Showing papers by "Khulna Medical College published in 2017"

Serum Metabolomic Profiles Identify ER-Positive Early Breast Cancer Patients at Increased Risk of Disease Recurrence in a Multicenter Population

Abstract: Purpose: Detecting signals of micrometastatic disease in patients with early breast cancer (EBC) could improve risk stratification and allow better tailoring of adjuvant therapies. We previously showed that postoperative serum metabolomic profiles were predictive of relapse in a single-center cohort of estrogen receptor (ER)-negative EBC patients. Here, we investigated this further using preoperative serum samples from ER-positive, premenopausal women with EBC who were enrolled in an international phase III trial.Experimental Design: Proton nuclear magnetic resonance (NMR) spectroscopy of 590 EBC samples (319 with relapse or ≥6 years clinical follow-up) and 109 metastatic breast cancer (MBC) samples was performed. A Random Forest (RF) classification model was built using a training set of 85 EBC and all MBC samples. The model was then applied to a test set of 234 EBC samples, and a risk of recurrence score was generated on the basis of the likelihood of the sample being misclassified as metastatic.Results: In the training set, the RF model separated EBC from MBC with a discrimination accuracy of 84.9%. In the test set, the RF recurrence risk score correlated with relapse, with an AUC of 0.747 in ROC analysis. Accuracy was maximized at 71.3% (sensitivity, 70.8%; specificity, 71.4%). The model performed independently of age, tumor size, grade, HER2 status and nodal status, and also of Adjuvant! Online risk of relapse score.Conclusions: In a multicenter group of EBC patients, we developed a model based on preoperative serum metabolomic profiles that was prognostic for disease recurrence, independent of traditional clinicopathologic risk factors. Clin Cancer Res; 23(6); 1422-31. ©2017 AACR.

Translation of DASS 21 into Bangla and validation among medical students

Abstract: Standard scale to assess the symptoms of depression, anxiety and stress among MBBS students are essential to take necessary steps to treat or prevent any psychiatric morbidity. But there was no such convenient tool in Bangla to measure the stated symptoms. With an objective to obtain a convenient scale to measure severity of above symptoms, short version of Depression Anxiety Stress Scales (DASS 21) was translated into Bangla and the study was carried out to validate this Bangla version with permission from the author of the original instrument. Two translations and back translations were carried out. A harmonized version was produced after meetings by persons involved in translation process in meetings. After pretesting on ten students and reviewing by panel of experts, finalized Bangla version of DASS 21 (DASS 21 -BV) was obtained. A cross sectional study was carried out among MBBS students of Pabna Medical College, Pabna using purposive sampling technique to validate this scale. They were given both Bangla and English version of the scale 3 to 7 days apart. Analysis was done on 15 samples. Correlation for depression subscale was 0.976, anxiety subscale was 0.917 and stress subscale was 0.931. Correlation was significant at the 0.01 level (2-tailed). Cronbach’s Alpha for Depression, Anxiety and Stress subscales were 0.987, 0.957, 0.964 respectively. This Validated Bangla version of DASS 21 can be used to measure severity of depression among medical students and persons having similar academic background treatable. Bang J Psychiatry Dec 2014; 28(2): 67-70

Assessment of depression, anxiety and stress among first year MBBS students of a public medical college, Bangladesh

Abstract: Medical students confront significant academic, psychosocial and existential stressors for coping with new college and schedule,. So assessment of the symptoms of depression, anxiety and stress among medical students are essential to take necessary steps to treat or prevent any psychiatric morbidity. The objective of the study was to assess depression, anxiety and stress among the first year MBBS students. This was a cross sectional and descriptive study conducted in Khulna Medical College, Bangladesh from December 2009 to July 2010. For this purpose, 105 students fulfilling inclusion and exclusion criteria were taken as sample. They filled up personal data and the short-form Bangla version of DASS (DASS-21 BV) scale. The results showed that, the mean age of students was 18.8 years with male predominance (54.3%). Symptoms of depression, anxiety and stress were found among 54.3%, 64.8% and 59.0% of students respectively. Eighty five (81%) students either had depression, anxiety or stress alone or in combination. Combination of depression, anxiety and stress was highest (36.2%). No significant association was found between gender difference and depression, anxiety or stress. Age was positively correlated with depression (p=0.004) and stress (p=0.001). Percentage of 1st year MBBS students suffering from depression, anxiety and stress were very high. Adequate psychiatric services should be provided to manage these symptoms among medical students. Bang J Psychiatry June 2015; 29(1): 23-29

