Faridpur Medical College Journal
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ISSN: 2079-3553
Frequency: Half yearly
Language: English
Open Access Peer-reviewed journal
Web site: https://www.banglajol.info/index.php/FMCJ/index
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Item A Rare Case Report on Benign Recurrent Intrahepatic Cholestasis.(2014-07) Niaz, M K; Ahmed, D S; Jannat, S N E; Masum, Q A A; Arifin, M S; Paul, B K; Ahmed, A; Jubaere, A K M; Hossain, M S; Sah, M P; Islam, M R; Sarker, A M; Titu, F A; Arafat, M Y; Paul, P; Islam, M S; Rahman, M; Jahangir, A; Gain, G; Mobin, A Q M; Hasan, M N; Saha, B N; Haq, S TBenign recurrent intrahepatic cholestasis is an inherited and occasionally sporadic disease presents as recurrent episodes of obstructive jaundice without any obstruction in billiary channel with intervening symptom free periods. Here we are presenting a case of 20-year-old male with a recurrent jaundice and pruritus who later diagnose as BRIC.Item Eisenmenger Syndrome - a Case Report.(2014-07) Khan, M I A; Ali, S Y; Hoque, M SEisenmenger syndrome (ES), the most advanced form of pulmonary arterial hypertension associated with congenital heart disease, is a devastating condition that has a considerable impact on patient's life. Patients who develop ES typically exhibit one or more of a range of cardiac defects including ventricular septal defects (VSD), atrial septal defects (ASD) and patent ductus arteriosus (PDA). The nature of the congenital defect underlying ES is important because it has prognostic implications. Early diagnosis & treatment of cardiac defect before development of pulmonary hypertension is the key to definite management, otherwise only supportive management can be offered. Our patient Mr. Abdul Khaleque, 55 years old, businessman, non diabetic, non hypertensive admitted in DAMCH, cardiac unit with the complaints of shortness of breath on exertion since childhood, bluish discoloration of nails and toes for 10 years, headache and vertigo for 2 weeks. Initially it was during severe exertion and relieved by rest. Gradually the severity of breathlessness has increased. Now he has developed NYHA class III. He had history of repeated attacks of cough with expectoration of mucoid sputum with occasional scanty amount of blood which did not foul smell and did not change with posture. We diagnose him as Eisenmenger syndrome secondary to ASD and treat him with only medical measure.Item Management of Patient with Sturge-Weber Syndrome: a Case Report.(2014-07) Karim, A K M B; Islam, M M; Hossain, M A; Alam, A M SSturge-Weber syndrome sometimes referred to as encephalotrigeminal angiomatosis, is a rare congenital neurological and skin disorder. This is case report of 7 years old mentally disabled boy, with long-standing seizures, with a portwine nevi on the right side of the face along the distribution of trigeminal nerve. Interictal encephalogram showed bilateral slow activity, pronounced in the right hemisphere, with epileptogenic activity in the right fronto-parietal region. Computerized tomography and magnetic resonance imaging showed intracranial calcifications and atrophy of the right hemisphere of brain. Professional counseling and support in addition to drug treatment provide help to patients and their family to overcome their problems and improve the treatment outcome.Item The Relationships between Thyroid Hormones and the Brain Serotonin (5-Ht) System and Mood: Of Synergy and Significance in the Adult Brain- A Review.(2014-07) Rahman, M H; Ali, M YThe use of thyroid hormones as an effective adjunct treatment for affective disorders has been studied over the past three decades and has been conformed repeatedly. Interaction of the thyroid and monoamine neurotransmitter systems has been suggested as a potential underline mechanism of action. While catecholamine and thyroid interrelationships have been reviewed in detail, the serotonin system has been relatively neglected. Thus, the goal of this article is to review the literature on the relationship between thyroid hormones and the brain serotonin (5-HT) system. In humans, neuroendocrine challenge studies in hypothyroid patients have shown a reduced 5-HT responsiveness that is reversible with replacement therapy. In the majority of the studies, the effects of thyroid hormone administration in animals will experimentally-induced hypothyroid sates include an increase in cortical 5-HT concentrations and a desensitization of auto inhibitory 5-HT1A receptors in the rap he area, resulting in disinhibition of cortical hippocampal 5-HT release. Furthermore, there is some indication that thyroid hormones may increase cortical 5-HT2 receptor sensitivity. In conclusion, there is robust evidence, particularly from animal studies, that the thyroid economy has a modulating impact in the brain serotonin system. Thus it is postulated that one mechanism, among others, through which exogenous thyroid hormones may exert their modulatory effects in affective illness is via an increase in serotonergic neurotransmission, specifically by reducing the sensitivity of 5-HT1A auto receptors in the raphe area, and by increasing 5-HT2 receptor sensitivity.Item Management of Hepatitis C Virus Infection - New Era Has Been Started.