Journal of Enam Medical College

Editor in Chief:Prof Md. Aminul Haque Khan

ISSN 2227-6688:; (Print)

Frequency: 2 issues a year

Language: English

Official organ of the Enam Medical College, Savar, Dhaka, Bangladesh

Open Access Peer-reviewed journal

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

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Recent Submissions

Now showing 1 - 20 of 150
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    College News.
    (2015-09) Journal of Enam Medical College
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    Craniopharyngioma in a 7-Year-Old Child.
    (2015-09) Sharmin, Lazina
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    Hypomagnesaemia Posing as Hypoparathyroidism.
    (2015-09) Ahmad, Sonia Nasreen
    Persistent hypocalcaemia usually is a presentation of hypoparathyroidism. When it is coupled with low parathormone levels the diagnosis seems almost certain. However, the fact that hypomagnesaemia can give rise to both hypocalcaemia and low parathormone levels gives us points to ponder. This case depicts a young woman soon after childbirth presenting with carpopedal spasm and biochemical abnormalities. Subsequent correction of hypomagnesaemia readjusts calcium, potassium and parathormone levels.
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    Behcet’s Disease: Presented with Genital Ulcer.
    (2015-09) Afroz, Sayma; Ara, Gulshan
    Behcet’s disease which can affect almost every organ system of the body and is diagnosed mainly clinically is a rare condition. The presence of certain clinical features, elimination of other possible causes of patient’s symptoms and if possible proof of vasculitis by biopsy of an involved tissue supports a diagnosis. We report a young female presented with 7-day history of vulval ulcer and erythema nodosum. Diagnosis was made according to International Study Group criteria for Behcet’s disease and histological findings. She was treated with corticosteroid, colchicine and dapsone which caused significant clinical improvement. We report this case to increase awareness among physicians on Behcet’s disease to improve its management.
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    Role of Laparoscopy in Management of Ectopic Pregnancy.
    (2015-09) Banu, Hasina; Hui, Ju Wen; Hua, Liu
    Ectopic pregnancy means implantation of fertilized ovum outside the endometrial lining of the uterus. It remains the leading cause of early pregnancy-related death. Delay in diagnosis and treatment puts the life of women at risk. Laparoscopic surgery is increasingly becoming the preferred approach for ectopic pregnancy management. Laparoscopic treatment in ectopic pregnancy raises question of safety and feasibility when compared to laparotomy. In this review article our objective is to summarize the role of laparoscopy in management of ectopic pregnancy in comparison to laparotomy. For this, a literature search was done by using Google and PubMed. The selected articles were analyzed on laparoscopic treatment outcomes such as surgery success rate, operating time, intraoperative and postoperative complications, hospital stay, future fertility, postoperative recurrent ectopic pregnancy, cost-effectiveness in comparison to laparotomy. After analyzing all selected articles, it can be concluded that the laparoscopic management of ectopic pregnancy is safe, effective, and economical in comparision to laparotomy. So, for the patients’􀀀 benefit, laparoscopy should be considered as the gold standard method in management of ectopic pregnancy and is worthy to be popularized in clinical practice
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    Maternal Health Care Practices among Mothers of a Selected Slum in Dhaka City.
    (2015-09) Karim, Mohoshina; Farah, Shayela
    Background: Bangladesh is a small South Asian country which became independent in 1971 after a bloody war. Rapid urbanisation in Bangladesh (26% of the 147.1 million inhabitants live in urban areas) is fuelling a growth in urban poverty, particularly in the urban slums where the quality of life is extremely poor. The average population density in slums was reported in 2005 as 831 persons per acre or 205,415 people per square kilometre.1 Early commencement of antenatal care by pregnant women as well as regular visits has the potential to affect maternal and foetal outcome. Objective: To assess the status of ANC service used by the pregnant mothers and their socio-demographic characteristics. Materials and Methods: A community-based cross-sectional study was conducted at Moghbazar slum area in Dhaka district of Bangladesh, during January to June 2014. A total of 161 slum dwellers were enrolled in the study. Information regarding education, occupation, monthly family income, antenatal care was gathered using a pretested structured questionnnare and data were analysed. Results: The majority respondents had knowledge about antenatal care and of them 89 (55.2%) completed >􀀀3 visits. Forty five (47.8%) pregnant women received ANC from government hospitals. Nearly 72% mothers received ANC service from doctors and 16.9% received from family welfare visitors (FWV). Half of mothers were satisfied with the overall care provided to them. About 86.2% mothers said that they had to wait for more than two hours for check-ups. More than 50% received information about exercise and 36% were reassured about discussing fear and anxiety about pregnancy. Conclusion: This study reveals that antenatal care provided was not up to the mark of standard care and measures should be taken to improve it.
