Category: Nevin Manimala

Mymensingh Med J. 2023 Apr;32(2):542-549.

ABSTRACT

A major concern during the COVID-19 pandemic has been the shortage of manpower for patient care. The recommendation of various authorised bodies encouraged the training of students from medical, nursing, and allied fields to manage COVID-19 cases by tele-consultation and monitoring of mild cases under the supervision of faculty. Anticipating a further shortage of human resources, leading to dire consequences, preparedness training for the final year and pre-final nursing undergraduates was initiated. The current study was conducted to evaluate the effectiveness of and feedback on COVID-19 preparedness training delivered to final-and pre-final-year undergraduate nursing students. A 3-day training was given to pre-final and final year nursing undergraduates on ECG, COVID-19 management protocols, personal protective equipment “donning and doffing”, “hand hygiene”, “biomedical waste management”, “contact tracing” and cleaning and disinfection and simulation-based skills. Scores before and after training were conducted and mean scores were compared using a paired t-test. In total, 154 nursing students participated in the training program. Mean pre-test and post-test scores included: general instructions (21.69±2.5 and 25.09±3.29); skill procedures (5.4±1.21 and 6.3±1.2) and COVID management (22.84±3.26 and 26.48±2.06). There was a statistically significant improvement in knowledge and skills in all training sessions (p=0.0001). The mean post-test scores obtained at the OSCE stations for cardiac monitoring, prone positioning, compression-only CPR, airway, ECG and ABG ranged from 97.0% to 100.0% and all participants scored >70.0%. About 92.8% of the students felt that hands-on training enhanced their learning experiences. A need-based initiative of training final-and pre-final-year nursing students in COVID-19 support care effectively and efficiently created a skilled workforce.

PMID:37002769

Mymensingh Med J. 2023 Apr;32(2):534-541.

ABSTRACT

Failed Tracheal Intubation with Subsequent inability to maintain an open airway and adequate oxygenation is the most frequent cause of brain damage or death during anesthesia. Recognizing before anesthesia the potential for difficult intubation allows time for optimal preparation. Proper Selection of equipment and techniques is needed to avoid unwanted situation. To find out difficulties associated with endotracheal intubation using Modified Mallampati Test (MMT) combined with Thyromental Height Test (TMHT) and MMT without TMHT. This prospective observational study was conducted at the Department of Anesthesia in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from April 2018 to September 2018. Two hundred two patients with different surgical procedures under general anaesthesia in different operation theaters of BSMMU, Dhaka were selected as study population. After taking written consents from each patient or his/her attendant elaborate history of illness, meticulous clinical examinations were performed and relevant laboratory investigations were done. All information was recorded in a preformed data sheet and statistical analysis was done by SPSS-22.0. Mean age ±SD of the study subjects was 42.49±14.29 years in MMT with TMHT group and 43.40±15.39 years in MMT without TMHT group. Females were enrolled more than males in both the groups. BMI was 28.75±3.59kg/m² in MMT with TMHT group and 29.44±8.64kg/m² in MMT without TMHT group. There were no significant differences in age, gender and BMI between the groups. Sensitivity, specificity, PPV, NPV and accuracy were 100.0%, 96.0%, 96.2%, 100.0% and 98.0% respectively of MMT with TMHT in predicting intubation difficulty. Sensitivity, specificity, PPV, NPV and accuracy were 100.0%, 96.0%, 96.2%, 100.0% and 98.0% respectively of MMT only in predicting intubation difficulty. MMT combined with TMHT is a better predictor of intubation difficulty than MMT alone.

PMID:37002768

Mymensingh Med J. 2023 Apr;32(2):502-509.

ABSTRACT

Bangladesh experienced the largest dengue epidemic during 2019, with more than 100,000 confirmed cases and 164 deaths. Almost one-third of these cases were children. The present study aimed to investigate the clinical and hematological manifestations of pediatric dengue cases during the epidemic. This was a multicenter cross-sectional study conducted in Dhaka Medical College Hospital, Dhaka, Dr. Sirajul Islam Medical College Hospital and Tangail Sadar Hospital, Tangail, Bangladesh between the period of June 2019 and September 2019. The study included 208 pediatric patients (age <18 years) with confirmed dengue fever. Patient’s demographics, clinical and laboratory features of dengue were collected through patients’ interview, clinical examination and laboratory investigations. Descriptive statistics were used to represent the patients’ socio-demographic information, clinical presentations and hematological parameters. The majority of the patients were aged between 6 and 17 years with male predominance. The most commonly presented clinical manifestations were fever (100.0%), headache (59.0%), myalgia (42.0%), rash (36.0%), retro-orbital pain (28.0%) and diarrhea (24.0%). Warning signs abdominal pain (40.0%) and persistent vomiting (29.0%), bleeding manifestations such as melena (17.0%), gum bleeding (7.0%) and epistaxis (6.0%) and evidence of plasma leakage such as oliguria (3.4%), ascites (2.4%), pleural effusion (1.4%), and shock (1.0%) were also present in the patients. Raised HCT levels, leucopenia and thrombocytopenia were present in almost 23.0%, 43.0% and 28.0% of children, respectively. Warning signs and plasma leakage were present in a substantial number of patients indicating potential risk of severe dengue. Prompt diagnosis and management based on best clinical judgment might prevent severe dengue at an early stage.

