Tertiary Level Hospital Research Articles

Characterization of the Elderly Patients Admitted with Infection to a Tertiary Hospital in Bangladesh

Background: The proportion of hospitalizations attributable to infectious diseases is high, and likely to increase further in the future as a result of the expected aging of the population and the increasing prevalence of comorbid conditions among the elderly. The present study aimed to investigate the clinical characteristics and outcomes of elderly patients admitted due to infection in a tertiary-level hospital in Chattogram, Bangladesh. Materials and methods: This prospective observational study was conducted in Chittagong Medical College Hospital (CMCH) Chattogram. Two hundred and six patients aged ≥60 admitted with a diagnosis of infectious aetiology in the medicine department were enrolled according to set inclusion criteria. Patients were followed up for in-hospital outcomes after admission. Results: Age ranges from 60-90 years with a mean age of 65.82 (±5.56) years) and 51.5% were male. Pre-hospital antibiotic was received by 108 (52.4%) patients and 7.4% had antibiotic prescribed by registered physicians The most frequent infections were respiratory tract infections (47.6%) and urinary tract infections (43.2%). Sixty-four (31.1%) patients developed sepsis and 17 (8.3%) required ICU support. Eleven patients expired in-hospital, indicating a mortality rate of 5.3%. Length of hospitalization ranged from 2 to 17 days, with a median of 6 days. Conclusion: This study result suggests that infection-related hospitalization and outcomes of elderly individuals were high and their health seeking behaviour was poor. IAHS Medical Journal Vol 6(2), December 2023; 31-34

Incidence of Tethered Cord Syndrome in Pediatric Patients With Neurofibromatosis Type 1

ObjectiveThe link between Tethered Cord Syndrome (TCS) and Neurofibromatosis Type 1 (NF1) remains unclear. To date, only two studies have indicated a high occurrence of TCS in the pediatric NF1 patient population. Our study aims to ascertain the incidence of TCS among Chinese pediatric patients with NF1. MethodsA single-institution, 8-year retrospective analysis at a tertiary-level children's hospital was conducted for patients with NF1 who underwent surgery for TCS. The clinical features, imaging characteristics, genetic testing outcomes, and histopathological findings of pediatric NF1 patients with TCS were analyzed. ResultsDuring the study period, a total of 115 pediatric patients were diagnosed with NF1. Among these 115 NF1 patients, 11 individuals, accounting for 9.6% of the sample, were confirmed to have TCS. This rate of occurrence is significantly higher than the incidence rate of TCS in the general population, which stands at 0.17%. All 11 of the pediatric NF1 patients underwent surgery for TCS. Out of the 11 patients who were advised to have tethered cord release surgery, 4 (which is 36.4%) were girls, and the average age of these 11 patients was 8.6 years old, with ages ranging from 2 to 17 years old. The conus medullaris position of the 11 pediatric NF1 patients ranged from L1 to L2, and 10 of them (91%) had a filum terminale lipoma, characterized by high signal intensity on T1-weighted magnetic resonance (MR) images. Another patient was diagnosed with Occult Tethered Cord Syndrome (OTCS). All 11 pediatric NF1 patients exhibited symptoms associated with TCS, such as neuromotor dysfunction, abnormalities in urination, defecation, skeletal system abnormalities, or pain. Eight of the 11 pediatric NF1 patients had undergone genetic testing, which is a crucial part of the diagnostic process for NF1. The histopathological examination of the 11 pediatric NF1 patients who underwent surgery revealed that 10 patients had fatty infiltration of the filum terminale (FT), while the remaining patient exhibited fibrosis of the filum terminale (FT). ConclusionsIn the group of pediatric patients with NF1, the incidence of TCS, presenting to the pediatric neurosurgery clinic for any reason, is significantly higher than that of the general population. However, the pathophysiological relationship between NF1 and TCS is still not clear. It is essential to provide counseling to NF1 patients and their families about the symptoms of TCS to make sure they are aware and can seek the necessary care when needed. This underscores the importance of not only diagnosing NF1 but also staying alert for related conditions like TCS, which may have a higher occurrence in this demographic.

