Showing papers by "Khulna Medical College published in 2015"

Clinical profile of oral squamous cell carcinoma patients attending a tertiary care hospital

Abstract: Oral cancer is one of the most common cancer and constitute a major public health problem. It is estimated that more than 90% of all oral neoplasms are oral squamous cell carcinoma. The purpose of the study was to evaluate the clinical profile of patients with oral squamous cell carcinoma for gender, age, education, occupation, personal habits, site of lesion and histological grading. Two hundred and sixteen confirmed cases of oral squarnous cell carcinoma were included in this study. It was conducted over a period of two years from July 2009 to June 2011 in the department of Dental Surgery of Khulna Medical College Hospital. Male female ratio was 1.5: 1. Mean age was 50.46 years. Correlation between two variables ie. level of education and histomorphological pattern of the lesion were found to be statistically nonsignificant (P>0.05). The commonest age of presentation was in the fifth decade of life. Most of the cases reported at advance stages of the disease which often leads to delay in the management. Majority of patients (70.73%) presented with well differentiated squamous cell carcinoma. Tobacco chewing was the major cause for the development of oral carcinoma DOI: http://dx.doi.org/10.3329/bmjk.v47i1-2.22554 Bang Med J (Khulna) 2014; 47 : 3-6

Kawasaki disease and its treatment - an update

Abstract: Aim: The aim of this review is to update the knowledge about the Kawasaki disease (KD) which includes the way of early detection and latest treatment plan for the disease. Method: A number of literatures were reviewed and latest information about the etiology, diagnosis, laboratory investigation, treatment and outcome of the disease was collected and depicted in the review article. Result: Kawasaki disease is a multisystem vasculitis mainly affecting medium sized blood vessels. It is the second most common cause of vasculitis after Henoch Scholein Purpura (HSP) in children. Etiology of the disease is still unknown. Auto-immunity with genetic influence is thought to associate with the disease. Many physicians are ignorant of the disease. The pediatrician must be aware of the disease and suspect this condition in less than 5 year old children presenting with more than 5 days fever. the number of methods on the basis of criteria is set for the diagnosis of the disease. Latest treatment plan is set up for the disease which reduces the morbidity and mortality to a great extent. Conclusion: Physicians must have consciousness and comprehensive knowledge for the early suspicion of this disease. Any child presenting with fever for more than 5 days should not be ignored and other criteria of KD have to be evaluated by the physician. Early diagnosis and updated treatment are imperative for the prevention of morbidity and mortality for the disease.

Anthropometry of the nose: a comparative study between adult male Santhals and Bengalis in Bangladesh

Abstract: Anthropometry is a scientific methods for taking various measurements of body parts and observation on the living subjects, which play an important role in distinguishing a pure race. The nose is a person's most defining feature because it is at the center of the face. The shape of the nose is a signature indicating the ethnicity, race, age and sex. The aim of this study is to document the mean nasal length, nasal width and nasal index of adult male Santhals and Bengalis in Bangladesh, which provides a comprehensive data for comparisons between each other and with the other ethnic group. Santhals, our study subjects living in the northwest part of Bangladesh, are usually recognized as an ethnic community. Because the Santhals have separate identity and their physical appearance is distinctive to some extent. The study, descriptive, observational and cross sectional is nature, was carried out in the Department of Anatomy, Rangpur Medical College, Rangpur, during the season of July, 2011 to June, 2012. A total number of 100 adult male Santhals and 100 adult male Bengalis were included from different location of Rangur and Dinajpur districts. Nasal length and nasal width were measured using sliding caliper and nasal index was calculated. Unpaired t -test was used to compare the measurement. The mean nose length of the Bengalis were significantly higher than the Santhals but the mean of nose width were significantly higher in Santhals than Bengalis. Most of the Santhals were mesorrhine, but most of the Bengalis were leptorrhine. Mediscope Vol. 2, No. 2: July 2015, Pages 28-32

The MURCS Association: Mullerian Duct Aplasia, Renal Hypoplasia and Cervicothoracic Somite Dysplasia - A Case Report.

