Showing papers by "Khulna Medical College published in 2018"

Acute pancreatitis- a clinical update

Abstract: Acute pancreatitis is an acute inflammatory process of the pancreas that can range from mild interstitial pancreatitis to severe pancreatitis with pancreatic necrosis with variable involvement of regional tissues and remote organ systems. The incidence of pancreatitis varies in different countries and depends on causes e.g, gallstones, alcohol, metabolic factors and viral infections. Gall stones continue to be the leading cause of acute pancreatitis in most series. Alcohol, hypertriglyceridemia and drugs are also a common cause of acute pancreatitis. Gall stone pancreatitis is more common in women than in men. Alcohol is also a common cause of acute pancreatitis. Alcoholic pancreatitis is more common in men, and usually occurs in individuals with long standing alcohol abuse. The increased frequency of acute pancreatitis may be due to the rising incidence of obesity, a risk factor for the development of gallstones and by extension, gallstone pancreatitis. Acute pancreatitis occurs when there is abnormal activation of digestive enzymes within the pancreas. This occurs through inappropriate activation of inactive enzyme precursors called zymogens or proenzymes inside the pancreas, most notably trypsinogen. Acute pancreatitis is typically rapid in onset and most commonly encountered in its mild form. While mild cases are often successfully treated with conservative measures, such as fasting and aggressive intravenous fluid rehydration, severe cases may require admission to the intensive care unit or even surgery to deal with complications of the disease process. Acute pancreatitis may be accompanied by life threatening complications as well as significant morbidity and mortality despite treatment. Bang Med J (Khulna) 2017; 50 : 35-40

Evaluation of scrotal reconstruction with thigh flap

Abstract: Background: Scrotal skin can be lost in many ways. Partial loss of scrotum is easy to manage but major scrotal skin loss represents a significant challenge to the reconstructive surgeon. Although many techniques have been established for the treatment of major scrotal defects, each technique has its own advantages and disadvantages in specific situations. Objective: The aim of this prospective study was to evaluate the outcome of thigh fascio-cutaneous flap for reconstruction of major scrotal loss with exposed testis. Methods: This prospective study was done for 5 years extending from January 2012 to December 2016. In this period we reconstructed major scrotal defects of eight patients with antero medial and pudendal thigh fascio-cutaneous flap in Burn and Plastic Surgery department, Khulna Medical College Hospital. Total eleven thigh fascio-cutaneous flaps were used for reconstruction of major scrotal defects. Results: The mean patient age was 41 years (range 24 to 62 years). The aetiology of scrotal loss was Fournier's gangrene in 4 cases and trauma in 4 cases. Three cases had bilateral and five cases had unilateral flap reconstruction. The flaps allowed sensate coverage and took well. Primary donor site closure obviated the need for skin grafts in most of the cases, Complications were flap tip necrosis (12.50%) and minor wound infection (12.50%) which were treated conservatively. Donor site scar was limited and acceptable. The flap had good aesthetic appearance except in one fatty patient where the flaps were bulky. Conclusion: The study concluded that thigh fascio-cutaneous flap is very reliable for coverage of major scrotal defects. Bang Med J (Khulna) 2017; 50 : 13-17

Laurence Moon Bardet Biedle Syndrome

Abstract: Laurence Moon Bardet Biedle syndrome is a rare, autosomal recessive genetic disorder involving multiple systems and has wide spectrum of clinical features. Characteristic features of this disorder are retinitis pigmentosa, polydactyly, truncal obesity and learning difficulties. It may also be associated with hypogonadism in male and complex genitourinary abnormalities in female. We present a case of 33 years male patient having obesity, decreased vision, polydactyly, hypogonadism and retinitis pigmentosa. These clinical features are consistent with Laurence Moon Bardet Biedle syndrome. Medicine Today 2018 Vol.30(1): 41-43

Procalcitonin – A Reliable Marker for Diagnosis of Neonatal Sepsis in Compare to CRP

