Showing papers by "Khulna Medical College published in 2016"

Clinical profile of amoebic liver abscess patients admitted in a tertiary care hospital

Abstract: Amoebic liver abscess is an important cause of space occupying lesions of the liver, especially in tropical and sub tropical regions. It is the most frequent complication of invasive amebiasis. It may be found in all age groups but relatively rare in children. The signs and symptoms vary according to the severity of illness. The present study was done to evaluate the clinical profile of patients with amoebic liver abscess for age, gender, clinical features, site of abscess, number of abscess, treatment modality by intravenous metronidazole along with percutaneous needle aspiration and prognosis. A prospective study of 86 admitted patients of amoebic liver abscess were included in this study which was carried out in the medicine department of Khulna Medical College Hospital over a period of 2 years from July 2010 to June 2012. Mean age of patients was 45 years. Male female ratio was 7:1. The mean duration of fever was 17.9 days and the mean duration of pain was 14.1 days. The duration of fever for more than 2 weeks was seen in 38 cases. Regarding clinical features, the major symptoms of fever, pain abdomen and dysentery were seen in 81, 78 and 10 cases respectively. The major signs as determined by clinical and radio imaging studies were hepatomegaly in 76, right lobe abscess in 60, left lobe abscess in 12, multiple abscesses in both lobes in 18, ascites in 5 and right sided pleural effusion in 12 cases respectively. All the cases underwent percutaneous needle aspiration. 5 cases died out of 86 patients. Bang Med J (Khulna) 2015; 48 : 20-23

Role of human chorionic gonadotrophin to prevent repeated early pregnancy loss

Abstract: Early pregnancy loss is a frustrating experience for both the patient and the physician. Approximately 5% of couples trying to conceive have 2 consecutive miscarriages and approximately 1% couples have 3 or more consecutive losses. Objective of this study is to determine whether therapy with dydrogesterone or Human chorionic Gonadotrophin hormone (HCG) in history of repeated pregnancy loss during the first trimester of pregnancy will improve pregnancy outcome. This is a prospective open comparative study.Women having early pregnancy presenting to a private clinic with history of early pregnancy loss, having no medical disorder were included in this study. Eligible subjects were randomised to receive either dydrogesterone 20mg daily or injection Human Chorionic Gonadotrophins (HCG) 5000 iu intramuscularly at 72 hours interval up to fourteen weeks of pregnancy or no additional treatment. Follow up of those patients were done with transabdominal ultrasonography. Hundred women were recruited. There was no statistically significant difference between the three groups with regard to pretreatment status. The continuing pregnancy success rate was higher in women treated with dydrogesterone (79.17%) and highest with Injection Human Chorionic, Gonadotrophin (86.36%) compared with women received no treatment (70%), (p=0.358). Hormonal support with either dydrogesterone or Human Chorionic Gonadotrophin may increase the chances of a successful pregnancy in women with a history of spontaneous abortion. Bang Med J (Khulna) 2015; 48 : 7-10

Outcome of Partial Splenectomy for Hypersplenism in Children with Thalassemia

Abstract: Background: Total splenectomy, exposes children to the high risk of overwhelming postsplenectomy infections (OPSI). To avoid these adverse consequences, partial splenectomy has long been practiced for thalasseemia in children. It has been reported that the partial splenectomy keeps the child immunologically competent, hematologically stable with minimum blood transfusion and makes their life more comfortable in comparison to total splenectomy. Objectives: To compare the results of partial and total splenectomy. Methodology: This prospective interventional comperative study was done in the department of Pediatric Surgery, BSMMU from 2010 to 2012. Children who underwent partial splenectomy were considered as the case and who underwent total splenectomy as the control. Number of blood (RCC) transfusions (ml/ kg/year), Peripheral blood film (Hb%, WBC count, platelet count, Howell-Jolly body, serum bilirubin), volume of liver (ml), volume of spleen (ml), number of OPSI case, were compared between the case and control groups both pre and postoperatively. Results: Postsplenectomy blood transfusion requirement is comparatively more decreased in control group than case group. The inter group difference at 6 month is significant (p= 0.004). Peripheral blood pictures are improved in both groups. Post splenectomy hemoglobin level was increased in both groups but it was maintained at a more static fashion in control group than case group (P = 0.114). Howell-jolly body in the partial splenectomy group disappeared almost completely at month 6, while the same inclusion body in the total splenectomy group appeared in all the children (p= 0.001). There was no postsplenectomy infection in case group while two found in control group. After partial splenectomy the residual volume of the spleen was gradually increasing. The increase in volume of the liver was notably greater in the total splenectomy group than that in the partial splenectomy group (p< 0.05). Conclusion: Partial splenectomy in patients with ²-thalassemia is effective in controlling hemolysis, improving peripheral blood picture while preserving the residual splenic phagocytic and immune function. J. Paediatr. Surg. Bangladesh 6 (2): 39-46, 2015 (July)