Abstract: We report on a 22 years old lady with aplasia of uterus and most of the vagina with normal secondary sexual characteristics, unilateral renal hypoplasia and anomalies of cervico throacic somites (MURCS Association), growth retardation, cardiac defect and congenital urethrovaginal fistula. Although there is a broad spectrum of anomalies described with MURCS association genitourinary fistula is not yet reported and reviewed in published articles. The relevance of this paper is to show the importance of further investigation in cases of primary amenorrhoea with mullerian agenesis to establish that the patient has MURCS association and not simply MRKH (Mayer Rokitansky-Kusterhauser Syndrome) syndrome. Consequently we should provide guidance to the patients and their families about the best way to conduct the case including genetic counseling and family screening.

Clinical effectiveness of VIA and colposcopy based management of cervical intraepithelial neoplasia

Abstract: Cervical cancer develops from early precancerous lesion known as cervical intraepithelial neoplasia (CIN). Khulna Medical college Hospital provides primary screening for preventing cervical cancer and a secondary referral centre for management of CIN by colposcopy. Primary objective of this study was to do an audit between January 2012 to February 2014 to update clinical efficacy of colposcopy based diagnosis, treatment and follow up of 510 CIN cases and also to document any shortcomings in existing services and suggestion for early rectification. Colposcopic findings in our study group were: 309(60.6%) cases were CIN-1, 124 (24.3%) cases was CIN II, and 49 (9.6%) cases were CIN III. Suspicious of invasive lesion was in 7 (1.4%) abnormal looking cervix and biopsy was done in 21(4.1%). Treatment procedure was done with individualization of cases and options were cold coagulation, Loop electrosurgical excision procedure (LEEP), hysterectomy, biopsy and post treatment follow up. Histopathological diagnosis was documented in 387 cases, where CINI was found in 161 (31.6%), CIN II in 92 (18%), CIN III in 26 (5.1%), non specific Inflammatory cervicitis in 87(17.1%), Squamous cell carcinoma in 15(2.9%), abnormalities consistent with koilocytic atypia in 6 (12%) and reports missed in 123 (24.1%). Cases results showed Positive predictive value (PPV) of 53% and 68% respectively for low grade (CIN I) and high grade lesion (CIN II, III). 481 patient were eligible for post treatment follow up but only 99 (20.5%) patient came and among them 74 (74.7%) were colposcopically negative, 25 (25.2%) had residual CIN and Risk Ratio (RR) was 0.25. Colposcopy is gold standard for diagnosis of CIN but our screening program is opportunistic and far way from population based. Histopathological correlation were often inaccurate with colposcopic diagnosis in practice and about one third case reports were missed. Majority of women did not complete follow up protocol. Residual or recurrent CIN lesion in dropped out cases would be a concern in near future. DOI: http://dx.doi.org/10.3329/bmjk.v47i1-2.22557 Bang Med J (Khulna) 2014; 47 : 16-20

The Role of Sentinel Lymph Node Biopsy in the Management of Breast Cancer

Abstract: The sentinel lymph node (SLN) is defined as the first node(s) receiving lymphatic drainage from a primary tumour. A promising alternative to axillary lymph node dissection (ALND) is sentinel lymph node biopsy. SLN biopsy has been introduced as a technique to identify axillary lymph node most likely to contain tumour cells metastasizing from a primary carcinoma of breast. Several methods of identifying the SLN exists, including the use of radioactive tracer, lymphazurin dye or combination of the two via intraparenchymal and/or intradermal, peritumoral or periaerolar injection sites. Intraoperative evaluation of SLNs are done by performing FS(Frozen Section) on all the lymph nodes after serially sectioning them at 3-4mm intervals; at least 2 levels are cut of all the sentinel lymph nodes. In addition, touch preparation cytology(TP) smear may also be made for evaluation. The limitations of SLNB is that a proportion of patients who have metastasis limited to the SLN can be predicted when there is a combination of tumour size <1.0cm, the absence of lymphovascular invasion and micrometastatic disease (<0.2cm) in SLN. However for patients with large breast cancer, the role of SLNB is controversial. Early studies of SLNB in large breast cancer patients demonstrated a high (8-18%) false negative rate, with the accuracy worsening with the increasing size. Excision of SLNs have an extremely low morbidity and a high degree of staging accuracy. A tumour-free SLN virtually excludes lymphatic involvement of the entire regional lymphatic basin. More than 50 observational studies of SLNB validated by a back up ALND demonstrate that SLNB is feasible, accurate and suitable for virtually all patients with operable clinically node negative disease. Sentinel lymph node biopsy not only provide prognostic information, but also aims to guide adjuvant therapy without the untoward side effects of complete axillary dissection. J Bangladesh Coll Phys Surg 2014; 32: 211-217

