Mymensingh Medical Journal

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Abdominal wall defect: a case report and review.
(2003-01-29) Hossain, G A; Islam, S M; Mahmood, S; Chakraborty, R K; Akhter, N; Nahar, K
Ultrasound is well recognized imaging modality for prenatal diagnosis of fetal congenital anomalies. However, precise diagnosis of fetal anomaly with gray scale ultrasound may not be possible at times. Color Doppler ultrasound compliments gray scale ultrasound in accurately diagnosing fetal anomaly. We report a case of an omphalocele with short lower limbs, diagnosed during 3rd trimester on the basis of color Doppler ultrasound. Gray scale ultrasound failed to diagnose the condition initially. Color Doppler sonography helped in accurate diagnosis. Findings were confirmed after termination of pregnancy.
Absorption and metabolism of paracetamol in rats drinking high concentration of arsenic.
(2005-07-02) Islam, N; Siddique, M A; Misbahuddin, M
The effect of chronic intake of arsenic on the plasma concentration of paracetamol in rat was investigated. Rats received saline water with or without arsenic trioxide (10 mg/kg body weight/day) by gastric gavage on every alternate day for 29 days. A single dose of paracetamol (range 10 infinity 40 mg/kg body weight) was administered by gastric gavage to both arsenic-untreated and -treated rats on 30(th) day. Rats were sacrificed after 30 min and the amounts of free paracetamol and its metabolites in plasma were estimated using isocratic reverse-phase High Performance Liquid Chromatography (HPLC). Arsenic toxicity reduced the plasma concentration of paracetamol to 53 - 65% when compared with the rats received no added arsenic. There were maximum 67.4 and 76.9% inhibitions of sulfate and cysteine conjugations of paracetamol respectively. But arsenic had no effect on glucuronide and mercapturate conjugations. Both liver and small intestine showed increased accumulation of arsenic and decreased amount of glutathione in arsenic-treated rats. This study suggests that chronic ingestion of arsenic inhibit the absorption and metabolism of paracetamol.
Advances in treatment and prevention of hepatorenal syndrome.
(2004-07-31) Rahman, S; Haque, M A; Sarker, C B
Hepatorenal syndrome (HRS) remains one of the major therapeutic challenges in clinical medicine today. The pathogenesis is complex, but the final common pathway seems to be that sinusoidal portal hypertension, in the presence of severe hepatic decompensation, leads to splanchnic and systemic vasodilatation and decreased effective arterial blood volume. Renal vasoconstriction increases concomitantly, renal haemodynamics worsens, and renal failure occurs. About 15 years ago it was shown that the renal failure is potentially reversible after liver transplantation. This potential reversibility together with increased understanding of the pathogenesis has led to successful preliminary attempts to reverse HRS nonsurgically with combinations of splanchnic vasoconstrictors and colloid volume expansion, insertion of trans-jugular intrahepatic portovenous shunt radiologically, and improved forms of dialysis. The aim of this chapter is to discuss the advances in the therapy of patients with HRS
Aetiology and primary prevention of type-2 diabetes mellitus.
(2002-07-25) Siddiqui, M Nazrul Islam
Alteration in iron status in pre eclampsia.
(2006-01-10) Basher, K; Deb, K
The aim of the study is to compare and contrast serum iron status in pre eclamptic women with normal pregnant women which may help in the establishment of diagnosis of pre eclampsia before appearance of its clinical manifestation. A total of 82 women in the last half of pregnancy, between 17 to 40 years of age, who attended the model family planning clinic, out patient and in patient departments of Obstetrics and Gynecology unit of Mymensingh Medical College Hospital, Mymensingh were selected for this purpose before any treatment was given in present pregnancy. Out of them 32 pregnant women were taken as control because they did not show any evidence of complication during the time of selection and 50 pregnant women were randomly selected as cases on the basic of having pre eclampsia. Mean value of serum iron was significantly increased in the pre eclamptic women in comparison to controls whereas mean values of both total iron binding capacity (TIBC) and unsaturated iron binding capacity (UIBC) were significantly decreased in pre eclamptic women in contrast to controls. The results allude to the possible contribution of released iron free radicals from ischaemic placenta in pre eclampsia to its etiology. So, routine investigation of serum iron status of pregnant women as part of antenatal checkup may help in the establishment of diagnosis of pre eclampsia before appearance of its clinical manifestation.
