Disease Profile and Death Pattern among the Children Admitted in Rajshahi Medical College Hospital

Background: Rajshahi medical college hospital is a tertiary care teaching and referral center in the North-West part of Bangladesh. To assess the epidemiological trend in hospital admission, including morbidity and mortality pattern of illness in the pediatric population, it needs to develop effective health care planning, appropriate resource allocation, and integration of existing health care service facilities. Objective: To evaluate the diseases and deaths of children admitted in the department of pediatrics, Rajshahi medical college hospital, Rajshahi. Materials and methods: This is a retrospective study. The collected case records of all patients admitted in the department of pediatrics from 1st January 2017 to 31st December 2019 (3 years) were analyzed. Result: A total of 62000 children were admitted during the mentioned study period. All the patients were distributed into three age groups infant, under five, and more than five, contributing 22%, 27.5%, and 19%, respectively. Acute watery diarrhea (21%), hereditary hemolytic anemia (18%), bronchopneumonia (10.4%), acute gastritis (9.4%), and acute bronchiolitis and wheezy child (7.17%) were the top five diseases in each of the three years of admission. Among the total admitted patients, 1003 (1.61%) patients died. Infant, under five, and more than five age groups constitute 61.3%, 28.1%, and 15.1%, respectively. Encephalitis and fulminant hepatic failure found the top two diseases causing death with a case fatality rate was 61% and 43%, respectively. The next highest case fatality rate was found in acute leukemia (15%). Other common causes of death include meningitis, cerebral palsy with complications (7.5%), bronchopneumonia with complications (3.8%). Conclusion: An admission-related comprehensive evaluation of this study will help to understand the diseases and death patterns of a hospital, leading to the development of more effective planning and case management strategies. TAJ 2021; 34: No-1: 55-62

Serum Uric Acid as a Prognostic Factor of Acute Myocardial Infarction in Hospitalized Patients

Background: Among non-communicable diseases, acute myocardial infarction (AMI) is a common killer of people in the world. The management of AMI patients is one of the major challenges in the field of cardiology. Uric acid has several effects of potential interest in cardiovascular disease. There are some markers indicating an unfavorable prognosis in AMI patients. Uric acid is one of the markers that have been evaluated in research. Objective: The aim of this study was to assess the association between serum uric acid level and in-hospital outcomes of AMI patients. Patients and methods: This longitudinal descriptive study was conducted over 115 AMI patients in the Cardiology Unit of Rajshahi Medical College Hospital during the period of January 2015 to December 2016. Baseline characteristics such as age, sex, BMI, BP, RBS, risk factors (hypertension, DM, smoking, family history of IHD, dyslipidemia), and outcomes of AMI patients (acute LVF, arrhythmia, conduction block, cardiogenic shock, death) were recorded. We measured the serum uric acid of this patient at admission. Results: The mean age of patients was 52.83±10.71 years. Out of 115 patients, 83.5% were male, and 16.5% were female. Among the risk factors, 65.2% of patients had HTN, 20.9% DM, 64.3% smoking, 16.5% family history of IHD, and 47.8% dyslipidemia. Out of 115, 35.7% of patients demonstrated high serum uric acid. In outcomes of AMI patients, acute LVF 24.4% (p=0.031) and death 12.2% (p=0.041) were significantly higher in patients with high serum uric acid levels. Conclusion: Significant association was found between high serum uric acid level and in-hospital outcomes of AMI patients. So, estimation of serum uric acid may offer an inexpensive, quick, and non-invasive method for identifying such high-risk patients. TAJ 2021; 34: No-1: 26-32

Evaluation of Delorme’s Procedure in the Treatment of Complete Rectal Prolapse- A Comparison with Abdominal Rectopexy (Well’s procedure)

Background: There are versatile operative techniques for treating complete rectal prolapse. Every procedure has some advantages and disadvantages. Delorme’s procedure and abdominal rectopexy (Well’s procedure) have gained more popularity. But to determine which approach is better, it is needed to evaluate the functional outcome of both procedures. Objective: To compare the outcome of Delorme’s procedure and abdominal rectopexy to treat complete rectal prolapse. Methodology: A randomized control trial was conducted in 25 patients with complete rectal prolapse in the department of Surgery, RMCH. They were divided into two groups by randomization. Fifteen patients included in Group-I underwent Delorme’s procedure, and ten patients included in group-II underwent abdominal rectopexy (Well’s procedure). The outcome of both procedures was compared postoperatively. Results: In group-1, we have found uneventful outcomes of 10 (66.66%) patients, and hemorrhage, minor incontinence, and retention of urine were found in 2(13.3%), 1(6.66), and 4(26.66%) patients, respectively. In group-2 patients, 5(50%) patients recovered uneventfully, whereas hemorrhage, surgical site infection, retention of urine, bladder dysfunction, and constipation were found in 2(20%), 1(10%), 1(10%), 1(10%) and 2(20%) patients respectively. The mean operation time in group-I was 92.86 min and in Group 2 was 124.00 min with a p-value of 0.001. The average post-operative hospital stay after Delorme’s procedure was <4 days in 4 patients and 4-6 days in the rest 11 patients. But the hospital stay is a little lengthier in the case of abdominal rectopexy (Well’s procedure), where seven patients were discharged within 4-6 days, and three patients were discharged after the 5th day of operation. In group I, expenditure was <7000 taka in 10 (66.66%) patients, whereas in group-2 , the cost was 10000-15000 in 7(70%) patients with a p-value of 0.001. Conclusion: We can conclude that Delorme’s procedure is comparatively safer and cost-effective than Well’s procedure, considering different vital parameters. TAJ 2021; 34: No-1: 40-46

