Sylhet MAG Osmani Medical College Research Articles

Outcome of Abdominal Wound Closure Following Continuous and Interrupted Suture in Elective Laparotomy

Closure is a crucial factor in laparotomy wound. Fascial layers provide the major tensile strength in wound closure. Poor wound healing and development of wound infection in incisional wounds are the common complications of open abdominal surgery. Continuous fascial closure commonly practiced and the interrupted closures are also practiced by some surgeon with an assumption that it causes less pain and less wound infection. The aim of this study was to determine the rate of postoperative wound infection and severity of wound pain following interrupted and continuous abdominal wound closure. A comparative cross-sectional study was done at the Department of surgery, Sylhet MAG Osmani Medical College Hospital from 1st July 2007 to 30th June 2008. A total 100 patients of clean-contaminated elective laparotomy were selected. The patients were randomly divided into two groups. Every odds number was included in group-I (interrupted suture) and every even number was included in group-II (continuous suture). Total 14% wound infection was detected in interrupted suture group where as wound infection was 18% in continuous suture group of wound closure. Though the wound infection is higher in group-II but the difference of wound infection is not statistically significant between two groups. The wound pain assessed in seven postoperative days was higher in continuous closure group than interrupted group but the difference was not significant. There is no significant difference of wound infection and wound pain between interrupted and continuous suture group in clean-contaminated laparotomy. DOI: http://dx.doi.org/10.3329/fmcj.v8i2.20373 Faridpur Med. Coll. J. 2013;8(2): 73-76

Association of HbA1c with Urinary ACR & eGFR in Type-2 Diabetes Mellitus

Background Diabetic nephropathy is a chronic micro vascular complication of poorly controlled diabetes mellitus (DM), leading to end stage renal disease (ESRD). Control of DM is monitored by HbA1c. There are two early markers - to assess early renal impairment: Microalbuminuria (MA) & Glomerular Filtration Rate (GFR). Estimation of MA - needs 24 hours collection of urine. GFR is clinically assessed by creatinine clearance rate (CCR) at the same time for accurate estimation of GFR which also needs 24 hours urine collection. Faulty timing and non compliance for 24 hours urine collection - may give erroneous results. MA is better reflected by spot urine urinary albumin-creatinine ratio (ACR). Some formula based calculation of GFR, called estimated GFR (eGFR) are well correlated with CCR which needs only single blood sample for S.Creatinine (S.Cr). For example one such formula is Cockroft-Gault (C-G) formula. Objective To evaluate the association of HbA1c with urinary ACR and eGFR in Type 2DM. Design It was a cross sectional study carried out in the department of Biochemistry, Sylhet MAG Osmani Medical College, from July 2010 to June 2011. Methods Fifty (50) known type 2 DM patients of 40-60 years age were evaluated dividing them on the basis of HbA1c (<8%,>8%), duration of DM (>5 years, <5 years), normotensives or hypertensives. FBS, S.Cr, Urinary Albumin & Creatinine were estimated. eGFR and urinary ACR were calculated. Results were expressed as mean ± SD. Data were analyzed with SPSS software version (12.0). Unpaired ’t’ test and Pearson’s correlation tests were performed as tests of significance. Value of ‘p’<0.05 was the level of significance. Results Significant difference of S.Cr & HbA1c was found between study groups on HbA1c<8% and >8%. DBP was significantly raised in hypertensive type 2 DM. Duration of DM did not show significant correlation with renal functional parameters. Serum Creatinine & U.ACR had significant positive correlation with HbA1c>8% and only with ACR but not with S.Cr in study subjects having HbA1c<8%. DOI: http://dx.doi.org/10.3329/pulse.v5i1.20183 Pulse Vol.5 January 2011 p.6-11

