Original Research Article
Dec. 3, 2020
Bilateral Asynchronous Spontaneous Achilles tendon Rupture in Alkaptonuria: A Case Report
Ammar Eltayeb Mahdi Awad, Hozifa Mohammed Ali Abdelmaged, Hassan Elshami Hassan Mohamed Ahmed, Adnan Ayman Mohammed Adnan Alnaser, Saad Elnour Hag Eltayeb Mukhtar
Sch J App Med Sci | 2685-2689
DOI : 10.36347/sjams.2020.v08i12.001
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Introduction: Alkaptonuria (AKU) is a rare autosomal recessive disorder result from a deficiency of homogentisate 1, 2 dioxygenase (HGD), and leading to the accumulation of homogentisic acid (HGA) in the tissue. The deposition of excess oxidized HGA in the connective tissues causes pigmentation (ochronosis) and degeneration of the joint (ochronotic arthropathy) and tendons (ochronotic tendinopathy). There is no effective therapy for this disorder a side of symptomatic treatment. Case: we report our 43-year-old male farmer, who presents with bilateral asynchronous spontaneous Achilles tendon rupture (5 months apart) with no history of trauma or drug use, nonspecific low back pain, and apparent black pigments in the sclera, with a positive family history of similar condition. Diagnosis: laboratory investigations revealed black urine upon long-standing. A blackish degenerative tendon found during the operation. In addition, the Intraoperative Histopathological study shows dark stains and fibrosis with presence of inflammatory cells consistent with Alkaptonuria. Interventions: debridement of the distal end of the tendon was done; repair was done with augmentation of repair by anchor suture to calcaneus. Outcomes: The patient recovered very well after the operation with the restoration of full activity.
Original Research Article
Dec. 3, 2020
“Postoperative Bleeding in Coronary Artery Bypass Grafting (CABG) Patients In Bangabandu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh”
Md. Magfur Rahman, A.K Al Miraj, H.N. Ashikur Rahaman
Sch J App Med Sci | 2690-2693
DOI : 10.36347/sjams.2020.v08i12.002
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Background: Post-operative blood loss remains a major problem after cardiopulmonary bypass. A common complication after Coronary Artery Bypass Grafting (CABG) is postoperative bleeding, which is considered as an important problem. Objective: The aim of this study is to study only patients who have never used drugs above so that it can assess postoperative bleeding in CABG with the absence of high-risk medications related to postoperative bleeding. Methods: This cross sectional study was carried out at the Department Of Cardiac Surgery in Bangabandu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2019 to December 2019. 50 patients who were candidates for CABG surgery participated in the study. Inclusions criteria included who were candidates for CABG surgery, avoiding the use of blood clotting drugs before surgery, avoiding the use of immunosuppressant, and the absence of an underlying medical condition such as kidney diseases. Patients with inflammatory, platelet diseases, or any coagulation disorder were excluded. All patients initially tested for hemoglobin, platelets and hemoglobin and International Normalized Ratio (INR). In addition to testing for hemoglobin, the amount of bleeding and packed red cell; frozen plasma and platelets were recorded. Results: Fifty patients who were candidates for elective surgery, including 33 men (66%) and 17 women (34%) were enrolled in this study. The mean patient age was 8.70+57.9years old. Test showed that mean hemoglobin level of patients before surgery was pre-operative of 1.5+12.4 g/dL, mean platelet was equal to 54.14+250.8 thousand/ μL and an average international normalized ratio (INR) was equal to 0.12+1.07. The results after surgery also showed that: The total units of given packed red cell; frozen plasma and platelets were (3.14+1.90; 2.34+2.36 and 0.06 +0.42). Also, postoperative hemoglobin was 1.30+10.30 g/dL, which significantly decreased compared to pre-operative hemoglobin. Bleeding in.....
Original Research Article
Dec. 7, 2020
Clinical Profile of COVID-19 Patients in Bangladesh: Study in a Tertiary Care Hospital, Cumilla, Bangladesh
Hoq AJMS, Dr. Fahmida Sultana, Babar ZUM
Sch J App Med Sci | 2699-2702
DOI : 10.36347/sjams.2020.v08i12.004
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Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the strain of coronavirus that causes coronavirus disease 2019 (COVID-19). Objective: The aim of the study was to evaluate the clinical profile of covid-19 patients in Bangladesh. Method: This cross-sectional observational study was done in Cumilla Medical College Hospital, Cumilla, Bangladesh (Covid-19 dedicated hospital) during the period from April 2020 to June 2020. Total 20 hospitalized patients, with laboratory confirmed COVID-19 were included in the study. We obtained the medical records and compiled data of patients admitted in the isolation wards of hospital. Results: during the study, maximum (50.0%) patients were in the age group of 41 – 50 years.42% had cardiovascular diseases, 20% had hypertension, 3% had hypothyroidism, 7% had COPD. Most of the patients had fever, 50% and cough,60% followed by 40% had myalgia, 20% had sputum production, 10% had headache, 45% had Diarrhoea, 15% had dyspnea.80% had abnormal Chest X-ray at the time of admission, followed by 42% had thrombocytopenia, 30% had lymphopenia, 15% had Leukopenia. Conclusion: This study showed variable range of presentation. Male patients are at risk for Covid-19 infection. Thrombocytopenia, lymphopenia, Leukopenia. Lymphopenia do help in prognosis. Old age and comorbidity are associated with poor prognosis. For treatment guidelines and testing protocols further study is needed.
Original Research Article
Dec. 5, 2020
Emergency Caesarean Section Anesthesia in Rural Africa: Prospective Study of 195 Cases
Diedhiou Moustapha, Dia C. A, Dieng M, Barboza D, Thiam O, Sarr N, Diouf A, Fall ML
Sch J App Med Sci | 2694-2698
DOI : 10.36347/sjams.2020.v08i12.003
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Objective: Evaluation of anesthetic practices during emergency cesarean sections at the regional hospital of Saint Louis in Senegal. Patients and methods: Prospective, descriptive and analytical study of 4 months (from February 1st to May 31st, 2019) including all patients who had an emergency caesarean section. The parameters studied were: age of patients, history and condition of patients, number of pregnancy and childbirth, preoperative clinical and paraclinical evaluation data, indication for surgery, types of surgery, anesthesia data, intraoperative incidents and accidents, postoperative complications, fetal and maternal morbidity. The data have been input and analyzed with the software Epi Info version 7.2.3.0. Results: We collected a total of 195 patients. The average age was 27 years (Extremes: 15 - 45 years). The preoperative evaluation found a score of ASA 1 in 41%, ASA 2 in 31.7%, and ASA 3 in 21% of cases. The initial Glasgow coma scale was 15 in 96% of cases, and variable consciousness disorders were noted in 4% of cases. Pre-operative hypertension was reported in 35% of cases and hypotension in 2.6% of cases. Anemia with a hemoglobin level < 11 g/dl was noted in 25% of cases. Patients received an average of 1400 ml of crystalloids (Extremes: 500 to 2000 ml). Feto-pelvic dystocia, vascular and renal syndromes and acute fetal distress were indications for Caesarean section in 49%, 28% and 25% of cases respectively. Spinal anesthesia was the anesthetic technique in 90.3% of cases. Intraoperative complications were hypotension, bradycardia and hemorrhage, which were mostly found during general anesthesia. Conclusion: The choice of anesthetic technique must consider the degree of urgency, the maternal and fetal condition. In rural Africa, our study has revealed that, beyond scientific recommendations, organizational, environmental factors and the equipment participate in the choice of the anesthetic technique.
Original Research Article
Dec. 7, 2020
Study of Serum Vitamin D, Calcium and Phosphorus in the Uncomplicated and Complicated cases of Type 2 Diabetes Mellitus
Akanksha Menaria, Dr. A K Verma, Shilpa Sharma
Sch J App Med Sci | 2703-2711
DOI : 10.36347/sjams.2020.v08i12.005
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Background: Diabetes mellitus also described as “Disease of Civilization” is a metabolic anamoly having gruesome impact on quality of life worldwide. The disease has been labeled since ancient times and was recognized as a serious illness. Objectives: The objectives of the study are to estimate the level of Serum Vitamin D, Calcium and Phosphorus in the Uncomplicated and complicated cases of Type 2 Diabetes Melitus. Materials & Methods: The work encloses clinical study on Type 2 Diabetes Mellitus. It is broadly categorized into two parts. The first part comprises of Control group study conducted on 100 healthy control subjects. The second part comprises of Clinical Study, further subdivided into two groups. The first group (Group 1) comprises of 100 newly diagnosed or Uncomplicated Type 2 Diabetic cases and the second group(Group 2) comprises of 100 Complicated (Microvascular or Macrovascular) Type 2 Diabetic cases. Patients and controls were selected from the outdoor and indoor area of Endocrinology and Medicine Department of M.B. Hospital, R.N.T. Medical College, Udaipur.Subjects of both Group I and II along with control group were analyzed for serum Vitamin D, S.Calcium, S.Phosphorus, FBS, PPBS, HbA1C, Lipid Profile and Liver Function Test. After assessing all the values, Mean and standard deviation of all subjects and parameters are analyzed. Statistical analysis is performed with SPSS software. Comparison of categorical variables (among category comparison) is done using Chi-Square Test. Comparison between cases and control is done by independent student’s t test. By using t value P value is calculated. P value less than 0.05 (P<0.05) is considered significant. Results: All the categories of Complicated Type 2 Diabetic cases when compared with Control of the same category gave a similar reflection of significantly low Vitamin D (P<0.05)Calcium, Phosphorus (P<0.05), HDL-C, Total Protein, Albumin (P<0.05) and significantly high glycemic status (P<0.00), Total...