Alteration of blood pressure among the donors in a blood donation camp.
(2005-07-02) Pramanik, T; Adhikary, P; Roychowdhury, P; Ghosh, A
Anxiety can alter the cardiovascular parameters. In the present study, among the normotensive donors, the effect of anxiety on alteration of blood pressure and heart rate was assessed. Blood pressure and pulse rate were recorded in the volunteers just before blood donation and the results were compared with the blood pressure and heart rate recorded previously (one week before the camp) in the same population. There was a rise of both systolic and diastolic blood pressure with a significant increase in pulse rate just before blood donation. As the donors had previous experience of blood donation; the mental stress just before blood donation can be regarded as known stress -- which caused increase in norepinephrine secretion leading to peripheral vasoconstrictions and rise in diastolic blood pressure. Anxiety through sympathetic stimulation increased the heart rate, cardiac output and systolic blood pressure.
Alteration of serum copper in Kala-azar patients during SAG therapy.
(2007-01-09) Banerjee, M; Rahman, M; Shamuzzaman, A K; Akhter, S; Deb, K
We conducted an analytic case-control study in Kala-azar patients during Sodium Antimony Gluconate (SAG) therapy to assess the changes in serum copper. A total of 89 subjects were included in the study. Diagnosed patients of Kala-azar with parasitological evidence of Leishmania Donovani (LD) bodies in bone marrow, were selected as cases (n=54). They were selected from Medicine and Paediatric wards of Mymensingh Medical College Hospital, Mymensingh and nearby Fulbaria upazila of Mymensingh district. Physically healthy volunteers of similar age, sex and body mass index (BMI) as cases, were included in control group (n=35). The study period was from July 2003 to June 2004. SAG was given intramuscularly (20 mg/kg/day) to Kala-azar patients for 30 days. Blood samples were collected from controls, Kala-azar cases before therapy and same cases during 15-20 days of SAG therapy. Serum copper was higher in cases before therapy than those of controls (p<0.001). However, serum copper reduced significantly (p<0.001) during SAG therapy. So biochemical monitoring may be considered in the management of the disease.
Alteration of serum glucose level in infection and surgical stress.
(2005-07-02) Hossain, M Z; Latif, S A; Khalil, M; Mannan, S; Akhter, S
The present study was conducted to see the alteration of serum glucose level in infection and surgical stress. For this purpose a total number of 37 subjects in the age range (18 - 55) years were selected from Mymensingh Medical College Hospital from July 2003 to June 2004. Subjects were grouped as follows: control (n=13), infection (n=14) and surgery (n=10). Fasting serum glucose levels were estimated from all subjects by enzymatic calorimetric (GOD-PAP) method. A distinct and statistically significant increase in serum glucose level was observed in infection and surgery group in comparison to control group (p< 0.001).
An anatomical study on interventricular septum of postmortem hearts of adult Bangladeshi people.
(2008-01-21) Mannan, S; Sultana, Sz; Sultana, S; Rahman, Mh
To study the thickness of interventricular septum (both muscular and membranous parts) of adult Bangladeshi people, fifty postmortem hearts were collected, fixed in 10% formol saline and examined. The thickness of both muscular and membranous parts of the septum was measured. Among fifty hearts, thirty-six were collected from male and fourteen from female cadavers. All hearts were collected from medicolegal cases. The findings were compared between male and female cadavers of our country as well as with the findings of the western countries. The findings suggest that in female, the thickness of both muscular and membranous parts of the septum was less than that of male though there was no significant difference statistically (P>0.05). The findings were compared with the findings of other workers and not so much variation was found. There was no available data regarding the thickness of the membranous part of the septum to compare.
An anatomical study on pyramidal lobe of thyroid gland in Bangladeshi people.