Clinical profile of acute pancreatitis in a teaching hospital

Abstract: Background: Acute pancreatitis is a potentially fatal disease. Mortality and morbidity depends on severity of the disease Objective : To find out the clinical presentation and to optimize the treatments. Method: This hospital based cross sectional descriptive study was performed to find out the clinical presentations of acute pancreatitis from the available clinical, biochemical, haematological and radiological data. Results: A total of 50 cases were studied. Age range was 13 to 74 yrs, with a peak incidence in the fourth decade. Male to female ratio were 1.78:1. Among the known aetiological factors 18% were due to gallstone disease and 10% due to alcoholism. Most common symptoms were upper abdominal pain (96%) and nausea, vomiting (88%). Among the clinical signs most common were abdominal tenderness (92%) and muscle guard (66%). In this study 82% patients had mild and 18% had severe acute pancreatitis. Overall mortality rate was 6%. Mortality was significantly higher (33.33%) in severe acute pancreatitis (33.3% vs 0%). Conclusion: A higher mortality was associated with concomitant medical or surgical diseases, but not to age or sex. A higher mortality was associated with leucocytosis but not to haemoglobin level. Among the biochemical parameters tested, a high blood glucose and serum creatinine level and a lower serum albumin and calcium level were significantly associated with a higher mortality. Bang Med J (Khulna) 2016; 49 : 7-12

Suicidal Death due to Hanging

Abstract: Background: Hanging is always suicidal unless otherwise proved. It is a form of violent asphyxial death. It produces painless death for the victims so that it is a widely practiced method of suicide. In Bangladesh hanging is one of the commonest methods of suicide. Objective: The objective of this study was to find out socio-demographic characteristics of victims, common ligature materials used by victims and post-mortem findings. Materials and method: A retrospective cross sectional study was done in Dhaka Medical College Mortuary during the period of January 2009 to January 2010. During this period data were collected from 2133 cases of medicolegal autopsies by purposive sampling. Results: A total of 2133 medicolegal autopsies were analyzed of which 78 (3.65%) were deaths due to hanging. Out of these 78 cases maximum 37 (47.44%) deaths due to hanging were in the age group of 21-30 years. Majority of the cases (48; 61.54%) were observed in females. Majority (32; 41.03%) of victims had used Dopatta (orna) as a ligature material. Cyanosis of fingertips and nail beds was the commonest (75; 96.15%) findings in cases of asphyxial death due to hanging. Conclusion: Suicidal hanging is observed in this study mostly within the young age group ranging from 21-30 yrs. So, awareness at the level of family and community should be raised to improve personal and social relation in every sphere. The factors provoking an individual for an attempt to suicide should also be investigated for its prevention. Delta Med Col J. Jul 2017 5(2): 89-93

H. pylori infection and gastric cancer in Bangladesh: a case-control study.

Abstract: Background: Like that of other Asian countries gastric cancer (GC) is also a leading cancer in Bangladesh and also a cause for cancer-related mortality. Infection with Helicobacter pylori (H. pylori) is the strongest recognized risk factor for gastric adenocarcinoma. The infection is also prevalent in common people. This case-control study was carried out to find an association between GC and H. pylori infection in the community. Materials and Methods: To evaluate association of H. pylori and carcinoma of stomach this study was conducted at National Institute of Cancer Research & Hospital, Dhaka from January 2013 to December 2014. H. pylori status was determined serologically by using H. pylori kit in the department of Biochemistry laboratory of Bangabandhu Sheikh Mujib Medical University. In total, 114 patients with GC and 520 patients not having GC were studied as controls. Logistic regression method was used to calculate the odds ratio. Results: Significantly more patients in the case group (86.8%) were found to be seropositive for H. pylori antigen in contrast to the control group (67.5%). All of the cases in the present study were in advanced stage. No significant association between H. pylori seropositivity and tumor location was found. It was noted that undifferentiated gastric carcinoma had slightly more association with H. pylori infection. Younger H. pylori–infected patients had been found to be at higher relative risk for GC than older patients. Conclusion: As there is a strong association found between GC and H. pylori infection special emphasis to eradicate H. pylori infection might reduce the incidence of this dreadly disease.

