Sylhet MAG Osmani Medical College Research Articles

Epidemiological Evaluation of Suicidal Deaths due to Hanging: A Retrospective Medicolegal Study in Sylhet

Background: Suicidal hanging is the most common method of suicide in developing countries, especially among young people. During conventional autopsies, it is one of the significant causes of unnatural deaths in Bangladesh. This study was performed to determine the epidemiological evaluation of suicidal deaths due to suicidal hanging at the mortuary of the Forensic Medicine Department of Sylhet MAG Osmani Medical College, Sylhet. Materials and methods: An autopsy record-based retrospective study carried out to ascertain the epidemiological evaluation of 340 cases of suicidal hanging deaths from January 2015 to December 2018 in the Department of Forensic Medicine, Sylhet MAG Osmani Medical College, Sylhet. Results: Hanging was more common in the age ranges of 10-19 years (33.0%) and 20-29 years (29.1%), accounting for nearly two-thirds (62.1%) of all deaths. The incidence was higher in females (59.3%) than males (46.7%). Gowainghat (12.1%) and Kotwali (9.5%) had the highest incidences of victims. The most common autopsy findings were that the subcutaneous tissues underneath the ligature mark were found to be pale, white, hard and glistening in 94.2% of cases, cyanosis was found in 89.8% of cases, dribbling of saliva was seen in 66.3% of cases and subconjunctival petechial haemorrhage was observed in 46.0% of cases. Asphyxia (93.3%) was the most common cause of suicidal hanging deaths identified during autopsy. Conclusion: The majority of victims were female and young individuals were especially vulnerable to suicidal ideation, attempts and suicide by hanging. To reduce suicides, awareness programs, psychological counseling andsuicidal behavioral treatment are recommended. IAHS Medical Journal Vol 7(1), June 2024; 13-16

Comparison between Split Dose and Single Dose Bowel Laxatives for Preparation of Colonoscopy in Patients with Bangladeshi Diets: A Randomized Clinical Trial

Introduction: Colonoscopy is an important diagnostic tool for colonic disease and its efficacy and safety have been correlated with adequate bowel preparation. This study compared the efficacy and tolerability of single-dose and split-dose sodium picosulfate lavage as a colon cleansing agent for colonoscopy preparation. Methods: This randomized clinical trial was conducted at the Department of Gastroenterology in Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh from June 2021 to May 2022.A total of 110 patients were selected by randomized sampling technique who underwent elective colonoscopy and were divided into split-dose (n=57) and single-dose (n=53) laxative groups. Bowel preparation was assessed by the Ottawa Bowel Preparation Scale (OBPS) and data were analyzed by SPSS 24.0. Result: The mean age of the patients was 47.4±17.7(SD) years in split-dose and 47.6±15.9 (SD) years in single-dose group. Both groups were statistically similar in terms of socio-demographic profile, medical history, clinical manifestation, and indication of colonoscopy (p>0.05). The mean of total OBPS score (4.39±2.0 vs 5.56±2.2, p=0.004) and caecal intubation time (6.60±3 vs 7.74±2.5, p=0.035) was lower significantly in split-dose than the single-dose group. However, colonoscopy findings, adverse events, and patient compliance were similar between groups (p>0.05). Conclusion: Split-dose is superior to single-dose bowel laxatives for colonoscopy preparation in terms of better mucosal cleanliness and lower caecal intubation time. However, further randomized controlled trial is recommended. J Bangladesh Coll Phys Surg 2024; 42: 329-335

Endoscopic Findings of a Patient Having Cholelithasis in SOMCH, Sylhet, Bangladesh

