bluuebunny/crossref_metadata_2025 huggingface dataset:
Etiological Spectrum of Diseases Among the Patients Presenting with per Rectal Bleeding Attending at Surgery Outpatient Department in a Tertiary Level Hospital
Authors: Mahmud Mayin Uddin , Hossain Md Motahhar , Ghosh Ajoy Kumer , Reza Roksana
Published: July 2023

Background: Per rectal bleeding is a problem that is frequently encountered by doctors. There is marked geographical variation in the frequency of different etiologies. This study was conducted to determine the frequency of various causes of per rectal bleeding in patients attending in a tertiary level hospital in Chittagong, Bangladesh.

Materials and methods : It was a retrospective study, and non-probability purposive sampling was done. All the patients over ten years of age presenting at the Surgery Outpatient Department with the complain of per rectal bleeding were included. A total of 685 patients were included in this study over a period of 2 years.

Results: Mean age of the patients was 36 ± 13 (Mean ± SD) with a range of 10-82 years. Male-female ratio was 1.5:1. Haemorrhoids were the most common cause (34.6%) of per rectal bleeding, followed by chronic anal fissure (26.1%), chronic anal fissure with haemorrhoids (14.9%), colorectal polyps (11.4%) colorectal cancer (8.3%) and Inflammatory Bowel Diseases (IBD) (0.9%). No cause of per rectal bleeding was found in 3.8% of patients. Maximum patients with colorectal cancer presented in their fifth and sixth decades of life.  

Conclusion: Haemorrhoids and fissures in ano are the most common causes of per rectal bleeding in our setting. However, the number of colorectal polyps and colorectal cancers are not negligible.

JCMCTA 2022 ; 33 (1) : 9-14
Neonatal Outcome of 100 Cases of Term Pregnancy Having Meconium Stained Liquor in a Tertiary Level Hospital
Authors: Azmi Nusrat Sultana , Nasrin Begum
Published: July 2023

Background : Presence of meconium in amniotic fluid is potentially a serious sign of fetal compromise and associated with an increased perinatal mortality and morbidities.Meconium stained amniotic fluid is considered a harbinger of fetal compromise because of its direct correlation with fetal distress and increased likelihood of aspiration of meconium with resultant deleterious effects on the neonatal lung. The purpose of the study was to find the neonatal outcome of pregnancy associated with meconium staining amniotic fluid. Outcome variable were birth weight, Apgar score, admission in NICU, neonatal complications, neonatal mortality and morbidity.

Materials and methods : The present prospective  observational study was conducted in the Department of Obstetrics and Gynaecology in Bangabandhu Sheikh Mujib Medical University, Dhaka and Dhaka Medical College Hospital. A total of 100 pregnant women admitted in the labour ward with meconium stained liquor were the study population.

Results : Nearly three-quarter (72%) of the patients were between 20 – 30 years followed by 17.2% more than 30 years and 10.8% below 20 years old. Over half (52.2%) of the neonates needed resuscitation and 58.7% had to be admitted in ICU. More than 90% of the neonates had normal birth weight and only 9.7% were of low birth weight. Over half (51.1%) of the neonates developed meconium aspirate syndrome and 10.5% respiratory distress syndrome. Neonatal jaundice and neonatal sepsis were observed in 5.4%, 4.3% neonates respectively. Ten neonates (10.5%) died early in the neonatal life, while 1(1.1%) was still-born. low APGAR score (< 7) at 1 and 5 minutes of birth was found in 63.6% and 53% of the cases respectively with thick meconium stained amniotic fluid as opposed to 26.3% and 17.7% of the cases respectively having thin meconium stained amniotic fluid (p = 0.002 and p = 0.014 respectively). Thick meconium tend to be associated with meconium aspiration syndrome (p < 0.001). Neonates needing immediate resuscitation and admission in ICU was staggeringly higher in the former group than those in the latter group (p < 0.001). The incidence of perinatal death was significantly higher in patients with thick meconium stained fluid than that in patients with thin meconium (p = 0.029).

Conclusion : The study concluded that meconium stained amniotic fluid is associated with low APGAR score, higher incidence of MAS, ICU admission and perinatal death and their severity depends on the concentration of meconium.

JCMCTA 2022 ; 33 (1) : 15-20
Retrospective Analysis of Neck Masses Diagnosed by Histopathology from Chattogram General Hospital
Authors: Chowdhury Pankaj Kumar , Ahmed Asfaq , Uddin Ahmed SM Tareq , Erfan Uddin Rabiul Alam Md , Biswas Supran
Published: July 2023

Background: Neck masses are found in all age groups from many causes, ranging from congenital to acquired pathology. There is a wide variation in the presentation of neck masses concerning its site of origin, clinical presentation, and the nature of the progression of the disease. This study was performed to have an idea about the prevalence of various neck masses according to age and sex so that it would help us in diagnosing the neck masses.
Materials and methods: This retrospective study was performed in the Department of Otolaryngology and Head Neck Surgery, Chattogram General Hospital, Chattogram from July 2018 and June 2019, over 97 patients presented with neck mass.  
Results: Of 97 cases 69.1% were female and range from 7-77 years. The maximum case holding age group was 21- 30 years (26.8%). The histopathological diagnosis of the neck masses was inflammatory in 68 (70.1%), congenital in 5 (5.2%) and neoplastic in 24 (24.7%) cases. Chronic granulomatous lymphadenitis was the most common inflammatory lesion (50.5%) and a branchial cyst was the most common congenital mass (2.2%). Neoplastic masses were malignant in 10 (10.3%) and benign in 14 (14.4%) cases. The most common malignant neoplastic mass was a follicular carcinoma (6.2%), and the most common benign neoplastic mass was goitre (12.4%).  
Conclusions: Cervical lymphadenopathy was the most commonly encountered neck mass. Most of the neck masses are benign. Out of these cervical lymph nodes, tubercular lymphadenopathy was most common.
JCMCTA 2022 ; 33 (1) : 21-24
Outcome of Conventional Linear Versus Purse String Skin Closure of Intestinal Stoma Reversal
Authors: Mostafa Faisal , Bhuiyan Md Nur Hossain , Banik Sreekanta Chandra , Akter Sadia , Abedin Mohammad Ahsanul , Muhsin Syed Md
Published: July 2023

