Social Struggles and Treatment Seeking Behaviors of Infertile Women among Different Classes in the Urban Areas of Bangladesh

Background: Infertility is considered a taboo in the society of Bangladesh and is negated in reproductive health programs as well as in the research setting. Yet it is crucial and endemic for social and public health sectors. In Bangladesh, infertile women have to bear the drudgery of dishonor and shame because of their childlessness. The childless women have to shoulder most of the burden of ill-treatment for impotence regardless of who is at fault. Like other social stigmas, this also intersects across class, gender and setting barriers. Objective: The aim of the study is to understand the social struggles, stigmatization and treatment seeking behavior of infertile women of different classes in the urban context of Bangladesh. Methodology: A descriptive qualitative research methodology with in-depth interviews was used to collect data from 20 childless urban women aged between 18 to 45 years. They were urban residents for at least ten years and were aware of their infertile condition for at least one year. Results: The research results showed that childless women, irrespective of their class identities, always live with stigma, accusations and fear of abandonment in their personal lives. It also initiates an arena of violence. Many infertile women face physical and mental abuse due to their childlessness. The treatment seeking behaviors also vary based on financial conditions and the formality of the services among infertile women of different social classes. Conclusion: Infertility is a critical component of reproductive health. When a woman’s worth is measured by her reproductive functions, the childless woman faces humiliation and even abandonment. Attitude towards them is changed due to the societal norms and patriarchal social structures. This affects their treatment seeking behaviors as well. A proper understanding of the social condition of infertile women will facilitate the improved quality of women’s reproductive health care services. J Shaheed Suhrawardy Med Coll 2020; 12(2): 82-86

Three Port Laparoscopic Cholecystectomy by a Modified Technique

Introduction:Since the introduction of laparoscopic cholecystectomy (LC) several modifications have been introduced to its procedure. Main aim of these modifications is to improve cosmesis & reduce pain. Several institutes are routinely performing conventional 3 ports laparoscopic. In modified 3 ports LC, the third port was moved from right hypochondrium to umbilicus, to conceal it in the umbilical scar, thereby giving the three port comfort to the surgeon and two port benefits to the patient. Methods: This observational study was conducted in the Department of Surgery of Shaheed Suhrawardy Medical College & Hospital from September 2015 to October 2016. After taking valid consent a total 45 patients were selected for modified 3 ports LC. Here we tried to see the safety and benefit of this modified technique by assessing operating time, intra-operative complications, open conversion rate, postoperative wound infection, post-operative hospital stay, pain score and satisfaction with cosmetic outcome. Results: 3 patients were excluded from study due to different reasons. So, among total 42 (N) patients 30 (71.4%) were female & 12 (28.6%) were male. Operative time was 58.48 ± 32.52 minutes (range 34 to 180 minutes). 2 patients required conversion to open surgery. Pain score was 2.07 ±1.71 and cosmetic score was 8.67 ± 1.99. Conclusion: Modified 3 port laparoscopic cholecystectomy can be performed safely with a higher cosmetic satisfaction in selected cases by expert surgeon. J Shaheed Suhrawardy Med Coll 2020; 12(2): 90-94

Relationship between C-Reactive Protein and Cardiovascular Diseases in Patient with ESRD

Background- Cardiovascular mortality is significantly higher in ESRD patient.There are various risk factors for development of cardiovascular diseases including traditional risk factors, factors unique to ESRD patients and emerging risk factors.It is believed that their combined actions are integrated in the progression of atherosclerosis and inflammation plays a central role. C-reactive protein is a valuable marker of inflammation. Determination of serum creactive protein levels may be a useful predictor of cardiovascular diseases in ESRD patients Objective-To find out relationship between c-reactive protein and cardiovascular diseases. Methods- This cross sectional study was carried out into department of Nephrology, Dhaka Medical College Hospital, Bangladesh following fulfillment of inclusion and exclusion criteria. For analytical purpose total study population were divided into two groups on the basis of creactive protein level. Patients having c-reactive protein £6 mg/L were considered as group A and >6 mg/L were considered as Group B. The differences between groups were analyzed by unpaired t-test, fisher’ exact test or chi-square (X2) test. Multivariable regression analysis was done to see the association between c-reactive protein and cardiovascular diseases. Results- Patients with raise c-reactive protein have significantly higher cardiovascular disease than that of normal c-reactive protein. Multivariable linear regression analysis after adjusting for age, sex, smoking and diabetes shows that subject with CRP £6 mg/L vs >6 mg/L had 1.51 (95% CI 1.02 to 2.19) times increase risk of having cardiovascular disease. Conclusion- Inflammatory process has a role in development of cardiovascular diseases in ESRD patient. J Shaheed Suhrawardy Med Coll 2020; 12(2): 95-99

Surgical Treatment of Iatrogenic Low Variety Anal Stenosis with Diamond Flap Anoplasty – A Prospective Study