Introduction: Cholelithiasis is one of the most frequently encountered disease and one of the major causes of abdominal morbidity throughout world [1]. Cholelithiasis is one of the most common and costly of all digestive diseases. Common causes of upper abdominal symptoms are peptic ulcer, acute and chronic gastritis and gallstones. Objective: To assess the endoscopic findings of a patient having cholelithasis in SOMCH. Methods: This was Retrospective Hospital based study conducted at Department of Surgery, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh from January to December 2022 were (One hundred patients were included). All patients underwent OGD after being diagnosed as having cholelithiasis proved by Endoscopic. All patients above 18 years of age presenting with upper abdominal pain, dyspepsia with or without jaundice diagnosed ultrasonically as cholelithiasis and choledocholithiasis with cholelithiasis were included in the study and patients managed conservatively, patients with primary choledocholithiasis and with asymptomatic gallstones were excluded from the study. Results: Out of 100 subjects evaluated during the study period, 58 were females and 42 males. The most common age group affected was between 31-50 years (65%), followed by less than 30 years of age being 18% and more than 50 years being 17%. It should also be noted the higher rate of incidence (65%) in the age group of 31-50 years. Associated symptoms with cholelithiasis were pain in abdomen, which was observed in all the patients (100%). Of these, 74 patients (74%) presented with chronic upper abdominal pain and 26 patients (26%) presented with acute upper abdominal pain. Remaining 56% of the subjects had positive endoscopic findings. Endoscopic findings were positive in 56 had hiatus hernia, duodinitis, duodenal ulcer or other positive findings. Among patients with positive findings 14 had both oeophagitis as well as gastritis while 12 had both gastritis as well as gastric ulcer. All the 56 patients (100%) underwent surgery. Forty patients (71.4%) underwent laparoscopic cholecystectomy, 14 (25.0%) open cholecystectomy and 2 cholecystostomy for empyema gall bladder. Of the 56 patients 40 patients (71.4%) patient had chronic cholecystitis, 9 patients (16.07%) had acute cholecystitis, 4 patients (7.14%) had carcinoma gall bladder, 2 (3.57%) had xanthogranulomatous cholecystitis and 1(1.78%) had cholesterolosis of gallbladder. Of the 4 patients diagnosed of carcinoma gallbladder, 1 patient had carcinoma confined to muscularis mucosa with negative margins and no metastasis, hence no further surgical management was advised and the rest of the 3 patients had either metastasis or positive margins which were managed as per standard guidelines. Conclusion: Cholelithiasis is commonly seen in females in 4th and 5th decade mainly presenting with abdominal pain and dyspepsia. Endoscopy the most common finding was gastritis, oesophagitis and gastric ulcer in decreasing order. There was no hiatus hernia, duodinitis or duodenal ulcer in our study. Patients presenting with dyspepsia and gall-stones in rural setup should be directly treated surgically. Multiple gallstones are common and Laparoscopic cholecystectomy offers best surgical management with 6.57% of conversion rate to open cholecystectomy, with lesser complications.

Comparison of Atorvastatin Alone and its Combination with Ezetimibe among Mixed Hyperlipidemic Patients

Background: Lowering the lipid levels remains the basis of recent medical therapy for preventing cardiovascular events. Statin treatment to attain target low-density lipoprotein cholesterol (LDL-C) levels is still associated with residual risk. Objective: To compare the efficacy of Atorvastatin and Atorvastatin combined with Ezetimibe among mixed hyperlipidemic patients. Methodology: This was a prospective interventional study among the 58 diagnosed mixed hyperlipidemic patients in the outpatient department (OPD) of the Department of Cardiology at the Sylhet MAG Osmani Medical College Hospital during February to November, 2023. Patients were divided into two groups. Group I had a combination of Atorvastatin 10mg and Ezetimibe 10mg, whereas Group II took Tab. Atorvastatin 20mg once daily at night for 12 weeks. Results: After 12 weeks of treatment, a comparison of lipid profile changes between the combination therapy group and the Atorvastatin group revealed a significant reduction (p<0.05) in total cholesterol (35.7% vs. 30.1%), triglycerides (30.6% vs. 16%), and LDL-C (47.5% vs. 40.1%). In the combination therapy group, ALT levels increased by 4.6%, compared to a 3.8% increase with Atorvastatin treatment alone. Combination therapy led to a 2.07% elevation in CK levels, while the Atorvastatin treatment group showed a 1.9% increase in CK values. The differences in HDL-C, ALT, and CK levels between the two groups were not statistically significant (p>0.05). Conclusion: The study revealed that combination therapy of Atorvastatin with Ezetimibe is more effective in reducing LDL-C, TG, and total cholesterol in patients with mixed hyperlipidemia compared to Atorvastatin alone. Journal of Monno Medical College June, 2024; 10 (1):23-29

Effect of Smoking on Red Blood Cell Parameters: A Cross-sectional Study in a Divisional City of Bangladesh

