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Most of the thalassemic children of Bangladesh are receiving repeated blood transfusion. But they do not receive chelation therapy due to financial constraints. As a result, iron overload occurs in various organs of these children. Extra iron that is loaded in thyroid gland causes thyroid dysfunction. This study was undertaken to evaluate thyroid status in children with transfusion dependent Thalassemia patient. This cross-sectional analytical study was conducted in the Department of Pediatrics, Mymensingh Medical College Hospital, Bangladesh from September 2016 to April 2018. Children having thalassemia diagnosed by Hb electrophoresis, aged 3-12 years of both sexes were included as study group. Children of same age and sex admitted in indoor of Mymensingh Medical College Hospital with minor illness and without thalassemia were taken as comparison group. Purposive Sampling technique was applied. Serum FT₄, TSH and ferritin level were estimated in all children. Data analysis was done with Statistical Package for Social Science (SPSS) version 21.0. A total of 60 patients were enrolled as study group and another 60 patients were compared as comparison group. Mean ages of study group was 7.88±2.55 years and comparison group were 7.22±2.48 years. The mean pre-transfusion hemoglobin, serum ferritin, serum FT₄ and serum TSH level were found 6.23±0.60 gm/dl, 2658.33±879.39 ng/ml, 15.14±4.40 fmol/mL, 4.29±4.60 μIU/mL respectively in study group. The mean serum FT₄ was found significantly lower and mean serum TSH was significantly higher in thalassemic children in comparison to non-thalassemic children (p= <0.05). Frequency of subclinical hypothyroidism was found significantly higher in study group (25.0%) compared to comparison group (3.3%) (p=0.001). Mean serum ferritin level was found significantly higher in hypothyroid cases. Mean FT₄ level was significantly lower and mean TSH level was significantly higher in hypothyroid thalassemic patients (p= <0.001). Significant positive correlation between serum ferritin level and serum TSH level was found. Higher serum ferritin level was found significantly associated with the development of hypothyroidism in thalassemic patients.

This cross-sectional study was conducted in Department of Paediatrics, Mymensingh Medical College Hospital (MMCH), Bangladesh from February 2016 to December 2016 to detect massive proteinuria by spot urinary protein creatinine ratio as an alternative diagnostic test to 24 hrs urinary total protein in nephrotic syndrome. Fifty one (51) children aged 2 to 12 years admitted with 1st episode of nephrotic syndrome in the pediatric department of MMCH were included in this by purposive sampling technique. All the patients were asked to give a 24 hours urine sample. After this collection the next spot urine samples were collected for protein and creatinine estimation. Among 51 patients 33 were male and 18 were female. The mean age was 5.5+2.3 years. The entire patient had normal renal function. The mean 24 hours urinary protein level was 3.8±1.7 gm/m²/24 hours, the mean spot urinary protein-creatinine ratio was 5.4±2.5. Mean serum albumin was 1.8±0.6 gm/dl and the mean serum cholesterol was 357.6±74.7 mg/dl. The spot urinary protein creatinine ratio was increased with the increase in the amount of 24 hours urinary total protein and a strong positive Pearson correlation (r=0.805) was found. In all the cases of nephrotic syndrome spot urinary protein creatinine ratio were found more than 2. Based on this study, it can be concluded that the determination of the spot urinary protein-creatinine ratio can replace the 24 hours urine collection in the quantitation of proteinuria in nephrotic syndrome.

In Intensive Care Units (ICUs) infection represents the most frequent complication leading to high mortality. Particularly the incidence of fungal infections, especially due to Candida spp., has been increasing during the last years. Over last two decades there is predominance of Non albicans Candida (NAC) infection with increased isolation of novel species and decreased susceptibility. Early identification of Candida species and determination of antifungal susceptibility pattern is essential for effective management. Therefore, the study was conducted to isolate and identify Candida species from the blood samples of the patients suspected of candidemia and assess their antifungal susceptibility pattern. This cross-sectional, descriptive type of observational study was conducted in the Department of Microbiology, Mymensingh Medical College, Bangladesh from March 2021 to February 2022. Venous blood was collected from clinically suspected patients admitted at ICU, Neonatal Intensive Care Unit (NICU), Mymensingh Medical College Hospital, Bangladesh. Primary blood culture was performed by automated method followed by sub-culture in Saboraud's Dextrose Agar (SDA) and blood agar media. Candida species were recognized by phenotypic and genotypic methods. Antifungal susceptibility testing was done by disk diffusion and broth microdilution method (BMD). Out of 125 blood specimens collected, Candida species were isolated from 39(31.0%) blood samples of which NAC species were 35(89.0%) whereas C. albicans was only 4(10.2%). Eight (8) different Candida species were identified of which C. parapsilosis was predominant 16(41.0%). Rare and emerging drug resistant species of C. ciferrii 23.0%, C. auris 7.7%, C. rugosa 10.3%, C. lusitaniae 2.6% were also isolated. Candidemia was highest in neonate 33(84.61%) with male predominance 24(61.54%). Use of broad-spectrum antibiotics, prolonged hospital stay, pre-maturity and low birth weight (LBW) were found to be important risk factors. In candidemia the highest resistance was to Fluconazole-33% and lowest to Voriconazole-5%. The study showed that NAC species were more common with emergence of rare and multidrug resistant species.

Takayasu's arteritis is a chronic large vessel vasculitis that mainly affects the aorta and its major branches such as brachiocephalic, carotid, subclavian, vertebral, renal, coronary and pulmonary arteries. It most commonly occurs in female at child bearing age and female to male ratio is 8:2. Initial presentations of Takayasu's arteritis may be nonspecific like fever, malaise, weakness, fatigue, arthralgia, myalgia and weight loss but in advanced stage there may be features of vascular inflammation like segmental stenosis, occlusion, dilatation and/or aneurysm. It is a sub acute process over months to years and usually with good collateral formation. So, critical limb ischemia due to acute onset of vascular stenosis is very rare. Here we are reporting a case of a 50-year- old male patient who presented with digital gangrene due to critical limb ischemia. Though the age of onset was at 50 years and the patient lacks clinical features like constitutional symptoms, bruit, claudication, asymmetrical blood pressure, the patient was diagnosed as a case of Takayasus's arteritis. The patient dramatically improved with oral glucocorticoid treatment. Although rare, takayasu's arteritis can presents only with digital gangrene without having other clinical features. The physicians should be aware of this unusual but limb threatening presentation and more studies are needed to find out the exact mechanism of this presentation.

