Covid-19 and Surgery

The severe acute respiratory syndrome (SARS) caused by the super-infectious, super-spreading, super-mutating novel coronavirus-2 (Covid-19) is responsible for the worldwide overwhelming panic and pandemic with a huge burden of suffering patients at a time. It has been causing alarming morbidity and unexpected mortality, shortening life span of many people that hadn’t happened since the second world war. It was first identified in Wuhan, China in the last months of 2019. The clinical scenario presents in the form of asymptomatic, mild, moderate and severe illnesses. More than 80% patients are either asymptomatic who transmit it to others and have a mild influenza-like illness clinically not different from common cold. The moderate and severe cases commonly need supervised home or institutional treatment. Many of the latter need intensive therapy that includes non-invasive and invasive ventilation along with other measures and medications. The treatment is principally conservative, HDU- and ICU-dependent. Surgery has no role as its primary treatment. But protection of surgical team and non-infected patients remains as a challenge to surgeons and hospital authorities. Many of the mutant variants now show resistance to antibodies generated by spike protein based and m-RNA based vaccines. The threat of infection still persists making surgeons overwhelmingly concerned while performing emergency, elective and cancer surgeries. This article describes some guidelines to be followed by the operating surgeons, hospital and regional health authorities to minimize the risks of spreading the disease and to protect the surgical team and other non-infected people from being infected. KYAMC Journal. 2021;12(3): 172-181

Efficacy of Trans-nasal Endoscopic Sphenopalatine Artery Ligation in the Management of Recurrent Posterior Epistaxis

Background: Recurrent posterior epistaxis is a challenging problem for most otolaryngologists. Of the several proposed treatment modalities, endoscopic ligation of SPA (Sphenopalatine artery) provides a simple and effective solution with relatively minor complications. Objectives: Aim of this study was to find out the success rate and complications of endoscopic ligation of SPA in the management of recurrent posterior epistaxis. Materials and Methods: This was an observational study conducted from Jan 2019 to Jan 2021. Total 60 patients were included in this study. Inclusion criteria were - recurrent epistaxis (at least 4 episodes in last 2 months) with bleeding point not seen in anterior rhinoscopy, Failure of previous conservative management with medications and nasal packing, age between 18–60 years of both sexes. All the patients underwent trans-nasal endoscopic Sphenopalatine artery ligation, and patients were followed up for 12 weeks to identify repeated bleeding and to evaluate complications. Results: In this study male to female ratio was 1.5:1. Mean age of study group was 44.66 (±8.62) years. No recurrent bleeding occurred in 51 (85%) and in 9 (15%) nasal bleeding occurred in the 2 months postoperative period. Anesthesia of incisor teeth occurred in 18 patients (30%), 22 patients (37%) complained about increased nasal crusting. Conclusion: Endoscopic ligation of Sphenopalatine artery shows good outcome in prevention of further episodes of epistaxis in most patients. Although some minor complications can occur, these are manageable. KYAMC Journal. 2021;12(3): 133-137

Association of Low Serum Cholesterol With Hemorrhagic Stroke

Background: Stroke is the second cause of death and third cause of disability in worldwide so control of risk factor is the best option for prevention of stroke and stroke related disability. Objectives: The study is to know the relation of low serum cholesterol with hemorrhagic stroke. Materials and Methods: This Study is a case control study carried out at Neurology and Medicine ward Mymensingh Medical college hospital (MMCH) from july2017 to December 2018 to see the association of low serum cholesterol with hemorrhagic stroke. A total number of 120 subjects more than 18 years were considered for the study. Among them 60 were study group and 60 were control group. The study population has been selected following some exclusion and inclusion criteria. Results: Result showed that hemorrhagic stroke was more in male than female, common after the age of 60 years. Lower middle classes are more sufferers. Hypertension was 76.7% of study group and serum cholesterol was significantly lower in study group than the control group. Conclusion: This study found that the serum total cholesterol level of study group is less than that of the healthy control group and the difference is statistically highly significant (p< 0.001). So it can be concluded that low serum cholesterol is associated with hemorrhagic stroke. KYAMC Journal. 2021;12(3): 147-152

A 15 month - old Bangladeshi Baby With Very Severe Hypertriglyceridemia, Secondary to Glycogen Storage Disease

Hypertriglyceridemia is increasingly identified in children and adolescents, due to improved screening and higher prevalence of childhood obesity. The etiologic origin can be primary (genetic) or secondary, but it is often multifactorial. Management is challenging because of the interplay of genetic and secondary causes and lack of evidence-based guidelines. In this case report a fifteen month old boy was incidentally found with hypertriglyceridemia while finding the cause of his abdominal distension and was managed with oral and intravenous medications. KYAMC Journal. 2021;12(3): 182-186