Background: Several metabolic and biochemical processes, hormone secretion, and the haematological system are all affected by smoking. Numerous studies have found that smoking is associated with higher levels of haemoglobin concentration (Hb%), total red blood cell count (RBC), and red cell distribution width (RDW). Objectives: To study the RBC parameters in healthy male smokers and non-smokers among adults. Methodology: This research was carried out in the Department of Physiology of Sylhet MAG Osmani Medical College, from July, 2021 to June, 2022. A total of 200 participants were included with healthy adult smokers and age-matched healthy adult non-smokers. History and physical examinations were used to evaluate each individual. We measured height and weight, and calculated body mass index of the subjects. Calculations were made on cigarette smoking intensity and duration. Blood was collected to determine RBC parameters, such as total RBC count, haemoglobin level, haematocrit, mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC) and red cell distribution width (RDW) by using Sysmex 500i automatic haematology analyzer (Japan). Results: Among the 200 participants, 100 were adult smokers and another 100 age-matched healthy adult non-smokers. The RBC indices were significantly elevated in smokers compared to non-smokers group: mean haemoglobin concentration (g/dl)+ standard deviation (SD) were 14.17 ± 2.13 versus 13.27 ± 1.39 respectively with p<0.001, mean haematocrit (HCT) (percent)+ SD were 41.60 ± 6.88 versus 39.13 ± 5.46 respectively with p=0.005, mean corpuscular volume (MCV) (fl) + SD 91.13 ± 8.86 versus 88.33 ± 5.58 respectively with p=0.033, mean corpuscular hemoglobin (MCH) (pg) + SD 31.16 ± 3.26 versus 30.05 ± 3.0 respectively with p=0.016 and mean red cell distribution width (RDW) (percent)+ SD 14.74 ± 1.63 versus 14.00 ± 1.57 respectively with p=0.001. However, RBC count (×106/μl) (4.60 ± 0.80 versus 4.46 ± 0.60; p=0.143) and mean corpuscular haemoglobin concentration (MCHC) (g/dl) (34.23 ± 2.11 versus 34.11 ± 2.32; p=0.707) did not differ significantly between smoker and non-smoker groups. There was no statistical difference between mild, moderate, and severe smokers, according to the study's variables. Conclusion: MCV, MCH, RDW, haematocrit, and haemoglobin concentration were all significantly higher in smokers. Journal of Monno Medical College December, 2023; 9 (2):41-46

Incidence of Colorectal Malignancy of a Young Patient in Sylhet M A G Osmani Medical College, Sylhet, Bangladesh

Background: Colorectal cancer is the third most common cancer in both men and women, and the second leading cause of cancer-related deaths. Colorectal cancer (CRC) is already the third leading cause of cancer death in the world, and its incidence is steadily rising in developing nations. Methods: A retrospective analytical study was conducted for newly diagnosed CRC patients treated in the Department of Surgery, Sylhet MAG Osmani Medical College, Sylhet, Bangladesh from January to June 2023. Convenient sampling method was followed to include 150 newly diagnosed young CRC patients registered. The study aimed to determine the burden of CRC among younger adults, and to evaluate its clinicopathological characteristics. Chi-square method was used to analyze the clinic pathological characteristics. P≤0.05 was considered statistically significant. Results: Out of total 150 newly diagnosed CRC patients. The median age at diagnosis was 54 years and 40 years for overall patients and younger adults respectively. Predominantly male patients were observed in the study population with male to female ratio (M: F) of 1.6:1. Most patients (approximately two third) presented with eastern co- operative oncology group (ECOG) performance status I. Family history of colorectal cancer or polyps was present in two patients, both of which belonged to the younger adults group. Greater than 90% of patients were diagnosed with advanced T stage (T3/T4) and over 80% patients had lymph nodal metastasis at diagnosis findings were age groups. Peritoneal metastasis was significantly higher among younger adults. Distant metastasis was observed in approximately one fourth of total patients, out of which majority (96%) were detected at multiple sites and numbers. Relatively higher number of distant metastasis was observed among younger patients. Common sites of distant metastasis were in the following order; liver> peritoneum> lung> bone> brain> others. Peritoneal metastasis was found to be ..........

An open clinical trial of Mefenamic Acid in Primary Dysmenorrhoea of Medical Students of Sylhet MAG Osmani Medical College, Sylhet

An open clinical trial of Mefenamic Acid in Primary Dysmenorrhoea of Medical Students of Sylhet MAG Osmani Medical College, Sylhet

Anatomical Variation of Sternal Angle and Body: a Cross sectional study

Background: The sternum is one of the important skeletal components ofthoracic case that frequently has congenital defects, and researchers routinely use variances to ascertain an individual's age and sex. Additionally, it helps the physician with biopsy procedures as well as therapy. The objective of this study was to evaluate the morphological characteristics of sternal body and sternal angle in both sexes. Method: This cross-sectional stuywas carried out at the Department of Anatomy, Sylhet MAG Osmani Medical College. For this purpose, 100 dried ossified sternums of unknown sex had been collected. The sample was collected in compliance with the inclusion and exclusion criteria. Discriminant function analysis was used to determine the sex of each sternum (DFA). Study variables were the maximum length of sternal body, maximum breadth of sternal body, thickness of the sternal body and sternal angle. Variables were measured using a vernier caliper and documented in a pre-designed data sheet. Result: The mean length of the body of sternum was 93.84±23.31 mm in male and 82.84±14.8 mm in female. The mean width of the body of the sternum was 35.3±10.83 mm in male and 29.22±9.65 mm in female. The thickness of the body of the sternum is 19.86±9.91 mm in males and 16.12±7.39 mm in females. Analysis revealed that length of body sternum, width of body of sternum and thickness of body of sternum were higher in male than female which was statistically significant (p<0.05).The mean angle of sternum was 148.29±8.240 degrees in males and 149.32±9.690degrees in females, respectively. The difference was statistically not significant (p<0.05). Conclusion: In females, the maximum sternal length, maximum sternal breadth, and maximum sternal thickness were all significantly lower.

