Isolation of Campylobacter Species in the Stool of Under Five Children With Acute Diarrhea in a Tertiary Care Hospital of Bangladesh

Campylobacter species is the main etiology of gastroenteritis due to bacteria. To determine prevalence of Campylobacter species in stool of children less than five years of age with acute diarrhoea, this observational study was conducted in the Department of Microbiology, Sylhet M A G Osmani Medical College, Sylhet from January to December, 2017. Stool samples were collected from 162 under-five children with acute diarrhoea admitted in the Department of Paediatrics. Isolation of Campylobacter species were done by stool culture. About two third of the children were male (65.4%) and more than one fourth of the affected children (26.65%) were in age group 6-12 months. Campylobacter species was isolated in 24 (15%) sample and among them, Campylobacter jejuni were 22 (91.7%) and Campylobacter coli were 2 (8.3%). Isolation rate of Campylobacter species did not differ significantly between age group of 6-12 months and above 12 months (p=0.211) of age; male and female children (p=0.288); among socioeconomic status (p=0.673) and between residential status (p=0.108). Isolation rate of Campylobacter species are frequent among under five children with acute diarrhea and most of the children came from low socioeconomic background and were male. However, a large multicenter study needs to be conducted to generate more evidence regarding the issue. Bangladesh Med J. 2020 Sept; 49(3) : 11-16

Comparison of the Ultrasonic Evaluation of Bi-Parietal Diameter and Femoral Length in 2nd and 3rd Trimester to Estimate the Gestational Age

During the gestational period, fetal biometrics are assessed through ultrasonography to observe the growth of the fetus. This study observed the corresponding of gestational age those were measured by two of the fetal diameters; gestational age were calculated from history of last menstrual period (LMP), in the last two trimesters. This descriptive type of observational study was carried out in the Department of Radiology and Imaging of Dhaka Medical College and Hospital, during the period of July, 2004 to June, 2005. Here 291 single-ton, non-complicated pregnant women of LMP were selected purposively from valid record. Bi-parietal diameter (BPD) and femoral length (FL) estimated through ultrasonography. These two parameters compared with the gestational age in second and third trimester. The study found that, before 36th week, the BPD based gestational age varied 2 to 3 days from LMP based gestational age and after that, the variation was 1 to 4 weeks. In case of FL, the ultrasonic measurement found to be 2 to 4 days backward in the second trimester and 2 to 3 days advance in the last trimester in contrast to the LMP based gestational age. In the second trimester, it has been found that, BPD has been the superior predictor of the gestational age than the FL with the correlation coefficient of 0.999 in case of BPD and 0.998 in case of FL when correlated with LMP based gestational age. Although, in third trimester, FL versus BPD predicted the gestational age with a correlation coefficient of 0.998 versus 0.978 respectively, when correlated with gestational age based on the history of LMP. This study has observed that, later in pregnancy, FL has the better predictability over BPD to determine the gestational age. Bangladesh Med J. 2020 Sept; 49(3) : 43-48

Clinico-Histopathological Consistency in Dermatological Diseases

Skin biopsy for histopathology is the most reliable investigation for diagnosis of skin diseases. The main purpose of skin biopsy is to confirm clinical diagnosis but dermatologists usually looking for the concordance with histopathological report. The aim of the study was to observe the consistency of clinical and histopathological diagnosis of skin diseases. An observational study was conducted on 630 patients that undertaken skin biopsy and that was performed at the Department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University from January 2018 to January 2019. Patients who were advised for biopsy by outpatient and inpatient department and the biopsy was done accordingly was included in the study. Finally the inclusion was confirmed when the histopathological report was available. Demographic information, clinical diagnosis, type of biopsy procedure, types of specimen taken and send for histopathological procedure and the histopathological diagnosis was noted in data collection sheet. Histopathological diagnosis and its correlation with clinical diagnosis was assessed for consistency and it was the main outcome measure of the study. The mean age of patients on whom biopsy was performed was 35.14 ±16.57 years and the age range was 5-82 years. Male patients outnumbered female and the male to female ratio was 1.15: 1. Three types of biopsy were performed among them incisional biopsy was the commonest type (93.5%). In most of the cases collected specimen was skin 94.76%, others type of specimens were mucous membrane 2.6%, nail matrix 1.9% and 0.6% specimen was hair follicle. Among the cases 71.43% was diagnosed clinically. The common clinical diagnosis in which biopsy was done was psoriasis and its types 17.77%, lichen planus and its variants 14.12%, the connective tissue diseases 6.19% and infectious diseases 5.39%. In 79.52% cases histopathological diagnosis was done and 68.22% diagnosis was consistent with the clinical diagnosis. The maximum clinico-pathological concordance was found in vesiculo-bullous disease 93.33%. Then connective tissue diseases 79.48%, vasculitides 75% and lichenoid diseases 73.56%. Skin biopsy is a conclusive tool to overcome diagnostic dilemmas in dermatological diseases. The clinico-pathological concordance is assumed lower than the expectation of dermatologists but the collective efforts of dermatologists and pathologists can improve the capacity of diagnosis of biopsy samples. Bangladesh Med J. 2020 Sept; 49(3) : 29-34