Empowerment of Medical Toxicology in Bangladesh: Inspiration from the APAMT

In the last issue of Asia Pacific Journal of Medical Toxicology (APJMT), editor-in-chief, Dr. Reza Afshari focused on an important contemporary issue of empowering toxicology in the Asia pacific region (1). The topic drew our attention and we would like to share the situation of Bangladesh in light of this editorial. Dr. Afshari correctly emphasized on forming national societies of medical toxicology in each country of Asia Pacific region (1). Bangladesh formed its own national society, ‘Toxicology Society of Bangladesh (TSB)’ in the year 2008 under the leadership of Prof. M. Abul Faiz (2). The society has its own website (http://www.tsbbd.org/index.php). Although in small scale, the society is trying its best to disseminate knowledge of medical toxicology throughout the country. So far, we have arranged two successful national conferences in the year 2011 at Rangpur medical college (northwest of Bangladesh) and in 2013 at Chittagong medical college (southeast of Bangladesh). The society decided to arrange a national gathering at every two years interval, and hence, the next conference is scheduled to be held at Sylhet MAG Osmani medical college (northeast of Bangladesh) in coming 2015. TSB purposefully has arranged the national meetings outside capital (Dhaka), so that medical toxicology as a subject can be ventilated to the remote corners of Bangladesh. Around four hundreds domestic and international participants attended both the conferences and some of the foreign participants were policy makers of the Asia Pacific Association of Medical Toxicology (APAMT). Bangladeshi physicians started to participate APAMT congresses since 2006 (Colombo meeting) and so far TSB sent members to each meeting of the APAMT. Dr. Afshari mentioned about travel grant as a strong step to motivate young investigators of this region (1). We also support his statement. So far, a number of participants from Bangladesh have received travel grants, and this surely encouraged them for future work. In fact, they are now the core members of the TSB. Undoubtedly, the APAMT is the encouragement behind all of our activities. Introduction of APJMT is clearly a milestone event for us. The young researcher of this region especially those who cannot publish their paper for various technical and linguistic reasons got a hope to see the evolution of APJMT. At least, now they can try their paper for possible publication even though their work needs fine tunes. As a Scientific and publication secretary of the TSB, I specially highlighted the journal to all of the members of TSB and others throughout the country and the journal is now receiving regular papers from Bangladesh. We firmly believe that in the near future, the APJMT will become the representative of the research in medical toxicology in this region.

Ultrasound guided fine needle aspiration cytology: a sensitive diagnostic tool for diagnosis of intra-abdominal lesions

Ultrasound guided fine needle aspiration cytology is widely accepted as a safe diagnostic procedure in various neoplastic and non-plastic disorders. This study was conducted to determine the usefulness and diagnostic accuracy of ultrasound guided fine needle aspiration cytology in the diagnosis of intraabdominal lesions. This cross sectional study was conducted in the Department of Radiology and Imaging, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh during the period of June 2007 to June 2009. A total 78 patients with intra abdominal lesions were included in this study. Fifty nine (75.6%) were males and 19 (24.4%) were females. Out of total aspirates 29 (37.2%) were categorized as benign, 41 (52.6%) were malignant and 8 (10.3%) were non-representative, as it contained only blood. Most of the benign lesions were liver abscess 19 (24.4%). A diagnosis of primary malignancy was established in 26 (33.3%) and that of secondary in 15 (19.2%). The results showed a sensitivity of 89.7%. Ultrasound guided fine needle aspiration cytology is a sensitive diagnostic tool in a wide spectrum of intra-abdominal neoplastic and non-neoplastic disorders. It is a simple, safe, rapidand inexpensive technique.

Prognostic Value of High-sensitivity C - reactive protein in Acute ST-segment Elevation Myocardial Infarction in Hospitalized Patients