(2014-07) Islam, M M S U; Sarker, M N; Rahman, M; Uddin, M R; Rahman, A T M A; Biswas, GHepatitis C virus is a major cause of chronic hepatitis and is responsible for majority of liver transplantation worldwide. It has got no vaccine for prevention. Interferon containing regimen was the only management options for treatment of Hepatitis C virus till last year. Due to side effect profile and treatment cost this treatment options was not reachable for general population. Besides, response rate was not so satisfactory (Genotype 1, 40-50%, Genotype 2 & 3, 70-80%). New oral antivirals were introduced in 2014 which has got little side effect profile as well as good treatment response rate (80-95%). These new drugs with their different combination regimens along with indications, contraindications and treatment monitoring of Hepatitis C virus are discussed briefly in this review.Item Evaluation of Adherence of Drug Promotional Literatures (DPLs) to World Health Organization Guidelines.(2014-07) Sultana, A; Sorkar, C; Karmaker, MThere is limited mechanism to monitor the drug promotional campaign by pharmaceutical industries despite the fact that there is enough evidence of irrational pharmacotherapy increasingly encountered even in the developed countries. Unethical pharmaceutical promotional practice is a common cause of irrational pharmacotherapy which is a most common problem worldwide. Main objective of this study was to evaluate the medicinal promotional literatures provided by the pharmaceutical companies for accuracy, consistency and validity of the information presented in it, using World Health Organization (WHO) criteria for ethical medicinal drug promotion. Two hundred & fifty (n=250) literatures were collected randomly from selected doctors chambers in Barisal, Bangladesh. One hundred & thirty (130) of those literatures were excluded for being either duplicates, reminder literatures, promoting medical devices or cosmetics. The remaining (120) literatures were then screened to match their macro-informational contents against same advised in world health organization ethical criteria for medicinal drug promotion. The name of active constituent(s), content of active ingredient(s) per dosage form & brand name, were mentioned in 100% (n = 120) of promotional literatures, whereas dosage form were mentioned in 91.66% (n = 110), therapeutic indications were mentioned in 99.1% (n = 119) of literatures but informations on side effects mentioned in only 55.33% (n = 70), contraindications in 63.33 % (n = 76), precautions in 51.67% (n = 62) & references in 70 % (n = 84) of drug promotional literatures (DPLs). None of them mention anything about adjuvant. None of the promotional literatures fulfilled all the WHO criteria. Screened literatures were found to display poorly reliable and unbalanced medication information. Healthcare providers shall, accordingly, seek independent medicinal information sources, and not solely depend on commercial sources of medicinal information. Official regulators shall strictly define and mandate medication information contents in printed pharmaceutical promotional materials. Healthcare providers should, also, master the skills of appraising such promotional printed materials if rational medication use is to be achieved. Pharmaceutical industries did not follow the WHO guidelines while promoting their products, thus aiming to satisfying their commercial motive rather than fulfilling the educational aspect of promotion.Item Laparoscopic Versus Open Appendicectomy: A Comparison of Primary Outcome.(2014-07) Rahman, M M; Rahman, M S; Ahmed, G; Rahman, M M; Miah, M Z I; Nath, S CCurrently, laparoscopic appendectomy is widely practiced for the management of acute appendicitis. It is not clear whether open or laparoscopic appendectomy is more appropriate. Our aim was to compare the safety and the advantages of laparoscopic versus open appendectomy in a prospective study. 102 patients were participated in this study. The group 1 patients were subjected to laparoscopic appendectomy [LA], whereas the group 2 patients were subjected to open appendectomy [OA]. 