Category: Nevin Manimala

Mymensingh Med J. 2024 Jul;33(3):868-875.

ABSTRACT

Both of neurological emergencies and hyperglycemia are independently associated risk factors of mortality in the ICU patients. In critically ills, hyperglycemia is secondary to already existing DM or stress-induced hyperglycemia (SIH). Admission glycemic gap (AGG) is considered as a reliable indicator of SIH. This study aimed to explore the association of AGG on diabetic neuro-critical patients’ short-term mortality, and understand the potential of AGG as the predictor of outcome. Sixty adult diabetic neuro-critical patients admitted in ICU and stayed at least for 24 hours, were prospectively observed for 30 days, or until discharge or death, whichever came first. The patients’ initial clinical assessment and HbA1c, CBC, ABG, and blood glucose level were done within 24 hours of admission. A1c derived admission glucose (ADAG) was calculated as, ADAG = (1.59 × HbA1c) – 2.59 (mmol/L). The AGG was calculated by subtracting ADAG from admission blood glucose level (ABGL). Death or survival of 30 days was our primary outcome and participants were divided between survivor or non-survivor groups according to primary outcome. Statistical comparisons of the study variables between the groups were performed and the relationship between parameters derived from blood glucose and mortality was prospected. Among the 60 patients enrolled, 35(58.3%) were non-survivors and 25(41.7%) were survivors. Age, sex, residence, primary diagnosis, co-morbidity, or drug history had no association with survival/non-survival. Among the initial clinical assessment parameters, lower GCS had significant association with non-survival. AGG, HbA1c, ADAG and ABGL were significantly different between the groups, with higher values in the non-survivors. Lower GCS, and higher AGG, HbA1c, ADAG and ABGL showed significant odds of non-survival. The highest odds of non- survival was for AGG (OR 2.95, 95% CI: 1.83-4.75; p<0.001). For ABGL and HbA1c the OR were 2.03 (95% CI: 1.44-2.86; p<0.001) and 1.93 (95% CI: 1.04-3.58; p<0.04) respectively. The final adjusted odds (aOR) of non-survival for higher AGG was 3.25 (95% CI: 1.71-6.16; p<0.001), signifying that AGG is independently associated with non-survival. AGG, GCS level, ABGL, HbA1c level, and ADAG can predict short-term outcome (mortality). However, AGG has the greatest potential to predict short-term outcome in diabetic neuro-critical patients.

PMID:38944734

Mymensingh Med J. 2024 Jul;33(3):840-847.

ABSTRACT

Multiple myeloma (MM), mature B-cell lineage neoplasm, is characterized by abnormal clonal proliferation of plasma cells and presence of monoclonal protein (M protein). The study was conducted to reveal presenting features, laboratory findings, Eastern Cooperative Oncology Group (ECOG) performance status and skeletal survey on patients with multiple myeloma. This descriptive, cross-sectional study was carried out in the Department of Haematology, Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2019 to July 2020 with a sample size of 81. Data were collected in a case record form after obtaining informed verbal consent from patients and /or their legal guardians. Relevant ethical issues and data quality assurance were taken into consideration. Data were analyzed with SPSS, Version 25.0 with presentation in figures and tables with frequency, percentage, mean and standard deviation based on data nature. Statistical tests were carried out as appropriate with 5.0% level of significance for assessing statistical association. Mean age of the patients was 58.9±12.0 years. Male female ratio was 2:1. 35(43.2%) patients were smokers with only 2(2.5%) had family history of haematological malignancies. Bone pain (72.8%) was the most common presenting feature, while hypertension (59.1%), diabetes mellitus (29.5%), respiratory illness (11.3%) and cardiac disease (11.4%) were the common co-morbidities. Most common ECOG performance status was ECOG-1(48.1%). Mean haemoglobin (Hb) was 9.4±2.3gm/dl and mean erythrocyte sedimentation rate (ESR) was 89.5±42.1 mm in 1st hour. Mean serum creatinine level was 2.0±1.85 mg/dl and ≥2.0mg/dl in 42(34.2%). Among 50 documentation serum lactate dehydrogenase (LDH) was raised in 18(36.0%). Mean serum calcium level was 9.6±1.8mg/dl >11.0mg/dL in 10(14.5%) cases. Serum albumin <3.5gm/dl in 37(49.3%), β2-microglobulin >5.5mg/dl in 37(57.8%) cases, International staging system (ISS) stage III was in 59.4% and Bence Jones Protein (BJP) was present in 46.7% cases. Lytic lesions were present in 75.0%, In 38(74.5%) patients vertebrae were involved, while in 18(35.2%) ribs were involved, in 14(27.5%) patients skull was involved and in 3(5.9%) patients involved bones were femur, humerus, sternum and scapula. Mean plasma cells percentage was 62.1±24.9%. Immuno-Fixation Electrophoresis (IFE) revealed IgG (72.7%), IgA (18.2%), Free light chain (FLC) (9.1%). FLC ratio was ≥100 in 29.0% cases. Significant statistical association was observed between serum creatinine with Hb concentration (p<0.05), serum creatinine level with ISS staging (p<0.05) and serum calcium level (p<0/05), while insignificant association was revealed between BJP present status and serum creatinine level (p>0.05). Bone pain, fatigue, fever and neurological impairment were the common presenting features. Anaemia, renal impairment and skeletal lytic events were the prominent physical findings. ISS staging was statistically associated with serum creatinine level, while serum calcium level was associated with serum creatinine and lytic lesions.

