peroperative intravenous lidocaine in reducing the intensity of postoperative pain after laparoscopic cholecystectomy.This prospective randomized clinical trial study was conducted in the Department of Anaesthesiology, Sir Salimullah Medical College Mitford Hospital (SSMC MH), Dhaka between April 2014 to September 2014. A total of 80 patients of chronic cholecystitis or cholelithiasis undergoing laparoscopic cholecystectomy in SSMC MH, Dhaka were consecutively included in the study and were randomly assigned to two study groups. Patients in the study group received I/V lidocaine administration @ 3 mg/kg/h and those in the control group received normal saline (0.9% saline) in the same volume by a different observer. When compared the changes in haemodynamic variables from baseline to endpoint of the study shows that there was no significant difference between the groups in terms of heart rate, systolic, diastolic and mean blood pressures except a sudden rise of the parameters at 5 minutes after induction. However, the systolic blood pressure of study group experienced a slight reduction from 30 minutes onwards to the end of the observation and differed significantly from the corresponding SBPs of the control group. The mean BP of both the groups also showed similar trend like systolic BPs.The SpO2 in both study and control groups was maintained at 99 to 100% throughout the study. The study concluded that peroperative infusion of nontoxic dose of lidocaine decreases the intensity of postoperative pain and reduces the postoperative analgesics(inj. Pethidine) requirement without causing any significant adverse effects. Sir Salimullah Med Coll J 2022; 30: 148-154