Caesarean Scar Pregnancy - A Rare Case Report

Abstract: Objective: The aim is to publish the case report of the rarely occurring and life threatening ectopic pregnancy developing in a Caesarean section scar causing uterine rupture. Methods and Results: This patient was diagnosed initially as a case of incomplete abortion. Other possible diagnoses were molar pregnancy, mass in the cervix. She was admitted in hospital for evacuation and curettage. During the procedure she developed severe pervaginal bleeding leading to hypovolumic shock. So decision was taken for emergency laparotomy. After opening the abdomen rupture was found in the lower uterine segment extending upto upper part of cervix. So hysterectomy was performed and histopathology confirmed the diagnosis of ectopic pregnancy that developed in a Caesarean section scar Analysis of the women’s obstetric history revealed that she had been previously operated because of breech presentation. Conclusion: Heightened awareness of the possibility of pregnancy in caesarean scar and early diagnosis by means of transvaginal sonography along with colour doppler can improve outcome and minimize the need for emergency extended surgery Bangladesh J Obstet Gynaecol, 2012; Vol. 27(2) : 83-86

Safety of non-descent vaginal hysterectomy

Abstract: The aim of our study is exploring the safety and feasibility of nondescent vaginal hysterectomy in benign diseases of uterus and also maximizing the proportion of hysterectomy performed vaginally. This was a prospective descriptive study done in obstetrics and gynaecology department of Khulna medical college hospital and two private clinic in Khulna and Satkhira. Over a period of 3 years from January 2012 to December 2014, a total of 56 cases underwent hysterectomy done vaginally for benign diseases. The most common age group affected was 41-50 years (64.28%) and second common group was below 40 years. Majority (73.21%) of the patients was multiparas and 6 weeks size affected uterus was 41.07%. Most common indication for NDVH was dysfiinctional uterine bleeding (39.29%) and fibroid uterus was 35.71%. Among 56 patients 25 cases needed dcbulking technique (44.64%) of which bisection was 32.14%. Maximum (53.57%) operation was completed within 61 to 90 minutes. Maximum blood loss of 201 ml or more was in 3 cases but only 5 patients needed blood transfusion. Among 56 patients. 5 (8.92%) patients suffered from various forms of complications but urinary fistula was nil. So it can be concluded that non descent vaginal hysterectomy has many advantages which include short hospital stay and fast convalescence. Bang Med J (Khulna) 2015; 48 : 16-19

Volvulus of the vermiform appendix

Abstract: Appendicitis is an extremely common presentation to general surgery in both adult and paediatric practice. Volvulus or torsion of the vermiform appendix, which is currently indistinguishable clinically from appendicitis, is an uncommon surgical emergency in children. Only a few cases are reported in the literature concerning this subject. We describe an 8 year old child who presented with right lower quadrant abdominal pain and was clinically diagnosed as perforated appendix. Laparotomy revealed a volvulus of the appendix and an emergency appendicectomy was performed. Bang Med J (Khulna) 2015; 48 : 32-33

Is There Any Association between Helicobacter pylori CagA Status and Patient's Habits with Gastric Carcinoma

Abstract: Enormous studies have been conducted worldwide regarding CagA + status of H. pylori and patients habits in gastric carcinoma. But no study has been carried out in our country yet. Thus, this study has been designed to see the association between CagA + H. pylori strain and patients habits with gastric carcinoma. For this purpose, a total number of 80 (eighty) patients were selected. Of the 80 (eighty) patients 40 (forty) were selected as cases (malignant) and the remainder 40 (forty) were selected as controls (non-malignant). H. pylori was detected by applying noninvasive ( H. pylori IgG serology and CagA IgG serology) and invasive (Histology and rapid urease test) technique. Of them Histology was done by Modified Giemsa stain, CagA IgG was detected by ELISA method. In this study, we see that among the 40 cases, 35 (thirty five) possess the CagA + H. pylori strain. And among the 40 controls, 33 (thirty three) bear the CagA + H. pylori strain. This study also discloses that among cases, who were habituated with betel leaf and betel-nut ranking the highest number of gastric carcinoma. There are sufficient papers in favor of it which argues that CagA positivity as well as H. pylori positivity is not the sole causative agent of gastric carcinoma. If so, it merely acts as an initiator. Faridpur Med. Coll. J. Jan 2015;10(1): 9-13

A giant femoral pseudo aneurysm secondary to arteriovenous fistula following stab injury

Abstract: Pseudo aneurysm wall is not formed by vascular tissue but develops from organized thrombus, associated fibrosis and surrounding tissue. Post stab injury pseudo aneurysm associated with arteriovenous fistula of lower limb is exceptional. Here one such case is reported who was operated 4 months after the incidence of stab injury in his way back home at an incidence of robbery. The patient was very poor and did not have the ability to seek higher medical care. He was moving everywhere with a big pulsatile mass on supero medial part of his left thigh. Lastly surgical intervention was done and the patient got well. Bang Med J (Khulna) 2015; 48 : 34-36

Fluid and Nutritional Management Can Significantly Reduce the Mortality of Patients with Eclampsia in Resource Poor Settings