Background: Stoma closure is one of the most frequently performed surgery. The common complications are surgical site infection (SSI) and poor scar cosmesis. Compared to the conventional linear closure, the pursestring closure technique is expected to have less wound infection, smaller size scar and good patient satisfaction. The aim of this study is to evaluate the feasibility of PSC of stoma site at a tertiary hospital and comparing it with LC of stoma.

Materials and methods: This study was performed in the Department of General Surgery, Chittagong Medical College Hospital for a period of one year with a sample size of 72. About 36 subjects were enrolled in each group, Group-A (Linear closure) and Group-B (Purse string closure). Each patient of both group were observed for wound infection, post-operative pain, scar formation, patient satisfaction, and length of post-operative hospital stay.

Results: The level of pain according to VAS score was 4 in 36 (100.0%) in Group A and 6(16.7%) in Group B. One third (33.3%) patients had wound infection in Group A and 4(11.1%) in Group B.  The mean duration of hospital stay was 9.72±3.46 days in Group A and 7.97±2.46 days in Group B which is statistically significant (p<0.05). The mean patient satisfaction score was 17.75±1.59 in Group A and 22.12±0.73 in Group B which is statistically significant (p<0.05). The mean patient scar assessment scale was 42.47±0.99 in Group A and 35.88±2.81 in Group B which is statistically significant (p<0.05). The mean observer scar assessment scale was 41.97±1.28 in Group A and 36.22±2.73 in Group B which is statistically significant (p<0.05).

Conclusion: Purse-string skin closure for stoma reversal had significantly less incidence of surgical wound infection, improved the scar outcome, good patient satisfaction, reduce complications and better cosmesis.

JCMCTA 2022 ; 33 (1) : 25-28
Variation of Carrying Angle of Elbow in Relation to Age, Sex and Dominant Arm in Adolescent Bangladeshi Population
Authors: Chowdhury Urmila , Ashrafuzzaman Md , Bhowmik Baishakhi , Hossain Mohammad Monir , Chowdhury Raju , Sumaiya Sarah Fatima
Published: July 2023

Background: Elbow carrying angle changes with skeletal growth and maturity, helps in carrying objects and keeps upper limb away from pelvis during movement. Variation of carrying angle value has been observed in relation to age, gender, and some selected anthropometric parameters. Present study was aimed to evaluate the carrying angle in normal adolescents of Bangladesh in relation to age, gender, and hand dominance.  

Materials and methods: This cross-sectional observational study was conducted in the Department of Anatomy, Chittagong Medical College, Chattogram, upon 100 male and 100 female adolescents (10-19 years) by dividing them into two groups (Group A: 10-15 years, Group B: 16-19 years) and all were right hand dominant. Recorded data were analyzed by using SPSS version 25. For statistical analysis unpaired student’s ‘t’ test was done. p value was considered significant if it was <0.05 at 95% level of confidence.  

Results: Carrying angle of both sides was significantly higher in age group 16 to 19 years and in female (p<0.001) also significant greater value found in dominant hand (p<0.001).   

Conclusion: Knowledge of normal carrying angle value is important for management of elbow fracture, designing of total elbow prosthesis, and differentiation of sex in skeletal remain in medicolegal purpose.

JCMCTA 2022 ; 33 (1) : 29-33
Efficacy and Safety of Levofloxacin Prophylaxis During Induction Therapy for Childhood Acute Lymphoblastic Leukemia
Authors: Urmi Rehnuma , Maayenu  , Das Nabanita , Salma Quazi Saminah , Karim A K M Rezaul , Jahangir Selim Md , Samad Rasheda
Published: July 2023

Background: Infection related complications represent an important cause of morbidity and mortality in pediatric cancer patients, especially in those receiving chemotherapy.  Although antibiotic prophylaxis is used in adult leukemic patients, but it is less practiced in pediatric cancer patients. The aim of this study was to evaluate the efficacy and safety of Levofloxacin prophylaxis to reduce infection which occur during induction phase of chemotherapy among pediatric Acute Lymphoblastic Leukemia (ALL) patients.

Materials and methods: This single centered, pilot study in RCT design was conducted in Pediatric HematoOncology Department of Chittagong Medical College Hospital (CMCH). Sixty newly diagnosed ALL patients admitted for chemotherapy were randomly allocated to two groups 30 in each: one group received Levofloxacin prophylaxis (Intervention group) and other group did not receive prophylaxis (Control group). During the whole period of induction, clinical and laboratory features of infection, fever and neutropenia were observed and adverse effects were noted in both groups.

Results: In induction phase of chemotherapy of ALL, significantly lower proportion of patients developed fever in the intervention group than in the control group [(18/30, 60.00%) versus (26/30, 86.67%)]. Incidence of infection was significantly less in intervention group compared to control group (60% versus 86.7%, p=0.039). Also, incidence of febrile neutropenia was significantly less in intervention group compared to control group (p=0.039). No major adverse effects were observed in any of the levofloxacin prophylaxis group except only two patients reported mild lower limb pain.  

Conclusion: It may be concluded from this pilot study that, Levofloxacin prophylaxis in children with ALL during the induction phase of chemotherapy is effective in reducing infection, febrile episodes and febrile neutropenia.