Electro-physiological diagnosis of mild Carpal Tunnel Syndrome (CTS) based on traditional median motor and sensory studies are often inconclusive. Therefore, we wanted to investigate the utility of Median-to-Ulnar Sensory Conduction studies in diagnosis of mild CTS. Data from Nerve conduction study (NCS) of 82 cases with symptoms suggestive of CTS from September 2017 to October 2020 attending electrophysiology department of Mount Adora Hospital, Sylhet, Bangladesh was selected for study. About 54(66.0%) out of 82 symptomatic patients were diagnosed as CTS by the conventional method, and 28(34.0%) patients required further investigation as their test report were found to be inconclusive. combining methods showed 70(85.37%) were found to be positive and 12(14.63%) were negative in comparison study. Thus, it can be concluded that those patients found to be negative in conventional methods; comparison method is an option for diagnostic confirmation.

Hypothyroidism is a common endocrine disorder and requires lifelong treatment. Hypothyroidism is often associated with dyslipidemia in some populations. The present study was designed to evaluate the impact of levothyroxine (LT₄) on lipid profile in hypothyroid patients. This cross-sectional analytical study was conducted in the Department of Pharmacology & Therapeutics, Rajshahi Medical College in collaboration with the Institute of Nuclear Medicine and Allied Sciences (INMAS), Rajshahi from July 2018 to June 2019 to compare serum total cholesterol (TC), serum triglyceride (TG), serum LDL-C and serum HDL-C levels among euthyroids, newly diagnosed hypothyroid patients and levothyroxine (LT₄) treated hypothyroid patients. A total of 30 patients with newly diagnosed hypothyroidism and an equal number of age-matched healthy controls (n=30, control group) of both sexes were recruited in the present study. Thirty (30) hypothyroid patients were reevaluated after 6 month of LT₄ therapy. The fasting blood samples were collected from the subjects for the estimation of lipid profile. Significantly higher values were observed in total cholesterol (TC) 198.5±19.2mg/dl, triglycerides (TG) 147.0±14.5mg/dl, low density lipoprotein cholesterol (LDL-C) 133.9±19.7mg/dl (p<0.001) and a significant decreased value was seen in high density lipoprotein-cholesterol (HDL-C) levels (35.1±3.67mg/dl) in newly diagnosed hypothyroid patients as compared to after LT₄ therapy and normal healthy individuals (p=0.009). These observations suggest that people with hypothyroidism have high risk of development of atherosclerosis which may lead to coronary heart diseases (CHD) due to persistent dyslipidemia. Hypothyroidism induces dyslipidemia or expedites the process of existing dyslipidemia, LT₄ therapy corrects it to a significant level thus reduce the risk for atherosclerosis.

Hypertrophic cardiomyopathy (HCM) is the most prevalent genetic hereditary cardiomyopathy characterized by sudden cardiac death. Mutations in the MYBPC3 gene are often the most prevalent genetic abnormality in HCM with a prevalence ranging from 20.0 to 42.0%. The mutation spectrum is available for different countries, but such studies are lacking in the Asian population including Bangladeshi patients. A cross-sectional descriptive study was conducted for mutation analysis of the whole MYBPC3 gene on a cohort of 75 HCM Bengali Bangladeshi probands through Next Generation Sequencing at the Genetic Research Lab of Bangabandhu Sheikh Mujib Medical University from 2016 to 2019. The structural and functional impact of the mutations was further analyzed by in silico process. We analyzed the data and found 103 variants in 102 locations in the MYBPC3 gene. Variants were identified in both the coding region and the non-coding region. We found one possibly novel variant in the MYBPC3 gene. The findings of this research will help to develop a genetic database of HCM which will help in the early diagnosis and proper management of HCM patients in Bangladesh. One pathogenic splice donor variant (47356592 C >T) was found in the intronic region. Among the variants in the coding region, one missense mutation was pathogenic (NP₋000247.2: p.Asp770Asn) which was found in seven patients and another one is of conflicting interpretations of pathogenicity (NP₋000247.2: p.Ser217Gly) which was found in two patients. We have identified one in-frame deletion (NP₋000247.2: p.Ala433del) that is possible a novel variant responsible for the development of HCM.

High blood pressure and its related problems are progressively assuming public health dimensions in developing countries like Bangladesh. There was a suggestion that hypertensive process can be aborted in its early stages. But it is poorly understood in its early stages. So, early natural history of hypertension and its evolution from the youth needs to be investigated. Objective of this study was to determine blood pressure distribution in school children aged 6-15 years. This descriptive cross-sectional study was conducted in the Department of Paediatrics, Mymensingh Medical College, Mymensingh, Bangladesh from November 2014 to October 2015. The sample was collected by simple random sampling from five different schools of Mymensingh after applying inclusion and exclusion criteria. After taking proper history and doing relevant examination, both systolic and diastolic BP was recorded by auscultatory method. Out of 994 children, 480(48.29%) were boys and 514(51.71%) were girls. In boys, the mean±SD of systolic and diastolic blood pressure (BP) were 105.9±10.8 mm of Hg and 67.4±6.7 mm of Hg and in girls it was 106.1±11.8 and 67.5±6.9 mm of Hg respectively. Systolic BP was found higher in girls belongs to 10-13 years. The study has shown that BP rises linearly with age and both systolic and diastolic BP has a significant positive correlation with age, sex, height and BMI in both sexes. This study also showed, 46(4.6%) children were hypertensive and 89(8.9%) were pre-hypertensive. Hypertension was found more in girls but there was no significant difference between two sexes. Hypertension was found more in relation to overweight, obesity and family history of hypertension. Hypertension is not uncommon in children. Routine blood pressure measurement should be conducted in all children.

