Relationship between Stature and Length of Tendo Achilles in Adult Male and Female of Bangladesh

Background: Tendo Achilles injuries are usually related to poor ankle flexibility and strength and to overuse. Morphology of tendo Achilles is an important tool for its assessment which can be done by measuring tendon thickness, cross-sectional area and length of tendon. Objective: The aim of the study was to correlate length of tendo Achilles with stature in several age groups of sedentary people as measured by ultrasonography. Materials and method: This cross sectional analytical type of study was conducted in the department of Anatomy, Dhaka Medical College Hospital, Dhaka, Bangladesh from July 2013 to June 2014. The present study was performed on 200 tendo Achilles of 100 people (50 male and 50 female) randomly selected from the patients who came to the Radiology department of Dhaka Medical College Hospital for ultrasonography of any region of their body other than leg. Results: In this study length of tendo Achilles was measured in both legs of adult people and was correlated with stature. Highly significant correlation was found between length of tendo Achilles with stature (p<0.001). Conclusion: The data of length of tendo Achilles obtained from the present study may provide valuable information in different aspects of medical science as a guide line for physiotherapists, radiologists, sports professionals and ortho-surgeons in early detection and monitoring of rehabilitation especially of professional athletes. Delta Med Col J. Jul 2019 7(2): 80-83

A Case Report of Rickettsial Meningitis

Rickettsial diseases are a group of infections caused by the obligate intracellular bacteria Rickettsia. Rickettsial infections are common in southern Europe. The disease is usually characterized by the classical triad of fever, eschar and rash. Complications including neurological involvement are rarely described. We report an unusual case of meningitis in a 55 years old man presenting with high grade fever for 8 days associated with persistent headache. The patient was suspected to have enteric fever and treated with injection ceftriaxone. Forty-eight hours after admission, the presence of continued high grade fever, conjunctival congestion, headache, cough, low platelet and increased WBC count, and elevated transaminase raised the possibility of a different aetiology. Finally, Rickettsial meningitis was confirmed due to history of field visit, presence of eschar, neck rigidity, raised titre of WF OX-K antigen and the cerebrospinal fluid analysis revealed increased cellularity, hypoglycorrhachia, and hyper proteinorrhachia (106 mg/dL). Patient was treated with capsule doxycycline and other supportive therapy and became afebrile within 48 hours. This uncommon clinical scenario should be taken into account in the management of patients with high grade fever on admission. Delta Med Col J. Jul 2019 7(2): 100-103

Reviewers in this Issue Vol.7(2)

not available Delta Med Col J. Jul 2019 7(2): 104

Metoclopramide Pretreatment for Prevention of Pain on Propofol Injection: A Randomized Placebo-Controlled Study

Background: Propofol, the most frequently used intravenous anaesthetic, is used for induction, maintenance of anaesthesia and for sedation in patients scheduled for routine elective surgical procedure. Pain on propofol injection still remains a considerable concern for the anaesthesiologist. Objective: Aim of this study was to observe the efficacy of metoclopramide as pretreatment for the prevention of pain caused by the propofol injection in patients undergoing elective surgery under general anaesthesia. Materials and method: A total of 80 patients were taken up in the study in the age group of 20 to 50 years of either sex, ASA grade I/II, scheduled for routine elective surgical procedure under general anesthesia with endotracheal intubation and using propofol as induction agent. The patients enrolled were divided randomly into two groups of 40 patients each. Group A received 10 mg metoclopramide IV diluted in 5 ml saline. Group B received 5 ml of normal saline as placebo before propofol injection. The patients were asked to report their pain according to the scale provided to them in the form of none, mild, moderate and severe after injection of propofol. Results: The overall incidence and severity of pain were significantly less in Group A (metoclopramide group) than in group B (placebo group) (p< 0.05). The incidence of mild and moderate pain in Group A versus group B was 15% vs 45% and 5% vs 25% respectively (p<0.05). The incidence of score ‘0’ (no pain) was higher in Group A (80%) thanGroup B (25%) (p< 0.05). Conclusion: Intravenous metoclopramide is effective for relief of pain on propofol injection without any significant side effects. Delta Med Col J. Jul 2019 7(2): 71-75

Polycystic Ovary Syndrome: A Brief Review with Recent Updates

Polycystic ovary syndrome (PCOS) is a chronic, complex and the most common endocrine disorder observed in women of reproductive age. This syndrome is heterogeneous by nature and is characterized by a combination of signs and symptoms of androgen excess and ovarian dysfunction. It is a significant public health issue. PCOS is associated with many comorbidities and also has a number of long-term metabolic and other consequences. The prevalence is quite high and is increasing day by day. It is a syndrome to be prevented by awakening awareness both in health workers and patients. There are many areas of controversies starting from its diagnosis, pathogenesis, consequences and treatment modalities. This review is an attempt to summarize the evolution of the diagnosis and current management guidelines and also to look into the future approaches. An extensive search was made through the Cochrane database, available systematic reviews and meta-analyses and recent international guidelines for providing an updated scientific overview of PCOS. Delta Med Col J. Jul 2019 7(2): 84-99

