Delta Medical College Journal

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https://imsear.searo.who.int/handle/123456789/149784

Executive Editor: Dr. Md. Rezwanur Rahman

ISSN: 2307-6615 (Print)

Frequency: 2 issues a year

Language: English

An official organ of Delta Medical College.

Online Peer-reviewed journal

Web site: https://www.banglajol.info/index.php/DMCJ/index/

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Now showing 1 - 20 of 49

Juvenile Localized Scleroderma: A Very Rare Case.
(2015-07) Paul, Nibedita; Islam, Md Rafiqul; Nusrat, Nadia; Sharmin, Lazina; Hasan, Md Mahamudul
Juvenile localized scleroderma (JLS) is a rare chronic inflammatory and fibrosing disorder. It can result in significant morbidity, disfigurement, and severe functional, aesthetic and psychological disabilities. Patients with JLS should be identified early, evaluated extensively, treated aggressively, and monitored carefully. Here the case of a 2 year old boy is reported who was admitted into the department of Paediatrics of Delta Medical College & Hospital, Dhaka, Bangladesh with painful swelling of all fingers of both hands for 6 months and blackish patches over the fingers for the last one and half months. Left little finger was the first finger affected and there was flexion contracture of both left little and index fingers. The boy was diagnosed as a case of juvenile localized scleroderma and was confirmed by skin biopsy. We treated the child with methotrexate and prednisolone. It is very essential to raise awareness about this disease among clinicians and also parents for early diagnosis and treatment.
Congenital Rubella Syndrome - A Major Review and Update.
(2015-07) Nazme, Nure Ishrat; Hussain, Manzoor; Das, Ashith Chandra
Rubella is a major public health problem which is usually a mild rash illness in children and adults. However, it has devastating systemic consequences when rubella virus crosses the placental barrier and infects fetal tissue resulting in congenital rubella syndrome (CRS). Congenital rubella syndrome is an under-recognized public health problem in Bangladesh and the burden of the disease weighs heavily on patients and society; therefore, routine vaccination and other preventative strategies are strongly encouraged. Extensive surveillance studies should be conducted to eliminate CRS from our country. In this review, we will characterize the epidemiology of CRS; describe the patho-phyisiology, clinical features and laboratory testing for the disease, and discuss measures needed for prevention of rubella and CRS
Pattern and Pain Assessment of Musculoskeletal Disorders Attending to Physiotherapy Services in Selected Physiotherapy Centres of Dhaka City.
(2015-07) Amin,Md Ruhul; Akhter, Sanjida; Rahman, Kazi Afzalur
Background: Musculoskeletal disorders are the most common causes of severe long-term pain and physical disability, affecting hundreds of millions of people around the world. Among different modalities of treatment and management for musculoskeletal pain, physiotherapy might be cost-effective. Objective: The aim of the study was to determine the pattern and pain assessment of musculoskeletal disorders attending to physiotherapy services in selected physiotherapy centers of Dhaka city. Materials and method: It was a cross sectional study. Sample size was 400 and a pre-tested, modified, semi-structured questionnaire was used to collect the data. Data were analyzed using SPSS software version 16.0. Results: Majority of the respondents (69.2%) belonged to 46-65 year age group with least in extreme age groups. Mean±SD of age was 33.58±12.33 years. Most of the respondents were male (69.2%). Study revealed that neck pain (75.2%) was the major complaint followed by back pain (48.00%). Regarding pattern of pain, intermittent (73.2%) type was predominant. Muscle spasm (29.2%) was the main cause for musculoskeletal pain followed by degenerative diseases (27.5%). Of the respondents 55.00% received traction, 91.25% exercise, 21.25% manipulation, 97.95% short wave diathermy, 85.00% ultrasound therapy, 33.75% infra red ray, and 12.75% electrical stimulation as physiotherapy treatment. There were statistically significant difference between sex and severity of pain (p=0.019), educational status and pain persisting time in years (p=0.000). There was also statistically highly significant difference between severity of pain responses before and after physiotherapy treatment (p=0.000). Conclusion: Study concluded that common areas of musculoskeletal pain were neck followed by back and shoulder and pain characteristics were intermittent, radiating, numbness, burning in nature. Respondents had taken medication and different type of physiotherapy services, including traction, exercise, short wave diathermy and ultrasound therapy.