Correlation between Serum Ferritin and Thyroid Hormones Level in Children with Thalassemia

Background: Thalassemia is a group of hereditary blood disorder characterized by reduced or absent globin chain synthesis resulting in transfusion dependent anaemia and iron overload. Due to regular blood transfusion and inadequate chelation therapy patient develop multiorgan dysfunction. Objectives: To find any correlation between serum ferritin and thyroid hormones level in children with transfusion dependent thalassemia. Methods: This cross-sectional study was carried out in the department of Paediatrics and department of Medicine, Sylhet MAG Osmani Medical College Hospital between June, 2021 to May, 2022, on one hundred children with transfusion dependent thalassemia who were on more than 12 times blood transfusion but did not take any chelation therapy and whose serum ferritin level were > 1000 ng/ml. Assessment of their thyroid hormones level and statistically its correlation with serum ferritin were done. Result: A total of 53 (53%) male and 47 (47%) female were included in this study. The mean age of the patients was 9.47 ±3.63 years. Mean serum ferritin was 1980±1126.19 ng/ml, mean serum TSH was 3.55±2.08 µIU/ml, mean serum free T4 was 1.10±0.18 ng/ml, mean serum free T3 was 3.64±0.37 pg/ml. Subclinical hypothyroidism and euthyroid were found in 20 patients (20%) and 80 patients (80%) respectively. No overt hypothyroidism or hyperthyroidism were found. Mean serum ferritin in subclinical hypothyroid and euthyroid were 2407±995.37 ng/ml and 1875.59±1131.18 ng/ml respectively which difference was statistically significant (P value <0.05). Scattered diagram was done and it showed linear correlation between serum ferritin and serum TSH of subclinical hypothyroid group. No linear correlation was found between serum ferritin and F.T3 and F.T4 on scattered diagram. Positive (Pearson) correlation was found between serum ferritin and serum TSH of subclinical hypothyroid group and strong positive (Pearson) correlation (r=0.74, P=0.02) was found between them. Conclusion: This study showed that good percentages of children with transfusion dependent thalassemia are suffering from subclinical hypothyroidism. There is positive correlation between serum ferritin level and subclinical hypothyroidism.

Comparison between Palonosetron and Ondansetron in Prevention of Chemotherapy Induced Nausea Vomiting

Background: Chemotherapy induced nausea and vomiting (CINV) is the commonest and the most incapacitating experience of thepatient undergoing cancer chemotherapy. Poorly controlled CINV sometimes make patients to refuse further treatment. This study aimed to compare the efficacy and safety of Palonosetron and Ondansetron in preventing CINV during cancer chemotherapy. Methods:This randomized controlled trial was conducted in the Department of Pharmacology and Therapeutics of Sylhet MAG Osmani Medical College from January 2021 to December 2021. There were 190patients enrolled initially; 14 patients from both groups withdraw themselves. Finally, 91 patients of Palonosetron and 85 patients of Ondansetron treated were recruited. The Palonosetron group were treated with Palonosetron at 0.25 mg and the Ondansetron group were treated with Ondansetron 8.0 mg intravenously, 30min before chemotherapy. After that Palonosetron 0.5 mg single time and Ondansetron 8.0 mg orally three times a day were given and total follow-up period was seven days. Episode of nausea and vomiting graded according to the guideline “Common Terminology Criteria for Adverse Events (CTCAE)”, version 4.0, which was published by the US Department of Health and Human Services (National Institute of Health and National Cancer Institute). Result: The groups were matched for the age (p = 0.263), gender (p = 0.630), body weight (p = 0.846),site of malignancy (p = 0.375), and drugsused for chemotherapeutic (p = 0.301) in both study groups. Palonosetron treated patients experienced significant lower episode of nausea in day-1 (p = <0.001) and day-2 (p = 0.025), and in case vomiting in day-1 (p = 0.026) compared to Ondansetron. Significantly higher number of patients of Palonosetron compared to Ondansetron treated group showed complete response in both acute phase (p = 0.026), delayed phase (p = 0.036) and finally in overall phase (p = 0.014). Only four patients experienced with treatment failure in Ondansetron treated group. Observed adverse effects were in low intensity and not caused to stop the treatment procedure. Conclusion: Palonosetron was found to be more efficacious and well tolerated in preventing acute, delayed and overall phase of chemotherapy induced nausea and vomiting in this study.