Abstract: Background: Early recognition and diagnosis of neonatal sepsis are difficult because of the variable and non-specific clinical presentation of this condition. It is extremely important to make an early diagnosis of neonatal sepsis for prompt institution of antimicrobial therapy. So the objective of the study was to evaluate the efficacy of serum procalcitonin as a reliable marker in diagnosis of neonatal sepsis. Methodology: This cross sectional analytical study was carried out in the Special Care Baby Unit of a tertiary level care hospital in Bangladesh from September 2012 to May 2013. Total 75 newborn with suspected sepsis were included in the study. Specimens of blood were obtained from each neonate prior to commencement of antibiotic for sepsis work up. Serum CRP and procalcitoninlevels were measured. The data from blood cultures were used as the gold standard to evaluate the optimum sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the Receiver Operative Characteristic (ROC) curves. Results: Among total 75 newborns included in this study, 49.3% (37) newborn were diagnosed as proven sepsis and 50.7% (38) newborn as clinical sepsis.The procalcitonin (PCT) was high in 58.7% (500- 500pg/ml, the sensitivity of PCT in detecting sepsis was 48.6%, its specificity 76.3%, positive predictive value was 66.7%, and negative predictive value was 60.4% whereas the sensitivity of CRP for predicting sepsis was 35.1%, specificity 78.9%, positive predictive value 61.9% and negative predictive value was 55.6%. The area under the ROC curve for procalcitonin(0.653) was significantly higher than CRP (0.571). Conclusion: Serum PCT was superior to serum CRP level in terms of early diagnosis of neonatal sepsis, in detecting the severity of sepsis. PCT is a reliable marker than CRP in the diagnosis of neonatal sepsis. Bangladesh J Child Health 2018; VOL 42 (1) :19-25

Helicobacter Pylori Infection And Gastric Cancer: Is It Our National Problem?

Abstract: Gastric cancer is a leading cause of cancer death worldwide. In Bangladesh it ranks a leading position among the cancers patients. A large body of evidence supports a causal role of Helicobacter pylori in the majority of gastric malignancies. Scientists throughout the world explored and reached to the understanding about the pathogenesis of their relationship, but much remains to be learned. Moreover, because of the high prevalence of infection, the lack of definitive trials, and the challenges of H. pylori treatment, there remains a debate regarding the consensus on the role of routine screening and treatment of this infection to prevent cancer. This article reviews the current knowledge on H. pylori and its role for gastric cancer, present status of Bangladesh and a recommendation for reduction of the infectivity among the common population. J Bangladesh Coll Phys Surg 2018; 36(2): 70-76

Outcome of meconium ileus in a tertiary care hospital

Abstract: Background: Meconium ileus is a common form of congenital intestinal obstruction. The condition results from the accumulation of sticky inspissated meconium in distal ileum. In about half the cases, however, the pathologic condition is complicated by volvulus, gangrene, perforation with meconium peritonitis. Relief of the obstruction is commonly accomplished with a variety of operative procedures. A number of operative procedures are in use, including Bishop-Koop enterostomy, Mikulicz ileostomy and primary closure Objective: Aim of this study was to evaluate the outcome of meconium ileus and its complications in two commonly practiced enterostomy procedure. Method: In this retrospective study from July 2007 to Jun 2017, a total of 52 cases of meconium ileus were included. Diagnosis of suspected cases was confirmed after laparotomy. Two commonly practiced ileostomy procedure were Mikulicz ileostomy and Bishop Koop ileostomy in this study. Survivors of all primary enterostomy underwent ileostomy closure after 3-6 months. Result: Mikulicz enterostomy was done in 38 cases and Bishop Koop ileostomy in 14 cases. After primary ileostomy 5 patients died following Mikulicz ileostomy and 2 after Bishop Koop ileostomy Among the 41 cases those who reached ileostomy closure, 35 were survived. Conclusion: Complications were more common after Mikulicz ileostomy and difficult to manage in our observation. Overall survival of meconium ileus was 66% in our study without any facilities of intensive neonatal care. Bang Med J (Khulna) 2017; 50 : 31-34

