Sir Salimullah Medical College Research Articles

Association between lymphovascular invasion (LVI) and prognostic factors in breast cancer.

Background: The presence of tumor cells within lymphatic or blood vessels in the surrounding tissue of a malignant tumor indicates the possibility of cancer spreading (metastasis) to other parts of the body. Lymphovascular invasion (LVI) is a significant pathogenic feature in invasive breast cancer that can provide valuable information about the tumor's aggressiveness and influence therapy options. Objective: To the association of LVI with prognostic factors in breast cancer. Methods: This cross-sectional study was conducted in the Department of Surgery, Sir Salimullah Medical College and Mitford Hospital, on 52 adult breast cancer patients who received Breast Conserving Surgery (BCS) or mastectomy. No patients with neoadjuvant therapy (recurring, breast cancer, metastases, or advanced breast cancer were excluded). Patients' demographic data, clinical data, and lab diagnoses were obtained. Histopathology and immunohistochemistry were performed on all samples. ER, PR, and Ki-67 were correlated with histological results. Pathologists diagnosed LVI in surgical resection tissue. All data were validated for consistency after collection. Data were analyzed using SPSS 12.0. A p value < 0.05 was considered statistically significant. Results: The presence of ER and PR was significantly higher in cases where LVI was negative. On the other hand, the presence of Ki-67 was significantly higher in cases where LVI was positive. It was observed that cases with LVI positive had higher stages of lymph nodes metastasis and tumor grading. It was also found that the Ductal type of breast cancer was significantly higher in cases where LVI was negative. Additionally, LVI positive case was found to be significantly higher among aged people. Conclusion: The presence of lymphovascular invasion has a negative association with ER, PR, and ductal type breast cancer and is positively associated with ki67, high grade, and greater lymph node metastasis. J Shaheed Suhrawardy Med Coll 2022; 14(2): 35-38

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 <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<0.001), higher rate of partial recovery with complications (OR: 7.302; 95.325% CI: -20.997; p<0.001). <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&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 (<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

Effect of Cigarette Smoking on Selected Coagulation Parameters in Apparently Healthy Male Smokers

Background: Smoking is a significant global health concern associated with increased mortality and morbidity, including cancer development. Tobacco smoke contains carcinogens that can disrupt cellular processes and immune function, potentially affecting coagulation parameters. Objective: This study aimed to investigate the impact of smoking on selected coagulation parameters in apparently healthy male smokers compared to non-smokers. Method: A cross-sectional analytical study was conducted at the Department of Physiology, Sir Salimullah Medical College (SSMC) in Dhaka, Bangladesh, from July 1, 2018, to June 30, 2019. Seventy male participants aged 20 to 40 years were enrolled, comprising 35 healthy non-smokers (Group A) and 35 male smokers (Group B). Smokers (Group B) were further categorized into two groups based on pack-years of smoking (group B1 and group B2). Coagulation parameters including prothrombin time (PT), activated partial thromboplastin time (APTT), bleeding time (BT), and clotting time (CT) were assessed. Results: In this study, age and BMI were almost similar between groups A (healthy non-smokers) and B (smokers), with mean (± SD) ages of 33.17 ± 2.91 and 34.11 ± 3.18 years, and mean (± SD) BMI values of 24.36 ± 2.28 and 24.68 ± 2.33 kg/m2, respectively. There was no statistically significant disparity between the two groups, indicating successful age and BMI matching. Smokers (group B) exhibited significantly lower mean (± SD) prothrombin time (PT) values (11.56 ± 0.87 seconds) compared to non-smokers (13.07 ± 0.77 seconds), with a statistically significant difference (p < 0.001). Similarly, activated partial thromboplastin time (APTT) was significantly decreased in smokers (28.42 ± 2.00 seconds) compared to non-smokers (31.50 ± 1.00 seconds) (p < 0.001). Bleeding time (BT) and clotting time (CT) were also significantly reduced in smokers (2.40 ± 0.24 minutes and 5.35 ± 0.29 minutes, respectively) compared to non-smokers (3.48 ± 0.36 minutes .....