(2008-01-21) Sultana, Sz; Mannan, S; Ahmed, Ms; Rahman, Mm; Khan, Mk; Khalil, M
The study was done to see the incidence of pyramidal lobe of thyroid gland including its position, attachment, length and incidence of its association with levator glandulae thyroidae in Bangladeshi population. Sixty postmortem tissue blocks containing thyroid gland and its related neighbouring structures were collected from 48 male and 12 female cadavers of different age groups and fixed in 10% formol-saline solution. Gross and fine dissection was carried out to study the incidence of presence of pyramidal lobe, its attachments, length, breadth and association with levator gladulae thyroidae. In the present study, findings were compared with those of Western and Bangladeshi researchers. It was evident that, fifty percent of the thyroids possesses pyramidal lobe. Incidence was more in male (52.1%) than in female (41.7%). It also appeared from the observations that, this lobe was commonly situated on the left side. In the majority of cases (56.66%), base of the pyramidal lobes were attached to the upper border of the isthmus with or without encroachment on the adjacent part of the left lobe. The range of length and breadth of the pyramidal lobe was from 1.8 to 35mm and 1.3 to 19mm respectively. In 73.33% cases, pyramidal lobe was associated with levator glandulae thyroideae and in only 26.66% cases pyramidal lobe was found independently.
Anemia in pregnancy in a northern district of Bangladesh.
(2005-01-08) Khondaker, A R; Obaidullah, M; Ahsan, R
Anesthesia for emergency cesarean section.
(2008-07-16) Haque, M F; Sen, S; Meftahuzzaman, S M; Haque, M M
Caesarean Section is one of the most common of all surgical procedures. Common indications for caesarean section may include foetal distress, Cephalopelvic disproportion and failure of labour to progress. Both regional and general anesthesia may be employed for caesarean section. Each is relatively safe and they have their own advantages and disadvantages. Actual decision to adopt one technique over another depends on maternal and foetal status and skill and ability of the anesthesiologist to tackle the situation with the aim of patient and baby safely. Among these, many of the cases come to the hospital as emergency basis. The Anesthesiologists have to face the challenge in providing anesthesia for emergency caesarean section, being the last member in the perinatal team. The challenge faces the risks in involvement of maternal changes in pregnancy, presence of foetal distress and various anesthetic complications arising in perioperative period. Still now anesthetic mishaps are considered as the sixth most frequent cause of maternal mortality. The use of regional Anesthesia reduced the number of deaths at about 80% but deaths involving general anesthesia has not decreased and the incidence is 17 times more than the regional anesthesia. Most of the deaths or complications are related to the airway management (also failed intubation). Better skill and knowledge in physiology, pharmacology and use of modern Anesthetic technique is essential to face the problems.
Angiographic severity and extent of coronary artery disease in patients with type 2 diabetes mellitus.
(2005-01-08) Uddin, S N; Malik, F; Bari, M A; Siddiqui, N I; Khan, G K; Rahman, S; Sadequzzaman, M
Coronary angiographic characteristics of fifty patients with type 2 diabetes mellitus and coronary artery disease (CAD) were compared with fifty non diabetic patients with CAD. Type 2 diabetic patients undergoing clinically indicated elective coronary angiography were individually matched with fifty non diabetic coronary artery disease patients for age, sex and major risk factors. No significant difference was present between the mean age, presenting complains and other coronary risk factors between the two groups. Severity and extent of coronary artery involvement was assessed by a coronary artery score (CAS) using the segmental distribution method for coronary artery lesions and morphometric analysis of atherosclerotic lesion was done. Type 2 diabetic patients had a higher CAS (11.74+/-5.04 vs 8.72+/-4.87; P<0.001) as compared to the non-diabetic patients. Multivessel disease were more prevalent in both the groups (82% vs 68%; P>0.05) but diabetic patients had significantly higher number of triple vessel disease (58% vs. 38%; P<0.001). Normal coronary arteries and single vessel disease were more prevalent in non-diabetic patients (32% vs. 18%; P<0.05). As compared to non-diabetic group diabetic patients had a higher total number of diseased vessels (78.66% vs. 68%; P<0.01), a higher lesion per patient ratio (3.94+/-1.80 vs 3+/-1.67:P<0.001) and more proximal lesions (40.83% vs. 34.70%; P>.05) though not statistically significant. Morphometric analysis of coronary artery lesions revealed that diabetic patients had significantly higher number of multiple irregularity lesions (24.37% vs. 15.33%; P<0.01) and lesions were more obstructive (lesion involving 70-90% of coronary lumen: 70.53.% vs. 57.33%; P<0.05). Though there was no significant difference between the systolic left ventricular function between the two groups but significant higher regional wall motion abnormality was found more in diabetic patients (76%vs 62%; P<0.01). So type 2 diabetic patients had more severe and extensive atherosclerotic lesion in their coronary arteries than the matched non diabetic control on coronary angiography suggesting an independent effect of diabetic mellitus on atherosclerotic process specially in our population.