Knowledge and Practice of Biomedical Waste Management among Nurses at a Tertiary Level Hospital in Bangladesh

Knowledge and Practice of Biomedical Waste Management among Nurses at a Tertiary Level Hospital in Bangladesh

FP6.10 - Improving Compliance & Implementation of WHO Surgical Safety Checklist At a Tertiary Level Hospital in India: A continuous process

Abstract Aim To complete an audit on the level of compliance with the WHO surgical safety checklist in surgical operating theatres at a Tertiary level hospital in India. Method A total of 40 general surgeries were observed at the operating theatres at a tertiary-level hospital in India to confirm the practice of the WHO surgical safety checklist. The study was conducted for 1 month in September 2021. The results were compared with standard guidelines and further analyzed. Interventions were carried out through a series of rigorous departmental meetings and discussions with the medical and nursing staff. A re-audit was conducted. Results Of all the operations audited, 45% Sign-In and only 1% Sign-Out were performed in the first cycle. After the re-audit, a significant change was reported as the Sign-In improved to 80%, and a 55% Sign-Out was conducted. The Time-Out was observed to increase from 15% to 65%. Compliance in the final third cycle showed improvement in Sign-In at 95%, Sign-Out at 85%, and Time-Out at 90%. Conclusion Though in the first cycle of our audit, the compliance to the SSCL was found to be suboptimal, significant improvement was demonstrated in the second cycle and eventually in the final third cycle bringing it closer to 100% compliance, after rigorous awareness programs and training sessions. Compliance with all items in the checklist and active participation by all medical and nursing staff is mandatory for the successful implementation of the Surgical safety checklist.

FP6.9 - Improving Compliance & Implementation of the STAR Score at a tertiary level hospital in India: A continuous process

Abstract Aim To perform an audit to check the Quality and compliance of Surgical documentation using STAR Score at a tertiary hospital in India. Method A total of 90 case files were studied and assessed in detail from all surgical departments. The “STAR: Surgical tool for auditing records” tool was used to collect data accordingly. The results were compared with standard guidelines and further analyzed. A series of departmental training and implementation meetings were carried out. Three cycles were carried out and a re-audit was performed at the end of every cycle. Result The overall compliance score of the hospital was found to be 74%. While the departments of General surgery and orthopaedics showed a higher rate of compliance, each constituting 82%, Neurosurgery showed the least compliance at 62%. It was also seen that the maximum percentage of missing information constituted anaesthetic records and subsequent entries. At the end of 3 cycles, a considerable improvement was observed, with the compliance rate improving to 98% in all departments. Conclusion We believe that compliance and implementation of the STAR Score is mandatory, as it can significantly improve the quality of documentation and can be implemented universally.

Association between polypharmacy and 2-year outcomes among Chinese older inpatients: a multi-center cohort study

BackgroundThe escalating global prevalence of polypharmacy presents a growing challenge to public health. In light of this issue, the primary objective of our study was to investigate the status of polypharmacy and its association with clinical outcomes in a large sample of hospitalized older patients aged 65 years and over.MethodsA two-year prospective cohort study was carried out at six tertiary-level hospitals in China. Polypharmacy was defined as the prescription of 5 or more different medications daily, including over-the-counter and non-prescription medications. Baseline polypharmacy, multimorbidity, and other variables were collected when at admission, and 2-year outcomes were recorded by telephone follow-up. We used multivariate logistic regression analysis to examine the associations between polypharmacy and 2-year outcomes.ResultsThe overall response rate was 87.2% and 8713 participants were included in the final analysis. The mean age was 72.40 years (SD = 5.72), and women accounted for 42.2%. The prevalence of polypharmacy among older Chinese inpatients is 23.6%. After adjusting for age, sex, education, marriage status, body mass index, baseline frailty, handgrip strength, cognitive impairment, and the Charlson comorbidity index, polypharmacy is significantly associated with frailty aggravation (OR 1.432, 95% CI 1.258–1.631) and mortality (OR 1.365, 95% CI 1.174–1.592), while inversely associated with readmission (OR 0.870, 95% CI 0.764–0.989). Polypharmacy was associated with a 35.6% increase in the risk of falls (1.356, 95%CI 1.064–1.716). This association weakened after adjustment for multimorbidity to 27.3% (OR 1.273, 95%CI 0.992–1.622).ConclusionsPolypharmacy was prevalent among older inpatients and was a risk factor for 2-year frailty aggravation and mortality. These results highlight the importance of optimizing medication use in older adults to minimize the risks associated with polypharmacy. Further research and implementing strategies are warranted to enhance the quality of care and safety for older individuals exposed to polypharmacy.Trial registrationChinese Clinical Trial Registry, ChiCTR1800017682, registered 09/08/2018.

