Tag: nevin manimala

Mymensingh Med J. 2022 Jul;31(3):773-778.

ABSTRACT

In recent years, diastolic dysfunction is an evolving context. Presence of left ventricular diastolic dysfunction (LVDD) indicates a poor prognosis in patients with an ACS and chronic coronary artery diseases. This study evaluated the association of LVDD and angiographic severity of CAD in patients with non-ST elevation myocardial infarction (NSTEMI). This cross-sectional analytical study was carried out in National Institute of Cardiovascular Diseases, Dhaka, Bangladesh, during the period of April 2017 to March 2018. A total of 120 NSTEMI patients undergoing coronary angiogram (CAG) during index hospitalization were included in the study. All patients underwent transthoracic echocardiography before they underwent CAG on different days. Presence (Group I, n=65) and absence of LVDD (Group II, n=55) was established by echocardiography. Severity of CAD was assessed by Vessel score and Leaman score. Association of traditional risk factors (smoking habit, hypertension, diabetes mellitus, dyslipidemia and family history of CAD) with severity of CAD was investigated. Vessel score showed coronary artery obstruction (CAO) was present in 62(95.4%) patients in Group I and 35(63.6%) patients in Group II, single vessel was involved in 17(27.4%) patients while multi vessel in 45(72.6%) patients was found in Group I. On the contrary 27(77.1%) single vessel patients and 8(22.9%) multi vessel patients were found in Group II. Positive Leaman score was significantly higher in Group I, 62(95.4%) than that of Group II, 35(63.6%) which is statistically significant (p<0.001). This study showed a positive correlation between LVDD and CAD severity in terms of vessel score and Leamanscore. This study also demonstrates that the severity of vessel score and Leaman score was higher in the higher grade of diastolic dysfunction. The present study concludes that LVDD is associated with angiographically severe CAD in patients with NSTEMI.

PMID:35780363

Mymensingh Med J. 2022 Jul;31(3):758-766.

ABSTRACT

Sleep problems are commonly seen in children with Autism Spectrum Disorder (ASD). According to previous research, sensory problems and anxiety may be related to the development and maintenance of sleep problems in children with ASD. To determine pattern and severity sleep disturbance in children with autism spectrum disorder. This descriptive cross sectional study was done in Institute of Paediatric Neuro-disorder and Autism (IPNA) and Department of Paediatric Neurology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from October 2017 to September 2018. A total of 59 children aged 3 to 15 year who were diagnosed as ASD according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) were enrolled in this study. Sleep disturbances were recorded in the standard questionnaire. The mean age was 49.78±20.69 months and male to female ratio was almost 4:1. More than two third (69.2%) patients had sleep awakening in mild, 7(36.8%) in moderate autism spectrum disorder. The difference was statistically significant (p<0.05) among three groups. More than half (56.4%) patients had sleep starting 12 am to 2 am in mild, 3(15.8%) in moderate autism spectrum disorder. The difference was statistically significant (p<0.05) among three groups. Sleep awakening and sleep starting time were significantly associated with autism spectrum disorder.

PMID:35780361

Mymensingh Med J. 2022 Jul;31(3):741-748.

ABSTRACT

Dengue is an arboviral infection dengue virus (DENV 1-4) transmitted by Aedes mosquito. It shows a wide range of clinical presentation from asymptomatic cases to undifferentiated fever, dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS) or non-severe and severe dengue. Most cases of dengue are self-limiting; however, severe dengue has high mortality if not diagnosed and managed early during the disease. Dengue virus (DENV) infection is a serious global public health challenge resulting approximately 200 million cases of morbidity and 50,000 cases of mortality annually. Management is based on clinical and lab parameters with certain lab tests aiding in the early forecast of severe dengue. While serological tests (detection of nonstructural protein 1 [NS1] antigen, immunoglobulin IgM and IgG antibodies aid in diagnosis of dengue, simple, cost-effective, easy tests such as hematocrit and platelet counts have great utility in resource-poor healthcare systems for predicting onset of severe dengue. To determine the clinical profile and lab findings of different varieties of Dengue fever in children admitted in a tertiary care hospital. This retrospective observational study was designed to collect data from the medical records of children of both sexes, aged up to 12 years old. The study was conducted from April 2019 to September 2019 in pediatrics department of BSMMU, Dhaka. A total of 50 children who were admitted with the complaints of fever and were found positive for either NS1 antigen or dengue IgM or IgG antibodies were included in the study. Patients with chronic diseases or any concurrent infections were excluded. Samples were collected from hospital record and kept in a separate management system only for dengue patients. The demographics, clinical and laboratory findings were recorded via structured data collection sheet. Among 50 cases, 22 were dengue fever, 17 were dengue hemorrhagic fever and 11 were dengue shock syndrome. The mean age of study participant was 6.95. Out of 50 patients, Male 62.0% were predominant over the female 38.0% and majority 74.0% came from urban area. Fever (95.5%) was mostly the presenting feature in dengue fever. Bleeding (29.4%) and tourniquet test positive (47.0%) were most in DHF. Hypotension (90.0%), tachycardia (90.9%), edema (18.2%), shock (90.9%) and hepatomegaly (72.7%) were mostly present in DSS. Neutropenia (72.7%) was significant in DSS. Platelet count (32,588.24±22,335.67) was significantly low in DHF. Albumin count (27.82±5.25) and TCO2 (18.27±1.8) were significantly low in DSS. Statistical analysis was done by Kuskalwallis test for categorical data analysis and one way ANOVA test for comparison of continuous data. P value <0.05 is considered as significant. This time it was seen that bleeding, tourniquet test positivity with low platelet count is seen in DHF. But DSS was marked by hepatomegaly and hypoalbuminaemia.