Relapsing polychondritis is a rare autoimmune disorder of unknown etiology, which can affect multiple organs. It usually presents with involvement of elastic cartilage of ear and nose and involvement of other organs like kidney and central nervous system. Here, we report a case of 60-year-old man, who initially presented with fever, polyarthritis, erythema nodosum and painful swelling and redness of both external ears admitted in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh on 13th December 2019. Two days after hospitalization, he developed sudden onset of proptosis with ophthalmoplegia. After evaluation, he was diagnosed as relapsing polychondritis with haemophagocytic lymphohistiocytosis and was treated with high dose prednisolone. His clinical condition and laboratory parameters significantly improved after treating with prednisolone during follow up.

Nephrotic syndrome (NS) represents a heterogenous group of glomerular disorders occurring mainly in children. Accumulated data suggest that patient with NS have an immunological basis. This cross-sectional comparative study was conducted in the Department of Paediatrics, Mymensingh Medical College Hospital (MMCH), Mymensingh during the period of March 2018 to October 2019 to determine the relationship of serum IgE level in frequent relapse and infrequent relapse nephrotic syndrome in children. Thirty cases of frequent relapse and 30 cases of infrequent relapse idiopathic nephrotic syndrome who were admitted in Department of Paediatrics, MMCH were included in this study by purposive sampling technique. After admission written informed consent from parents or guardians obtained. Serum IgE level was measured in all patients of idiopathic nephrotic syndrome during relapse and again four weeks after steroid therapy when patient was in remission. Serum total IgE levels were measured by ADVIA centaur CP immunoassay system. Most of the patient's age was within 2-6 years in both groups. Male children were predominant in both groups. Most of the patients came from rural area. Frequency of relapse per year was significantly higher and 24 hours urine output was significantly lower in frequent relapse nephrotic syndrome than that of infrequent relapse nephrotic syndrome. Significantly higher mean IgE was found in children with frequent relapse nephrotic syndrome (1439.8±388.5 IU/ml during relapse and 852.3±103.7 IU/ml at remission) than infrequent relapse nephrotic syndrome (1109.5±248.3 IU/ml during relapse and 776.6±108.5 IU/ml at remission) at both relapse and remission state. A linear, positive, significant correlation was found between rate of relapse and serum IgE level (Pearson correlation coefficient, r=0.674). Based on results it is concluded that serum IgE is high in relapsing nephrotic syndrome and it is persistently and significantly higher in frequent relapse nephrotic syndrome than infrequent relapse nephrotic syndrome.

Coronary artery disease is the leading cause of death and disability globally. The presentation of Non-ST segment elevation myocardial infarction (NSTEMI) is heterogeneous, with different risk levels in terms of death, infarction and recurrence of infarction. Current evidence suggests that plasma glucose level or hyperglycemia is a mediator of worse prognosis of MI. The objective of the study was to correlate on admission plasma glucose level in non-diabetic patient with in-hospital outcome of patients after first attack of NSTEMI. This prospective analytical study was conducted among purposively selected 280 patients with NSTEMI admitted in coronary care unit of Mymensingh Medical College Hospital during the period of June 2016 to May 2017. Data were collected from the informant by face to face interview, clinical examination and investigations using a pretested semi-structured case record form. Data were analyzed by SPSS. Patients were categorized into two groups; Group A: NSTEMI with admission plasma glucose level below 7.8mmol/l, (n=150, Male-110, Female-40). Group B: NSTEMI with admission plasma glucose level ≥7.8mmol/l, (n=130, Male-95, Female-35). Group B (n=130) is divided into two subgroups. Subgroup-I: NSTEMI with Hyperglycemia (7.8-9.3mmol/l), n = 67 (male 44, female 23), Subgroup-II: NSTEMI with Hyperglycemia (≥9.4mmol/l), n = 63 (male 51, female 12). All Patients were non diabetic excluded by HbA₁c. The mean left ventricular ejection fraction (LVEF) of Group B, Subgroup-II was significantly less than that of Subgroup-I (p<0.05). Correlation between LVEF levels and on admission plasma glucose level showed statistically significant moderate negative correlation, suggesting that the higher was the level of on admission plasma glucose level; the lower was the LV ejection fraction level in first attack of NSTEMI patients. Correlation coefficient between Troponin-I and plasma glucose level on admission of the study population (r=0.030) suggesting that the higher was the level of admission plasma glucose level the higher was the Troponin-I level in first attack of NSTEMI patients. The more was the plasma glucose level, less was LVEF, more was the heart failure and prolonged hospital stay. The study showed a strong predictor of adverse in-hospital outcome in the various levels of plasma glucose and NSTEMI. There was association between the concentration of the plasma glucose and the extent, severity of disease in the means of mean LVEF, the rate of heart failure and duration of hospital stay. The importance of this finding is even clear that RBS is a standard, valuable diagnostic tool for evaluation of severity and prediction of outcome of patients with NSTEMI.