Comparison of Plain X-ray and MRI Findings By Determining The Sensitivity and Specificity in the Diagnosis of Lumbar Spinal Stenosis

Background: Lumbar spinal stenosis is the most frequent indication for spine surgery. The X-ray and MRI are the choice of investigation. Justified use of radiography can be cost effective in the management of lumbar spinal stenosis. Objective: To evaluate and compare the sensitivity and specificity of the plain X-ray and MRI in the diagnosis of the lumbar spinal stenosis. Materials and Methods: A multicenter cross sectional analytical study was carried out from January 2014 to December 2015 on 70 patients of both sexes aged more than 25 years with chronic low back pain. Plain x-ray and MRI were done in all patients. The interval between plain x-ray and MRI was less than 3 months. A descriptive analysis was performed for all data. Results: The mean age (+ SD) was 45.1 (+ 5.4) years. Forty two (60%) were male and 28 (40%) were female. In plain x-ray of the lumbosacral spine, 30 (42.9%) had diskogenic spinal canal stenosis and 22 (31.4%) had both diskogenic and non diskogenic spinal canal stenosis. In the MRI, 35 (50.0%) cases had diskogenic spinal canal stenosis and 24 (34.3%) had both diskogenic and non diskogenic spinal canal stenosis. The validity of MRI evaluation for only diskogenic spinal canal stenosis was correlated, where the calculated values of plain x-ray were: sensitivity 80.0%, specificity 60.0%, accuracy 77.5%, positive predictive value 93.3% and negative predictive value 30.0%. The validity of MRI evaluation for both diskogenic and non diskogenic spinal canal stenosis was correlated, where the calculated values of plain x-ray were: sensitivity 83.3%, specificity 66.7%, accuracy 80.0%, positive predictive value 90.9% and negative predictive value 50.0%. Conclusion: Plain x-ray is a useful and reliable diagnostic modality for the evaluation, assessment and the subsequent appropriate management of lumbar spinal stenosis. KYAMC Journal. 2021;12(3): 161-165

Early Management of Hyperuricemia Might Delay the Development of Essential Hypertension

Background: In the 21st century, the prevalence pattern of hypertension in different developing countries differs from developed countries. Persistent hypertension is one of the risk factors and is the leading cause of heart disease, chronic kidney disease (CKD) & cerebrovascular disease. Even mild to moderate essential hypertension usually causes significant renal function impairment only after several years. Objectives: To assess the serum uric acid level in hypertensive patients and compare the findings with those found in normotensive people. Materials & Methods: This case-control study was done at the Department of Biochemistry, Mymensingh Medical College, Mymensingh during the period of January 2010 to December 2010. A total of 143 subjects of both sexes were selected for the purpose. Out of them, 73 were the case and 70 were the control. The subjects were classified into the following groups; Group I includes 73 were essential hypertensive subjects. Group II includes 70 were healthy adults. All statistical parameters analysis were done by SPSS 12.0 version; P-value<0.05 was considered as significant. Results: There was a significant (P<0.05) increase in blood urea in subjects with hypertension compared to that of the control. Conclusion: Evaluation of uric acid before and during treatment of hypertension is required to identify as a risk factor. KYAMC Journal. 2021;12(3): 117-121

Relation of Volume of Hemorrhage With Mortality Within First 48 Hours in Hemorrhagic Stroke

Background: Hemorrhagic stroke accounts for 10-15% of all strokes with higher mortality rates than cerebral infarction. Intracerebral hemorrhage has a reported 30-day mortality of 44% to 51%, with almost half of the death occurs within the first 48 hours. Advanced age, low level of consciousness, large volume of hemorrhage has been linked with poor outcome. Objectives: To predict early outcome of hemorrhagic stroke patient in relation with age, Glasgow Coma Scale, volume of hemorrhage and ventricular extension. Materials and Methods: Hospital based prospective study carried out in hundred hemorrhagic stroke patients. The formula of ABC/2 was used to calculate hemorrhage volume in bedside by using CT scan. Results: 1st month mortality rates of hemorrhagic stroke was 44% with 45.45% of patients died within the first 48 hours of onset. Mean age of patients of hemorrhagic stroke was 61.2 ± 13.88 years. Mortality rate of intracerebral hemorrhage after age of 60 was 51.06% in 1st month. Volume of intracerebral hemorrhage was the strongest predictor of both 48 hours and 30 days mortality. Using three categories of intracerebral hemorrhage (X for < 30 ml, Y for 30 - 50 ml and Z for > 50 ml group) calculated by ABC/2 formula showed 100% mortality rate in Z group, 50% in Y group and only 12% mortality rate in X group in 1st month. Among all death, 61.5% of Z group 25% of Y group and 16.67% of patients of X group died within 48 hours. Two categories of Glasgow Coma Scale (≤ 8 and ≥ 9) were used and shown death rates 80.77% in GCS ≤ 8 and 4.55% in GCS ≥ 9 in 1st month. Conclusion: Volume of intracerebral hemorrhage in combination with advanced age, initial Glasgow Coma Scale is a powerful and easy to use in both 48 hours and 1st month mortality in patients with spontaneous intracerebral hemorrhage. KYAMC Journal. 2021;12(3): 127-132