PMID:35780359

Mymensingh Med J. 2022 Jul;31(3):719-724.

ABSTRACT

Every human being has gas in abdomen. But patients try to correlate varieties of symptoms with abdominal gas. So this cross sectional symptom based study was designed to see the patients view regarding abdominal gas and its relation with medically explained symptoms at the out patient department of North East Medical College, Sylhet from January 2017 to December 2019. Consecutive patients presenting with complain of abdominal gas were included in this study. Their demographic information and explanation of symptoms resulting from abdominal gas were recorded on a pre-designed data sheet. Statistical analysis was done using SPSS 20.0 version. Total 346 patients, male 239(69.1%), female 107(30.9%), age varying from 17-83 years (mean 38.27) were enrolled. Common symptoms were bloating (fullness) of abdomen (194, 56.1%), abdominal pain (164, 47.41%), belching or eructation (149, 43.1%), heart burn (137, 39.6%), anorexia (124, 35.8%), nausea (120, 34.7%), noisy bowel (88, 25.4%), chest pain (79, 22.8%), headache (56, 16.2%), whole body pain (58, 16.8%), incomplete bowel evacuation (185, 53.5%), excess flatus (76, 22.4%), movement of gas to different part of body including head 87(25.1%) and expulsion of hot air from ear, nose and head in 69(19.9%) patients. Among them 107(30.9%) patients believed abdominal gas to be a curable disease with treatment and 222(64.2%) believed it to be a relapsing disease even after treatment. And 307(88.7%) patients were taking proton pump inhibitor (PPI) as its remedy regularly. Most of the symptoms of patients can be explained by abdominal gas. Again some patients have a misperception regarding some symptoms like heart burn, noisy bowel and sense of incomplete bowel evacuations are also related with abdominal gas. But in some instances causal relations with patients’ symptoms and abdominal gas could not be explained by medical knowledge. These differences in perceptions might be related to their personal thinking and social, cultural, educational, economic condition.

PMID:35780356

Mymensingh Med J. 2022 Jul;31(3):696-703.

ABSTRACT

Malnutrition is recognized to be a serious and common complication of chronic kidney disease (CKD) and is associated with increased morbidity and mortality in children. Early identification and swift intervention is the key in the management of malnutrition in CKD. The objective of the study was to determine the prevalence of malnutrition in children with CKD, to see the prevalence of malnutrition according to different anthropometric indices, to see the prevalence of malnutrition in different stages of CKD, to compare the nutritional status of children with CKD according to chronological age and height age. This analytical cross sectional study was done in the Department of Pediatric Nephrology of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from March 2014 to May 2015. Thirty children were enrolled in the study by purposive sampling. Nutritional assessment was done from dietary assessment by 72 hours recall and anthropometric measurements. Anthropometric indices were expressed in Z-scores and percentiles according to both chronological age and height age. Numeric data was analyzed by ANOVA and categorical data was tested by chi-square test. Difference between proportions was tested by Z-test of proportion. P value (<0.05) was considered significant. Data shows that the mean age of the studied population was 10.99±3.5 years with a male predominance. Eighteen (60.0%) children were on hemodialysis and rests on conservative management. Average calorie intake was 74.31±9.34% of estimated energy requirement (EER). The prevalence of malnutrition was 70.0% (95% CI: 53.6-86.4) according to height Z-score (HAZ), 66.7% (95% CI: 45.8-80.2) for weight Z-score (WAZ) and mid upper arm circumference (MUAC) Z-score, according to BMI percentile it was 56.7% (95% CI: 39-74.4), for mid arm muscle circumference (MAMC) the prevalence was 53.3% (95% CI: 35.5-71.1), according to arm muscle area (AMA) and arm fat area (AFA) the prevalence was 50.0% (95% CI: 38.1-67.9) and for triceps skin fold thickness (TST) it was 43.3% (95% CI: 25.5-61). Height was the most affected parameter and triceps skin fold thickness was the least affected parameter. When anthropometric indices were adjusted for height age, the prevalence was 36.7% according to BMI and TST, 30.0% according to AFA, 13.3% according to MUAC, 10.0% each for MAMC and AMA and 3.3% for WAZ. The difference in the prevalence of malnutrition according to this two approach was statistically significant in all parameters accept BMI, TST and AFA. Malnutrition was more associated with advanced stage of CKD. Low calorie intake was associated with low BMI and low serum albumin level. Serum albumin level was low in the present study population. In conclusion, prevalence of malnutrition is very high in children with CKD.