Study on Homocysteinemia as a Risk Factor of Ischemic Stroke

Despite recent advances, only two-third of all strokes can be attributed to known causal risk factors. Homocysteine (tHcy), a sulfur-containing amino acid, is now considered to be an important risk factor for vascular diseases, along with the established risk factors like hyperlipidemia, hypertension, diabetes mellitus, and smoking. Elevated homocysteine levels play a causal role in the pathogenesis of atherosclerosis, thromboembolism and vascular endothelial dysfunction with an increased incidence of ischemic stroke. This study aimed to find out the association of hyperhomocysteinemia with ischemic stroke. A total of 100 subjects were included in this study, 50 were ischemic stroke patients enrolled as case, and 50 were normal healthy individuals enrolled as control. Serum homocysteine level was measured in both case and control groups. The comparison was made in both groups regarding other common risk factors like diabetes mellitus, hypertension, smoking, dyslipidemia, family history, etc. Among 100 patients, 50 had ischemic stroke and 50 were healthy individuals. In this study, out of all patients, abnormal serum homocysteine level was found in 32% of cases and 12% of controls. The mean (±SD) serum homocysteine level was found 16.50±13.86 μmole/L in cases and 9.46±3.49 μmole /L in the control group. Significant (p<0.05) difference was found between the case and the control. The incidence of hyperhomocysteinemia is higher in ischemic stroke cases than that in age-sex-matched healthy controls. In our study, serum homocysteine was high in both younger age group patients (16.65±14.55 μmole/L vs. 9.52±3.19 μmole/L) and older age group patients (16.33±9.87 vs. 9.35±3.97 μmole/L,) in case and control group respectively. Significant (p<0.05) difference was found between the case and the control. Multiple logistic regression analysis showed that abnormal serum homocysteine is an independent risk factor of ischemic stroke. So we conclude that hyperhomocysteinemia is an important and independent risk factor for the development of ischemic stroke. Hypertension and smoking are important contributory to elevated serum homocysteine. TAJ 2021; 34: No-1: 33-39

Histopathological Study of Pathological Specimens of Various Organs in a Tertiary Care Hospital in Bangladesh

This retrospective study of histopathological specimens was done at the Department of Pathology of Rajshahi Medical College, Bangladesh, from July 2019 to June 2020, emphasizing challenges and diagnosis outcomes. Data obtained from their case notes included age at admission, the site from where the specimens were collected, and histopathological diagnosis. Out of the 2026 histopathology samples, chronic cervicitis constitutes about 50% of the cases. Serous cystadenoma (about 1/4th cases) was common among ovarian pathology. 54.16% of the breast pathology exhibited Invasive ductal carcinoma. Reactive follicular hyperplasia and lymphoma constitute 49.44% of the lymph node pathology. About 80% of the gall bladder pathology was chronic cholecystitis, and metastatic adenocarcinoma was the commonest pathology involving the liver. Squamous cell carcinoma constitutes about 40% of the skin pathology. Osteosarcoma, osteochondroma, and giant cell tumor were the common pathologies involved in bones. Transitional cell carcinoma constitutes about 45% of urinary bladder pathology, and renal cell carcinomas were the commonest pathology of the kidney. Adenocarcinoma constitutes about 45 % of stomach pathology, 28% of small intestine pathology, and 14% of large intestine pathology. Histopathological specimens at the pathology Rajshahi Medical College department with a wide range of pathologies are a major problem. From this study necessity of screening programs for early cancer detection appeared as a time-demanding issue. TAJ 2021; 34: No-1: 16-25

Modified Volar Oblique Triangular Flap for Coverage of Fingertip Defects

Fingertip includes the portion of the digit which is distal to the insertion of flexor digitorum profundus (FDP) tendon and the extensor tendon. It is the most vulnerable part of the hand to be injured. So, reconstruction of this part requires a good outcome in sensation and function. To meet the goal of the reconstruction principle, "Like with Like" local flap is the most preferable. Such type of flap is a Volar oblique triangular flap based on volar perforator vessels from the Digital artery proper. The aim of the study is to identify its reconstruction outcome in viability, sensation, range of movement of DIPJ, and patients' satisfaction regarding contour. This was a prospective observational study; ten patients were included who were admitted in the Burn and Plastic surgery Department of Rajshahi Medical College Hospital, Rajshahi, from September 2019 to December 2020. Thirteen flaps were harvested to cover for the fingertip defect of ten patients; among them, three were female. The age range of our operated patient was 2- 38 years. None of the flaps was lost except marginal necrosis or epidermal loss. The range of movement of DIPJ and 2SPD were within the normal limit. Patients were satisfied with their contour. So, the modified volar oblique, triangular flap is one of the good options for fingertip defects. TAJ 2021; 34: No-1: 63-69