Cutaneous atypical mycobacteriosis

Abstract: Mycobacterium chelonae rarely causes skin infection, usually after minor trauma. A 44 year old lady complained of skin rashes on left lateral back above the flank for 6 months. Physical examination showed multiple papulo-pustular eruption and sinus on an erythematous base. Repeated histopathological examination did not give any authentic clue. Ultimately on clinical ground and therapeutic trial, it was diagnosed as rapidly growing atypical mycobacterial (Mycobacterium chelonae) infection. Bang Med J (Khulna) 2017; 50 : 44-45

Causal factors and treatment outcome of genitourinary fistula in a teaching hospital

Abstract: Background: Urogenital fistula, majority of which is vesicovaginal fistula is a public health problem especially of developing countries. It is commonly caused by prolonged and obstructed labor. With the advancement of health care delivery system etiology of urogenital fistula is changing in our country. Objective: This study was done to find out the causal factors and to determine the success rate of operative procedure for treatment of urogenital fistula. Method: This was an observational type of cross sectional study, carried out in Department of Obs and Gynae in Khulna Medical College Hospital from January 2013 to June 2014 among 30 women at different ages suffering from urogenital fistula due to gynaecological or obstetrical causes or malignancy. Result: Majority of the patients were young primipara, short stature and malnourished, coming from lower socioeconomic condition of rural areas. Prolonged labor 12 (40%) was the most common cause of urogenital fistula, followed by gynaecological surgeries mainly hysterectomies 9 (30%) and malignancy 2 (6.6%) rare cause. The success rate of repair following first and second attempt was 92% and 8% respectively. Overall success rate was 24 (96%) and functionally failed with a failure in 1 (4%) cases. This study showed main cause for developing fistula showing prolonged labor and majority of patient were treated pervaginally. Most of the cases (96%) had successful repair which is very encouraging and correlates well with recently published series. Conclusion: Fistula can be totally preventable by proper antenatal care, identification of high risk cases, timely referral, proper intranatal, postnatal care, and proper training. So improvement of health care services and dedication will prevent this type of morbidity. The best results are obtained when repair of urogenital. fistulae is carried out under optimal conditions. Bang Med J (Khulna) 2017; 50 : 18-21

Hearing Status of the Traffic Police with or without Use of Sound Protector in Dhaka Metropolitan City

Abstract: Background: Sound protector is an essential tool to protect hearing. Objective: The purpose of the present study was to see the hearing status of traffic police with or without sound protector. Methodology: The cross-sectional study was conducted in the Department of Otolaryngology and Head Neck Surgery at Bangabandhu Sheikh Mujib Medical University, Dhaka from January 2003 to June 2004 for a period of one and half year. Traffic police who were working in the Dhaka metropolitan city at any age were included as study population. Hearing status was measured to all subjects. The traffic police at any age working in the Dhaka metropolitan city with the duration of service more than 5 years were included as study population. Otoscopic examination, tuning fork test and pure tone audiometry were performed by clinical audiometer (AC 33) with two channels, with TDH39 earphones among the entire study subject. Result: A total number of 100 traffic polices working in Dhaka metropolitan city were examined. Highest (56%) number of the respondents was in between 30 to 40 years of age group. The mean age with SD was 36.15 ±5.5. In this study 53.0% respondents found to have exposure of 6 to 10 years and 16.0% found to have exposure between 16 to 20 years. It was found that 26 traffic police used ear protector occasionally. Among them 7(26.9%) subjects had different degree of hearing loss. Nonusers had higher rate (23%) of hearing loss (p=0.685). Conclusion: In conclusion use of sound protector by traffic police is not significantly related with the hearing loss though this is clinically significant. Journal of Current and Advance Medical Research 201 7 ; 4 ( 1 ): 13-16

