Unilateral Eagle’s Syndrome

Eagle’s syndrome represent as a neck, cervicofacial pain, dysphagia, facial pain, globus sensation, tinnitus, otalgia and headache, it may be unilateral or bilateral. About 4% of adult population accounted elongated styloid process, which are the principal factor of Eagle’s syndrome and followed by 0.16% of patients are symptomatic. Stylohyoid ligament calcification is the second most common factor. The diagnosis must be made through a detailed history, clinical examination, and various imaging modalities. A 36 years old female patient presented with persistent pain in the throat. An elongated styloid process was diagnosed and was removed by transoral approach following the patient was relieved from her symptoms. J Bangladesh Coll Phys Surg 2022; 40: 72-74

Maternal and Fetal Outcome of Pregnancy with COVID- 19 in A Tertiary Level Hospital, Bangladesh

Introduction: Pregnant women have long been recognized as a vulnerable population during infectious disease pandemics due to physiological changes in the immune, pulmonary, cardiac and coagulation systems. It is essential to acquire knowledge of pregnancy outcomes, potential complications and neonatal health conditions born to an infected mother with COVID-19. Material and methods: This cross-sectional observational study was conducted in Combined Military Hospital (CMH), Jashore from June 2020 to July 2021 among 100 hospitalized laboratory-confirmed COVID-19 positive pregnant women, patients who had clinical symptoms of COVID but RT PCR negative were excluded. The aim of the study was to evaluate the clinical profile and maternal and fetal outcome of pregnancy. Relevant data were recorded in a preformed data collection sheet and analyzed by SPSS version 20. Results: Among 100 COVID-19 positive hospitalized pregnant women, the mean age of participants was 27years (range 19-40 years), Maximum infection rate observed during 12 to 28 weeks of gestation among the participants, 21% got infected at 37 to 40 weeks of gestation and 20% got infected at 32 to 36 weeks. Seventy-four percent patients underwent delivery during the study & 23% of them continued with ongoing pregnancy; 67 of the participants underwent LUCS and 7 vaginal deliveries were done, 3% had abortion and IUFD 1% ,61% were multipara and 39% were Primipara, associated co-morbidities were subclinical hypothyroidism(15%), pregnancy induced HTN(12%) and GDM(8%); 36% participants were asymptomatic and 44% had mild symptoms, rate of LUCS was higher than (90.64%) vaginal delivery. Among the 73 live births, 80.82% were term and 10.18% were preterm of neonates, small for gestational was seen in the case of 20.55% neonates. Testing for SARS-CoV-2 was performed in all neonatal throat swabs and found positive in one case only. Eighty-six percent neonates were well-baby and 9.58% neonates required NICU admission. There were 2 neonatal deaths due to severe prematurity and 2 babies were found to have congenital cardiac anomaly and cleft lip, cleft palate. Though 36% of patients were asymptomatic but 10% were severe and in the critical stage. HDU support needed for 8% of patients and ICU support for 6%. Conclusion: This cross-sectional study supports that pregnant women with COVID-19 infection are at increased risk of adverse pregnancy and birth outcomes and a low risk of congenital transmission. Availability of ICU in critical conditions is needed for better pregnancy outcomes. J Bangladesh Coll Phys Surg 2022; 40: 10-16

COVID-19 and Pregnancy: An Unwanted Combination

not available J Bangladesh Coll Phys Surg 2022; 40: 3

Chorea Associated with Diabetic Striatopathy in an Elderly Female: A Case Report

Diabetic striatopathy is a rare manifestation of diabetes mellitus. The disease commonly affects individuals of Asian descent, female, and the elderly. Patients usually present with hemiballism-hemichorea caused by hyperosmolar hyperglycemic state. Prompt recognition of a hyperglycemiainduced hemiballism-hemichorea is essential because the symptoms are reversible with correction of hyperglycemia. Diagnosis is possible based on blood reports and neuroimaging findings. J Bangladesh Coll Phys Surg 2022; 40: 65-67

A Systematic Review on Immunotherapy for Guillain- Barre Syndrome

Guillain-Barré syndrome (GBS) is an acute immunemediated polyradiculoneuropathy with a highly variable clinical course and outcome. Intravenous immunoglobulin (IVIG) and plasma exchange (PE) are proven effective treatments, but about half of the patients may not respond to these therapies; moreover, these are not established yet to treat patients of every stage of GBS or its variants. Results from the International Guillain-Barré Syndrome Outcome Study suggest that geographical variations exist in Guillain-Barré syndrome, including insufficient access to immunotherapy in low-income countries. There is a need to provide improved access to treatment for all patients with Guillain-Barré syndrome, and to develop effective disease-modifying therapies that can limit the extent of nerve injury. In this review, the current literature about immunotherapeutic options is highlighted in the context of stages of the disease and its variants and additionally, upcoming modalities are discussed briefly. J Bangladesh Coll Phys Surg 2022; 40: 57-64

