Laboratory parameters of COVID-19 patients in Khulna, Bangladesh

Background: Recent studies have demonstrated the role of several laboratory tests in addition to RT-PCR in the diagnosis of COVID 19. Some of these, laboratory tests are indicators of the current state of the disease, while others have proved to be useful prognostic markers. Objective: The objective of our study was to evaluate the hematological, biochemical and radiological changes in COVID-19 patients. Methods: It was an observational and analytical study done retrospectively. The whole number of patients were included on the basis of inclusion and exclusion creteria. All were confirmed cases of COVID-19 patients either admitted in different hospitals or were in home isolation. Results: Total study cases was 112. Complete blood count revealed, leukocytosis was present in 9 (8.0%) cases and leucopenia in 8 (7.14%) cases. Neutrophilia was present in 27 (24.1%) cases; neutropenia in 9(8.0%) cases, lymphocylosis in 17 (15.2%) cases; lymphopenia in 28 (25%) cases. Neutrophil Lymphocyte ratio (NLR) revealed mean value of NLR 2.3(±1.1) with a range of 0.6-4.0. Decreased total circulating eosinophil count (<40/cmm) was found in 6 (5.3%) cases. Thrombocytopenia was found in 31 (27.7%) cases, Elevated ESR was found in 53 (47.3%) cases; CRP value was increased in 47 (42.0%) cases. Increased serum ferritin was found in 29 (25.9%) cases. D-dimer was increased in 35 (31.3%) cases; Xray chest showed bilateral pneumonia in 26 (23.2%) cases. High resolution computed tomography (HRCT) of chest revealed ground glass opacities in 11(9.8%) cases. Conclusion: Multiple changes in laboratory findings were observed such as altered NLR, elevated acute phase reactants, increased seromarkers (S ferritin, D-dimers) and also opacities in chest imaging. Bang Med J Khulna 2020: 53 : 13-16

Clinical presentation and outcome of snakebite cases in a teaching hospital

Background: Snake bite is an important but under recognised public health issue in Bangladesh. It is one of the important cause of mortality in our country specially in this southern part of Bangladesh. Objective: This study was carried out to evaluate the common type of snake bite in local area with their clinical presentation and outcome of admitted patients in hospital. Methods: Patients of snake bite diagnosed by history and clinical examination were consecutively selected for the study after fulfillment of inclusion criteria in the inpatient department of medicine ward, Khulna Medical College Hospital from July 2017 to June 2018. Data were collected and analysed afterwards. Results: Among 54 snake bite patients 27 (50%) were female and 27 (50%) were male. Twenty nine (53.7%) were venomous snake bite and 25 (46.3%) were non venomous. The common victims were farmers 14 (25.9%) and housewife 19 (36.2%). The bites were commonly encountered during walking (30%) in rural area. Bite also occured during sleeping (20%). The majority of the snake bite was observed during the month of June & July. Total 95% patient applied multiple tight tourniquet in the affected limb. A common local practice was to receive prehospital treatment from 'Ohzas'. Among 29 poisonous cases, drooping of the upper eyelid was present in 29 (100%) patients, External Opthalmoplegia and broken neck sign were present in 19 (66.6%) patients. Among the venomous snake bite cases 25 (93%) patients recovered completely after getting antivenom. Conclusion: Neurological manifestation (Ptosis, Opthalmoplegia, Broken neck sign) are very common in venomous snake bite. Early detection and application of antivenom is needed for better outcome. Treatment of venomous snake bite with Polyvalent serum is successful and safe. Bang Med J Khulna 2020: 53 : 23-26

Indiscriminate use of antimicrobials during Covid-19 pandemic

not available Bang Med J Khulna 2020: 53 : 1-2

Clinical features & outcome of dengue cases at a tertiary care centre

Background: Dengue is a very common seasonal public health problem causing significant mortality every year. In 2019 an outbreak occurred in Bangladesh. Few new manifestations and multi organ involvement were found. Objective: The objective of the study was to see the clinical and laboratory manifestations and outcome of dengue fever in a medical college hospital. Methods: It was an observational study in a medical college hospital in Bangladesh. Study period was one year. The patients were confirmed cases of dengue. Apart from detailed clinical history, examination of patient, relevant investigations and follow up was done until discharge. Result: Total number of cases was 98. Out of them 62 (63.2%) were male and 36 (36.73%) were female. Fever was most common (100%) manifestation and duration of fever ranged from 5 to 8 days with a mean duration of 6.3 (± 1.0) days. Among other symptoms generalized body ache was most common (63, 64.3%). Generalized weakness was present in 60 cases (61.2% cases) Bleeding manifestations was present in 41 cases; abdominal manifestations were found in 11 cases. Blood for NSI was positive in 94 (95.9%) cases; most cases (71, 72.4%) became positive between 2nd to 4th day. Ninety (91.9%) cases developed thrombocylopcnia and it started at 5th day in 45 (45.9%) cases. Blood transfusion was given in 12 (12.2%) cases & Platelet transfusion was given in 3 (3.1%) cases. Complete recovery was in 96 (98%) cases and Death occurred in 2 (2.0%) cases. Conclusion: Bleeding was a dominant presentation. Some atypical manifestations like gastro intestinal features were also observed. These findings will help physicians in early diagnosis of dengue. Bang Med J Khulna 2020: 53 : 3-7

Abstract From Current Literature Vol. 53 (1-2)

not available Bang Med J Khulna 2020: 53 : 35-38

Comparison of efficacy between intrathecal nalbuphine and fentanyl as adjuvant to hyperbaric bupivacaine for perianal surgery

