Mymensingh Medical Journal

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Grading & scoring systems used for pre-anaesthetic evaluation of the patients.
(2002-01-01) Meftahuzzaman, Abusayed M; Rickta, Das; Sarker, Subhash Chandra
Pre-anaesthetic assessment of the patients is an integral part of anesthesia & surgery. In assessing the present condition and to determine the prognosis of the outcome of the patients after surgery in relation to anesthesia, different grading and scoring systems have been used. Grading & scoring for physical status, cardiac index, dyspnoea, liver function, hepatic coma, lung function, multiple injury etc. are very much useful and used for particular system involved. ASA grading covers the general physical condition used for all patients. So it is accepted widely around the world as well as all most all hospitals in Bangladesh.
Instructional improvement: how to overcome the barriers?
(2002-01-01) Ahmed, Shafi Uddin; Ahmad, Mainuddin; Nessa, Taufiqun
This is no easy way to improve teaching. Not one or even two activities are right or best for all instructions. The improvement of instruction requires a multi directional approach. When faculty members, departmental heads or interested administrator come across an idea they find appealing, they often tend to be converted and start proselytizing. The way to better teaching lies in review of videotaped teaching samples or diagnostic student evaluation with consultation, or seminars on course design, or monitoring with master teachers, peer assessment or whatever the favored strategy happens to be. All of these are possible ways to better teaching, made right or best only after they have been carefully matched with their instructional needs of the teacher, course content & instructional setting.
Kallmann syndrome: a case of hypogonadotropic hypogonadism.
(2002-01-01) Siddiqui, M Nazrul Islam; Mia, M Abdur Razzaque; Ghani, M A
An eighteen years old boy hailing from Nandail, Mymensingh was complaining of small external genitalia, small testes, and gradual enlargement of breast, weight gain, absence of facial, axillary and public hair, absence of sense of smell. His height was 162 cm, weight 59 kg, BMI-22.52 kg/m2 with eunuchoid body habitus. His stretch penile length was 5 cm, testicular volume < 5 ml, stage B3 development of breast and absence of facial, axillary and public hair. He was found anosmic of standard odors. Patient was clinically and biochemically in euthyroid state with low level of testosterone, LH and FSH and normal serum prolactin level. He was diagnosed as a case of hypogonadotropic hypogonadism due to Kallmann syndrome.
Gall stone: a rare cause of acute abdomen in a seven years old girl.
(2002-01-01) Malek, M A
Jamila Khatun a seven years old girl from Shurjunagar, Rajbari, presented with acute pain in the right side of her abdomen. Blood test was normal except mild elevation of serum bilirubin. Chest X-ray reveals no fluid level & no gas under the dome of diaphragm. Ultrasonogram of the abdomen reveled multiple stone in the gallbladder.
Surgical management of thyroid diseases--a study on 78 cases.
(2002-01-01) Hossain, M Monwar; Haque, M Rojibul; Rashid, Abdur; Siddiqui, M Nazrul Islam; Kundu, Samaresh Chandra; Halder, Kishore Kumar; Chowdhury, Wazir Ahmed
A total of 78 cases with thyroid diseases were treated surgically in the Department of ENTD, Mymensingh Medical College Hospital during the period from 2000-2001. The different types of surgery were done according to the diagnosis being presented here. Out of 78 cases, 60 (76.9%) were female and 18 (23.1%) were male having female to male ratio of 3.3:1. The highest number, 47 cases (60.3%) belongs to 21-40 year age group. The study revealed the incidence of thyroid diseases as follows: 53 (67.9%) Benign cold single nodular goitre. 17(21.8%) Benign cold multinodular goitre and 08 (10.3%) Papillary carcinoma of thyroid. Regarding surgical management 40 (51.3%) patients underwent hemithyroidectomy. Lobectomy were done for 13 (16.7%), subtotal thyroidectomy for 15 (19.2%), total thyroidectomy for 5 (6.4%) patients and total thyroidectomy with functional neck dissection were performed for 5 (6.4%) patients. The study showed that females were the mostly affected group having benign single cold nodular goitre who were treated surgically by hemithyroidectomy.
Role of hepatobiliary scintigraphy in the evaluation and management of post-cholecystectomy pain due to biliary dyskinesia.
(2002-01-01) Khan, M Nasim; Islam, M Moinul; Mohammod, Saiyeeda; Hossain, Gazi Abul; Chakraborty, Ratan Kr; Amin, Nurul
Imaging with technetium-99m analogs of imminodiacetic acid has been shown to be useful in the diagnosis of various hepatobiliary diseases. The biliary ductal dilatation is usually late response of obstruction. With the development of TC-99m IDA scintigraphy, however, the functional aberrations associated with obstruction can be detected prior to the development of ductal enlargement identifiable by US & CT. We report a case of post-cholecystectomy pain due to biliary dyskinesia diagnosed by 99m TC-HIDA hepatobiliary imaging.