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    Neonatal Tetanus, Yet Not Gone: Infectious Disease Hospital Experience.
    (2015-09) Ehsan, Amimul; Akter, Shaheen; Salam, Fatema
    Background: Although neonatal tetanus (NT) has been declared eliminated from Bangladesh in June 2008, it is not uncommon in Infectious Disease Hospital (IDH) in Dhaka. There are various presentations of NT cases and treatment practices also vary. Objective: This study was conducted to describe our experiences with NT at IDH outlining the clinical characteristics, maternal immunization and treatment outcome. Materials and Methods: Thirty neonates admitted with tetanus in IDH from March 2011 to December 2012 were observed prospectively to study risk factors, clinical features and outcomes during hospital stay. Results: Among 30 neonates with tetanus 80% were male. Eighty seven percent of these cases were delivered at home and 83% of mothers did not receive any dose of tetanus toxoid (TT). Fifty percent of the neonates were admitted within 3–5 days of age. Shidur (Vermillion) was applied to the cord stump in 23% neonates. Hot soak was applied to the umbilicus in 5 (17%) neonates. Presenting features were convulsion and/or stiffness or rigidity (93%), inability to suck (90%) and umbilical infection (70%). During hospital care multiple cardiac arrests developed in 86% neonates and apnea developed in 60% of the neonates. Treatment was given in pediatric ward. Case fatality rate was 50%. Conclusion: Risk factors observed in NT cases were maternal non-immunization, unhygienic delivery practices and application of substances in the umbilicus. Antenatal TT administration and universal immunization under school health program should be more emphasized to prevent NT.
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    Prescribing Pattern in Outpatient Departments of Two Tertiary Care Teaching Hospitals in Dhaka.
    (2015-09) Begum, Halima; Rowshan, Mahfuza Mazeda; Khanom, Sayeda; Haque, Shammin; Afroze, Farhana; Dina, Ashrafun Naher
    Background: Medically inappropriate, ineffective and economically inefficient use of drugs is very common in our country. About 40% or more drugs expenditure may be wasted through irrational prescribing and dispensing. The need for promoting rational use of drugs is not only because of economic considerations; also it is an essential element for achieving quality of the health and medical care for patients and the community. For this purpose a cross sectional study was carried out among the individuals attending the outpatient departments (OPD) of Medicine, Surgery, Gynecology & Obstetrics, Pediatrics, Orthopedics, Dermatology & Venereology, Ophthalmology and Otolaryngology of two tertiary care teaching hospitals of Dhaka, Bangladesh. Objective: To observe the prescribing pattern in outpatient departments of two tertiary care teaching hospitals (Dhaka) by using World Health Organization (WHO) core prescribing indicators. Materials and Methods: Six hundred prescriptions of patients attending the OPD of Medicine, Surgery, Gynecology & Obstetrics, Pediatrics, Orthopedics, Dermatology & Venereology, Ophthalmology and Otolaryngology of Enam Medical College Hospital (private hospital) and Sir Salimullah Medical College Hospital (public hospital) were collected randomly on working days from April to September 2014. Then the prescriptions were analyzed by following the “Prescribing indicators form” as recommended by the International Organization of Rational Use of Drugs (INRUD)/WHO. Results: Average number of drugs per prescription was significantly high (3.07 in public hospital and 3.00 in private hospital). Generic prescribing was significantly lower in private hospital (4.00%) than that in public hospital (21.00%). Antibiotic prescription was higher in private hospital (42.35%). Injection prescribed in public hospital was 5.74% whereas 5.66% in private hospital. Drugs prescribed from Essential Drug List of Bangladesh were less in both the hospitals (42.85% in public hospital and 40.06% in private hospital). Conclusion: Average number of drugs per prescription was higher in both hospitals. Generic prescribing was lower in private hospital and prescribing from EDL was low in both hospitals.
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    Ultrasonographic Discrimination of Benign and Malignant Breast Lumps with Histopathological Correlation.