Background: Anal stenosis results from loss of anoderm with subsequent fibrosis and scarring of underlying tissue. The condition represents a technical challenge in terms of surgical management. It is a serious complication of anorectal surgery, most commonly seen after surgical haemorrhoidectomy. However, stenosis can also occur after perianal circumferential burn due to application of herbal medicine by village doctors. Objective: This study was conducted to see the outcome of diamond-flap anoplasty for the treatment of moderate to severe anal stenosis. Patients and interventions: Unilateral diamond flaps anoplasty was performed for moderate to severe anal stenosis. Final anal calibre of 25 to 26 mm was targeted. The demographic characteristics, causes of anal stenosis, number of previous surgeries, anal stenosis severity, postoperative complications and the time of return to work were recorded. Results: From July 2012 to January 2017, 18 patients (12 males, 67% and 6 female patients, 33%) with a mean age of 34 years (range, 25-52) were treated. 15 of the patients had a history of previous haemorrhoidectomy and 3 had circumferential perianal chemical burn due to application of herbal medicine by village doctors. Five patients (28%) had moderate anal stenosis and 13 (72%) had severe anal stenosis. Preoperative, intraoperative, and 12-month postoperative anal calibration values were 9 ± 3 mm (range, 5-15), 25 ± 0.75 mm (range, 24- 26), and 25 ± 1 mm (range, 23-27). The clinical success rate was 98.9%. No severe postoperative complications were observed. Conclusion: Diamond-flap anoplasty is a highly successful method for the treatment of anal stenosis caused by previous haemorrhoidectomy and perianal circumferential chemical burn by herbal medicine. J Shaheed Suhrawardy Med Coll 2020; 12(2): 67-71

Impact of COVID-19 Pandemic on Health Care Providers- Bangladesh Perspective

not available J Shaheed Suhrawardy Med Coll 2020; 12(2): 61-62

Gastric GIST: A Rare Cause of Upper GI Bleeding

Gastrointestinal stromal tumours are the most common mesenchymal tumours of the gastrointestinal tract. This case report highlights the necessity of early surgical intervention in such cases to avoid mortality due to bleeding and to raise the awareness of rare causes of upper gastrointestinal bleed and their management. A 19 year old male presented in the surgery department of Shaheed Suhrawardy medical College Hospital with complaints of recurrent episodes of melena with anorexia and weight loss for 6 months. Apart from anaemia no significant findings were noted on physical examination. Investigations including upper GI endoscopy was not conclusive. So he underwent laparotomy which revealed an exophytic growth along the lesser curvature. Lower partial gastrectomy was done and histopathological and immunohistochemistry report showed evidence of benign low risk GIST. As the tumor was benign with no malignant potential imatinib therapy was not advocated. J Shaheed Suhrawardy Med Coll 2020; 12(2): 119-122

Perforated Meckel’s Diverticulum with Pancreatic and Gastric Heterotropia and Acute Peritonitis - A Case Report

Meckel’s diverticulum, the most common congenital anomaly of small bowel although usually silent, can cause complications like intestinal obstruction, bleeding, diverticulitis, perforation etc. We report a case, which presented with acute onset of severe pain in right iliac fossa which was clinically and sonographically diagnosed as acute appendicitis. Histopathological report of appendix was non specific findings. Four days after appendectomy patient again came with features of acute abdomen. X-ray abdomen showed free gas under diaphragm. Abdomen was explored with a midline incision, a perforated Meckel’sdiverticulum was found which was managed by wedge resection and repair of the ileum. Histopathological examination of specimen revealed diverticular wall with normal appearing intestinal mucosa and muscle coat which showed two heterotrophic tissues (pancreatic and gastric ) in the wall.These also showed features of perforation and acute peritonitis. This is probably the first case of Meckel’s diverticulitis with heterotropic pancreatic and gastric tissue in Bangladesh. J Shaheed Suhrawardy Med Coll 2020; 12(2): 115-118

Analysis of Maternal Death in a Tertiary Care Hospital

Objectives: Maternal death was analyzed in Shaheed Suhrawardy Medical College hospital to improve the quality of maternal health care. Methods: In this cross -sectional study, each case was reviewed individually and factors responsible for maternal death were identified and noted. Results: During the study period January 2019 to December 2019 total 16 maternal death recorded among 3410 deliveries. 68% deceased mother were less than 30 years of age. Parity shows 37.50% multipara. 75% deceased mother was delivered by caesarean section, 6% was vaginal delivery and 12.5% mother died undelivered. Regarding time interval 25% of death occurred within 24 hours of admission to hospital. The main causes of death were severe preeclampsia- eclampsia (31.25%), PPH (12.5%), septicemia (12.5%), DIC (12.5%). Some factors were identified and among them lack of proper ANC, delayed admission to hospital, delayed blood transfusion were related. Conclusion: Substantial number of maternal death occurred at or <30 years of age. Preeclampsia-eclampsia, hemorrhage, septicemia were identified as the major cause of maternal death. J Shaheed Suhrawardy Med Coll 2020; 12(2): 63-66

