Comparison of Ultrasonographic Evaluation of Gallbladder Volume in Type II Diabetic Patients with Non-diabetic Healthy Subjects

Background: Measurement of increased gallbladder volume is necessary for the detection of pathology of gallbladder. Objective: The purpose of the present study was to find out the difference between ultrasonographically measured gall bladder volume in fasting and post prandial states of type II diabetic patients and non-diabetic control subjects. Methodology: This cross-sectional study, carried out department of Radiology and Imaging at Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) Hospital, Dhaka, Bangladesh from June 2013 to July 2014. The type II diabetic patients were selected as group A and the healthy individual with age and sex matched were selected as group B. An ultrasonographic evaluation of fasting gallbladder volume and 2 hours after meal was done in all the subjects using a 3.5 MHz transducer. Information was recorded in preformed data collection sheet. Results: There was statistically significant (p<0.001) difference of mean fasting gall bladder volume between diabetic and non-diabetic subjects. The mean postprandial gall bladder volume of type II diabetic patients was significantly higher than that of the non-diabetic controls. By using Karl-Pearson coefficients of correlation it was found that gallbladder enlargement in type II diabetics, was significantly correlated with body mass index (p= 0.05) and systolic blood pressure (p= 0.05). Conclusions: Cholecystomegaly is found in type II diabetics in the present study to a significant degree which is also significantly correlated with body mass index and systolic blood pressure. Journal of Current and Advance Medical Research, July 2021;8(2):114-118

Predictors of Post-Operative Acute Kidney Injury in relation with N-Terminal Pro-B-Type Natriuretic Peptide Level among Patients Undergoing Mitral Valve Replacement

Background: The N-terminal Pro-B-type natriuretic peptide (NT-proBNP) level can be utilized as post-operative prediction models suring cardiac surgery. Objective: The objective was to find out the predictors of post-operative acute kidney injury in relation with N-Terminal Pro-B-Type natriuretic peptide level among mitral valve replacement patients. Methodology: This cross-sectional study was conducted in the Department of Cardiac Surgery at National Institute of Cardiovascular Diseases, Dhaka, Bangladesh from January 2018 to December 2019. Patients with the age of more than or equal to 18 years with both sexes who were underwent mitral valve replacement were selected as study population. Patients were divided into two groups based on pre-operative NT-proBNP level. Post-operatively patients were observed on the basis of post-operative serum creatinine. Results: A total number of 100 patients were recruited for this study of which 50 cases were in group A and the rest of 50 cases were in the group B. Elevated NT-proBNP was the most powerful and independent pre-operative variable in predicting post-operative AKI development (OR 0.999, 95% CI 0.998-1.00) Conclusion: In conclusion elevated NT-proBNP is the most powerful and independent pre-operative variable in predicting post-operative acute kidney injury. Journal of Current and Advance Medical Research, July 2021;8(2):85-89

Role of Serum B-type Natriuretic Peptide before and after 2hours of Spontaneous Breathing Trial among Patients under Mechanical Ventilation

Background: Weaning of a patient from mechanical ventilation is very important for the outcomes of the patients. Objective: The purpose of the study was to evaluate the serum level of BNP before and after 2hours of spontaneous breathing trial (SBT) among patients under mechanical ventilation. Methodology: This prospective cohort study was conducted in the Department of Anesthesia, Analgesia and Intensive Care Medicine at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh over a period of 2 years. Study population was selected for weaning from mechanical ventilation support for the first time in the age group of more than 18 years with both sexes. Plasma BNP level of all patients was measured before and after 2 hours of spontaneous breathing trial. Results: A total number of 30 patients were recruited for this study. One-third (33.3%) of the patients failed on SBT. The mean percent changes of BNP (pg/ml) during 2-h of SBT in weaning success and failure groups were 38.41±9.379 and 59.51±2.940 respectively (p=0.01). The receiver-operating characteristic curve analysis for BNP as a predictor of weaning outcome, showed that the area under the curve (AUC) was 0.89. Conclusion: In conclusion BNP is currently a good predictor of different cardiac diseases. Journal of Current and Advance Medical Research, July 2021;8(2):125-129

Obstetric Haemorrhage Related Maternal Mortality: A Two-Year Experience at a Teaching Hospital in Bangladesh