Study on Finger Ridge Pattern of Palmar Dermatoglyphics and their Association of Type 2 Diabetes Mellitus in Bangladeshi Population

The skin on the palmar surface of human hands & the planter surface of the feet differ from skin found also where on the body. The projection of dermal papillae which are interdigitate with epidermal evagination, is called epidermal ridges. By the 17thweek of intrauterine life, these ridges are permanent and remain unchanged throughout life, with the exception of a little increase in size that coincides with growth. Thus, it is quite helpful to predict various genetically acquired disorders. Diabetes mellitus is a condition of partial genetic background. The objective of this study was to determine whether type II diabetes mellitus in Bangladeshi people was associated with a certain finger ridge pattern. This observational cross sectional study was conducted in Sylhet MAG Osmani Medical College from July 2018 to June 2019. A total of 200 subjects were included; among them, 100 were diagnosed patients of type II DM and the rest were healthy individuals. The age and sex of the research participants were matched between the groups under investigation. The ink and paper method was used for making a print of the finger. A mounted hand lens was used to examine the prints. The distribution of finger ridge pattern between the diabetics and controls showed that the ulnar loops (p = 0.003) and whorls (p = 0.001) were significantly higher in diabetic group; whereas arches (p = <0.001) and radial loops (p = <0.001) were found to be significantly higher in control group. The study came to the conclusion that type II DM has the unique characteristics of the finger ridge distribution patterns in palmar dermatoglyphics, it can be employed as a reliable screening method for type II DM early diagnosis.

Correlations between Stature and Hand Breadth in Bangladeshi Medical Students

Introduction: From an anatomical view point human hand acts as both mechanical and sensorytool. It helps us in grasping objects, skilled movements and sensing any object by touching it. Theopposition of the thumb to the index finger and other digits is highly evolved in mankind.Aim: The aim of this study was to evaluate the correlations between stature and hand breadth inBangladeshi medical students.Methods: This was a descriptive study carried out in Department of Anatomy, Sylhet MAGOsmani Medical College, Sylhet, Bangladesh from July 2019 to June 2020. In the present study,anthropometric measurements were done in 240 adult Bangladeshi medical students. Directphysical measurements of the hand breadth were taken from both hands of all 240 subjects. Thestature was also measured physically. The mean values and the standard deviations were calculatedfor each variable.Results: The stature of male students aging 18-23 years age ranged from 151 cm to 176.2 cm.More than 76% of the respondents possessed stature between 155 cm to 170 cm. Besides, thestature of 120 female students ranged from 138 cm to 162 cm. More than 86% of the respondentshad stature between 145 cm to 160 cm. All the anthropometric measurements of male participantsshowed positive and statistically significant correlation with stature (p <0.05). All theanthropometric measurements of female participants showed positive and statistically significantcorrelation with stature (p <0.05).Conclusion: This study offers valuable insights into the correlation between stature and handbreadth among Bangladeshi medical students.

Comparative Outcomes of Propranolol Monotherapy and Combined Therapy with Intralesional Triamcinolone in Infantile Hemangioma

Background: Infantile Hemangiomas (IHs) are the most common vascular tumors of infancy. Oral propranolol has achieved great success in treating IHs since 2008. Recently combined oral propranolol with intralesional injection of Triamcinolone acetonide is the effective method of treatment for infantile Hemangioma with minimal adverse effects. Objectives: To observe the outcome of Propranolol monotherapy and combined therapy with intralesional Triamcinolone in Infantile Hemangioma. Materials and Methods: This prospective study was carried out in the Department of Pediatric Surgery, Sylhet MAG Osmani Medical College Hospital, Sylhet, during the period from January 2018 to December 2019. It included 42 infantile hemangioma patients divided into two groups: Group A (21) treated with oral propranolol, and Group B (21) treated with oral propranolol plus intralesional triamcinolone acetonide. Patients were followed up at regular intervals for 6 months. Results: The data of two groups of patients with IH were compared in the study. The demographic variables, including median age, sex, size, type, and site of IH, were comparable between the two groups. This showed that pre-treatment complications were slightly higher in Group B but not significantly different. Superior size reduction was observed in Group B (71.4% vs. 38.1%), though the difference was not significant statistically. Group B had excellent color regression, which was significantly higher compared to the other group (90.5% vs. 9.5%, p < 0.001). The mean treatment cost was higher in Group B, which was 187.86. taka compared to 124.76. taka in Group A (P value was <0.001). In summary, Group B had better color regression of the pinprick but at a higher cost of treatment as compared to Group A, and other parameters were almost equal in both groups. Conclusion: Combined propranolol and intralesional Triamcinolone is more effective compared to propranolol alone in the treatment of IHs.