46 patients included in LA group and 54 patients in OA group. The mean operative time for LA and OA was 84.4 (45-220) minutes and 59 (30-180) minutes respectively. Although LA was associated with a shorter hospital stay [LA-3.5 days versus OA-5 days] but duration of operation is prolong in LA than OA and the postoperative wound infection is significantly higher in OA than LA. LA is safe and superior to OA in respect to an early discharge, lesser postoperative pain; decreased post operative wound infection, early return to work and a better cosmetic scar.Item Circadian Variation in Frequency of Stroke in Bangladesh: a Hospital Based Cross Sectional Study.(2014-07) Hossain, A M; Saha, R; Tarafder, B K; Salam, M A; Islam, M R; Saleh, M A; Rahman, MA hospital based cross sectional study was carried out to analyze diurnal variation of stroke and their association to sleep awake cycle. Four hundred and two patients of stroke admitted in different Medicine Units of Faridpur Medical College and Dhaka Medical College Hospitals from July 2012 to June 2013 were chosen using purposive sampling technique. Enrolled patients were with their first stroke, subsequently proved by CT scan of brain. The initial clinical diagnosis of stroke was made from history and examination obtained from the patient himself or from his/her attendant. The time of onset of stroke was recorded by attending doctor at the time of assessment and recorded on a fixed proforma. Patient who could not give history properly or had no responsible attendant and who had history of head injury, intracranial space occupying lesion or bleeding disorder were excluded from the study. Age ranged from 25 years to 98 years with mean age of 62.02 years (+_SD 11.75 years). Out of 402 patients 59.7% suffered from ischemic stroke. Highest incidence of stroke (26.9%) occurred between 4:01am to 8:00 am and lowest (7.5%) between 8:01 pm to 12:00 am. Among the subtypes, ischaemic stroke has shown a single peak incidence at 4:01 to 8:00 am and lowest between 8:01 pm to 12:00 am. 50 % of ischaemic stroke cases developed between 0:01 am to 8:00 am. In this study, maximum number of patients developed hemorrhagic stroke between 4:01 am to 8:00 am (25.9%) and lowest number developed hemorrhagic stroke between 12:01 pm to 4:00 pm (9.3%). This study confirms the diurnal variation of both hemorrhagic and ischaemic stroke in Bangladesh and most of them occurs in early morning after wakening.Item Death due to Poisoning - a Medicolegal Study at Dhaka Medical College, Dhaka.(2014-07) Ahmad, M; Rahman, F N; Islam, M M; Majumder, M R USelf destruction or suicide by pesticide poisoning is a burning problem of Bangladesh. Rapid development in science and rapid growth in agricultural activities has led to the increase in the incidences of poisoning. The objective of this study was to find out the incidences and pattern of poisoning in an urban area, different aspects of poisoning along with demographic pattern, social factors related and other related perimeter, and modality to prevent loss of precious life due to poisoning. This retrospective cross sectional study was conducted among victims of poisoning at Dhaka Medical College, Dhaka Morgue during the period of January 2008-December 2009. Specific identification of poisons was made from Chemical Examiner's report. All the data were later on analyzed. A total of 5114 medico legal post mortems were performed during this study period. Among these 300 (5.87%) cases were suspected poisoning. Out of these cases specific poisons were identified in 131 (43.66%) cases. Among the detected poisoning cases OPC was the commonest agent 103 (78.63%) followed by alcohol/rectified spirit 12 (9.16%) and barbiturate 7 (5.34%). No poison was detected (Negative results) in 116 (38.66%) cases and no reports from chemical examiner were received in 53 (17.66%) cases during the study period. Out of 300 victims 174 (58%) were male and 126 (42%) were female. Highest incidence of poisoning was observed in 21-30 years age group 117 (39%) followed by age group of 31-40 years 84 (28%). Most of the victims were agricultural workers/ farmers 108 (36%) followed by housewives 51 (17%). Among the study subjects 178 (59.33%) were illiterate and 198 (66%) were married. Considering manner of death 274 (91.33%) victims committed suicide by poisoning and rests 26 (8.67%) were due to accidental poisoning. To reduce poisoning cases proper emphasis should be given for safe use of pesticides and consciousness should be created among the population about poisonous compounds. Detail study regarding death due to poisoning is required to be carried out in this country.Item Depression among Urban Adolescent Students of Some Selected Schools.