PMID:38944730

Mymensingh Med J. 2024 Jul;33(3):810-816.

ABSTRACT

Objective of the study was the effect of Covid-19 infection on pregnancy and neonatal outcomes. This prospective cohort study was conducted in Combined Military Hospital (CMH) Bogura, Obstetrics and Gynaecology department from June 2020 to October 2020. We have collected and analyzed data of 29 pregnant ladies positive for Covid-19. Control group was Covid-19 negative pregnant patients. Nasopharyngeal swab was taken for real time polymerase chain reaction for detection of Covid-19. We observed symptoms, compared any complication in mother and fetus, mode of termination, and duration of hospital stay. Only six patients were asymptomatic (10.3%). Fifteen (25.9%) had fever, six (6) had weakness (10.3%), 5(8.6%) had sore throat, 3(5.2%) had nausea and 5(8.6%) presented with loss of smell. Among twenty-nine patients, 5(8.6%) delivered normally, 24(41.4%) were delivered through caesarean section which was significantly higher than control group (p value <0.001). No mother became critical or expired, neonatal death was also absent. Mean duration of hospital stay was 14.13±6.192 days in case and 5.18±4.99 in control which was significantly (p value <0.001) higher. Breast feeding was significantly higher in control group (p value <0.001). This study shows feto-maternal outcome of Covid-19 pregnancy is almost same as those of normal pregnancy.

PMID:38944726

Mymensingh Med J. 2024 Jul;33(3):798-804.

ABSTRACT

Pressure sore is an important post-stroke complication that results in increased morbidity, mortality and poor prognosis of the patients. The objective of the present study was to find out the prevalence and the factors associated with pressure sore among stroke patients. This prospective cross-sectional study includes 50 stroke patients admitted in the Department of Neurology of Dhaka Medical College Hospital, Bangladesh from July to December 2018. Data were collected from the by direct interview of the patients or their relatives or caregiver using a structured case report form. Descriptive statistics were used to represent patients’ characteristics and the chi-square test was used to determine the difference between patients’ groups. The mean ±SD age of the stroke patients was 59.16±11.53 years and half of them were male. Fifty percent of the patients had been suffering from ischemic stroke and the rest from hemorrhagic stroke. Of all, one-fourth of the patients (24.0%) developed post-stroke pressure sore during the hospital stay and type-specific prevalence was 20.0% in ischemic stroke and 30.0% in hemorrhagic stroke. Common sites of the pressure sore were sacrum (50.0%), buttock (25.0%), heels (17.0%), and greater trochanter (8.0%). Only 8.0% of the patients developed grade IV wounds. Pressure sores of 42.0% of patients healed spontaneously, 25.0% needed conservative management and 25.0% needed a skin graft. This study found that a large portion of stroke patients develop a pressure sore during hospital stay which can deteriorate clinical outcomes and compromise the quality of life of the patients. Adequate preventive measures and proper rehabilitation should be encouraged for better stroke management and to reduce long-term complications.

PMID:38944724

Mymensingh Med J. 2024 Jul;33(3):794-797.

ABSTRACT

Rectal malignancies that require abdominoperineal resection (APR) and Anterior resection (AR) is very common. Laparoscopic APR or AR can be a better option. This study observed the feasibility of this newer technique for alternative to conventional open method. This prospective type of observational study was comprised of patients with diagnosis of rectal cancer, who admitted to BIRDEM General Hospital for Laparoscopic APR or AR from November 2015 to April 2016. Among 19 patients, age range was from 20-78 years, mean age was 49.84±17.04 years. Male: female ratio was 12:7 (63.2%:36.8%). Twelve (12) patients underwent Laparoscopic APR, 6 Laparoscopic AR, one conversion (conversion rate – 5.3%). Less analgesics were required, a mean of 5.61±1.57 dose/ample/mg opioid injections needed for 4.05 days. An early postoperative ambulation (2.16±0.76 days) was noted. Mean post-operative hospital stay was 11.53±1.98 days. Laparoscopic APR or AR is a safe, effective and technically feasible procedure. It can be a better operative procedure in terms of early postoperative outcome such as less analgesics requirement, early ambulation and shorter hospital stay.