Challenges of Online Medical Education During the COVID-19 Pandemic Faced by 3rd and 4th Year Medical Students of Sir Salimullah Medical College, Dhaka

Background: Online education is a form of education where students use their home computers through the internet staying away from academic institutions. Due to the emergence of the pandemic of COVID-19, the whole world is experiencing number of huge deaths along with widespread panic and uncertainty. Countries of the world are trying to fill the gap and minimize the losses of students caused by the ongoing pandemic. Objective: This study mainly explores the challenges of online medical education during COVID-19 pandemic faced by 3rd and 4th year medical students of Sir Salimullah Medical College, Dhaka, Bangladesh. Methodology: This Descriptive cross-sectional study was conducted in Sir Salimullah Medical College, Dhaka from January 2021 to December 2021. A weblink of survey was shared with 439 3rd and 4th year medical students and 309 responses were obtained. Data were collected by using pretested semi structured questionnaire by face-to-face interview and by online google form due to COVID-19 pandemic situation and sample were collected by purposive sampling. Result: Among 309 respondents, 60.2% were female and 39.8% were male, 95.8% respondents were Bangladeshi, 46.3% respondents’ family income were around 30000 taka, 64.4% respondents lived in city, 22% respondents faced some challenges regarding internet connection, 8.41% respondents faced knowledge about internet browsing, 5.18% respondents faced problem regarding time management and 3.8% respondents faced problem about the adaptation of new method of learning. Despite these challenges 59.2% of the respondents reported positive response about beneficial effect of online classes and half (52.8%) of the respondents were satisfied with online classes. Conclusion: In medical education face-to-face education is essential. But due to lockdown there was no scope of practical and face to face education during COVID-19 pandemic situation. This study showed that there were some positive and negative impacts of online education. Eastern Med Coll J. July 2023; 8 (2): 7-12

Evaluation of Serum Triglyceride and TG/HDL-Cholesterol Ratio in Good and Poor Control Type-2 Diabetes Mellitus

Introduction: Patients with type-2 diabetes have an increased prevalence of dyslipidemia, which contributes to their high risk of cardiovascular diseases. The mortality and morbidity are increased if there is poor glycemic control. Diabetic dyslipidemia is characterized by elevated TG levels, decreased HDL-C levels and increased levels of LDL-C. The aim of this study was to evaluate serum triglyceride and TG/HDL-cholesterol ratio in good and poor control type-2 diabetes mellitus. Methodology: The present study was carried out in departments of Biochemistry, Medicine and Endocrinology of Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh between the periods of July 2020 to June 2021. By convenient sampling, a total of 50 subjects aged between 30-59 years were enrolled in this study. Study subjects were divided into 2 groups. Group-A included subjects with good glycemic control (n=25) and group-B included subjects with poor glycemic control (n=25). Results: The mean HbA1c level was significantly higher in poor glycemic group than good glycemic group (10.9±12.02% vs. 5.98±0.95%). The mean TG was 173.16±36.9 mg/dl in good glycemic control group and 219.4±70.32 mg/dl in poor glycemic group. There was significant difference in TG/HDL-C ratio in 2 groups. Serum triglyceride and TG/HDL-C ratio had positive correlation with HbA1c but was not significant. Conclusion: Poor glycemic control is associated with dyslipidemia in Type-2 Diabetes Mellitus. Eastern Med Coll J. July 2023; 8 (2): 24-28

Evaluation of Gene Xpert Test of Stool Specimen with that of Induced Sputum as Gold Standard

