Background: GDM is common, with raising prevalence, and is associated with a variety of adverse maternal and neonatal outcomes and higher morbidity. Many studies have been done recently to establish relationship between C-reactive protein level and GDM. But conflicting conclusions were found among different study populations. Objective: Aim of this study was to assess the correlation between C-reactive protein level and GDM in Bangladeshi population. Materials and Methods: This case control study was carried out in BIRDEM General Hospital from July 2019 to June 2020. One hundred subjects were selected. Among them 50 were GDM cases and 50 were healthy pregnant controls in second trimester. Structured questionnaire was used to obtain data. BMI was calculated. OGTT, HbA1c and C-reactive protein level were measured in all study subjects. Independent t-test, Pearson’s correlation test and multiple logistic regression analysis were done. Data were analyzed by using SPSS software, version 23.0 for windows. Results: Mean age of GDM cases were 29.62± 3.96 years and that of controls were 28.54± 4.1 years. No significant difference between GDM and healthy pregnant women was found. Mean BMI of GDM cases was 29.63± 3.45 and of healthy controls was 24.17±2.10 kg/m2 (significantly higher in GDM cases with p<0.001). FBG, 2 hrPPG and HbA1c levels were significantly higher in GDM cases than in controls. Serum CRP level of GDM cases and controls were 13.63 ±4.20 mg/L and 4.35±2.10 mg/L respectively. CRP was significantly higher (p<0.001) in GDM cases than in healthy controls. Age does not show any significant correlation with any of the glycemic status in GDM cases. BMI correlated significantly with FBG (p<0.05), 2-hr PPG (p<0.05) and HbA1c (p<0.001) in GDM cases. CRP correlated significantly with FBG (p<0.001), 2-hr PPG (p<0.01) and HbA1c (p<0.001) in GDM cases. Multiple logistic regression analysis showed significant association between HbA1c and CRP ( p<0.05) in our GDM study subjects. Conclusion : This study revealed that CRP level is significantly elevated among women with GDM compared with women with normal glucose tolerance, especially during the second trimester. J Enam Med Col 2023; 13(1): 22-28
Background: The incidence of maxillofacial injuries is on the rise due to motor vehicle accidents and increase in incidence of violence in recent times. The preference of open reduction and internal fixation of various fracture management leads to early recovery of patients. Objective: The aim of this retrospective study was to determine the incidence, aetiology, common age, gender, types, treatment modality and complications. Materials and Methods: The medical records of all cases admitted to Enam Medical College Hospital and some other hospitals were reviewed. The statistical analysis was done using IBM SPSS version 200. Results: A total of 215 patients with maxillofacial fractures were included in this study. The most affected age group was 21–30 years with mean 30.69 years (± 14.65). Among them 153 patients were males and 62 were females and the ratio was 2.5:1. Road traffic accidents (RTAs) were the most common cause of maxillofacial fractures (90%). Zygomaticomaxillary complex (ZMC) fracture was more than any other maxillofacial bones (55%) followed by mandibular angle (13.3%) and majority cases (44.89%) were associated with head injuries. Open reduction with internal fixation (ORIF) was the commonest treatment method (95%) utilized in this study. Conclusion: The findings of this study reveal gradual annual increase in the number of cases of maxillofacial trauma. Road traffic accidents (RTA) were the commonest cause and the age group most affected was between 21-30 years. ORIF of these fractures was chosen for its obvious advantages of direct anatomical reduction, early return to function and minimal complications. J Enam Med Col 2023; 13(1): 29-34
Background: The supraclavicular brachial plexus (SBPB) block is widely used for upper limb surgeries. Adding adjuvants such as dexamethasone and clonidine to bupivacaine may enhance its efficacy. This study evaluates and compares these adjuvants in terms of improved peripheral nerve blocks by reducing the onset time, improving the efficacy of the block during surgery and extending postoperative analgesia block, postoperative analgesia. Objective: This study was designed for the evaluation of the effectiveness of dexamethasone versus clonidine as an adjuvant to bupivacaine for ultrasound-guided supraclavicular brachial plexus block in patients undergoing upper limb surgery. Materials and Methods: This randomized controlled trial was conducted on 75 adult patients undergoing upper limb surgeries at Dhaka Medical College Hospital. Patients were divided into three groups: Group A (bupivacaine + normal saline), Group B (bupivacaine + dexamethasone), and Group C (bupivacaine + clonidine). Outcomes