Stellar Neuroretinitis as Presenting Sign of Behcet’s Disease
Wafae Jouidi, Karim Lalaoui Moutarajji, Elhassan Abdellah, Amina Berraho
Sch J App Med Sci | 2712-2713
DOI : 10.36347/sjams.2020.v08i12.006
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Stellar neuroretinitis is the association of papillary edema with stellate macular exudates. Its differential diagnosis are multiple dominated in the young subject by infectious pathologies. Behçet's disease being one of the rare causes.
Occipital Encephalocele: A Case Report and Literature Review
Nadia Ch’michi, Mariyam Benayada, Nada Douraidi, Maimouna Bouh, Oumaima Sarhdaoui, Hounaida Mahfoud, Najia Zeraidi, Ibrahim Rhrab, Amina Lakhdar, Aziz Baidada, Aicha Kharbach
Sch J App Med Sci | 2714-2717
DOI : 10.36347/sjams.2020.v08i12.007
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An encephalocele is defined as the protrusion of brain tissue and / or meninges out of the skull through a congenital gap in the skull. It can be isolated or part of a polymalformative context, such as MECKEL syndrome. Thanks to the ultrasound a prenatal diagnosis can be made and reveals a cranial defect with a cerebral hernia of varying degrees, either the hernia is purely cystic or may contain echoes from brain tissue. The treatment of encephalocele is surgical, it consists of a resection of the dysplastic brain tissue, a systematic coagulation of the choroid plexus within the malformation, and in some cases a preservation without pressure of the healthy looking nervous tissue. The prognosis depend mainly on the size of the herniated brain parenchyma and the associated malformations. At the end of this observation we will focus on the occipital encephalocele, the prenatal diagnosis as well as its management.
Original Research Article
Dec. 10, 2020
Imaging Evaluation of Paediatric Patients with Spinal Dysraphism: A Prospective Observational Study
Sultana N, Rima S, Zubery M H, Jabeen S, Rana R A, Faruque M A, Rahman S, Islam MK
Sch J App Med Sci | 2718-2722
DOI : 10.36347/sjams.2020.v08i12.008
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Background: Spinal dysraphism includes a spectrum of congenital disorders caused by incomplete or abnormal closure of the neural tube during early embryogenesis. As a result, fusion of the midline spinal elements is either absent or incomplete. MRI (Magnetic resonance imaging) is an excellent imaging modality to visualize the spinal cord of patients of all ages. Although worldwide it is considered as imaging modality of choice for defining spinal dysraphism we have very few information regarding this issue. Aim of the study: The aim of this study was to assess the role of MRI in the evaluation of spinal dysraphism in paediatric patients. Methods: This was a descriptive observational study which was conducted in the Department of Radiology and Imaging, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh during the period from July 2015 to June 2016. In total 47 paediatric patients presented with a clinical diagnosis of spinal dysraphism and referred to the Department of Radiology and Imaging, BSMMU for MRI were selected as study population. All patients underwent a detailed physical examination, followed by MRI. All data were collected, processed, analyzed and disseminated by MS Office and SPSS version 16 as per need. Result: In this study we found 42.55% patients were with open and 57.45% were with closed dysraphism. Among total study people in 36.17%, 4.26% and 2.13% participant meningomyelocele, myelocele and hemimyelocele were associated as features respectively. Among total study people in 8.51%, 6.38%, 17.02%, 4.26% and 21.28% participant lipomyelomeningocele, meningocele, diastematomyelia, filum terminale lipoma and dorsal dermal sinus were associated as features respectively. In analyzing the levels of spinal involvement among participants we observed, in 47%, 38%, 11% and 4% patients lumber, sacral thoracic and cervical dysraphism were found respectively. Conclusion: Paediatric spinal dysraphism as well as associated malformations or features....
Original Research Article
Dec. 13, 2020
Evaluation of the Antibacterial and Phytochemical Activity of Ripe and Unripe Orange Peels (Citrus sinensis and Citrus aurantium)
Turay, A. A, Braimoh, K. O, Iyevhobu, K. O, Obodo, B. N, Udoaka, A. M, Erazua, O. P, Ovbiebo, E. L, Ignatius, S. S
Sch J App Med Sci | 2729-2735
DOI : 10.36347/sjams.2020.v08i12.010
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Citrus fruits are rich in bioactive compounds such as vitamin C, carotenoids, flavonoids, vitamin B complex and minerals which are highly beneficial to human’s health. This study was carried out to evaluate the invitro antibacterial and phytochemical activities of ripe and unripe orange peels extract on selected microorganisms. These microorganisms include Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, Streptococcus spp., Proteus spp. and Enterobacter spp. isolated from urinary tract infections and wound swabs of patients that visited Irrua Specialist Teaching Hospital, (ISTH) Irrua, Edo State. A stock concentration of each successive orange peel extract was obtained using alcohol (95% ethanol + 5% methanol) and 100% methanol (absolute). These extracts along with positive and negative controls were tested for the presence of active phytochemicals. The result showed that the zones of inhibitions were significantly higher with methanol extract than alcohol extract against the test organisms. The zone of inhibition of all extracts against the test pathogenic organisms showed a significant increase as the concentration of the extract increased. The minimum inhibitory concentrations of the methanol and alcohol peel extracts ranged between 6.25-12.5 mg/ml while the minimum bacteriocidal concentrations ranged between 12.5- 25mg/ml. Invitro investigations confirmed the antimicrobial potential of Citrus sinensis and Citrus aurantium peels against pathogenic bacteria. It is therefore recommended that further in vivo studies should be done to determine the exact dosage and its effectiveness in practical situations along with toxicity studies.
Original Research Article
Dec. 13, 2020
Magnetic Resonance Imaging in Assessment of Perianal Fistulae
Dr. Nikita Vinod Nemade, Dr. V. M. Kulkarni, Dr. Neeraj Patil
Sch J App Med Sci | 2736-2754
DOI : 10.36347/sjams.2020.v08i12.011
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Background: This study analyses the perianal fistulae in detail with various MRI sequences to get the best possible surgical outcome. Materals and Methods: Prospective Study with the sample size of 50 cases, studies over 2 years from August 2018 to September 2020, studies at Padmashree Dr. D. Y. Patil Medical College and Hospital and Research Centre, Pimpri, Pune. Result: From our study involving 50 patients, 21 patients underwent surgery. The sensitivity and specificity of MRI in detection of thick fistulous tracts is 100%. The sensitivity of MRI in detecting thin primary fistulous tract and thin side branch are 50% and 71.4% respectively. Conclusion: MRI fistulography is an excellent guide for diagnosis, surgical intervention and has emerged as an imaging modality of choice.
Anterior Transverse Approach in Osteosynthesis of a Type II Fracture of the Coronoid Process in an Adolescent
Mohamed Rida El Galiou, E.Y. Houass, M. Boufettal, R.A. Bassir, M. Kharmaz, M.O. Lamrani, M.S. Berrada
Sch J App Med Sci | 2755-2757
DOI : 10.36347/sjams.2020.v08i12.012
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The anterior transverse elbow approach for the management of coronoid process fractures is not common. The authors report the case of an 18-year-old youngster presenting with a type II coronoid fracture according to Regan and Morrey, treated surgically, by anterior approach, with compressive osteosynthesis by two mini screws. At a follow-up of six months, the clinical radiological evolution was satisfactory.
Posterior Glenohumeral Instability in an Athlete: A Rare Sport Injury
Mohamed Rida El Galiou, E. Y. Houass, M. Boufettal, R. A. Bassir, M. Kharmaz, M. O. Lamrani, M. S. Berrada
Sch J App Med Sci | 2758-2760
DOI : 10.36347/sjams.2020.v08i12.013
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Recurrent gleno-humeral posterior dislocations represent 4% of all recurrent shoulder dislocations, their causes are diverse. The therapeutic management depends mainly on the size of Mac Laughlin's humeral notch. The authors report the case of an athlete with posterior glenohumeral instability following a first episode of posterior dislocation. Computed tomography revealed a notch occupying 35% of the humeral head. The patient underwent a bloody reduction with filling of the humeral notch by transposition of the trochin and subscapularis.
Medial Subtalar Dislocation: Case Report and Review of the Literature
Mohamed Rida El Galiou, E.Y. Houass, M.Boufettal, R.A. Bassir, M. Kharmaz, M.O. Lamrani, M.S. Berrada
Sch J App Med Sci | 2761-2763
DOI : 10.36347/sjams.2020.v08i12.014
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Subtalar dislocation is a very rare lesion. This is an orthopedic emergency. The authors report the case of a young sports patient who presented a stage I open internal talar dislocation of Couchoix Duparc following a sports accident during a competition. The treatment was orthopedic. After one year of follow-up, the functional result was satisfactory.