Photographic Estimation of Intercanthal Width of Bangladeshi Women.
(2015-07) Farhat, Nazma; Naushaba, Humaira; Chowdhury, Md Shahjahan; Karmakar, Mallika
Background: Estimation of intercanthal width and biocular breadth from digital photography is important in the evaluation of several systemic syndromes, craniofacial abnormalities and in surgical treatments of post-traumatic telecanthus. Dysmorphologists employ canthal measurements in evaluating the degree of hypertelorism. So intercanthal width and biocular breadth values are very important for clinicians, ophthalmologists, plastic and reconstructive surgeons. The reliability of estimation of intercanthal width from biocular breadth by using multiplication factor is high. Objective: To make an attempt to determine the multiplication factor for estimation of intercanthal width. Materials and method: This is a cross sectional study conducted in the Anatomy department of Sir Salimullah Medical College, Dhaka, Bangladesh from January 2010 to June 2011. One hundred Bangladeshi 25 to 45 years old women were selected purposively for the study. Results: The mean±SD intercanthal width was 3.456±0.3585 cm. Multiplication factor for measuring intercanthal width from biocular breadth (9.348±0.7174 cm) was 0.369±0.0232 cm. The mean±SD of estimated intercanthal width was 3.449±0.2647 cm. No significant difference was found between the measured and estimated intercanthal width. Conclusion: Multiplication factor can be used to determine intercanthal width in Bangladeshi women though agreement test would have been done to generalize the finding.
Breast Milk Iodine and Iodine Status of Breast-Fed Infants.
(2015-07) Molla, Golam Morshed; Arslan, M Iqbal; Milky, Mafruha Tazkin
Background: Breast milk is the only source of iodine for exclusively breast-fed infants. Iodine status of breast-fed infants depends on iodine in breast milk and also number of feeding in 24 hours. Iodine deficiency and iodine excess both have bad impact on infant’s health. Objective: To measure the iodine in breast milk and to evaluate iodine status of their breast-fed infants. Materials and method: This observational analytical study was carried out in the department of Biochemistry, Bangabandhu Sheikh Mujib Medical University, Dhaka with active cooperation of Kumudini Women’s Medical College Hospital, Mirzapur, Tangail involving fifty lactating mothers and their exclusively breast-fed infants. Early morning urine and breast milk samples were collected in dry and clean plastic container free from any chemical contamination. Urinary iodine was used as indicator for assessing iodine status. All statistical analyses were done by using SPSS (statistical programme for social science) 12 version software package for Windows. Results: The median (range) urinary iodine concentration of lactating mothers and their breast-fed infants were 225.25 μg/L (61.50-530.00) and 225.75 μg/L (100.50-526.00) respectively. The median (range) breast-milk iodine concentration was 157 μg/L (54.50-431.50) which was more than three times of recommended minimum concentration (50 μg/L). Only 2 (4%) lactating mothers had mild biochemical iodine deficiency (UIE, 50-99 μg/L). There was no biochemical iodine deficiency of breast-fed infants. Iodine in breast milk of lactating mothers was positively correlated with their urinary iodine excretion (p<0.01). Infant’s urinary iodine was positively correlated with iodine concentration in breast milk (p<0.01) and with urinary iodine of lactating mothers (p<0.01). Conclusion: Lactating mothers and their breast-fed infants in this study were iodine sufficient. If iodine content of breast-milk is within normal range, 10-12 numbers of feeding in 24 hours for infants is enough to get sufficient iodine from their mother’s milk.
Knowledge and Practice of Personal Hygiene and Sanitation: A Study in Selected Slums of Dhaka City.