Anti H.pylori IgM in Symptomatic and Asymptomatic Population.
(2009-01-03) Sumona, A A; Hossain, M A; Musa, A K; Shamsuzzaman, A K; Mahmud, M C; Khan, M S; Ahmed, S; Begum, Z; Zahan, N A; Ahmed, M U; Debnath, C R; Anne, R A
To evaluate the usefulness of specific IgM in the diagnosis of Helicobacter pylori infection, a cross sectional study was carried out in the Department of Microbiology, Mymensingh Medical College between July 2006 to June 2007. A total of 45 patients having upper gastrointestinal symptoms underwent endoscopy and were subsequently diagnosed as patients with gastritis, peptic ulcer (PU) and non-ulcer dyspepsia (NUD) and another 45 asymptomatic individuals aged 18-65 years, were included in the study. The serum samples of participants were tested for presence of anti-H pylori IgM by using ELISA method. The ELISA for anti H. pylori IgM provided sensitivity and specificity of 73.33%, 93.33% respectively.
Anti phospholipid syndrome.
(2009-01-03) Miah, M T; Hoque, M A; Sutradhar, S R; Mahmood, T; Tarafder, B K
Anti Phospholipid Syndrome (APS) is a relatively new conception of syndrome complex first noticed in 1983. It may be primary or secondary to other diseases like SLE, RA, Systemic sclerosis, behchet's syndrome, temporal arteritis, sjogren's syndrome psoriatic arthropathy etc. Clinical manifestations are consequences of vascular thrombosis and embolism like DVT, pulmonary embolism, stroke, TIA, complication of pregnancy with pregnancy loss. We report a 34 years married female housewife who presented with sudden onset of nausea, vomiting, vertigo, dysphagia, dysarthria and ataxia. She had a chronic leg ulcer. Neurological findings were consistent with lateral medullary syndrome due to stroke though she was normotensive, nondiabetic with normal lipid profile. She had history of two abortions in last three years. Investigations were done accordingly and she fulfilled the diagnostic criteria of APS. No secondary cause was detected after thorough clinical examination and laboratory investigations. She was treated symptomatically along with oral anticoagulation. She improved slowly but steadily.
Anticholesterol antibody: the way for reduction of hypercholesterolemia.
(2008-07-16) Sarkar, D; Latif, S A; Aich, J; Uddin, S N
Antibodies specific to cholesterol was first reported in 1925. It may develop in the body naturally and it is believed that this antibody has a protective role against harmful forms of cholesterol, such as LDL & VLDL. An immunoglobulin protein, anticholesterol may be found in both circulation as well as digestive tract. Many studies have been done on anticholesterol antibody. Our immune system may produce anticholesterol antibodies in response to elevated levels of cholesterol rich particles, such as LDL & VLDL. It can be induced in animals by conjugating or incorporating the cholesterol antigen into a variety of structures. Immunization markedly decreases the risk of developing atherosclerosis. In comparison to non-tumorous normal subject, the antibody is found to be significantly higher in non-small cell lung cancer (NSCLC). Elevated anti-cholesterol antibodies might be applicable for the serodiagnosis of NSCLC. Some studies showed that LDL immunization induces T-cell dependent antibody formation that protects atherosclerosis. Origo Biosciences scientists had identified a dietary antibody to cholesterol. This protein, when ingested, binds to cholesterol in the human digestive tract and blocks its absorption into the bloodstream. These studies may lead to us to realize the importance of anticholesterol and to find the way for reduction of hypercholesterolemia and thereby reduction of morbidity and mortality.
Antigen detection from urine of Kala-azar cases by latex agglutination tes.
(2008-01-21) Alam, M; Shamsuzzaman, Ak; Musa, Ak; Khan, Ah; Mahmud, Mc; Hossain, Ma; Ahmed, Aa
A recently developed Latex agglutination method known as "KATEX" for detecting leishmanial antigen in urine of Kala-azar patients was evaluated on 97 Kala-azar cases and 35 controls in the department of Microbiology, Mymensingh Medical College during the period from March' 2004 to February' 2005. The method yielded sensitivity as 100% and 82.8% in 33 confirmed and 64 ICT positive cases respectively. Since 8.6% controls showed antigen positive results, so specificity of KATEX was calculated as 91.4%. KATEX methods for antigen detection in urine should be used as an early immuno-diagnostic test as it has yielded high sensitivity. But interpretation of a positive test must be made cautiously having correlation with clinical findings as because it becomes false positive in Kala-azar free person. Further elucidation of KATEX method including larger population from community giving particular emphasis on its prognostic use was strongly recommended.