EP592 - A surgical case report of an epiploic hernia - A mobile right colon herniating through the foramen of Winslow

Abstract Introduction An Epiploic Hernia is an extremely rare type of abdominal hernia with <0.1 % incidence where the bowel or other intra-abdominal contents herniate through the Foramen of Winslow. A case of an Epiploic hernia in a middle-aged female is presented here. Presentation of case A woman in her 60s was admitted to a tertiary level hospital with severe right sided intermittent upper abdominal pain associated with nausea, bloating and constipation. The symptoms were thought to be due to biliary colic and managed conservatively. Since the symptoms persisted and a computed tomography scan of abdomen was organized. CT scan showed that the caecum was in the upper left quadrant. A laparoscopy was performed and demonstrated that her right colon was mobile herniating through the Foramen of Winslow into the lesser sac. The hernia was reduced, and the bowel was viable. The patient was discharged with no complications. Discussion There have been case reports of small bowel as the content of the hernia with lesser occurrences of caecum, ascending colon, transverse colon, gall bladder, omentum, or Meckel's diverticulum. A caecal herniation through the Foramen of Winslow is reported only with an incidence of 0.02 %. <10 % of these Epiploic hernias are diagnosed preoperatively making it a potentially life-threatening condition if not treated promptly due to high risk of bowel strangulation and mortality of up to 50 %. Conclusion A high index of suspicion is needed for the diagnosis of this internal hernia and radiological investigation is fundamental in making this diagnosis for allowing prompt surgical treatment.

482. REFLUXSTOP PROCEDURE IN THE LAPAROSCOPIC REPAIR OF HIATAL HERNIA

Abstract The video demonstrates laparoscopic anti-reflux surgery with the RefluxStop procedure, first introduced in 2016 and now offered in multiple centers across Europe. As this tertiary level hospital was among the first to offer this treatment to patients in clinical practice, this video provides unique insight to the lessons learned from the early experience of this surgery, with regard to optimizing effectiveness and safety. In light of the promising clinical outcomes that are emerging as follow-up data become available, the number of surgeons performing this this technique is likely to continue to increase. The RefluxStop procedure addresses all 3 components of the anti-reflux barrier as follows: 1) laparoscopic hiatal hernia repair, 2) high mediastinal dissection to achieve 4-6 cm intraabdominal length of esophagus, allowing the LES to be brought into an optimal intraabdominal position, and 3) recreation of the flap valve at the angle of His though creation of a 90-degree esophago-gastric plication. The 22mm round silicone RefluxStop device is then positioned high-up and close to the esophagus in a fundic pocket, to maintain the correct position of the repair. https://drive.google.com/file/d/1hlXXRUUMkDPmheW_mgPM_g1wWCu2R_Y3/view

Demographic and Clinical Characters of the Patient of Condylar Fracture Treated under the Department of Oral and Maxillofacial Surgery in a Tertiary Level Hospital

Introduction: Mandible is the only mobile bone of the facial skeleton which plays an important role in mastication, speech and deglutition. Being a prominent bone of the facial skeleton, it is one of the most common facial bone to be fractured. Fracture in the mandible causes severe loss of function and disfigurement. Objective: The aim of this paper was to investigate the demographic and clinical characteristics of the patients of condyle fracture treated under the oral and maxillofacial department of a tertiary level hospital of Bangladesh. Methods: This retrospective cross-sectional descriptive type of study was conducted at the Department of Oral and Maxillofacial Surgery in Dhaka Dental College and Hospital, Dhaka, Bangladesh during June, 20 23 to December, 2023. A consecutive sampling technique was used and a series of 120 cases of condyle fracture aged 17-65 years of both sex were retrospectively enrolled in this study. The data were analyzed using Statistical Package for Social Sciences (SPSS), version-23.0. Results: A series of 120 cases of condyle fracture patients were enrolled in this study. Among the patients, the most frequent age group was 30-39 years which includes 62(51.25%) patients. The mean age of the patients was 41.10±10.21 years. A significant gender disparity was observed, with 87(72.5%) of the patients being male. Most of the patients were service holder 63(52.5%). The major cause of injury of the patients was road traffic accident 75(62.5%).Among the study patients, 111(92.5%) had third molar teeth present. Of them, the most frequent 75(67.56%) patients had erupted third molar condition and 36(32.43%) patients had impacted third molar condition. According to distribution of type of impacted teeth, 21(50%) cases, had oriented vertically and followed by mesioangular 11(25%), disto-angular 4(10.7%), and horizontal 6(14.3%). According to distribution of condylar fracture, the most frequent 73 (6.25%) patients had non-displaced injuries. followed by displaced 36(30%) and dislocated 11(8.75%). Conclusion: This study investigated that road accident is the principal factor of condylar fracture and third molar teeth and its position has a significant impact on condylar fracture and at the same time the male are the more prone to condylar fracture than the female in Bangladesh