Nationwide prevalence of Rickettsia felis infections in patients with febrile illness in Bangladesh.

Abstract: From July 2015 to December 2016, the presence of rickettsial pathogens was investigated for 414 patients with unknown fever in eight places in all the divisions of Bangladesh. Rickettsia felis was identified in blood samples from all the regions (overall detection rate, 19.6%), suggesting nationwide prevalence of R. felis infections.

Prevalence of Hepatitis B Virus and Hepatitis C Virus in a Tea Garden of Bangladesh.

Abstract: Introduction The overall health status of workers of tea garden of Bangladesh is below the national standard. Also, almost nothing has been reported about status of hepatitis virus infection among these population and there is also a lack of consensus. Materials and methods Several health-related facts, especially those of liver diseases, were collected from 130 workers of tea garden via questionnaire. Sera were also collected from these subjects to assess positivity of hepatitis B surface antigen (HBsAg) and antibody to hepatitis C virus (anti-HCV). Hepatitis B virus (HBV) genotype was also done using genotype-specific primers in HBsAg-positive sera. Results Out of 130 tea garden workers, 5 were positive for HBsAg; however, none was reactive to anti-HCV. Genotyping of HBV deoxyribonucleic acid of 4 sera samples revealed that 2 belonged to genotype A, 1 to genotype C, and 1 to genotype D. Various risk factors were documented in HBV-infected subjects by analyzing the questionnaire. Conclusion Hepatitis B virus in considerable high percentage is prevalent among workers of tea garden in Bangladesh, and immediate vaccination against HBV should be employed. Also, health education system should be accentuated in specific population like tea garden workers.How to cite this article: Al Mahtab M, Akhter S, Mollick KU, Uddin MH, Khan SI, Akbar SMF. Prevalence of Hepatitis B Virus and Hepatitis C Virus in a Tea Garden of Bangladesh. Euroasian J Hepato-Gastroenterol 2017;7(1):107-110.

Use of lateral calcaneal flap for coverage of posterior heel defects

Abstract: Lateral calcaneal flap is frequently used for coverage of lateral calcaneum and posterior heel defects. We conducted a prospective study using lateral calcaneal artery flap to cover posterior heel defects from July 2011 to June 2015 in the Department of Burn and Plastic Surgery, Khulna Medical College to observe the clinical outcome of use of lateral calcaneal artery flap. A total number of ten soft tissue defects in posterior heel with and without exposed Achilles tendon or calcaneus due to different causes were reconstructed with lateral calcaneal artery flap. All ten flaps survived completely with no subsequent breakdown of the skin, even after regular wearing of normal shoes. The flap donor sites were grafted with split-thickness skin grafts in all cases. Partial graft loss was noted in two cases which were eventually healed spontaneously with dressing without the need for a secondary graft. Epidermal necrosis developed in one case which was ultimately healed with conservative treatment. There was no loss of sensation in flap area but sensory disturbance at the lateral part of the dorsum of foot was found in all cases. Our results were satisfactory in terms of coverage adequacy, perioperative morbidity, and functional and aesthetical outcomes. The lateral calcaneal artery skin flap can be used safely to provide sensory skin coverage in posterior heel defects. Mediscope Vol. 4, No. 1: Jan 2017, Page 5-10

Randomized controlled trial of three oxytocic regimens to prevent primary postpartum haemorrhage at caesarean section