Original Research Article
Dec. 14, 2020
Hoffa's Disease: Retrospective Study of 16 Cases
Mohamed Rida El Galiou, E.Y. Houass, M.Boufettal, R.A. Bassir, M. Kharmaz, M.O. Lamrani, M.S. Berrada
Sch J App Med Sci | 2764-2767
DOI : 10.36347/sjams.2020.v08i12.015
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Hoffa's disease was described by Albert Hoffa in 1904, it is rare, benign and unrecognized. Our work corresponds to a retrospective study of 16 cases operated on between 2007 and 2017, correlated with a simple review of the literature. The average age of the patients was 42 years with a predominance of females (M / F = 0.6). MRI confirmed the diagnosis. The treatment was open surgical and consisted of excision of the mass and resection of the PAH, sometimes associated with surgical procedures. The anatomopathological study of the surgical specimens was systematic in all our patients. Over a mean follow-up of 3 years, the outcome was favorable in 87% of cases. A recurrence of osteochondroma has been reported and subsequently resumed.
Original Research Article
Dec. 14, 2020
Response of Paclitaxel-Capecitabine Prior Radiotherapy in Locally Advanced Inoperable Oesophageal Carcinoma
Mohammad Rifat Zia Hossain, Alam S
Sch J App Med Sci | 2768-2771
DOI : 10.36347/sjams.2020.v08i12.016
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Introduction: The incidence of oesophageal carcinoma is increasing in the world as well as in Bangladesh. Aim of the Study: The aim of the present study was to assess the efficacy and safety of paclitaxel-capecitabine based sequential chemoradiotherapy for advanced inoperable oesophageal cancer. Material & Methods: This prospective analytical study was conducted in the Department of Oncology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh and in the Department of Radiation oncology and Department of Radiotherapy, National Institute of Cancer Research and Hospital, Dhaka, Bangladesh from July 2016 to June 2017. Forty (40) patients with locally advanced carcinoma of the oesophagus (stage IIB – stage IVA) treated with sequential chemo radiation were enrolled in this study. They were treated with Paclitaxel and Capecitabine followed by radiotherapy. Results: Final follow up was done at 6 month (24 weeks) after completion of treatment and it was observed that 72.5% had clinical response. Conclusion: Sequential chemo radiation with Paclitaxel-Capecitabine is an effective, tolerable and convenient regime in the treatment of locally advanced carcinoma oesophagus.
Original Research Article
Dec. 14, 2020
Study on Surgical Management of Humeral Shaft Fractures by Various Modalities
Dr. Saini Thirupathi, Dr. Mamidi Anil Kumar
Sch J App Med Sci | 2772-2776
DOI : 10.36347/sjams.2020.v08i12.017
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Introduction: Fractures of humeral shaft account for approximately 3% of all fractures. Most fractures may heal conservatively by hanging casts [1], although a small but consistent number will require surgery for optimal outcome. Aim: To assess the results of humeral shaft fractures managed by various surgical modalities. Materials and methods: This is a prospective study of 40 cases of fracture shaft of humerus admitted in department of orthopaedics, Prathima Institute of medical sciences, Nagnoor, Karimnagar, and Telangana between October 2018 to September 2020. Cases were taken according to inclusion and exclusion criteria. Various modalities used were : Broad or narrow 4.5mm DCP, LCP, extra articular distal humeral long plates, TENS, rush nails, Enders nails, inter locking nail humerus, Ilizarov fixator, External fixation for additional stability in case of TENS and rush nails and also for temporary immobilization in case of infected non-union. Case follow up done up to 2yrs. Results: In our series of 40 cases, there were 23 males and 17 females, with average age of 44 yrs. 29(72%) cases were admitted due to road traffic accident and with slight predominance of left side. Out of 40 cases, 4(10%) were proximal third, 32(80%) were middle third and 4 (10%) were distal third. Transverse or short oblique fractures were most common i.e., 27(67%) patients. 4(10%) cases were having associated injuries. The fractures united in 28(70%) patients with 6(15%) cases going for non-union. There was 6(15%) case of delayed union which united after 6 months. Good or full range of mobility of shoulder and elbow joints was present in 30 (75%) patients with 1(2.5%) patients having stiffness of elbow. Conclusion: Surgical management of the humerus shaft fractures with various methods achieves variable union rates. Each implant has its failure rates whatever may be the fracture type. Union rates not only purely depends on implant but also on age, bone quality, infection,...............
Original Research Article
Dec. 14, 2020
Blood Culture Profile and Antimicrobial Resistance Pattern: A Study in Intensive Care Unit (ICU) Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh
Md. Shafiul Hoque, Probir Kumar Sarkar, A.S.M. Nawshad Uddin Ahmed
Sch J App Med Sci | 2777-2782
DOI : 10.36347/sjams.2020.v08i12.018
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Background: Antimicrobial resistance is one of the major public health emergencies worldwide, and this trend didn’t spare developing countries like Bangladesh. Objective: To Evaluate The Blood Culture Profile And Antimicrobial Resistance Pattern: A Study In Intensive Care Unit (ICU) Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh. Methods: A hospital based observational study was conducted from April 2018 to May 2019 in Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh. A total of 303 neonates with clinical sepsis were included. Collected data were entered into EPI-INFO version 6.04(CDC, Atlanta, GA) for cleanup; and then exported to SPSS version 21.0 for further analysis. Frequencies and proportion were used to describe the study population in relation to relevant variables. Results: Bacterial growth was detected in 88 (29.4%) of blood cultures. Predominantly isolated bacteria were coagulase negative staphylococci (CoNS) 22 (25%), Escherichia coli (E.Coli) 18 (20.5%) and Staphylococcus aureus 16 (18%). Resistance rates of S. aureus and CoNS against Ampicillin were 11 (69%) and 20 (91%) respectively. The resistance rate of E. coli against Ampicillin and Gentamycin were 12 (66.7%) and 10 (55.6%) while Klebsiella spp. resistance rate gets much higher against these two first line antibiotics [10 (91%) and 9 (82%) respectively]. Similarly, both Gram positive and Gram negative bacteria isolates were also highly resistant to third generation Cephalosporins, and 63 (72%) isolated bacteria showed multidrug-resistance. However; Gram-positive bacteria isolates had better susceptibility patterns to third line antibiotics like Clindamycin, Vancomycin and Ciprofloxacin while Gram-negative isolates had a higher susceptibility to Ciprofloxacin and Amikacin. Conclusion: CoNS, S. aureus, E. coli and Klebsiella spp. were the leading bacterial causes of neonatal sepsis in our study. They were highly resistant to first- and second-line empiric antimicrobial treatment used .......
Original Research Article
Dec. 14, 2020
Comparison of the Characteristics and Outcomes of Patients Undergoing Concurrent CABG with MVR
Md. Alauddin, Md. Zanzibul Tareq, Abu Jafar Md. Tareq Morshed, Md. Mohiuddin Aslam, Dharmendra Joshi, Nur-A-Musabber, Hridita Nawrin, Nazrana Martuza, Nahedul Morshed
Sch J App Med Sci | 2783-2788
DOI : 10.36347/sjams.2020.v08i12.019
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Background: Concomitant CABG patients in undergoing mitral valve replacement (MVR) has been shown to be an important risk factor for hospital mortality. Patients who have each mitral valve dysfunction and atherosclerotic coronary artery disease (CAD) kind a heterogeneous cluster in terms of origin of the control disease, extent of coronary atherosclerosis, left ventricular function, and hemodynamic standing at operation. Objective: To assess preoperative characteristics, postoperative complications, in-hospital mortality rate, and length of stay in hospital for patients undergoing concurrent CABG with MVR. Materials and Methods: Study were preoperative and postoperative clinical data from 175 patients undergoing concurrent CABG with MVR operation at Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from Jun 2018 to July 2020 were collected and entered into a database. Information was obtained by clinical and case note review as well as detailed questionnaires to physicians and patients. Results: This study were 175 concurrent CABG with MVR operations performed on patients. The mean age of patients was 57.95 ± 10.54 years and 5.7% were under 40 years. Male/female ratio was 1.05 (male 51.4%, female 48.6%). The mean ejection fraction was 48.15 ± 10.14 and BMI ≥30 was 18.3%. Among studied patients, 18.3% and 2.9% underwent aortic and tricuspid valve replacement, respectively. In-hospital mortality was 6.9% and 96.0% of patients were hospitalized ≥14 days. History of congestive heart failure (P=0.027) and postoperative brain stroke (P=0.004) were independent predictors for in-hospital mortality. Conclusion: In conclusion, based on the outcome of this research, among postoperative characteristics, re-intubation and congestive heart failure were associated with in-hospital mortality after concurrent CABG with MVR operation. Therefore, exact considering and control of these characteristics before and after CABG and MVR are........