(2015-07) Farah, Shayela; Karim, Mohoshina; Akther, Nasreen; Begum, Meherunnessa; Begum, Nadia
Background: : Slum dwellers are likely to be among the most deprived people in urban areas. Poor hygiene practices and inadequate sanitary conditions play major roles in the increased burden of communicable diseases within developing countries like ours. Objective: To assess the knowledge and practice about personal hygiene and environmental sanitation in selected slums of Dhaka city. Materials and method: This cross sectional study was conducted in purposively selected urban slum areas of Moghbazar slum, Bashabo slum and T&T slum of Dhaka city during February 2014 to April 2014. Convenient sampling technique was applied. Semi-structured pre-tested questionnaire was used and face to face interview was conducted. Total 475 subjects, irrespective of age and sex, were included in this study. Results: Out of 475 respondents, more than fifty percent slum dwellers resided in tin shaded room while 21.7% in ‘kacha’ houses. Sixty six percent of the respondents used to drink water from tube-well and 24% used supplied water provided by the city corporation. The study revealed that near 59% of the respondents used sanitary latrine. About 67% slum dwellers regularly practiced hand washing before taking meal and 59.2% respondents used soap after defecation. About fifty percent respondents brushed their teeth regularly with tooth paste. Regarding personal cleanliness, 81% subjects took bath regularly while 78% washed clothes irregularly. A statistically significant relation was found between washing of hands before meal (p=0.001), washing of hands after defecation (p=0.02), tooth brushing (p=0.001), bathing (p=0.009), washing of cloths (p=0.001), use of footwear (p=0.63) with knowledge of personal hygiene of the slum dwellers. Conclusion: Continuous community hygiene education along with adequate access to water supply and sanitation improves hygiene behaviour and policy makers and health care providers should have definite strategy and implementation.
Effect of Pre-treatment with Moringa oleifera (Drumstick) Leaves on Diabetogenesis Produced by Alloxan in Rats.
(2015-07) Nahar, Shamsun; Parveen, Feroza; Ara, Ferdous; Faisal, Ferdous Mahmud
Background: Medicinal plants constitute an important source of potential therapeutic agents for diabetes. Objective: In the study, we aimed to investigate the pre-treatment effect or preventive effects of Moringa oleifera (MO) leaves on blood sugar of rats. Materials and method: This experimental study was carried out in the department of Pharmacology and Therapeutics of Sir Salimullah Medical College in collaboration with Bangladesh Council of Scientific and Industrial Research (BCSIR), Dhaka. A total 24 long Evans rats were included in this study and divided in to four groups. Hyperglycemia was induced on rats using alloxan (100 mg/kg body weight, intraperitioneally). Blood sample was collected from tail vein by tail tipping method. Pre-treatment effect or preventive role of Moringa oleifera (drumstick) leaf powder on diabetogenesis produced by Alloxan in rats was tested by giving 50 mg/rat/day Moringa oleifera leaf powder for 14 days orally as pre-treatment along with standard rat feed. Then alloxan was administered intraperitoneally on 15th day of the experiment and 50mg/rat/day Moringa oleifera leaf powder was given for 7 days as post-treatment. Results: No significant effect of MO on blood glucose level was observed on normal rats and non significant hypoglycaemic effect was found in rats that were pretreated with MO. Conclusion: The present study suggests that Moringa oleifera leaf powder did not produce any significant protective effect in diabetogenesis produced by alloxan though it has hypoglycaemic effect.
Cancer Types and Treatment Modalities in Patients Attending at Delta Medical College Hospital.
(2015-07) Parveen, Rafia; Rahman, Shaikh Shofiur; Sultana, Syeda Adib; Habib, Zakir Hossain
Background: Cancer is a major health burden worldwide. By 2030, over 9 million cancer patients are assumed to die in developing countries from different types of cancers. Incidence of different types of cancers is increasing due to unhealthy life style. At present, lung cancer is most prevalent in Bangladeshi male whereas it is cancer cervix in female. Objective: To determine the frequency, pattern and treatment modalities in different types of cancer in different age and sex group to get an idea about national cancer scenario. Materials and method: A cross-sectional study was conducted on 1300 cancer patients attending at Delta Medical College Hospital within three months duration (from 15.07.10 to 15.10.10). Histologically proven malignant cases were included in the study. Results: There were 400 male and 900 female patients. Male: female ratio was 1:2.25. Among all patients, cervical cancer was the top most common malignancy (23.07%) followed by breast (22.46%). In male, lung cancer was found to be the most common cancer (15.75%), followed by non-Hodgkin’s lymphoma (13.75%), colorectal (12%), stomach (6.75%), and oesophageal (5.75%) carcinomas. In female patients, carcinoma cervix was the top most cancer (33.33%), followed by breast (32.33%), ovary (6.11%), gall bladder (3.77%), and colorectal (3%) carcinomas. Majority of cancers occurred in middle and older age groups. Combination of surgery, chemotherapy and teletherapy was the most common form of treatment. Conclusion: The findings of the study may provide a helpful clue to important facts and figures of different types of cancers in Bangladesh.
