A Study of Liver Function Tests in Patients Receiving Four Drugs Regimen in Initial Two Months as Antitubercular Drugs

Biochemical monitoring of liver function is essential because Anti Tubercular Therapy (ATT) induced hepatotoxicity can cause permanent injury to liver and death. This cross-sectional comparative study was conducted in department of Biochemistry of Chittagong Medical College during the period of July 2009- Jun 2010 to determine the association of Anti-TB treatment to alter the liver function in patients of intensive phase of tuberculosis taking Four Fixed Dose Combination of Isoniazid, Rifampicin, Pyrazinamide and Ethambutol. A total of 100 subjects were enrolled in this study. They were divided into two groups. Group A (case) was diagnosed case of tuberculosis and had taken anti TB drugs (four Fixed dose combination) at least for fifteen days and group B (control) was consisting of normal subjects. Serum ALT, AST, Bilirubin and prothrombin time were measured. It was found, that out of 70 subjects 20% had increased level of serum ALT, 17.1% had increased level of serum AST, 20% had increased level of serum bilirubin and only 2.9% had increased level of prothrombin time in case group. Finally, determination of liver functions in patients receiving Anti TB therapy (in intensive phase) should be done irrespective of presence or absence of established risk factors, to minimize not only the incidence but also the morbidity and mortality. JCMCTA 2012 ; 23 (2): 27-29

Gastrocnemius Muscle Flap for Coverage Of Knee & Proximal Third of Tibial Defects

Gastrocnemius is the muscle of choice for reconstruction of defects involving soft tissue loss over the upper third tibia as well as knee joint. We present a series of 12 patients who underwent gastrocnemius muscle flap(Medial head, proximally based) coverage for this type of defects. Patients age-18 years or above. There were 9 males and 3 females. In all cases, delayed reconstruction was performed ranging from 1 week to 3 months after the creation of defects. Maximum number of pts were within 18-35 years age groups (66.66%), 75% were victims of RTA, 75% had associated fractures. Results of surgery were graded as excellent(83.33%) to good(16.67%) depending upon the outcome and functional restoration of patients. There was no case of complete muscle flap failure. Minor complications were ( 1 pt. developed partial flap necrosis & 1 pt. developed infection) noted but none required a separate operative procedure. We have found this procedure to be reliable, technically easy, biologically sound and esthetically acceptable. JCMCTA 2012 ; 23 (2): 58-61

Probiotics and Prebiotics

Thousands of species of bacteria colonize gut. The number of microbes is ten times that of total human body cells. The intestinal microbiota is not always harmful, sometimes it is beneficial for human health. If the growth and activity of the intestinal microbiota is perturbed, it may lead to various diseases such as irritable bowel syndrome, autoimmune diseases, infections, colon cancers, gastric ulcers, cardiovascular disease and obesity. Restoration of the gut microbiota may be done by the use of probiotics (beneficial bacteria). Prebiotics, on the other hand, are the food substrate for probiotics. This review article describes uses and harms of probiotics and prebiotics in the body and their rationale for using in diet. JCMCTA 2012 ; 23 (2): 62-68

Comparison Between Preoperative Image Guided Biopsy and Open Biopsy in Clinically Labeled “Unresectable Carcinoma Pancreas”

Although clinical findings along with modern laboratory investigations and imaging can help to diagnose pancreatic cancer and label them respectable or unrespectable, tissue diagnosis is essential to confirm the diagnosis and proper management. This retrospective review was done form July 2004 to June 2006 in BIRDEM hospital, Dhaka, Bangladesh, in patient with clinically labeled 'unresectable carcinoma pancreas' to evaluate the preoperative and postoperative biopsy pattern with their histopathological diagnosis. Forty (40) patients were clinically labeled as ‘unresectable carcinoma pancreas'. Preoperative image guided biopsy was taken in 25 patients. Methods of preoperative tissue diagnosis with their histopathology reports were noted. In forty (40) patients it was planned to take open biopsy along with other palliative surgical procedures. In 38 patients tumours found unresectable and biopsy were taken from the lesion, involved organ or lymph node. In 2 patients curative resection were done and whole specimens were sent for histopathology. Histopathology report of post surgical specimen was compared with preoperative histopathology report. Preoperative biopsies were done by ERCP in 12 patients. Ten (10) image (ultrasonography, computed tomography scan) assisted fine needle aspiration biopsy were taken from the pancreatic lesion. Preoperative imaging failed to detect any pancreatic mass in the rest 3 patients but showed suspected liver metastasis. Image (computed tomography scan) assisted 03 fine needle aspiration biopsies were taken from 3 hepatic metastasis. Histopathological report showed pancreatic duct cell carcinoma in 19 (76%) patients, 1(4%) patients had chronic pancreatitis. Biopsy report was not conclusive in 2 (8%) patients. All 3 biopsies from liver focus were metastatic pancreatic cancer (12%). Histopathology report of laparotomy samples revealed that 35 patients (87.5%) had pancreatic duct cell carcinoma. Out of the rest 5 patients 2 patients (5%) were chronic pancreatitis, non Hodgkin's lymphoma 01 patients (2.5%), tuberculosis 01patients (2.5%) and metastatic renal cell carcinoma 01 patient (2.5%). Open biopsy has a greater diagnostic accuracy than preoperative biopsy in diagnosing unrespectable pancreatic carcinoma and to exclude other pancreatic mass lesions labeled clinically as ‘unrespectable carcinoma pancreas'. Open biopsy is recommended in clinically labeled 'unrespectable carcinoma pancreas'. JCMCTA 2012 ; 23 (2): 53-57