A morphological and morphometric study of extra hepatic biliary duct of autopsied population of Bangladesh.
(2002-01-01) Khalil, Mohsin; Khalil, Mansur; Fakir, M Abdul Hai; Akhtar, Aysha; Sultana, Zakia
The study was carried out in 20 humans to observe the mean length, external and luminal diameters of different parts of the extra-hepatic bile duct. The largest mean length and diameters were found in common bile duct.
Effect of combined oral contraceptives on bone mineral density in pre and postmenopausal women.
(2002-01-01) Sultana, Sayeeda; Choudhury, Shahnaz; Choudhury, S A R
A retrospective urban-based cross-sectional study was done in the department of Pharmacology in collaboration with the department of Obs and Gynae of BSSMU, Dhaka, to define any relation between the OCP and BMD in pre and postmenopausal women. A total of 100 closely matched healthy women were selected non-randomly. The age range was 35-55 years. Among them 50 were controls or nonuser and 50 were case or users of OCP. They were further subdivided into pre and postmenopausal groups. Bone density of the 100 women was measured in distal radius and ulna by single photon Absorptiometry Bone Densitometer DTX-100. Statistically significant higher bone mineral density (BMD) was found in oral combined OCP users than non-users, both in pre and postmenopausal women. It can be concluded from this study that the most important non-contraceptive benefit of OCP may be positive effects on bone mass and thus reduced risk of postmenopausal osteoporosis and osteroporotic fracture.
Uniform requirements for manuscripts submitted to biomedical journals--updated October 2001.
(2002-01-01) ,
Thyroid status of normal pregnant women in Dhaka City.
(2002-01-01) Khandakar, M Abu Rayhan; Ali, M Suhrab; Kahtun, Mahfuza
The thyroid gland secretes thyroid hormones having important role in embryogenesis and fetal development during pregnancy. The present study was carried out to find out alteration in the thyroid size and serum thyroid hormonal levels (T4, T3 and TSH) in normal pregnant women as compared to non-pregnant women in Dhaka City. For this purpose, thirty-five pregnant women during third trimester attending OPD Dhaka Medical College Hospital from January 1998 to July 1998 were selected randomly and twenty-one non-pregnant women of childbearing age group were selected as control. The study revealed a high prevalence of goiter in both pregnant (34.2%) and non-pregnant women (28.5%). The study showed that the serum TT4 level of non-pregnant women was normal (mean +/- SD = 113 +/- 23 nmol/L) and the serum TT4 of pregnant mother during third trimester was significantly higher (mean +/- SD = 200 +/- 63 nmol/L, P < 0.001) compared to that of non-pregnant women. The serum TT3, levels of both pregnant and non-pregnant women were within normal range without significant difference between them. It was found that the serum TSH level of pregnant mother was within normal limit and was closely similar to that of non-pregnant women showing no significant difference between them. It can be concluded from the study that although goiter was present in a considerable number of pregnant women but they were euthyroid status as observed by increased production of serum total thyroxin (TT4) by thyroid to fulfill the maternal requirement, with nearly unchanged TT3 and TSH secretion.
Protective effect of dietary fibers against colorectal carcinoma.
(2002-01-01) Mia, M Abdur Razzaque; Siddiqui, M Nazrul Islam; Rukunuzzaman, M; Rahman, M Matiur; Deb, Kalpana
Dietary fibers are remnant of plant cells resistant to hydrolysis by human alimentary tract enzymes. These are cellulose, hemicellulose, lignin, pectins and gums. Intake of dietary fibers or foods rich in dietary fibers decreases the incidence of colorectal carcinoma. Reduced risk of colorectal carcinoma is reported when populations with diet high in red meat and total fats switched to a diet high in total fibers and certain whole grain, goods. Fibre intake is also inversely related to mortality from colorectal carcinoma. Beneficial influence of most vegetables and fruits against colorectal carcinoma is confirmed and this is due to their fibre contents.
Tuberculous prostatitis--a case report.
(2002-01-01) Gafur, M A; Talukder, M S I; Siddiqua, S S
Tuberculous prostatitis is a rare condition. A 55 years-old man admitted into a surgery unit of Mymensingh Medical College Hospital with features of prostatism. After clinical examination and investigations, it was diagnosed as a case of benign enlargement of prostate (BEP) and surgery was decided to do. During exploration a large cystic cavitation found in prostate and the intact median lobe taken out for histopathological examination, which revealed tuberculous granuloma. The patient had no evidence of past or present pulmonary tuberculosis. He was treated with anti-tubercular chemotherapy and responded well. No such case is found reported in Bangladesh yet in through medline search database. So, the case is reported here.