Original Research Article
Dec. 16, 2020
Current Status of Otolaryngological Diseases among Paediatric Population Attending ENT OPD in Sylhet Women Medical College
Dr. Md. Azadur Rahman, Dr. Nasrin Jahan, Dr. Mst. Tamanna Begum
Sch J App Med Sci | 2789-2792
DOI : 10.36347/sjams.2020.v08i12.020
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Objective: In this study our main goal is to evaluate current status of otolaryngological Diseases among Paediatric Population Attending ENT OPD in Sylhet women medical college. Methods: In this observational study, was conducted at Sylhet women medical college during January, 2018 to July 2019, where total number of 200 patients attended ENT OPD and among them 100 patients were children aged between 0-15 years presenting with ear, nose and throat diseases were taken as a study sample. Then parameter like: socio-demographic data such as age, residential area, types of ENT were collected from the patients parents using standard questionnaires and kept confidential during the research. Results: Most of the patients belong to in age group of 0-5 years and it was 55%. During the study, otitis media with effusion (50%) was the most common ear problem followed by wax (25%). Also, rhinitis (35%) was the commonest problem followed by sinusitis (29%), epistaxis (20%) and foreign body (10%). Conclusion: According to the conducted study, otitis media, rhinitis and tonsillitis are most prevalent ENT disorder among paediatric study population presenting to ENT OPD during the study period. These acute problems if not diagnosed and managed accurately lead to chronic or recurring symptoms and ultimately either require surgical intervention or produce chronic morbidity.
Original Research Article
Dec. 19, 2020
Evaluation of the Prevalence of Vitamin D Deficiency in Postmenopausal Women with Fractures in Different Hospitals in Tangail
Dr. Aklima Akter, Dr. Mokhlesur Rahman, Dr. Fowzia Yasmin, Dr. Nazma Khalil, Dr. S.M. Rokonuzzaman, Dr. Sudhangsu Kumar
Sch J App Med Sci | 2793-2798
DOI : 10.36347/sjams.2020.v08i12.021
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Background: Vitamin D deficiency is common among the post-menopausal women and the prevalence of vitamin D deficiency is high in postmenopausal women with fractures regardless of whether the injury mechanism was high or low energy. Objective: To evaluate the prevalence of vitamin D deficiency in postmenopausal women with fractures that revealed a high prevalence of vitamin D deficiency regardless of whether the injury mechanism was high or low energy. Methodology: The study was a cross sectional observational study conducted in different hospitals in Tangail over a period of 2 years from 1st January 2017 to 31st December 2018. Total 150 postmenopausal women aged 50 years or older with long bone or pelvic fractures and measurements of serum vitamin D levels were included and those with pathological fractures, metabolic diseases such as Paget’s disease and hyperparathyroidism and isolated hand or foot fractures were excluded. Result: Majority 72 (61.0%) patients were found osteoporosis in low energy group and 12 (37.5%) in high-energy group. Median BMD at the total femur was found -2.1 in low energy group and -1.3 in high-energy group, which were statistically significant (p<0.05) between two groups. Calcium and vitamin D supplements after injury were statistically significant (p<0.05) within the low and high-energy group in comparison prior to the injury. Conclusion: Majority patients were found osteoporosis in low energy group in comparison to high-energy group. Calcium and vitamin D supplements after injury were statistically significant within the low and high-energy group compared with before injury.
Original Research Article
Dec. 20, 2020
“Outcome of Primary Closure of Common Bile Duct After Choledochotomy-Personal Experience”
A.B.M. Abdul Matin, Md. Serazul Islam, Md. Akramuzzaman, Md. Masudur Rahman
Sch J App Med Sci | 2799-2802
DOI : 10.36347/sjams.2020.v08i12.022
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Introduction: Choledocholithiasis is the common problem that necessitates surgical intervention. It is managed either by endoscopic sphincterotomy or surgical exploration i.e. choledochotomy. The choice of surgical technique to extract stones from the common bile duct (CBD) depends on local experience, anatomical characteristics and also on the size, location and number of stones. Most authors consider choledochotomy an alternative to failed Transcystic exploration, although some use it exclusively. Objective: To assess the outcome of primary closure of common bile duct after choledochotomy. Methodology: This retrospective case series was conducted at the Department of Surgery, Sheikh Sayera Khatun Medical College & Hospital, Gopalganj, and different Clinical Centers Gopalganj and Dhaka, Bangladesh. Clinical records of all the patients who underwent open CBD exploration with primary closure between January 2017 to December 2019 were retrieved. Patient’s demographics (like age and gender), operative time, duration of hospital stay, and postoperative complications; including bile leakage, biliary peritonitis, subphrenic abscess and postoperative jaundice were recorded on a proforma. Results: A total of 38 patients were found from clinical records having male to female ratio of 1:6.6. Mean (±SD) operating time was 95 (+7) minutes. The overall complication rate was 10.52%. Bile leak was encountered in three (7.89%) patients whereas small subphrenic collection was noticed in one (2.63%) patient who was treated conservatively. None of the patients experienced postoperative jaundice and biliary peritonitis. Mean (±SD) duration of hospital stay was 7.0 (+1.63) days. Conclusion: Primary repair of common bile duct after open choledochotomy is safe and associated with low complication rate.
Original Research Article
Dec. 20, 2020
Treatment of the Displaced Middle Third Clavicle Fracture with Pre Contoured Clavicular Locking Plate: Study in Border Guard Hospital, Pilkhana, Dhaka, Bangladesh
Shameem MAA, Reza H, Hossain SZ, Alam SAU, Siddiqui EH
Sch J App Med Sci | 2803-2808
DOI : 10.36347/sjams.2020.v08i12.023
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Background: Till now treatment of displaced middle third clavicle fractures is highly controversial. Clavicle fracture is a very common fracture of human skeleton. Midshaft clavicle fractures accounts more than 80% among total clavicle fractures. Open reduction along with internal fixation with pre-contoured locking plate is a good treatment option for displaced middle third clavicle fracture. We have very few data regarding this issue. Aims & Objectives: The aim of this study was to evaluate the outcome of treatment procedure of displaced middle third clavicle fracture with pre-contoured locking plate. Materials & Methods: This was a prospective observational study which was conducted on 50 patients in Border Guard Hospital, Dhaka, Bangladesh during the period from June 2017 to December 2019. All the participants had displaced middle third clavicle fracture and treated with pre-contoured locking plate. The study was approved by the ethical committee of the mentioned hospital. All necessary data were collected, processed, analyzed and disseminated by MS office and SPSS version 16 program as per need. Results: In this study as complications of this treatment procedure we found, the highest 5 patients suffered from dysesthesia. Then 2, 1, another 1 and 2 patients suffered from superficial infection, plate pullout, plate loosening and hardware irritation respectively. In analyzing the treatment duration for union we found the highest (48%) number of cases taken 11-12 weeks for radiological union. Then 36%, 12% and 4% taken 9-10, >12 and <8 weeks respectively. According to the Constant Murley Score (CMS) as final outcome we found maximum patients got ‘Excellent’ result which was 66% and the rest 34% got ‘Good’ result. Conclusion: Comparatively open reduction and internal fixation with pre-contoured locking plate is a good option for displaced midshaft clavicle fracture. It ensures immediate pain relief, early return to work and prevents complications like non-union, ..
Original Research Article
Dec. 24, 2020
Does Diuretic During Extra-Corporeal Shock Wave Lithotripsy (ESWL) Really Help in Stone Fragmentation and Clearance?
Dr. Vipin Chandra, Rajesh Tiwari
Sch J App Med Sci | 2809-2813
DOI : 10.36347/sjams.2020.v08i12.024
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Background: Extra-corporeal shock wave lithotripsy (ESWL) is the important mode of stone management for the patients who are fulfilling the criteria for fragmentation and clearance using shock waves. ESWL only helps in fragmentation. Clearance is done by the diuresis. In this study we aim to compare stone clearance with ESWL procedure using diuretics and fluids versus fluid alone. Material and methods: This is a prospective parallel arm randomized open label single center study conducted at Indira Gandhi institute of medical sciences (IGIMS), Patna between January 2019 to December 2019. Inclusion: Patients between 18 to 60 years of age with solitary renal stone of size less than 1.5 cm measured on ultrasound. Any patient having coagulopathy, positive urine culture, altered anatomy of urinary system etc. are excluded from the study. Enrolled patients were randomized to either standard group or diuretic group. Diuretic group received diuretic in the form of injection furosemide 20 mg slow iv along with continuous 0.9% Normal Saline (NS) during the procedure (total 1 liter) while standard group received only 0.9% NS infusion during the procedure. Outcome: Clearance was measured as residual stone after 3 months of last session of ESWL using X ray, ultrasound and NCCT KUB. Result: 130 patients were screened and 94 were found eligible for randomization. Baseline characteristics were similar in both groups. Average size of stone was 1.75±0.2 cm in the standard group and 1.64 ±0.3 in the diuretic group. In our present study, the stone clearance rate was significantly better in diuretic group as compared to standard group (82.97% vs 59.57% P < 0.05). Conclusion: We conclude that there is a beneficial role of using diuretics along with hydration in renal stone fragmentation and clearance as compared with hydration alone.
