Study on serum zinc and copper levels in pulmonary tuberculosis patients before starting Directly Observed Treatment, Short-course

Background: Tuberculosis is a major public health concern throughout the world including Bangladesh. The prevalence of tuberculosis (TB) is increasing day by day. Around one-third of world population is infected with M. tuberculosis. Still pulmonary tuberculosis (PTB) remains one of the important causes of mortality throughout the world with economic burden. Objective: To evaluate levels of the serum zinc and serum copper in smear positive PTB patients before starting Directly Observed Treatment, Short-course (DOTs) therapy. Methods: This was a cross-sectional type of observational study. A total of 100 subjects were included in this study. Among them 50 were smear positive PTB patients denoted as case group and 50 were apparently healthy individuals denoted as control group. Biochemical tests were carried out in the department of biochemistry of Mymensingh Medical College, Mymensingh. All the statistical analyses were performed by using SPSS version 21. Results were evaluated by using Student’s t-test. Results: After careful evaluation there was significant decrease in serum zinc level along with significant increase in serum copper level among the case group when compared with the control group. The mean values of serum zinc level were 93.96±10.04 μg/dl and 72.84±7.73 μg/dl in control and case group respectively. Serum zinc level decreased significantly (p <0.001) in PTB patients. The mean values of serum copper were 111.81±21.26 μg/dl and 125.99±27.93 μg/dl in control and case group respectively. There was significant (p <0.001) rise of serum copper level in PTB patients. Mediscope 2021;8(2): 122-127

Management outcome of blunt renal trauma in a tertiary level hospital of Bangladesh

Background: The kidney is the commonly injured genitourinary and abdominal organ. Renal injuries are classified by their mechanism: blunt or penetrating. Failure to perform appropriate evaluation and treatment of these injuries may result in significant long term patient morbidity. Objective: To evaluate blunt renal trauma cases at a tertiary level hospital to find out management practices along with patient outcomes. Methods: This prospective observational study was conducted in the Department of Urology of Dhaka Medical College Hospital during the period of January 2011 to December 2012 to observe the management outcome of blunt kidney injuries. Sampling technique was purposive and sample size was 110. After management of blunt kidney injury by either conservatively or by surgical means, some patients were followed up for 2 years and others for less than 2 years. Results: In this study, 90.1% patients were diagnosed and staged by contrast enhanced CT scan. Most of the early grade injuries (grade I-III) were treated conservatively and outcome in terms of surgical conversion and short term complications were favourable. Few bluntly injured grade IV and V required operative interventions. Overall nephrectomy rate was only 3.6%. Haemodynamic instability, associated organ injury, higher grade injury - all were predictive indicators of operative interventions. The study showed that rates of complications were more in higher grade injury, with concomitant other organ injuries and in patients who required blood transfusion (indicator of hemodynamic instability). Conclusion: Most of the blunt kidney injuries can be managed in conservative way with favourable outcome. Mediscope 2021;8(2): 103-111

Arachnoid cyst at upper lumbar region - A case report

A young male patient of 22 years was presented with the complaints of low back pain, hypoesthesia and inability to walk. MRI of lumbosacral spine reveals intradural mass lesion extending from L2-L3 with no enhancement of gadolinium. Hence an extensive laminectomy and total removal of the mass was done. Peroperative impression confirms arachnoid cyst. After operation there was dramatic improvement of signs and symptoms; patient was able to walk without support during discharge from the hospital after one week. Mediscope 2021;8(2): 128-130

Study on rickettsial diseases evidenced by Weil-Felix test among febrile patients visiting a tertiary care hospital in Mymensingh

Background: Rickettsial diseases are neglected, re-emerging vector borne zoonosis & increasingly considered as one of the most important causes of pyrexia of unknown origin (PUO). They are grossly underdiagnosed due to wide range of non-specific symptoms, low index of clinical suspicion, lack of widely available specific diagnostic tools, leading to significant morbidity & mortality. Appropriate diagnosis in early stages is therefore necessary to prevent fatal complications associated with this disease. Objective: Present study was attempted to assess the burden of rickettsial illness by Weil-Felix agglutination test, among the suspected febrile patients, visiting a tertiary care hospital as well as to analyze the demographic profile & clinical manifestations of the seropositive cases. Methods: This was a cross-sectional study, conducted at department of microbiology, Mymensingh Medical College from March 2018 to February 2019. A total of 453 febrile patients of suspected rickettsial illness, irrespective of age and sex, were enrolled in this study. Serum sample from all the enrolled cases were then analyzed for rickettsial antibodies by Weil-Felix slide agglutination test. Results: Out of 453 cases, a total of 260 (57.39%) showed significant agglutination by Weil-Felix test, of which 101 (38.84%) were reactive to OX2 (spotted fever group rickettsiae), 65 (25%) were reactive to OXK (Scrub typhus) & 13 (5%) showed significant titers to OX19 (typhus fever). Remaining 81 (31.15%) sera were reactive to more than one antigens (mixed reactivity). Seropositivity was higher among female subjects (142; 54.61%) & age group >15-30 accounted for highest number of cases (95; 36.53%). Positive cases showed diverse clinical manifestations like headache (55.76%), myalgia (50.76%), skin rash (10.38%), eschar (9.23%), oliguria (7.3%), jaundice (10.76%), splenomegaly (6.81%), hepatomegaly (7.30%) etc. Conclusion: Rickettsial diseases should be considered as an important etiology of PUO & early diagnosis should be done to initiate proper treatment to prevent fatal complications. Though it lacks sensitivity & specificity, in a resource constraint area like Bangladesh, Weil-Felix test still serves as the cheapest initial diagnostic tool for rickettsial illness to guide the physician for further approaches. Mediscope 2021;8(2): 112-121