PMID:35780353

Mymensingh Med J. 2022 Jul;31(3):711-718.

ABSTRACT

Renal dysfunction following cardiopulmonary bypass is well recognized. The pathophysiology of renal injury is multifactorial and culmination of the interplay of several pathophysiological mechanism. Cardiac surgery requiring cardiopulmonary bypass (CPB) is being carried out on an extended patient population of different age groups and undergoing complex surgical procedure, and thus it places them at an increased risk of renal impairment. Valve replacement surgery is a major and complex surgical procedure requiring CPB. This study was therefore designed to observe the impact of CPB and short term outcome on patients with reduced estimated Glomerular Filtration Rate (eGFR) (60-89ml/min/1.73m²) after valve replacement surgery. This cross-sectional study was conducted in the Department of Cardiac Surgery, National Institute of Cardio Vascular Diseases (NICVD) during the period of January 2015 to August 2016. After fulfillment of enrollment criteria 100 patients were studied for the purpose of the study and they were grouped in two, patients with normal eGFR (≥90ml/min/1.73m²) in Group A and patients with reduced eGFR (60-89ml/min/1.73m²) in Group B. A total of 100 patients, 50 in each group were studied for renal function alteration after valve replacement surgery under cardiopulmonary bypass. The incidence of Acute Kidney Injury (AKI) was higher in Group B. Chi-square test was done and p value was 0.011 which is statistically significant. Postoperative blood loss (ml/hr) (p=0.038), duration of Intensive Care Unit (ICU) stay (in hours) (p=0.009), postoperative hospital stay (days) (p=0.014) was significantly higher and postoperative Urine Output (ml/hr) (p=0.001) was significantly lower in patients with reduced eGFR (60-89ml/min/1.73m²) in Group B. Deterioration of renal function is more in patient with eGFR (60-89ml/min/1.73m²) after valve replacement surgery under cardiopulmonary bypass in comparison with patients with eGFR (≥90ml/min/1.73m²).

PMID:35780355

Mymensingh Med J. 2022 Jul;31(3):683-689.

ABSTRACT

Infertility is a common gynaecological problem which remains unexplained in 10-30% cases. This study explores the difference of blood levels of homocysteine between women with unexplained infertility and normal fertility. This was a cross-sectional study conducted from January 2015 to December 2015 in the Department of Gynaecology and Obstetrics of a tertiary care hospital of Bangladesh drawing 30 women with normal fertility as controls and 30 with unexplained infertility as cases. The subjects in both groups were well matched in terms of age (p value 0.875) as well as height, weight and BMI (p value 0.418). There was no statistically significant difference between the two groups in socio-economic status and educational levels. The two groups had similar duration of marriage (7.88±3.5 years in controls vs. 8.15±3.88 years in cases) and coital frequency (3.63±0.76 week in controls vs. 3.33±0.55 week in cases). Based on the institutional cut-off value for normal serum fasting homocysteine level of 15 micromoles/L, the frequency of hyper-homocysteinemia was significantly higher (40%) in unexplained infertility group compared to control group (16.7%, p value 0.044). Fasting serum homocysteine levels were significantly higher in the unexplained infertility group compared to the normal fertility group (13.46±5.05 vs. 9.87±4.84 micromoles/L, p value 0.007). Serum fasting homocysteine levels and frequency of hyper-homocysteinemia were increased in women with unexplained infertility compared to age and BMI matched women with normal fertility.

PMID:35780351

Mymensingh Med J. 2022 Jul;31(3):656-665.