Background: Globally Tuberculosis (TB) is a major infectious disease. In 2011, there were an estimated 8.7 million new cases with 6% childhood tuberculosis. The majority of the cases occurring in high TB burden countries worldwide. Confirmed diagnosis of childhood TB remains challenging for physicians. MT test and Chest X-ray usually has very little diagnostic value for the diagnosis of pulmonary tuberculosis in children who has symptom criteria suggestive of PTB. Objectives: This study was done to evaluate of Gene Xpert Test of Stool Specimen with that of Induced Sputum as Gold Standard. Methods: The cross-sectional study was conducted in the Department of Pediatrics, Sir Salimullah Medical College & Mitford Hospital from January 2020 to June 2021. A total of 48 subjects of both sexes with the age range from 1 month to 59 months were included in the study. Data were collected over a period of eleven months and analyzed by appropriate computer based programmed software Statistical Package for the Social Sciences (SPSS), version 22. Results: In this study, most of the children 14 (29.2%) lies between 13 months to 24 months. About most of the children 28 (58.33%) were male and 20 (41.67%) children were female. According to the clinical presentation majority of the children present with fever 39(75.0%), followed by cough (72.9%) and weight loss (50%), history of contact was present in 15 (31.3%) children. Chest X-ray of 54% children was suggestive of PTB (as Consolidation, Milliary mottling, patchy opacity etc) 46% showed normal X-ray findings. Gene X-pert of Induced sputum could detect M.Tuberculosis in case of 12.5% children and in 87.5% cases Gene X-pert could not detect M.Tuberculosis in induced sputum. M.Tuberculosis was detected by Stool X-pert in 18% of children who were clinically diagnosed as PTB. In 82% of patient stool X-pert could not detect M.Tuberculosis. Conclusion: Gene Xpert test of stool specimen is a relatively easy test for the diagnosis ........

Association between Serum Ferritin and Insulin Resistance Markers with Distinct Glycemic Profiles in an Adult Bangladeshi Population

Background: Type 2 diabetes mellitus (T2DM) is a global health concern. Around 56% of subjects in Bangladesh go undiagnosed, increasing the risk of stroke and cardiovascular issues. Iron stores' impact on diabetes is gaining attention, with ferritin as a key biomarker. Hyperferritinemia probably contributes to insulin resistance and subsequently to decreased insulin secretion, causing the development of insulin resistance. The link between ferritin and insulin resistance (IR) varies based on ethnicity, gender, and glycemic state. Objectives: This study investigates serum ferritin levels in different glycemic stages and explores potential correlations between ferritin and insulin resistance markers (blood glucose, serum insulin, and HOMA-IR) Methods: The study was conducted at the Department of Biochemistry, Sir Salimullah Medical College, Dhaka, Bangladesh, from March 2018 to February 2019. A total of 140 subjects were included to conduct this study. Participants were categorized into three groups: those with normal fasting glucose (NFG group), impaired fasting glucose (IFG group), and newly diagnosed type 2 diabetes mellitus (Diabetic group) according to WHO (2006) criteria. A purposive convenient sampling method was used, focusing on adults aged 25 to 55 years. Exclusion criteria were applied to eliminate individuals with inflammatory diseases, chronic conditions, major cardiovascular events, anemia, or specific medications that could affect ferritin levels. Results: The study found that serum ferritin levels significantly differed among three glycemic groups (NFG, IFG, and T2DM) with higher levels in T2DM. IFG and T2DM groups also had elevated serum insulin and HOMA-IR. Serum ferritin correlated strongly with fasting blood glucose, serum insulin, HOMA-IR, and BMI. The highest tertile of ferritin levels were associated with the IFG & diabetic group. Conclusion. Elevated serum ferritin levels in IFG and type 2 diabetes may significantly impact glucose regulation. Compared to NFG, there are high insulin resistance markers (fasting insulin, glucose, HOMA-IR) in T2DM and IFG. They have crucial implications for both therapy and prognosis in these conditions. Mugda Med Coll J. 2023; 6(2): 57-63

Role of Computed Tomography in Differentiating between Benign and Malignant Gallbladder Masses with Histopathological Correlation