Optic Chiasmatic Hypothalamic Glioma Presented as with Panhypopituitarism with Bilateral Primary Optic Atrophy

Optic chiasmatic hypothalamic gliomas are among common primary neoplasm of the optic nerve. It presents with decreased vision as well as features of hypopituitarism due to infiltration of the hypothalamus. In this case report, a young man presented with loss of libido, increased thirst, gradual loss of vision, bilateral optic atrophy and visual field defect. The MRI of sellar and paraseller region showed optic chiasmaticglioma with hypothalamic extension and biochemical parameter showed panhypopituitarism. We diagnosed this patient as a case of Optic chiasmatic hypothalamic gliomas (OCHGS) with panhypopituitarism with partial cranial diabetes insipidus with bilateral primary optic atrophy.The patient underwent surgery after adequate hormonal treatment but died due to post-operative complications Bangladesh Med J. 2020 Sept; 49(3) : 49-52

Clinical Profile and Outcome of Children with Congenital Heart Disease in First Year of Life

Diagnosis of congenital heart disease (CHD) which is a structural abnormality of the heart or intra thoracic great vessels in the earliest possible time is very important. Identifying the various modes of presentation, early referral and appropriate intervention can save lives and reduce risk of complications. The objectives of this study were to determine the clinical profile, complication and immediate outcome of children with congenital heart disease in first year of life. This cross-sectional observational study was conducted from October 2011 to March 2012 among 50 children from zero to one year of age who was diagnosed as CHD by echocardiography admitted in Department of Paediatrics of ShaheedSuhrawardy Medical College, Dhaka and Department of Paediatric Cardiology of National Institute of Cardiovascular Diseases, Dhaka, Bangladesh. Among 50 infants acyanotic CHD was detected in 70% and cyanotic in 30% infants. Major structural defects were venticularseptal defect 34%, patent ductusarteriosus 30%, tetralogy of fallot’s 14%, transposition of great arteries 12%, atrial septal defect 6%. Presenting features were cough 82%, dyspnea 80%, poor weight gain 70%, feeding difficulty 68% and fever 58%. Frequently observed complications were failure to thrive, pulmonary hypertension and heart failure. Among the outcome of CHD 8% cases closed spontaneously, case fatality rate was 8% and the rest were advised accordingly for surgery, intervention and medical management among which 14% had device closure within the study period. High index of suspicion, early diagnosis, close monitoring and timely intervention can reduce complication of CHD. Bangladesh Med J. 2020 Sept; 49(3) : 17-21

The Concentration of 25-Hydroxy Vitamin D in Chronic Liver Disease and its’ Correlation with Severity

Chronic Liver Disease (CLD) is a common disease all over the world and the major biological factors are Hepatitis B virus (HBV) and Hepatitis C virus (HCV) in Bangladesh and Alcoholic liver disease in the western world. Life expectancy of CLD patient is increasing now a days by available modern treatment; but the long term complications are now evident. Hepatic osteodystrophy is one of the most common complication which is associated with vitamin D deficiency. Vitamin D undergoes hepatic 25-hydroxylation, but as the hepatic parenchyma is jeopardized so the metabolic activation of this vitamin is impaired. The aim of the study was to measure the concentration of 25-hydroxy vitamin D 25(OH) D in CLD patient in different etiology and to find out the relationship of level of 25(OH) D in different stages of the disease according to Child-Pugh classification. This cross sectional study was carried out in the Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka during the period of April 2015 to March 2016. Patients attending the Gastroenterology Department with cirrhosis of liver and who fulfilled the inclusion criteria were initially enrolled for the study. Study objectives were explained and informed consent was taken from patients prior to record their clinical history, examination findings and initial investigation reports in the standard data sheet. The diagnosis of liver cirrhosis was made by combination of clinical features, blood profile and trans abdominal ultrasonography (T. USG). Endoscopy of the upper GIT was also done to see the presence of oesophageal or gastric varices which is a sign of increase portal pressure. Stages of CLD were assessed by Child-Pugh scoring system and level of 25(OH) D was measured from blood with the help of the Department of Bio-chemistry. Data was collected using a structured data sheet and analyzed by SPSS. Out of 85 patients, male-female ratio was 3:1 and mean age was 53.0 ± 10.7 year within the range of 25-70 years. Most of the patients had acites 92.9% and anorexia 90.6%; where four-fifth patients had weight loss and more than one third had Jaundice. Nearly half of the patients had abdominal pain and 42.4% had melaena. Four-fifth patients had history of blood transfusion and most of them had H/O hospitalization 94.8%, anaemia (97.6%) and Splenomegaly 92.9%. More than half (52.9%) of patients had bone pain; where jaundice 61.2% and Leukonychia 61.2% were detected in equal number of patients. Mean vitamin 25(OH) D was 16.29 ± 7.96 in 69 HBV patients and 20.14 ± 9.76 in 16 HCV patients. In this study, 28.2% patients were in child Pugh A, 36.4% in child Pugh B and 32.9% in child Pugh C stages. Mean vitamin 25(OH) D were 27.12 ± 6.11, 15.97 ± 5.40 and 9.57 ± 1.I5 in Child-pugh A, Child-pugh B and Child-pugh C stages respectively. Mean vitamin 25(OH) D was observed at decreased level as the changes of stage from lower to higher. Vitamin D deficiency was highly prevalent in patients with CLD and inversely correlated with disease severity. In the case of chronic liver diseases, vitamin D seems to modulate the innate and adaptive immune system, which explains the association. This study suggest that these parameters may improve with vitamin D supplementation. Monitoring of S. 25(OH) D is reasonable in CLD patient. Bangladesh Med J. 2020 Sept; 49(3) : 35-42