assessed included onset and duration of sensory and motor block, time for first demand of analgesia and total consumptions of analgesics within 24 hours, haemodynamic parameters, adverse effects were observed among three groups. Data were analyzed using ANOVA and t-tests, with statistical significance set at p<0.05. Results: The demographic profiles were similar in three groups (p value >0.05).The time for complete sensory block was 23.6±3.1, 18.9±3.2 and 14.7±3.0 minutes and time for the onset of maximum motor level was 29.5±3.9, 23.5±3.1 and 20.8±2.4 minutes in Group A, B and C respectively. These are significantly less in clonidine (group C) group compared to normal saline (group A) and dexamethasone (group B) group (p<0.05). The Ramsey sedation score (RSS) was higher in group C in first eight hours during postoperative periods than two other groups which was also statistically significant (p value <0.05). The time to regression of sensory block was 242.1±16.57, 932.9±44.9 and 739.16 ±13.47 minutes and motor block was 175.6±17.5, 780.8±26.2 and 570.6 ±22.0 minutes in groups A, B and C respectively. It was significantly longer in group B than in other two groups which was statistically significant (p value <0.05). Similarly in comparison to other two groups, group B had significantly increased time for motor recovery (190.8±18.3, 810.6±25.8 and 600.6±24.9 minutes in groups A, B and C respectively with p value <0.05). On the other hand, group B had significantly longer time for 1st demand of analgesic (260.6±23.0, 975.2±29.0 and 760.8±25.5 minutes in groups A, B and C respectively), significantly decreased total analgesic requirements in 24 hours (232.8±15.5, 84.7±13.8 and 166.1±19.4 mg in groups A, B and C respectively) and also significantly decreased total anti-emetic requirement in 24 hours (11.8±0.3, 4.1±0.8 and 8.0±0.0 mg in groups A, B and C respectively with p value <0.05). All over adverse effects were significantly less in group B compared to group A and group C (p value <0.05). Conclusion: Dexamethasone is superior to clonidine as an adjuvant to bupivacaine in terms of prolonged analgesia and fewer side effects, making it a better choice for ultrasound-guided supraclavicular brachial plexus blocks. J Enam Med Col 2023; 13(1): 10-21
Background: CA 125, as a biomarker, holds promise in a wide range of applications, including risk assessment, early detection, diagnosis, prognosis, monitoring, and therapy. Objectives: To find out expression of AgNOR staining in benign, borderline and malignant epithelial tumors of ovary and its correlation with serum CA 125. Materials and Methods: The cross-sectional analytical study, spanning from March 2018 to July 2020 in the Department of Pathology, Sir Salimullah Medical College, Dhaka included 70 diagnosed cases of ovarian epithelial tumors with known CA 125 status. Paraffin blocks and CA 125 reports were gathered, ensuring ethical practices throughout. Results: The mean CA 125 levels in patients with benign was 61.70±30.75 U/mL, in borderline group 65.0±7.07 U/mL and in malignant cases 463.67±249.48 U/mL. CA 125 level was significantly higher in malignant tumors compared to benign and borderline (p<0.001). There was significant positive correlation between CA 125 with mAgNOR (r=0.821; p=0.001) and with pAgNOR (r=0.853; p=0.001). Conclusion: Elevated CA 125 levels were notably significant in malignant tumors compared to benign and borderline cases. A strong, positive correlation existed between CA 125 and both mAgNOR and pAgNOR. J Enam Med Col 2022; 12(3): 137−142
Globally, stroke is a leading cause of mortality and disability and there are substantial economic costs for post-stroke care. Barriers to the rehabilitation of stroke survivors with disabilities in low- and middle-income countries are many. There are enormous challenges in overcoming the barriers. The socioeconomic impacts of disabilities are high. Developing and delivering cost-effective rehabilitation services to stroke survivors with disabilities are daunting challenges to low- and middle-income countries. The barriers and unmet needs for rehabilitation treatments are high. These challenges are amplified by resource constraints like infrastructural facilities for rehabilitation management, and an inadequately trained healthcare workforce in low- and middle-income countries (LMICs). Multidisciplinary team care management led by physicians, therapists, rehabilitation nurses, and community health workers need to be strengthened. Threats to the outcomes of stroke care in resource-poor settings are the non-availability of cost-effective team care at the hospital and at the community level. Long-term medical and rehabilitation care needs organizational and financial support. The future challenge is to identify what elements of organized stroke care can be implemented to make the largest gain. Simple interventions