    (2015-09) Yasmin, Tarana; Sultana, Sohely; Amin, Mashah Binte; Arephen, Syed Shamsul; Rafat, Sania; Farzana, Tayseer
    Background: A lump in the breast is a cause of great concern. High frequency high resolution ultrasonogram helps in its evaluation. With major advances in ultrasonographic technology during the past 20 years, ultrasonogram can now distinguish benign and malignant solid breast lumps. Knowledge of the specific benign and malignant ultrasonographic characteristics of breast lumps is imperative for accurate diagnosis and optimal patient management. Objective: To determine the validity of ultrasound in the assessment of palpable breast lump by detecting the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of ultrasonogram in distinguishing benign and malignant breast lumps. Materials and Methods: This cross sectional study was done in the department of Radiology and Imaging of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka in collaboration with the department of Pathology of BSMMU for histopathological correlation during July 2008 to June 2009. A total of 100 patients who were clinically suspected of having breast lump were included in this study. Data on clinical presentation, ultrasonographic findings including histopathological reports were collected and documented in structured forms. Analysis was done using SPSS 13.0 version. Results: The study was done in 100 women of 18–70 years of age with mean age 41.46 ± 11.62 years. Breast lumps were found with associated clinical presentation of pain in 26 (26%) cases, discharge in 12 (12%) cases, skin changes in 28 (28%) cases, nipple retraction in 10 (10%) cases, and palpable lymph nodes in 10 (10%) cases. On ultrasonogram, lesions were diagnosed as benign in 62% cases and malignant in 38% cases. Out of sonographically diagnosed 62 benign lesions 58 (93.5%) were also proved benign histopathologically and 4 (6.5%) as malignant. Out of 38 sonographically malignant lesions, 34 (89.5%) were also proved as malignant histopathologically and 4 (10.5%) as benign. Conclusion: Ultrasonographic findings of benign and malignant breast lumps correlated well in most of the cases with the histopathological results. Therefore, it can be concluded that ultrasonogram is a useful imaging tool to discriminate benign and malignant breast lumps and thus we can reduce unnecessary breast biopsies, patient discomfort and anxiety in addition to increase in cost of the patient.
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    Study of Cerebrospinal Fluid (CSF) and Clinical and Electrophysiological Features of Hospitalized Patients with Gullain-Barre´ Syndrome.
    (2015-09) Huda, Md Nazmul; Khan, Mohammed Momenuzzaman; Azam, Bakhtiar; Uddin, Md Jalal
    Background: Since the elimination of poliomyelitis from most part of the world Gullain-Barre' Syndrome (GBS) has been the leading cause of acute flaccid paralysis which leads to substantial morbidity and mortality. Though GBS has received a lot of attention in developed countries, there is a paucity of reports on the GBS from the developing world including Bangladesh. Objective: The objective of the study was to correlate clinical, cerebrospinal fluid (CSF) and electrophysiological findings of hospitalized Gullain-Barre´ syndrome patients for early diagnosis and appropriate management. Materials and Methods: A total of 47 clinically diagnosed GBS patients admitted in Neurology, Medicine and Pediatrics departments of Dhaka Medical College Hospital (DMCH) were included in this quasi-experimental study. Biochemical, cytological and bacteriological studies of CSF of these patients were done. Electrophysiological studies of all subjects were done and values were compared with upper and lower limits of normal. Results: In this study, antecedent event were present in 55.30% cases and upper respiratory infection (23.40%) and gastroenteritis (21.30%) were the commonest antecedent disorders. All the study patients had numbness or paresthesia and limb weakness, and muscle pain was in 44.7% cases, facial weakness in 36.2% cases, ophthalmoplegia or ptosis in 6.4% and bulbar involvement was in 6.4% cases. Most of the patients (95.7%) had deep tendon hypo/areflexia followed by respiratory distress (21.3%), and ataxia (19.1%). Majority of the study patients (57.4%) required one week time to develop maximum deficit. Maximum subjects (70.2%) had motor type GBS followed by sensorimotor type (21.3%), Miller-Fisher type (6.4%) and sensory type (2.1%). Eighty three percent of the study patients had CSF protein concentration >45 mg/dL with mean ± SD of 71.32 ± 20.20 mg/dL (37–112 mg/dL). The cell count in CSF was <5 per mm3 in 95.7% of the study patients with mean ±SD cell count of 3.2 ± 1.80/mm3 (2–15 cells per mm3). The mean ± SD time to perform EMG was 9.4 ± 3.6 days with a range from 5–17 days and the mean ± SD disability grade at that time to EMG was 3.6 ± 0.9 with a range from 2–5. Regarding the electrodiagnostic types, the commonest pattern (40.40%) was found AIDP, AMAN was 29.80%, AMSAN 19.15% and mixed pattern was in 10.65% of the patients. Conclusion: This study reveals that clinical, CSF and electrophysiological findings accurately diagnose the GBS patients along with typing of GBS.