PMID:38944723

Mymensingh Med J. 2024 Jul;33(3):785-793.

ABSTRACT

This study was intended to evaluate the pathological outcome of cardiopulmonary bypass whilst considering socio-demographic variables and surgical technique on early postoperative results following coronary artery bypass graft (CABG) surgery in patients at a tertiary level hospital in Bangladesh. This observational study evaluated a total of 880 patients with ischemic heart disease in Bangabandhu Sheikh Mujib Medical University, Bangladesh from 2011 to 2019 who were undergoing an isolated CABG surgery. In this current study, the population divided into two groups- Group A: Off-pump CABG (n=440) and Group B: On-pump CABG (n=440). The mean age of the patients was 55.25±5.0 years in off-pump and 50.75±5.2 years in the on-pump group. Risk factors, including smoking, hypertension, and hyperlipidemia, were predominant in both study groups. Total operative time was notably higher in the on-pump CABG group. However, grafting time was more in the off-pump CABG procedures. Postoperative neurological deficits were higher amongst the on-pump CABG population. The mean time of mechanical ventilation, intensive care unit (ICU) stay, total hospital stay, and mortality was notably higher in the on-pump CABG group. Moreover, the number of mortalities in on-pump CABG patients was primarily due to the low output syndrome, failure of weaning from cardiopulmonary bypass (CPB) and sudden cardiac arrest. Off-pump CABG is now more acceptable due to its potentiality to avoid CPB induced complications, aortic cannulation, and cross-clamping. Cardiac arrest in on-pump CABG induces global ischemia and reperfusion injury to the cardiac muscle. Besides, the Off-pump CABG provides a conspicuous survival advantage compared to the on-pump CABG, in association with a notable reduction in postoperative morbidity and mortality.

PMID:38944722

Mymensingh Med J. 2024 Jul;33(3):758-765.

ABSTRACT

The extremely contagious global outbreak of the novel Coronavirus disease 2019 (Covid-19) caused by Severe acute respiratory syndrome coronavirus-2(SARS- CoV-2) is causing concern worldwide since its emergence. Healthcare workers (HCWs) are more susceptible for acquiring Covid-19 due to direct or indirect exposure to Covid-19 patients. Therefore, it is important to investigate demographic, clinical characteristics and outcome of affected persons and possible source of infection with exposure details. This study aimed at determining the demographic and clinical profile, outcome and possible risk factors for infection among the HCWs at Kurmitola General Hospital (KGH), Bangladesh. This retrospective observational study was done among the SARS-CoV-2 positive HCWs of Kurmitola General Hospital (KGH) from April 2020 to January 2021. Out of total 1323 HCWs, 180(13.9%) cases were detected Covid-19 positive. Among the infected HCWs, 76(42.2%) were male and 104(57.8%) were female. The mean age was 32.8±6.95 years. Eighty nine (89) were nurses (49.4%) and 67 were physicians (37.2%). Among them, 23(13.0%) had no definite symptoms. Mild symptoms had in 137(76.11%) and 40(22.22%) had moderate symptoms. Most common symptoms were fever 112(62.0%), weakness 108(60.0%), cough 102(57.0%) and myalgia 54(30.0%). Pre-existing comorbidities had 43(24.0%). Bronchial asthma 27(15.0%), HTN 24(13.0%) and DM 21(12.0%) were the most prevalent comorbidities. All completely were recovered ultimately. Fatigue 52(28.89%), shortness of breath 15(8.3%), cough 13(7.2%) were the most common long-term complications. Among them, 53(29.0%) pointed toward lack of maintaining a hygienicatmosphere, as their possible cause of being infected, whereas 37(21.0%) could not identify the cause. Maximum HCWs, 170 cases (94.44%) used PPE during their duty. Adequate training get 26(14.44%) on PPE use and Infection prevention and control (IPC). This study concludes almost 1.4 in 10 HCWs at KGH were infected with SARS-CoV-2 while working in hospital during the Covid-19 pandemic. Affected HCWs have relatively female predominance with younger age, milder symptoms, and less underlying diseases in this study. Fatigue and shortness of breath are most common long-term complications, which hampers their working ability. Most of them did not get any training on PPE use and IPC.

PMID:38944718

Mymensingh Med J. 2024 Jul;33(3):741-749.