A cross-sectional study was done to evaluate computed tomography (CT) scans as a diagnostic tool for distinguishing between benign and malignant gallbladder masses corroborated by histopathological findings. The study was conducted in the Department of Radiology & Imaging of Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh, between January and December of 2013. The study included a total of 45 patients who were ultrasonographically diagnosed with gallbladder masses. Later, those patients underwent CT scans using a 16-slice helical CT scan machine. All CT scan findings were interpreted by the specialist radiologists, focusing on lesion involvement, contrast enhancement characteristics, and invasion into adjacent structures. Postoperative tissues were examined histopathologically, and these findings were correlated with the CT scan results. The study revealed a higher prevalence of GBC in females (73.33%) and in the age group of 40-60 years. CT scans indicated malignancy in 84.44% of cases, which was confirmed as adenocarcinoma in 88.89% of cases through histopathology. The sensitivity, specificity, and accuracy of CT scans for detecting malignant gallbladder masses were 90.24%, 75.00%, and 88.89%, respectively. For benign masses, the corresponding values were 75.00%, 90.24%, and 88.89%. The positive predictive value was notably high at 97.37% for malignant masses but lower at 42.86% for benign masses. CT scans demonstrated high sensitivity and specificity in the diagnosis of malignant gallbladder masses, corroborated by histopathological findings. The study underscores the utility of CT scans as an effective, non-invasive diagnostic tool for early detection and management of gallbladder masses, although caution is advised in interpreting benign results due to a lower positive predictive value. CBMJ 2024 January: vol. 13 no. 01 P: 22-27

Electrophysiological Evaluation of Common Peroneal Nerve in Chronic Cigarette Smokers.

Background: Researchers have identified multiple negative health effects of smoking on the respiratory and cardiovascular systems. It was recently reported that substances in cigarette smoke also have pathological effects on peripheral nerves, which causes neuronal impairment. The common peroneal nerve conduction study is an essential electrodiagnostic test of the lower limb for the detection of peripheral motor nerve dysfunction.Objectives: To assess the potential influence of smoking on the electrophysiological status of common peroneal nerve in young male chronic cigarette smokers.Materials and Methods: This case-control study was conducted in the Department of Physiology, Sir Salimullah Medical College, Dhaka, from July 2017 to June 2018, including thirty male cigarette smokers aged 25 to 40 years. For comparison, another thirty age and BMI-matched healthy male non-smoker subjects were selected in the control group. The electrophysiological parameters (distal latency, amplitude, and motor nerve conduction velocity) of the left common peroneal nerve were evaluated by standard methods in the Department of Neurology, Dhaka Medical College Hospital. For the statistical analysis, an independent t-test was performed.Result: In this study, the mean distal latency of the common peroneal nerve was slightly prolonged, while the mean amplitude was slightly reduced in smokers. However, these changes were not statistically significant. However, the motor nerve conduction velocity was significantly (p ˂ 0.05) slower in cigarette smokers compared to non-smokers.Conclusion: Chronic cigarette smoking causes significant impairment of common peroneal motor nerve conduction, while it does not affect the amplitude in young individuals. KYAMC Journal Volume: 14, No: 03, October 2023: 111-115.

Electrophysiological variations of Guillain-Barre syndrome in Bangladesh- Hospital based study