Background: Intrathecal opioids enhance the duration of action of local anasthetic drugs. Both nalpuphine and fentanyl enhance the action of hyperbaric bupivacaine when introduced intrathecally as adjuvant with bupivacaine. Objective: Our study was aimed to compare the clinical efficiency of nalbuphine and fentanyl as adjuvant to hyperbaric bupivacaine for anal and perianal surgery. Methods: In this prospective randomized clinical trial patients were included from January 2007 to June 2008 at Khulna Medical College & some private clinics in Khulna. Patients were ASA (American Society of Anaesthesiology) status I & II of both gender aged 18-70 years and was randomized into two groups. Each group received either nalbuphine, (Group I) or fentanyl (Group-II) with bupivacaine. After intrathecal use every patient was examined for sensory and motor block, drug related side effects like hypotension pruritus, nausea, vomiting respiratory depression for three hours and were recorded. Results: Among two hundred study patients mean age was 49.5 and 5.2 in respective group I & II. Male female ratio was 16:14 in group I, whereas in group II it was 65:35. Mean duration of surgery was 46 and 43 minutes respectively in group I & II. Onset and cephalic extension of block was almost same in both groups. Time to recovery of sensory and motor block were significantly prolonged in Group 1. Duration of analgesia was also extended in group I. No significant drug related side effects were observed in either group. Conclusion: Nalbuphine as adjuvant to bupivacaine was clinically more efficient than fentanyl for post--operative analgesia and duration of sensory and motor block in SAB (Sub Aracnoid Block) for anal and perianal surgery. Bang Med J Khulna 2020: 53 : 27-30

Guidelines For Authors Vol. 53 (1-2)

not available Bang Med J Khulna 2020: 53 : 39-40

Association News-2020 Vol. 53 (1-2)

not available Bang Med J Khulna 2020: 53 : 41

Diagonostic parameters of polycystic ovarian syndrome in outpatient setting

Background: Polycystic ovarian syndrome (PCOS) is one of the most common endocrinopathy in reproductive age women. PCOS has complex etiopathology, diverse clinical presentation and diagnostic criteria. Objective: Objective of this study was to find out the determinant clinical feature and investigations for improving diagnostic accuracy and assessment of PCOS, thereby evolving opportunity for proper treatment. Methods: This prospective cross sectional observational study was conducted in Islami Bank hospital, Khulna, from January 2017 to February 2020. Women seeking gynecological consultation in outdoor with at least one complaint of oligomenorrhoea, hirsutism, weight gain or infertility were enrolled for study. Subjects were selected on the basis of inclusion and exclusion criteria. A structured proforma, based on relevant history, laboratory work up, risk factors and co morbidities were prepared before-hand. Diagnosis of PCOS was based on Rotterdam criteria, 2003. The clinical manifestations of PCOS, frequency of different sub phenotypes and associated morbidities were measured as outcome. Results: Total study population was 202. Age of subjects were in between 13- 37 years. Thirty seven (18%) were adolescent, one hundred forty (65.7%) patients were overweight and obese. Majority of cases were married. Complaint of infertility was present in 125 (61.9%) cases. Oligomenorrhoea, hirsutism, poly cystic ovary was present in 145 (71.8%), 137 (67%), and 130 (64.4%) patients respectively. LH/FSH ratio >2 in 45 (22.3%) cases, Serum free testosterone >0.79 ngm/ml were associated with hirsutism. PCOS with clinical sub phenotypes A, B, C, and D were 38(18.9%), 72 (35.6%), 27 (13.4%) and 65 (32.2%) cases respectively. Case morbidities were Hypertension 75 (37.1%), Diabetes mellitus 18 (8.9%) and Metabolic syndrome 44 (20.1%). Link with Hypothyroidism Hyperprolactinemia were identified in 47 (19%) cases. Conclusion: Oligo-anovulatory woman with hyperandrogenism with or without poly cystic ovary were diagnosed as a largest group of PCOS-A and B sub phenotypes. Infertility, hypothyroidism, hypertension, diabetes mellitus, metabolic syndrome and endometerial hyperplasia were common. Bang Med J Khulna 2020: 53 : 17-22

Effectiveness of tibolone in the management of postmenopausal symptoms

Background: Tibolone is a synthetic hormone relplacemert therpy prepration with estrogenic, progestogenic and androgenic tissue selective mechanism of action. It has advantages over traditional preparations of estrogen and progesterone considering the risks and adverse effects. Objective: To evaluate the extent of effectiveness and adverse effects of Tibolone. Method: This clinical trial was done in Khulna Medical College Hospital between January to December 2019. Postmenopusal women were selected by inclusion and exclusion criteria. Alternate participant was included in two different group. Participants of group A was treated with Tibolone for 6 months and participants of group B was treated with placebo for 6 months. Each participant was followed up after 3 and 6 months. Four categories of postmenopausal symptoms (hot flushes, night sweats, sleep disturbance and mood swinging) were evaluated. Participants were monitored for any adverse effects. Severity of postmenopausal symptoms was measured by using menopausal visual analogue scale. Results: Total 90 partcipants, were enrolled in this study, half of them were included in each group. Baseline assessment in group A participants revealed mild, moderate and severe symptoms in 05 (12%), 29 (64%) and 11 (24%) women respectively. After 6 months of treatment with tibolone, 35 (78%) participants became asymptomatic. This improvement is statistically significant (p<0.001). In group B, participant's baseline assessment revealed mild, moderate and severe symptoms in 07 (16%), 28 (62%) and 10 (22%) cases respectively. After 6 months of treatment with placebo, 02 (05%) women were asymptomatic. This improvement is not statistically significant. No adverse event was observed during treatment with tibolone. Comparison between the tibolone and placebo treatment group showed, tibolone treatment is better. Conclusion: Tibolone effectively relieves the postmenopausal symptoms and improves the quality of women's health at menopause. Bang Med J Khulna 2020: 53 : 31-34