PMID:37002764

Mymensingh Med J. 2023 Apr;32(2):480-486.

ABSTRACT

Colorectal carcinoma is the most common cancer of the gastrointestinal tract. More than 95.0% of the cancer is adenocarcinoma. Mucinous adenocarcinomas account for about 10.0% of all colorectal cancers. The expression of mucin themselves may play a role in the ability of tumors cells to escape the effect of systemic therapy and the process of tumor progression, invasion, survival and protection against the host immune response. The mucin lakes may also be a physiological barrier for the delivery of targeted therapy to the tumors cells. The aim of this study was to evaluate and compare the morphologic and histologic prognostic factors of mucinous and non-mucinous adenocarcinoma of the colon and rectum. In this descriptive cross-sectional type of observational study a total of 98 samples with colorectal adenocarcinoma were evaluated on the basis of presence or absence of the mucin from 2017 and 2018. The study was conducted in paraffin-embedded tumor tissue whose slides were stained using the hematoxylin-eosin technique. Mucin was evaluated by Periodic acid schiff and Diastase periodic acid schiff stain. Totally, 27 of 98 patients with colorectal adenocarcinoma (27.6%) had mucinous histologic subtype. Statistical significant results found in this research are as follows: Mucinous subtype tended to have present with moderate anaemia, history of low vegetable diet and larger tumor size, proximal colon involvement, infiltrative morphology and higher stage II compared to non-mucinous histologic subtype. Mucinous histologic subtype was associated with some adverse pathologic features in patients with colorectal cancer.

PMID:37002761

Mymensingh Med J. 2023 Apr;32(2):459-462.

ABSTRACT

Diabetic retinopathy (DR) is one of the most important causes of preventable visual impairment among patients of working age and leading cause of blindness. Deficiency of vitamin B12 and folate has been associated with increased serum homocysteine (Hcy) levels. This study was done to find out the role of vitamin B12 and Hyperhomocysteine (HHcy) in Diabetic retinopathy. The present study is a hospital-based case-control study conducted during over a period of 12 months from January 2019 to December 2019 study conducted in the Department of Ophthalmology at BIRDEM General Hospital, Dhaka, Bangladesh consisting of 100 Type 2 DM patients either with or without retinopathy (DR, n=50 and DNR, n=50, respectively). Subjects with Type 2 DM with and without retinopathy were recruited from patients attending in the department of Ophthalmology at BIRDEM General Hospital, Dhaka and were matched for duration of diabetes. Diabetes subjects on nutritional supplements for the last 6 months and those with a history of nephropathy (based standard renal function tests) and complications other than DR were excluded. Homocysteine (Hcy) levels were inversely related (p<0.05) with Diabetes patients with retinopathy. Vitamin B12 also significant correlated with Diabetes patients with retinopathy. A statistically significant negative linear relationship was found between serum homocysteine and vitamin B12 levels (Pearson r = -0.918, p=0.001) Diabetes patients with retinopathy. Vitamin B12 significantly correlated with diabetes retinopathy and homocysteine levels were inversely related with diabetes patients with retinopathy.

PMID:37002758

Mymensingh Med J. 2023 Apr;32(2):386-392.