(2014-07) Billah, S M B; Khan, F ITo determine the factors related with depression among adolescent students, 165 male adolescent students aged 15 to 19 years from 2 urban schools and colleges were interviewed with semi-structured questionnaire during January to June 2012.The socio demographic details, smoking and depression histories were recorded. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to measure the presence of depression. Smoking behavior was measured by a number of questions. Almost 49% respondents were depressed and 66% were smokers. Most of the respondents started smoking around the age of 14.3 years (54.1%) by the influence of their friends. Among the smokers 82.7% were depressed while 17.3% were depressed among nonsmokers (c2=19.69, p=<0.001). Parental smoking affected 62.5% respondents for depression against 59.4% normal respondents whose parents were non smokers (c2=7.52, p=.006). Domestic violence (c2=18.4, p=<0.001), familial disharmony (c2=18.44, p=0.001), stressful events in the life (c2=21.38, p=<0.001), failure in love (c2=12.6, p=0.002) also played roles for depression. After adjusting the non significant factors in logistic regression, familial disharmony (p<0.001), smoking (p=0.005) and stress (p=0.04) became significant factors associated with depression. Depression level was higher among adolescent smoker than nonsmoker students.Item A Comparative Study of Oral Ivermectin and Topical 5% Permethirn Cream in the Treatment of Scabies in Patient Suffering from Diabetes Mellitus.(2014-07) Khan, M M U; Ahamed, A R S; Islam, M A; Mostofa, K; Khan, M I A; Walid, K M; Showkath, M S; Khan, A M; Islam, M N; Akter, TScabies is one of the commonest diseases among all age groups. Topical permethrin is a widely used treatment option for scabies. Ivermectin is a newer oral agent for the treatment of scabies. This study was done to compare the efficacy of permithrin and oral Ivermectin in the treatment of Scabies in patient suffering from Diabetes mellitus. This comparative clinical trial was carried out in the outpatient department of Dermatology & Venereology, Diabetic Association Medical College Hospital (DAMCH), Faridpur from January 2012 to December 2012. A total 60 cases were enrolled purposively and divided into 2 groups. Group I received 2 doses oral Ivermectin and group II treated with 5% permethirn cream. Patients were followed up at the 3rd and 4th week. Total 86.6% patients of Ivermectin group and 90% of permethrin group were cured. Though permethrin showed somewhat more effective, the difference was not statistically significant. The study found that both ivermectin and permethrin were similarly effective in the treatment of scabies in patients suffering from Diabetes Mellitus.Item Comparative Study of Surgical Treatment of Chalazion.(2014-07) Hossain, K A; Rashid, M A; Islam, A K M RA chalazion is chronic lipogranulomatous inflammatory lesion caused by blockage of meibomian gland orifices & stagnation of sebaceous secretion. Common practices in treatment of chalazion are intralesional steroid injection, incision & curettage and excision of chalazion. Recurrence rate is high for incision & curettage in case of large chalazion. The aim of the study is to established that excision large chalazion give better result than incision & curettage. The study was carried out at Diabetic Association Medical College & Hospital, Faridpur and General Hospital, Fadidpur. A total 100 cases were selected for study. Technique of operation were incision & curettage through conjunctival surface and excision of chalazion through skin surface. In 50 % cases we performed incision & curettage both in small (size <5mm) and large (size >5mm) chalazion. In 50 % cases of large chalazion we performed excision of chalazion. The follow up period was 3 months to 6 months. In group -A with incision & curettage through conjunctival surface, in case of small chalazion 27 out of 30 patients were cured (90%). In case of large chalazion 14 out of 20 patients were cured (70%). In group B with excision of chalazion through skin surface, in case of large chalazion 49 out of 50 patients were cured (98%). So higher success rate after excision of large chalazion through skin surface.Item Nebulization by Isotonic Magnesium Sulphate Solution with Salbutamol Provide Early and Better Response as Compared to Conventional Approach (Salbutamol Plus Normal Saline) in Acute Exacerbation of Asthma in Children.