Introduction: Guillain-Barre syndrome (GBS) is an immune mediated disorder of peripheral nerves which usually presents by rapidly evolving ascending weakness & mild sensory loss and hypo- or areflexia. Electrodiagnostic study (EDS) is the basis for classification of different subtypes of the disease. EDS also has a crucial role in diagnosis, ruling out of some differential diagnosis like myopathic and motor neuron disorders and confirming the neuropathic nature of GBS. The benefit of immunotherapy is greatest when introduced early. In addition, electrophysiological characteristic can predict the prognosis of patients with GBS. This study was conducted to determine the predominant subtype and electrophysiological pattern of GBS in the context of Bangladesh. Objectives: Objective of this study was to compare the electrophysiological variations among different electrophysiological subtypes of GBS. Methods: It is an observational cross sectional study conducted in Department of Medicine and Neurology, Sir Salimullah Medical College & Mitford Hospital and National Institute of Neuroscience (NINS), Dhaka, over a period of one year & four months. Total 30 patients were selected by purposive sampling technique. Demographic data were collected from the patients and recorded in structured case report form. Clinical examination and relevant investigations were done meticulously. Collected questionnaire were checked to identify any error in data. Data was analyzed with SPSS version 21 software. Result: In this study, maximum numbers of patients 53% were between 21-30 years of age group with mean value 27.47±8.1 years. Male to female ratio was 1.7:1. Frequency of Guillain-Barre syndrome is predominance at middle age group. Commonest presentation was limb weakness (parapledgia or quadripledgia) in 60% patients, paresthesias & numbness (40%), pain (100%) and deviation of mouth (63%) of GBS patients. Cerebrospinal fluid shows a mild pleocytosis (5 to 50 cells/µl) in majority of cases was found in 76% of patients. Whereas elevated CSF Protein (>45 mg/dl) was seen in all GBS patient. Increased distal motor latency (DML) was found in 93% patients, whereas 7% patients had normal DML. In the case of the lower limbs, increased distal motor latency was predominant. Decreased amplitude of sensory nerve action potential (SNAP) was seen in 83% patients while 16% patients had normal. Slowing of motor conduction velocities, decreased amplitude as well as increase in distal motor latencies were observed, being more pronounced in the lower limbs. F-wave was completely absent in 20.0% patients while 20% patients showed decreased conduction velocity with prolonged latency. Sensory nerve action potential revealed that decreased sensory conduction velocity (SCV) was seen in 26%, absent SCV in 10% and normal SCV in 63% patients. Present study demonstrated that Acute inflammatory demyelinating polyneuropathy (AIDP) was the commonest type of Guillain-Barré syndrome, present in 56% of patient. Around 30% of the patients belonged to acute motor axonal polyneuropathy (AMAN) and 13% were acute motor sensory axonal polyneuropathy (AMSAN). Conclusion: In this study AIDP was the most frequent subtype. The characteristic findings supportive of AIDP include prolonged distal motor latencies, reduced conduction velocities, conduction blocks at non-entrapment sites, temporal dispersion and prolonged F wave latencies. J MEDICINE 2024; 25: 11-16

Risk factors, Clinical presentation and In-hospital Outcome of Acute Myocardial Infarction in Elderly Patients

Background: Coronary artery disease (CAD) is the leading cause of mortality, morbidity in the developed and developing country. Ageing is important risk factor for coronary artery disease. The role of conventional cardiovascular risk factors in older persons is incompletely understood because only fragmentary and inadequate data are available in most instance and manifestations of acute myocardial infarction are generally believed to be atypical in the elderly. The aim of the study was to find out the clinical presentation, common risk factors and In-hospital Outcome of Acute Myocardial Infarction in Elderly Patients. Methods: An observational study in tertiary level hospital. Study protocol was approved by ethical review committee of Sir Salimullah Medical College & Mitford Hospital, Dhaka. Sample was selected from the population by purposive sampling technique. Detail demographic data were collected from the subject and recorded in structured case report form. Researcher makes contact with patient and patients caregiver, and describe them about study aim-objective, and then informed consent was taken. All collected questionnaire checked very carefully to identify the error in the data. Data processing work were consisting of registration of schedules, editing, coding and computerization, preparation of dummy tables, analysis and matching data. Result: In this series, the maximum number of patients (57.0%) was between 60-69 years age group, with mean value 67.21 ± 9.05 years. Out of 100 cases (62%) cases were male and (38%) were female (Figure 1). Male – female ratio was 1.63:1. Large numbers of respondents came from urban area (58%). Among the patients the poor class (44%) comprising the major percentage of the myocardial infarction patients. In this study majority (58%) of the patients had sedentary lifestyle before the onset of myocardial infarction. Among all the risk factors hypertension was the most common risk factor, present in 62% cases; next common risk factors were Diabetes mellitus 56%, dyslipidemia 32%, obesity 22%, smoking 40%. In this study majority of patients (56%) presented with shortness of breath as predominant symptoms. Besides typical chest pain others important atypical symptoms were atypical chest pain (31%), upper abdominal pain (18%), giddiness (4%) and confusional state (3%). In this study many of the patients had developed acute LVF (34%), arrhythmia (17%), cardiogenic shock (8%). Conclusion: We concluded that the manifestations of AMI are more subtle in the elderly, with different risk factors. The elderly subjects are under thrombolysed and have higher complication rate. Bangladesh J Medicine 2024; 35(1): 9-14