Outcome of management of congenital diaphragmatic hernia

Abstract: Congenital Diaphragmatic Hernia (CDH) is a defect in the dome of diaphragm, more often in left and postero-lateral that permits the herniation of abdominal contents into the thorax. The lungs hypoplasia, pulmonary hypertension and persistent foetal circulation are important determinant of survival. The incidence is <5 in 10,000 live-births. Antenatal diagnosis is ofen made and this may be helpful in postnatal management. Treatment after birth requires all the refinements of critical care prior to surgical correction. The best hospital series report 80-100% survival. Advances in surgical management include delayed surgical approach that enables preoperative stabilization, improved prenatal diagnosis, introduction of minimal invasive surgery and application of extracorporeal membrane oxygenation in addition to the standard open repair. In our short series survival was 100% where surgical correction was made on selective 12 cases of left sided CDH in a non-ICU set-up. DOI: http://dx.doi.org/10.3329/bmjk.v47i1-2.22556 Bang Med J (Khulna) 2014; 47 : 12-15

Metastatic male breast cancer

Abstract: Breast cancer of female is common but rare in male. It is diagnosed in advanced stage due to the limited amount of breast tissue and lack of awareness. Most cases occur over the age of 60 years. Male breast cancer is treated like female breast cancer. The outcome of the disease is worse, 5-4 year’s survival in about 40% cases. Mediscope Vol. 2, No. 1: 2015, Pages 36-38

A comparison of drug treatment outcome of irritable bowel syndrome patients with and without education: a randomized controlled study

Abstract: The objective of the prospective randomized controlled comparative study to explore about the role of education in the treatment of irritable bowel syndrome (IBS), a chronic continuous or remittent gastrointestinal illness characterized by frequent unexplained symptoms that include abdominal pain, bloating and bowel disturbance. The patients who fulfilled the set criteria of this study and had normal physical examination were considered to undergo screening investigations (Hb%, TC, DC, ESR, blood glucose, serum TSH, stool for R/M/E and short colonoscopy or double contrast barium enema) to exclude any organic disease. In order to administer the same pharmacological treatment only diarrhea predominant patients without any organic disease were recruited for the present study. The number of recruited patients was 80. Of them, 40 patients were given only pharmacological management with Mebeverine Hydrochloride 135 mg thrice daily half an hour before meal and Amitryptyline 10 mg at night for 6 months, and the other 40 patients were given education by a structured and planned educational class for 1 hr in addition to the same pharmacological treatment. In both groups, changes of symptoms and quality of life of the patients were assessed by using a valid IBS related quality of life (IBS-QOL) instrument. The results showed that significant improvement occurred in both the groups of patients at 1 month and 6 months in respect to their baseline IBS-QOL score. But the improvement was not significantly higher in the group with education in comparison to the group without education. Therefore, it can be concluded that the educational class had no extra impact on drug treatment protocol for IBS used in the present study. Mediscope Vol. 2, No. 2: July 2015, Pages 22-27

Juvenile granulosa cell ovarian tumor- a rare presentation

Abstract: Juvenile granulosa cell tumor is a rare gynecologic malignancy. A fourteen year old girl was brought to the emergency with acute abdominal pain with distension of abdomen and admitted in surgical unit, clinically suspected perforation of gut. Transabdominal ultrasonography revealed a right adenexal irregular mass with a moderate amount of ascitic fluid. On laparotomy, it was suspected malignant ovarian tumor stage Ic, and then ipsilateral salphingoophorectomy was done considering the age of the patient. It was juvenile Granulosa cell tumor which confirmed by histo-pathologically. The epidemiology, natural history, presentation, histological and imaging appearances, prognosis and treatment of this malignancy were reviewed. DOI: http://dx.doi.org/10.3329/mediscope.v1i1.21636 Mediscope Vol. 1, No. 1: 2014, Pages 36-39