JCMCTA 2022 ; 33 (1) : 34-39
Association of Insulin Resistance with Dyslipidemia in Gestational Diabetes Mellitus
Authors: Hasina Hafsa , Islam Md Hafizul , Haque Mahmudul , Karim Razaul , Akter Shammi , Salma Ummey
Published: July 2023

Background: Gestational Diabetes Mellitus is the most common metabolic condition during pregnancy. Insulin resistance is a known risk factor for development of GDM. Women with Gestational Diabetes Mellitus are at increased risk for developing dyslipidemia. The aim of this study was to evaluate the occurrence of Dyslipidemia among women with GDM.  
Materials and methods: This cross-sectional comparative study was conducted in Obstetrics and Gynecology Department, Chittagong Medical College Hospital. 100 patients were taken by non-probability convenience sampling where 70 women with GDM were taken as cases and 30 normal pregnant women as controls.
Results: GDM cases presented significantly higher mean HOMA-IR values and increased serum TC, TG, LDL-C and decreased HDL than those of controls. So from this point of view GDM cases had both insulin resistance and dyslipidemia. GDM patients with Insulin resistance had significantly higher Triglyceride level and decreased serum HDL-C level when compared to non-insulin resistance state of the same. This study revealed significant association of insulin resistance with dyslipidemia (Increased TG and decreased HDL-C, p<0.01) in GDM.
Conclusion: Insulin resistance was significantly associated with dyslipidemia in GDM. Soestimation of fasting lipid profile and fasting insulin in women with GDM may provide baseline information in course of planning and management of GDM patients.
JCMCTA 2022 ; 33 (1) : 40-45
A Six Months Analysis of COVID-19 Death : Experience From a Tertiary Hospital, Chattogram
Authors: Roy Biswas Rajat Sanker , Nath Jishu Deb , Nisha Fatema Emrose , Sarker Prasenjit
Published: July 2023

Background : COVID 19 pandemic had taken away lots of human life prematurely worldwide and death laid its icy hands also on Bangladesh. So, objectives of this study were to explore the monthly distributions, age, sex, comorbidities, localities and duration of hospital stay among the COVID 19 death cases.  

Materials and methods: In this observational study six months hospital death registries were collected and explored for monthly distributions, age, sex, comorbidities, localities and hospital stay.  RT-PCR positive confirmed 113 COVID deaths were enrolled and suspected COVID deaths were excluded. Ethical clearance from the hospital authority was taken before hand. Data was compiled and analyzed by SPSS-20.

Results: There was a low frequency of death in the months May-2021 and October-2021(7.1% and 2.7% respectively) but more during June -2021 to September 2021 (12.4%, 16.8%, 42.5% and 18.6% respectively). Female deaths were   more than male deaths (53.1% vs 46.9%, p<0.05). Age more than 51 years were the most vulnerable where 26(23%) deaths were at age group 51- 60 years, 39(34.5%) deaths were at 61-70 years and 22(19.4%) deaths were more than 71 years.  Mean age of death was found 60.66 years and mean duration of hospital stay was found 9.45 days.  Maximum duration of hospital stay was 45 days for one patient.  Co-morbidities of death cases revealed 52(46.00%) patients had DM and HTN both, 17(15.0%) patients had HTN, 16(14.1%) had DM, 3(2.6%) had BA and COPD, 4(3.5%) had CKD, 2(1.7%) had cancer, 3(2.6%) had CVD, 19(16.8%) had IHD and 16(14.1%) patients had no co-morbidities. Locality of the death cases revealed 44(38.9%) patients came from rural areas and 69(61.1%) came from urban areas.  

Conclusion: Higher age group and multiple comorbidities specially DM, HTN and IHD were related with COVID deaths mostly found in our study.

JCMCTA 2022 ; 33 (1) : 46-49
Correlation of Clinical and Biochemical Parameters with the Stages of Chronic Kidney Disease in Type 2 DM Patients in a Tertiary Care Hospital in Chittagong
Authors: Ahmed Shahryar , Chowdhury Sumon Rahman , Begum Rasheda , Siddiki Amam Zonaed
Published: July 2023

Background : Microalbuminuria is a term to describe a moderate increase in the level of urine albumin. It occurs when the kidney leaks small amounts of albumin into the urine. The main objective of this study is to determine the correlation between microalbuminuria and diabetic kidney disease at a tertiary care hospital in Chittagong.

Materials and methods : Institutional based cross- sectional study design was conducted on randomly selected diabetic population from Chittagong Diabetic and General Hospital by using systematic random sampling  method from 1st June to 30th November 2019.

Results : Out of a total of 160 participants, the prevalence  of microalbuminuria was in 59(36.9%) patients. Ten (6.3%) patients had cardiovascular disease, 18(11.3%) had neuropathy, 7(4.4%) had retinopathy, 117(73.1%) had hypertension and 47(29.4%) had duration of diabetes of 610 years. Majority 132(82.5%) patients had stage 1-2 followed by 22(13.8%) had stage 3, 4(2.5%) had stage 4 and 2(1.3%) had stage 5. Gender, age, cardiovascular, retinopathy, hypertension, BMI, albumin to creatinine ratio, fasting sugar, creatinine level and LDL were not statistically significant (p>0.05) when compared to different stages of CKD. Stage 1-2 was significantly higher in no microalbuminuria group than microalbuminuria group (92.1% vs 66.1%). Stage 3 was significantly higher in microalbuminuria group than no microalbuminuria group (23.7% vs 7.9%). Stage 4 was significantly higher in microalbuminuria group 4(6.8%) and Stage 5 was higher in the microalbuminuria group 2(3.4%).

Conclusion: Neuropathy, mean diabetes duration, mean HbA1c, and mean Triglyceride were significantly greater in CKD stage 5 than in other stages of illness in the current research. When comparing different stages of CKD, mean HDL was considerably lower in stage 5. In the microalbuminuria group, CKD Stages 3, 4, and 5 were considerably higher than in the non-microalbuminuria group.