(2014-07) Akter, T; Islam, N; Hoque, M A; Khanam, S; khan, H A; Saha, B KAsthma attacks are serious respiratory problem that can be lethal when not treated appropriately. Till today the main stay of therapy is short acting ß2-agonist. Unfortunately in acute asthma episodes this is not enough to relieve the bronchospasm and reduce dyspnea. The shortcoming of ß2-agonist therapy has resulted in the use of a variety of other treatment in the management of acute asthma. The use of magnesium sulphate is one of the recent treatment options. This study was done to compare the efficacy of nebulized salbutamol with magnesium sulphate versus salbutamol with normal saline in the treatment of acute exacerbation of asthma in children. This randomized controlled trial was carried out among 60 patients with acute exacerbation of bronchial asthma fulfilling the inclusion criteria, admitted in the department of Paediatrics, Mymensingh Medical College Hospital over a period of one year from January 2009 to December 2009. They were distributed randomly, 30 patients received nebulized salbutamol (0.15mg/kg; minimum dose 2.5mg) with 2.0 ml of isotonic magnesium sulphate solution and another 30 patients received the same dose of salbutamol with 2.0 ml of normal saline on 3 occasions at 20 minute intervals. With single dose of nebulization in the magnesium sulphate with salbutamol group, by 20 minute almost all 26 (86.7%) patients achieved at least 60% of predicted PEFR. Within 20 minute from control group none could achieve 60% of predicted PEFR. After second dose of nebulization control group started achieving 60% of predicted value. Regarding response criteria, with second dose of nebulization, at 40 minute 16 (53.3%) patient from magnesium sulphate with salbutamol group showed good response (PEFR>70% predicted). But within the first 40 minutes, none could show good response in control group. With 3rd dose of nebulization all from magnesium sulphate group showed good response but even at 60 minute, 5 (16.7%) patients in control group failed to be included as good responder. In conclusion, nebulization by isotonic magnesium sulphate solution with salbutamol provide early and better response as compared to conventional approach (salbutamol plus normal saline) in acute exacerbation of asthma in children.Item Food Safety in Bangladesh.(2014-07) Ali, M YItem Primary Tuberculosis of Tonsils: a Case Report.(2014-01) Islam, M R; Sanjowal, L; Islam, M S; Afrin, AThe occurrence of tuberculosis of the upper respiratory tract including oral cavity has become uncommon. Isolated tuberculosis in the absence of active pulmonary tuberculosis is very rare clinical entity. Here is a report of primary tuberculosis of tonsil, presented with complaints of sore throat.Item Nonsyndromic Aplasia Cutis Congenita: a Case Report.(2014-01) Hassan, K; Paul, A C; Fatema, K; Islam, RNonsyndromic aplasia cutis congenita is a condition in which babies are born with localized areas of missing skin. These areas resemble ulcers or open wounds, although they are sometimes already healed at birth. Lesions most commonly occur on the top of the head (skull vertex). In some cases, the bone and other tissues under the skin defect are also underdeveloped. If the baby is born by cesarean section, then the patient's attendants recognize the wound as an injury which might be performed by the surgeon at the time of cesarean section. We are reporting this type of a case whose father attempted to take legal procedure against the surgeon, but finally he understood that this was a congenital disease of his baby.Item Management of Inferior Vena Cava Injury in a Non Specialized Tertiary Hospital-a Case Report.(2014-01) Rahman, A S M T; Rahman, A S M Z; Shaha, R K; Biswas, S K; Biswas, S; Sen, SK; Biswas, G; Rahman, M MAbdominal vascular injury are among the most challenging and lethal injuries in the traumatized patients. Inferior vena cava (IVC) is the most frequently injured vein during the blunt or penetrating trauma. Ligation of IVC, venorrhaphy, venoplasty, end to end anastomosis, endovascular stenting or graft interposition should be considered in selected cases. However most of the procedures require special setting and surgical team. Relatively simple procedure e.g. venorrhaphy produces narrowing of lumen in many cases. Ligation of IVC may result in thrombosis and embolism thus increases morbidity of patients. Here, in the present case the authors report a patient with IVC injury repaired by venoplasty (cavaplasty) with great saphenous vein patch in a non specialized tertiary hospital and it can be performed by a team led by general surgeon.Item Management of Chronic Kidney Disease- an Update.