Original Research Article
Dec. 24, 2020
Detection of Carbapenemase Production by Rapidec Carba NP Test among Gram Negative Isolates in a Tertiary Care Hospital
Sabina Ansari, Maimoona Mustafa, Md Khaleel
Sch J App Med Sci | 2814-2817
DOI : 10.36347/sjams.2020.v08i12.025
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Introduction: The spread of carbapenemase producers by Gram negative bacteria has been a cumbersome issue. Several phenotypic and genotypic tests are present for detection of carbapenemases but are time consuming, require expertise and well established laboratory. This study aims at detection of carbapenemase production by using Rapid turnaround time test Rapidec Carba NP. This test is based on the detection of carbapenem hydrolysis by carbapenemase producing bacteria. Hydrolysis acidifies the medium which results in color change of the pH indicator. Materials and Methods: A prospective study of six months duration was done among 150 gram negative bacterial isolates obtained from various clinical samples in a tertiary care hospital. Resistance to carbapenem was detected using Meropenem disk (10μg) by kirby bauer disc diffusion method. Rapidec Carba NP test were carried out on all these carbapenem-resistant GNB isolates. Results: Among 150 Gram negative isolates 29(19%) showed resistance to Meropenem were subjected to Rapidec carba np. 93% (27/29) showed the presence of carbapenemase by Rapidec Carba NP test. Among the carbapenem resistant GNB isolates, 48.27% (14/29) were Klebsiella pneumoniae, 24.13% (7/29) were Escherichia coli, 20.68% (6/29) were Pseudomonas aeruginosa and 6.89% (2/29) were Acinetobacter baumanni. Conclusion: Rapidec Carba NP was sensitive enough to confirm carbapenemase producing isolates within a short time of less than<2h accurately.
Original Research Article
Dec. 24, 2020
“A Study of Mentzer Index as Screening Tool for Diagnosis of Beta Thalassemia Trait in Microcytic Hypochromic Anemia”
Dr. Dhiral Bhupatbhai Kavad, Dr. Chandrika G. Algotar, Dr. Neelam K. Mori, Dr. Siddhartha D. Ghelani
Sch J App Med Sci | 2818-2820
DOI : 10.36347/sjams.2020.v08i12.026
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Context: Beta thalassemia trait (beta-TT) is common among Indian population especially among communities like Sindhis, Bengalis and Gujaratis (Lohanas). Individuals having beta-TT have mild Microcytic Hypochromic Anemia (MCHCA) and asymptomatic course same as that of Iron Deficiency Anemia (IDA). The aim of our study is to evaluate the reliability of Mentzer index as a screening tool in diagnosis of beta-TT and differentiate between other causes of MCHCA. Aim: To study the reliability of Mentzer index as a screening tool for diagnosis of beta thalassemia trait. Methods and Material: The data were taken from 100 patients of Microcytic Hypochromic Anemia at Green Cross laboratory, C. U. Shah Medical College and Hospital, who underwent CBC (Complete Blood Count) and Hb electrophoresis. Statistical analysis used: Sensitivity, Specificity, Positive predictive value (PPV), Negative predictive value (NPV). Results: The blood samples of 100 patients (Age: 0-26 years), who are included in the study, were run through a 5-part cell counter which revealed Hb, PCV, MCV and RDW of each sample. The peripheral smear examination of the samples revealed the finding of Microcytic Hypochromic Anemia. All 100 blood samples then studied for Hb electrophoresis. Out of 100 patients 58 patients had Mentzer index <13, out of which 43 patients were diagnosed with beta thalassemia trait by Hb electrophoresi (Hb A2 >3.5%). Conclusions: Mentzer index is a reliable screening tool for diagnosis of beta-TT and it can be used as a screening tool at small setups and at peripheral areas where Hb electrophoresis is not readily available.
Original Research Article
Dec. 26, 2020
The effect of intraoperative Mitomycin-C in different dose schedule and time of application in Trabeculectomy
Dr. Siddhesh VikramadityaGarg, Dr. Subhash Sharma, Dr. Isha Lohmror
Sch J App Med Sci | 2821-2827
DOI : 10.36347/sjams.2020.v08i12.027
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Background: Mitomycin-C used as adjuvant drug to enhance the outcome of trabeculectomies has no established regime regarding ideal site, dose and duration of application. The purpose of this study is to find out and compare the effect of intraoperative Mitomycin-C, in different dose schedule and time of application, emphasis being laid on intraocular pressure (IOP) lowering effect and side effects. Methods: In this prospective study, a total of 38 eyes of 28 patients were randomized into 4 groups: group A & B with 0.2mg/ml and group C & D with 0.4mg/ml mitomycin-C with one minute application repeated five times and with single five minute application respectively. All eyes undergo trabeculectomy surgery with intraoperative mitomycin-C used as per the group allocated. Surgical success was defined in terms of IOP measurements. Results: All the study groups were effective in lowering the IOP, the percentage reduction being 61.9% in group A, 54.30% in group B, 75.2% in group C, 69.9% in group D (p<0.05).The highest mean change was observed in group C as compared to group A,B&D. Postoperative bleb score was significantly higher in group D on 18 week followed by group C and A. Surgical success defined in terms of pressure control, all eyes of group C & D attained pressure reduction to 21mmHg or less without medication whereas in group A, 8 eyes (88.9%) and in group B, 6 eyes (60%) achieved complete success rate. Postoperative complications occurred more commonly in study groups in which higher concentration of Mitomycin-C was used .There was no major intraoperative complication in any of the groups. Conclusion: From the results, we suggest that the optimum dose and exposure time of Mitomycin-C in trabeculectomy may be 0.2 mg/ml, 5 applications of one minute each without increasing the complication rate.
Original Research Article
Dec. 26, 2020
Prevalence of Cardiovascular Risk Factors among Group ‘C’ Employees of a Public Health Institute in Delhi, India
Dr. Rabi Bhushan, Dr. Shikha Nargotra, Dr. Nanthini Subbiah
Sch J App Med Sci | 2828-2833
DOI : 10.36347/sjams.2020.v08i12.028
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Introduction: Cardiovascular disease (CVD) is a class of disease that involves heart or blood vessels. A risk factor is any attribute, characteristic or exposure of an individual that increases the likelihood of developing disease or injury. The WHO has prioritized the following risk factors for CVD: - Tobacco use, Alcohol consumption, Hypertension, Physical inactivity, Unhealthy diet and Obesity. If appropriate action is taken to control or reduce these risk factors, the onset of CVDs can be prevented or delayed. Material and Methods: A descriptive cross-sectional research study was conducted using interview schedule (modified WHO STEPS instrument) to gather data from the Group ‘C’ employees working in The National Institute of Health and Family Welfare, New Delhi. The information regarding the various risk factors related to the cardiovascular disease was collected and analysed using MS excel and SPSS version 20 software. Result and Conclusion: The findings revealed that almost all of the risk factors are present in study population. Physical inactivity (62%) was the commonest cardiovascular risk factor followed by tobacco use (54.5%). Almost all of the behavioural risk factors were started in adolescence or in young age. Based on the findings, it is recommended that screening at the time of joining the job and thereafter, frequent health education and health promotion activities should be imparted.
Original Research Article
Dec. 26, 2020
Comparison Between, 'Loading' Dose and 'Traditional' Dose of Magnesium Sulfate for Controlling Convulsion in Eclampsia
Halima Khatun, Md. Saiful Islam, Tarikul Islam, Tanzila Rubaba Rahman
Sch J App Med Sci | 2834-2839
DOI : 10.36347/sjams.2020.v08i12.029
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Introduction: Eclampsia is important cause of maternal mortality during pregnancy, child birth and puerperium. It accounts for (16%) of maternal mortality and still regarded as one of the leading cause of maternal death. In Bangladesh, eclampsia is the 3rd major cause of maternal death. Magnesium sulfate is now the drug of choice for women with eclampsia for controlling convulsion with strong evidence that it is better than diazepam, phenytoin or lytic cocktail. Objective: To compare the effect of 'loading' dose of magnesium sulfate with that of 'traditional' dose for control of convulsion in eclampsia. Methods: Prospective comparative study. In the Department of Obstetrics and Gynaecology, Rajshahi Medical College Hospital (RMCH)" from January 08 to December, 08 Ectamptic patients with gestational periods beyond 28 weeks. A total of 100 eclamptic patients who are eligible for magnesium sulfate therapy were purposively assigned to receive either only loading "dose or traditional dose for control of convulsion. Data was organized and the results were presented in tables, figures, diagram etc by using SPSS-10 and MS-Excel 2016. Continuous variables between groups were compared by using the unpaired’t’ test and chi-square test and 'P' Value less than 0.05 were considered statistically significant. Results: It shows that there is no significant difference between the two groups in terms of patient's profile, physical findings, distribution of convulsion along with recurrence, feto-maternal out come and regarding the toxicity of magnesium sulfate. Conclusion: The present study shows that only loading dose has some advantage over traditional dose because once loading dose is administered frequent monitoring of the patient is not necessary. So manpower involvement is less. As single loading dose can effectively control and prevent recurrent convulsion, so no extra cost" is required for extra MgSO4. For the above reasons eclampsia can be treated effectively by only loading
Original Research Article
Dec. 26, 2020
A Short Description on Transrectal Modality- Gray Scale & Power Doppler Ultrasonography in Detecting Prostate Cancer
Islam S, Islam T, Khatun H, Rahman A
Sch J App Med Sci | 2840-2844
DOI : 10.36347/sjams.2020.v08i12.030
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Introduction: Prostate cancer rarely causes symptoms early in the course of the disease because the majority of adenocarcinomas arise in the periphery of the gland, distant from urethra. The presence of symptoms as a result of prostate cancer suggest a locally advanced or metastatic disease. The lesion turns into advanced stage cancer due to accurate early detection. Aim of the study: To observe the specificity, accuracy both the transrectal sonographic modality-gray scale (TRUS) and Power Doppler ultrasonography in detecting prostate cancer. Methods: This was an observational study and was conducted in Urology Department of Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Bangabandhu Sheikh Mujib Medical University (BSMMU) and Dhaka Medical College hospital (DMCH), Bangladesh during the period from July 2005 to June 2007. 36 patients were included in the study. Statistical analysis of the results was done by computer software devised in the statistical packages for social scientist (SPSS-10) and MS excel-16. Result: In total 36 patients for study the validity found in gray scale TRUS were evaluated by calculating sensitivity 75.0%, specificity 18.8%, accuracy 50.0%, positive and negative predictive values were 53.6% and 37.5% respectively and the validity found in Transrectal Power Doppler sonography was evaluated by calculating sensitivity 90.0%, specificity 75.0%, accuracy 83.3%, positive and negative predictive values were 81.8% and 85.7% respectively. Conclusion: To reduce the rate of prostate cancer detection of the prostate lesion is much more important. As the histopathological diagnosis of the present study significantly correlate with both gray scale TRUS and transrectal Power Doppler findings as well as the validity tests are almost identical as observed by other researchers of different study, it can be concluded that transrectal Power Doppler ultrasonogram is useful diagnostic modality in......