JCMCTA 2022 ; 33 (1) : 50-55
Malnutrition in Children with Uncomplicated Versus Complicated Appendicitis
Authors: Chowdhury Md Tameem Shafayat , Khastagir Rajib , Chowdhury Tahmina Akhter , Al Farooq Md Abdullah , Alam Sarwar Md Khurshid , Chowdhury Tanvir Kabir
Published: July 2023

Background : Acute appendicitis is one of the commonest surgical emergencies in children and malnutrition is prevalent in the country. This study was designed to compare if complicated appendicitis occurs more in malnourished children.

Materials and methods: This cross-sectional study was conducted in Department of Paediatric Surgery, Chittagong Medical College Hospital from March 2017 to December 2019 with 155 children. Anthropometric measurements (Height, weight, Mid Upper Arm Circumference (MUAC) Triceps Skin Fold Thickness (TSFT) were recorded and biochemical assessment (Haemoglobin, albumin and total lymphocyte count) were done before surgery. Patients were grouped into two groups: Group A (Acute uncomplicated appendicitis; n=65) and Group B (Acute complicated appendicitis, n=90). Anthropometric and biochemical indices were compared between these two groups.  

Results: Age ranged from 2 -12 years (Mean 9.2 ±2.5 years) (Male: female- 1.35:1). Among the five anthropometric indices abnormal measurements in Group A vs Group B were respectively. Abnormal TSFT (73.8% vs 80%, p=0.4) wasting (38.5% vs 44.4%, p=0.4) low MUAC for age (13.8% vs 17.8%, p=0.8) low weight for age (30.8% vs 36.7%, p=0.5) and low height for age (21.5% vs 24.4%, p=0.7) low albumin (52.3% vs 83.3%, p<0,001); low haemoglobin (61.5% vs 60.0%, p=0.6)) and low total lymphocyte count (39.5% vs 44.8%, p=0.7).

Conclusions: Malnutrition was widely prevalent in both groups. Although the proportion of malnutrition was more with acute complicated appendicitis, it was not statistically significant. The lower serum albumin level in these patients might be due to the consequence of the disease rather than prevailing malnutrition.

JCMCTA 2022 ; 33 (1) : 66-70
Evaluation of Cervix at Risk with Pap Smear and with Colposcopy
Authors: Ferdous Nasrin , Khanam Mafruha , Mahmud Anika Anan , Iqbal Tajrin , Begum Anjuman Ara , Gupta Chandrika Dash
Published: July 2023

Background: Unhealthy cervix is a very common finding in Bangladesh due to poor genital hygiene, malnutrition, and multiparity. Cervical Cancer is a serious health problem in Bangladesh and other developing countries. Cervical Cancer is a preventable cancer due to long preinvasive state and available cervical screening program like pap smear, colposcopy etc. Upon detection the treatment of pre-invasive lesions is highly effective. The objective of our study is to observe and evaluate suspicious cervix upon specimen collection by pap smear and viewing them by colposcopy when required.  

Materials and methods: This is a descriptive type of observational cross-sectional study conducted in the Department of Obstetrics and Gynecology of BBMH, Chittagong over a period of six months from December 2020 to June 2021. A total of 64 women were selected, who came to hospital outdoor for the treatment of persistent vaginal discharge, post coital bleeding, postmenopausal bleeding. A thorough general, systemic and pelvic examination was done. Pap smear was conducted and colposcopy was done for women who had persistent inflammation on pap smear cases. Multiple variables like age of marriage and first intercourse, parity contraception was taken in consideration. The data obtained were recorded and statistically analyzed.                       

Results: Out of 64 women the minimum age was 30 and maximum was 62 years with a mean age of 32.6 ± 7.2 years. Of the 64 women with unhealthy, inflammatory pap smear cases, 33 (51.6%) patients were colposcopically positive for CIN. Then histopathological evaluation of the biopsy material of those 33 women were done. It revealed 12 (36.3%) with abnormal cytology. Patients with positive CIN experienced early marriage, early age of child birth, and also had higher parities than patients without CIN.

Conclusion: This study should that cervical lesion is one of the commonest problems among the females worldwide, including Bangladesh. This revealed the importance of emphasizing on proper screening of carcinoma cervix to decline incidence and mortality in developed and developing countries.

JCMCTA 2022 ; 33 (1) : 71-76
Study of Sociodemographic Characteristics, Clinical Profile and Pattern of Pathogens of Meningitis in Children Admitted in A Tertiary Level Medical College Hospital
Authors: Nahar Kamrun , Alam Md Shah , Chowdhury Muhammad Jabed-Bin-Amin , Nahar Najmun
Published: July 2023

Background: CNS Infection are likely to arouse tremendous anxiety in both the physician and the patients. It is one of the most potentially serious infections occurring in children and important cause of mortality and morbidity in worldwide. Laboratory surveillance of pathogen is crucial in formulating the empirical treatment guidelines. To evaluate sociodemographic characteristics, clinical profile and pattern of pathogens of meningitis in children.

Materials and methods: A descriptive study was carried out in paediatric Inpatient Department of Pediatric CMCH (Chittagong Medical College Hospital) Chattogram during the period of May 2013 to April 2014 where History, clinical examination and CSF sample were obtained from 40 patients of suspected meningitis. Diagnosis was based on the clinical presentation and CSF analysis.  

Results: In this study, out of 40 patient, 25 patients were diagnosed as bacterial meningitis and 15 patient were diagnosed as aseptic meningitis based on clinical features and CSF analysis. 20% Culture positive bacterial menigitis was found, S pneumonae was found the leading pathogen. Overall, mortality rate was 2.5 %.