Comparison of Cost Effectiveness of Complementary & Alternative Medicine and Conventional Medicine in the Treatment of Rheumatoid Arthritis in Two Public Hospitals of Bangladesh

Background: Rheumatoid arthritis (RA) is one of the main causes of disability worldwide. Currently, controversy remains about the best therapeutic alternatives such as complementary and alternative medicine (CAM) and conventional medicine (CM) for this disease when evaluated from a cost effectiveness viewpoint. Objective: To examine the cost effectiveness of CAM and CM in the treatment of RA. Materials and method: The data were collected from Dhaka Medical College Hospital and Government Unani and Ayurvedic Medical College Hospital from August 2008 to February 2009 by primary sources in the study. Total 60 patients were included who had been treated for six months. Patients were assessed with EuroQol 5D (EQ-5D) tool. Results: The outcome is more effective in CAM than CM by EuroQol 5D. The EQ-5D average outcome of CAM is 0.239 and CM is 0.202. The cost of CAM is also lower than that of CM. Conclusion: Our results support that complementary and alternative medicine (CAM) is a more cost-effective option, compared to the conventional medicine for the treatment of RA. Delta Med Col J. Jul 2019 7(2): 76-79

Dengue – What to Do?

not available Delta Med Col J. Jul 2019 7(2): 54-55

Changing Pattern of Shingles (Herpes Zoster) in Hill Tracts: A Study among Tribal Community of Bangladesh

Background: Herpes zoster infection (shingles) is a common painful disease in Bangladesh. Changing pattern of the disease presentation can cause delayed diagnosis, inappropriate treatment, prolongation of the disease with debilitating symptoms and post herpetic neuralgia. Objective: The study was done to evaluate the different changing clinical and dermatome pattern of shingles among tribal community in Hill tracts of Bangladesh. Materials and method: This descriptive hospital based study was carried out among 74 shingles patients using simple, direct, standardized questionnaire with history, clinical and dermatological examination from July 2015 to July 2016 in Rangamati General Hospital, Rangamati, Bangladesh. Results: August to October was the vulnerable period for Shingles (75.7%) with highest number of cases found in September (32.4%). Rural area (70.2%) is vulnerable than urban area. Lumbar region (39.1%) is the commonest dermatome involved during examination. Itching was the commonest complaint (41.9%) for physician consultation and 15% cases suffered reactivation within six months in the same dermatome region. Conclusion: As changing and different pattern of manifestations are common in shingles in Hill Tracts, these are to be considered by local and consultant physicians in the total management to decrease delayed complications and reactivation. Delta Med Col J. Jul 2019 7(2): 56-60

Gastroprotective Effect of Azadirachta indica Leaves (Neem) Extract on Aspirin Induced Gastric Ulcer in Rats

Background: Gastric ulcer is one of the common diseases worldwide. Different parts of Azadirachta indica (Neem) tree has different uses in medicine for its beneficial properties and its leaves are also known to have anti ulcerant effect. Objective: This study was conducted to find out the protective role of Azadirachta indica (Neem) extract in the development of gastric ulcer. Materials and method: The study comprised of 30 Albino rats: Group-A, Group-B, Group-C, Group-D and Group-E having 6 rats in each group. The experiment was divided into 2 parts: Experiment-1 and Experiment-2. Experiment-1 comprised of Group-A and Group-B where Group-A served as control and was provided with normal saline (2 ml/kg body wt). In group-B rats ulcer was produced by administration of aqueous suspension of Aspirin (200 mg/kg body wt). All the rats were sacrificed after 4 hours to confirm gastric ulcer by histopathology. In Experiment-2, rats of Group-C served as disease control group and provided with normal saline (2ml/kg body wt). Group-D was provided with alcoholic extract of Azadirachtaindica leaves (150mg/kg body wt) and Group-E was provided with Ranitidine suspension (20mg/kg). After 8 days of treatment, animals were fasted for 24 hours. Then aqueous suspension of Aspirin (200 mg/kg body wt) was administered and after 4 hours all rats were sacrificed. Gross and microscopic examinations were performed to evaluate the results. Results: Histologically Aspirin treated rats showed ulcerated mucosa. Pretreatment with Neem extract showed protection against Aspirin induced gastric mucosal damage which was statistically highly significant (p<0.001). Conclusion: The study suggests that pretreatment with Azadirachta indica (Neem) leaves extract may be useful in prevention of Aspirin induced gastric ulcer. Delta Med Col J. Jul 2019 7(2): 61-65

From the Desk of Editor-in-Chief Vol.7(2)

not available Delta Med Col J. Jul 2019 7(2): 50