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    Outcome of Adjuvant Concurrent Chemo-Radiation in Operated Locally Advanced Rectal Cancer.
    (2015-09) Mustafa, Syed Arshad; Ismail, M; Zaffar, Saquib; Hassan, Ghulam; Qureshi, Waseem; Kadri, S M
    Background: Rectal cancer is one of the most common cancers in Kashmir, India. The clinical course of patients treated with surgery alone has been characterized by a high death rate and also by the pain and disability associated with pelvic recurrence of the tumor. Adjuvant radiation combined with chemotherapy has been studied for prevention of such recurrences. We treat more than 200 rectal cancer patients annually at our center. Most of the patients registered at our center are those who have been already subjected to surgery at the peripheral hospitals. We studied role of 5-fluorouracil (5-FU) and calcium leucovorin concurrently with radiotherapy in Dukes’ stage B2 and C and toxicities thereof in the adjuvant setting. Objective: To assess the outcome of concurrent chemoradiation in operated locally advanced treated cancer patients. Materials and Methods: In operated Dukes’ B2 and C rectal cancer patients, we conducted a prospective non-randomized study comprising of 40 patients between 2012 and 2014. Patients were treated with two hours protracted infusion of calcium leucovorin 500 mg/m2 on day 1 followed by 5-fluorouracil 500 mg/m2 on days 1 to 5 and repeated four weekly for total of six cycles. Radiotherapy of 45 Gray in 20 fractions was delivered concurrently with chemotherapy for first two cycles. Results: Combination of chemotherapy and radiotherapy in a concurrent setting appears to be more efficient in reducing local recurrence rates and improving survival than either modality alone. Toxicities with this schedule were mostly gastrointestinal mucositis, but no treatment interruption was needed. Conclusion: A combination of 5-fluorouracil and radiotherapy can be administered in operated locally advanced rectal cancer patients.
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    Promoting Global Health.
    (2015-09) Winker, M A; Ferris, L E
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    From the Desk of Editor-in-Chief.
    (2015-09) Khan, Md Aminul Haque
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    College News.
    (2015-05) Journal of Enam Medical College
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    Bilateral Acoustic Schwannomas in a 35-Year-Old Male.
    (2015-05) Amin, Mashah Binte
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    Emphysematous Pyelonephritis in a 32-Year-Old Diabetic Female.
    (2015-05) Rahim, Muhammad Abdur; Ananna, Mehruba Alam; Samad, Tabassum; Chowdhury, Tufayel Ahmed; Haque, Wasim Md Mohosinul; Iqbal, Sarwar
    Emphysematous pyelonephritis is a rare, severe, necrotizing renal parenchymal infection characterized by gas accumulation in kidney(s) with or without involving surrounding tissues. Patients with diabetes mellitus are the usual sufferers. Here we describe a case history of a young Bangladeshi diabetic lady who presented with dysuria, fever and abdominal pain. Investigations confirmed left sided emphysematous pyelonephritis. She responded to and recovered with intravenous antibiotics.
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    Pregnancy Located below the Internal Os --- Cervical and Caesarean Scar Ectopics.
    (2015-05) Bari, Sumia; Ara, Gulshan; Nessa, Kamrun
    Cervical pregnancy is an extremely rare condition with potential grave consequences if not diagnosed early and treated properly. Here we report two cases of early cervical ectopic pregnancy with a history of previous one caesarean section. One case severely bled during evacuation and curettage and was successfully treated by hysterotomy followed by digital separation of product of conception. Another case was managed conservatively by medical method with injectable methotrexate.
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    Medication Errors Associated with Look-alike/Sound-alike Drugs: A Brief Review.
    (2015-05) Rahman, Zaida; Parvin, Rukhsana
    The existence of confusing drug names is one of the most common causes of medication errors. There are many types of medication errors: wrong drug, wrong dose, wrong route of administration, wrong patient etc. Misreading medication names that look similar is a common mistake. These look-alike medication names may also sound alike and can lead to errors associated with verbal prescriptions. Similar sounding drugs may produce confusion and may lead to unintended interchange of drugs causing harm to patients or even patient death. The main aim of the study was to evaluate medication errors related to look alikesound alike drug names and to find out the strategies to prevent these medication errors.