Conclusion: Bacterial meningitis is a medical emergency. Making an early diagnosis and prompt treatment are lifesaving. For Starting early empirical treatment of meningitis, knowledge about the local pathogen is necessary.

JCMCTA 2022 ; 33 (1) :77-81
Gender Difference in Palatal Rugae Patterns Among Adult Bengali Population in Chattogram
Authors: Sumaiya Sarah Fatima , Ashrafuzzaman Md , Begum Tamanna , Mahmud Manjur E , Bhowmik Baishakhi , Chowdhury Urmila , Alam Mohammed Morshed
Published: July 2023

Background: The anatomical fold on the front portion of the hard palate is known as the palatal rugae. They are distinct and do not change during life, making them perfect for use as an identification tool when other options are unavailable. The aim of our study is to determine gender differences in palatal rugae pattern among the Bengali population in Chattogram of Bangladesh.

Materials and methods: A total of 200 Bengali male (100) and female (100) populations aged 18 years and above were studied. The data was assessed based on the Thomas and Kotze classification. The student's t-test was used to compare all quantitative data.

Results: Curved and straight type palatal rugae were significantly higher (p < 0.05, p < 0.001 respectively) in males than females. Wavy and circular type palatal rugae were higher in females than males and the difference was significant (p < 0.001, p < 0.05 respectively). The female exhibited a higher converging palatal rugae p > 0.05. The male exhibited a higher diverging palatal rugae p < 0.001.

Conclusion: The Bengali population of Chattogram has a distinctive pattern and sexual diversity of palatal rugae. That can be used to reliably identify subjects and gender differences in the Bengali population.

JCMCTA 2022 ; 33 (1) : 82-87
Risk Factor Stratification in Patient with Recurrent Stroke in Bangladesh
Authors: Ahmed Faruk , Hoda Md Durul , Rashid Md Abdur , Badiuzzaman Md , Hossain Amir , Refatul Islam Mohammad , Hossain Md Emran
Published: July 2023

Background: Stroke is a non communicable disease of increasing importance. Stroke is a major cause of death and disability in the world. Individual who suffered from stroke are at high risk of suffering recurrent stroke. So it is important to establish the risk factor for secondary prevention. The aim of this study is to find out the association of risk factor of recurrent stroke and it helps to take steps to reduce recurrent stroke.
Materials and methods: This is a cross sectional observational case control study was conducted at Dhaka Medical College Hospital during 1st January to 31 December 2011. Definition was followed by WHO stroke manual.  
Results: In this study two leading risk factors were found hypertension and smoking respectively 78% and 72%. Among risk factors others were diabetes 56%, dyslipidemia 24%, cardiac diseases (AF, IHD, Valvular heart disease) 22%, Mean age of patient 61.09. Ischemic stroke found in 68% and haemorrhagic in 32% of patient.
Conclusion: The common risk factors of stroke are also attributed to risk factor of stroke. Noncompliance to drug and life style modification also important cause of recurrent stroke.
JCMCTA 2022 ; 33 (1) : 93-96
Endoscopic Adenoidectomy with Microdebrider Versus Conventional Adenoidectomy
Authors: Das Sanjoy , Dutta Pranay Kumar , Sen Tuli
Published: July 2023

Background: Adenoidectomy is one of the most common surgical procedures performed in children in Bangladesh. Though conventional curettage is highly popular as it has the advantage of being cost effective and continues to be a commonly used method especially in developing countries but Microdebrider has opened the new horizon in this arena. To compare conventional curettage adenoidectomy and endoscopic-assisted powered adenoidectomy using a microdebrider.

Materials and methods: This is randomized single blinded comparative study, which was performed in the Medical Center Hospital, Chattogram from August 2019 to July 2020. A total of 60 patients were randomly divided into two groups. Group I underwent conventional curettage adenoidectomy while Group II underwent endoscopic- assisted powered adenoidectomy. Duration of surgery, amount of intra-operative bleeding, adequateness of removal and damage to the adjacent structures were assessed and compared between two groups. All patients were followed for 12 months. Statistical analysis was done using statistical software package SPSS v 22.0. Data were represented as mean ± SD. Continuous variables were compared using the were using the t test while nonparametric data were compared using Mann-Whitney U test. The c2 test was used to compare the nominal data. A p value <0.05 was considered statistically significant. Ethical directives from the Managing Body of Medical Centre Hospital, Chattogram for this study was obtained.

Results: in our study, we observed approximately almost three times more mean blood loss and total operating time in the endoscopic-assisted powered procedure compared to the conventional technique (149 and 56 ml, respectively, 63 and 27 min, respectively). Nine (30%) cases in group I had more than 50% residual adenoid tissue while 20 – 50% of residual adenoid tissue was documented among 7 patients (23%). Postoperative pain was found to be significantly higher in group I compared to group II. In both groups, recovery time ranged from 24-48 hour with a mean of 33.6 hour in group I and 36 hour for group II. 23 patients (77%) in group I presented with residual disease in the 3 months follow up period, where number of patients with the exact instance in group II was 0.

Conclusion: Endoscopic assisted adenoidectomy may appear more handy over conventional curettage. But precise peri-operative care and awareness are required to attain the successful outcomes.

JCMCTA 2022 ; 33 (1) : 88-92
Is There Decreasing Prevalence of Helicobacter Pylori Infection in Patients with Dyspepsia?
Authors: Perveen Irin , Saha Madhusudan , Hasan Md Quamrul
Published: July 2023

Background: Word-wide there is decreasing prevalence of Helicobacter pylori (H. Pylori) infection. As we are lacking in consistent data regarding H. Pylori infection in our polpulation, we aimed to find out prevalence of H.pylori infection in patients with dyspepsia in Nort-East part of Bangladesh.  