ABSTRACT

Congenital anomalies are one of the four leading causes of neonatal mortality in Bangladesh. The risk factors which are predictive of congenital anomaly in babies vary from country to country. In a developing country like Bangladesh many possible factors are present which should be identified & frequency needs to be assessed to understand the burden. The aim of this study was to determine the patterns and related maternal factors of fetal congenital anomaly. This cross-sectional type of comparative study was conducted at Department of Obstetrics & Gynecology in Mymensingh Medical College Hospital, Mymensingh, Bangladesh from September 2019 to August 2020. All the births occurring in the labor room were recorded. All newborn babies born with congenital anomalies were identified & included in this study. The rate of congenital anomalies was estimated and common types of congenital anomalies were noted. This study was conducted involving all women who had babies with congenital anomalies and the same number whose babies had no congenital anomalies. A structured questionnaire was used during data collection. Data was analyzed by Chi square test, bivariate analysis & multivariate logistic regression using statistical package for social sciences (SPSS) version 26.0. During the study period, 11479 deliveries were conducted. Among them 87 cases with congenital anomalies were identified. Frequency of congenital anomaly was 0.8%. Central nervous system was the predominant system involved (49.4%). Regarding risk assessment, Maternal age >30 years (OR 2.96, 95% CI 1.10-7.93, p value 0.032), consanguinity (OR 7.73, 95% CI 1.79-33.39, p value 0.006), first degree relative with history of congenital anomaly (OR 35.52, 95% CI 4.31-292.86, p value 0.001) and no intake of folic acid (OR 15.99, 95% CI 5.28-48.52, p value <0.001), passive smoking (OR 6.45, 95% CI 1.66-25.09, p value 0.007) were independent risk factors for congenital anomalies.

PMID:35780347

Mymensingh Med J. 2022 Jul;31(3):642-648.

ABSTRACT

Colorectal carcinoma (CRC) is one of the major public health problems. Vascular endothelial growth factor (VEGF) is an effective angiogenic factor and plays a pivotal role in the development, progression and metastasis of CRC. It also could further help in selecting patients of high risk of disease progression for adjuvant therapy. Therefore, this study was undertaken to reveal the importance of angiogenic factor (VEGF) as an adjunctive tool with histologic parameters of CRC. Total 45 cases were included in this cross-sectional observational study, performed in the department of Pathology, Mymensingh Medical College, Mymensingh and Immunohistochemistry was done in the department of Pathology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from March 2019 to February 2021. All the cases were evaluated for VEGF immunohistochemical expression. Majority of cases were low grade adenocarcinoma (86.9%) and most common stage was stage III (48.9%). Among 45 cases collectively 13 (4-negative + 9-weak positive) cases were low for VEGF expression and 32 (22-moderate positive + 10-strong positive) cases were high for VEGF expression. Statistically significant association was found with VEGF expression and increasing tumor stage as well as with lymph node metastasis (p<0.05). VEGF had positive significant correlation with stage (r=0.322; p=0.031) of tumor. However, no correlation with VEGF expression and grade (r=0.219; p=0.149) and other clinicopathological parameters of tumor was seen.

PMID:35780345

Mymensingh Med J. 2022 Jul;31(3):634-641.

ABSTRACT

Breast cancer is the most common diagnosed cancer in female over the world. It is the most important cause of ‘cancer death’ among female. For diagnosis of breast masses the Fine needle aspiration cytology (FNAC) is applied as the primary tool. Though it is an easy, rapid and comparatively minimally invasive and inexpensive procedure for quick diagnosis, it is largely a subjective tool. Computer-assisted image morphometry provides a new influential method for high-precision measurement of nuclear features and can help to differentiate between benign and malignant breast aspirates. Therefore, the aim of study was to evaluate computer assisted semi-automatic nuclear morphometry on cytology of breast lesions to differentiate benign and malignant lesions of breast. Total 70 cases were included in this cross sectional study, performed in the department of Pathology, Mymensingh Medical College, Mymensingh, Bangladesh from March 2019 to February 2021. Morphometric analysis was done on images captured from FNAC slides of the selected cases. Image J Morphometric Software was used for image analysis. Statistical analysis was done by using SPSS 26.0 version. On analysis of morphometry, four nuclear size parameters, two nuclear shape parameters and one nuclear chromasia parameter were measured. The cut-off values with sensitivity and specificity between benign and malignant category for mean nuclear area were 61.54μm², 91.0%, 97.0%, for mean maximum feret diameter 10.89μm, 94.0%, 95.0%, for mean minimum feret diameter 7.71μm, 94.0%, 97.0% and for mean nuclear perimeter 33.32μm, 94.0%, 95.0% respectively. So, in this observation, morphometry is adjunctive tools which may overcome the limitations of inter observer agreement, improve diagnostic accuracy and avoid unnecessary repeat Fine Needle Aspiration (FNA) in breast aspirates.

PMID:35780344