Plagiarism – A Noble Misconduct.
(2015-07) Rahman, Md Rezwanur
A Massive Ovarian Mucinous Cystadenoma: A Rare Case Report.
(2015-01) Gupta, Ruma Sen; Jesmen, Suha; Noor, Aysha; Shermin, Shahana
Ovarian mucinous cystadenoma is a benign tumour that arises from the surface epithelium of the ovary. It tends to be huge in size if not detected early. We describe a 32 year old woman (para 1+0) presented with marked abdominal distension, discomfort and vague pain in the abdomen with dyspepsia, anorexia, nausea, vomiting and irregular menstruation for last three months with the suspicion of pregnancy. On examination no findings were in favour of pregnancy, rather an ill defined abdominal mass about 30 weeks pregnancy size was found. Transabdominal USG revealed a big multiloculated ovarian cyst of about 25x20 cm. On laparotomy a huge cystic mass was noticed arising from left ovary. The cyst wall was smooth, intact and without any external projection though adherent with the left fallopian tube and left salpingo-oophorectomy was done. Histopathological examination revealed an ovarian cyst compatible with mucinous cystadenoma. Such giant ovarian tumours have become rare in current practice. This case report emphasizes the significance of thorough evaluation of all women presented with non specific complaints like vague abdominal pain or simple dyspepsia. Although the condition is rare, it is potentially dangerous in the massive form if not timely diagnosed and managed properly. With the increasing awareness of such conditions, more and more cases could be detected and reported early.
Adrenal Insufficiency - Aetiology, Diagnosis and Treatment.
(2015-01) Akter, Nazma; Qureshi, Nazmul Kabir
Adrenal insufficiency is caused by either primary adrenal failure or by hypothalamic-pituitary impairment of the corticotropic axis. Adrenal insufficiency, first codified in 1855 by Thomas Addison, remains relevant in 2014 because of its lethal nature. Though, it is a rare disease but is life threatening when overlooked. Main presenting symptoms such as fatigue, anorexia and weight loss are nonspecific, thus diagnosis is often delayed. The diagnostic work-up is well established but some pitfalls remain. The diagnosis is adequately established by the 250 μg ACTH (adrenocorticotropic hormone) stimulation test in most cases. Glucocorticoids provide life saving treatment but long-term quality of life is impaired, perhaps because therapy is not given in a physiologic way. Dehydroepiandrosterone-replacement therapy has been introduced that could help to restore quality of life. It may be useful in pubertal girls, but not in adults. Monitoring of glucocorticoid-replacement is difficult due to lack of objective methods of assessment and is therefore largely based on clinical grounds. Thus, long-term management of patients with adrenal insufficiency remains a challenge, requiring an experienced specialist Search strategy We searched Medline and PubMed for reviews and original articles related to adrenal insufficiency. Keywords used included adrenal insufficiency and incidence, prevalence, cause, origin, diagnosis, function test, imaging, hydrocortisone, glucocorticoid, mineralocorticoid, dehydroepiandrosterone, management, treatment, therapy, replacement, crisis, quality of life, well-being, pregnancy, prognosis, morbidity and mortality.
Rape in Rural Bangladesh.