Material and methods: Clinical variables, stool antigen test result and endoscopic findings of consecutive patients with dyspepsia were recorded in a semi-structured questionnaire. Statistical analysis was done with SPSS programme 17.0(). Significance level was set at 0.05 or less.

Results: A toal of 790 patients (male 549, female 241) were included in the study with higher mean age among female patients (41.46 VS. 39.19, p.008) than male patients. Three most common dyspetic symptoms were abdominel pain (n=365, 46.2%), bloating (n=280, 35.4%) and vomiting (n=163, 20.6%). A total of 217(39.5%) male and 87(36.0%) female were positive for stool antigen test (n=308, 38.5%) for H. pylori. No significant association was found between Helicobacter pylori infection and presence of individual dyspeptic symptom, number of dyspeptic symptoms (OR 1.385, p .103), age (OR .998, p .668), sex (OR 1.157, p .362), rural/urban residence (OR 1.126, p .503) or socioeconomic condition (OR .965, p .09).  Around 81% (293/360) subjects had upper GI lesion (Gastritis/gastric ulcer, duoudenitis/duodenalulcer, oesophagitis/ulcer) in endoscopy and stool antigent positivity in paietnts with duodenal and gastric lesions (37% VS. 36.6%) were comparable.

Conclusion: H. pylori infection rate among patients with dyspepsia is is in favour of declining prevalence of H.pylori infection in comparison to previous sudies. Majority of patients with dyspepsia had upperGI lesion in endoscopy. No sigficant differece was noted in H. pyori prevalence rate anong gastric or duodenal lesion or among PPI takers or non-takers.

JCMCTA 2022 ; 33 (1) : 97-102
The Pattern of In-patient Referral in the Psychiatry Department of a Tertiary Care Hospital in Bangladesh
Authors: Acharjee Panchanan , Hasan Rakibul , Yusuff Sajjad Mohammad , Fatima Maria , Shaha Shinjan , Chowdhury Faisal , Kibria Sarah Binte
Published: July 2023

Background: A referral system allows patients to have optimal care. This study aimed to provide the current referral pattern in the context of a tertiary care hospital in the periphery of Bangladesh.  

Materials and methods: This retrospective observational study was conducted from January to December 2020 at the Psychiatry Department of Chittagong Medical College Hospital using data from the referral book. 428 cases were analyzed using SPSS-26, and shown in frequency distribution.    

Results: Majority responders were male (53%) and from the 21 to 30 age group (31%). Patients referred to Psychiatry Department were more (66.7%) than referred from. Among 27 departments, internal medicine was the highest in referral in both instances (31.1% and 9.6%), followed by neurology (5.8% and 5.1%). The majority of patients (29.4%) had Schizophrenia Spectrum and Other Psychotic Disorder, followed by Bipolar and Related Disorder (25.4 %). Frequently, the name of psychiatric diagnosis was mentioned wrongly by other departments. In majority of cases, other disciplines did not mention a clinical diagnosis in the referral note.

Conclusions: Proper awareness regarding referral pattern may aware physicians about the importance of referral to psychiatry, resulting in better patient care.

JCMCTA 2022 ; 33 (1) : 103-111
Femoral Neck Fracture Treated with Dynamic Hip Screw System with De-rotation Screw Versus Cannulated Hip Screws
Authors: Saha Shantonu Kumar , Hira Hasina Momotaj , Jahangir Jabed , Deb Ajoy , Mustafa Mamun , Ghosh S Ripon Kumar
Published: July 2023

Background: Fracture neck of femur has always presented a great challenge to orthopedic surgeons due to its nature of going into non-union and osteonecrosis of femoral head even with the best fixation method and adequate reduction. Treatment of fracture neck of femur varies according to patient’s age and fracture pattern. Purpose of this study was to compare the outcome of DHS with side plate and de-rotation screw with multiple cannulated hip screws in fracture neck of femur in adult.

Materials and methods: This quasi-experimental study was carried out in the Department of Orthopedic Surgery, Chittagong Medical College Hospital from July 2017 to June 2019. Sixty patients age limit between 18 to 55 years, with (AO/OTA 31-B) fracture was taken by purposive sampling technique as per set criteria and were treated either by DHS with side plate and de-rotation screw or by cannulated hip screws. Harris Hip Score was used for evaluation of functional outcome of surgery.  

Results: In this study, out of 60 patients, male (83%) were more than female (17%), maximum age incidence was found in 26-36 years age group (30%), left side involvement was 51.7% and right side was 48.3%. Over 60% incidence was due to RTA. Functional outcome was 68% excellent and 24% good in DHS with de-rotation screw group and 55.6% good and 25.9% excellent in cannulated hip screw group according to Harris Hip Score. Only 6.7% had soft tissue infection, 13.3% had deep seated infection and delayed union, 10% had non-union and hip stiffness and 6.7% had AVN in DHS with de- rotation screw group and 10% had soft tissue infection, 6.7% had deep seated infection and delayed union, 13.33% had non-union and hip stiffness and 10% had AVN in cannulated hip screw group. Mean ± SD radiological union time in DHS with de-rotation screw group was 12.5 ± 1.225 weeks and in cannulated hip screw group was 13.61 ± 1.559 weeks.

Conclusion: The functional outcome of fixation by DHS with de-rotation screw was better than fixation by cannulated hip screw for femoral neck fracture in adults.

JCMCTA 2022 ; 33 (1) : 112-117
Use of Silicon Vaginal Pessary for Treatment of Pelvic Organ Prolapse
Authors: Mazumder Afroza Akther , Begum Shamim Ara , Yousuf Nadia
Published: July 2023

Background: Use of vaginal pessary as a conservative therapy for pelvic organ prolapse is very common and upto 77% of clinicians uses ring pessary for 1 line management of prolapse. Aim to treat prolapse by conservative approach is to alleviate the symptoms of prolapse and avert or delay the need for surgery. Aim of this study was to find out improvements of symptoms related to pelvic organ prolapse and satisfaction rate after 3 months of using vaginal pessary.  