such as swallowing assessments, bowel and bladder care, mobility assessments, and consistent secondary prevention can prove to be key elements to improving post-discharge morbidity and mortality. Recognition of the importance of stroke rehabilitation by WHO and global health leaders are new opportunities for LIMCs to fight back the stroke-related disabilities. Successful rehabilitation of stroke survivors with disabilities is a paramount challenge in LIMCs. But opportunities are coming up as there is increased awareness about stroke among general people. Task shifting of the rehabilitation health workforce to caregivers at the home or community level can help augment disability-adjusted life years. Proper Caregivers Training is coming out as a good prognostic indicator in stroke survivors in low resource settings. Structured training of caregivers is essentially needed at the low resource outset in developing countries and should be emphasized in stroke rehabilitation protocol. Universal health coverage should be extended to poor stroke survivors with disability. The burden of stroke will further increase until effective stroke prevention strategies are more widely implemented. The objective of this review article is to highlight the elements of health system behavior that affect barriers and opportunities in addressing stroke survivors with disabilities. J Enam Med Col 2022; 12(3): 148−154
Background: Coronavirus Disease 2019 (COVID 19) is a novel infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It emerged in Wuhan and has quickly spread across the world. In Bangladesh, the mortality rate in critically ill patients with COVID-19 is high. This study compares biochemical parameters between mild/moderate and severe patients, helping to identify severe or critical patients early. Objective: To identify severe or critical covid-19 patients early by analysis of biochemical parameters. Materials and Methods: This cross-sectional study was done in Intensive Care Unit (ICU) of Enam Medical College Hospital from April 2021 to August 2021. Total 60 Covid positive patients were enrolled. Among them 30 were severe (ICU) patients and 30 were mild/moderate (non–ICU) patients. Results: A comparison of the hematological parameters between the mild and severe groups showed significant differences in lymphocyte, neutrophil, ferritin, D-dimer and CRP levels. Conclusion: The findings suggest that ferritin, D-dimer and CRP levels can be used to detect the severity of COVID-19 patients. J Enam Med Col 2022; 12(3): 127−131
Background: Idiopathic Intracranial Hypertension (IIH) is a disorder primarily among overweight women of childbearing age. Acetazolamide (AZM) is commonly used to treat IIH, but there is insufficient information regarding VF changes in response to treatment with this drug. Objective: This study was designed to evaluate the visual field changes of patients with IIH treated with oral acetazolamide. Materials and Methods: A total of 30 patients with IIH treated with oral acetazolamide (500 mg twice daily) were followed up after 3 months and 6 months. Demographic features were recorded. Visual field analysis was done and papilledema was graded accordingly. Mean value of perimetric mean deviation of the follow-up periods were compared with that of baseline values. Results: The mean age of the study patients was 25.3±8.7 years with a female predominance (83.3%). Most common field defect was nasal or temporal field defects (46.67% in their right eye and 50.0% in their left eye). The mean of perimetric mean deviation (PMD) and papilledema of both eyes were reduced significantly over time. This study concluded that oral acetazolamide 500 mg twice daily is effective in reduction of symptoms/signs and improve perimetric mean deviation in visual filed among patients with idiopathic intracranial hypertension with minimum side effects. Conclusion: Changes in visual field parameter are important marker in diagnosis and monitoring of patients of IIH treated with oral acetazolamide. J Enam Med Col 2022; 12(3): 122−126
Background: Knowledge about diameters of head of the femur is necessary in order to reduce the risk of complications associated with surgical procedures performed in the area of hip joint due to vascular, metabolic or trauma causes, and to achieve an alignment of prosthesis to be implanted. This comprehensive studies and standardization of data for a study population have great importance, not only for anatomists and forensic experts but also for the determination of risk factors in pathological conditions (like osteoporosis, fractures etc), for preoperative planning and design of components of prostheses which may be used by the orthopedic surgeons in femoral head replacement surgery. Objectives: To construct the baseline data on different diameters of the fully ossified femoral head, determine any significant differences