Surgeon-related Factors in the Surgical Treatment of Proximal Humerus Fractures.

In this study, we reviewed proximal humeral fractures surgically treated with open reduction and internal fixation (ORIF) to test the null hypothesis that there is no association between fracture characteristics and surgeon characteristics in outcomes after surgical management of displaced proximal humeral fractures with ORIF. A retrospective review of surgically treated proximal humeral fractures was done at a tertiary-level hospital. The data were organized into two categories: fracture characteristics and surgeon characteristics. There were 314 proximal humeral fractures treated with ORIF. In total, there were 112 failures (36%). Bivariate Pearson correlations demonstrated that the number of proximal humerus fixation surgeries performed by an individual surgeon was associated with adequate calcar reduction (r = 0.995, P < 0.001) and greater tuberosity reduction (r = 0.994, P < 0.001). Years of experience was positively associated with adequate calcar reduction (r = 0.594, P = 0.012) and greater tuberosity reduction (r = 0.589, P = 0.013). Regression analysis of two surgeons versus the rest of the cohort demonstrated significantly lower failure rates (P = 0.001). Complex proximal humeral fractures (3-part and 4-part) have better calcar reduction and tuberosity reduction when treated by surgeons with greater volume of proximal humeral fracture surgery. Among surgeons with high volume, there may be individuals who have the unique ability to provide markedly better results.

Prevalence of Subclinical Peripheral Neuropathy in Patients With Autoimmune Connective Tissue Disorders: An Observational Cross-Sectional Study.

Background Autoimmune connective tissue disorders (AICTDs) are a group of chronic inflammatory diseases characterized by immune responses targeting the body's own tissues. Peripheral neuropathy, which can be symmetrical or asymmetrical, is a common complication in AICTD patients. Early detection of subclinical peripheral neuropathy remains challenging, as nerve conduction studies are not routinely performed. This study aimed to determine the prevalence of subclinical peripheral neuropathy among patients with AICTD and to assess its association with potential predictor variables, including laboratory parameters and autoimmune markers. Materials and methods This observational cross-sectional study included 100 patients undergoing treatment for AICTDs for over three years, conducted over 15 months. Ethical approval and informed consent were obtained before detecting subclinical peripheral neuropathy through nerve conduction studies on bilateral ulnar, radial, sural, peroneal, and tibial nerves at a tertiary-level medical college hospital. Inclusion criteria encompassed patients treated at the tertiary hospital, not on immunosuppressants other than steroids, with at least three years of treatment, while exclusions were made for established peripheral neuropathy and other specified conditions. Descriptive statistics, Chi-square/Fisher's exact tests, independent samples t-tests, and logistic regression were used for data analysis at a 0.05 significance level, with IBM SPSS Statistics for Windows, Version 20 (Released 2011; IBM Corp., Armonk, NY, USA). Results Subclinical peripheral neuropathy was present in 18% (n = 18) of the study participants, while 82% (n = 82) did not exhibit neuropathy. Patients with subclinical neuropathy had a significantly higher mean age (49.66 ± 4.77 years) compared to those without neuropathy (46.02 ± 12.7 years, p = 0.047). The majority of the study population was female, 79 (79%), and there was no significant gender difference between the groups (p = 0.513). There was no significant association between inflammatory markers (C-reactive protein (CRP), erythrocyte sedimentation rate (ESR)) and neuropathy. However, patients with subclinical neuropathy were more likely to test positive for rheumatoid factor (RF) (8 (66.7%) vs. 71 (58.5%), p = 0.011) and anti-cyclic citrullinated peptide (Anti-CCP) antibodies (11 (78.5%) vs. 32 (47%), p = 0.032). Steroid use did not significantly affect the presence of neuropathy (p = 0.769). Conclusion The study found a high prevalence of subclinical peripheral neuropathy in AICTD patients, detectable only by nerve conduction studies. RF and Anti-CCP antibodies were associated with subclinical neuropathy, suggesting these markers could guide early detection, and inform treatment intensification to reduce neuropathy prevalence among AICTD patients.