Original Research Article
Dec. 29, 2020
Correlation of Clinical Findings of Infantile Hypertrophic Pyloric Stenosis with Ultrasonography and Operative Findings
Karim MR, Khan H
Sch J App Med Sci | 2845-2850
DOI : 10.36347/sjams.2020.v08i12.031
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Introduction: Infantile hypertrophic pyloric stenosis (IHPS) is characterized by hypertrophy of the pyloric muscularis propria, predominantly involving the circular layer and subsequent narrowing of the pyloric outlet. Aim of the Study: To find out the correlation of clinical findings and ultrasonography findings in diagnosis of infantile hypertrophic pyloric stenosis. Material & Methods: This prospective comparative study was conducted in Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh during the period from February 1997 to October 1998 in a period of 21 months. The data were collected for all 31 patients. Following, collection of all the required data, these were checked, and tabulated into the computer using the SPSS/PC software 23. Results: During my study period February 1997 to October 1998 total surgical admission was 4006 and infantile hypertrophic pyloric stenosis patients (IHPS) were 31. So IHPS represented .77% of the total surgical admission during the study period in DSH. Correlation of clinical and ultra-sonogram findings with operative finding, clinical findings true +ve 20(64.52%), true –ve 2(6.45%), false +ve 1(3.23),false –ve 8(25.81) and ultra-sonogram observation true +ve 27(87.10%),true –ve 2(6.45%),false +ve 2(6.45%), false –ve 2(6.45%)and then finally operation needed IHPS 29(93.35%) also others than IHPS 2(6.45%). Correlation of pattern of sensitivity and specificity in clinical findings 93.1% and 50%, ultra-sonogram findings 71.43% and 66.67%. Conclusion: In conclusion we would like to advice that infantile hypertrophic pyloric stenosis is a most common cause of non-bilious vomiting in an infant. Its diagnosis not so difficult in most cases. The diagnosis being made primarily by palpation of the hypertrophied pylorus.
Original Research Article
Dec. 29, 2020
Knowledge of Osteoporosis and Its Related Risk Factors among Nursing Professionals
Dr. A.H.M. Aktaruzzaman, Dr. Afsar Ahammed, Dr. Mst. Sabina Yasmin, Dr. Md. Shafiqul Islam Dewan
Sch J App Med Sci | 2851-2854
DOI : 10.36347/sjams.2020.v08i12.032
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Introduction: Osteoporosis is rapidly assuming epidemic proportions in Bangladesh. Osteoporosis is defined as a systemic skeletal disorder characterized by low bone mass and micro architectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture. Currently, it is estimated that over 200 million people worldwide have osteoporosis. This disease can be prevented by maintaining some precaution. Nursing professionals are the key link in the chain of multidisciplinary approach to the management of this potentially preventable disease, and in educating patients about the various aspects of its evaluation and management. So, to prevent and lessen osteoporosis, appropriate knowledge among nursing professionals is exigent. Aim of the study: The aim of this study was to find out the knowledge of Osteoporosis and its related risk factors among nursing professionals. Methods: This cross-sectional study was conducted in the Department of Endocrinology, National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka, Bangladesh during the period from September 2018 to September 2019. A self-administered questionnaire was selected as the tool of assessment to collect primary data from 123 nurses. The respondents needed to answer 20 questions regarding knowledge of osteoporosis and its related risk factors. There were 4 age groups which were 30-39, 40-49, 50-59 and >60.All these primary data were compiled on a master chart first, and then organized by using scientific calculator and standard statistical formula. Percentage was calculated to find out the proportion of the findings. Further statistical analysis of the results was done by computer software devised in the statistical packages for social scientist (SPSS-23) and MS excel. Result: After getting response from 123 nurses through a questionnaire we found that nursing professionals had moderate level of knowledge of osteoporosis and its related risk factors.
Original Research Article
Dec. 29, 2020
Surgical Outcome of Total Knee Replacement
Dr. Md. Tofayel Hossain, Dr. MD. Asaduzzaman, Dr. Sanjoy Kumar Ghosh, Dr. Abdul Kader
Sch J App Med Sci | 2855-2859
DOI : 10.36347/sjams.2020.v08i12.033
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Introduction: Total Knee Replacement (TKR) involves the surgically removing ailing cartilage and bone particles from the knee area, knee cap, shinbone, and thigh bone, and substitutes them with artificial joints made of metal alloys, high-grade plastics, or polymers. Although it is generally considered as an effective treatment for knee osteoarthritis and severe knee pain, complications after surgery can arise in various forms. Aim of the study: This study aimed to determine the surgical outcome of total knee replacement and the patient's experience after the surgery. Methodology: This observational study was conducted in the Department of Orthopaedic Surgery of National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka, Bangladesh during the period from March 2018 to April 2020. For this study, a total of 73 patients with severe knee pain was approached, compiled from a patient list of two different practitioners, to include a wide variety of demographic with varying characteristics, lifestyles and gender. Of them, 23 patients refused to participate in the study and share their information. The remaining 50 patients faced a basic interview describing their daily lifestyle, their pain severity, and any prior medical history they might have had. After this step, 23 patients were excluded from the list because their knee pain was manageable through medication and it was not necessary to perform TKR on them. Two more patients were excluded because they died of prior conditions before their surgery. Result: A Total of 35 patients most of the patients found male 14(40.0%) and 21(60.0%) female patients with total knee replacement (Table-I). Also, 7(20.0%) of them were aged under 50, 17(49.0 %) are aged between 51 to 70, and the remaining 11(31.0%) are aged 71 and above 10(28.57%) of the sample patients had prior operations of orthopedical nature. From the range of collected data portrayed in the above bar chart, we can see that 60% of the sample.....
Original Research Article
Dec. 29, 2020
An Observation of the Clinical and Laboratory Profile in Patients with Sepsis and Severe Sepsis
Al-Aziz MZ, Ali M, Ashrafozzaman SM, Haque MJ, Islam MS, Hasam T, Gani ABMS, Amin MR, Ahasan HAMN
Sch J App Med Sci | 2865-2873
DOI : 10.36347/sjams.2020.v08i12.035
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Introduction: Sepsis is one of the oldest and most elusive syndromes in Medicine. The clinical manifestations of sepsis are highly variable, depending on the initial site of infection, the causative organism, the pattern of acute organ dysfunction, the underlying health status of the patient, and the interval before initiation of treatment. Aim of this study: To observe the clinical and laboratory profile of patients with sepsis & severe sepsis as well as hospital mortality at the end of the 1st week. Method: It was hospital based cross sectional, observational study and was carried out in the Department of Medicine, Dhaka Medical College Hospital (DMCH) during the period of January 2015 to December 2015.Patients admitted in the intensive care unit (ICU) of DMCH, who fulfilled the criteria of sepsis or severe sepsis and aged more than 14 Years, among them 100 patients were enrolled in the study. Data from each patient was collected in structured data sheets. Finally, all data compiled and statistical analysis was carried out by using IBM SPSS Statistics 22.0 (IBM Inc, Chicago, Illinois, USA). Result: Among 100 patients, 35% were in sepsis group and 65% were in severe sepsis group. Fever was present in 97.1% cases, Heart rate > 90 beats/min in 82.9%, Tachypnea in 37.1%, edema 5.7%, Hyperglycemia in 25.7%, Arterial hypoxemia in 22.9%, Leukocytosis in 88.65% and Plasma C-reactive protein was 94.3%.Sepsis induced arterial hypotension was 40%, Hyperlactataemia was 44.6%, Acute oliguria was 18.5%, Acute lung injury with Pao2/Fio2 < 200 in the presence of pneumonia as infection source was 16.9%, Creatinine > 2.0 mg/dL was 23.1%, Serum bilirubin > 2 mg/dL was in 7.7%, Thrombocytopenia was 38.5% and Coagulopathy was 21.5%. Correlation of GCS score at seventh day with initial AMT score appeared to be particularly strong (Rs = 0.663, P<0.001). Blood Culture was positive in 8.2% only. Whereas Throat Swab culture is positive in 83.3% cases. Systemic hypotension (P=0.004), ......