between the right and left femur and correlate with the previous study. The aim of the study is to record morphometric measurement that can throw further light on the existing data. Materials and Methods: This cross-sectional, descriptive type of study was conducted in Department of Anatomy, Mymensingh Medical College, Mymensingh from January 2019 to December 2019 on 150 dry fully ossified femurs of both sides with unknown sex. Data were statistically analyzed by using SPSS software, version 27.0. The diameters of head of the femur were measured by digital slide caliper. Results: The means (±SD) of vertical diameters of head of right and left femurs were 39.59 (±3.49) mm and 39.31 (±3.59) mm, of transverse diameters of head of right and left femurs were 36.32 (±3.79) mm and 34.81 (±3.06) mm and antero-posterior vertical diameters of head of right and left femurs were 41.15 (±3.18) mm and 41.20 (±3.44) mm respectively. Conclusion: There is no statistically significant differences between the right and left femoral diameters. J Enam Med Col 2022; 12(3): 132−136
Background: Head and neck cancers are the common cancers in developing countries. Concurrent chemoradiotherapy is the treatment of choice for locally advanced stage III to IVB squamous cell carcinoma of head and neck. Carboplatin possesses comparable treatment response and better tolerability than cisplatin. Objectives: The study has been conducted to elucidate the comparable efficacy and favorable toxicity profile of carboplatin instead of cisplatin. Materials and Methods: This study was conducted at National Institute of Cancer Research and Hospital, Dhaka from March 2018 to March 2019 over 60 patients divided into 2 groups. Group A patients received cisplatin 40 mg/ m2 and group B patients received carboplatin AUC 2 along with 66 Gy in 33 fractions of radiation. Treatment response and toxicities was evaluated periodically. Results: Total 12 (40%) patients of arm A and 8 (26.7%) patients of arm B had complete response, 10 (33.4%) patients of arm A and 12 (40%) patients of arm B had partial response, 6 (20%) patients of arm A and 3 (10%) patients of arm B had stable disease and 2 (6.7%) patients of arm A and 7 (23.3%) patients of arm B developed progressive disease. Cisplatin showed more vomiting (57.6%), nephrotoxicity (55.2%), ototoxicity (33.9%) and neurotoxicity (35.4%). On the other hand, carboplatin showed more myelosuppression (anemia 43.6%, neutropenia 44.5% and thrombocytopenia 64.3%). Conclusion: This study concluded that, both cisplatin and carboplatin have comparable efficacy and carboplatin has favorable safety profile. J Enam Med Col 2021; 11(3): 173−179
Creutzfeldt-Jakob disease (CJD) is an extremely lethal and rapidly progressive spongiform encephalopathy caused by abnormal form of prion protein. It occurs worldwide with an estimated annual incidence about 1−2 cases per million populations. Several forms of the disease have been described−the most common is the sporadic type. Clinical features include briskly progressive dementia, myoclonus, visual or cerebellar signs, and pyramidal/extra-pyramidal signs. Diagnosis of CJD is usually challenging. Combining clinical features with laboratory parameters, electroencephalogram (EEG), and magnetic resonance imaging (MRI) of the brain expedites the diagnosis. It has no definitive treatment; only symptomatic and supportive managements are provided to the patients. Affected patients generally die within 1 year of the onset of illness. We report a 40-year-old lady who presented with 2 months’ history of rapidly progressive cognitive decline, vertigo and blurring of vision. Her diagnosis was made by classic findings on EEG, MRI of the brain along with clinical features and laboratory parameters. In spite of continuous supportive treatment, she died after 3 months from the onset of her illness. Early diagnosis, extensive research activities regarding prevention and treatment, raising social awareness and educating health care professionals about the disease might improve the current unsatisfying scenario of CJD. J Enam Med Col 2022; 12(1): 54−58
Background: Cardiovascular diseases (CVD) have increased greatly in the last 2 decades in low- and middle-income countries. Among the CVDs, atherosclerotic coronary artery disease is rare in young adults aged 40 years or less. However, South Asia is among the top 3 of the countries with highest proportion of cases of first acute coronary syndrome events occurring at age 40 years or less. Five classical risk factors account for 80% of population attributable risk in overall population and the impact of these risk factors are remarkable in young adults. Objective: To explore the prevalence of the classical risk factors of coronary artery disease among patients of ischemic heart disease aged 40 years or less. Materials and Methods: This crosssectional retrospective analysis