Showing papers by "Khulna Medical College published in 2020"

Prevalence of musculoskeletal conditions and related disabilities in Bangladeshi adults: a cross-sectional national survey

Abstract: Nationally representative data on burden of musculoskeletal conditions (MSK) in Bangladesh are not available. The objective of this study was to determine the prevalence of MSK conditions and related disabilities in the adult population of Bangladesh. A total of 2000 individuals aged 18 years or older were targeted from 20 primary sampling units (urban and rural) of all former seven divisions of Bangladesh in 2015. Structured interviews were done using the modified Community Oriented Program for Control of Rheumatic Disorders questionnaire to detect positive respondents. Standard criteria were used for diagnosing MSK conditions by rheumatology residents. In case of uncertainty, opinion was taken from senior rheumatologists. A Bangla version of the Health Assessment Questionnaire was used to determine disability. A total of 1843 (92.1%) participated. Among them, 892 men and 951 women participated from rural (n = 716) and urban (n = 1127) areas. Their mean age was 40.5 (standard deviation 14.7) years. Almost a third did not have any formal schooling. Overall, 30.4% (95% confidence interval, 28.3–32.5) had MSK conditions. Low back pain (18.6%, 16.9–20.5), knee osteoarthritis (7.3%, 6.1–8.5) and soft tissue rheumatism 3.8% (2.9–4.7) were the three top-ranking MSK conditions. Rheumatoid arthritis (1.6%, 1.0–2.1), spondyloarthritis (1.2%, 7–1.8) and adhesive capsulitis (1.4%, 0.9–1.9) were relatively uncommon. Among those who had MSK conditions, 24.8% (21.3–28.6) had some degree of disability. Of them, 24.4% (21.0–28.1) had history of work loss during last 12 months. The high burden of MSK conditions and related disabilities in Bangladesh warrants greater attention of the health system. Further studies are needed to estimate the impact of this group of conditions particularly addressing related disabilities and loss of work.

Genetic polymorphisms in DNA repair genes XRCC1 and 3 are associated with increased risk of breast cancer in Bangladeshi population.

Abstract: Genetic polymorphisms in DNA repair genes, XRCC1 (Arg399Gln) and XRCC3 (Thr241Met), may affect their DNA repair capacity leading to individual variation in breast cancer susceptibility among Bangladeshi females. The case–control study comprised 121 breast cancer patients and 133 healthy controls. Genomic DNA isolated from peripheral blood was genotyped for target SNPs using PCR-RFLP method. For XRCC1, heterozygous Arg/Gln and homozygous Gln/Gln genotypes showed 1.78-fold (95% CI 1.0084 to 3.1442, p = 0.0467) and 2.41-fold (95% CI 1.0354 to 5.5914, p = 0.0413) increased risk of breast cancer, respectively, when compared with Arg/Arg genotype. The presence of any XRCC1 Gln showed association with 1.93-fold increased risk. The variant Gln allele was associated with increased risk of breast cancer (95% CI 1.1885 to 2.6805, p = 0.0052). For XRCC3, Thr/Met heterozygous and combined Thr/Met + Met/Met genotypes were associated with 1.85-fold (95% CI 1.0815 to 3.1834, p = 0.0248) and 1.89-fold (95% CI 1.1199 to 3.1908, p = 0.0171) higher risk, respectively, compared to Thr/Thr genotypes. The variant Met allele showed significant association with increased breast cancer susceptibility. Among cases genotype frequencies were significantly different in patients with age 55 or above, and with menopause and diabetes. XRCC1 (Arg399Gln) and XRCC3 (Thr241Met) polymorphisms may be associated with increased breast cancer risk in Bangladeshi females.

Comparison of Surgical Outcome between Endoscopic and Microscopic Type 1 Tympanoplasty

Abstract: Background: Chronic otitis media (COM) is the long-standing infection of a part or whole of middle ear cleft characterized by ear discharge & perforation. The most common presenting symptoms are ear discharge, mild to severe hearing loss, sometimes tinnitus even vertigo. Treatment of COM is mainly operative. The treatment of inactive mucosal variety of COM is Type 1 tympanoplasty. It can be done by microscopic or endoscopic technique. Both methods have some merits and demerits. Objectives: Aim of the study was to compare the surgical outcomes between endoscopic and microscopic type 1 tympanoplasty. Methods: This study was carried out in the Department of Otolaryngology–Head & Neck surgery of Bangabandhu Sheikh Mujib Medical University, Dhaka from March 2017 to June 2019 and 60 (30 in each group) patient were included in the study. All patients underwent type 1 tympanoplasty. In Group A endoscopic tympanoplasty cases and in Group B microscopic tympanoplasty cases were placed. Operation duration, post-operative pain, postoperative hearing status, graft uptake was compared in two groups. Results: There were no significant difference of graft uptake and hearing gain (>0.05). But endoscopic operative time and post-operative pain were less than microscopic group (<0.05). Conclusion: Through endoscopic tympanoplasty is a newer approach and it has some limitations. As endoscopic tympanoplasty requires less time, less pain with similar graft uptake and audiological success. It can be adopted as an alternative method of tympanoplasty. Bangladesh J Otorhinolaryngol; October 2020; 26(2): 109-115