Association of Serum Uric Acid and Liver Enzymes in Adults at Tertiary Level Hospital in Bangladesh

The level of serum uric acid (SUA) has been linked to metabolic syndrome, diabetes, and cardiovascular disease. The purpose of this study was to evaluate the relationship between SUA and serum liver enzymes in a Bangladeshi adult population. This cross-sectional study was conducted among apparently healthy adults aged >18 years, from March 2019 to February 2020 at the Department of Biochemistry, Sir Salimullah Medical College (SSMC), Dhaka. SUA, liver enzymes, lipid profile and other biochemical markers were measured in the collected samples by using standard methods. All statistical analyses were performed by using SPSS version 22.0 software and p<0.05 was considered statistically significant. A total of 140 subjects were selected and blood sample were collected for biochemical analysis. Among them 70 were male and 70 were female. Serum uric acid (SUA), Alanine transaminase (ALT), Aspartate aminotransferase (AST) and Gamma-glutamyl transferase (GGT) levels were significantly (p<0.001) higher in male than female group. Pearson’s correlation analysis showed that there were significant positive correlation between SUA and serum ALT, AST, GGT (p<0.001). However, it also showed significant positive correlation between SUA and total cholesterol (TC), triglycerides (TG), low density lipoprotein cholesterol (LDL-C), while negative correlation was found between SUA and high density lipoprotein cholesterol (HDL-C) (p<0.001). The role of SUA in the prediction of elevated liver enzymes showed area under the ROC Curve (AUC) 0.839 for ALT, 0.848 for AST and 0.809 for GGT respectively. SUA is positively related with ALT, AST, GGT in adults. More prospective studies are needed to clarify the complex relationship between SUA and liver enzymes in the general population. Bangladesh Med J. 2022 Sept; 51(3): 18-27

Association of Serum Electrolytes Level with Premenstrual Syndrome

Background: Premenstrual syndrome (PMS) is a significant health condition that affects a significant portion ofthe female population. Due to the ovarian hormone, changes in serum electrolyte levels can happen in the late lutealperiod of the menstrual cycle. Methods: A cross-sectional study was conducted to find out the association of serum electrolytes levels of 30 youngunmarried women with PMS from July 2016 to June 2017 in the Department of Physiology, Sir Salimullah MedicalCollege, Dhaka, Bangladesh. Results: The mean age of both groups of young unmarried women of was 20.30±1.15 years and 20.53±1.17 years. Themean serum sodium level was 139.97±1.30 and 140.93±1.68 mmol/L, and the serum potassium level was 4.20±0.32and 4.17±0.31 mmol/L. The mean serum sodium level was significantly higher in group B in comparison to groupA (p<0.05). Premenstrual scores of irritability, abdominal bloating, backache, depression, fatigue, breast tenderness,headache, and anxiety were significantly higher in comparison to those of postmenstrual scores in the PMS group(p<0.05). Conclusion: These study results acclaimed that serum sodium levels influence the physical and psychological symptoms of women with PMS.

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 <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<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.