Morphological Parameters of Gallbladder are Correlated with Age

Introduction: Gallbladder issues are prevalent globally, particularly in Bangladesh, and become more common with age. Diagnosis involves clinical assessment and confirmation through noninvasive and invasive methods. Understanding gallbladder features is crucial for effective investigation, diagnosis, and management. Objectives: To find out relation between morphological parameters of human gallbladder with age. Materials and Methods: This cross-sectional descriptive study was conducted in the Department of Anatomy in collaboration with the Department of Forensic Medicine, Sylhet MAG Osmani Medical College, Sylhet from January 2014 to December 2014. Fifty human postmortem gallbladders were selected. Dead bodies autopsied within 36 hours of death. Considerable signs of decomposition or decomposed dead body, presence of gross gallbladder disease and any history of poisoning cases were excluded. All the specimens were examined to detect the length, breadth, weight and thickness of the gallbladder; and length and diameter of cystic duct. Results: The study included cadavers ranging in age from 11 to 55 years, with a mean age of 35.02 ± 19.98 years. Of the total, 29 (58.0%) were male, and 21 (42.0%) were female. The length and thickness of the gallbladder increased significantly with age, as did the length and diameter of the cystic duct. But the weight and breadth also change with age, although not significantly. Conclusion: The length and thickness of the gallbladder; the length and diameter of the cystic duct were varied with age; but no variation in weight and breadth. Medicine Today 2023 Vol.36 (1): 31-35

Efficacy of Doxylamine and Pyridoxine during Pregnancy Induced Nausea and Vomiting

Introduction: Nausea and vomiting in pregnancy (NVP) is the most common medical condition of pregnancy causes a significant clinical, psychological and economic burden. Therefore, it is very important to treat this condition appropriately and effectively. The combination of Doxylamine and Pyridoxine is recommended as first-line therapy for nausea and vomiting in pregnancy. Objectives: To observe the therapeutic efficacy of combined Doxylamine and Pyridoxine for treatment of nausea and vomiting in pregnancy. Materials and Methods: An observational study was conducted on patients with nausea and vomiting in pregnancy attended the Model Family planning clinic in the Department of Obstetrics and Gynaecology, Sylhet MAG Osmani Medical College Hospital, Sylhet during the period from January 2019 to December 2019. A total 90 patients with clinically meaningful nausea vomiting (Pregnancy-Unique Quantification of Emesis [PUQE] score > 6) were selected and given 2-4 tablets each containing combined Doxylamine succinate 10 mg and Pyridoxine hydrochloride 10 mg based on a pre-specified titration protocol response to symptoms by respective physician and PUQE score was recorded in all participants before initiation of treatment and at 8th day and 15th day of treatment. In course of follow up period 7 patients were dropped out and finally 83 patients were analyzed in this study. Result: The mean PUQE score was decreased from 10.27 ± 1.76 to 7.94 ± 1.75 at 8th day and to 5.35 ± 1.47 at 15th day of treatment was significant (p<0.001). The percentage reduction of PUQE score was 23.14% at 8th day and 46.91% at 15th day of treatment. The difference was significant (p<0.001). Conclusion: Combined Doxylamine-Pyridoxine is effective and well tolerated in the treatment of nausea and vomiting in pregnancy (NVP). Medicine Today 2023 Vol.36 (1): 26-30

The Evaluation of Parenting Styles of Children with Attention Deficit/ Hyperactivity Disorder

Background: Parenting has an important role in improving the performance of children with ADHD and in their families, this study will create awareness about parenting styles among parents addressing differences in parenting styles and improving the quality of child mental health.
 Objective: This study was intended to evaluate the different parenting styles of parents having children with ADHD and healthy children. It also aimed to find out any relationship between the socio-demographic variables of children and parents with the parenting style of the diseased child. 
 Methodology: This was a case-control study. The study was conducted in the Department of Psychiatry, Sylhet MAG Osmani Medical College, Sylhet during the period from September 2020 to August 2022. ADHD was diagnosed using DSM-5 and confirmed by a consultant psychiatrist. A total of 60 parents of children (ADHD=30, Healthy=30) were interviewed who fulfilled the enrollment criteria. Semi-structured questionnaire for socio-demographic variables and a Bangla Parenting Style and Dimension Questionnaire (PSDQ) were used for assessing parenting style. The data analysis was conducted utilizing the one-way analysis of variance (ANOVA) method, followed by post-hoc comparisons using the Bonferroni correction.
 Results: The predominant parenting style found to be applied to children with ADHD was authoritative (56.67%), followed by 26.67% authoritarian parenting and 16.33% permissive parenting style. Among the parents of healthy children, 53.33% were authoritative, 23.33% were authoritarian and permissive. There was a statistically significant association of parenting styles with education level and occupation. ADHD children's parents who studied up to the primary level had a significantly higher authoritarian score and (authoritarian p = 0.005) and the normal children's parents who studied up to the secondary level had a significantly higher authoritarian score (authoritarian p = 0.007. A significant association was found in the authoritarian domain in parents who were housewives (p = 0.032). Individuals within 6-9 years age range exhibit significantly higher scores in the authoritative domain (p=.001). Both boys and girls groups exhibit a considerably higher score in the authoritative domain (p=.003, p=.001). 
 Conclusion: The fact that parenting styles influence ADHD may appear to be a burden, but it can also be an opportunity to change one's life. Solutions like parent training programs can provide skills and strategies as well as help build resilience in parents to manage the challenging behavior of children with ADHD.