Study on Clinical and Histopathological Changes of Alopecia Areata

Abstract: Alopecia areata is a common, unpredictable, nonscarring form of hair loss. It is characterized by rapid and complete loss of hair in one or more round or oval patches, usually on the scalp, bearded area, eyebrows, eyelashes and less commonly on other hairy areas of the body. The present study was undertaken in the department of Dermatology and Venereology of Ibn Sina Medical College, Dhaka from July 2014 to June 2015 to observe the histopathological changes in different stages of alopecia areata. For this purpose 30 patients with age ranged from 18 to 45 years were enrolled. Of them 17 were males and 13 were females. A 4 mm punch biopsy from the involved scalp taken from each patient and histopatological changes were examined. The study revealed that anagen hairs decreased but catagen and telogen hair increased in all stages of alopecia areata. Telogen hairs increased in acute and chronic stage and catagen hair increased markedly in subacute stage. Although miniaturized (atrophic) follicle was frequently found in chronic stage. It was absent in acute and subacute stages. Moderate to dense peribulbar infiltration of lymphocytes were observed in acute stage and mild to moderate infiltration in subacute stage. In chronic stage either no or mild infiltrations were observed. Peribulbar infiltration of eosinophils and macrophages was seen in all stages of alopecia areata. Thus we can conclude that alopecia areata can be diagnosed with some confidence, even when inflammatory infiltrate is absent, based on increasing numbers of telogen hairs in the acute and subacute stages and increasing miniaturized hairs in chronic stage. Medicine Today 2018 Vol.30(1): 30-33

Outcome of treatment of OPC poisoning patients with atropine or atropine plus pralidoxime

Abstract: Background: Organophosphorus compound (OPC) poisoning is common in Bangladesh and management facility is not adequate in most hospitals. Both inj. Atropine and inj. Pralidoxime is used as antidote for the management of OPC poisoning, although there is controversy regarding benefit of inj. Pralidoxime. Objective: This randomised clinical trial was conducted to compare the outcome of OPC poisoning patients treated by inj. Atropine along with supportive measures and by inj. Atropine plus inj. Pralidoxime along with supportive measures . This study also evaluated the clinical profile of OPC poisoning patients. Methods: A total number of 109 patients, admitted in medicine ward in Khulna medical college hospital during one year period were included in this randomised clinical trial. The patients were divided into two groups according to alternate day of admission in the medicine wards. Forty nine patients of group A was treated by inj. atropine only along with other supportive measures required and group B of 60 patients was treated by inj. atropine plus inj. pralidoxime along with supportive measures. Results: 49 patients of group A was treated with atropine alone and 60 patients in group B was treated with atropine plus pralidoxime. Death rate was 14.28% in atropine treated group and 16.66% in atropine plus pralidoxime treated group (p=0.733). The difference in death rate is not statistically significant. Four (8.18%) patients from atropine treated group and 4 (6.67%) patients from pralidoxime intervention group developed respiratory failure and ventilatory support was given in ICU. These 8 patients recovered. But this difference in development of respiratory failure is not statistically significant (p=0.766). The difference of death rate between male and female (12.5% Vs 18.87%) is not also significant (p=0.360). Conclusion: This study reveals that pralidoxime provides no better outcome in the management of OPC poisoning patients. Bang Med J (Khulna) 2017; 50 : 3-7

30-days’ outcome of haemorrhagic stroke: correlation between intracerebral hemorrhage score and modified Rankin score

Abstract: Intracerebral hemorrhage (ICH) constitutes 10% to 15% of all strokes. Within 30 days reported mortality is 35-52% and only 20% is functionally independent in 6 months. Despite several existing outcome prediction models for ICH, modified Rankin scale is found to be best predictor of outcome in early and long term period. To find out 30-day mortality in ICH and predict outcome based on modified Rankin score. In this study, 48 patients presenting with acute ICH presenting to a tertiary hospital in Khulna were enrolled. The 30-day mortality and disability were recorded, and ICH score along with modified Rankin score at presentation were calculated. In this study, the 30-day mortality rate was 27.1%; regression analysis showed the correlation between the scores (as measured by modified Rankin scale) for patient disability, intraventricular hemorrhage, the Glasgow Coma score, and volume of hematoma (>30 ml vs <30 ml) were significantly correlated with corresponding ICH scores. The ICH scale is a simple clinical grading scale which can predict mortality as well as disability in haemorrhagic stroke within 30 days that can be helpful to physicians in prioritization of their patient management and forecasting about prognosis. Mediscope Vol. 5, No. 1: Jan 2018, Page 10-14