Systemic lupus erythematosus (SLE) is an autoimmune disorder involving multiple systems and often presents with diverse clinical manifestations. The objective of the present study was to investigate the initial clinical presentations of SLE patients attending a tertiary care hospital in Bangladesh. This cross-sectional study was conducted among 85 SLE patients diagnosed according to the 1997 ACR Revised Criteria for Classification of SLE attending the Lupus Clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2012 to June 2013. Sociodemographic and clinical data were collected from patient interviews, physical examinations and medical records. Almost 75.0% of the patients aged below 30 years had a female predominance (male-female ratio 1:5.6). Fever (71.0%), joint pain (60.0%) and alopecia (28.0%) were the most common initial presentations among the patients. Constitutional symptoms such as fatigue, malaise and weakness (23.5%), malar rash (21.0%), oral ulcer (20.0%), photosensitivity (15.0%) and Raynaud's phenomenon (13.0%) were also present in variable proportions. The musculoskeletal and mucocutaneous systems were most commonly affected (85.0% and 75.0% respectively), followed by lupus nephritis (40.0%), hematological symptoms (22.0%) and vasculitis (17.6%). Out of 85 patients, 78 (92.0%) tested positive for anti-nuclear antibodies. SLE patients commonly present with musculoskeletal and nonspecific symptoms at the initial phase. Hence, physicians should consider this clinical and immunological evidence along with conventional symptoms included in the ACR criteria.

The study was aimed to assess the psychological aspects and relevant factors of the health-care workers (HCWs) working in COVID 19 pandemic condition in Bangladesh. This online cross-sectional survey was conducted from different tertiary, secondary and primary hospitals in Bangladesh. Eligible 638 HCWs who were directly involved in the caring of confirmed or suspected COVID-19 patients were recruited in this study. The mental health was assessed by the Patient Health Questionnare-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7) and Athens Insomnia Scale (AIS). High frequency of depression 536(84.0%), anxiety 386(60.5%) and insomnia 302(47.3%) was found among the HCWs, which were significantly higher in physicians (p<0.001) than nurses. Moderate to severe depression was significantly higher in female, whereas minimal to mild depression was significant in male HCWs (p=0.014). Symptoms of depression (p<0.001), anxiety (p<0.001) and insomnia (p=0.004) were significantly higher among the HCWs of primary and secondary compared to the tertiary level. The HCWs developed psychological trauma due to family health (45.3%) and contagious disease property (66.6%). After adjusting confounders, multivariable logistic regression analysis showed that physicians and HCWs of secondary hospital had significant symptoms of severe depression (OR=2.95, 95% CI=0.50-17.24; p<0.001), anxiety (OR=2.64, 95% CI=0.80-8.72; p<0.001) and insomnia (OR=2.67, 95% CI=1.23-5.84; p=0.018); whereas female HCWs had more risk of developing symptoms of severe insomnia (OR= 1.84; 95% CI=1.23-2.75; p=0.003). High rate of depression, anxiety and insomnia was found among HCWs working in the COVID-19 pandemic condition in this survey.

Severe acute malnutrition (SAM) is the most severe form of protein energy malnutrition (PEM). Few studies found serum electrolyte, serum calcium level changes as important factors of poor outcome. Hypoglycemia is already established as a risk factor for death in severe acute malnutrition. Edema, diarrhea and vomiting are commonly present in severe acute malnutrition which has impact on electrolyte balance and blood sugar level in healthy children. Their impact in severe acute malnutrition is not clearly established. This cross sectional descriptive study was conducted in Department of Pediatrics, MMCH from March 2018 to October 2019 to estimate serum electrolyte, serum calcium and random blood sugar level in severe acute malnutrition and their relationship with edema, vomiting and diarrhea. Forty-one (41) cases of SAM were enrolled in this study. Test samples were collected before starting the treatment. Case record form was used to collect information. Cases were divided into Group A and Group B based on the presence or absence of vomiting or diarrhea, respectively. Again, all cases were divided into Group C and Group D based on presence or absence of edema, respectively. Data were analyzed using IBM SPSS statistics version 23. Mean age was 9.71±10.4 months with 85.36% having age less than 1 year. Twenty-four (58.5%) were male and 17(41.5%) were female. Parents had low level of education with 48.8% mother and 51.2% father having primary education or no education. Higher number of serum electrolyte, serum calcium and blood sugar were found with hyperglycemia present in 29.3%, hypocalcemia in 22%, hypokalemia in 22% and hyponatremia in 19.5% cases. Hypokalemia was present more in SAM with vomiting or diarrhea (p=0.008). Other disturbances do not vary on presence or absence of edema and vomiting or diarrhea. Result of the present study shows hypokalemia is associated with SAM with vomiting/diarrhea. Hypocalcemia, hyperglycemia, hyponatremia and hypernatremia were also present in high number. These changes should be detected early and treated accordingly.

There is progressive increase of Hb levels is observed during course of intrauterine development of fetus but high concentrations found at birth. In preterm neonate normal Hb is characteristically deviated from term neonate. Breast milk is the only natural ideal food for both term and preterm babies from birth up to 6 months. Preterm milk was found to contain significantly higher concentrations nutrients particularly iron than term milk. Preterm human milk is more suitable for the premature infant than term human milk. As Hb concentration varies in term and preterm babies in different counties in different feeding practices. The purpose of this longitudinal descriptive study is to find out the pattern of changes in the Hb level among exclusively breastfed preterm and term infants during the first six months of life. This study was carried in the Neonatal Intensive Care Unit (NICU), Mymensingh Medical College Hospital (MMCH), Mymensingh from September 2016 to February 2018. One hundred fifty (150) neonates both term and preterm were included in this study and followed up to 6 months of age. After admission informed written consent was taken from parents, thorough history taking and clinical examination were done. Data were collected in a pre-designed case record form. All the babies of Group A provided 2mg/kg iron supplementation from 6 weeks for 2 months for universal recommendation. Hb level was measured of all exclusively breast feed babies at admission after birth then next follow-up at 6 weeks, 3 months and 6 months. All information regarding history, anthropometrics measurement, Hb level was recorded in structural questionnaire. Data analysis was done by SPSS version 20.0. Male were predominant in both groups. Most of the preterm (72.0%) and term babies (65.3%) were delivered by vaginal route. Mean Hb level was found significantly higher among preterm babies than term babies after birth were 16.55g/dl and 15.98g/dl respectively. Sharp fall of Hb concentration was observed after birth up to 6 weeks in both preterm and term babies but Hb level was found significantly lower in preterm in comparison to term babies (9.27gm/dl vs. 9.58gm/dl). In term babies, even after 6 weeks fall of Hb level continued to 3 months of age followed by gradual increase up to 6 months without iron supplementation. Hb level of in preterm babies gradually increased from 6 weeks up to 6 months with universal iron supplementation. Hb level fall sharply up to 6 weeks in both exclusively breastfed term and preterm babies but even after 6 weeks term babies experienced gradual fall of Hb levels up to 3 months. Hb level increases in exclusively breast-fed term babies without iron supplementation from 3 months of age. Hb level in exclusively breastfed preterm babies increase from 6 weeks onward might be effect of universal iron supplementation.