Circadian Variation of Stroke in a Tertiary Level Hospital

Introduction: Stroke, a primary global health concern, is the fifth leading cause of death in Bangladesh, with a prevalence of 0.3%. While 85% of stroke cases globally are cerebral infarctions, Asian countries exhibit stroke patients on average 15 years younger than developed countries. Survival studies reveal strokes exceeding coronary events in hypertensive patients. Observational data suggests circadian, circaseptan, and circannual variations in stroke occurrence, with a morning peak. Circadian rhythm in ischemic stroke is higher in the early morning. Thrombotic strokes, influenced by platelet aggregation and fibrinolysis, often occur in the morning. Haemorrhagic strokes result from blood vessel ruptures. Population-specific circadian patterns remain unconfirmed.
 Aim of the Study: The study aims to find out the relation of circadian variation of stroke.
 Methods: This cross-sectional study, conducted at Sylhet MAG Osmani Medical College Hospital, Bangladesh, analyzed 100 stroke patients over six months. Ethical approval was obtained, and informed consent was taken. Inclusion criteria covered patients with clinical and imaging stroke diagnoses, while exclusion criteria excluded transient ischemic attack, previous stroke, head injury history, and refusal to participate. Stroke onset time was categorized into four six-hour intervals. Demographic data, risk factors, and comorbidities were recorded, and brain CT scans were performed. Data analysis used SPSS version 22, employing descriptive statistics, Chi-square Test, and Student's t-test. Significance was set at p<0.05. Results were presented in tables.
 Results: The study involves 100 participants, primarily aged 60-70 (50%), predominantly male (76%), residing 62% in urban and 38% in rural areas. Occupationally, 35% are businessmen, 24% are housewives, and 15% are service holders and laborers. Smoking status shows 58% smokers. Stroke types include 57% ischemic strokes and 39% hemorrhagic strokes. Hypertension (72%) is the significant risk factor. Stroke symptoms predominantly occur between 06:01 and 12:00 (46%). These insights comprehensively understand the study population's demographics, lifestyle, and clinical characteristics.
 Conclusion: The study established circadian patterns in stroke onset, with the highest frequency between 06:00-12:00 and the lowest between 18:01-24:00. Ischemic stroke was the most common subtype, followed by hemorrhagic stroke and fewer subarachnoid hemorrhages. Managing blood pressure and coagulation during peak onset times could aid stroke prevention, but further extensive studies are needed for validation.

Correlation Between Magnitude of ST Segment Elevation and the Proximal Right Coronary Artery Lesion in Acute Inferior Myocardial Infarction

Introduction: The determination of the probable site of occlusion within RCA in acute inferior MI is very important because proximal occlusions are likely to cause greater myocardial damage and an early invasive strategy may be planned in such cases. Furthermore, identification of infarct-related artery and its site in acute inferior myocardial infarction not only guide decision regarding the urgency of revascularization but also guide to avoid therapy that may adversely affect the outcome. Objective: To predict the site of lesion in right coronary artery in acute inferior myocardial infarction by the magnitude of ST segment elevation in inferior leads (II, III and aVF). Methodology: This cross-sectional study was conducted in the Department of Cardiology, Sylhet MAG Osmani Medical College Hospital, from January 2014 to December 2015. A total of 50 consecutive patients with inferior MI who present within 12 hours of symptom onset and received fibrinolytic therapy were selected according to inclusion and exclusion criteria. Using 12-lead ECG, height of ST segment elevation in leads II, III and aVF were measured & coronary angiography(CAG) was performed during index hospital period .CAG which showed culprit lesion in RCA were only taken for the study. The sum of STsegment elevation in inferior leads were then correlated with the proximal lesion in RCA. Results: The age of the patients ranged from 31 to 70 years with the mean age of 51.1 (SD 9.2) years. Majorities (88%) of the patients were male and ratio of male to female was 7.33:1.Out of 50 patients, 26(52%) had the lesion in proximal, 19 (38%) in mid and 05 (10%) in distal RCA. Patients with proximal RCA lesion showed a mean ST segment elevation of 12.5(SD 1.07) mm, with mid RCA lesion 8.5 (SD 0.80) mm and distal RCA lesion 6.5(SD 0.42) mm. There was a positive correlation of sum of ST segment elevation in inferior leads II, III and aVF to the proximal lesion in RCA (r=0.923, P < 0.05). Conclusion: From the study it is concluded that the magnitude of ST segment elevation in inferior leads (II,III, aVF) can predict site of lesion in RCA in acute inferior wall myocardial infarction; the greater the sum of the height of ST segment elevation in inferior leads, the higher is the probability of lying the lesion in proximal right coronary artery. Bangladesh Heart Journal 2024; 39(1): 44-48