Evaluation of 500 cases of Pap's test in Mymensingh.
(2002-01-01) Talukder, M S I; Huq, M H; Haque, A
Papaniculaou test (Pap's test) is a screening test for cervical pre-malignant and malignant lesions. A total of 500 cases of Pap's smear were examined in a private laboratory in Mymensingh during the period from May, 1997 to April 1998. The aim of the present study was to find out the patterns of cytologically detected lesions in these cases. The age of the case range from 17 to 65 years. Majority of the cases was in the age group of 21-30 years (53%). The pattern of cytologically detected lesion was as follows: within normal limit 13.8% (69), Chronic non-specific inflammation 82.8% (414), inflammation associated with Tricomonus vaginalis 1.6% (8), candidiasis 3.2% (16), Herpes simplex 0.6% (3), low grade squamous cells of undetermined significant (ASCUS) 0.6% (3), low grade squamous intraepithelial lesion (LSIL) 1.2% (6), high grade squamous intraepithelial lesion (HSIL) 0.6% (3), squamous cell carcinoma (SCC) 0.2% (1) and squamous metaplasia 1.4% (7).
Updating of hereditary haemoglobin disorders.
(2002-01-01) Rahman, M E; Parveen, R; Chowdhury, A M; Khan, M I
Hereditary haemoglobin disorders (E-beta Thalassaemia & Thalassaemia) are inherited as recessive disorders so that the heterozygote subjects are generally healthy. They commonly present with progressive pallor, thalassaemic facies, splenohepatomegaly & growth retardation. Diagnosis of carriers & patients are usually confirmed by haemoglobin electrophoresis. Transfusion-chelation therapy is usually employed for their treatment. Allogenic bone marrow transplantation is the only definite cure. Gene therapy remains to be the major challenging goal of future curative therapy. During the last 10 years wit medical advances, the number of pregnancies in thalassaemia is increasing. Normal pregnancy can be maintained with regular packed blood cells transfusion given carefully. In Bangladesh, HHD can be prevented by I. carrier identification and marriage counseling, II. passing and enforcing laws against marriage between two carriers, III. introducing thalassaemia in school curriculum and IV. creating public awareness.
Carcinoma larynx--topographical distribution.
(2002-01-01) Haque, M Rojibul; Abdullah, Mohammad; Alauddin, M; al-Haroon, Abdullah; Majed, M A; Ali, M Suhrab
One hundred and sixty subjects were included in our study, collected from four hospitals in Dhaka City. The mean age (+/- SD) of study subjects were 54.67 +/- 11.27 years. Out of 160 subjects 155 was males and 5 were females, and male to female ratio was 31:1. The highest number of study subjects was related to cultivation (40.62%). The majority of study subjects were from the low socio-economic status (68.72%). Carcinoma larynx is a multifactorial disease. Smoking and chewing habit are the most important factors associated with carcinoma larynx. Most of the male (93.12%) subjects were smoker. One hundred and fifteen (71.87%) subjects were found chewing habit of betel leaves with other ingredients. Hoarseness of voice was the commonest symptom 65.62%. Regional distribution of tumour showed supraglottic carcinoma topping the list (69.38%) followed by glottic carcinoma (30.62%) and there was no subglottic carcinoma. Site involvement in supraglottic carcinoma was found in combined location topping the list (89.20%). In glottic carcinoma majority was found glottic with supraglottic extension (65.31%). In majority cases growth were exophytic 52.50%. Palpable lymph mode was found in 48.75% of cases. All the carcinoma of larynx was found histologically of squamous cell type.
Urinary incontinence due to duplication of ureter--a case report.
(2002-01-01) Rahman, Muzibur; Gafur, M A; Sarwar, Jahangir; Rahman, M Matiur
A seventeen years old female student from Nakla, Sherpur was admitted in the surgical unit I of Mymensingh Medical College Hospital (MMCH) on 28th October 2000 with the one and only complain of continuous dribbling of urine since her birth. Besides her urinary incontinence she used to have urge for micturition and normal voiding pattern as well. She has a good physique but a very depressed mental state. IVU suggested about the duplication of the right ureter but not clearly. Voiding cystourethrogram excluded any degree of vesicoureteral reflux. During examination under anesthesia (EUA) a tiny orifice was noted in the urethro-vaginal septum just below the external urethral orifice through the orifice delineated whole of the ecotopic ureter. Right heminephrectomy was done including excision of the pelvis and proximal part of the upper ureter that was draining directly to the exterior. Postoperative recovery was uneventful and the patient got rid of the ever-disgusting problem.
Use of iodized salt and the prevalence of goiters in an endemic area of Bangladesh.