Background: Bangladesh is one of the developing countries where the maternal mortality is extraordinarily high. Objectives: This study was conducted to find out the number and cause of obstetric haemorrhage related maternal death. Methodology: This retrospective study was conducted in the department of obstetrics & gynaecology at M.A.G Osmani Medical College Hospital, Sylhet, Bangladesh from January 2006 to December 2007. From all maternal deaths related to pregnancy occurred in that period, only death due to obstetric hemorrhage were enrolled. Thereafter, the records of hemorrhage related death patients were scrutinized and data were collected from death register. All necessary information was collected in a pre-designed clinical data sheet and analyzed. Results: Among all deaths in obstetric unit, maternal mortality due to obstetric haemorrhage was 32.09%. The deaths were common among multipara (3-4) in 26-30 years age group. Most of them were from lower socio-economic condition having no or irregular antenatal checkup. Among the causes of obstetric haemorrhage, PPH was the commonest. Atonic uterus was the main cause of PPH. Injudicious use of oxytocin and obstructed labour were the common cause of rupture of uterus. Although the causes of haemorrhage were different, most of the patients died due to haemorrhagic shock. Conclusion: This study helps to detect the magnitude of problem and major causes of maternal deaths specially haemorrhage related maternal deaths. Journal of Current and Advance Medical Research, July 2021;8(2):90-94

Post-Operative Complications after Thyroid Gland Surgery due to Different Pathologic Condition: A Prospective Study

Background: The outcome and complication rates of post-operative cases are largely dependent on different factors. Objective: The objective of this study was to determine the risk factors responsible for major postoperative complications after thyroid surgery. Methodology: This was a prospective cohort study which was carried out at the Department of Surgery, Bangabandhu Shiekh Mujib Medical University, Dhaka, Bangladesh. Adult patients undergoing elective surgery for various thyroid disorders were selected as study population. This study was carried out from March 2009 to June 2011 for a period of two years. The study was included patients of various thyroid disorders that required surgical intervention of different magnitude. They were evaluated by history, physical examination, biochemical tests, ultrasound scan and FNAC where indicated. Histopathology was done and patients were followed up for subsequent outcome. Results: Among 2(2%) of them developed reactionary haemorrhage. The most common immediate surgical complication following thyroidectomy is hypocalcaemia and 12 patients (12%) experiencing this problem. 11(11%) patients developed transient tetany (hypocalcaemia) on 2nd post-operative day which was improved later on and 1(1%) patient developed permanent hypoparathyroidism and the patient supplemented by vitamin-D more than 6 months follow-up . In this study the mortality rate is 0% and complication rate is acceptable in comparison to other study. Conclusion: Hypoparathyroidism is a relatively common complication after thyroid surgery. Journal of Current and Advance Medical Research, July 2021;8(2):119-124

Clinical Response to Different Medical Treatment Options for Mastalgia in Fibrocystic Breast Disease among Women at a Tertiary Care Hospital in Dhaka City

Background: Various types of medical management are given for mastalgia in fibrocystic breast disease. Objective: The aim of this study was to compare the effects of different commonly used medical management options of mastalgia of fibrocystic breast disease on the quality of life of the respondents and their side effects as well. Methods: This prospective longitudinal study was carried out in Out-patients Department of General Surgery, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) General Hospital, Dhaka, Bangladesh from July 2018 to June 2019. The patients with fibrocystic breast disease were selected according to the eligibility criteria and are allocated to two groups by alternative random selection. In non-pharmacological treatments receiving group, lifestyle modification advices along with Evening Primrose Oil were given. On the other hand, in pharmacological treatment receiving group, Bromocriptine and Danazole were given according to some selection criteria of the patients. Response of treatments to each group & side effects were determined at one month, three months and six months follow up respectively. Results: A total number of 45 patients were recruited for this study. Majority of them presented with cyclical mastalgia (57.78%), bilateral mastalgia (60%) and mastalgia with lumpiness (44.4%). Among the patients who received non- pharmacological treatment, mastalgia improved in 34.78% cases and patients received pharmacological treatment, mastalgia improved in 72.73% cases. Different domains of quality of life were improved significantly in patients who received pharmacological treatment. Conclusion: In conclusion pharmacological management by Danazol or Bromocriptine has well tolerated to the patients. Journal of Current and Advance Medical Research, July 2021;8(2):95-99

Short-Term Outcome of Video Assisted Thoracoscopic Decortication in Empyema Thoracis