Prevalence, pattern and predictors of fast-food consumption among the undergraduate nursing students of a tertiary level hospital

The global fast-food industry has grown exponentially, significantly impacting public health by contributing to metabolic disorders like obesity and diabetes. This study aimed to investigate the prevalence, patterns, and predictors of fast-food consumption among 201 undergraduate nursing students at a tertiary-level hospital in India. Using a cross-sectional design, data were collected through a validated self-administered questionnaire and analyzed using R software. Descriptive statistics, chi-square tests, and logistic regression were employed to assess associations between demographic factors and fast-food consumption. Results showed a high prevalence of fast-food consumption (90.0%), with a significant association between fast-food and carbonated drink consumption (p &lt; 0.01). However, no significant predictors of fast-food consumption were identified among demographic factors such as gender, academic year, and residence type. These findings underscore the need for targeted nutritional interventions within nursing curricula to promote healthier dietary habits among future healthcare providers.

Assessment of Quality of Life of Doctors during Corona Pandemic in a Tertiary Hospital in Dhaka City

Background: Corona pandemic is an event where there is a rupture of the normal life pattern. The healthcare professionals specially doctors had faced an unknown potential threat to life that made them work in an intense and fearful situation. So, their quality of life (QOL) was affected in that pandemic. Objectives: To assess the physical health, psychological, social relationship, and environmental domains of quality of life of doctors during COVID-19 pandemic in a tertiary level hospital. Methods: It was a cross sectional study that included 100 doctors who were working during corona pandemic in BSMMU. Then they were interviewed with a semi-structured socio-demographic questionnaire. Quality of life was assessed by validated Bengali version of World Health Organization quality of life scale brief (WHOQOL-BREF). Data analysis was performed by statistical package for social science (SPSS), version-20. Results: Among the four domains, the environmental domain had the lowest score followed by physical health and psychological health domain and the social relationship domain showed a relatively higher score. Besides, environmental health scores of female doctors were significantly higher than those of male doctors. Perceptions of quality of life were significantly poor among doctors who were in current economic struggle (p=0.034) or in fear of future economic struggle (p=0.009). Score of environmental health domain were significantly low among doctors who were in current economic struggle (p=0.0137) as well as in fear of future economic struggle (p=0.015). Conclusion: All domains of quality of life were impaired in doctors during COVID-19 pandemic situation. Among the four domains of WHOQOL-BREF scale, environmental domain was mostly affected. Environmental health of male doctors was worse than female doctors during COVID-19 pandemic. Current as well as fear of future economic struggle in COVID-19 pandemic detrimentally affected perception of quality of life among responded doctors. These also caused poor environmental health among doctors in COVID-19 pandemic. J Com Med Col Teachers Asso Jan 2024; 28(1): 09-13

Correlation of psychological resilience with social support and coping style in Parkinson's disease: A cross-sectional study.

To analyse the current status of psychological resilience in Parkinson's disease (PD) patients and its correlation with social support and coping style. A cross-sectional study. PD patients hospitalized in a tertiary-level hospital in Shijiazhuang, Hebei Province, from March 2022 to March 2023 were selected for the study using the convenience sampling method. A general information questionnaire, psychological resilience scale, Medical Coping Modes Questionnaire and Perceived Social Support Scale were used to investigate 111 cases of PD. SPSS 25.0 software was used for statistical analysis. The data were analysed using independent samples t-test, one-way ANOVA, multiple linear regression analysis and the Pearson correlation coefficient. Parkinson's disease patients have a moderate level of psychological resilience. The results of the Pearson correlation analyses showed that the level of psychological resilience was positively correlated with social support and confrontation and was negatively correlated with avoidance and acceptance-resignation. The results of multiple linear regression analysis showed that social support and acceptance-resignation were the influencing factors of psychological resilience in PD patients. The psychological resilience of PD patients is at a moderate level. Social support and acceptance-resignation are the factors influencing the psychological resilience of PD patients. This study analysed the level of psychological resilience in PD patients and its correlation with social support and coping style from the perspective of positive psychology to provide some reference for targeted clinical interventions. Our study found that social support and acceptance-resignation are influential factors in psychological resilience in PD patients. Medical staff should encourage patients to face the disease positively and their social support should be increased in order to improve their level of psychological resilience. No patient or public contribution.