(2002-01-01) Sarker, Fazlul Haque; Taufiqun-Nessa, U K; Chowdhury, Shahjahan Ahmed
To find out the prevalence of goitre and assess the knowledge regarding goitre and iodized salt among the respondents in a selected goitre endemic area. This cross-sectional study included 155 respondents of purposively selected endemic villages of Nilphamary Sadar upazilla. Information was collected from all households of the villages considering one responsible person from each household. Data was collected by face to face interview through pre-tested questionnaire and checklist. Study population was 747. Department of Community Medicine, National Institute of Preventive & Social Medicine, Mohakhali, March to June 2001. Out of 155 respondents 63.87% was female and 36.13% were male. Mean age was 34.13 with +/- 10.87 and mean monthly family income was 1974.74 with +/- 1025.92 taka, only 65% had > 5000 taka. Level of education SSC and above was minimum (6.46%). Mean occupation was cultivation, day labour and housewife. Only 11.6% respondents had correct knowledge regarding goitre and 77.30% had knowledge about iodized salt. But only 58.71% respondents' families are using iodized salt according to test result by iodized salt testing solution. The prevalence of goitre among 747 people was found 8.3%, among them 4.53% were male, 12% were female and 6.96% were grade I and 1.07% were grade II (visible) goitre. The study result indicate that the prevalence of goitre still high, knowledge regarding goitre is minimum and use iodized salt is not satisfactory.
A comparative study of body iron status and lipid profile in acute myocardial infarction patients.
(2002-07-25) Sultana, N; Haque, M M; Ali, M S; Begum, B A; Jahan, N; Akter, S; Roy, M
This study was carried out to evaluate the relationship between body iron status and lipid profile in hospital admitted clinically diagnosed AMI patients considering the concept that there is a potential association between body iron status and coronary heart disease (CHD). Total 80 subjects were selected, of which 40 were healthy adults and 40 were AMI patients. Fasting blood samples were collected from healthy adults. Blood samples of AMI patients were collected within 24 hours of the attack of myocardial infarction. Body iron status was measured in term of 3 variables serum total iron concentration, TIBC and transferrin saturation. Lipid profile variables measure were total cholesterol, triglyceride, LDL-cholesterol and HDL-cholesterol. No correlation was found between serum iron and the variables of lipid profile. TIBC was found to maintain negative correlation with total cholesterol, triglyceride and LDL-cholesterol but positive correlation with HDL-cholesterol. Transferrin saturation was found to maintain strongly positive correlation with total cholesterol, triglyceride and LDL-cholesterol but strongly negative correlation with HDL-cholesterol. This correlation of TIBC and transferrin saturation with lipid profile supports the hypothesis that there is a potential association between body iron status and coronary heart disease.
Gastrojejunocolic fistula following surgery for peptic ulcer complications: two case reports.
(2002-07-25) Rahman, M; Miah, M A G; Sarwar, J M; Rahman, M
Two patients were admitted in the surgical unit--I of Mymensingh Medical College Hospital on January 2001 and March 2001 with the complaints of epigastric pain and discomfort, feculent eructation and fecal vomiting, diarrhoea with lienteric stools, weight loss and weakness. Both of them had previous history ulcer complications. The diagnoses of gastrojejunocolic fistula were made on the basis of history, barium enema examination and upper gastrointestinal endoscopy. Early resuscitation with correction of nutritional deficiencies, fluid and electrolyte imbalance was attempted along with blood transfusion, antibiotics and other supportive measures. But the first patient was too ill to cope up with the treatment and developed cardio-respiratory symptoms. A single stage procedure comprising of partial gastrectomy along with resection of the fistula and restoration of bowel continuity (by jejunojejunostomy, colocolostomy and closure of duodenal stump) was adopted in both patients. Early postoperative recovery was good in both but the first patient expired on 8th postoperative day from acute myocardial infarction, while the second one developed anastomotic leakage and wound infection, which were managed conservatively. On follow up the second patient was found in sound health till to date after his discharge from the hospital.
Brief report on Ziprasidone.
(2002-07-25) Firoz, A H M; Rahman, A H M M; Chowdhury, W A; Mamun, A A
Ziprasidone is a new antipsychotic with combined dopamine and serotonin receptor antagonist activity. The initial evidence suggests an effective dosage range of 80-160 mg/day. Clinical trials suggest that the drug is an effective antipsychotic in schizophrenia and schizo-affective disorder with a beneficial effect on negative symptoms and symptoms of depression. The main adverse effects appear to be somnolence (14%) and nausea (10%). Ziprasidone has relatively fewer side effects and yet has at least equivalent efficacy for florid 'positive' symptoms compared to conventional anti psychotics. The additional serotonergic actions deliver further efficacy against 'negative' and affective symptoms of schizophrenia. Reduced effects on cognitive abilities compared to conventional anti psychotics make Ziprasidone more attractive.

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