Status of Serum bilirubin, Serum Proteins and Prothrombin time in babies with Perinatal Asphyxia

Background and Objectives: Because of hypoxemia, different organ systems of the body are affected in perinatal asphyxia. This study was carried out to see the status of Serum bilirubin, Serum Proteins and Prothrombin time in asphyxiated babies and to know any correlation existing between hepatic dysfunction and the severity of perinatal asphyxia. Methods: A total of 70 full-term asphyxiated newborns (study group) were studied during January ‘2008 to December ‘2008 in the department of Paediatrics, Mymensingh Medical College Hospital. After enrolment these babies were grouped according to Sarnat & Sarnat stages of HIE as stage I, II & III (Sarnat & Sarnat’ 1976). Babies who are small for gestational age, having severe jaundice, sepsis or congenital anomalies of the hepatobiliary system were excluded from the study. A total of 50 healthy newborns were also studied as reference group. Two c.c. of venous blood were taken both from asphyxiated and healthy babies between 2nd and 5th day of life to estimate Total serum bilirubin (TSB), Serum Total protein (STP), Serum Albumin and Prothrombin time (PT). Data were analyzed by computer software SPSS version 15. Unpaired student’s ‘t’ test was used to measure the level of significance and Spearman’s rank correlation was done to see the correlation and at P < 0.05 the results were considered significant. Results: The mean TSB, STP & S. Albumin of asphyxiated babies were 5.52 ± 2.01mg/dl, 55.74 ± 8.84 & 32.60 ± 5.48 g/L respectively and those of normal babies were 4.51 ± 1.19 mg/dl, 66.30 ± 10.36 & 40.90 ± 6.45 g/L respectively and these differences were statistically significant (P < 0.001). On the other hand no significant changes were noted in prothrombin time. The rise of PT showed a significant positive correlation with the severity of perinatal asphyxia. On the other hand STP, S. Albumin & TSB showed no significant correlation. Conclusion: This study concludes that TSB, STP & S. Albumin significantly elevated and this elevation was proportional to the severity of perinatal asphyxia. On the other hand no significant changes were noted in prothrombin time. Recommendation: A large scale multi-centre study is recommended to establish this finding. DOI: http://dx.doi.org/10.3329/jdnmch.v18i2.16022 J. Dhaka National Med. Coll. Hos. 2012; 18 (02): 43-46

Multiple Active Tuberculosis : A rare case

Tuberculosis is a peculiar infectious disease because of the latent period between the infection and the appearance of the disease which may be prolonged for many weeks , months or years as it is in case of the secondary tuberculosis. Extra pulmonary tuberculosis gained new importance, because it represented a progressively greater proportion of new cases. Multiple extra pulmonary sites were reported rarely except for one anatomical site, which was reported frequently. A 20 yrs old boy was admitted at Dhaka National Medical Institute Hospital with pain at back, buttock and thigh with a swelling at the anterior aspect of upper part of left thigh. He was diagnosed as a case of tuberculosis of spine (D12 and L1) with psoas abscess with tuberculosis of hip joint (lt) and an enquiry and investigation found to have pulmonary TB as well. So this rare involvement of multiple tuberculosis is presented here. DOI: http://dx.doi.org/10.3329/jdnmch.v18i2.16026 J. Dhaka National Med. Coll. Hos. 2012; 18 (02): 61-63

Prediction of major adverse cardiac events of patients with acute coronary syndrome by using TIMI risk index

Patient with acute coronary syndrome (ACS) has considerable variability in outcome and mortality risk. The Thrombolysis in Myocardial Infarction (TIMI) risk index (TRI) for unstable angina/non ST elevation myocardial infarction & ST elevation myocardial infarction were a convenient bedside clinical risk score for predicting 30 days mortality at presentation with ACS. This study was done to predict and validate major adverse cardiac events in patients of ACS thus it will help us to quantify risk, observe the prognostic value and to guide appropriate therapy by using TRI. This prospective study was carried out in the department of cardiology, BSMMU, Dhaka from April, 2011 to March, 2012. After considering all ethical issues, data were collected from 279 patients attending at cardiac emergency department with the presentation of ACS. History & physical examinations were done. TIMI risk index were calculated for each patient. The major adverse cardiac events (recurrent myocardial infarction, urgent revascularization, and all-cause mortality) were measured for next 30 days in hospital setting & outpatient department by follow up. After follow-up, Cox univariate and multivariate regression analysis were used to evaluate the influence of potential risk factors on duration of event-free survival, and likelihood ratio tests to assess the outcome. Major adverse events of TIMI risk index group 1, 2, 3, 4 & 5 were 0%, 0%, 3.7%, 12.9% & 19.2% respectively in UA/NSTEMI group. In STEMI group major adverse cardiac events of TIMI risk index group 1, 2, 3, 4 & 5 were 0%, 4.7%, 12.5%, 17.1% & 24.1% respectively. Increasing TRI were associated with increased risk of major adverse cardiac events. These score were a valid tool for risk assessment. DOI: http://dx.doi.org/10.3329/jdnmch.v18i2.16024 J. Dhaka National Med. Coll. Hos. 2012; 18 (02): 52-57

