Study of Fasting Lipid Profile in Patients with Subclinical Hypothyroidism in a Tertiary Care Hospital in Bangladesh

Subclinical hypothyroidism (SCH) is a metabolic disorder with prevalence about 4-10% in general population. This study was conducted to observe the pattern of fasting lipid profile in SCH and to correlate the components of it with thyroid stimulating hormone and free thyroxin level. This cross sectional observational study included 31 newly diagnosed cases of SCH and 17 age and BMI matched healthy control subjects with normal thyroid function test. Fasting lipid profile was recorded and compared. TSH was significantly higher in SCH compared to controls (9.09±2.79 vs 2.31±0.92 μIU/ml; p=0.001). FT4 was comparable between the groups (1.17±0.18 vs 1.28±0.20 ng/dl; p=0.938). Significantly higher level of Total cholesterol and LDL-C were observed in SCH compared to controls (TC 194.77±29.70 vs 156.59±20.45 mg/dl; p=0.042 and LDL-C 124.81±27.85 mg/dl vs 88.59±18.41mg/dl; p=0.045 respectively). Triglycerides and HDL-C were comparable between the groups (TG 134.90±80.97 vs 118.12±49.14 mg/dl; p=0.171 and HDL-C 42.87±4.83 vs 44.47±5.66; p=0.633 respectively). TSH showed significant positive correlation with TC and LDL-C (r=0.591, p<0.001 and r=0.644, p<0.001 respectively), but not with TG or HDL-C (r=0.011, p=0.943 and r=0.115, p=0.435 respectively). FT4 only showed significant negative correlation with LDL-C (r=0.302; P=0.037) but not with TC, TG or HDL-C (TC: r=0.245, P=0.093; TG: r=0.121, p=0.411 and HDL-C: r=0.108, p=0.466 respectively). SCH is associated with raised TC and LDL-C. So patients with SCH are more vulnerable to develop future adverse cardio-metabolic complications. Faridpur Med. Coll. J. 2021;16(1):17-20

Laboratory Predictors of Esophageal Varices in Children with Chronic Liver Disease

Variceal bleeding results as a consequence of portal hypertension and it is a leading cause of morbidity and mortality of children with chronic liver disease (CLD). Upper gastrointestinal endoscopy is the only confirmatory tool for detecting esophageal varices but due to its invasive nature, high cost and lack of available facilities for pediatric endoscopy, alternative laboratory predictors are essential. In this study, we aimed at identifying laboratory predictors that may predict the presence of esophageal varices in children with CLD. This cross-sectional study was done at the department of Pediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, from July 2008 to June 2010. Fifty consecutive children with CLD, aged 3-15 years of both sexes, who had no history of active/recent variceal bleeding, taking beta blockers or surgery for esophageal varices were included in the study. All patients underwent history and physical examination. Venous blood of the patients was taken for laboratory analysis of serum bilirubin, serum alanine aminotransferase, serum albumin, platelet count and International Normalization Ratio (INR). Later, upper gastrointestinal endoscopy of the patients were done. Based on endoscopic findings children were divided into two groups. Group-I: CLD with esophageal varices included 29 children and Group-II: CLD without esophageal varices included 21 children. A univariate analysis was initially done on laboratory variables followed by a logistic regression analysis to identify the independent variables associated with presence of esophageal varices. Then performance of these independent variables were analyzed using upper gastrointestinal endoscopy as the gold standard test. Out of 50 patients 30 were male. Male-female ratio was 1.5:1. Fifty eight percent (29 out of 50) had esophageal varices. Amongst all the laboratory variables, thrombocytopenia (platelet count <150000/mm3) was an independent predictor of esophageal varices (p=0.018). Thrombocytopenia showed good sensitivity and specificity (82.7% and 80.9% respectively) to be used as a screening test for predicting esophageal varices in children with chronic liver disease. Thrombocytopenia can be used as an independent predictor for esophageal varices in children with chronic liver disease. Faridpur Med. Coll. J. 2021;16(1):3-7