Original Research Article
Dec. 29, 2020
Prevalence of Gastroesophageal Reflux Symptoms among People in a Village, Sherpur, Bangladesh
Hasan MN, Rakib KHB, Akbar S, Asaduzzaman M
Sch J App Med Sci | 2874-2880
DOI : 10.36347/sjams.2020.v08i12.036
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Introduction: GERD is a common and chronic gastrointestinal disorder with a significant negative impact on health related quality of life. Heartburn and regurgitation, typical symptoms of GERD are considered to be reasonably specific for diagnosis. Several factors may predispose patient to pathological reflux including hiatus hernia, lower esophageal sphincter hypotension loss of esophageal peristaltic function, increase intra-abdorninat pressure due to chronic cough, BEP, obesity and pregnancy, gastric hyper Secretary state, delayed gastric empting and overeating, etc. Often multiple factors are present. Objective: This study was carried out to find out prevalence of GERD symptoms among people in a rural area of Bangladesh. Methodology: This study was descriptive, cross sectional observational study. The study was carried out from 8th, October, 2012 to 10ln, April, 2013 for a period of 6 months. 384 people were participant from Kamaria village of Sherpur district, Categorical variables were reported as percentage and Correlation was carried out Using the Chi-square test (X2-test) through determining the association of different variables by SPSS software version-22. Result: Our present study has shown that 18.75% people have GERD symptoms. It is more common among female (22.44%) than male (14.89%) (p<0.05). Study population was 384 and male (188) female (196) number was almost equal. Among study population 51.82% people was in age group18-38 years, 33.85% was age group 39-59years, and 14.32%was age group>59years Among GERD patient 12 has mild symptoms, 22 has moderate symptoms and 38 has severe symptoms. Most GERD patients are of age group 39-58years (male-14, female-20) Average weight of GERD patient is 54.33 kg in case of male and 48.66 kg in case of female which is greater than normal people (p<0001). GERD patient have BMI (male-20.44. female-24 13) which is greater than normal people (male-19.82, female-23.63). GERD patient consume Biri, Batle nut and .........
Original Research Article
Dec. 29, 2020
Effects of Calcium and Phosphorus Supplementation on Metabolic Bone Disorders in Premature Infants
Debabrata Roy, M. A. Mannan, Farhana Afroj, Nahida Islam
Sch J App Med Sci | 2881-2884
DOI : 10.36347/sjams.2020.v08i12.037
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Introduction: Every year, 15 million babies are born prematurely around the world of which more than 1 million die as a result of prematurity. Premature infants are considered to be at high risk for developing osteopenia due to their reduced bone mineral content. Mothers milk containing 25-35 mg/dl of calcium and 10-15 mg/dl of phosphorus simply does not contain enough minerals to support skeletal growth of growing premature infants. Supplement of calcium and phosphorus along with breast milk can reduce the rate of osteopenia and improve the growth of premature infants. Objective of the study: To determine the efficacy of calcium and phosphorus supplementation for prevention of metabolic bone disease and improvement of growth in preterm infants. Methodology: A randomized clinical trial study was conducted at the Department of Neonatology, BSMMU, from 16th August 2016 to 27th August 2017. It involved monitoring 50 premature neonates over a period of six weeks. The babies who were fed with breast milk were randomly divided into two equal groups. One group received supplement of calcium and phosphorus along with breast milk while other group did not receive any supplement. Serum calcium, phosphorus and alkaline phosphatase levels as well as growth parameters (including weight, length, and head circumference) were measured at enrollment and at 6 weeks post birth. At the end of 6 weeks, wrist X-ray was done for evaluation of osteopenia. Data was analyzed using SPSS version 20. Results: Radiological and biochemical evidence of metabolic bone disease were found in 6 (28%) supplemented group and 7 (35%) non supplemented group (p=0.45). S. calcium, S. inorganic phosphate and S. alkaline phosphatase level were comparable at enrollment between two groups. At 6 weeks S. calcium, S. inorganic phosphate level were more (9.5±0.4 mg/dl Vs 9.4 ± 0.5, and 357±253 U/L Vs 4.4 ± 1.2 respectively) and S. alkaline phosphatase level were less (4.8±1.1mg/dl Vs 4.4±1.2mg/dl) in supplemented
Original Research Article
Dec. 30, 2020
A Measurement of Clinical Profile, Complication and Outcome of the Studied Patients with Typhoid Fever
Rashed SKMA, Akhter M, Bari MW, Amin MR, Mutanabbi M, Kawser CA
Sch J App Med Sci | 2885-2889
DOI : 10.36347/sjams.2020.v08i12.038
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Introduction: Typhoid fever is a common pyretic illness and one of the major health complications in Bangladesh. Hence, the present study was conducted to determine the, clinical profile, complication and outcome of the studied patients suffering from typhoid fever in some of the tertiary care hospitals in Dhaka. Material & Methods: This was a cross sectional study conducted in the Department of Paediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka Medical College Hospital (DMCH) and Sir Salimullah Medical College Hospital (SSMCH), Dhaka, Bangladesh for a period of one year from July 2015 to June 2016. A total number of 100 children with Typhoid fever were studied and analyze based on clinical profile, complications and outcome. During the study period febrile patients admitted in above mentioned hospital with the diagnosis of suspected typhoid fever was screened. Suspicion was made on the basis of clinical features like continued fever, toxic look, diarrhea/constipation, splenomegaly, hepatomegaly, diffuse tenderness and caeca gurgling. Clinically suspected cases undergone laboratory investigation that includes CBC, Widal test and blood culture and other tests as per individual case merits. Results: Out of 100 diagnosed typhoid fever children, 60 (60%) were male and 40 (40%) were female. Fever was present in all patients. Other most common appearance is loss of appetite, vomiting, diarrhea, headache and constipation. Coated tongue was the predominant examination finding followed by hepatomegaly, splenomegaly and abdominal tenderness. Sensitivity to ceftriaxone was 100% in our study while resistance to nalidixic acid was 90%. Conclusion: Clinical profile of typhoid fever in children admitted in tertiary care hospitals matches to what had been seen in the past and recorded in different local and regional publications. Typhoid fever is endemic in our country and affect all ages beyond infancy as found in this study.
Original Research Article
Dec. 30, 2020
Clinical Outcome of Single Antibiotic versus Combination Antibiotics in Enteric Fever
Tazin Afrose Shah, Farhan Matin, Anarul Islam, Md. Mahbubur Rahman, Mohiduzzaman Tony, SM Rokonuzzaman, Md. Hyder Ali
Sch J App Med Sci | 2890-2896
DOI : 10.36347/sjams.2020.v08i12.039
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Background: In recent times the treatment of enteric fever is becoming more and more difficult. The aim of our study was to find out a cost effective way of treatment of enteric fever and to determine the success rate & fever clearance time of ceftriaxone as monotherapy in comparison to combinations of cefixime plus azithromycin. Method: Randomized single blind controlled comparative experimental study carried out in the Department of Medicine, Uttara Adhunik Medical College & Hospital, and Dhaka, Bangladesh during the period from 1st September, 2015 to 1st September, 2015. A total 96 cases of enteric fever patients were included based on inclusion and exclusion criteria. After taking informed written consent data was collected by a questionnaire and relevant investigations were done. Control group were given inj ceftriaxone and experimental group were given cefixime plus azithromycin. Then collected data was analyzed. Main Outcome measures: Age, Sex, response of treatment of Fever, Myalgia, Headache, Anorexia, Constipation, Diarrhoea, Abdominal pain, Cough, Relative bradycardia, Rose spot on trunk, Splenomegaly, Hepatomegaly, Coated tongue and treatment failure. Results: Out of 96 cases majority of cases were seen in the age group of 18-25 years (30.20%), followed by 26-33 years (23.95%). There was a slight male preponderance with 53.1% male and 46.9 % female. Majority (47.92%) of cases were brought to hospital during the 1st week of illness. Fever was common to all (100%) cases, followed by headache (62.5%), anorexia, and nausea (62.5%), abdominal pain (58.33%), diarrhoea (52.08%), and constipation (29.16%) and vomiting (8.33%). Less common symptoms were cough (14.58%), generalized weakness (8.33%), jaundice (4.16%), and bloody diarrhoea (2.08%). None of the patients had G.I bleeding or rash. Coated tongue was present in 83.33% patient. Hepatomegaly was present in 66.66% patients and more common than splenomegaly (41.66%).Only 41.66% patients were of toxic.......