Materials and methods: A prospective observational study was conducted from January 2019 –to June 2019 in the Department of Gynaecology and Obstetrics of Bangabandu Memorial Hospital, Chattogram. Total 31 patients were included with symptomatic Pelvic Organ Prolapse (POP) willing to use pessary. Primary outcome were improvement of symptoms and their satisfaction from baseline to 3 months.  

Results: Age of the respondents were between 25-80 years with a mean of 50 ( +-12) years, maximum respondents were postmenopausal 54.8% .Out of 31 respondents 27(87.1%) continue pessary use upto 3 months and their after, 2(6.5%) cases spontaneous expulsion took place, 2(6.5%) discontinue the use. Compare with base line findings significant improvement in patients symptoms were observed at 3 months. Nearly all symptoms related to pelvic organ prolapse resolved from baseline to to 3 months: buldge (92.3% to 7.7% , p < 0.001), dragging pain in lower abdomen (100% to 14.8% , p<0.001). Urinary symptoms voiding difficulty improved in 88% ( p<0.001), urinary urgency improved in 81.8% (p<0.001), urge and stress incontinence improved in 100% (p<0.001). Incomplete empting of bowel improved in 100%(p<0.001). During follow up 4(12.9%) women complain of vaginal discharge. At 3months 88.9% women were satisfied with pessary and 3(11.1%) were dissatisfied.  

Conclusion: This study showed that treatment with use of ring pessary in women with pelvic organ prolapse had significant improvements in the symptoms with high satisfaction rate.  

JCMCTA 2022 ; 33 (1) : 118-123
Factors Associated with Glycemic Control Among Patients with Type 2 Diabetes at Chittagong Medical College Hospital
Authors: Aktar Parvin , Ali Mohammad Moharam , Akter Salma , Islam Md Hafizul , Tasnim Nayeema , Mandal Ripan Kumar , Haque Mahmudul
Published: July 2023

Background: Glycemic control is the main therapeutic goal for the prevention of diabetes related complications. However, achieving optimal glycemic control on long term basis among patients with Type 2 diabetes remains challenging in developing countries like Bangladesh. The purpose of the study to determine the factors associated with glycemic control among patients with Type 2 diabetes at Chittagong Medical College Hospital, Chattogram, Bangladesh.  

Materials and methods: This cross sectional study included 120 patients with Type 2 diabetes aged 40-75 years who attended at Outpatient Department of Endocrinology, Chittagong Medical College Hospital between July 2020 to June 2021. Important variables in this study were socio-demographics, fasting blood glucose, HbA1c, BMI, waist circumference, duration of DM, proteinuria and documented history of chronic complications. Patent’s HbA1c were categorized into good glycemic control <7% and poor glycemic control ³7%.  

Results: 84.2% of the patient’s had poor glycemic control. The mean (±SEM) BMI, waist circumference, SBP, DBP, HbA1c and FBG were significantly higher in patients with poor glycemic control. Majority of patients with poor glycemic control were female and ³60 years old. Patients with a history of higher BMI (65.3%), waist circumference (85.1%), 10 years of diabetes (33%), combination of OHA and insulin (42.6%) had poor glycemic control. There was no significant association with glycemic control and family history of diabetes, history of smoking, other socio-demographic variables. Patients without complications and proteinuria had significantly better glycemic control.

Conclusion: The proportion of patients with poor glycemic control was high. Age, duration of diabetes, obesity, anti-diabetic agents and complications were associated with glycemic control.

JCMCTA 2022 ; 33 (1) : 132-137
Predictors of Outcome in Hospitalized Adult COVID-19 Patients Admitted to a Tertiary Hospital in Chattogram
Authors: Biswas Rajib , Karim Mirza Nurul , Ullah Enshad Ekram , Arif Mahmud Hasan , Chowdhury Moinuddin , Chowdhury Mohammad Abu Sayeed , Yusuf Sabrina , Johra Fatema Tooj
Published: July 2023

Background: The COVID-19 pandemic emerged as a major public health emergency affecting the healthcare services all over the world. It is essential to analyze the epidemiological and clinical characteristics of patients with COVID-19 in different parts of our country. This study highlights clinical experience in managing patients with COVID-19 at a tertiary care centre in southeastern Bangladesh.

Materials and methods: Clinical characteristics and outcomes of consecutive 199 adult patients admitted to Chittagong Medical College Hospital, Chattogram, Bangladesh, from February 1 to March 31, 2021 were studied in this prospective observational study. The diagnosis of SARS-CoV-2 infection was confirmed by real-time reverse transcriptase polymerase chain reaction (RT-PCR) on throat and/or nasopharyngeal swabs. All patients were managed according to the hospital’s consensus protocol and in accordance with National Guidelines on clinical management of COVID-19.

Results: The median age of the patients was 57 years (Range: 20-102 years) and 118 (59.3%) were male. One hundred and thirty two (67.3%) patients had associated comorbid condition and diabetes (44.7%) and hypertension (33.3%) were the most common. Majority (57.3%) was classified as having moderate severity and mortality of 10.1% (20 patients) was observed. Elderly age (>60 years), diabetes mellitus, elevated levels of D-dimer and neutrophillymphocyte ratio were the predictors of mortality.

Conclusions: These findings suggest that the mortality rate in elderly COVID-19 patients with comorbidity is high and neutrophil-lymphocyte ratio could be a cost effective predictor of mortality in our context.