Comparison between fractionated dose with bolus dose in Spinal Anaesthesia for haemodynamic stability and duration of analgesia in patients undergoing elective Lower Segment Caesarean Section (LSCS)

Abstract: Background: Elective or emergency caesarean sections are routinely done under spinal anaesthesia (SA) with bolus dose of local anaesthetic drugs. Objective: To compared fractionated dose with bolus dose in SA for haemodynamic stability and duration of analgesia in patients undergoing elective lower segment caesarean section (LSCS). Methods: The present study was carried out in the Department of Anaesthesiology, Ad-din Akij Medical College Hospital, Khulna from January 2018 to December 2018 on sixty female patients (thirty in each group) of the American Society of Anesthesiologists physical status I–III, age from 18 to 40 years, height from 140 to 180 cm, singleton pregnancies scheduled for elective LSCS under SA. Patients with pre-existing diseases or pregnancy-induced hypertension, cardiovascular or cerebrovascular disease, any contraindication to SA, those weighing 110 kg and those taller than 180 cm or shorter than 140 cm and severely altered mental status, spine deformities or history of laminectomy were excluded from the study. Results: The mean duration of analgesia was statistically significant (p 0.05) between two group. 14 patients (46.7%) in group B and 5 patients (16.7%) in group F required vasopressor. The difference was significant (p<0.05) between two groups. Conclusion: Separation process in which a certain quantity of a mixture dose of SA provides better haemodynamic stability and longer period of analgesia compare to bolus dose in patients undergoing elective caesarean section. Mediscope Vol. 7, No. 2: July 2020, Page 95-102

Comparative study between Silodosin alone and Silodosin plus Tadalafil for the medical management of lower Ureteric Stone in South-Western part of the Bangladesh

Abstract: Objective: To compare the treatment outcome of Silodosin alone and Silodosin plusTadalafil as a medical expulsive therapy (MET) of lower ureteric stone in south-westernpart of Bangladesh. Methodology: The study was conducted in a tertiary hospital in Khulna, over a periodof 12 months (January 2019 to December 2019). Out of 108 patients, 100 meet theinclusion criteria who were purposively assigned into 2 groups. 48 patients included inSilodosin alone group and 52 in Silodosin plus Tadalafil group. Result: There was a significant higher stone expulsion rate in Silodosin plus Tadalafilthan Silodosin alone which was 88.46% vs75% respectively (P value 0.02). The meanstone expulsion time of Silodosin alone was14.33 (±3.1) days and Silodosin plus Tadalafilwas 11.48(±2.3) days (P value 0.001). The episodes of pain in Silodosin alone were0.7(±0.06) and 0.6(±0.2) in Silodosin plus Tadalafil group that was statisticallysignificant. Conclusion: The present study concludes that Silodosin plus tadalafil combinationtherapy significantly increases ureteric stone expulsion rate and decreases the expulsiontime and pain episodes than treatment with silodosin alone. Bangladesh Journal of Urology, Vol. 23, No. 1, January 2020 p.67-71

Indication and Complication of Induction of Labour by Misoprostol among Pregnant Women in a Clinical Trial in Dhaka City

Abstract: Background: Misoprostol is very useful for induction of labour among the pregnant women. Objective: The purpose of the present study was to see the indication and complication of induction of labour by misoprostol among pregnancy women. Methodology: This single center clinical trial was carried out in the Department of Obstetrics and Gynaecology at a private hospital in Dhaka city, Bangladesh from September 2005 to February 2006 for a period of six months. Primi or second gravida patients with the gestational age between 37 weeks to 42 weeks in singleton pregnancy with cephalic presentation and not in labour were selected as study population. After proper selection of the cases, induction of labour was done by applying tablet misoprostol 50mcg in the posterior vaginal fornix. Complication of induction were recorded. Result: A total number of 60 patients were recruited for this study. 24 patients were between 23 to 26 years and 12 patients were between 27 to 30 years. Pre-eclampsia, pregnancy induced hypertension and intrauterine growth retardation were the most common indication of induction. In this study 31(51.7%) patients needed only 1 dose of Misoprostol and 24 (40.0%) patients needed 2 doses and only 5(8.3%) patients needed 3 doses of Misoprostal. In this study 11.67% patients experienced Nausea & vomiting and 3.33% patients developed hyperstimulation. Conclusion: In the conclusion, the use of misoprostol results in a shorter induction to delivery time and miserable adverse effects on the method of delivery. Journal of Current and Advance Medical Research 2020;7(2): 80-83