Clinico-Mycological Study of Dermatophytosis among Diabetic and Non-Diabetic Patients in a Tertiary Level Hospital: A Comparative Study

Abstract Background: Dermatophytosis is a major public health concern in India, especially in recent years, with an alarmingly rising trend, particularly in relation to recurrent and chronic infection. The number of studies examining the relationship between an individual’s glycemic status and the development of dermatophytosis, and a comparison of the evolving species trend between diabetic and non-diabetic patients infected with dermatophytes, is limited. Aims and Objectives: To study and compare the clinical and mycological aspects of dermatophytosis among diabetic and non-diabetic patients and to compare the culture isolates in both groups. Materials and Methods: The study included 378 patients of clinically suspected dermatophytosis, divided into two groups of 189 known diabetics and non-diabetics each. We subsequently analysed and compared the demographics, clinical data, potassium hydroxide (KOH) mount, calcofluor white (CW) staining and fungal culture results of all patients in both groups. Results: Among the 378 patients, diabetic patients had a significantly greater extent of involvement and higher rates of recurrence when compared to non-diabetics. The overall positivity rate was higher in CW staining (77.8%) as compared to KOH (57.7%) in both non-diabetics and diabetics. Trichophyton mentagrophytes was the most common isolate (47.6%) in both diabetic (55.0%) and non-diabetic (61.4%) patients, followed by Trichophyton rubrum (31.8% and 29.6%, respectively). The positivity percentages of fungal culture, KOH and CW staining increased to 100%, 77.9% and 95.7%, respectively, when scrapings were taken from ≥2 sites. Conclusion: The pattern of dermatophytosis is comparatively more chronic and severe in diabetics compared to non-diabetics. T. mentagrophytes was the most common culture isolate in both groups. CW staining can potentially be used as the initial method of choice for the diagnosis of dermatophytosis as it has significantly outperformed the conventional KOH mount. Scrapings can regularly be taken from ≥2 sites to avoid false negative results.

Clinical characteristics and management of patient with portal hypertension at tertial level hospital in Tanzania

BackgroundPortal hypertension is a common diagnosis in Sub-Saharan African countries, with the majority of patients presenting late. This study aimed to understand Clinical characteristics, aetiology, the treatment offered in our setting, and factors associated with portal hypertension at a tertiary-level hospital, in Tanzania.MethodologyA prospective cross-sectional observational single hospital-based study was conducted at MNH, from May 2021 to April 2022. A minimum of 152 subjects were required with an error of less than 5% and a study power of 80% at a 95% confidence interval. A structured questionnaire was used to collect data. Ethical clearance was obtained from the MUHAS/MNH IRB.ResultsA total of 154 eligible participants consented and participated in this study. The mean age of participants was 42 ± 15.8 years (range 2–87). Most of the study participants were males 64.9% with a male-to-female (M: F) ratio of 1.8:1. Vomiting blood was the common symptom among the study participants 51.3%. Schistosomiasis 53.9% and viral infection 26.6% were the common etiologies followed by alcohol abuse 7.8%. Most were medically treated at 89.61% followed by radiological treatment at 8.44% while only 1.95% of patients received surgical treatment. There was a significant association between the grade of oesophagal varices and bleeding consequences (p-value < 0.01).ConclusionThe majority of patients were medically treated while patients who require surgical care are unable to assess it. We recommend the establishment of a transplant services program to counteract the unmet need and more retrospective research toward policy establishment.

Clinical manifestations and treatment outcomes among hospitalised COVID-19 patients in tertiary hospitals in Tanzania, 2021–2022: a retrospective cohort study

BackgroundThere have been differential mortality rates from COVID-19 in different parts of the world. It is not clear whether the clinical presentation does also differ, thus the need for this...