included 140 patients who had coronary angiography for definite and probable ischemic heart disease at the department of Cardiology of Enam Medical College between July 2012 and December 2020. Clinical and classical risk factor profiles were recorded by recording height, weight and self-reported hypertension, diabetes mellitus, hyperlipidemia, tobacco smoking, family history of premature coronary artery disease, supplemented by testing for diabetes and hyperlipidemia as necessary. Coronary angiography was performed and analyzed in the same center as per standard protocol. Results: Of the 140 patients included in the study, 85% were males. The age range was 18−40 years, with a mean age 35.90 (SD 4.05) years, and 59.28% were in the 36−40 years age group. Indications for coronary angiography were: acute myocardial infarction in 69.28%, unstable angina in 3.57%, stable angina in 20% and other miscellaneous causes in 7.155 (e.g., heart failure, arrhythmia, prior PCI and positive exercise stress test). A prior history of myocardial infarction was present in 25.43%. Coronary angiogram revealed single vessel disease in 39.29%, double vessel disease in 25.72% and triple vessel disease in 23.57%. Normal Coronaries were found in 9.28% and myocardial infarction with non-obstructed coronary arteries (MINOCA) in 2.14%. Of the risk factors, hypertension was present in 38.57%, smoking in 34.91%, diabetes mellitus in 27.14%, a family history of coronary artery disease in 19.29% and dyslipidemia in only 15.71%. Obesity was present in 12.86%, while 37.86% were overweight. Altogether 57.72% had excess body weight, making it the most prevalent factor contributing to ischemic heart disease. Clustering of 2 or more risk factors was seen in 45% of patients, while 45.71% had only one risk factor and 9.29% having none. A history of substance abuse was found in only 03 (2.14%) patients, 02 of them having additional traditional risk factors. Conclusion: In patients aged up to 40 years with ischemic heart disease, significant coronary artery disease burden was seen, including a significant proportion with multi-vessel disease. Traditional risk factors of coronary artery disease were found to play a significant role among them. Weight related problems (overweight and obesity) was seen to be significant. Further epidemiological studies with pooled data from all the tertiary care centers need to be carried out. J Enam Med Col 2021; 11(3): 147−155
Background: The oral and injectable contraceptives fulfill the human need for birth control with great effectiveness. These can effectively prevent pregnancy and alleviate menstrual disorder when used correctly. Many biochemical profiles of women taking oral and injectable contraceptives are disturbed due to metabolic alterations induced by its hormonal content. Objective: To find out the effects of oral and injectable contraceptives on serum calcium and magnesium levels. Materials and Methods: This cross-sectional comparative study was done in BIRDEM General Hospital, Shaheed Suhrawardy Medical College Hospital and Gandaria Family Planning Clinic of Nagar Shastho Kendro from July 2018 to June 2019. Study parameters serum calcium and magnesium were estimated in each case. One hundred fifty women aged 18 to 45 were included according to the inclusion criteria. They were divided into three groups－50 oral contraceptive users as group I, 50 injectable contraceptive users as group II and 50 normal healthy controls as group III. After taking the informed written consent from the study subjects, a structured questionnaire was filled in for each subject to collect data including personal identification, age, sex, chief complaints, duration of contraceptive use, socioeconomic status, demographic history, family history, genetic history, drug history, menstrual history and history of other systemic diseases. Results: The results of the study showed mean age and SD of the study subjects in Group I, Group II and Group III were 31.08±6.67, 31.60±7.83 and 36.74±6.27 years respectively. Mean (±SD) age was significantly higher in control group (Group III) than Group I and Group II (p <0.001). This study found that mean (±SD) serum calcium of the study subjects in Group I, Group II and Group III were 9.34±0.47, 9.20±0.40 and 9.14±0.49 mg/dL (p <0.05). The mean serum calcium was significantly higher in Group I compared to Group II and III. The mean value of magnesium in Group I, II and III were 0.82±0.09, 0.85±0.11 and 0.80±0.09 mmol/L respectively. There was significant increase in serum magnesium in injectable contraceptive users than oral contraceptive users and control group. Conclusion: This study concluded that oral contraceptives increased the serum calcium and injectable contraceptives increased the serum magnesium levels in comparison with control individuals and these were significant. J Enam Med Col 2022; 12(2): 95−101