Morphometric study of fully ossified head and neck diameter of the human left femur

The femur is the weight bearing typical long bone of lower limb which extends from the pelvis to the knee. The anatomical knowledge of different dimensions of femur specially head and neck of the femur is very essential in anthropological and medico-legal practice for sex determination and as well as to radiologists, rheumatologists and orthopedic surgeons for diagnosis and planning of treatment. This is an observational descriptive type of study carried out in the Department of Anatomy, Sir Salimullah Medical College (SSMC), Dhaka from July 2011 to June 2012. The present study was performed on one hundred and ninety-nine (n=199; male-89 & female-110) left sided fully ossified human femur bones collected from the Department of Anatomy and the medical students of 1st & 2nd year MBBS source Sir Salimullah Medical College (SSMC), Dhaka and Dhaka National Medical College (DNMC), Dhaka. Morphometric study was carried out on all samples by direct physical methods. There was statistically significant difference found in the diameter of the head and neck of the femur bones between male and female bones. The present study attempted to provide a morphometric base line data of adult human left sided femur and also to see the sexual variations. DOI: http://dx.doi.org/10.3329/jdnmch.v18i2.16014 J. Dhaka National Med. Coll. Hos. 2012; 18 (02): 9-13

Accuracy Of Fine Needle Aspiration Cytology (FNAC) In The Diagnosis Of Thyroid Swellings

Objective: To evaluate the accuracy of fine needle aspiration cytology (FNAC) in comparison to paraffin section in thyroid swelling. Study design: Cross sectional study. Place and duration of study: Department of Surgery, Bangabandhu Sheikh Mujib Medical University from July 2009 to June 2011. Patient and method: One hundred patients with enlarged thyroid gland of both sexes were selected from admitted patient of Surgery department. All patients had preoperative FNAC, performed by pathologist at the Histopathology department and postoperative specimen were also examined and histopathological diagnosis were made. All FNAC diagnosis were correlated with the histopathological diagnosis. Results: Out of 100 patients 23 were male and 77 were female, male-female ratio 1: 3.3. In FNAC 76 patients were diagnosed as benign lesion of which 8 were later diagnosed as malignant on histopathological examination (68 were true negative 8 were false negative). 22 cases were diagnosed as malignant, both on FNAC and histopathological examination. Only 2 cases were diagnosed as follicular neoplasm on FNAC but on histopathological examination diagnosed as follicular carcinoma (22 cases were true positive) in this study. Overall sensitivity of FNAC were 68.75%, specificity 100.00% and accuracy 90%; PPV=100% & NPV=87.18% Conclusion: FNAC is a reliable, safe and accurate method as a preoperative evaluation in thyroid gland swelling before surgery. FNAC has more accuracy and specificity in detecting thyroid gland malignancy and therefore it is a reliable diagnostic test for evaluating thyroid swellings. DOI: http://dx.doi.org/10.3329/jdnmch.v18i2.16023 J. Dhaka National Med. Coll. Hos. 2012; 18 (02): 47-51

Studies on Cardiac Troponin I in patients with Cardiogenic Shock

Despite recent advances in the care of patients with acute coronary disease and the benefits associated with the early use of reperfusion strategies, cardiogenic shock as a complication of acute myocardial infarction continues to be associated with a dismal prognosis. There is a strong relationship between serum cardiac troponin I with cardiogenic shock as a complication of acute myocardial infarction. A case control study was designed to see the association of serum cardiac troponin I with cardiogenic shock. The study was done from July 2008 to June 2009. Sixty subjects were selected as study population which were taken from department of Cardiology, Mymensingh Medical College hospital, Mymensingh. Among them 30 were diagnosed case of cardiogenic shock and 30 were age and sex matched control. It revealed that the mean cardiac troponin- I levels in case group were 15.998±28.31 ng/ml and control group were 0.065 ± 0.08 ng/ml respectively. The study suggest that serum cardiac troponin- I level is significantly associated with cardiogenic shock. DOI: http://dx.doi.org/10.3329/jdnmch.v18i2.16017 J. Dhaka National Med. Coll. Hos. 2012; 18 (02): 21-23

The Increasing importance of Normal Flora – Commensals in Health or Potentially Pathogens for Disease

not availableDOI: http://dx.doi.org/10.3329/jdnmch.v18i2.16011 J. Dhaka National Med. Coll. Hos. 2012; 18 (02): 1

Lung Function and Chronic Exposure to Air pollution A Study on adolescent male of urban area.