Outcomes of Fetal Malpresentation Beyond 28 Weeks of Gestation at a Tertiary-Level Hospital

Background: The term malpresentation encompasses any fetal presentation other than vertex, including breech, face, brow, shoulder, and compound presentations. Both fetal and maternal factors contribute to the occurrence of malpresentation. Objective: To determine the outcomes of fetal malpresentation beyond 28 weeks of gestation at a tertiary-level hospital. Material and Methods: It was a cross sectional descriptive type of observational study carried out in the Department of Obstetrics &amp; Gynaecolgy, Mymensingh Medical College Hospital, Mymensingh during the period of March 2019 to August 2019.Structured questionnaire including history and physical examination of pregnant women were included in data collection sheet-and analysis was done by computer software SPSS version 20. Results: This study shows majority of the women 20(40%) were in the age group of 26-30 years. The average age was 29.9 years. The common fetal malpresentation was breech presentation 35(70%) followed by5(10%) was brow presentation, 5(10%) was shoulder presentation and 3(6%) was compound presentation and maximum seen in multiparity 20(40%) Regarding mode of delivery, 15(30%) delivered vaginally and 35(70%) had to do caesarean section. 13(26%) women suffered from complication during labour. Most common fetal morbidity were birth asphyxia 10(20%) and perinatal mortality was 2(4%). Conclusion: It was observed that major fetal morbidities were low birth weight, birth asphyxia and perinatal infection. Majority patients were delivered by caesarean section. Identification of the cases that require caesarean section, and allowing appropriate and safe trial of labour and vaginal delivery (if no contraindication) require clinical experience and technical skill. The obstetricians should acquire and maintain such knowledge through clinical exposure and attending obstetric emergency skill courses.

Exploring the Incidence of Malignancy in Thyroid Swelling: A Cross-Sectional Perspective

Introduction: Thyroid malignancy is a global health problem. It is the most common among all endocrine malignancies. The incidence of thyroid cancer is increasing all over the world. Bangladesh is not exempted. The worldwide prevalence of goiter in the general population is estimated at 4-7%. The incidence of malignancy in goitrous thyroid is about 10%. An increased incidence of thyroid carcinoma has been noted in endemic goiter zones. Bangladesh also has some goitrous zones. The frequency of carcinoma is two times higher in solitary thyroid nodules than in multinodular goiter. Male patients with thyroid swelling showed a high incidence of malignancy. Objective: The study aims to find out the incidence of malignancy in thyroid swelling in a tertiary level hospital of Bangladesh. Materials and Methods: It is a cross-sectional observational study done in the department of ENT &amp; HNS, Cumilla Medical College Hospital from January 2023 to December 2023 with 60 hospitalized patients of different thyroid swelling undergone surgery. Results: In this series of 60 patients of thyroid swelling the age of the patients ranged from 15 to 80, the mean age was 37.73. There were 53 females (88.33%) and 07 males (11.66%) with female to male ratio of 7.6:1. Among the non-neoplastic group (n=33;55%) nodular goitre had the highest incidence (n=20;33.33%) followed by multinodular goitre (n=11;18.33%). The incidence of papillary cell carcinoma was predominant. Among 60 patients with thyroid swelling, it was 28.33% (n=17) and among the malignant lesions (n=22) it was 77.27%. (n=17). The incidence of malignancy (n=22;36.66%)) is more than that of benign (n=5;8.33%). A high incidence of malignancy is observed in male sex. 05 male patients out of 07 were malignant bearing an incidence of 71.42%. In relation to the age of the malignant patients, the incidence is high in 31–40-year group (27.27%). The incidence of malignancy is high in extreme ages also noted. Conclusion: The incidence of thyroid malignancy in thyroid swelling is high. Females of middle age are in a risk group and papillary carcinoma is the commonest of all thyroid malignancies. Appropriate medical attention is warranted for early diagnosis and proper management to reduce morbidity and mortality. Medicine Today 2024, Vol.36 (2): 99-103

The Barriers to Implantable Cardioverter Defibrillator Implantation in Patients With Heart Failure With Reduced Ejection Fraction After ST-Segment Elevated Myocardial Infarction at a Regional Tertiary-Level Hospital

The Barriers to Implantable Cardioverter Defibrillator Implantation in Patients With Heart Failure With Reduced Ejection Fraction After ST-Segment Elevated Myocardial Infarction at a Regional Tertiary-Level Hospital