Acute Myocardial Infarction (AMI) is an inflammatory condition. C-reactive protein (CRP) is a sensitive inflammatory marker. Elevated plasma CRP levels detected in the first few days of AMI is a predictor of unfavourable short and long term outcome. This cross sectional comparative study included 60 patients of 28-85 years with acute ST segment elevation myocardial infarction (STEMI) admitted within 24 hours of onset of chest pain in coronary care unit (CCU) of Sylhet MAG Osmani Medical College Hospital. Based on high-sensitivity C-reactive protein (hS-CRP) levels on the first day, the patients were divided into two groups: Group-I Low hs-CRP group (?10 mg/L, n=22); Group-II High hs-CRP group (?10 mg/L, n=38). Clinical and echocardiographic prognostic variables were compared between two groups. The mean values of 1st and 3rd day hs-CRP levels of acute STEMI patients who developed the worse outcomes and who did not develop the outcomes are also compared. Among the in-hospital outcomes in group-I and group-II, (recurrent angina, cardiogenic shock, heart failure (HF), arrythmias, left ventricular ejection fraction (LVEF), wall motion abnormality (WMA), hospital stay and mortality) only arrhythmia was found significantly higher in high hs-CRP group (36.4% vs 76.3%, P<0.01). On the other hand, the patients who developed these worse outcomes had significantly higher mean values of both 1st day and 3rd day hs-CRP compared to those who did not develop these outcomes. Mean values of 1st and 3rd day hs-CRP (mg/L) of patients who develops recurrent angina or not was 68.42 (SD 12.56) and 110.14 (SD 10.66) vs 29.08 (SD 5.83) and 36.74 (SD 6.64) p<0.01. Among patients with arrhythmias, the values were 62.77 (SD 9.06) and 83.94 (SD 10.0) vs 14.23 (SD 2.92) and 35.20 (SD 7.65) p<0.001. Hs-CRP can be used as a simple and cost effective tool for prediction of in-hospital prognosis in patients with acute STEMI. DOI: http://dx.doi.org/10.3329/medtoday.v24i1.14113 Medicine TODAY Vol.24(1) 2012 pp.36-39

Comparative efficacy of levofloxacin and ceftriaxone in the treatment of community acquired pneumonia in children

Pneumonia is a common cause of mortality and morbidity in under-5 children throughout the world. Globally an estimated 156 million new episodes of pneumonia occur each year in children and 2 million children die from pneumonia each year which is 20 percent of all deaths of children under five years old. Ceftriaxone is a commonly used drug for empiric treatment of community acquired pneumonia (CAP) in children. Levofloxacin may be an adequate option for empiric therapy in treatment of CAP in children because it gives the broad spectrum activity against both bacterial and atypical pathogens causing CAP and studies suggest that it can be safely used in children. This open labeled, randomized, comparative clinical trial was carried out in the Department of Pediatrics, Sylhet MAG Osmani Medical College Hospital, Bangladesh during January, 2011 & December, 2012 to compare the efficacy of levofloxacin and ceftriaxone in the treatment CAP in children. A total 70 cases of CAP were enrolled. 35 cases were allocated to levofloxacin group and another 35 cases to ceftriaxone group. At first the study cases were selected by systematic random sampling. Group allocation to either levofloxacin or ceftriaxone group was done by lottery method. Total duration for receiving study drugs was seven days. Dose of levofloxacin was 10 mg/kg/day children ≥5 years, where as it was 10 mg/kg 12 hourly in 6 months to Clinical responses were categorized as cured and treatment failure. 91.43% cases were cured in levofloxacin group, whereas cure rate of ceftriaxone group was 68.57% which was statistically significant (p = 0.0168). Adverse effects of levofloxacin were found as skin rash in 1 case and vomiting in 2 cases whereas skin rash was found in 1 case in ceftriaxone group. So it can be concluded that levofloxacin is more effective than ceftriaxone in the treatment of CAP in children.

Suicide in Young Age Group

This paper presents the study of 200 cases of death which were 'suicidal in nature' received in the dept. of Forensic Medicine, Sylhet MAG Osmani Medical College, Sylhet, Rajshahi Medical College, Rajshahi, Comilla Medical College, Comilla and Faridpur Medical College, Faridpur for Post Mortem examination (PME), during the period of 2007 to 2009, The post mortems were conducted by the authors. Out of 200 PME of Suicide cases 98 {49%) were hanging by neck, 86 (43%) were poisoning and 16 (8%) by other methods.TAJ 2009; 22(1): 194-197

Seroprevalence of Hepatitis Virus Antibodies in Newly Admitted Students of Sylhet MAG Osmani Medical College