Correlation of Forced Vital Capacity and Peak Expiratory Flow Rate with Serum Estrogen and Progesterone Levels in Combined Oral Contraceptive Pill (COCP) User

Background: Combined oral contraceptive pill (COCP) is the most commonly used contraceptive method in Bangladesh. This COCP has some effects on different organs including the lungs. So, there may be a relationship between forced vital capacity (FVC) and peak expiratory flow rate (PEFR) with serum estrogen and progesterone levels in combined oral contraceptive pill (COCP) users.
 Objective: To observe the relationship between FVC and PEFR with serum estrogen and progesterone levels in combined oral contraceptive pill users (COCP-U).
 Methodology: This cross-sectional study was carried out in the Department of Physiology, Sir Salimullah Medical College (SSMC), Dhaka between July 2017 and June 2018. A total of 30 apparently healthy young women, age ranged 20 to 30 years were included in this study, who were combined oral contraceptive pill users (COCP-U) for at least 6 months. Another 30 age and BMI matched combined oral contraceptive pill nonusers (COCP-NU) were also taken as control for comparison. FVC and PEFR of all the subjects were measured by using Digital Auto Spirometer (MINATO AS-507). Moreover, their serum estrogen and progesterone levels were done to observe their levels and also to observe the relationship between them if present. Statistical analysis was done by Independent t-test and Pearson’s Correlation Coefficient test.
 Result: Spirometric parameters like FVC and PEFR were significantly higher in COCP-U women than those of nonuser women. Moreover, the mean serum estrogen and progesterone levels were also significantly higher in COCP users in comparison to those of non-users. Here, FVC showed positive and PEFR showed negative correlation with serum estrogen level and FVC showed negative, PEFR showed positive correlation with serum progesterone level in COCP users, though the relationships were statistically non-significant. 
 Conclusion: The positive correlation of FVC and PEFR with serum estrogen and progesterone indicates, that improvement of pulmonary function occurs in COCP-U due to its estrogen and progesterone contents, which may be by increasing the strength of the muscles along with decreased airway resistance.
 J Shaheed Suhrawardy Med Coll 2022; 14(1): 37-42

Effect of Meconium Stained Liquor on Mode of Delivery and Fetomaternal Outcome in a Tertiary Level Hospital

Background: The appearance of meconium-stained liquor during labour is generally considered to be a sign of hypoxia and a predictor of poor fetal outcome.It is one of the clinical events where normal pregnancy can turn into a high risk one for the mother as well as for the foetus.
 Objective: To evaluate the obstetric outcome in meconium stained liquor during labour.
 Study design: Prospective comparative study.
 Study setting and period: Gynaecology and Obstetrics department of Sir Salimullah Medical College and Mitford Hospital (SSMC and MH), Dhaka, between January 2019 to June 2019.
 Study population: The study patients in labour with meconium stained amniotic fluid and women in labour but having clear amniotic fluid who admitted for delivery during study period.
 Result: A total 75 cases were enrolled in the study as case and 75 cases were enrolled as control. The mean age was found 29.14±5.59 years in case group and 28.9±6.2 years in control group. Patients received irregular ANC was 20(26.7%) and 25(33.3%) in case and control group respectively. Patients who did not receive ANC was 24(32.0%) in case group and 12(16.0%) in control group. Mean gestational age at delivery was found 38.87±1.4 weeks in case group and 38.75±1.6 weeks in control group. Primigravida was predominant in both groups. Caesarean deliveries were high (80.0%) in cases and it was much higher with thick meconium (74.7%) as compared to thin meconium (25.3%). APGAR scores in first minute and fifth minute were also low in cases. Birth asphyxia was found 20.0% in case group and 6.3% in control group. Meconium aspiration syndrome 25.0% and convulsion 3.8% developed only in cases. Neonatal ward admission was 22.0% in case group and 6.3% in control group. Neonatal mortality was higher (3.8%) in cases than control 1.3%. Majority (6.65%) patients had post partum hemorrhage in case group and 3(4.0%) in control group.
 Conclusion: Meconium stained amniotic fluid were associated with higher rate of caesarian delivery, increased need for neonatal resuscitation, increased rate of birth asphyxia with hypoxic ischemic encephalopathy, meconium aspiration syndrome, hospital admission, and mortality. Electronic foetal monitoring, timely obstetrical intervention and neonatal care can reduce associated complications and improve foetal outcome.
 J Shaheed Suhrawardy Med Coll 2022; 14(1): 43-49