Original Research Article
Dec. 30, 2020
Retrospective Analysis of Patients with Post-Tonsillectomy Hemorrhage in a University Hospital
Merih Onal
Sch J App Med Sci | 2897-2900
DOI : 10.36347/sjams.2020.v08i12.040
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Background/Aim: Tonsillectomy is one of the most common surgical procedures performed by otolaryngologists. Recurrent/ chronic tonsillitis and sleep disorders due to tonsillar hypertrophy are among the most common indications for tonsillectomy. Although complications such as pain, dehydration, airway obstruction, sleep disorders, and pulmonary edema may occur after tonsillectomy, the most common life-threatening complication is post-tonsillectomy hemorrhage (PTH). In our study, we aimed to help clinicians with this potentially fatal complication by retrospectively examining the characteristics of patients with PTH and the management of PTH treatment. Materials and Methods: Twenty-five patients who underwent a tonsillectomy in a university hospital between 2011-2020, who was diagnosed with PTH, and whose bleeding was surgically controlled were included in the study. In addition to the demographic data of these patients, tonsil size, tonsillectomy surgery technique, postoperative bleeding location, postoperative bleeding day, and the technique of surgery for PTH treatment were examined. Results: The incidence of PTH was found to be 1.1 % in patients who underwent tonsillectomy. Five patients (20 %) had a primary hemorrhage and 20 patients (80 %) had a secondary hemorrhage. The most common tonsillectomy method was the cold blade dissection method with a rate of 88 %, and the most commonly used method in bleeding control was bipolar cauterization with a rate of 76 % regardless of suturing. Conclusion: Although new developments in tonsil surgery and surgical instruments have come into use, the method of cold blade dissection is still seen as the most commonly used method. Suturing with bipolar cauterization used in the treatment of PTH that occurs after tonsillectomy surgery provides effective success.
Original Research Article
Dec. 30, 2020
Association between Glycosylated Haemoglobin and Serum Lipid Profile in Patients with Type 2 Diabetes Mellitus
Dr. M. Ravi Kumar, Dr. Venkata Subbarao. M
Sch J App Med Sci | 2905-2909
DOI : 10.36347/sjams.2020.v08i12.042
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Introduction: In India, diabetes is turning into an epidemic as currently, more than 62 million individuals suffer from the disease. To our knowledge, very few studies have evaluated the correlation between lipid profiles and glycated hemoglobin (HbA1c) in newly diagnosed type II diabetes patients with hypertension. The early detection of lipid abnormalities in these patients will help prevent the cardiovascular outcomes. Material and Methods: This is a prospective and cross-sectional study conducted at Tertiary care teaching centre and Hospital over a period of 6 months. In our study 70 patients of Type 2 diabetes mellitus were taken for the study after applying inclusion and exclusion criteria. Biochemical data such as fasting plasma glucose (FPG), HbA1c and lipid profile, along with the patient’s age, BMI and gender, were also taken from the electronic file system. The inclusion criteria allowed for only patients who were regularly seeing their physician and whose electronic file was up to date. Results: In our study, among 80 Type 2 diabetic individuals included in this study, 47 were male and 33 were female. Distribution of Glucose Triad results of FBS, PPBS and HbA1c levels of patients presented as Mean±SD, mean FBS was 201.49±41.84, mean PPBS was 273.39±91.48 and mean HbA1c was 8.83±0.83. Mean total cholesterol was 201.38 ± 11.48, mean total triglyceride was 198.48 ± 12.39, Mean HDL was 36.48 ± 4.62, mean LDL was 140.09 ± 9.63 and VLDL was 24.81 ± 2.47. HbA1c positively and significantly correlated with total cholesterol (r=0.223), LDL (r=0.243), HbA1c negatively and significantly correlated with HDL (r= - 0.126), and did not show any show correlation with VLDL (r=0.039) and total triglycerides (r=0.17). Conclusion: This study showed a significant correlation between levels of glycosylated hemoglobin (HbA1c) and lipid profile. This may help in predicting the lipid profile levels from the degree of glycemic control and therefore, identifying the patients .....
Original Research Article
Dec. 30, 2020
Portal Vein Reconstruction in Solid Pseuodpapillary Epithelial Tumor of Pancreas - Case Series and Review of Literature
Dr. Ajay Sharma, Dr. Anjali Sharma, Dr. Rudhee Sehgal, Dr. Peeyush Varshney, Dr. Rajneesh Meena, Dr. Priyamvada Gupta, Dr. M L Yadav
Sch J App Med Sci | 2910-2915
DOI : 10.36347/sjams.2020.v08i12.043
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Solid Pseudopapillary Epithelial Neoplasm (SPEN) are rare pancreatic tumours, which have generated curiosity of surgeons due to their variable biologic nature. We report three cases of SPEN in young females presenting with hematemesis, nausea, anorexia, abdominal pain and weight loss. Based on computed tomography each of these cases were found to have the neoplasm in pancreas with portal vein (PV) involvement. SPEN is a benign tumour with only 5% displaying malignant features [1]. All three cases were managed by Whipple's pancreaticoduodenectomy with PV resection and reconstruction. Histology and immunohistochemistry confirmed the diagnosis of SPEN in all cases. All cases were followed up and after one year all revealed a patent PV graft with normal flow pattern and no recurrence of disease. Since SPEN has low malignant potential with a favourable prognosis, aggressive management should be pursued. PV invasion by the lesion is neither a contraindication for surgery, nor does it indicate poor prognosis. SPEN with vascular invasion can be managed safely with vascular resection and reconstruction and has a good prognosis.
Original Research Article
Dec. 30, 2020
Bacteriological Profile and Antimicrobial Susceptibility Pattern of Clinical Specimen at a Tertiary Care Centre, Rajasthan
Dr. Archana Bora, Dr. Saroj Kumari Meena, Dr. P. K. Khatri
Sch J App Med Sci | 2916-2921
DOI : 10.36347/sjams.2020.v08i12.044
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Background: The prevalence of bacterial infections is a major cause of morbidity and mortality in patients. Inappropriate and irrational use of antibiotics has led to increasing resistance in commonly isolated gram positive and gram-negative organisms. Antimicrobial resistance is a matter of concern as it compromises the management of infectious diseases and increases the cost of health care as well. Aims and Objectives: The Aims of this study includes Isolation and identification of pathogens from various clinical samples and their antibiotic susceptibilities patterns in a tertiary care centre, Rajasthan. Materials and Methods: This retrospective study was conducted in Department of Microbiology. The records of bacteriology section were compiled for a period of 12 months from October 2016 to September 2017. The results were consolidated for types of clinical samples, organisms isolated and their susceptibility patterns. Results: A Total of 352 samples were received in Department of Microbiology over a period of one year from October 2016 to September 2017.Out of 352 samples 129 (36.64%) were positive on culture. In this study E. coli, 27(20.9%) was the predominant isolate followed by Pseudomonas spp, 23(17.8%) and Staphylococcus aureus, 20(15.5 %). The susceptibility pattern in E. coli to Ceftazidime, Gentamicin and Meropenem were 81.4%, 59.2% and 96.2% respectively and in Pseudomonas to Piperacillin/Tazobactam and Meropenem both were 87.0%. Among S. aureus, 50.0% strains were Methicillin resistant. Conclusions: Gram negative bacteria still remain the predominant causes in most of the clinical infections in health care settings. E coli were the most common organism in most of the cases. Antimicrobial resistance is a major challenge and antibiotics need to be tested and prescribed according to standard guidelines. Local anti-biograms should be available periodically to help clinicians guide on antibiotic prescribing.
Original Research Article
Dec. 30, 2020
Study of Adverse Drug Reactions related to Pre Extremely Drug Resistant and Extremely Drug Resistant Tuberculosis on Bedaquiline drug within 14 days of admission
Dr. Sushama R. Dugad, Dr. Ravindra J. Shinde, Dr. Khandpur Jaspreet Singh Mohinderpal Singh, Dr. Harshal Tukaram Pandve
Sch J App Med Sci | 2922-2927
DOI : 10.36347/sjams.2020.v08i12.045
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Background: Globally out of 600,000 cases of rifampicin-resistant tuberculosis about 190,000 people died from multidrug-resistant tuberculosis. New class of anti TB drug bedaquiline (BDQ) has shown efficacy in pre-extremely drug resistant (pre XDR) and extremely drug resistant (xdr) patients. Objectives: 1. To evaluate tolerability of bedaquiline in combination with background regimen (BR) for treatment of preXDR and XDR TB and observing incidence of subjects with emergence of type of adverse events in the form (mild, serious and required discontinuation of bedaquiline, 2. To observe the adverse reactions of bedaquiline for 14 days after starting bedaquiline, 3. To assess the factors (comorbidity) responsible for causing increase in adverse reactions or event for bedaquiline, 4. To assess clinical outcome at end of 14 days (at the end of first 2 weeks of bedaquiline therapy) in form of favourable and unfavourable clinical response. Material and Methods: This observational study was carried out in Department of Respiratory Medicine Dr. Vasant rao Pawar Medical College and tertiary health care institute with the duration of study from April 2019 to December 2019 with sample size 50. All patients aged > 18 years with pulmonary Tb with preXDR and XDR which were admitted at DR-TB ward in tertiary health care centre were evaluated. After complete pretreatment evaluation, according to RNTCP guideline, all patients started bedaquiline to all pre XDR and XDR patients. Tablets were given with food. Intake of bedaquiline and BR was supervised with direct observation and patients were monitored for 14 days (daily). Patients were assessed for adverse events, vital signs, ECG and clinically and were assessed daily for any adverse reactions for 14 days. All events were recorded, ECGs of all patients were taken at alternate days and sputum of all patients was sent for culture. Statistical analysis: Measurements were expressed as means and standard deviations for continuous ........