A life threatening rare condition called catastrophic antiphospholipid syndrome leading to multiple organ failure is characterized by vascular thrombosis in the presence of anti-phospholipid antibody which often appear as a medical emergency. Antiphospholipid antibody syndrome whether primary or secondary cause thromboembolic manifestation resulting recurrent fetal loss, but catastrophic antiphospholipid antibody syndrome may not present in such a way, rather multi-system involvement occurs within a short period of time. We would like to present a case of 50 years old female who is hypertensive, non-diabetic, a known case of hypothyroidism for two years, who was admitted to our hospital after developing fever for 7 days and black discoloration of lateral three fingers of left hand for short period of time. The patient had no medical problems and had been in her usual state of health until 7 days before admission. Patient is anaemic and found to have severe renal failure. She was found high titer antiphospholipid antibody both IgM and IgG positive and anti-cardiolipin antibody positive. Her routine investigations revealed very high neutrophilic leukocytosis, high acute phase reactant, urinary findings revealed no active sediment; we thought that our patient might have sepsis that may trigger catastrophic antiphospholipid syndrome. Multi-disciplinary consultation gave us valuable opinion. Considering her septicemia, she was given broad spectrum antibiotic. Anticoagulation was given with unfractionated heparin followed by warfarin and as an immunosuppressive protocol methylprednisolone followed by prednisolone along with pulse cyclophosphamide was given. Treatment option with plasma pheresis and monoclonal antibody was not attempted, but she was given several session of hemodialysis, within a few days her biochemical parameters improved. Severe renal failure in this patient may be explained by septicemia or thrombotic micro-angiopathy that was reversed with anti-coagulation or proper antibiotic. Amputation of three digit of left hand was done by orthopedic surgeon but unfortunately two weeks after admission the patient expired due to sudden stroke.

The objective of this study was to determine whether Magnetic Resonance Imaging is a sensitive and specific alternative method to clinical FIGO criteria in the staging of cervical carcinoma. This prospective cross-sectional study was conducted in the Department of Radiology and Imaging, BSMMU, Dhaka during the period of September 2018 to August 2020. A total of 60 patients were selected purposively and all are staged clinically by EUA. Then all samples underwent MRI in Department of Radiology and Imaging, BSMMU. Images of uterine cervix, corpus, vagina and parametrium were taken with a prefixed standard protocol (TIWI axial, T2WI axial and sagittal, DWI axial & DCE) and reporting was done by Radiologist. Comparison was done between the MRI and clinical FIGO criteria of staging of cervical carcinoma. P value <0.05 was considered as significant. Sensitivity & specificity of the MRI was measured. Data were analyzed by using Statistical Package for Social Sciences (SPSS) software version 23.0 for Windows (SPSS Inc., Chicago, Illinois, USA). Out of 60 patients in this study the mean age was found 47.5±10.1 years with range from 22 to 60 years. Positive correlation (r=0.993; p=0.001) between histopathological size and MRI size of tumour. Positive correlation (r=0.950; p=0.001) between histopathological size and FIGO size of tumour. MRI findings more correlates with histopathology than clinically detected tumor size. The sensitivity, specificity, accuracy, positive and negative predictive values of MRI diagnosis evaluation for vaginal extension was 100.00%, 95.20%, 100.00%, 98.30% and 97.50% respectively. Sensitivity, specificity, accuracy, positive and negative predictive values of MRI diagnosis evaluation for parametrial invasion was 100.00%, all. In this study we observed that MRI staging was more likely to be concordant with pathological stage in comparison to the clinical stage. There was a concordance rate of 95.00% in MRI and 65.00% in clinical staging respectively. Out of 3 non-concordant cases in MRI, 2 were upstaged and 1 case was down staged in histopathology. FIGO staging concurred with histopathology in 39(65.00%) cases and differed in 21(35.00%) cases. Magnetic resonance imaging (MRI) is a sensitive and specific modality for accurate staging of cervical carcinoma in comparison with clinical FIGO criteria considering histopathology as gold standard.

Urinary tract infection (UTI) is a common complication in nephrotic children and leads to most morbidity and mortality in developing countries like Bangladesh. This case control study was conducted in the Department of Pediatrics and Pediatric Nephrology ward of Dhaka Medical College Hospital, Dhaka from July 2016 to June 2018 to identify the risk factors of UTI in children with nephrotic syndrome. Total 90 patient of nephrotic children aged 2-12 years, who were fulfilling the inclusion and exclusion criteria were selected as Group I (case) and Group II (control) according to urine culture report. Group I was UTI positive and Group II was UTI negative. The mean age of Group I was 5.26±3.18 years and Group II was 6.03±2.85 years. There was male predominance in both groups. No significant difference has been found regarding age and sex (p>0.05). No significant difference was also observed regarding economic status and educational level of mother among both groups (p>0.05). Fever, dysuria, abdominal pain, anasarca, vomiting and pallor were found as common presentations in Group I. Children with dysuria and abdominal pain were significantly higher in Group I than Group II (p value <0.001). UTI was found more in relapsed cases than initial attack. E. coli was the most common etiologic agent (37.8%). Mean Hb (gm/dl), serum total protein, serum albumin and serum IgG level were found significantly lower and spot urine protein creatinine ratio was significantly higher in Group I, which implies that those biochemical factors were associated with development of UTI in nephrotic children. Younger age group (<6 years), Constipation and uncircumcised male were found as risk factors and has association with UTI in nephrotic children.