Abstract: The objective of this present study was to compare the efficacy of three oxytocic regimens to prevent primary postpartum haemorrhage (PPH) at caesarean section. A randomized controlled trial including 90 patients who underwent caesarean section were selected according to inclusion and exclusion criteria assigned randomly into three groups (30 patients in each group) was conducted. Group 1 and group 2 were exposure groups and group 3 was control group. All patients were given 10 units intravenous (IV) bolus oxytocin immediately after delivery of baby. Group 1 was given additional 20 units oxytocin in each 1000 ml fluid for 24 hours. Group 2 received additional 1000 microgram misoprostol per rectal. Group 3 did not receive any additional oxytocic drug. Background characteristics of all the three groups were similar. It was observed that 501-1000 ml blood loss was found among 25 (83.3%) cases in group 1, 27 (90.0%) in group 2 and 27 (90.0%) in group 3. The mean (SD) amount of blood loss was found 733 (190) ml in group 1792 (187) ml in group 2 and 818 (14) ml in group 3. Occurrence of PPH and blood transfusion needed among 1 (3.3%) in group 1, 2 (6.7%) in group 2 and 3 (10.0%) in group 3. Side effects occurred in 7 (23.3%) patients of group 1, 18 (60.0%) in group 2, and 6 (20.0%) in group 3. Shivering was found among 4 (13.3%) in group 1, 10 (33.3%) in group 2 and 3 (10%) in group 3. Vomiting was found among 2 (6.7%) in group 1, 4 (13.3%) in group 2, and 2 (6.7%) in group 3. Pyrexia was 1 (3.3%) in group 1, 4 (13.3%) in group 2 and 1 (3.3%) in group 3. Side effects were more in the group where misoprostol was used. Except side effects there was no statistical difference of occurrence of different events among the three groups. Only bolus IV oxytocin appears to be as effective as oxytocin infusion in addition to bolus IV oxytocin or per rectal misoprostol in addition to bolus IV oxytocin to prevent primary PPH at caesarean section. But occurrence of transient side effects such as shivering, pyrexia and vomiting were noted more frequently with the use of misoprostol. Mediscope Vol. 4, No. 2: Jul 2017, Page 5-11

Vivax Malaria Presenting with Fever and Tender Hepatomegaly

Abstract: Malaria caused by vivax is more common than those caused by falciparum. We report here a patient of vivax malaria presented with tender hepatomegaly. A 30 year old male from a rural area was admitted with high grade irregular fever for 5 days with severe right hypochondriac pain for 2 days. Patient was toxic and agonizing with pain. He had tender hepatomegaly. His cardiovascular and respiratory examination findings were normal. ICT for malaria and blood film revealed presence of P. vivax . His hepatic enzymes and viral markers were negative and ultrasonogram of hepatobiliary system excluded features of hepatitis or any abscess cavity. Echocardiogram showed no cardiac abnormality. Presence of tender hepatomegaly in the absence of other co-morbidity is rare in vivax malaria and not well documented in adults, which makes this presentation. Faridpur Med. Coll. J. Jul 2016;11(2): 90-92

Safety & efficacy of manual vacuum aspiration compared to dilatation & curettage in the management of early pregnancy failure

Abstract: Background: Early pregnancy failure is a major health problem across the globe. This is particularly important for the woman of Bangladesh. Objective : The aim of our study was to evaluate the safety and efficacy of manual vacuum aspiration (MVA) compared to dilatation and curettage (DC 49 : 18-22

Laparoscopic Management of Tubal Ectopic of Heterotopic Pregnancy

Abstract: A heterotopic pregnancy is a rare complication of pregnancy in which both extra-uterine (ectopic pregnancy) and intrauterine pregnancy occur simultaneously. The prevalence of heterotopic pregnancy is estimated at 0.6- 2.5: 10,000 pregnancy. It is a challenge for obstetrician to manage the tubal pregnancy without interruption of intrauterine pregnancy. Here we describe a case who had left tubal alive ectopic pregnancy & also intrauterine alive pregnancy simultaneously after a natural conception. This patient was managed successfully with laparoscopic left salpingectomy, and intrauterine pregnancy has been continuing. There are some precautions during laparoscopic procedure & post operative period which can help for continuation of intrauterine pregnancy. In our clinical experience, this is an extreme rare disorder and we feel interest to report this case. A heterotopic pregnancy can result from a natural conception; it requires a high index of suspicious for early and timely diagnosis; a timely intervention can result in a successful outcome of the intrauterine fetus. J Bangladesh Coll Phys Surg 2016; 34(4): 218-221