Immunoexpression of p53 and Ki-67 in Urinary Bladder Carcinoma and Their Association with Tumor Grade and Muscle-invasiveness

Background: Urinary bladder carcinoma is one of the threatening causes of human morbidity and mortality. Various molecular studies and prognostic biomarkers are helpful to assess the outcome of urinary bladder carcinoma. High expression of p53 and Ki-67 represents the aggressiveness of the disease and indicates poor prognosis. Methods: This cross-sectional study was conducted at the Department of Pathology, Sylhet MAG Osmani Medical College from September 2018 to July 2020 to observe the immunoexpression of p53 and Ki-67 in urinary bladder carcinoma and their association with tumor grade and muscle-invasiveness. Total 57 transurethral resection (TURBT) samples of radiologically and clinically suspected bladder tumor cases were diagnosed histopathologically included in the study. Results: Age of the study patients ranged from 35 to 80 years with a mean of 60.60 ± 11.14 and male to female ratio was 4.7:1. There were 31 (54.4%) high grade and 26 (45.6%) low grade urinary bladder carcinomas on histopathological examination. Thirty (52.6%) cases were histopathologically muscle invasive bladder carcinoma (MIBC) and 27 (47.4%) cases were non-muscle invasive bladder carcinoma (NMIBC). Positive p53 expression was observed in 24 (77.4%) cases of high grade carcinoma while only in 6 (23.1%) cases of low grade urinary bladder carcinoma. Positive p53 expression was seen in 22 (73.3%) cases of MIBC and 8 (29.6%) cases of NMIBC. Ki-67 expression was found positive in 27 (87.1%) cases of high grade carcinoma while only in 7 (26.9%) cases of low grade urinary bladder carcinoma. Positive Ki-67 expression was seen in 25 (83.3%) cases of MIBC and 9 (33.3%) cases of NMIBC. Statistically significant association (P<0.05) was observed in histopathological grades and muscle invasiveness of UBC with p53 and Ki-67 expression. Conclusion: p53 and Ki-67 immunomarker may be helpful to provide additional prognostic information in urinary bladder carcinoma.

Caregiver Burden in Substance Use Disorders Patients

Background: Substance Use Disorders (SUDs) impose significant challenges not only on individuals grappling with addiction but also on the caregivers who provide support and care. The caregiving role is associated with multifaceted burdens that require understanding and targeted interventions. Recognizing the diverse dimensions of caregiver burden is crucial for offering effective support. Objective: The study aimed to find out the caregiver burden in substance use disorder patients, examining severity and socio-demographic correlations, contributing insights into effective support strategies. Methodology: The cross-sectional observational study took place at Sylhet MAG Osmani Medical College's Psychiatry Department and a private psychiatric and drug rehabilitation center in Sylhet from September 1, 2018, to August 31, 2020. The research focused on substance use disorder patients and their caregivers, involving 50 eligible patients selected through inclusion and exclusions criteria. Diagnoses followed DSM IV criteria. Socio-demographics were gathered via semi-structured questionnaires. Caregiver burden was assessed using the Bengali Zarit Burden Interview (ZBI) scale through approximately hour-long interviews, with 1-2 daily. Ethical procedures encompassed informed consent and confidentiality assurance. Result: The study included 50 male participants. Patients mean age was 31.92 (±8.21) and caregivers mean age was 41.68 (±12.89). Mainly, caregivers were mothers (40%) and wives (34%). Caregivers experiencing moderate to severe burden were 58%, mild to moderate burden were 26%, and severe burden were 16%. Mean ZBI score was 48.22±13.55. Higher burden correlated with illiteracy, low family income, excessive drug spending, prolonged substance use, and multiple drug usage. Alcohol users faced more burden than other substance users. Female caregivers, younger age, and housewives experienced heightened burden. No burden links were found with marital status, habitat, religion, family type, or drug administration method. Conclusion: This study concluded that Substance use heightens caregiver burden, notably among female, young, and housewife caregivers. Addressing these trends is vital for effective care of substance use