Background: Video-assisted thoracoscopic surgical decortication (VATS Decortication) is one of the technique for treating empyema thoracis. Objective: The purpose of the present study was to assess radiologic and functional short-term outcomes of VATS decortication in comparison with open decortication among empyema thoracis patients. Methodology: This comparative type of observational study was done at Department of Thoracic Surgery at National Institute of Diseases of Chest and Hospital (NIDCH), Dhaka, Bangladesh from July 2018 to June 2019 for a period of one year. Patients with empyema thoracis in stage II or III were included. Short-term outcomes were measured according to collection of chest drain tube in post-operative observational days (PODs), post-operative lung expansion, time taken for chest drain tube removal, postoperative hospital stay and post-operative pain (numeric rating scale) observations up to discharge from hospital. Result: A total number of 70 patients were recruited. The mean age was 36.20 ± 12.50 years. In post-operative phase apical chest drain tube collection followed by VATS procedure was found significantly lower than that of open decortication (2nd POD: p= 0.04; 3rd POD: p =0.039). Both the apical (p=0.001) and basal (p=0.039) chest drain tubes were removed earlier in patients with VATS decortication. Again, patients with VATS decortication had to stay less days in post-operative time (p=0.01). The mean post-operative pain scores was significantly higher among the patients underwent open decortication (p<0.001). Conclusion: VATS decortication has shown better outcome in terms of collection of chest drain tube in post- operative days, time taken for chest drain tube removal, post-operative hospital stay and post-operative pain in managing patients with empyema thoracis. Journal of Current and Advance Medical Research, July 2021;8(2):100-105

Scopes and Opportunities of Interventional Radiology in Clinical Settings

not available. Journal of Current and Advance Medical Research, July 2021;8(2):78-79

Correlation of Serum Magnesium Level and Blood Glucose status among Type 2 Diabetic Patients

Background: Serum magnesium level is an important electrolytes for the maintenance of haemodynamic of the body. Objective: The purpose of the present study was to correlate the serum magnesium level and blood sugar status. Methodology: This cross sectional study was carried out in the Department of Medicine at Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh from July 2012 to December 2012. All the type 2 diabetic patients admitted in the Department of Medicine in-patient department of ShSMCH who were 18 years and above age with both sexes were included as study population and were designated as group A and non-diabetic patients were included as group B. Blood samples were drawn after an overnight fast for the measurement of fasting blood sugar and serum magnesium. Result: In this present study a total number of 60 patients were enrolled for this study after fulfilling the inclusion and exclusion criteria of which 30 patients were in group A and the rest 30 patients were in group B. The correlation coefficient of FBS and HbA1C with Serum Magnesium level was recorded. The FBS and serum magnesium was negatively correlated to each other significantly which was -0.534. The HbA1C and serum magnesium was negatively correlated to each other significantly which was -0.556. Conclusion: In conclusion the blood sugar level is inversely correlate with the serum magnesium level in type 2 diabetic patients. Journal of Current and Advance Medical Research, July 2021;8(2):106-109

Prevalence and Structural Abnormal Findings of Injured Knee Joint among Adult Patients detected by Magnetic Resonance Imaging Study of 70 Cases in a tertiary hospital of Bangladesh

Background: Magnetic resonance imaging is a very useful diagnostic tool for the detection of abnormalities of injured knee joint. Objective: This present study was performed to see the different abnormalities of injured knee joint detected by MRI among adult patients. Methodology: This cross-sectional study was conducted in the Department of Radiology and Imaging at Bangabandhu Sheikh Mujib Medical University (BSSMU), Dhaka, Bangladesh from January to June 2021 for a period of six months. The patients in the age group of equal or more than 18 years with both male and female who were visiting Department of Orthopaedics at BSMMU, Dhaka with history of knee injuries were subjected to MRI were selected as study population. MRI findings of the knee joint were analyzed for the presence of any signal changes or lesions of varying severity for the structures of menisci, cartilage, bone marrow, tendons and ligaments of injured knee joint. Results: A total number of 65 cases of knee joints were analyzed. The mean with the SD of age of the study population was 35.34±13.371. The left knee (60.0%) was more involved than right knee (40.0%). The lesion in femur and tibia were found in 10(15.4%) cases and 8(12.3%) cases respectively. Out of 65 knee joints there were 41 joints were found the tear of anterior cruciate ligament. The complete, interstial tear in the anterior cruciate ligaments were 26(40.0%) and 15(23.1%) knee joints respectively. However, anterior cruciate ligaments of 24(36.9%) knee joints were found normal. Medial meniscus (36.9%) was more involved than lateral meniscus (18.5%). Conclusion: In conclusion young adult male are more commonly affected their left knee joint with the tearing of complete tear of anterior cruciate ligaments and involvement of medial meniscus. Journal of Current and Advance Medical Research, July 2021;8(2):80-84