Institutional and population based analyses on misdiagnosis of appendicitis in Khulna, Bangladesh

Abstract: The aim of the present study was to identify factors associated with misdiagnosis of appendicitis to propose solutions to decrease the misdiagnosis rate of appendicitis. The study conducted an institutional and a population based analyses on misdiagnosis of appendicitis conducted in Khulna district, Bangladesh. The study dealt with 2 groups of patients. Group 1 consisted of the patients treated in Gazi Medical College Hospital (GMCH), Khulna either in out-patient department (OPD) within the last 3 years (from 2014 to 2016), treating doctors suggested appendicectomy and in indoor-patient department (IPD) within the last 5 years (from 2012 to 2016), the diagnosis was done either during operation or admitted as postoperative complications. Patients for Group 2 were selected purposively from the patients who were from different villages of Rupsha and Fakirhat Upazila or from Khulna city previously underwent appendicectomy within the last 5 years (from 2012 to 2016) in different hospitals other than GMCH, Khulna and previous symptoms were still existed. The study revealed that the majority of the patients were female (OPD 81.5%, IPD 68.8% in Group 1 and 83.2% in Group 2). The misdiagnosis rate of appendicitis for the patients attended GMCH OPD and GMCH IPD was 23.0% and 8.9%, respectfully. The overall misdiagnosis rate of appendicitis for the patients attended GMCH was 14.0%. In case of the patients attended GMCH OPD, most of them had UTI and chronic cystitis (45.5%). In case of the patients attended GMCH IPD, most of them had non-inflamed appendix (84.4%). The misdiagnosis rate of appendicitis for the patients in Group 2 was 23.2%. Some factors were identified and bearing in mind the factors, all the concerned should be more careful and conscious while making the diagnosis of appendicitis to avoid misdiagnosis and patients’ suffering. Mediscope Vol. 4, No. 2: Jul 2017, Page 29-34

Etiological basis of pleural effusion in a teaching hospital

Abstract: Background: A pleural effusion represents the disruption of the normal mechanisms of formation and drainage of fluid from the pleural space. Pleural effusions are associated with diseases of varied etiologies and often carry a grave prognosis. Objective: To evaluate the common cause of pleural effusion in developing country and also to compare to that of developed countries. Methods: This is a prospective observational study. Fifty four patients, diagnosed with pleural effusion on admission were randomly selected from I April 2016 to 30 September 2016 in Medicine ward of Khulna medical college hospital. Etiologic diagnosis was established by sequential clinical history and findings on physical examination, laboratory tests, chest radiograph, CT Scan of chest and pleural fluid analysis. Patients who remained undiagnosed were subjected to fibre-optic bronchoscopy, thoracoscopic pleural biopsy, and histopathology. Results : Etiologic diagnosis of pleural effusion was established in 50 (92.59%); tuberculosis 25 (46.29%), parapneumonia 10 (18.52%) malignancy 7 (12.96%) nephrotic syndrome 3 (5.55%),cirrhosis of liver disease 2 (3.71%) congestive cardiac failure 2 (3.71%), systemic lupus erythematosus I (1.85%). 4 patients (7.41%) remain undiagnosed. Among subjects, exudative pleural effusion was 43 (79.63%) and transudative 11 (21 57%). Among exudative pleural effusion sputum for AFB positive 15 (34.88%), FNAC 10 (23%), fibreoptic bronchoscopy was positive 2 (4.6%), gene expart test for tuberculosis positive in 5 (11.62%). Conclusions: Most of the pleural effusion cases are diagnosed as tuberculosis, Early and adequate treatment results in complete recovery of the patient. Bang Med J (Khulna) 2016; 49 : 27-30

Etiological factors of Intussusception among children in a tertiary care hospital