(2015-01) Ali, Nowsher; Akhter, Sanjida; Hossain, Nur; Khan, Nashid Tabassum
Background: Rape is one of the silent brutal sexual offences in Bangladesh. Despite strong laws against it, the evil of rape continues to rise. Increasing trend of the silent cruel sexual offence (rape) represents a major psychopath sexual disorder and public health problem and progress of the country. Objective: The aim of the study was to determine the pattern of alleged rape victims in a rural district of Bangladesh with the ultimate aim to create public awareness about the brutal crime. Materials and method: This retrospective study was carried out on 330 sexually assailed alleged rape victims’ report forms, who reported at Faridpur Medical College, Bangladesh from 2007 to 2011 for medical examination. Results: Among the study subjects maximum number (70.0%) of alleged rape cases were under the age of 20 years. More than two-thirds (64.60%) of the assailants were known to the victims, most of the incidents (64.20%) occurred in the victims’ houses and nearby places. The study also revealed that minimum number of victims (14.20%) reported within 24 hours for medical examination. Almost one fourth of the alleged rape cases were gang rape and no positive finding in favour of sexual intercourse was found in about three fourth (72.40%) of cases. Conclusion: Public awareness about rape would be effective to report in due time with preserving the evidence of crime and modern techniques like DNA diagnosis may be of help to detect the assailant.
Current Microbial Isolates from Wound Swab and Their Susceptibility Pattern in a Private Medical College Hospital in Dhaka city.
(2015-01) Sultana, Shahin; Mawla, Nurunnahar; Kawser, Shamima; Akhtar, Nayareen; Ali, Md Khoybar
Background: Wound infection is one of the major health problems that are caused and aggravated by the invasion of pathogenic organisms where empiric treatment is routine. Objective: To isolate and identify the bacteria causing wound infection and to determine the antimicrobial susceptibility pattern. Materials and method: A total of 263 wound swab and pus samples were collected during the period of January to December 2012 from Delta Medical College and Hospital, Dhaka, Bangladesh. Swabs from the wound were inoculated on appropriate media and cultured and the isolates were identified by standard procedures as needed. Antimicrobial susceptibility testing was performed by disk diffusion method according to ‘The Clinical Laboratory Standard Institute’ guidelines. Results: In this study 220 bacterial isolates were recovered from 263 samples showing an isolation rate of 83.65%. The predominant bacteria isolated from infected wounds were Staphylococcus aureus 89 (40.45%) followed by Escherichia coli 62 (28.18%), Pseudomonas aeruginosa 34 (15.45%), Enterococci 18 (8.18%), Acinetobacter 5 (2.27%), Klebsiella 9 (4.09%) and Proteus 3 (3.36%). Staphylococcus aureus was sensitive to linezolid (94.38%), fusidic acid (91.01%), vancomycin (87.64%), amikacin (74.15%) and gentamicin (73.03%). Among the Gram negative isolates Escherichia coli was predominant and showed sensitivity to imipenem (93.54%) amikacin (83.87%) colistin (53.22%) and piperacillin and tazobactum (53.22%) and pseudomonas showed sensitivity to amikacin (73.52%), imipenem (70.58%) and colistin (70.58%). Conclusion: Staphylococcus aureus was the most frequently isolated pathogen from wound swab and the antibiotic sensitivity pattern of various isolates help to assist the clinician in appropriate selection of empirical antibiotics against wound infection.
Effect of Wheatgrass (Triticum aestivum) Juice on High Density Lipoprotein (HDL) Level in Experimentally Induced Dyslipidaemic Male Long Evans Rat
(2015-01) Afroz, Rokhsana Dil; Nurunnabi, Abu Sadat Mohammad; Khan, Md Ismail; Jahan, Tuhin
Background: Evidence shows that high density lipoproteins (HDLs) may exert multiple anti-atherogenic and anti-thrombotic effects that together decrease the risk of cardiovascular morbidity in hyperlipidaemic state. Experimental studies showed that fresh wheatgrass (Triticum aestivum Linn.) juice exerts lipid lowering effect as well as increases HDL-cholesterol level in rats. Objective: The present study was done to observe the effect of wheatgrass juice on serum HDL-cholesterol on experimentally induced dyslipidaemic rats evident by reduced HDL-cholesterol level. Materials and method: This experimental study was carried out in the Department of Pharmacology & Therapeutics, Dhaka Medical College, Dhaka, from July 2009 to June 2010. A total number of 48 healthy adult male Long Evans rats, age ranging from 2-3 months, and weighing from 140-200 grams were used for the present study. Six rats were taken in each group of total 8 groups treated differently with 1 control group. Rats of the first 5 groups were sacrificed at 29th day and their lipid profile was measured. Rests of the rats were sacrificed at 57th day and their lipid profile was measured. Results: Mean HDL-cholesterol of the group of rats treated with 10 mL/kg grass juice and 1% cholesterol diet, with 10 mL/kg grass juice and with 20 mL/kg grass juice were significantly increased (P<0.05, P<0.05, P<0.01 respectively). The mean HDL-cholesterol of the group treated with Atorvastatin for 28 days were also significantly increased (P<0.001). Conclusion: The present experiment showed that HDL-cholesterol level is increased by ingestion of wheat grass juice in experimental animals. Therefore, it provides the initial step for demonstrating cardio-protective effect of wheatgrass juice by increasing HDL-cholesterol level in blood in dyslipidaemic state.