Clinical Profile and Feto-Maternal Outcome of Preterm Prelabour Rupture of The Membrane in a Tertiary Level Hospital

Background: The rupture of fetal membrane before onset of labour at less than 37 completed weeks of gestation. Incidence of Preterm prelabour rupture of membrane (PPROM) ranges from 3.0-10.0% of all deliveries and causes around 25-30% of all preterm deliveries. Objective: To see the clinical profile, maternal and fetal outcome of preterm prelabour rupture of the membrane. Materials and Methods: One hundred fifteen pregnant women with 28-37 weeks of gestation and diagnosed as PPROM admitted in different units selected by purposive sampling, fulfilled the inclusion and exclusion criteria were enrolled as study population in this study. Results: The mean age was 24.65(±3.68) years. Majority (75.65%) were primi para. The mean gestational age was 32.34(±2.86) weeks, 79.13% had gestational age between 30-36 weeks and 20.87% had up to 30 wks. The common risk factors of the study population were history of coitus, CPD, infection and history of abortion which were 42.61%, 9.57%, 5.22% and 4.35% respectively. Majority 55.65% women had vaginal delivery, 44.35% had caesarian section. Majority of the babies born to PPROM group were in the very low birth weight category (53 cases 62.3%), whereas only 32 cases (37.6%) were of normal birth weight. Infection and perinatal mortality was significantly associated with PPROM. Conclusion: PPROM can be prevented avoiding the certain risk factors by proper ante natal checkup, strict follow up, good obstetrical care and perinatal care , making mass awareness of the sequele. KYAMC Journal. 2021;12(3): 166-171

Pattern of Aerobic Bacteria in Adult Patients Isolated from Endotracheal Tubes in Tertiary Care Center

Introduction: Nosocomial infections have been described as an important issue among intubated patients which leads to significant morbidity and mortality. The pattern of microbiological colonization and antibiotic resistance are much valuable in this regard. Objectives: The aim of present study was to determine the pattern of aerobic bacteria isolated from endotracheal tubes in adult patients and determination of their antimicrobial susceptibility patterns. Materials and Methods: Specimens were collected from tracheal tubes of patients with endotracheal aspiration and microbiological investigations were done. The isolated bacteria were identified by using standard cultural and biochemical tests. Then antibiotic susceptibility testing was performed on the isolates by disc diffusion method according to clinical and laboratory Standards Institute (CLSI) guideline. Results: Among 104 participants 68 (65.4%) were female and 36 (34.6%) were male. Most of the patients were in the age group of 71-80 years (48.0%). From 104 positive growths, both Gram positive and Gram negative organisms were found. Maximum samples showed growth of gram negative organism. Antimicrobial susceptibility testing revealed that the most resistant Gram negative isolate was Klebsiella with highest resistance against Vancomycin (40.4%) and which showed highest sensitive against Cefotetan, Cefoxitin and Norfloxain (39.4%). Conclusions: It may be concluded that this study indicates the emergence of antibiotic resistant infections in the studied hospital. So, there is a need to improve the effectiveness of integrated infection control programs to control and manage nosocomial infections caused by highly resistant organisms. KYAMC Journal. 2021;12(3): 153-160

Demographic Profile of Homicide Cases Occurred at Rajshahi District of Bangladesh

Background: Homicide is the significant issues of major public health crisis in relation to health and safety of all individuals. The number of homicide is increasing in Bangladesh at alarming rate day by day. Objectives:Considering this context, we aimed to study and explore the demography of homicidal deaths occurred at Rajshahi districtin 2020. Materials and methods: The statistics presented here isbased on the post-mortem of the dead bodies that were submitted from different police station in the Department of Forensic Medicine & Toxicology (DFMT) at Rajshahi Medical College. This present data based on the observed mark which might be analogous with corresponding manner of homicide. Results: A total 37 homicides were occurred in January 2020 to December 2020. Among them, 59% were male and 41% were female. Almost 50% victims were between 16 and 30 years old. Maximum of the male victims were farmer in profession, whereas all of the females were house wife. Surprisingly, 24% cases were from area of Charghat police station. Conclusion: The overall situation suggests taking proper action that may decrease the homicidal deaths. KYAMC Journal. 2021;12(3): 138-141