Abstract: Background : There are still dearth of knowlege of intussusception regarding its aetiology and predisposing factor among children. Objectives: We attempted to find out per operatively the etiological factors responsible for intussusceptions in children and their association with predisposing factors in our context. We also intended to know peroperatively the specific role of hypertrophid Peyer's patches of mesenteric lymph adenitis as lead points. Methodology: This prospective observational study was conducted in Khulna Medical College Hospital and other private hospitals in Khulna from November 2012 to April 2016. A total of 50 patients who underwent surgery for intussusception were included in the study. Seasonal influences, gastroenteritis and upper respiratory tract infections were evaluated as predisposing factors and presence of hypertrophied Peyer's patches and other lead points were evaluated as etiological factors. Peroperatively the causes were identified and their association with viral gastroenteritis and respiratory tract infection were intended to find out. Results: seventy two percent of the patients were below one year. A male preponderance was observed (70%). Thirty two percent were affected in the spring and 36% in the summer. Half (54%) of the patients had a history of gastroenteritis, while 40% had a history of respiratory tract infection. Per operative findings, show that three quarter (76%) had ileo colic, 18% had ileo ileo colic and only 6% had ileo ileal variety of intussusceptions. Forty two (89.3%) patients had hypertrophied Peyer's patches or Mesenteric lymphadenities. Conclusion : Hypertrophied Peyer's patches or Mesenteric lymphadenitis are the main etiological factor of intussusceptions in our children. Bang Med J (Khulna) 2016; 49 : 23-26

FAHR'S Sy ndrome: A rare Neurodegenerative Disorder

Abstract: Idiopathic Basal Ganglia Calcification, also known as Fahr disease or Fahr's Syndrome or Bilateral StriatoPallidoDentate Calcinosis (BSPDC) is a rare, genetically dominant, inherited neurological disorder characterized by abnormal deposits of calcium in areas of the brain that control movement, including the basal ganglia and the cerebral cortex. A rare idiopathic disease which manifests in middle age characterized by punctate areas of non-arteriosclerotic calcination in parts of the gray and dentate nuclei, particularly of smaller brain vessels. The symptoms include mental and growth retardation, dystonic movements, and athetosis. May be caused by a malfunction of the glandula parathyreoidea. The term Fahr triad consists of symmetrical calcification of the basal ganglia, neuropsychiatric symptoms, and hypofunction of the parathyroid gland. Treatment is directed toward minimizing symptoms. The prognosis for any individual with Fahr's Syndrome is variable and hard to predict. Progressive neurological deterioration generally results in disability and death. Medicine Today 2017 Vol.29(1): 39-41

Point of care high resolution ultrasound in the evaluation of Bangladeshi women presenting to a breast care center

Abstract: Background: Mammography and ultrasound examinations for diagnosis and staging of breast problems have been traditionally performed in specialized facilities, which circumstances are associated with increased costs and inconvenience for patients. Point of care or clinical office provision of high resolution ultrasound may allow addressing these equity barriers to health services, but there are limited data in Bangladesh about such practice and the associated quality of care. Objective: To ascertain the advantage of ultrasonogram in the diagnosis of breast disease and screening of breast cancer. Methods: From February through November 2014, 1085 women presented to the Amader Gram Breast Care Center in Khulna. In each of these women in addition to standard history and physical examination, a high resolution ultrasound scan was performed of both breasts. Standard clinical and ultrasound practice definitions of breast conditions were applied to each case by an specialist surgeon trained in breast sonology. Results: Two thirds of women had history, physical examination and ultrasound findings consistent with fibrocystic conditions. 12% had fibro adenomas, 5% inflammatory infectious conditions, 2% obvious or strongly suspected breast malignacy, and 1% had masses of uncertain nature. 3% had more than one abnormal breast condition and 3% had no breast abnormalities at all. The overwhelming majority of women benefitted from having ultrasound examination which contributed to prompt, definitive characterization of their breast conditions and which pictorial demonstration contributed to patient education about the clinical diagnosis. Conclusion: Point of care high resolution breast ultrasound can contribute favorably to quality and equity of care for Bangladeshi women with breast problems. Bang Med J (Khulna) 2016; 49 : 3-6