Relevance of mast cell infiltration in well-differentiated oral squamous cell carcinoma in biopsy specimen

Oral cancer is very common worldwide. More than 90% of all oral cancers are squamous cell carcinoma (SCC). The molecular biological markers of oral SCC have been extensively studied to aid in prevention and prognosis. However, no marker has been universally accepted so far. Mast cells are important component of cancer stromal interaction. Their early recruitment in tumor microenvironment and multifarious function make them a burning topic of interest in the field of research. So mast cell may act as a new target for the adjuvant treatment of oral SCC. Therefore, the aim of the study was to assess the number of mast cell infiltrations in well differentiated oral SCC. In this cross-sectional study the sample size was 66. After routine tissue processing and staining with Hematoxylin & Eosin (H/E) stains slides of all cases were grouped as well differentiated oral SCC. Identification of mast cell was done by Toluidine blue stain. Distribution of mast cells was observed and number of mast cells was counted. The data was tabulated and statistical analysis was performed. The number of mast cell was highly increased in all cases of oral SCC than normal. The mean ± SD number of mast cells was 3.28 ± 1.21 in oral SCC, whereas in control oral tissue it was 0.44 ± 0.19. The p-value was found to be highly significant (p<0.001). So, in our observation mast cell is a good cellular indicator of tumorigenesis. Mediscope 2021;8(2): 67-74

Early results of different types of anorectoplasty for anorectal malformations

Objective: To document our experience with the technique of surgical repair in anorectal malformations (ARM) and the short term anatomical and functional outcomes. Methods: This study included total 31 babies. Fourteen were perineal fistula cases with age range between 1 to 4 days. Ten patients had vestibular fistula and seven had rectourinary fistula. Primary diverting colostomy was done for vestibular and rectourinary fistula patients. On the other hand low imperforate anus with anoperineal fistula without associated major anomalies had undergone fistulectomy and simple anoplasty. Results: Simple anoplasty was done for fourteen perineal fistula cases. Anterior sagittal anorectoplasty (ASARP) was done for 10 vestibular fistulae and posterior sagittal anorectoplasty (PSARP) was done in 10 recto-urinary fistula cases. Simple anoplasty and vestibular anus scored good (5-6) in 70% to 71% while PSARP scored fair in 58% of the cases. Postoperative mucosal prolapse, anal stenosis and retraction occurred in two, six and one patient respectively. Redo surgery was done in mucosal prolapse and retraction cases. Four responded to anal dilation and the other needed redo surgery by a simple cutback technique for anal stricture. Continence was assessed in 23 patients whose follow-up periods were longer than 3 years. Twenty one patients had a good score and two had a fair score. No patients had a poor score. Conclusion: Our approach has the following advantages: (i) The operative technique is simple and easy to perform. (ii) Minimal complication rate with good cosmetic results. Mediscope 2021;8(2): 75-79

Study on Palmar Dermatoglyphics and their Association with β Thalassemia Major Patients among Bangladeshi Population

Objectives: To observe the palmar dermatoglyphic patterns of β thalassemia major patients. Methods: This cross-sectional type of analytical study was performed in the Department of Anatomy, Sir Sallimullah Medical College, Dhaka between the periods of January 2016 to December 2016. 55 β thalassemia major patients aged between (5-35) years were considered as case group and 55 healthy individuals of the same age & sex were considered as control group in this study. The palmar dermatoglyphic patterns and Total Finger Ridge count (TFRC) on the distal phalanges of the β thalassemia major patients were observed and compared with healthy individuals. Results: The palmar dermatoglyphic patterns were significantly different between the two groups (p > 0.05). The mean (±SD) of Total Finger Ridge count (TFRC) were higher in β thalassemia major patients in comparison to the healthy individuals. Conclusion: This study concludes that, palmar dermatoglyphic has a diagnostic value for β thalassemia major patients. Mediscope 2021;8(2): 94-102