Designing and Prototyping of an Electromechanical Ventilator based on Double CAM operation Integrated with Telemedicine Application

Abstract: In this paper, we proposed to design a new model of mechanical ventilator based on the Ambu bag automation for the patient who is unable to take breath normally. Here we have automated an Ambu bag for air supply whose inlet is connected with an oxygen cylinder and environmental air and outlet is connected to lung patient. The project device includes a robotic operator which can operate an Ambu bag continuously by compressing and decompressing it. The robotic operator is a Computer-Aided Manufacturing (CAM) arm that is controlled by a single microcontroller for operating on the Ambu bag from outside. It has a great advantage of using a single adult Ambu bag to deliver necessary air to all aged lung patients by setting different controlling modes with respect to age with reducing the necessity of pediatric Ambu bag and infant Ambu bag. By considering all of the physiological parameters, we have added three modes namely Adult mode, Pediatric mode, and Child mode. Each mode is included by different respiratory rate and tidal volume to be friendly with their corresponding subject. The proposed device can detect the air pressure and temperature from the Ambu bag outlet to make feedback for preventing the lung harm of the patient and display the parameters using an LCD. All medical data can be transferred via a communication protocol to an Android or iOS phone for telemedicine purposes in real-time. The overall system is portable, small in size (45cm×25cm×35cm), low weighted, time-efficient, and cost-effective. There is no need for training or the study of an operator about the proposed system to handle the device for the benefit of automation of the device.

Screening for cervical cancer in younger women may be an issue - A comparative study

Abstract: Cervical cancer is a burning issue in our health sector. A project on cervical & breast cancer screening has been running already in Bangladesh. All sexually active women of 30-years and above or those who are married for 10 years or more are included in this project. But significant numbers of women, less than 30 years of age were referred to Colposcopy clinic for evaluation. They also had high grade lesion. The purpose of this study was to identify the need for cervical cancer screening programme in younger women who are less than 30 years old. This is a comparative retrospective study conducted in 30 years old women and less than 30 years old (21-29 years) women, who were attending Colposcopy clinic for evaluation & treatment in Khulna Medical College & Hospital (KMCH) from January 2013 to December 2013. We analysed 235 Colposcopies in 225 women (30 years old in Group-A; less than 30 years old in Group-B) who were attending at Colposcopy clinic in Khulna Medical College Hospital in 2013. Among group A (n=90), colposcopic findings were: normal-36 (40%), CIN I-30 (33.33%), CIN II-15 (16.67%), CIN III-2 (2.22%), invasive carcinoma-3 (3.33%). Among group B (n=135), colposcopic findings were: normal-52 (38.52%), CIN I-38 (28.14%), CIN II-26 (19.25%), CIN III-3 (2.22%), invasive carcinoma-2 (1.48%). There characteristics were analysed and compared with each other. Although cervical cancer is extremely rare at younger age, there is increasing rate of younger women with high grade cervical lesion who may need treatment. It seems that these lesions have comparable behaviors as in older women. Early age of marriage is responsible for developing cervical cancer & precancerous conditions. So screening should be started in earlier. Careful colposcopic assessment and evaluation before treatment remain indispensable in this regard. Mediscope Vol. 7, No. 2: July 2020, Page 82-88

Customer relationship management in a tertiary level hospital

Abstract: This cross-sectional study was conducted at OPD of Khulna Medical College Hospital (KMCH). This study aimed to assess the status of Customer Relationship Management (CRM) in a tertiary level hospital in Khulna city from 1st January to 31st December 2016. Total 200 samples were included purposively. Among them 150 respondents were health care receivers and 50 participants were health care providers and interviewed with a pre-tested semi-structured questionnaire and a checklist was used to collect information regarding administrative facility, physical facility and utility services. Data were analyzed by using Statistical Package for Social Science version (SPSS) 22 and appropriate statistical tests were performed. Most (62.3%) of the service receivers were satisfied about the doctors dealing in OPD. It was found that majority of service provider (82%) had not knowledge about CRM and its objectives. Majority (82%) of the service receiver came to hospital willingly and (47.3%) of service receivers were spent less than one hours for getting total treatment.). Most (40%) of service providers said that there were a lack of service provider, modern equipment and medication in the OPD and they recommended that enhanced manpower, modern equipment and adequate supply of medication. About half 49.3% of the service receivers suggested in manpower should be increased. Therefore, attempts could be taken to implement customer relationship management as a process for improving hospitals performance and improving communication between service providers and service receiver in hospitals. Asian J. Med. Biol. Res. September 2020, 6(3): 599-607