A Clinicopathological Appraisal of Port-site Infections after Laparoscopic Cholecystectomy: Our Experience at Shaheed Suhrawardy Medical College Hospital

Background: Undoubtedly the port site infections have remarkably enhanced to be a stigma as post laparoscopic morbidity and is still a field of debate and further exploration to surgeons. These port site infections (PSI) are infrequent surgical site infection, complicating the recovery of patients undergoing laparoscopic cholecystectomy. Hence, the necessity of further evaluation of the regarded facts was intended to be explored. Aim: This study was aimed to evaluate the factors that created or provoked PSI after laparoscopic removals of gall-bladder and at analysing which of these factors can be traced and modified to combat PSI in a trail to conquer these complications and to achieve maximum advantages from laparoscopic surgeries. Methods: A prospective descriptive qualitative study conducted on patients who underwent laparoscopic cholecystectomies in our hospital as well as at other facilities remote from our work stations. Factors as gender, site of infected port, types of microorganism, acuteness versus chronicity of the disease, types of infection (superficial or deep infection) and intraoperative spillage of stones, bile or pus were analysed in our study. Swabs were taken for culture and sensitivity tests in all patients who developed infections. Explorations were done under GA for some patients who had deep surgical site infections and wound debridement was done, excisional biopsies were taken for histopathological studies, and tissue samples for Gene-Xpert analysis for detection of Mycobacterium tuberculosis was done. All patients were followed up for six months postoperatively at our surgery unit rooms. Results: Port site infection rate was recorded in 40 cases amongst 340 procedures from the July 2018 to June 2020 (11.76%). A higher rate was observed in female patients 32 cases (9.41%) and 13 cases (3.82%) of acute cholecystitis. Larger number of cases of the PSI were superficial infections (77.5%) with non-specific microorganism in 34 cases (80.0%). Conclusion: We reconciled a significant association of PSI with spillage of bile or stones during the procedure and with acute cholecystitis. Most of the infections are superficial and more common in males. Precautions and protocols should be taken in measure to avoid unnecessary hurry and faulty procedure of sterilization during and prior to the whole surgery to combat PSI effectively. J Shaheed Suhrawardy Med Coll 2020; 12(2): 76-81

Domestic Accidents among the Children in a Selected Rural Area

Background: Children are very prone to accidents which more often occur in and around the house. These domestic accidents are one of the five leading causes of death in both industrialized and developing countries. Objectives: The present study was conducted to determine the proportion and pattern of domestic accidents among the under 15 children of rural areas of Bangladesh. Methodology: This cross-sectional type of descriptive study was carried out from October 2015 to May 2016. Parents of 735 children below 15 years of age from Kaliakair Upazilla under the district of Gazipur were interviewed through a pretested semi structured questionnaire. The study place was selected conveniently and the sampling technique was purposive type of nonprobability sampling. Results: The present study revealed that, about one fourth (23.4 %)of the 735children were affected by domestic accidents.Among them injuries from sharp objects and falls from heights were equal (33.1% each) and were the leading causes of domestic accidents. The next leading cause was due to burns (8.7%) and then burns from hot liquids were 7.6%,Injuries from blunt objects were 6.4% and drowning were 4.1%. Kerosene poisoning (0.6%), insect bites (0.6%) and snakebites (0.6%) had the lowest incidence. Majority (53.7%) of the children in this study were male and 46.3% were female and their mean age was 7.05 (±3.842)years. Mean age of the affected children was 7.66 (±3.583) years and age group of 7-9 years were largely (29.1%) affected.Male children were affected more (59.3%) than female children.The children of class IV were affected mostly (48.8%). Most of the children of the study as well as the affected children belonged to nuclear families (61.8% & 65.7% respectively). The mean monthly family income of the respondents was 17260.82 (± 12726.70)taka and that of the affected group was 17125(±13303.60)taka. Children living in semi pucca house affected by domestic accidents more (65.1%) than children living in other housing. Most (56.4%) of the accidents occurred in the surroundings of the house and the rest (43.6%) occurred inside the house. Maximum (32.55%) accidents took place in winter, whereas 30.23% in summer, 23.25% in the rainy season, 6.4% in autumn, 6.4% in late autumn, & 1.17% in spring. All the 7 cases of drowning occurred in rainy season. It was found that only 6.98% of affected children suffered from disabilities. Among the affected children 59.8% took treatment and 7% children took preventive measures. Conclusion: From this study it was concluded that nearly a quarter of the children were affected by domestic accidents and the leading causes of the accidents were injuries from sharp objects and falls from heights. To build up awareness and explore the situation in detail, in depth community based epidemiological study may be carried out by covering whole population. J Shaheed Suhrawardy Med Coll 2020; 12(2): 100-108