Prevalence of gallstones and biliary sludge formation during pregnancy detected by ultrasonography

Abstract: The risk of gallstones is thought to increase with number of pregnancies. Cholesterol gallstones are more prevalent in women than men and primarily related to sex steroids, particularly progesterone. During pregnancy there are changes in bile composition and gallbladder motility that promote gallstone formation. This study was conducted to determine incidence and outcome of pregnancy related biliary sludge and gallstone formation. Two hundred and nine consecutive expectant women were evaluated by ultrasonography at 1st trimester, 3rd trimester and at 4-6 weeks after delivery. Socio-demographic, medical and obstetrical history were taken and recorded. Incidence of gallstone and sludge formation were found 5.7% and 2.9%, respectively. The results suggest that pregnancy may be a risk factor for gallstone and biliary sludge formation. Mediscope Vol. 4, No. 2: Jul 2017, Page 21-24

Huge abdominal swelling due to haemorrhagic splenic cyst

Abstract: Splenic cyst is an uncommon problem in surgical practice. It is usually diagnosed in scanning procedure. In some cases it produces symptoms like abdominal mass, abdominal pain, distention, constipation either due to haemorrhage, rupture or big size. In our case, patient presents with abdominal pain, distention, vomiting, constipation and respiratory embarrassment. Routine investigation was done and diagnosis was confirmed after laparotomy, Splenectomy was done. Post operative recovery was good. Bang Med J (Khulna) 2016; 49 : 34-36

Etiological causes of exudative pleural effusion in patients treated in a teaching hospital

Abstract: The aim of this study was to find out the common etiological causes of exudative pleural effusion in patients before starting treatment. Fifty patients, diagnosed with pleural effusion on admission were randomly selected from Medicine and Paediatric wards of Khulna Medical College Hospital during the period from March 2016 to November 2016. Etiological diagnosis was established by sequential clinical history and findings on physical examination, laboratory tests, chest radiograph, CT scan of the chest and pleural fluid analysis. Patients who remained undiagnosed were subjected to fibro-optic bronchoscopy, thoracoscopic pleural biopsy, and histopathology. Among the patients having pleural effusion, there were tuberculosis, pneumonia, malignancy and systemic lupus erythematosus in 27 (54%), 11 (22%), 7 (14%) and 1 (2%), respectively. Despite all investigations, 4 (8%) were remained undiagnosed etiologically. Most of the pleural effusion cases were diagnosed as tuberculosis. Early and adequate treatment resulted in complete recovery of the patients. Mediscope Vol. 4, No. 1: Jan 2017, Page 30-33

Correlation of B-Type Natriuretic Peptide Level with Severity of Coronary Artery Disease in Non St Elevated Acute Coronary Syndrome with Normal Left Ventricular Function