ABSTRACT

Coronavirus disease 2019 (Covid-19) disease have been associated with significant mortality amongst doctors globally including Bangladesh. To delineate the clinico-epidemiological characteristics of the physician affected with Covid-19 was the objective of the study. This cross-sectional ‘Facebook’ based survey was conducted in the period of August 2020 to September 2020. Snowball sampling methods was followed. A total of 151 physicians affected with Covid-19 participated in this survey. Self-reported perceived severity scale (zero meaning not severe at all and ten denoting the most severe) was used. Collected data were analyzed by SPSS 25.0. Among the participants, the majority were male, 98(64.9%). The most prevalent affected age groups were 24-35 years 131(86.8%). Approximately 45.0% worked in COVID dedicated hospital. Entry-level physicians (Medical Officer or Assistant Surgeon) were the most affected 117(94.4%). One-third of the physicians had at least the one co-morbidity. Bronchial asthma, obesity and diabetes were the most frequent. Predominate symptoms of the infection were fever 94(62.3%), cough 94(62.3%) and myalgia 92(60.9%). Half of the participants had sore throat, anosmia, gastro-intestinal symptoms and one-third of the patients developed dyspnea. Perceived severity of the symptoms ranged between 2 and 6. The pattern of drug use to prevent the Covid-19 showed no uniformity. However, intake of Zinc, Vitamin C, Vitamin D, antihistamine and Ivermectin was found in 74.8%, 67.5%, 41.7%, 49.0% and 37.7% respectively. As the current pandemic continues to evolve, physicians must be equipped with appropriate knowledge, skills and must be cautious on the prevention measures against Covid-19.

PMID:38944716

Mymensingh Med J. 2024 Jul;33(3):736-740.

ABSTRACT

Parieto-occipital sulcus is one of the major sulcus of the cerebral hemisphere which separates the occipital lobe from the parietal lobe. Morphology of this sulcus varies with age, sex, manual skill, handedness and in many diseases. For various clinical investigations and surgery, detailed morphological knowledge of this sulcus is very much essential for the surgeons and radiologists. This study is carried out to establish a normal standard in length of the parieto-occipital sulcus in different age and sex groups of Bangladeshi people. A cross-sectional, descriptive type of study was conducted in the department of Anatomy, Mymensingh Medical College, Bangladesh from July 2016 to July 2017. About 60 specimens were collected from medico-legal cases and divided into four age groups including, Group A (20-29 years), Group B (30-39 years), Group C (40-49 years) and Group D (50 years and above). The mean length of parieto-occipital sulcus was 3.92±0.559cm to 3.29±0.434 cm in male and 3.81±0.715cm to 3.03±0.551cm in female. The difference in mean length of the parieto-occipital sulcus for both left and right hemisphere between male and female was statistically non-significant in all age groups. For statistical analysis, differences between age and sex groups were analyzed by using students unpaired ‘t’ test. In this study, the length of the parieto-occipital sulcus showed gradual decreasing values with advancing age.

PMID:38944715

Mymensingh Med J. 2024 Jul;33(3):716-723.

ABSTRACT

The spectrum of indications for primary caesarean section changes with advancing parity. As parity advances more cesarean section are done for maternal rather than fetal indications. The objective of this study was to determine the indications and complications of caesarean section in multiparous women with history of previous vaginal delivery. This cross-sectional descriptive observational study was conducted in Mymensingh Medical College Hospital from January 2019 to June 2019 among 100 purposively selected multiparous women who underwent primary caesarean section. A well-designed, semi-structured questionnaire was used to collect data by face-to-face interview, clinical examinations and laboratory investigations. Data analysis was conducted in SPSS 20.0 version. Majority (74.0%) of the women in this study were in the age group 21-30 years with mean age of 26.3±5.76 years. Majority of the patients were of second gravida (42.0%) followed by third gravida (33.0%). The highest gravida in this study was 6th. Most of the patients were of para 1(44.0%). Highest para in this study was para 5. The most common indication of caesarean section in this study was foetal distress (26.0%). The next common indications were cephalo-pelvic disproportion (22.0%), antepartum haemorrhage (13.0%), mal-presentaion or mal-position (16.0%). Other causes were PROM (8.0%), prolonged labour (6.0%), cord prolapse (2.0%), post-dated pregnancy (4.0%), severe pre-eclampsia (2.0%) and secondary subfertility (1.0%). There was no case of maternal mortality in this study but 15 mothers suffered from various post-operative complications like wound infection (4.0%), UTI (4.0%), puerperal pyrexia (3.0%), postpartum haemorrhage (3.0%) and paralytic ileus (1.0%). Among the babies delivered 97 were live births. Among the 97 live births 11(11.34%) were preterm babies. Among the babies delivered majority (85.0%) was with good APGAR score (7-10). In conclusion it can say that a multiparous women in labour requires the same attention as that of primigravida. A parous women needs good obstetric care to improve maternal and neonatal outcome and still keeping caesarean section to a lower rate.

PMID:38944712