Patient Delay and Stage of Diagnosis among Breast Cancer in Bangladesh

Early diagnosis and prompt treatment is the principal goal of physicians dealing with breast cancer. In breast cancer care there are several causes of delay. Delay in diagnosis may be either patient or health provider originated. Besides there are no effective surveillance system, no nationwide active campaign for early diagnosis and screening. Hence delay in diagnosis is not unlikely. The study was done in a Cross sectional setting during January to December 2009 at the Department of Oncology of Bangabandhu Sheikh Mujib Medical University, Dhaka Medical College Hospital, National Institute of Cancer Research & Hospital. A total 106 breast cancer patients were recruited for the study from the mentioned study places. Our data suggests on average 40 days delay from development of first symptom to attending traditional or unqualified provider. Time taken in transition from unqualified provider to qualified medical personnel was around another month. The time taken by medical personnel to establish the diagnosis through histopathology was around another 12.5 ±7.0 days, thereafter to perform surgery after diagnosis it took 17.8 ± 18.1 days. After surgery another 31.05±33.8 days were needed to start adjuvant chemotherapy or radiotherapy. Mean total time lapsed from appearance of symptom to perform surgery among breast cancer patients was 114.3±53.2 days with a median delay of 117.5 days. Mean total time lapsed from appearance of symptom to have chemotherapy or radiotherapy among breast cancer patients was 151.2±62.8 days with a median delay of 124 days. Regarding the cause of delay, in 53.8% cases, delay was resulted due to lack of awareness, in 38.9% cases delay was due to lack of money for treatment, in 7.5% case delay was due to the attempt to rely on alternative medicine, in 14.2% cases patients were reluctant, in 18% cases delay was due to problem in diagnosis. In 13.2% cases physician was treating the patient for other reason, in 36% cases patient herself made the delay for fear of consequences of disease or treatment and in 22% cases delay occurred due to long waiting period for surgery. In most cases delay resulted from multiple reasons. Patients with stages III & IV were found to have significantly more total delay than stage I & II diseases (p<.05). Patients with higher educated level made less delay than lower educated level. In conclusion, most important delay is caused by patient's own criteria and negligence. Awareness raising campaign may play an important role in reduction of the delay. Faridpur Med. Coll. J. 2021;16(1):12-16

Pattern of Complementary Feeding Practices among Mothers Attending at a Tertiary Level Hospital in Bangladesh

Optimal growth and development of a child depends mostly on proper breastfeeding and complementary feeding practices. However, many children yet suffer from malnutrition and the recommended practices of complementary feeding have yet not been established among the majority of the population. In this observational study, we looked for the causes behind the improper complementary feeding practices among the mothers attending the outdoor and indoor units of the Department of Pediatrics, Faridpur Medical College Hospital, Faridpur, Bangladesh, from January 2018 to January 2019. A total of 447 mothers were interviewed regarding their complementary feeding practices and data were analyzed to find out the demographic and social influences. The majority of the respondents were between the age group of 21-25 years (54%). Thirty five percent were illiterate, 60% were from the rural area, 78% were housewives, 64% came from a nuclear family, and 87% had a monthly family income of 5000-20000. Most of the deliveries were conducted at home (58%) and the most common source of feeding related information was healthcare workers (66%). Only 41% of the mothers started complementary feeding at the age of 6 months. The most common complementary food was Suji, 60% of them lacked the knowledge of food preparation and 35% of them practice forceful feeding to the children. The promotion of proper complementary feeding needs to be ensured to achieve the children's catch-up growth and development. Faridpur Med. Coll. J. 2021;16(1):30-33