Background Chronic exposure to heavily polluted air affects the respiratory status. Objectives: To observe the effects of air pollution on pulmonary functions of adolescent male living in urban areas of Bangladesh. Methods: This cross-sectional study was done in the department of Physiology, BSMMU. For this purpose, 60 apparently healthy adolescent male of age 13 to 18 were selected from different slum areas of Dhaka city. Sex and age matched 55 subjects were taken as control from rural area of Bangladesh. All subjects were of low socio-economic status and living in the corresponding areas since birth. In the study, Forced vital capacity (FVC), Forced expiratory volume in first second (FEV1), FEV1 /FVC % and Peak expiratory flow rate (PEFR) were estimated by VMI ventilometer on standing position. Statistical analysis was done by using “Z” test. Result: The mean measured values of FVC, FEV1, FEV1/ FVC% and PEFR were lower in the experimental group than in the control group. FVC and FEV1 were lowered significantly (p<0.05) but FEV1/FVC % and PEFR in experimental group though lowered , the result were not statistically significant. Conclusion: The results of the study reveals that pulmonary functions were lowered in urban adolescent and it was of restricted lung function type. DOI: http://dx.doi.org/10.3329/jdnmch.v18i2.16025 J. Dhaka National Med. Coll. Hos. 2012; 18 (02): 58-60

Short term catheterization versus long term catheterization after vaginal prolapsed surgery: A randomized control trial in Dhaka National Medical College & Hospital

Objective: This study was undertaken to determine whether short term bladder catheterization would be more beneficial than the routinely practiced long term catheterization after vaginal hysterectomy for prolapsed uterus. Materials and methods: This randomized controlled trial was conducted in Obstetrics and Gynecology Department of Dhaka National Medical College Hospital from January 2009 to January 2011. A total of 106 women were included in this study. They were randomized into short term catheterization group where transurethral catheter was removed after 24 hours of surgery and long term catheterization group where catheter was removed on 3rd post operative day. Result: Mean time of first voiding after removal of catheter was almost equal in both groups (2.82±1.42 hours and 2.74±1.52 hours). Duration of catheter did not affect the duration of first voiding time after removal of catheter (P>0.05). None of the women had residual volume of urine >200 ml in both groups. Mean residual volume is significantly high in long term catheterization group (P<0.05). Urinary tract infection was also significantly high in long term catheterization group (P<0.05) and majority of the infection were caused by E. coli. Conclusion: Short term catheterization is more beneficial in terms of lower incidence of urinary tract infection and prevention of bladder over filling as compared to long term catheterization after vaginal prolapsed surgery. DOI: http://dx.doi.org/10.3329/jdnmch.v18i2.16012 J. Dhaka National Med. Coll. Hos. 2012; 18 (02): 4-8

Intracellular changes of Na+, K+, Ca++ & Mg++ in rat pancreatic islets in different glucose concentration and their relation with insulin secretion

Impairment of insulin secretion from pancreatic ?–cell constitutes an important pathophysiological factor in the development of diabetes mellitus. The changes of intracellular concentration of Na+, K+, Ca++ and Mg++ were observed in substimulatory and stimulatory different glucose concentrations. Pancreatic islets from Long-Evans rats were isolated by collagenase digestion. The concentrations of ions expressed in terms of islet protein in the homogenized islets were measured by using an ion-sensitive electrode based autoanalyzer. In the physiological medium, the islet content of all the four ions increased significantly in response to glucose with maximum level at 11 mM and no further increase at 20 mM. Initial depolarizing effect of glucose is due to reduction of K+ permeability. The reduction of K+ permeability by glucose in ?–cell is a major step in stimulus-secretion coupling for insulin release. DOI: http://dx.doi.org/10.3329/jdnmch.v18i2.16016 J. Dhaka National Med. Coll. Hos. 2012; 18 (02): 17-20