Laparoscopic Hand-Sewn Duodenojejunostomy for Superior Mesenteric Artery Syndrome Using 3D-4K Image - A Case Study

Background: Superior mesenteric artery (SMA) syndrome, also known as wilkie’s syndrome, is a rare condition characterized by vascular compression of third part of the duodenum that leads to duodenal obstruction. Traditionally, open or laparoscopic stapled duodenojejunostomy is recommended when conservative management failed. We report a 3D-4K image hand-sewn duodenojejunostomy (DJ) for the treatment of SMA syndrome. Materials and Methods: A 13 years old patient presented with anorexia, post prandial vomiting, dull abdominal pain & weight loss for 6 years. Upper GI endoscopy revealed duodenal stenosis and Barium follow through demonstrated obstruction to the third part of the duodenum. Ultrasound examination revealed gastric & duodenal dilatation. With these clinical and radiological findings, the diagnosis of SMA syndrome was suspected. He was identified as a candidate for a duodenojejunostomy. 3D-4K image system was used for superior image quality and binocular depth perception and a laparoscopic hand-sewn duodenojejunostomy performed on september 20, 2020 Results: Diagnostic laparoscopy detected SMA syndrome. Laparoscopic hand-sewn duodenojejunostomy took 120 minutes time. There were no intraoperative complications. The blood loss was minimum. The postoperative course was uneventful with resolution of duodenal obstruction. The patient discharged on 6th postoperative day. He gained 10 kg weight 6weeks after surgery. Conclusion: 3D-4K image laparoscopic hand-sewn duodenojejunostomy as a surgical option for the treatment of SMA syndrome is safe, cost effective, feasible, and valid alternative to open and laparoscopic stapled technique with added benefits of a minimally invasive approach. Additionally hand-sewn anastomosis ensures good tissue approximation. Of course it is time consuming and needs expertise in intracorporeal suturing. 3D-4K image technology makes this difficult procedure easier. J Bangladesh Coll Phys Surg 2022; 40: 68-71

Lipid Accumulation Product (LAP) Index as Predictor Tool for Metabolic Syndrome

not available J Bangladesh Coll Phys Surg 2022; 40: 1-2

Rehabilitation of COVID 19 Patients, Bangladesh Perspective

The global outbreak of COVID 19 has created an unprecedented challenge to the society. America, Europe and India were catastrophic sufferers from this virus next to China. They had highest number of daily morbidity and mortality in the global context. Bangladesh is facing terrible experiences of dealing with this pandemic and making a tremendous turmoil in health and economic sector. Our healthcare system is overburdened with critically ill patients. Disability arising out of neurological, pulmonary, neuromuscular, and cognitive complications, need to be addressed by rehabilitation professionals. Many patients presenting with COVID-19 will have no specific airway clearance needs.There have been no reports of COVID-19 positive patients having high secretion loads that would require intensive chest physiotherapy or postural drainage. In Bangladesh in ICU settings physiatrist or physiotherapists are not directly involve in respiratory care management. In mild to moderate cases advice about a post-acute care breathing exercises, other musculoskeletal exercises, bed positioning and pressure sore care are helpful. In Bangladesh medical care facilities are not adequate in corona care hospitals especially in peripheral medical college or hospital. Many patients are dying of shortage in oxygen supplies and lack of availability of ICU. Post discharged plans of comprehensive rehabilitation are grossly neglected in discharged certificate. Our national guidelines on corona management do not have any instructions on rehabilitation management at any point. The objectives of this fast review article on corona pandemic are to highlight the global scenario and our limitations in the rehabilitation management of COVID 19 patients particularly post discharged patients and patients with long COVID complications. J Bangladesh Coll Phys Surg 2022; 40: 52-56

Evaluation of Pressure Ulcer Among the Critically Ill Patients Admitted in a Tertiary Hospital