Humoral Immune Responses to Amebic Liver Abscess

Background: Amebic liver abscess (ALA) is an ancient parasitic disease caused by E. histolytica described first by Hippocrates. It is endemic worldwide, mainly in tropic and subtropics countries. About 50 million true E. histolytica infections and approximately 100,000 deaths occur each year globally. In Bangladesh, exact incidences of amebic liver abscess cases are not estimated, but hospital reports indicate that it is endemic. Immunity and immune responses in acute and post infections of ALA are not well understood to date. However, the understanding of immunology is essential to know disease progression, recovery, morbidity, and mortality as well as diagnosis and newer prevention strategies like vaccine development. In this 15-month prospective and follow-up study, different antibody responses are estimated periodically. Methods: About 90 amebic liver abscess patients diagnosed initially by ultra-sonogram confirmed followed by Real-Time PCR were selected for this study. All were admitted into Rajshahi Medical College Hospital, Bangladesh. Antibody responses against different antigens, which include Serum anti-lectin IgG, Salivary anti-CRD (carbohydrate recognition domain) Ig A, and Stool anti-CRD (carbohydrate recognition domain) IgA were estimated by ELISA periodically thrice, in acute stage after 06 and 09 months and between 12 and 15 months. Results: Serum anti-lectin IgG in ALA persists remarkably high well up to 09 months in 98% cases, Secretory anti-CRD IgA was also determined from the saliva, and only 36(40%) show positive titer during first 06 months, and about 40% of ALA cases show high titer of anti-CRD IgA from stool samples in first six months of infection. Conclusion: Only serum anti lectin Ig G showed significant high titer in 98% of cases in the acute stage and up to nine months of infection. TAJ 2021; 34: No-1: 05-08

Detection of Dengue Serotypes by Two Molecular Techniques, qPCR and LAMP

Background: Dengue virus is a mosquito-borne flavivirus and the most widely prevalent arbovirus in tropical and subtropical regions. Detection of this virus by a new molecular technique named Loop-mediated isothermal amplification (LAMP) is a very sensitive, easy, and less time-consuming diagnostic method. It can amplify up to 109 copies in less than 1 hour under isothermal conditions (65°C). Aims: To establish a dengue LAMP as simple, less time-consuming, more specific, and sensitive than the qPCR to detect dengue serotypes. Materials and Methods: This prospective analytical study was conducted from January- December 2017 at the Department of Virology, BSMMU, Dhaka, Bangladesh. A total of 290 serum samples were used, confirmed by ICT (immune chromatographic test). These samples were used to perform qPCR for the detection of dengue serotypes. After that, dengue LAMP was performed using the same samples to establish the LAMP technique as a suitable, time-saving molecular technique that is more sensitive than qPCR. Results: A total of 290 dengue confirmed samples by ICT were used for qPCR to detect dengue serotypes. Among which 137 dengue I and 113 dengue II RNA positive serum samples were confirmed by qPCR, and those were also positive by LAMP assay. Besides, 20 both dengue NS1 and dengue IgM negative by ICT were tested by qPCR, and 01 positive dengue II serotype was detected by qPCR, whereas 02 dengue II serotypes were detected by dengue LAMP technique from the same samples. Conclusion: RT-LAMP assay had been developed in this study which allowed the rapid and accurate identification of dengue virus serotypes. TAJ 2021; 34: No-1: 01-04

Presentation and Comparison of Unnatural Deaths Due to Different Types of Accidents in the Rajshahi District of Bangladesh

Background: Accidental deaths are the object of public health issues. This study was designed to explore and compare the statistics of all types of accidental deaths that occurred in the Rajshahi district in 2019 and 2020. Materials and methods: The data presented here were accumulated from the forensic examination of the corresponding dead bodies, which were submitted by police from the different police stations in the Department of Forensic Medicine & Toxicology (DFMT) at RMC for postmortem examination. This study confirms and explores the number of accidental deaths based on the observation, which were analogous with corresponding signs of studied accidental events. Results: According to the data, road traffic accident (RTA) was the most prevalent cause of unnatural accidental death in both years. In 2019, the number of deaths due to unwanted bomb explosions was the lowest. But, in 2020, the lowest number of deaths were observed due to alcohol overdose. The numbers of deaths due to other accidents were almost equal. Conclusion: This study suggests taking preventive measures that may reduce accidental deaths. TAJ 2021; 34: No-1: 70-74

Distinct MRI Findings of Nipah Encephalitis: Report of Two Cases

Nipah virus, a zoonotic paramyxovirus transmitted by specific types of fruit bats, causes an occasional outbreak of encephalitis in Bangladesh and India. We are reporting two cases of Nipah encephalitis with distinct MRI findings. TAJ 2021; 34: No-1: 106-108