Unusual and Late Recurrence in Ovarian Adult Granulosa Cell Tumour: A Case Report

Granulosa cell tumour of ovary are rare hormonally active neoplasm characterized by indolent course, local spread with a preponderance for extremely late recurrence and high survival rate. We report a 60 year old lady presented in 2009 with aggressive looking growth in vulva 16 years after her total abdominal hysterectomy with Bilateral salphingo-ophorectomy with infracolic omentectomy for suspected stage granulosa cell tumour of ovary , confirmed by histopathology. She remained disease free for 13 years and in 2005 underwent resection of retroperitoneal mass with multiple peritoneal implant, confirmed to be a granulosa cell tumour after biopsy. Despite six course adjuvent combination therapy with complete response she presented after 4 years in 2009 with a second recurrence in vulva. She had tumour reductive surgery followed by chemotherapy and hormonal therapy but the disease was progressive. In conclusion late recurrence and repeat recurrence is a hallmark for granulosa cell tumour of ovary, so we emphasis the need for long term follow up and consider the possibility of recurrence when presented with acute abdomen after initial surgery for granulose cell tumour. But there is no standard management protocol and we review this patients treatment in the context of current literature. JCMCTA 2012 ; 23 (2): 42-46

Anthropometric Parameters of Newborn Infants

Bangladesh is a densely populated developing country. Majority of the population live here in the rural community. Illiteracy, poverty and malnutrition are widely prevalent here. Health service facilities even for the neonate are not satisfactory. Anthropometric parameters at birth are considered to be of great value. Incidence of low birth weight is high in our area. Though study on anthropometric parameters on neonate in our country had been undertaken in the past, attempt on various anthropometric parameters at a time are not much. Here, an attempt has been taken to study maximum anthropometric parameters on neonates at a time so that an idea can get on these parameters. It was a descriptive cross-sectional study on 560 newborn infants over a period of one year six months. In this work, mean gestational age of neonate was 37.9±10 week. Mean birth weight was 2507 580 gm but mean birth weight of term neonates were 2770 gm. Approximately 47% babies were low-birth weight. Though observed mean birth length was 48.1 = 3.1cm, the average length for term babies was 49.4±1.8 cm. Values of observed mean mid-arm circumference, head circumference, chest circumference, abdominal girth and calf circumference were 9±1.3 cm, 32.8±2.0 cm, 30.2±2.9 cm, 27.7±2.6 cm and 10.11.2 cm respectively. All anthropometric parameters were marginally more in male than in female babies. JCMCTA 2012 ; 23 (2): 38-41

Study on Relationship of Serum Total Cholesterol Low Density Lipoprotein and Triglycerides With Body Mass Index

The present case control study was designed to determined the relationship between serum Total cholesterol, Low Density Lipoprotein (LDL), Triglycerides (TG) and Body Mass Index (BMI). The study was carried out in the Department of Biochemistry Chittagong Medical College during the period of January 2010- December 2010. Samples were collected from population of different area of Chittagong City Corporation of different occupations, age from 35- 60 years. The data were collected by a structured questionaries which includes age, sex, occupation, dietary habits, family history of hyperlipidemia and DM. BMI was calculated by standardized protocol. Population suffering from DM, renal diseases and other endocrine disease were excluded. A total of 105 subjects were included in this study. Among them 70 were considered as case ( whose BMI was 25 kg/m2) and 35 were considered as control ( whose BMI was < 25 Kg/ m2).Serum Total cholesterol, LDL-C, HDL-C and TG were measured in all samples in fasting state. Study showed that female were more obese than male,( 31.14 +2.23kg/m2 Vs 29.71 +2.69kg/mo), p= <0.05.Results showed that Serum TC(45%), LDL-C(65%), TG(70%) were significantly higher in cases than that of controls (p=<0.001).Serum HDL-C(35%) was significantly decreased in cases than that of controls (p=<0.001).Study showed that hypertriglyceridemia (70%) was the common lipid abnormality and then LDL-C (65%). Study revealed that there was no significant difference in lipid profile between male and female. Pearson's Correlation Coefficient showed that there were positive correlation between TC (r=0.234,p=<0.05), LDL-C (r=0.258,p=<0.01), TG (r=0.409,p=<0.001) and BMI, and was negative correlation between HDL-C(r= -0.403, p= <0.001) and BMI. So early detection and prevention of obesity and abnormal lipid profile can largely reduce morbidity and mortality and alleviate undue burden on our limited health budget. JCMCTA 2012 ; 23 (2): 22-26