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    Causes, Management and Immediate Complications of Management of Neonatal Jaundice --- A Hospital-Based Study.
    (2015-05) Hossain, Mahmud; Begum, Momotaj; Ahmed, Shafi; Absar, Md Nurul
    Background: Jaundice is very common in the neonatal period of life. Although it is not a major cause of mortality, it is an important cause of morbidity. So, assessment of the causes and risk factors of neonatal jaundice is very important. Objectives: The objectives of the study were to find out the causes of jaundice, its clinical features, evaluation of the outcome of current management strategy and complications encountered by the participating subjects following treatment. Materials and Methods: This prospective study was conducted in the Neonatal Unit of Rangpur Medical College Hospital (RpMCH) during July to December 2006. A total of 100 neonates having jaundice on admission or who developed jaundice following admission were included in the study. A number of investigations were done for the purpose of assessment of neonates and their icteric condition. The test statistics used to analyse the data were descriptive statistics, Chi-square (c2) and correlation tests. Results: In the present study the median age of the jaundiced newborns on admission was 5 days, while the median age of appearance of jaundice was 3.5 days. Most of the newborns exhibited jaundice 24 hours after birth and peaked by 3–4 days. Majority of the subjects (77%) had pathological jaundice and only 23% had physiological jaundice. This study shows septicemia was in 28% cases followed by asphyxia (20%), prematurity (18%), Rh incompatibility (15%), IUGR (11%) etc. Half of the newborns (51%) had serum bilirubin (indirect) >10 mg/dL. Gestational age and serum bilirubin was found to exhibit a negative correlation. Preterm babies also tend to develop severe to very severe jaundice more than their term counterparts (p<0.001). Birth weight was also found to bear a negative correlation with serum bilirubin. Low birth weight (LBW) babies also had a significantly higher tendency to develop severe to very severe jaundice (p<0.001). Of the 77 patients who were treated, about 64% received phototherapy, 61% received antibiotics and very few (5.2%) received exchange transfusion. Majority of the patients developed some sorts of complications. The predominant complications of phototherapy were irritability (40.8%) followed by skin rashes (26.5%), loose motion (20.4%) and dehydration (16.3%). Very few newborns (4%) had hyperthermia. All four babies who received exchange transfusion suffered from hypovolaemia, one developed hypoglycaemia and one exhibited anaemia. Conclusion: Neonatal jaundice is a leading cause of hospitalisation in the first few weeks of life throughout the world. Though management of unconjugated hyperbilirubinaemia in newborns has undergone changes based on emerging evidences, phototherapy and exchange blood transfusion are still the most commonly used effective modalities for lowering serum bilirubin level.
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    Association of Streptococcus with Plaque Type of Psoriasis.
    (2015-05) Hossain, Mohammad Akram; Khondker, Lubna
    Background: Guttate psoriasis has a well-known association with streptococcal throat infections, but the effects of these infections in patients with chronic plaque type of psoriasis remains to be evaluated. In Bangladesh several studies were done on psoriasis but no data about association between streptococcal throat infection and plaque type psoriasis are available so far. Considering the co-morbidities of psoriasis patients, it might be justifiable to find out the events that provoke the initiation or exacerbation of psoriatic disease process. Objective: To observe the association of streptococcus with plaque type of psoriasis. Materials and Methods: This observational study was conducted in the department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University, Dhaka. Forty seven patients clinically and histopathologically diagnosed as having plaque psoriasis were selected as cases and patients with skin diseases other than psoriasis were selected as controls. Results: In this study majority of subjects (55%) were diagnosed as chronic plaque psoriasis. Among the subjects with guttate flare of chronic plaque psoriasis 64.2% gave a positive history of sore throat. ASO titer was raised (>200 IU/mL) in 28 (59.5%) patients of chronic plaque psoriasis and 7 (17.9%) patients of non-psoriatic respondents. The difference between two groups was significant (p<0.05). Streptococcus pyogenes was found in 12 (25.5%) in chronic plaque psoriasis patients versus in 4 (10.2%) in controls (p>0.05). Conclusion: This study shows that streptococcal throat infections are associated with plaque psoriasis and early treatment of throat infections may be beneficial for plaque type of psoriasis patients.