Abstract: Background : Coronary artery disease (CAD) is predicted to be the most common cause of death and disability globally by 2020. In Bangladesh, for better management of coronary artery disease and to reduce the burden of acute coronary events patients with non ST elevated acute coronary syndrome (NSTE–ACS) should be focused. B-type natriuretic peptide (BNP) can be suggested as a tool to predict severity of coronary atherosclerotic lesion even with normal left ventricular (LV) function and thus to categorize the patients for appropriate referral and invasive evaluation. Aims : This study is designed to assess the relationship between level of BNP and severity of coronary artery disease assessed with SYNTAX score in NSTE-ACS patients with normal LV function. Methods: This cross sectional observational study was conducted at UCC, BSMMU during the period of May 2014 to April 2015 among the patients with non ST elevated myocardial infarction (NSTEMI) and unstable angina. 116 patients were enrolled by non-random purposive sampling who was admitted for coronary angiogram. All the data were recorded in structured questionnaire including details of medical history, coronary risk factors and physical findings. In NSTE-ACS patients with normal LV function venous blood samples were collected for BNP and later SYNTAX scoring was assessed during coronary angiogram. The relationship between level of BNP and SYNTAX score in patients with both UA and NSTE-MI was assessed statistically to evaluate the validity of BNP as a tool to predict severity of coronary atherosclerotic lesions among the patients with NSTE-ACS. Results : The mean age was 57.84±8.82 years. Among the 116 patients, highest frequency of patients was in the age group 51-60 years 55(47.4%) .In which 88(75.9%) were male. Male:Female ratio is 3.1:1.The percentage of risk factors was higher in NSTEMI group and difference with UA was statistically significant (p <0.05). Serum BNP in UA 64.9±13.07 and in NSTEMI 107.2±11.53. The mean difference of serum BNP between two groups is statistically significant. In UA group the SYNTAX score was found 13.2±11.1 and in NSTEMI 19.9±13.5 which is statistically significant. In UA group maximum patients were found two vessel disease and in NSTEMI maximum patients in three vessel disease. 70.0% of patients of three vessel disease had e” 80pg/ml of BNP. The association is statistically significant (p< 0.05). Higher the level of BNP reflect higher the vessel involvement and SYNTAX score irrespective of UA and NSTEMI. Conclusion : Our study reveals BNP is a candidate for entry into the setting of principal risk scores. Our findings indicate that the level of BNP may reflect the severity of ischemic insult even when irreversible injury and systolic dysfunction have not occurred. University Heart Journal Vol. 12, No. 1, January 2016; 17-22

Chorionic Villus Sampling (CVS) for Prenatal Diagnosis of Genetic Disorders in Bangladesh

Abstract: Objective(s): The aim of the study was to identify safety and outcome of trans abdominal Chorionic Villus Sampling (CVS) for prenatal diagnosis of genetic disorders. Materials and methods: This is a retrospective analytical study on women who had undergone trans abdominal CVS. All CVS were done at Fetal medicine centre, Family Foundation, Green Road, Dhaka, from June 2013 to December 2016. A total of 286 couples, who were referred for prenatal diagnosis of various genetic disorders were studied. Trans abdominal CVS was done under local anesthesia and real-time ultrasound guidance. A 18G/88mm Spinal Needle (B Braun, Germany) was used. All CVS were performed with the “2 operators” technique. The needle was introduced trans abdominally into the placenta in its longitudinal direction. Once the needle was adequately placed, the chorionic villi were aspirated with a to and fro jiggling movement of the aspiration needle and a suction force was applied through a syringe. Results were recorded and analyzed for descriptive statistics. Results: A total of 286 CVSs were performed as outdoor basis. The most common indication was detecting Beta-thalassaemia (82.5%). Other indications were for diagnosis of aneuploidy (9.7%), Hemophilia (3.1%), Spinal muscular atrophy (SMA) (2.4%), Duchenne Muscular Dystrophy (DMD) (2%). Most procedures were done between 11 and 13 weeks (range 11- 14 weeks). Most aspirations (95.1%) were easy; however, in 4.8% cases the aspiration was difficult due to a variety of factors. The overall success rate was 100%. Minor complications like placental hematoma and pervaginal (P/V) bleeding occurred in 2% and 1.3% respectively, which were subsided by conservative management. The procedure related miscarriage within three weeks not occurred in any cases. Conclusion: Trans abdominal CVS under real-time sonography is a useful outdoor procedure for prenatal diagnosis in early pregnancy without significant risk to the mother and the fetus. Bangladesh J Obstet Gynaecol, 2016; Vol. 31(2) : 63-69

Association between cytotoxin producing H. pylori and gastric carcinoma

Abstract: Background: Enormous studies have been conducted worldwide regarding CagA + status of H. pylori in gastric carcinoma Objective: No study relating CagA + status and gastric carcinoma has been carried out in our country yet. This study has been designed to see the association between CagA + H. pylorl strain and gastric carcinoma Methods: 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 non invasive (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 which was regarded as gold standard, CagA IgG was detected by ELISA method. Results: In this study, 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. In this study, no significant difference between case and control on the point of CagA-IgG status was found. Conclusion: H.pylori may be a simple initiator and not the actual cause of gastric carcinoma. Bang Med J (Khulna) 2016; 49 : 13-17