Effect of combined treatment with Methotrexate and Non-steroidal anti-inflammatory drugs on plasma alpha-tocopherol level and Rheumatoid factor among Rheumatoid Arthritis patients

Background: Oxidative stress might play a significant role in the pathogenesis of Rheumatoid Arthritis. Traditional therapies of Rheumatoid Arthritis are governed by different NSAIDs which improve symptoms of Rheumatoid Arthritis. But addition of Methotrexate (MTX) to Non-steroidal anti-inflammatory drugs (NSAIDs) has been found to be extra beneficial by halting the disease process. Objectives: To evaluate the status of anti-oxidant alpha-tocopherol and rheumatoid factor before and after treatment with MTX and NSAIDs for two months in Rheumatoid Arthritis patients. Methods: This quasi-experimental study was carried out in the Department of Pharmacology and Therapeutics of Rajshahi Medical College, Rajshahi between the periods of January 2011 to December 2011. Total ten clinically diagnosed Rheumatoid Arthritis patients were enrolled in the study. Purposive sampling technique was used to select each study subject from medicine wards of Rajshahi Medical College Hospital. Alpha-tocopherol, an anti-oxidant in plasma was measured as marker of anti-oxidant defense. The patients were then treated with oral MTX at a dose of 10 mg weekly and Indomethacin 150 mg in three divided doses daily for 2 months. After 2 months of continuous aforementioned treatment, alpha-tocopherol levels were estimated again. Moreover qualitative assessment of rheumatoid factor was done. For statistical analysis, paired t-test was done. Results: After two months of treatment with Methotrexate and Indomethacin, plasma alpha-tocopherol levels were significantly higher (P<0.05) in Rheumatoid Arthritis patients. However no significant change was observed in qualitative assessment of rheumatoid factors. Conclusion: From the findings of this study, it can be concluded that the endogenous alpha-tocopherol level increases even without any supplementation of alpha-tocopherol by combined treatment with MTX and Indomethacin in Rheumatoid Arthritis patients and thereby reduces oxidative stress. So alpha-tocopherol level is a better marker for early assessment of prognosis of Rheumatoid arthritis than Rheumatoid factor test. Mediscope 2021;8(2): 80-86

Association of gallbladder carcinoma with gallstone and its prevalence in a tertiary care teaching hospital

Objective: To see the association of gallstones with gallbladder carcinoma and its prevalence in patients undergoing surgery for cholelithiasis. Methods: This cross-sectional observational study was conducted from July 2012 to June 2013 at the Department of Surgery, Mymensingh Medical College Hospital, Mymensingh with 150 cases of cholelithiasis. Results: Of 150 cases those were operated for gall bladder stone disease, 8 (eight) were found to have carcinoma of gall bladder i.e. prevalence was 5.3%. On ultrasound, only three (37.5%) patients were suspected as gall bladder carcinoma pre-operatively. Females are more affected than males by this disease. Also gall bladder carcinoma was found to be associated with single large-sized stone. Conclusion: The ultrasonography can miss a significant number of malignant lesions of the gall bladder in early stages and every cholecystectomy specimen should be examined histologically. Mediscope 2021;8(2): 87-93

Incidence, pattern and presentation of Congenital Heart Disease in neonates in southern part of Bangladesh

Background: Congenital heart disease (CHD) has already been recognized as one of the important cause of neonatal mortality and morbidity. The reported prevalence of CHD in live newborns tends to vary a lot due to various unrecognizable lesions at birth and lack of technical expertise. Aims & objectives: The ultimate aim of this study was to assess the birth incidence and pattern of congenital heart disease (CHD) using echocardiography in babies born in different government and private hospitals and also in different households. Results: Overall incidence of congenital heart disease in neonate in this study was 4.9 per 1000 live birth. Mean age of diagnosis was 22.5±4.6 days. Average weight of these neonates was 26.70 gm. 61.5 % neonates were female. 30.8% was preterm. Respiratory distress was the most common clinical presentation (76.9%). The commonest type of congenital heart disease was Ventricular septal defect (VSD) (61.5%). Maternal co-morbidity may have influence. 30.8% mothers had gestational diabetes mellitus. Hypothyroidism, hypertension and maternal infection may have co-relation. Conclusion: In this study, we have found that the overall incidence of neonatal congenital heart disease is 4.9 per 1000 live birth. A high index of suspicion and routine neonatal cheek-up may have key role in diagnosis. Mediscope Vol. 8, No. 1: January 2021, Page 27-32