Transverse Testicular Ectopia: A Rare Case Report

Transverse testicular ectopia (TTE) is a rare but well-known congenital anomaly that occurs 1 in 4 million in which both testes migrate toward the same hemiscrotum. In most of the cases it is an intra-operative finding, but preoperative diagnosis can be made by careful history taking, physical examination and imaging studies. Further evaluation is very important because it can be associated with other congenital anomalies. We report a case of TTE in a 32 years old male who presented with sudden painful swelling in right inguinoscrotal region. Physical examination revealed right sided obstructed inguinal hernia and left sided non palpable testis with underdevelopment of left hemiscrotum. On exploration, one testis is found within the hernial sac and the other testis within scrotum of same side. The testis which was already in right side of scrotum was kept in same place and the other testis which was found within hernial sac was kept in subdartos pouch at the root of right side of scrotum. Faridpur Med. Coll. J. 2021;16(1):52-54

Oral Nifedipine versus Intravenous Labetalol for Acute Blood Pressure Control in Severe Hypertension of Pregnancy: A Study at Faridpur Medical College Hospital

The first line antihypertensive treatment for severe hypertension of pregnancy includes labetalol, hydralazine, or nifedipine. Rapid but safe blood pressure control allows the definitive treatment, the delivery of baby to be carried out with minimal delay and good maternal and fetal outcomes. This non-randomized clinical trial was performed in Faridpur Medical College Hospital to compare the effectiveness and tolerability of oral nifedipine and intravenous labetalol in the acute control of severe hypertension of pregnancy. Total 50 admitted pregnant women with a viable fetus (>_ 24 weeks of gestation) having severe hypertension were allocated into two groups, Group A: 25 patients receiving oral nifedipine (10 mg), Group B: 25 patients receiving injectable labetalol (with incremental doses: 20, 40, 80mg). Up to 5 doses were tried for each drug at 15 minutes interval until target blood pressure (<_150/100 mmHg) was achieved. Baseline characteristics like mean age, mean weight, heart rate, systolic and diastolic pressures were similar in both labetalol and nifedipine groups. The average time required to achieve target blood pressure was 30.33 ± 10.44 minutes for labetalol and 25.63 ± 10.12 minutes for nifedipine (p=0.9129). Feto-maternal outcomes and adverse drug related effects were similar among the two groups. Both intravenous labetalol and oral nifedipine were found to be equally effective and well tolerated. Nifedipine may be preferable as it is a simple, flat dose schedule and an oral regimen. Faridpur Med. Coll. J. 2021;16(1):25-29

Correlation of Cardiac Troponin I with Left Ventricular Systolic Function in Patients with Acute ST-segment Elevated Myocardial Infarction

Myocardial infarction is one of the leading cause of death globally and following acute myocardial infarction prognosis depends on extent of myocardial damage. This study was aimed to correlate cardiac troponin I level with the left ventricular systolic function in patients with acute ST-elevated myocardial infarction. A total of 104 patients of acute ST-segment elevated myocardial infarction receiving streptokinase therapy within 12 hours of onset of chest pain were studied. Cardiac troponin I concentration was measured by immunometric assay and echocardiographic left ventricular ejection fraction was calculated by modified biplane Simpson's method. Left ventricular ejection fraction (LVEF) was compared with serum cardiac troponin I concentration. Study subjects were divided into two groups on the basis of LVEF. In group I, there were 54 patients with LVEF < 50% and in group II, there were 50 patients with LVEF >_ 50%. The mean cTnI within 12 hours of onset was 129 ± 8.7 ng/ml in group I and11 ± 2.1 ng/ml group II and the difference was statistically significant (p<0.001). Serum cardiac troponin I concentration has a strong negative correlation with left ventricular ejection fraction after first acute myocardial infarction. A level of serum cardiac troponin I >_ 6.6 ng/ml provided a good indication for LVEF <50% and this can be used to detect patients with higher risk. Faridpur Med. Coll. J. 2021;16(1):34-38

