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

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

A Study on Type-1 Tympanoplasty in Perforated Ear Drum

Tympanoplasty without mastoidectomy is performed to prevent recurrent infection and reconstruct the sound conducting mechanism. In our study 60 patients were selected for tympanoplasty operation. All operations were done in Dhaka National Medical college hospital and private hospital in Dhaka city. Choice of incision was post auricular approach. 20% of patients were operated under general anesthesia and 80% of patients were operated under local anesthesia. Age range of patient was between15 to 40 yrs. Female patients were predominant. Follow up of patients were up to 2yrs. Overall success rate was 93.3%. DOI: http://dx.doi.org/10.3329/jdnmch.v18i2.16015 J. Dhaka National Med. Coll. Hos. 2012; 18 (02): 14-16

Relationship between Age and Serum Intact Parathyroid Hormone in Adult Obese Males

Background: Obesity is a common health problem in urban population nowadays. Objective: The present study was carried out to asses the relationship of age with obesity in adult males. Methods: This cross sectional study was done in department of Physiology, Dhaka Medical College, Dhaka. For this purpose, 60 male subjects within the age range of 25 to 50 years were included in the study. Among them 30 non-obese, apparently healthy subjects were selected as control (Group A) and 30 obese subjects as case (Group B). Case and control subjects were selected from the Urban Primary Health Care Project (UPHCP), PA-2, Dhaka City Corporation, Dhaka and by personal contact during the period from January 2010 to December 2010. All the subjects were apparently healthy. Result: In this study, obese males showed significant negative correlation (p=0.032, r= -392) but non obese male showed non-significant (p=0.719, r= +0.069) positive correlation with age. Conclusion: This study concludes that, Serum iPTH level decreases with age in obese males. DOI: http://dx.doi.org/10.3329/jdnmch.v18i2.16019 J. Dhaka National Med. Coll. Hos. 2012; 18 (02): 27-29