Blood samples from randomly selected 100 newly admitted first year MBBS students of Sylhet MAG Osmani Medical College were tested to find the seroprevalence of antibodies against Hepatitis A, Hepatitis B, Hepatitis C and Hepatitis E viruses. The study revealed a lower seroprevalence of HAV antibodies than the common perception of their age group. The rate of vaccination against hepatitis B virus was found not very high, considering the affluence of their parents. Also there were lack of awareness about risk factors of viral hepatitis and many of the students were in habit of taking food outside. Institutionalized vaccination policy for 1st year medical students against Hepatitis A and Hepatitis B along with awareness building measures regarding the professional risk among the new entrants are suggested. Policy planners and other stakeholders in the field should come up with a comprehensive intervention strategy to protect the future caregivers from the scourge of hepatitis viruses. Keywords: Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis E, Seroprevalence doi: 10.3329/bjmm.v3i1.2967 Bangladesh J Med Microbiol 2009; 03 (01): 20-26

Urogenital anomalies associated with anorectal malformations in children

The urogenital tract is the most severe and common site of associated defects in anorectal malformations (ARM). Urogenital anomalies and their complications significantly increase the morbidity in these children after the ARM is corrected. The purpose of this study was to estimate the incidence of different types of urogenital anomalies with various types of anorectal malformations and to discuss the possible management and outcome. A retrospective study of patients with ARM and associated urogenital abnormalities admitted in the department of paediatric surgery of Sylhet MAG Osmani Medical College Hospital between 1998 and 2002 was undertaken. A total of 155 patients with Anorectal malformations were admitted of which 47 (30.32%) patients had associated anomalies involving other systems. Urogenital abnormalities were found in 25 (16.13%) patients. Patients of Anorectal malformations with urogenital abnormalities require careful assessment and well-timed intervention to minimize the morbidity.

Leech in urinary bladder causing hematuria

Objective To estimate efficacy of normal saline in the management of hematuria caused by accidental entry of a leech per urethra into the urinary bladder. Methods An intervention study was carried out in the Department of Pediatric Surgery of Sylhet MAG Osmani Medical College between January 1998 and December 2003. A total of 43 boys (mean age 8 years, SD ± 2.6) were enrolled. In all cases, a leech had entered the urinary bladder through the urethra causing hematuria. All patients were equipped with a self-retaining Foley catheter. They were managed by infusing 50 ml of normal saline into the urinary bladder through the catheter that was then clamped for 3 h. Results After removing the catheter, in all cases the whole leech was spontaneously expelled intact, dead or alive, within 2–24 h during the subsequent act of micturition. Hematuria gradually diminished to a clear flow within the next 6 h in 27 cases, 12 h in 14 cases and 24 h in two cases. All patients were followed up for 2 weeks, and none developed recurrent hematuria. Conclusion Catheterization and irrigation of the urinary bladder with normal saline is a relatively simple, safe and inexpensive method of removing the leech and controlling hematuria.

Prevalence of Metabolic Syndrome in Newly Diagnosed Type 2 Diabetes Mellitus

Background: People with metabolic syndrome are twice as likely to die from, and three times as likely to have a heart attack or stroke compared with people without the syndrome. People with metabolic syndrome have a five-fold greater risk of developing type 2 diabetes. We investigated the prevalence of metabolic syndrome in patients with newly diagnosed diabetes mellitus. Methods: It was a cross sectional study. The study was conducted in Department of Biochemistry, Sylhet MAG Osmani Medical College, Sylhet & Diabetic Hospital, Sylhet. The study was conducted From July 2008 to June 2009 among 200 patients with newly diagnosed type 2 diabetic patients with age >20 years. Along with blood glucose, different components of metabolic syndrome was assessed, i.e. serum triglyceride level, serum HDL level, blood pressure and waist circumference. Results- Prevalence of metabolic syndrome was 73.5% according to NCEP-ATP III criteria, 81.0% according to modified NCEP-ATP III criteria, 82.5% according to modified WHO criteria and 61.0% according to IDF criteria. All variables other than waist hip ratio and fasting blood sugar had statistically significant higher mean values among patients with metabolic syndrome than patients without metabolic syndrome. Conclusion: It may be concluded that prevalence of metabolic syndrome is considerable in newly diagnosed type 2 diabetic patients in our population. The considerable prevalence of metabolic syndrome in our population is implicative of an alarming risk of cardiovascular disease in future. Keywords: Metabolic syndrome; Type II diabetes mellitus. DOI: http://dx.doi.org/10.3329/cardio.v4i1.9385 Cardiovasc. J. 2011; 4(1): 17-25