Drugs used for the treatment of COVID-19: A Review

COVID-19 is primarily a respiratory disease caused by a newly discovered SARS-CoV-2 virus and identified in the city of Wuhan, China in December 2019. World Health Organization (WHO) has declared this disease as a pandemic, and warned other countries. Presently this has affected 221 countries, areas or territories worldwide, Spreading of this disease is very fast in USA, India, Brazil, and Russia than in the country of its origin China. Like other coronaviruses, this may develop respiratory tract infections in the patients range from mild to fatal illness like pneumonia and acute respiratory distress syndrome (ARDS). Bangladesh, a country of 170 million people, is not an exception regarding COVID-19; it has been reported 5,70,800 confirmed cases with 8690 documented deaths. Still now no effective drug, vaccine, or any procedure is available and experiments are underway. However, empirical therapy is being followed to manage and save the lives of the patients. There is a need for pharmacological alternatives to combat this deadly virus and its complications. Based on the previous experiences with similar coronavirus management and present preliminary data from uncontrolled studies, drugs like Chloroquine, Hydroxychloroquine, Remdesivir, Lopinavir/Ritonavir, and Favipiravir have been recommended by the researchers to manage COVID-19. This review had assessed the potential mechanisms, safety profile, availability and cost of these drugs. This review concludes that the drugs mentioned above are having different properties and act differently in combating the COVID-19 viruses. Faridpur Med. Coll. J. 2021;16(1):45-51

A Study on Efficacy of Oral Itraconazole in the Treatment of Seborrheic Dermatitis

Seborrheic dermatitis is a common chronic disease. Malassezia yeasts have been implicated in the pathogenesis of this disease. Antifungal agents are known to be effective in the treatment of Malassezia yeast infections. This study was done to evaluate the efficacy of itraconazole in the treatment of seborrheic dermatitis. Sixty patients with Seborrheic dermatitis were evaluated in an open non-comparative study. Patients were treated with itraconazole capsule 100 mg twice a day for a week; then after a 3-week interval 100 mg capsule was given twice a day for 2 days of following months for two consecutive months. Four clinical parameters (Itching, burning erythema, scaling, and seborrhea) were assessed using a 0 to 3-point (0= absent, 1 = mild, 2 = moderate, 3 = severe) score. Mycological evaluation determined the presence of Malassezia spores in the scales using a direct smear. At the end of the initial treatment significant improvement was reported in four clinical parameters: Itching, burning erythema, scaling, and seborrhea. Maintenance therapy led to further improvement slightly. Burning sensation mildly improved during the treatment. The quantity of Malassezia spores present in the direct smear decreased throughout the treatment period. Blood test abnormalities were not found during the treatment. So initial treatment with itraconazole is beneficial in patients with seborrheic dermatitis. Faridpur Med. Coll. J. 2021;16(1):21-24

An Unusual Etiology of Submandibular Sialadenitis, Migration of an Ingested Fish Bone to the Submandibular Gland: A Case Report

Recurrent sialadenitis of submandibular gland can have multiple causes, one of the rare being foreign bodies. Motor vehicle accidents, assaults, bullet wounds and iatrogenic surgical fault are the most common causes of traumatic foreign bodies. Fish bone is one of the most common foreign bodies that gets lodged in the upper digestive tract, often located in the tonsil, base of tongue, epiglottis, pyriform fossa and esophagus, where it may be easily identified on routine inspection and removed. The forcible swallowing of food such as rice balls after ingesting fish bones by mistake may lead to the migration of the fish bone from the pharynx, throat or esophagus to the surrounding tissues. Migration most commonly occurs to the soft tissues of the neck, even to the thyroid gland, but migration to the submandibular gland has rarely been reported. Here, we present a case of submandibular sialadenitis due to unusual migration of ingested fish bone to submandibular gland. Foreign body ingestion may cause a series of complications and endanger a patient's life. Cases require high awareness and attentiveness on the part of the first physician to diagnose and manage the condition and appropriate health education should be imparted to the patient. Faridpur Med. Coll. J. 2021;16(1):55-57