ABSTRACT

Radial artery occlusion (RAO) is now a major concern in transradial approach (TRA). RAO limits future radial artery use for further TRA, for as a conduit during CABG, for invasive hemodynamic monitoring and for creation of arteriovenous fistula for hemodialysis in Chronic Kidney Disease (CKD) patients through same vascular approach. The effect of duration of hemostatic compression of RAO is unknown in Bangladesh. This prospective observational study was conducted in the department of Cardiology, National Institute of Cardiovascular Diseases, Dhaka, Bangladesh (NICVD) from September 2018 to August 2019, to evaluate the effect of duration of hemostatic compression on the incidence of radial artery occlusion (RAO) after transradial percutaneous coronary intervention. A total of 140 patients underwent percutaneous coronary intervention (PCI) through TRA. RAO was defined as an absence of antegrade flow or monophasic flow or invert flow on Duplex study. In this study 70 patients (Group I) received 2 hours hemostatic compression after transradial PCI. Another 70 patients (Group II) received 6 hours hemostatic compression after transradial PCI. Radial arterial blood flow assessed at early (24 hours) and late (30 days) by color duplex study after the procedure in both groups. Early radial artery occlusion occurred in 4.3% of patients in Group I and 12.8% of patients in Group II, (p=0.04). Late radial artery occlusion occurred in 2.8% of patients in Group I and 11.4% of patients in Group II, the difference was statistically significant (p=0.04). From multivariate logistic regression analysis duration of hemostatic compression time 6 hours (p=0.01), post-procedural nitroglycerine use (p=0.03) and procedure time (p=0.03) were predictors of RAO. Shorter duration of hemostatic compression is associated with a lower incidence of early and late radial artery occlusion after transradial intervention.

PMID:37002749

Mymensingh Med J. 2023 Apr;32(2):355-360.

ABSTRACT

Hypertension ‘The sustained elevation of systemic arterial pressure’ is a significant risk factor for heart disease, stroke and other cardiovascular diseases and an estimated 970 million people worldwide suffer from the disease resulting in significant morbidity, mortality and financial burden globally. It is the leading modifiable risk factor for morbidity and mortality worldwide. Worldwide an estimated 1.28 billion adults aged 30-79 years have hypertension, the majority (two-thirds) living with low and middle income countries. One of the global targets for non-communicable diseases is to reduce the prevalence of hypertension by 33% between 2010 and 2030.Sodium plays an important role in blood pressure regulation with a reduced sodium intake being associated with a reduction in systolic and diastolic blood pressure. This study was done to evaluate the differences in body mass index (BMI) and serum sodium in hypertensive and normotensive subjects. This analytical type of cross sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh between the periods from January 2022 to December 2022. A total number of 140 male subjects, age ranged from (30-59) years were included in this study. Among them, seventy (70) hypertensive subjects were taken as study group (Group II) and seventy (70) age matched normotensive subjects were taken as control group (Group I). The results were calculated and analyzed by using Statistical Package for Social Science (SPSS) version 26.0. Anthropometric measurements like height and weight taken in meter and kilogram respectively. Systolic and diastolic blood pressure was performed by aneroid sphygmomanometer (ALPK2, Japan), laboratory analysis of serum sodium by colorimetric method. In this study we found that body mass index in control group 23.59±1.29 kg/m² and study group 26.81±2.31kg/m²; blood pressure (systolic pressure in control group 113.21±6.76 mm Hg and in study group 149.14±5.03 mm Hg, diastolic pressure in control group 75.57±4.55 mm Hg and in study group 100.21±5.28 mm Hg) and serum sodium in control group 138.84±2.12 & in study group was 147.94±1.41 which were significant in study group in comparison with control group. In study group parameters were significantly increased in comparison to control male group. Therefore, by this study we recommended that routine estimation of these parameters is important for prevention of complication related to hypertension for leading a healthy life.

PMID:37002745

Mymensingh Med J. 2023 Apr;32(2):348-354.

ABSTRACT

Trichomonas vaginalis (T vaginalis) is the most prevalent non-viral sexually transmitted infection of the reproductive age group, which may lead to various complications, if left untreated. This study aimed to diagnose Trichomonas vaginalis infection by different diagnostic procedures and to evaluate the efficacy of different diagnostic procedures. This cross-sectional descriptive study was conducted among 102 women with vaginal discharge at the Department of Obstetrics & Gynecology at Mymensingh Medical College Hospital (MMCH) from July 2019 to December 2020. Three ectocervical swabs were collected from each patient. Saline wet mount microscopy, giemsa staining and PCR were performed for each patient. Data were collected using a structured questionnaire and analyzed using Excel 2007, statistical package for social sciences (SPSS) version 26.0. The PCR assay detected Trichomonas vaginalis positivity in 6(5.9%) of 102 patients, followed by Giemsa staining 4.9% and Wet mount examination 2.9%. Wet mount microscopy showed less sensitivity 33.33%, but high specificity 98.95%, 66.67% positive predictive value, 95.96% negative predictive value and accuracy 95.09%. The sensitivity, specificity, PPV, NPV and accuracy of Giemsa staining were 66.67%, 98.96%, 80.0%, 97.94% and 97.06% respectively. Statistical significance was observed when both WMM and Giemsa staining were compared to gold standard test PCR. In resource limited settings, a wet mount is a good option for diagnosis of T vaginalis infection as giemsa staining requires heavy T vaginalis infection to be positive. But wherever facilities are available, PCR should be performed.