Background: All over the world pressure ulcer is a significant health care problem due to high morbidity and mortality rates and also high health care cost. This study was carried out with the objectives to identify the characteristics and associated factors of pressure ulcer among the critically ill patients admitted in a tertiary military hospital. Few studies have been conducted on pressure ulcer in Bangladesh and very few in military hospitals. Methodology: This was a cross sectional study conducted among purposively selected 53 critically ill admitted pressure ulcer patients in CMH Dhaka from 01 July 2018 to 31 December 2018 and data were collected by face to face interview and checklist. Results: Among the study population half (50.9%) were aged between 61-80 years with the mean age 69.13 years. The most common anatomical site of pressure ulcer were buttock (51.9%) followed by sacrum (38.5%) and 30.2% had multiple pressure ulcer. Among the critically ill patients, 81.1% had developed pressure ulcer after admission into hospital. The most common place of pressure ulcer was geriatric HDU (30.2%) and officers ward (18.9%). Among the pressure ulcer patients 79.2% were male. Most common stage of pressure ulcer were stage II (66.0%) followed by stage I (18.9%), stage III (13.2%) and stage IV (1.9%). All of them were bedridden and half (50.9%) were completely immobile. According to Braden Scale, about half (50.9%) had high risk for development of pressure ulcer followed by moderate risk (26.4%) and there were none beyond risk. About three fourth (73.6%) of pressure ulcer patients had hypertension & cerebrovascular diseases. Age group of 60-90 years, SSC & above educational group, male sex, immobility, low Braden score group patients are statistically significant (p < 0.05), and hypertensive and cerebrovascular diseased patients are not statically significant (p > 0.05) but having clear trends to be associate factors of pressure ulcer. Conclusion: The number of pressure ulcer were increasing with the increase of age. The higher age, male sex, immobilization, low Braden score, hypertension, and cerebrovascular diseased patients were more prone for development of pressure ulcer among the critically ill patients. J Bangladesh Coll Phys Surg 2022; 40: 23-30

Menstrual Abnormalities and Associated Hormone Profile In Chronic Kidney Disease Stage 5 Patients

Background: Although menstrual abnormalities and associated hormonal dysregulations are very common in the reproductive age group of Chronic Kidney Disease (CKD) patients, this remains a neglected area. This field had been poorly explored in last ten years worldwide and a few research regarding this area in Bangladesh as well. Aim: To evaluate menstrual abnormalities occurring in CKD stage 5 (CKD5)patients undergoing twice-weekly and thriceweekly maintenance hemodialysis (HD) also in non-dialytic CKD5 patients and to provide more detail information on hormone profile (FSH, LH, Prolactin, Estradiol) of these patients. Materials and method: This obsevational study was conducted in the Department of Nephrology, DMCH, the sample population was also collected from BSMMU and NIKDU from April 2017 to March 2018. A total of 51 CKD stage 5 patients were enrolled in this study. Among them, 34 patients were dialytic (17 of them were taking twice weekly HD and 17 of them were taking thrice weekly HD) and 17 non-dialytic patients at reproductive age were evaluated. Detailed menstrual histories, thorough clinical examinations as well as investigations were done in all the patients. Serum FSH, LH, Estradiol, and Prolactin were evaluated using chemiluminescence immunoassay in the Department of Microbiology of BSMMU. Statistical analysis of the study was done by SPSS-24. The confidence interval was considered at 95% level. P-value <0.05 was considered statistically significant. Results: 100% of non-dialytic CKD5 women had menstrual disorders (72% of patients had secondary amenorrhea, 18% had oligomenorrhoea and 10% had menometrorrhagia). And 73.52% of patients in the HD group had menstrual disorders (29% patients had regular menstruation, 28.5% had secondary amenorrhea, 23.5% had oligomenorrhoea and 19% had menometrorrhagia). With continuation of HD amenorrhea disappeared in 43% of patients in the thrice-weekly HD group, also 22.22% patients in the twice-weekly HD group regained menstruation. Serum LH and prolactin levels were significantly higher in the non-HD group compared to the HD group (p<0.05). Estradiol levels were also higher in HD patients than the non-HD patients. LH and Prolactin levels were also higher in the twice-weekly HD group compared to the thrice-weekly HD group. In the secondary amenorrheic group, serum FSH, LH, Prolactin levels were significantly higher than the other groups having menstrual disorder (p<0.05). Conclusion: Menstrual abnormalities and associated hormonal dysregulations were significantly lower in thriceweekly HD patients compared to the twice-weekly HD patients and significantly lower in twice-weekly HD patients compared to the non-dialytic CKD5 patients. Besides, it is suggested that long-duration dialysis might improve menstrual disorders in such patients as prolactin, LH levels gradually decreased with longer duration of dialysis. J Bangladesh Coll Phys Surg 2022; 40: 45-51