#359 : Impact of Genitourinary Prolapse on Quality of Life and Sexual Function in Women at Their Midlife

Background and Aims: Pelvic organ prolapse (POP) is a common condition affecting women during their midlife, leading to various symptoms and decreased quality of life (QoL). This study aimed to assess the association of POP severity with QoL and sexual function in women at their midlife, with the objective of providing valuable insights for comprehensive care and effective management of POP. Method: A cross-sectional study included 130 symptomatic GUP women aged 40-60 years from Sir Salimullah Medical College & Mitford Hospital in Dhaka. Group 1 (85 women) had stage 1 GUP, while the remaining were in group 2. Face-to-face interviews and POP-Q staging were conducted, followed by statistical analysis using Chi-Square, Mann-Whitney U, and Spearman rank correlation tests to examine the association of GUP severity with QoL and sexual function between the groups. Results: The mean age of the participants was 51.24 years (SD=5.5). The majority of the respondents were above 50 years of age (56%), and 65.38% of the study population were in group 2. One-third of the respondents (35.38%) had stage III GUP whereas only 4.62% were in stage IV. The frequency of urinary symptoms was most commonly occurring (70%) where dribbling of urine was least frequent (38%). Sexual and bowel symptoms were correlated with advanced stage of disease where urinary symptoms were not associated with GUP severity. Sexual dysfunction symptoms were positively associated with uterine descent. Regarding quality of life, all nine domains of QoL scores had positive correlation with severity of GUP. Conclusion: This study reveals the correlation between POP and urinary, bowel, and sexual symptoms. Clinicians should assess these symptoms for comprehensive care, and further research is required to determine effective treatment options for women with POP.

Assessment And Comparison of Bacterial Contamination in Anterior Chamber Aspirates in Small Incision Cataract Surgery (SICS) And Phaco-Emulsification

Introduction: The rate of occurrence of endophthalmitis after cataract surgery has been reduced to a greater extent now a day. Even then endophthalmitis related consequences are devastating. Several sources of infection, including contamination by air, solutions, surgical instruments, intraocular lens, and wound leakage have been identified. Aim of the Study: The study aimed to evaluate the influence of two methods of surgical technique of cataract surgery in bacterial as well as comparison of contamination by these two techniques. Methods: This prospective observational study was conducted over 60 patients with age related cataract in the department of Ophthalmology and Microbiology in Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh, from 1st January, 2009 to 30th June, 2009. Patients were selected purposively based on specific selection criteria. Selected patients underwent detail ophthalmic and systemic evaluation as well as relevant investigations. Cataract extraction followed by intraocular lens implantation was planned for all patients. The two techniques of cataract surgery such as SICS and Phacoemulsification were assigned to the patients randomly by 1:1 basis. 1 ml of anterior chamber contents were aspirated through aseptic technique by 26G needle from each patient pre-operatively, after capsulorrhexis (early per-operative) and just before wound closure by stromal hydration (late per-operative). All samples were sent for 10% KOH staining and culture and sensitivity test after proper leveling. Results: Micro-biological examination shows no sample was positive for 10% KOH staining. In SICS group, out of 30 samples 3 were found culture positive, which were positive in 4 and 5 samples in early per-operative and late per-operative sample respectively and in Phacoemulsification group, it was 2, 3, 5 pre-operative, early per-operative and late per-operative sample respectively. The common organisms isolated were Coagulase positive Streptococcus, Corynebacterium species, Streptococcus viridans, and Staphylococcus aureus etc. Almost none of the patients showed clinical activity except few cells and flare in the anterior chamber in early post-operative period. Conclusion: The microbiological examination shows the incidence of microbial contamination of anterior chamber contents is very low after cataract surgery by both form of technique, and there was no statistically significance difference in incidence between these two techniques. J.Natl.Inst.Ophthalmol.2023;6(1): 37-41

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.
 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.
 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.
 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<0.05).Spot urine protein and creatinine ratio and serum cholesterol level was significantly higher in patients experience relapse attack (P<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<0.001). 
 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.