PMID:37002744

Mymensingh Med J. 2023 Apr;32(2):330-337.

ABSTRACT

A prostate gland biopsy is a test to remove small sample of prostate tissue to be examined under a microscope. A biopsy may be done when a blood test shows a high level of prostate-specific antigen (PSA) or after a digital rectal examination finds an abnormal prostate or a lump. Transrectal ultrasound (TRUS) guided biopsy is a commonly performed procedure for the detection of prostate cancer. It is associated with serious complication like urosepsis. Although the incidence of post-TRUS urosepsis is low, when it occurs it is typically serious and leads to hospitalization. Antibiotics are used prior, during and after the procedure to prevent infections as a result of TRUS biopsy. Ciprofloxacin is being used as antibiotic of choice for a long time. Antibiotic prophylaxis may prevent such complications. This cross-sectional descriptive type of observational study was taken place in Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2010 to December 2011 among purposively selected 70 patients with an aim to determine the urosepsis and bacteriuria after TRUS guided prostate biopsy. Patients attending the Urology OPD in DMCH having of LUTS and other non-specific symptoms were evaluated by history, physical examination including digital rectal examination (DRE) and necessary investigations like serum PSA to identify the potential candidates. Patients with abnormal DRE findings and increased PSA level were included in this study and those who had any painful anal and rectal condition, bleeding diathesis, anticoagulant therapy and any known allergy to lidocaine, previously undergone prostrate biopsy and those who refused to give the informed consent were excluded from this study. Data were collected on variables of interest using a structured case record form. Data were processed and analyzed using Statistical package for social science (SPSS), version 17.0. Frequency of bacteriuria and urosepsis was measured according to urine and blood culture report. Sensitivity pattern was also seen. According to this study, the frequency of bacteriuria and urosepsis was 17.1% and 5.7% respectively. Most common uropathogen was E coli both in urine and blood culture. Organisms (100.0%) were found resistant to ciprofloxacin and amoxicillin. Most of the pathogens were sensitive to tobramycin, gentamycin and cefipime. A potentially dangerous ciprofloxacin resistant organism (ESBL producing E. coli) was found positive in 25.0% of culture positive patients.

PMID:37002742

Mymensingh Med J. 2023 Apr;32(2):313-319.

ABSTRACT

The BMI and fasting serum glucose was estimated in chronic kidney diseased patient to observe low body mass and the frequency of high in fasting serum glucose level in chronic kidney diseased patient (CKD). BMI fluctuations may indicate other serious comorbid conditions. Wasting is prevalent among patients with chronic kidney disease. It is to be distinguished from chronic inflammation and malnutrition, which is defined as the consequence of insufficient food intake. Diabetes is the most common cause of kidney disease. The chronic hyperglycemia of diabetes mellitus is associated with long-term damage, dysfunction and failure of kidneys, blood vessels, nerves, heart. This cross sectional study was carried out in the department of Physiology of Mymensingh Medical College, Mymensingh from July 2014 to June 2015. In this study total 200 subjects were selected with age ranged from 25 to 60 years and divided into 100 healthy persons as control group and 100 CKD patients as study group. Both control and study group were further divided into 50 male and 50 female. Unpaired student’s t test was used for Statistical data analysis. The mean±SE BMI of control group male and study group male were 25.04±0.13 and 23.87±0.41 kg/m² respectively. In study group male, mean±SE BMI was decreased. Result was statistically significant (p<0.05). The mean±SE BMI of control group female and study group female were 24.13±0.43 and 22.90±0.27 kg/m² respectively. In study group female, mean±SE BMI was decreased and result was significant (p<0.05). BMI was decreased in study group than in control group. The results were statistically significant. Fasting serum glucose was evaluated by the Enzymatic, colorimetric, GOD-PAP method. The results showed that the mean±SE fasting serum glucose of control group male & study group male were 5.31±0.17mmol/L and 7.56±0.37mmol/L respectively. In study group male, mean±SE FSG was increased. Result was statistically highly significant (p<0.0001). The mean±SE FSG of control group female & study group female were 5.11±0.11mmol/L and 7.37±0.33mmol/L respectively. In study group female, mean±SE FSG was increased & result was highly significant (p<0.0001). According to the above result, FSG was increased in study group than in control group. The results were statistically significant. Fasting serum glucose levels increased significantly in chronic kidney disease patients than the normal healthy persons. The increasing frequency of blood glucose level in CKD may predispose the patients to diabetes and increasing the other complications.

PMID:37002740