(2014-01) Ahammad, FChronic kidney disease (CKD) is a global public health issue demanding continuous improvement in its management. Different international groups and organizations have now achieved a good progress in its definition, classification (staging), treatment and referral criteria to nephrologists. In definition of CKD, "CKD is defined as abnormalities of kidney structure or function, present for at least three months with implications for health", the phrase "with implications for health" has been added at the end of the previous definition, which reflects the concept that there may be certain abnormalities of kidney structure or function that do not have prognostic consequences (for example, a simple renal cyst). At staging of CKD, grade 3 has been subdivided into G3a and G3b, according to whether the glomerular filtration rate (GFR) is (59 - 45) or (44 - 30) ml/min/1.73m2, respectively. Furthermore, albuminuria has been classified in any GFR grade, in to A1, A2 or A3 according to the albumin-creatinine ratio (ACR) in an isolated urine sample for values <3, 3-30 or >30mg/mmol, respectively. The term "microalbuminuria" has now been replaced by the term "moderately increased albuminuria". For GFR measurement Chronic Kidney Disease Epidemiology Collaboration (CKD- EPI) equation has been preferred than the Modification of Diet in Renal Disease (MDRD) study equation and new 2012 KDIGO guidelines consider the use of alternative formulas to be acceptable if they have been shown to improve accuracy when compared with the CKD-EPI formula. For detection of albuminuria ACR is preferred rather than conventional 24 hours urine albumin. The recommended BP control target is <_140/90mmHg (both diabetic and non-diabetic) if ACR <3mg/mmol and a stricter target is suggested, with BP <_130/80mmHg, (both in diabetic and non-diabetic) if the ACR is >_ 3mg/mmol. Use of erythropoisis-stimulating agent (ESA) in anemia of CKD should be rational; to avoid its adverse effects like stroke, thrombosis or hypertension acceleration and hemoglobin goals should not exceed 11 g per dl. Treating dyslipidaemia in CKD with statins for all adults >50 years of age, irrespective of low density lipoprotien (LDL) cholesterol levels is recommended. Referral to nephrologist should be rational according to guidelines and at least one year prior to the start of renal replacement therapy (RRT).Item New Cholesterol Management Guideline 2013: A Review.(2014-01) Fattah, S A; Saha, A K; Alam, M T; Ali, M YManagement of high blood cholesterol is the key point for the treatment and prevention of Atherosclerotic Cardiovascular Disease (ASCVD). Till 2013, Adult Treatment Panel III (ATP III) report was the guideline for the physician for blood cholesterol management. The main feature of this guideline was to achieve a particular target cholesterol level by lifestyle modification, dietary changes and lipid-lowering drugs. But the recently released American College of Cardiology (ACC) and American Heart Association (AHA) guidelines shifted attention to Statin use at high-, moderate- or low-intensity instead of chasing a cholesterol goal. This article reviews the main features of this new guideline comparing to the previous one, where appropriate.Item Role of CT scan in the Evaluation of Lung Tumor with Cytopathilogical Correlation.(2014-01) Hoque, M S; Hashem, M A; Hasan, S; Siddique, A B; Hossain, A; Mahbub, M; khan, M I ALung cancer is an important & widespread disease that contributes a major health problem worldwide. Lung cancer kills over 1 million people per year. Cigarette smoking is the major cause of lung cancer. CT scan is the principal radiological examination adjunct to X-Ray chest examination in diagnosis & management of lung cancer. The main Objective of the study was to assess the diagnostic usefulness of CT scan in evaluating & characterize the different types of lung tumors and to correlate CT findings of lung tumors with that of cytopathology. This study was carried out in the department of Radiology & Imaging, Dhaka medical college hospital, Dhaka during the period from 1st January 2007 to March 2008. It was a cross sectional study. Total 51 patients were selected conveniently, detailed history particularly symptoms related to lung tumors was carefully elicited to obtain maximum possible information regarding the illness. Possible diagnosis was established by the combination of history, physical examination, laboratory & radiological investigations. Then patients were underwent CT examination of lung. Cytopathological sample were obtained from the lesion by guided aspiration. Collected FNAC samples were send for cytopathology & collected reports were compared with CT scan reports. Sensitivity of CT to diagnose lung tumor was 97.4%, specificity 76.9% & accuracy 92.2 %.