Danis-Weber type-B ankle fracture is one of the most common injuries in young and active individual. This fracture offers a considerable challenge to orthopedic surgeon. Though there are several options for treating such type of fracture, ORIF by Pre-contoured Distal Fibular Locking Plate is the preferred option in the recent years. This descriptive type of observational study was performed from July 2017 to June 2019 in NITOR. Thirty (30) patients, 22 male and 8 female with an average age of 39 years with Danis-Weber type-B ankle fracture underwent ORIF by Pre-contoured Distal Fibular Locking Plate for fractured fibula and ORIF by 4.0mm cannulated cancellous screw for fractured medial malleolus. All the patients were initially managed by analgesic and short leg posterior slab. Average follow up was 24 weeks. Final outcome was assessed by AOFAS score. The main cause of injury was RTA (56.67%). Mean operation time was 1.2 hours. Mean duration of Hospital stay was 16.43±1.73 days. Superficial infection was in 3.33% and skin necrosis in 3.33% patient. Mean duration of radiological healing was 12.73±0.39 weeks. At final follow up, mean dorsi flexion was 10.93°±0.357° and plantar flexion was 50.93°±0.357°. Ninety percent (90%) patient had no difficulties in walking on any surface; 96.67% patient had stable ankle hind foot; 86.67% patient had good. Ten percent (10%) had fair and 3.33% patient had poor alignment of foot. The mean score in this study was 88.67±2.31. Satisfactory outcome was observed in 86.67% patients and 13.33% had unsatisfactory results. On the basis of results in the present study, it can be concluded that treatment of Danis-Weber type-B ankle fracture by Pre-contoured Distal Fibular Locking Plate is an effective and reliable method.

Neonatal sepsis is associated with increased mortality and morbidity including prolonged hospital stay. Management of such cases is difficult, costly and need expert centers in many cases. Therefore, continued surveillance is mandatory to identify risk factors of neonatal sepsis which help optimizing its management. With the above idea, this cross-sectional descriptive study was conducted at the neonatal intensive care unit (NICU) in the department of Neonatology, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from July 2017 to December 2017 to observe the effects of maternal and neonatal risk factors in the development of neonatal sepsis and to determine risk factors of neonatal sepsis. Ninety four neonates (0-28 days) who were admitted in NICU with suspected sepsis were included in this study by purposive sampling technique. After admission written informed consent from parents or guardians obtained and histories were obtained including perinatal history and full physical examination of the infants were done and septic screening were sent. All the relevant information was recorded in a pre-designed questionnaire and all data were compiled, tabulated and then analyzed by SPSS version 21.0. Among 94 cases, 72.3% were preterm and 27.6% were term. There was male predominance and male/ female ratio was 1.9:1. Most (76.6%) of the patient admitted within 72 hours of birth. Most (83%) had low birth weight (<2500gm). Most came from rural area 61(64.9%) and also from low income family 59(62.8%). Premature onset of labour 40(42.6%), PROM >18 hours 36(38.3%), vaginal route of delivery 52(55.3%), instrumental resuscitation 15(16%), prelacteal feeding 11(11.7%), bottle feeding 15(16%) were the antenatal, natal and postnatal risk factors in this study. Also the neonatal factors, like prematurity, resuscitation at birth and low APGAR score carried the significant risk of developing sepsis. Poor feeding, lethargy, respiratory distress, jaundice were more common presenting symptoms. Tachycardia, tachypnea, chest indrawing, cyanosis hypothermia, hyperthermia and apnoea were found as more common presenting sign of sepsis in this study. Based on result it is concluded that prolonged rupture of membrane>18 hours, vaginal route of delivery, preterm birth, instrumental resuscitation, prelacteal feeding, bottle feeding were the major perinatal risk factors in this study.

This cross sectional comparative analytical study was undertaken with the objectives to find out the nutritional status of children with congenital heart disease by anthropometric measurement and was compared it with those of children having minor illness and without any congenital heart disease in indoor and outdoor Department of Paediatrics of Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from December 2015 to November 2016. Purposive sampling was done. One hundred children aged 6 to 60 months with congenital heart disease confirmed by echocardiogram were taken as Group A and one hundred children of same age and sex matched having minor illness and without any congenital heart disease were taken as Group B. Age of the patients ranged from 6 to 60 months. There was no obvious difference of socio-demographic status between two groups. Most of the patient (64.0%) had acyanotic congenital heart disease among them VSD was commonest (68.8%). Thirty-six percent (36.0%) patient had cyanotic congenital heart disease and among them Tetralogy of Fallots (83.3%) was commonest. There were significant differences regarding weight, height and MUAC values in between two Groups. Underweight (51%), Stunting (50%) and Wasting (29%) all were higher in congenital heart disease than that of Group B where they were 28%, 31% and 13% respectively and the differences were statistically significant (p<0.05). The findings of this study imply that malnutrition is very common among children with congenital heart disease. So, anthropometric measurement should be done in each and every child with congenital heart disease.