JCMCTA 2022 ; 33 (1) : 138-143
Accuracy of Frozen Section Biopsy in the Diagnosis of Ovarian Malignancy : An Institutional Experience
Authors: Sultana Ismat , Haque Mohammad Azizul , Sultana Nasrin , Sultana Nazmin , Nessa Badrun
Published: July 2023

Background: Women with early-stage ovarian cancer need surgical staging, which entails taking samples from areas within the abdominal cavity and retroperitoneal lymph nodes for further treatment. The frozen section is an essential and beneficial adjunct in the intraoperative diagnosis of ovarian tumors. The study aimed to evaluate the diagnostic accuracy of frozen section biopsy in malignant lesions among ovarian masses.

Materials and methods: This was a cross sectional study. Thirty cases of ovarian masses from the patients who underwent laparotomy for ovarian massesat the Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from March 2014 to August 2014 were included in the study. Surgical specimens were first processed for frozen section reporting, then processed routinely for final paraffin section histopathology evaluation. Results of frozen and paraffin sections were categorized as benignand malignant, and the accuracy of the frozen section was determined.

Results: The mean age was found to be 35.6±12.4 years, with a range from 14 to 70 years. Frozen section biopsy for evaluation of ovarian masses, true positive was in 6 cases and no false, one false negative and true negative in 23 cases identified by histopathology. Frozen section biopsy has a sensitivity of 85.7%, specificity of 100.0%, accuracy of 96.7%, a positive predictive value of 100.0%, and a negative predictive value of 95.8% in the evaluation of malignant ovarian masses.

Conclusion: The present study confirms that frozen section diagnosis is a reliable method for the surgical management of patients with ovarian masses.

JCMCTA 2022 ; 33 (1) : 144-147
Association of Serum C-Peptide with the Components of Metabolic Syndrome among Non Diabetic Obese
Authors: Akter Shammi , Islam Md Hafizul , Haque Mahmudul , Tasnim Nayeema , Hasina Hafsa , Akther Mosammat Tanjina
Published: July 2023

Background: Obesity is a major health concern and is associated with metabolic syndrome that increases the risk for cardiovascular disease and diabetes mellitus. C-peptide or connecting peptide, is a short polypeptide that connects A-chain of insulin to its B-chain in the proinsulin molecule.  In different studies it was found that C-peptide level are associated with Metabolic Syndrome and its complication. C-peptide is also reported to be more reliable than insulin as a measure of endogenous insulin secretion, insulin resistance and pancreatic beta cell function. The aim of the study is to observe the association of C-peptide levels with the components of metabolic syndrome in non diabetic obese subjects.

Materials and methods: This was a hospital based cross- sectional study comprising hundred non diabetic apparently healthy obese subjects age between 30-70 years. This study was carried out at the Department of Biochemistry and Outpatient Department of endocrinology, Chittagong Medical College Hospital. Samples were collected by non-probability convenient sampling.  

Results: Serum C-peptide was significantly higher in Metabolic Syndrome positive subjects (4.29 ±0.28 ng/ml) than non-Metabolic Syndrome (1.72 ± 0.12ng/ml). There was significant association between Metabolic Syndrome and increased serum C-peptide concentration. Serum Cpeptide levels were significantly associated and positively correlated with serum triglyceride, blood pressure, fasting plasma glucose and negatively correlated with HDL-C in the cases.

Conclusion: However, this study did not find any significant association between WC (Waist Circumference) or HDL and Serum C-peptide concentration. Higher Cpeptide level was associated with the components of Metabolic Syndrome and BMI (obesity) was the most important factor affecting the C-peptide concentration to develop Metabolic Syndrome.

JCMCTA 2022 ; 33 (1) : 148-153
Association of Serum Ferritin with Gestational Diabetes Mellitus
Authors: Debnath Keya , Hossain Fawzia , Haque Nadira , Hosain Nazmul , Islam Fahmida , Rumi Badrunnahar , Sumona Rezwana Haque , Haque Shakila , Aziz Tabinda Anzum
Published: July 2023

Background: Gestational Diabetes Mellitus (GDM) is the most common metabolic disorder during pregnancy and is associated with increased maternal and neonatal morbidity. There are many serum markers known to be associated with Gestational Diabetes Mellitus (GDM). High serum ferritin level has been associated with the risk of developing gestational diabetes mellitus. The aim of the study was to investigate the association of serum ferritin levels with GDM.

Materials and methods: This case control study was carried out in the Department of Obstetrics & Gynecology, Bangabandhu Sheikh Mujib Medical University (BSMMU) Dhaka, Bangladesh between February 2018 and January 2019.  A total of 120 pregnant women between 18 and 35 years of age attending outdoor antenatal clinic in their second or third trimester of pregnancy were included in this study. Among them 60 diagnosed cases of GDM were consider as group A and rest 60 (Without GDM) were considered as group B. Serum ferritin concentration was measured in all of these patients. Statistical analysis of the results was obtained by using window based computer software devised with Statistical Packages for Social Sciences (SPSS-22).

Results: The mean serum ferritin level was 124.1±14.7 ng/ml and 87.4±18.9 ng/ml in group A and group B respectively. The difference was statistically significant (p<0.05) between two groups. More than half (55.0%) patients had serum ferritin level >120 ng/ml in group A and 15(25.0%) in group B. Serum ferritin level >120 ng/ml had 3.67 (95.0% C.I. 1.58 to 8.60) times significantly (p<0.05) increase to developed gestational diabetes mellitus. There was a significant positive correlation between serum ferritin and fasting plasma glucose (r=0.445, p=0.001) in GDM patients. Similarly, a significant positive correlation between serum ferritin and 2-h after plasma glucose level following 75g oral glucose (r=0.427, p=0.001) in GDM patients.  

Conclusion: A significant positive association was found between GDM and maternal serum ferritin levels.

JCMCTA 2022 ; 33 (1) : 154-159