Antimicrobial use in paediatric wards of teaching hospitals in Bangladesh.
(2004-01-30) Akter, F U; Heller, D; Smith, A; Rahman, M M; Milly, A F
To ascertain the pattern of antimicrobial use and to assess its appropriateness a 4-month prospective study was conducted from January through April 1998 in paediatric wards of five selected medical college hospitals in Bangladesh. The hospitals were selected by simple random technique. Every patient in the paediatric wards of the selected hospitals who was being treated with antimicrobials during the data collection period was considered for the study. The treatment charts of 2171 admitted paediatric patients were reviewed. Pneumonia and diarrhoea were the two most common infectious diseases among them. The most commonly used antimicrobials were ampicillin, gentamicin, amoxicillin, cloxacillin and ceftriaxone. The majority of the admitted paediatric patients (56.1%) included in this study received two or more antimicrobials in combination for their treatment. The percentages of appropriate antimicrobial treatment of pneumonia, and diarrhoea were 57.1% and 67.8% respectively across the hospitals. The evident of high percentages of inappropriate antimicrobial treatment for the most common infectious diseases suggested the need for intervention to improve antimicrobial use in hospitals.
Antioxidant vitamins improves hemoglobin level in children with group a beta hemolytic streptococcal infection.
(2003-07-02) Ahmed, J; Zaman, M M; Ali, K
A study was done on school children infected with group A beta hemolytic streptococci to examine whether antioxidant vitamins play a role in improving the hemoglobin level. A total of 606 primary school children aged 5 to 15 years were randomly divided into two intervention groups. Group 1 (n=299) was treated with pehnoxymethyl penicillin V and group 2 (n=307) was treated with phenoxymethyl penicillin V plus antioxidant vitamins for eight weeks. From each group two blood samples were drawn in acute and convalescent (after eight weeks) states. Before treatment, mean hemoglobin values were 11.0 and 10.8 mg/dL in groups 1 and 2 respectively. After treatment hemoglobin values were 10.5 and 11.6 mg/dL respectively. Values were significantly decreased in group 1 (P=0.0001), whereas increased in group 2 (P=0.001). Adjustment for age and sex by ANCOVA confirmed the difference in hemoglobin levels between group (LS means-0.5 vs 0.8 in groups 1 and 2 respectively (P=0.0001). Hemoglobin level increases after antioxidant vitamin supplementation in children suffering from group A beta hemolytic streptococcal infection.
Arthrographic distension of the shoulder joint in the management of frozen shoulder.
(2005-01-08) Khan, A A; Mowla, A; Shakoor, M A; Rahman, M R
The study was an open randomized controlled trial to compare the outcome at 8 weeks with two different modalities in the treatment of 'Frozen shoulder'. Clinical cases with painful limitation of movement of shoulder were randomized to receive physical therapies alone versus physical therapies and shoulder arthrography with intra-articular steroid in a sequential randomization process. Cases suspected of having a concomitant illness and has potential to cause secondary frozen shoulder were excluded, such as, history of trauma to shoulder over the last 6 months, symptomatic clinical cervical degenerative diseases, and causes in and around the shoulder (infective and non-infective). Physical Therapies provided to all patients were therapeutic exercises, transcutaneous electrical nerve stimulation (TENS) and infra-red radiation (IRR). Outcome measures were improvement of pain on a Visual Analogue Scale (VAS) score and range of motion measured by Goniometer at 8 weeks. Patients were followed weekly for 8 weeks and outcome parameters were recorded on every evaluation. The baseline range of motion in the two groups was comparable. At 8 weeks a statistically significant difference in outcome were observed in the two groups. The chi-square means difference of improvement in range of motion for abduction was p <0.00 and for external rotation was p <0. 00. The pain reduction on VAS score was not significant in the two groups (p <0. 40). In the present small series, the distension arthrography with intra-articular (IA) steroid plus physical therapy was superior over physical therapy alone in the functional improvement of the frozen shoulder. Further studies with larger sample size are required to confirm the observations.

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