Outcome of Bridge Technique with Fibular Graft in Patients with Distal Tibial Non-Union

Abstract: Background: Non-union is an inevitable consequence in many circumstances of compound distal tiabial fracture. In many recent research papers, now-a-days, it has been claimed that bridge graft with fibula is good treatment option for management of such cases of non-union in clinical situations with distal tibial fracture. Methodology: This prospective study was conducted with a toal number of 12 patients with non-infected distal tibial non-union were treated with fibular graft technique from October, 2014 toSeptember 2020 in Khulna Medical College Hospital and in private hospitals. To select sample, convenient purposive sampling was used. Results: Among the study population, 58.3% (07) patients were male. 33.3% (04) of male patients were in 30-40 years age group, whereas in female patients, majority of the patients (25%) were in 40-50 years age group. Road traffic accident was found as the commonest mode of injury in 50% (06) patients of distal tibial fracture. Gustilo-Anderson grade IIIA was the mostcommon type (58.3%). Excellent outcome was observer in 75% (09) patients. In 58.3% (07) patient, there was no chronic pain in follow-up. However, chronic pain at donor site was found in approximately 33.3% (04) patients. Only in 1 patient (8.3%) persistent chronic pain was observed donor site. Healing occurred fairly by primary intention in 83.3% (10) patients, whereas in 16.7% (02) patients, healing occurred by secondary intention. Overall in 75% (09) patients, no obvious complication was observed. Refractory complication was observed in only 1 patient (8.3%). Conclusion: Bridge graft with fibula for managing distal tibial non-union isaresilient treatment option with fewer and manageable complications.

Prevention of Intra-Operative Cerebrospinal Fluid Leaks by Lumbar Cerebrospinal Fluid Drainage during Endoscopic Endonasal Trans- Sphenoidal Surgery for Pituitary Macroadenomas

Abstract: Aim and Objective: Postoperative cerebrospinal fluid leak is a recognized complication of endoscopic endonasal trans- sphenoidal surgery for pituitary macroadenomas. In this study we assess the utility of prophylactic use of lumbar drain in preventing intra-operative cerebrospinal fluid leakage during endscopic endonasal transsphenoidal surgery for pituitary macroadenoma which will ultimately reduce the rate of persistent post-operative cerebrospinal fluid leakage. Materials and Methods: 34 patients who underwent endscopic endonasal transsphenoidal surgery for pituitary macroadenoma were dividedd into two groups by non-probability convenient sampling technique. In one group of which lumbar subarachnoid drain were given just before induction of anesthesia named LD Group and another group went through conventional method without giving lumbar drain named No LD Group. In all patients of LD Group 20-30 ml of CSF was drawn through lumbar drain before giving dural incision. Valsalva maneuver was used in each group to identify intraoperative CSF leaks at the end of definitive surgery before repairing the sellar floor.Zero degree rigid endoscope was used in all cases. Intraoperative CSF leak was categorized as ‘Yes’ or ‘No’ which was decided by surgeon.Lumbar drains were removed within 24 hours of operation in 16 patients of LD Group and in case 1,who developed intraoperative CSF leak, lumbar drain was removed later. Results: Thirty four patients were eligible for inclusion, of which 17 were assigned to the LD Group and 17 to the no LD Group. There were no statistically significant differences in patient demographics, tumor pathology, or radiology between the two groups. In LD Group intraoperative CSF leak occurred in 1(5.9%) patient and leak did not occur in 16(94.1%) patients, in No LD Group intraoperative CSF leak occurred in 14(82.4%) patients and leak did not occur in 3(17.6%) patients. Intraoperative CSF drainage significantly reduced the incidence of intraoperative CSF leaks from 82.4% in the No LD group to 5.9% in the LD group (P < 0.001). There were no catheter related complications. Conclusion: Intraoperative CSF drainage significantly reduces the incidence of intraoperative CSF leakage in patients undergoing endoscopic endonasal transsphenoidal surgery for pituitary macroadenomas. Bang. J Neurosurgery 2020; 10(1): 52-56