Correlation between Aminotransferase Ratio (AST/ALT) and Other Biochemical Parameters in Chronic Liver Disease of Viral Origin.
(2015-01) Karim, Shah Md Fazlul; Rahman, Md Rezwanur; Shermin, Shahana; Sultana, Razia
Background: In recent years the ratio of aspartate aminotransferase (AST) to alanine aminotransferase (ALT) in patients of chronic liver disease (CLD) of various origins has gained much attention. This variable is readily available, easy to interpret, and inexpensive and the clinical utility of the AST/ALT ratio in the diagnostic workup of patients with CLD is quite promising. Objective: The present study was designed to find out the link between aminotransferase (AST/ALT) ratio with commonly measured biochemical parameters of liver function tests in CLD of viral origin. Materials and method: This cross sectional study was carried out in the department of Biochemistry, Sir Salimullah Medical College, Dhaka, Bangladesh. Forty four biopsy proven diagnosed subjects of chronic viral hepatitis without cirrhosis of both sex were selected purposively. With aseptic precaution 5 mL venous blood was collected from each subject and common liver function tests (serum AST, ALT, AST/ALT ratio, alkaline phosphatase, total bilirubin, serum total protein, serum albumin, serum globulin, serum albumin/globulin ratio, prothrombin time) and viral serology (HBsAg, Anti HDV antibody, Anti HCV antibody) were performed. Data were analyzed by SPSS version 19 for Windows. Pearson’s correlation test was done to determine association between AST/ALT with other biochemical parameters. Results: Mean(±SD) age of the study subjects was 32.55±10.55 years (range 20-50 years) with 48 (77.7%) male and 14 (22.6%) female subjects. Pearson’s correlation test was done between AST to ALT ratio with other biochemical parameters and prothrombin time showed significant positive correlation (p <0.01). Conclusion: In our study we found significant positive correlation between AST/ALT with prothrombin time in CLD subjects without cirrhosis.
Factors Affecting Gingivitis among Patients Attending in a Tertiary Care Hospital of Bangladesh
(2015-01) Zannath, Mst Mostary; Haque, Md Monoarul; Akther, Masuma
Background: Gingivitis is one of the common diseases in Bangladesh and a public health problem also. Broadly factors of two categories are responsible for the occurrence of gingivitis: anatomical and behavioral. Few physiological factors also have influence. In Bangladesh we have no national health survey on periodontal condition. Objective: The aim of this study was to find out the factors affecting gingivitis among patients of 15 to 40 years of age attending in a tertiary care hospital in Dhaka city. Materials and method: This was a cross sectional study and purposive sampling method was used. Total 200 samples were taken who fulfilled the inclusion criteria by pretested structured questionnaire in outpatient department (OPD) of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Results: The mean(±SD) age of respondents was 27±5 years. Dietary factors responsible for gingivitis were sweets (80%), followed by fast food (14%). Regarding behavioral factors, smoking (48%), tobacco using (8%) and betel nuts chewing (28%) influenced gingivitis. Most of the respondents (89%) were suffering from gingivitis for at least one year and gum bleeding was documented in 99% of respondents. Conclusion: Dietary and behavioral patterns were found to be responsible for gingivitis.
Hypofractionated Radiotherapy for Post-Operative Breast Cancer Patients at Delta Hospital - an Evaluation of Clinical Experience.