One Year Review of Maternal Mortality Associated With Eclamsia in a Tertiary Care Level Hospital

To enlist the causes of maternal death in patients of eclampsia and to determine how sociodemograpphic and clinical characteristics of the women influence the death in eclampsia in our setup. This study was conducted in obstetrics and gynaecology department of Chittagong Medical College Hospital, Chittagong, from January 2011 to December 2011. Patients were admitted through emergency obstetrics care unit. Patients demographic record including age, parity, education, socio-economic status along with antenatal care records, level of care and distance from hospital number of fits, gestational age, type of eclampsia, presence of complications, mode of delivery and causes of death were analyzed. All this information was collected from patients records. Eclampsia accounted for 38 (37.7%) of the 101 total maternal deaths recorded within the 1 year period, with case fatality of 9.9%.All patients were unbooked and majority were primigridia(63%) and less than 20 years(39%). Education and socioeconomic status were poor. Ante partum eclampsia was the cause in 78.9% and 5.2% of the pregnancies were not delivered before their death. Overall 23% patients had at least one complications and the remaining 67% had more than one complications. The complications leading to eventual death were pulmonary oedema 7(18.4%), LVF 6(15.7%), CVD 6(15.7%), Multiorgan failure 6(15.7%), HELLP 4(10.5%), DIC 3(7.8%), Renal failure 3(7.8%), peroperative cardiac arrest 2(5.2%) and pulmonary embolism 1(2.6%). The distance from the hospital was 10km to 150km. The level of care at nearest health facilities were estimated.52.6% was attended by traditional birth attendant, 6.9% by skilled birth attendants, 2.9% by doctors and for 25.7%, no level of care was available. Eclampsia stil remains the major cause of maternal mortality in our setup resulting from unsupervised pregnancies and deliveries. There is need to educate and encourage the general public for antenatal care and hospital delivery. JCMCTA 2012 ; 23 (2): 30-33

Erectile Dysfunction and Its Management: An Update

Erectile dysfunction (ED) defined as "the inability to achieve or maintain an erection sufficient for sexual intercourse”—is one of the most common sexual dysfunctions in men. Some men assume that erectile failure is a natural part of the aging process and tolerate it, for others it is devastating. Withdrawal from sexual intimacy because of fear of failure can damage relationships and have a profound effect on overall wellbeing for the couple. Erectile dysfunction often accompanies chronic illnesses, such as diabetes mellitus, heart disease, hypertension, and a variety of neurological diseases. Therefore, physicians need to identify any underlying co-existing organic diseases in their patients presenting with ED. Whenever possible, patients are encouraged to attend their consultation sessions with their partners because ED is a condition affecting the couple' and not just the man. Psychogenic aspects of ED should also be explored during the consultation. The first-line treatment of ED is oral phosphodiesterase-5 inhibitors. For those who do not respond to oral therapy, there is no defined 'step-ladder' escalation in alternative therapy. It is up to the physician to discuss the options with the patient or couple and reach a decision based on their preference. JCMCTA 2012 ; 23 (2): 5-17

Uterine Perforation With Bowel Infarction In a Case of Unsafe Abortion

Every year worldwide about 42 million women with unintended pregnancies choose abortion, and nearly half of these procedures, 19 million, are unsafe. Some 70,000 women die of unsafe abortion annually, making it one of the leading causes of maternal mortality (13%). Of the women who survive unsafe abortion, 5 million will suffer longterm health complications. Unsafe abortion is thus a pressing issue. Both of the primary methods for preventing unsafe abortionless restrictive abortion laws and greater contraceptive useface social, religious, and political obstacles, particularly in developing countries, where most unsafe abortions (97%) occur. Even where these obstacles are overcome, women and health care providers need to be educated about contraception and the availability of legal and safe abortion, and women need better access to safe abortion and post abortion services. Otherwise, desperate women, facing the financial burdens and social stigma of unintended pregnancy and believing they have no other option, will continue to risk their lives by undergoing unsafe abortions. According to the World Health Organization (WHO), every 8 minutes a woman in a developing nation die of complications arising from an unsafe abortion. The fifth United Nations Millennium Development Goal recommends a 75% reduction in maternal mortality by 2015. WHO deems unsafe abortion one of the easiest preventable causes of maternal mortality and a staggering public health issue. We report a case of a 21 years female who presented with uterine perforation with small intestinal prolapse through uterine perforation that required repair of uterine perforation with resection anstomosis of small gut after a unsafe abortion of a 16 weeks pregnancy. JCMCTA 2012 ; 23 (2): 50-52