Obesity is now recognized as a major cause of morbidity and mortality throughout the world. The relative percentage of change is higher in developing countries. Childhood obesity has become a serious public health emerging problem because of its strong association with adulthood obesity and related adverse health consequences. The main objective of the study was to find out the status of overweight and obesity among primary school children of Mymensingh municipal area. This cross sectional descriptive study was carried out among primary school children of Mymensingh municipal area from September 2016 to February 2018. Total 1450 students were enrolled from 6 schools. Schools were selected by random lottery method. Data was collected in predesigned case record forms by investigator with the help of students, teachers and parents. Anthropometry was measured by principal investigator. Body mass index (BMI) was calculated and plotted by using Center for disease control (CDC) BMI growth charts for age and sex. Children were categorized as obese, overweight, normal and underweight. Data analysis was done by computer software SPSS version 20.0. Mean age of children was 9.0±1.124 years. There was 47.4% male and 52.6% female. Among the 1450 children 18.6% obese, 17.5% overweight, 53.5% normal and 10.4% underweight. So, total 36.1% children had BMI above normal limit. Obesity was found more common among male children (p<0.001). Obesity and overweight was significantly associated with fast food consumption (p<0.001), playing computer and mobile games (p<0.001), watching TV (p<0.001), higher parent's education (p<0.001), higher parent's income (p<0.001), service holder father (p<0.001), family history of overweight or obesity (p<0.001), single child in family (p<0.001) and increased birth weight (p<0.001). A large number of primary school children in Mymensingh municipal area were overweight and obese. Childhood obesity and overweight varies from school to school. Childhood obesity and overweight is an emerging and growing health issue in municipal area.

No Abstract.

Undernutrition in children under five years remains a significant health problem in Bangladesh, despite substantial socio-economic progress and a decade of interventions aimed at improving it. Although Bangladesh has made rapid progress over the last decade in the field of health and nutrition, there has been very slow progress in improving the state of child nutrition. Studies aiming at determination of interrelationship between child undernutrition and maternal undernutrition are to be scientifically established if appropriate intervention policy is to be introduced. This study was undertaken to see whether this assumption has a statistically proven basis that maternal undernutrition influences child undernutrition. The objective of this cross sectional analytical study was to evaluate the association between child undernutrition and their maternal undernutrition in child-mother pair in a tertiary care hospital and was conducted from July 2017 to April 2018 in the department of General Paediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. The study subjects were 196 children between the ages of six months to five years who were admitted in BSMMU and their accompanying mothers. Children who had any known chronic diseases or clinically obvious syndrome were excluded. Before enrollment, parents of all the patients were informed about the study & its objectives. Anthropometric measurements of children and mothers were done by standard procedure. Demographic profile and relevant maternal information were collected by interviewing the mothers. Among the undernourished children, 17.3% were found underweight, 7.1% stunted, 16.3% wasted. Combined underweight & wasted were 34.7%, underweight & stunted 9.2%, stunted & wasted 5.1%, underweight, stunted and wasted 10.2%. Maternal undernutrition was more common (95.7%) in undernourished children group. Undernutrition was significantly higher in mothers of children with undernutrition (OR=40.75, p<0.001). Children having a better nutrition were born from mothers who were well nourished, educated, had good childcare knowledge and higher family income. This emphasized the need to provide the guideline for appropriate measure to be taken to reduce child undernutrition.

Treacher collins syndrome (TCS) or Franceschetti syndrome is an autosomal dominant inherited disorder with variable expressivity. It affects mainly craniofacial structure that derives from 1st and 2nd branchial arches approximately between the 20th day and 12th week of intrauterine life. This syndrome has different clinical types. Most common features are antimongoloid slanting of the palpebral fissures, hypoplasia of zygoma, maxilla & mandible with various eye and ear abnormalities. Here we present a case of an 11 days old female neonate, who was ill looking, dyspnoeic having significant facial profile, multiple congenital anomalies and dolicocephaly; admitted in the department of Neonatology, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh on 7th August 2020. After taking all the diagnostic assistance of the multidisciplinary approach mainly on the basis of clinical features and radiology we diagnosed the case as TCS. We managed the patient by maintaining temperature, giving nutritional support and injectable antibiotic, took consultation from Otolaryngology department then we discharged the baby with proper counseling, advised regarding further follow up and to consult with paediatric surgeon and cardiologist.

The objective of the study was to investigate and quantify the severity of COVID-19 infection by high resolution computed tomography (CT) of chest and to determine its relationship with clinical parameters. This study also aimed to see CT changes with clinical recovery or progression of disease. This cross sectional study was performed from July 20 to August 20, 2020, where both chest HRCT and clinical features were included in laboratory confirmed COVID-19, 100 patients, attending the depertment of Radiology & Imaging, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. This study included clinical symptoms, comorbidities of patients, HRCT chest characteristics, CT severity score. After collection of all required data and careful medical chest review, the clinical data of laboratory confirmed patients was compiled and tabulated. In this study group out of 100 patients, most of the patients were in 5th & 6th dacades with a mean age of 53.7 years. In this study out of 100 patients 72% were male and 28% were female with an average sex ratio of male : female being 2.5:1. Prevalance of various clinical presentation in this study sample population distributed as fever in 76% cough in 77.4%, shortness of breath in 55%, sore throat in 17% were the most common clinical manifestations while a few patients (13.2%) also had other symptoms like headache, chest tightnes, anosmia and diarrhoea. Major comorbid conditions were diabets mellitus, hypertension, bronchial asthma and Chronic kidney disease (CKD). Patient with comorbid disease, especially if multiple had higher symptomatic presentation. Out of 100 patients 75.5% patient had co-morbidity where as 24.5% ptaients did not have any co-existing disease. According to HRCT imaging severity score the lung pathological changes were evaluated, when typical covid findings in 80%, intermediate in 10%, atypical in 2% and normal chest CT findings in 8% patients. Symptomatic presentation had found higher (85.21%) who had CT severity index >15/25 while sympotomatic presentation lesser (14.79%) who had CT severity index <15/25. CT severity index of 1-5 was seen in 20(21.73%) patients, 6-10 in 38(41.30%) patients, 11-15 in 22(23.91% patients, 16-20 in 10(10.86%) patients and 21-25 in 2(2.17%). As positive CT findings were more prominent in symptomatic and co-morbid patients HRCT chest in COVID-19 patient had a major diagnostic and prognostic importance. Clinical symptoms of patients directly correlated with CT severity score. Therefore, CT imaging was found to be useful in predicting clinical recovery of patient or progression of disease.