Abstract: Objective: To observe fluid and nutritional management along with specific management and close clinical monitoring without intensive care management improve the condition of unconcious eclamptic patients in the resource poor setting. Method: Six hundred and nine(609) eclamptic patients were admitted in Mymensingh Medical College Hospital from January to December 2008. Twenty four (24) unconscious eclamptic patients were enrolled for this clinical trial study. These patients were managed in eclampsia ward with fluid therapy of 0.9% sodium chloride, 25% glucose, 5% aminoacids along with hydrocortisone and in some cases nasogastric feeding in addition to other regular medications. They were compared with 26 eclampsia patients treated with normal regular hospital management. A systematic guideline was followed and patients were closely monitored until the outcome. Results: The mean age of 23 years, 18 cases were primi-gravida; 16 had intrapartum, 6 had postpartum and 2 had antepartum eclampsia. The mean number of convulsion before admission was 12. The mean Glasgow Coma Scale (GCS) of these patients during admission was 5, which improved to 10.3 in 24 hours and 14.5 in 36 hours. None of these patients had fatal outcome in compare to observation group where three patients died following complications. Conclusion: Close monitoring with fluid and nutritional management can significantly reduce the mortality of unconscious eclamptic patients in resource poor settings where intensive care facility is limited. Development and adaptation of feasible systematic guideline for the management of unconscious eclamptic patient should be scaled up for the resource poor settings of developing and under developed countries. Bangladesh J Obstet Gynaecol, 2012; Vol. 27(1) : 18-20

Steatocystoma Multiplex of Scortum- Rare Genetic Disorder: A Case Report and Review of Literature

Abstract: A 25 years old male attended the skin & VD outpatient department of Khulna Medical College Hospital on 16th June, 2013 with complaints of multiple asymptomatic small rounded firm, cystic nodules that are adherent to the overlying skin of scortum. The microscopic examination of the cystic nodules showed the features of steatocystoma multiplex. This disorder, although it is asymptomatic, is a cosmetic threat to the patient. Only a few cases of the patients with an autosomal dominant mutation, who had keratin 17; have been reported. We are reporting here a case of steatocystoma multiplex of scortum in a 25 years old male along with review of literature. J Bangladesh Coll Phys Surg 2015; 33(4): 218-221

Evaluation of risk factors associated with stroke

Abstract: Stroke is the leading cause of adult disability and is the third commonest cause of death worldwide. It is a major cause of morbidity and mortality with disability and social dependence throughout the world. An observational, descriptive, cross-sectional study was conducted among purposively selected one hundred and seventy patients with stroke admitted at Kushtia Medical College Hospital, Kushtia from July 2014 to June 2015 to evaluate the different modifiable risk factors and their frequency among stroke patients. Stroke patients with more than 24 hours duration presenting within seven days of onset irrespective of age, sex and demographic profile were included in the study. After obtaining informed consent, patients who fulfilled the inclusion criteria were thoroughly evaluated for the presence of risk factors. Data were collected by investigators themselves. Out of 170 confirmed cases of stroke, 89 (52.35%) were male, while 81 (47.65%) were female. Mean age of the patients was 63.74 years with a standard deviation of 16.5 years. The highest incidence 43 (24.70%) of stroke was in the age group of 60 to 69 years. As many as 122 (71.76%) had ischaemic stroke, while 48 (28.24%) had haemorrhagic stroke. At least 119 (70.00%) cases were hypertensive. 41 (24.11%) cases had diabetes mellitus, 31 (18.23%) had hyperlipidaemia, 52 (30.6%) were smokers and 25 (14.70%) had past history of stroke. Among 81 female patients, 66 (81.48%) were in post-menopausal, whereas 15 (18.52%) were in the reproductive age group. Of them 5 (33.33%) had history of taking oral hormonal contraceptive. Hypertension, smoking, diabetes mellitus and hyperlipidaemia are the identified modifiable risk factors associated with stroke. Bang Med J (Khulna) 2015; 48 : 24-27

Outcome of scalp reconstruction in a teaching hospital

Abstract: An area of loss of scalp could be covered by various methods including local flap, distant flaps, skin graft, free flap surgery or tissue expansion. Each method has some disadvantages, such as postoperative alopecia or donor site morbidities. The study was conducted in the Department of Burn and Plastic Surgery, Khulna Medical College Hospital from July 2011 to June 2015. Scalp reconstruction was performed on 16 patients who sustained scalp loss from RTA, surgery for cancer, burn injuries and machinery injury. The size of the wound ranged from 6 cm2 to 320 cm2. Transposition flap, rotation flap, removal of osteomyelitic bone and skin grafts were done. Among 16 cases, 3 cases (18.75%) were skin grafted, 6 cases (37.5%) were reconstructed with transposition flaps, 5 cases (31.25%) were reconstructed with rotation flap and 2 cases (12.5%) were reconstructed with skin graft after removal of osteomyelitic outer table of skull bone. The postoperative complications seen in this series includes partial graft loss in 2 cases (skin graft), marginal necrosis in 1 case (transposition flap) and alopecia in 11 cases (in skin graft and transposition flap). There was no alopecia in reconstruction with rotation flap. Rotation flaps brings the best outcome in terms of durability and aesthetic acceptability where it is applicable in comparison to other procedure. Bang Med J (Khulna) 2015; 48 : 3-6