Bone Mineral Density and Body Mass Index in Postmenopausal Women

Osteoporosis is a typical medical issue that overwhelmingly influences postmenopausal women. A bone density test is the only test that can diagnose osteoporosis before a broken bone occurs. The aims of this study was to find out the relationship between bone mineral density (BMD) and body mass index (BMI) in postmenopausal females. This cross sectional descriptive study was carried out in the Institute of Nuclear Medicine and Allied Sciences (INMAS), Sylhet. Study subjects comprised of 117 postmenopausal women between ages 45 to 85 years, with a mean age of 60.8 ± 9.2 years, who underwent BMD scan from January 2018 to June 2019. Duration of the study was 5 months ( march 2019 to august 2019). BMD was measured by the MedilinkMedix DR system. Findings of BMD of right femur showed osteopenia and osteoporosis (low BMD) in most of the women with under weight (81.0%) about one third (32.3%) of normal body weight and few (16.7%) of them over weight. Contrarily in left femur, low BMD was found in 08 (80.0%), 25 (40.3%) and 6 (16.7%) among underweight, normal, overweight patients respectively. According to BMI compare to the lumbar spine, low BMD was found in 48 (77.4%), 10 (100 %), 20 (55.6%), 03 (33.3%) among normal, underweight, overweight, and obese patients respectively. Relationship among BMD and BMI was found statistically significant in the both femurs (p < 0.001) and lumbar spine (p = 0.02). Low BMD was more severe in the 65-74 years’ age group in both femurs 65.4% and 65-85 years’ age group in lumbar spine 84.6% compare to other groups. The findings of this study reveal that low BMI and aging are associated with bone loss. Routine BMD checking in postmenopausal women might be important to initiate an early clinical intervention for osteoporosis. Bangladesh Med J. 2020 Sept; 49(3) : 22-28

Magnetic Resonance Imaging (MRI) Evaluation of Sellar Region Tumors with Histopathological Correlation

MRI is a complex, rapidly evolving modality which has assumed an increasingly important role in the diagnosis of Sellar region tumors. It is now the preferred modality for the definitive evaluation and follow-up of the most sellar region tumors. Using different pulse sequence small lesion can be detected even without contrast. Gd-DTPA provides valuable information in MR imaging sellar region tumors, particularly in pre-operative evaluation. This study was conducted to elucidate the accuracy of MRI in pre-operative evaluation of sellar region tumors and its validity by determining sensitivity, specificity, positive and negative predictive value with histopathological correlation. This cross sectional observational study was carried out in the department of radiology and imaging in collaboration with department of Neurosurgery, Dhaka Medical college Hospital, Dhaka during the period of January 2008 to April 2009. MRI of brain was done on 42 patients referred for evaluation of sellar region tumors. The following result and observation were obtained. The age range of the patient was 20 to 80 years. The mean age (HSE) was 34.31(+2.80). Maximum patients were in age group 20-30 years and male-female ratio was 1.8:1. Most sellar region tumor located in the intrasellar with suprasellar extension. Out of 42 patients 37 (88%) patients were truly diagnosed by MRI as sellar region tumors. The sensitivity of MRI to diagnosed macro adenoma was 81.25%, specificity 80.76%, positive predictive value 72.2%, negative predictive value 87.5%, accuracy 80.95%. This study finds that MRI is a valid imaging modality in the diagnosis of pituitary adenoma and sellar region tumor. Bangladesh Med J. 2020 Sept; 49(3) : 1-10

Obituary News September-2020 Vol.49(3)

not available Bangladesh Med J. 2020 Sept; 49(3) : 57-63

‘Crush Programme’ as Part of Combined Control Programme for Culex Mosquito in Both North and South Dhaka City Corporation

not available Bangladesh Med J. 2020 Sept; 49(3) : 53-56