Role of ultrasound and color Doppler in the evaluation of acute scrotal pain

Abstract: Background: Traditionally acute scrotal pain is evaluated by gray scale ultrasound, which dissipated only the morphological changes of the lesion. But pattern of vascularity either normal, increased or absent of affected structure help to definitive diagnosis of the lesion and help to proceed the type of management either medical therapy or surgical treatment. Objectives: To determine the relative importance of color Doppler in the evaluation of acute scrotal pain by ultrasound. Methods: From June 2013 to June 2017 a total 150 patients with acute scrotal pain were selected. A thorough history taking and physical examination were done. Then patient were scanned with gray scale ultrasound followed by color Doppler study. Color Doppler diagnosis is compared with gray scale diagnosis. Results: In gray scale ultrasonography among the 150 cases, 54% were diagnosed as epididymitis, 16.66% were epididymo-orchitis and 16% patient diagnosed as normal. But in combined gray scale and colour Doppler study 58% were diagnosed as epididymitis, 22% were epididymo-orchitis and 6% of patient diagnosed as normal. In gray scale 10% patient were diagnosed as normal but become epididymitis and epididymo-orchitis in colour Doppler. Four percent were diagnosed as epididymitis in gay scale but became epididymo-orchitis in colour Doppler. Four percent patient was diagnosed as epididymitis orchitis but became testicular torsion in Doppler study. Total 14.66% of gray scale diagnosis became another diagnosis in the Doppler study. Conclusion: Combined gray scale and color Doppler study is superior than gray scale ultrasound in differentiating various cause of acute scrotal pain. Bang Med J (Khulna) 2017; 50 : 26-30

Safety and feasibility of myomectomy during caesarean section in case of pregnancy associated with fibroid uterus

Abstract: Routine myomectomy during pregnancy is not recommended because of excessive bleeding during myomectomy and the difficulty in securing hemostasis may need hysterectomy. This prospective observational study was carried out in Obstetrics & Gynecology department of Ad-din Akij Medical College, Khulna from June 2016 to August 2017 to evaluate safety and feasibility of performing myomectomy at the time of caesarean delivery. Nineteen patients with fibroid uterus with pregnancy whom needed cesarean section for various indications were the target population for this study. Main outcome measures were difficulty of myomectomy & cesarean section, time needed for operation, per-operative complications, need for blood transfusion, postoperative complications and duration of hospital stay. Caesarean myomectomy operation was successful in all cases. No patient was required hysterectomy. The duration of operation was 45-60 minutes. Only one patient had one unit of whole blood transfusion during postoperative period. Mean (SD) duration of hospital stay and post-operative Hb concentration were 6.9 (0.6) days and 8.6 (1.4) g/dl, respectively. Two patients developed post-operative fever which delayed their hospital stay. Myomectomy during cesarean section in selected cases with proper indication is safe and feasible. Mediscope Vol. 5, No. 1: Jan 2018, Page 5-9

Ewing's sarcoma of rib

Abstract: Ewing's sarcoma is an uncommon malignant bone tumour occuring in children, adolescents and young adults. We report a case of a 13 year old male admitted to Khulna Medical College Hospital with history of pain and swelling in chest wall for two weeks. Earlier chest X-ray showed a mass lesion in the left upper part of chest wall and erosion of first rib. Subsequent X-ray revealed left sided massive pleural effusion. CT scan revealed a mass lesion in the left upper part of chest wall originated from left first rib and left sided pleural effusion. FNAC from the mass lesion revealed features suggestive of Ewing's sarcoma. Patient was treated with chemotherapy and after first cycle there was significant improvement of all the signs and symptoms. Bang Med J (Khulna) 2017; 50 : 41-43