(2015-01) Banu, Parvin Akhter; Rukhsana, Naheed; Jabber, M A; Rahman, Motiur; Malik, Sadiq R
Background: As hypofractionated radiotherapy for post-operative breast cancer patients safe, effective and more convenient, it might be beneficial for patients of developing countries like ours. Objective: This study was done to evaluate the safety and efficacy of hypofractionated whole breast radiation therapy in patients who underwent breast conserving surgery and hypofractionated radiation therapy in patients who underwent mastectomy and axillary clearance. Materials and method: This cross sectional study was conducted in Delta Hospital Ltd, Dhaka, Bangladesh, including 50 postoperative patients, (12 patients in Breast Conservation Therapy group and 38 in Post Mastectomy Radiation Therapy group), with invasive ductal carcinoma of breast treated with this hypofractionated radiotherapy protocol during the last 1.5 year. The patients were treated with 3DCRT, LINAC, 6 MV photon and appropriate electron energy. Results: Minimal post treatment acute morbidity was observed. Forty seven patients (94%) had grade-I acute skin toxicity and only 3 patients (6%) developed grade-II acute skin toxicity. Conclusion: Hypofractionated radiotherapy is as safe and effective as conventional fractionated radiotherapy and superior in terms of convenience.
Ebola Virus Disease – Global Scenario & Bangladesh.
(2015-01) Rahman, Md Rezwanur
Acardiac Twin.
(2014-07) Maherunnessa, M S; Begum, Rahima; Jahan, Samsad; Bela, Shamsunnahar; Habib, Syeda Riffat Binta; Shermin, Shahana
Acardiac anomaly is a rare complication of multiple pregnancies. It is a hemodyamically disadvantaged nonviable twin which occurs in association with a twin reversed arterial perfusion sequence (TRAP). In TRAP, blood flows from an umbilical artery of the pump twin in reverse direction into umbilical artery of the perfused (or acardiac) twin via an arterial to arterial (AA) anastomosis. Its blood is poorly oxygenated and results in variable degrees of deficient development of the head, heart, and upper limb structures. The lower half of the body is usually better developed, which may be explained by the mechanism of perfusion. The pump twin is at risk of heart failure and problems related to preterm birth with a reported mortality of 50-75%. We present a case of multiple pregnancy with acardiac twin in a 26 year old lady with gestational diabetes mellitus. During ante natal check up several ultrasonographic (USG) screening showed twin pregnancy with one healthy fetus and the other fetus with inconspicuous anatomy and structure. Repeat USG at 36th week of gestation diagnosed twin pregnancy with acardiac twin. Strikingly the pump twin did not develop the usual complications and was delivered by cesarean section at 37th week of gestation.
Perioperative Management of Diabetes: A Review.
(2014-07) Kayes, Md Nazmul; Prodhan, NMN Kabir; Malik, Refat Hossain
Diabetes increases the requirements of surgery as well as perioperative morbidity and mortality. Careful preoperative evaluation and treatment of cardiac and renal diseases, intensive intraoperative and postoperative management are essential to optimize the best outcome. Stress hyperglycemia in response to surgery, osmotic diuresis and hypoinsulinemia can lead to life threatening complications like ketoacidosis or hyperglycemic hyperosmolar syndrome. Wound healing is impaired by hyperglycemia and chance of postoperative wound infection is more in diabetics. Therefore aseptic precautions must be taken. Adequate insulin, glucose, fluid and electrolytes should be provided for good metabolic control. Though some current study reveals that oral hypoglycemic agents can be used for the effective management of perioperative diabetes; the adverse effects of newly introduced agents need more clinical observations. Subcutaneous administration of insulin as in Sliding Scale may be a less preferable method, because of unreliable absorption and unpredictable blood glucose. Intravenous administration of rapid onset soluble (short acting) insulin as in Alberti (GIK) regimen, is safe and effective method controlling perioperative hyperglycemia. Patient with type 1 diabetes needs frequent monitoring of glucose, electrolytes and acid-base balance as chance of high hyperglycemia and ketoacidosis is more. In case of emergency surgery assessment for diabetic ketoacidosis (DKA) and meticulous management is essential. Postoperative pain and hyperglycemia should be treated carefully to avoid complications.

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