Efficacy of propranolol in infantile hemangioma

Abstract: Hemangiomas, are the most common benign tumors of infancy. Despite their selflimited course, infantile capillary hemangiomas can cause local complications e.g. pain, ulceration, bleeding etc. The usual treatments include oral/intralesional steroids, alpha interferon, cytotoxins, pulsed dye laser and cosmetic surgery resection. These treatments are not free of multiple complications and toxic side effects. We report our experience with the use of propranolol in 2 children with haemangiomas along with review of relevant literature. Both the hemangioma cases promptly responded to low-dose oral propranolol. DOI: http://dx.doi.org/10.3329/bmjk.v47i1-2.22561 Bang Med J (Khulna) 2014; 47 : 32-35

Impact of Momordica charantia (karela) on serum aspartate aminotransferase level in streptozotocin induced diabetic rats

Abstract: The present experimental study was conducted at Department of Anatomy in BSMMU (Bangabandhu Sheikh Mujib Medical University) & BIRDEM (Bangladesh Institute of Research & rehabilitation in Diabetes, Endocrine & metabolic Disorders) to investigate whether Momordica charantia (karela) has got any impact on serum alanine aminotransferase (ALT) level in the streptozotocin-induced diabetic rats. Sixty healthy young Long Evans rats of male sex weighing 150 to 280 gm aged between 10 to 12 weeks were used in this study. The rats were divided into 4 equal groups depending on their different sorts of dietary feedings and drug treatment. The final ALT level (on 51st day) ranged from 23 to 34 u/L (mean 30.10 u/L) in healthy rats, 56 to 80 u/L (mean 68.50 u/L) in the untreated diabetic rats, 36 o 37 u/L (mean 31.50 u/L) in the insulin-treated diabetic rats and 61 to 96 u/L (mean 81.10 u/L) in the karela-treated diabetic rats. The ALT percentage change value of diabetic rats on 51st day corresponding to the initial on 7th day was significantly higher than that healthy rats (p 0.05). The present study did not show that karela has any significant impact of acting against higher serum ALT level in streptozotocin-induced diabetes mellitus. Further investigation is recommended for establishing karela as an agent against higher serum ALT level in diabetes mellitus. DOI: http://dx.doi.org/10.3329/mediscope.v1i1.21634 Mediscope Vol. 1, No. 1: 2014, Pages 29-32

Kugelberg-Welander disease

Abstract: Spinal muscular atrophy (SMA) is a group of genetically determined disorders affecting spinal and cranial motor neurons, characterized by proximal and distal wasting, fasciculation and weakness of muscles. This patient presented with the features of slow progression of weakness and wasting of limbs, involuntary muscle twitching & without sensory impairment. No definitive treatment is yet to be discovered. SMA in adulthood is very rare. Most cases are detected in childhood and adolescence period. Sooner the diagnosis can be done, better the prognostic value. DOI: http://dx.doi.org/10.3329/bmjk.v47i1-2.22560 Bang Med J (Khulna) 2014; 47 : 29-31

Pelvic congestion syndrome

Abstract: Chronic pelvic pain is a common gynecological problem with many causes and may account for approximately 10% outpatient gynecological visit. Pelvic Congestion Syndrome (PCS) is defined as a condition characterized by congestion of the pelvic veins visible on selective ovarian venography in multiparous premenopausal women with a history of chronic pelvic pain for more than six months. We report a case of PCS in 35 years old multiparous lady complaining of chronic pelvic pain for one year. The pain was worsened by sitting and standing position. Other general symptoms were present such as dysmenorrhea, rectal discomfort and urinary frequency. On examination patient was depressed, there was abdominal and pelvic tenderness. Pelvic ultrasound and Doppler examination showed dilated and tortuous ovarian veins and dilated tortuous arcuate veins in the myometrium. An ovarian cyst was present and uterus was enlarged. In this case total abdominal hysterectomy was done although ideal treatment for PCS is ovarian vein embolisation by interventional radiology which is not available in our country. DOI: http://dx.doi.org/10.3329/mediscope.v1i1.21635 Mediscope Vol. 1, No. 1: 2014, Pages 33-35