An observational longitudinal study was conducted in the Department of Neonatology and Child Developmental Center, Mymensingh Medical College Hospital (MMCH), Bangladesh during the period of September 2016 to February 2018 to find out the neuro-developmental outcome of high risk neonates at the age of 6 months. Five hundred seventy six (576) high risk neonate who were admitted in the neonatology department in Mymensingh Medical College Hospital were selected as study population by Purposive sampling technique. After admission written informed consent from parents or guardians obtained and Data was collected in a pre-designed case record form. At 6th months of age total 400 baby were came to Child Development Centre and their motor, cognition and behavior development were assessed by Bayley Scale of Infant Development and severity of cognitive, motor and behavior impairment were graded. All data were compiled, tabulated and then analyzed by computer software SPSS version 20.00. Mean age was 7.2±3.3 days. Among studied newborns 18.1% were preterm and 81.9% were term. Most of the newborn were male (63.0%). Developmental delay was found in 81.5% and neuro-developmental outcome was found normal in only 18.5% newborns. Significant delayed motor performance was found in 52% newborns where 17% had mild delay. Significantly delayed mental performance was found in 57.0% and 28.52% had mildly delayed mental performance. Non-optimal behavior was found in 57.0% newborns and14% had questionable behavior. Very low birth weight, preterm very low birth weight, home delivery, perinatal asphyxia and neonatal seizure were found to have significant relation with developmental delay. Most of the high risk neonates develop developmental delay.

This cross-sectional descriptive study was conducted at the neonatal intensive care unit (NICU) in the department of Neonatology, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from July 2017 to December 2017 to determine antimicrobial sensitivity pattern in neonatal sepsis. Ninety four neonates (0-28 days) who were admitted in NICU with suspected sepsis were included in this study by purposive sampling technique. After admission written informed consent from parents or guardians obtained and then septic screening along with blood culture and antimicrobial sensitivity was done. All data were compiled, tabulated and then analyzed by SPSS version 21.0. Among 94 cases, 68(72.3%) were preterm and 26(23.4%) were term. There was male predominance and male female ratio was 1.9:1. Most of the patient admitted within 72 hours of birth. Most (84%) had low birth weight (<2500gm). Pre-mature onset of labour, pre-mature rupture of membrane >18 hours, vaginal route of delivery, instrumental resuscitation, pre-lacteal feeding, bottle feeding were the major perinatal risk factors in this study. Early onset sepsis (76.6%) was most prevalent in this study. Blood culture yielded positive growth in 20(21.3%) cases. Among them, Klebsiella was found in 7(35%). E. coli in 6(30%), Acinetobacter was in 3(15%), Staphylococcus aureus in 2(10%) cases. Pseudomonas and Enterobacter were found in rest 2(10%) of the cases. Gram negative bacteria were found in 18(90%) cases. Klebsiella was sensitive to Imipenem (85.7%), Colistin (85.7%) and Ciprofloxacin (77.5%). Sensitivity of E. coli was Imipenem (100%), Colistin (100%), Amikacin (66.7%), Ciprofloxacin (66.7%), Netilmicin (66.7%) and Gentamicin (50%). Acinatobecter had sensitivity to Netilmicin, Colistin, Imipenem (100%). Staphylococcus was 100% sensitive to Imipenem, Netilmicin and Vancomycin. Pseudomonas was found sensitive to Imipenem (100%), Amikacin (100%), Netilmicin (100%) and Colistin (100%). Enterobacter was found highly sensitive to Ciprofloxacin, Colistin and Imipenem. Almost all organisms were resistant to Ampicillin, Gentamicin, Cefotaxime and Ceftazidime. Based on result it is concluded that Klebsiella pneumoniae and Escherichia coli are the leading cause of neonatal sepsis in this study and most of them resistant to multiple antibiotics. Organisms found more sensitive to Imipenem, Colistin, Ciprofloxacin and Netilmicin.

More than 120,000 anterior cruciate ligament (ACL) injuries occur every year in the United States, mostly during the high school and college years. The incidence of these injuries is slowly increasing, especially in females. This is likely caused by their increasing participation in high school and other organized sports. In addition, several studies have shown that female athletes are at an increased risk of ACL injury in sex comparable sports. The goal of this study was to evaluate the functional outcome of Arthroscopic anterior cruciate ligament reconstruction using Bone-Patellar tendon- Bone autograft. 25 patients with chronic ACL deficient knee presenting to Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from January 2018 to December 2019 were included in the study. The patients with severe osteoarthritis (OA) knee, local active infection and systemic disease, intraarticular fracture of knee that might influence the study results were excluded from the study. Bone patellar tendon bone graft was harvested from ipsilateral knee. The patient was followed till 6 months with specified program of rehabilitation. Results were evaluated by an independent examiner using radiography, subjective and objective evaluation. Assessment using Lysholm's score was 50 (42-63) preoperatively and 90.8 (63-97) at the latest follow up (p<0.005). No patient complained of instability at latest follow up. The quadriceps muscle showed atrophy at final follow-up. Five Patients complained of anterior knee pain. We found no graft displacement on follow up radiographs. Osteo-integration occurred in all cases. ACLR with a BPTB graft can stabilize the knee without loss of motion by closely mimicking the native ACL without any hazards and additional complications. It is useful in high demand patients and cost effective option with high patient satisfaction rate for reconstruction of ACL.

Femoral fractures are frequent in the pediatric population. Treatment options are based on the patient's age, fracture pattern, type of trauma and associated soft tissue injury. The traditional treatment method for pediatric femoral shaft fracture has been traction and spica casting. The immediate spica cast is safe and effective for children up to 6 years of age with isolated femoral fracture and acceptable reduction. Patients between 6 and 10 years of age can also be treated with spica casting with or without traction. This prospective study was done in the department of Orthopaedics, Mymensingh Medical College Hospital, Mymensingh, Bangladesh form from July 2015 to June 2019 to evaluate the outcome of closed reduction and internal fixation by titanium elastic nailing for fracture shaft of femur. Twenty patients, all presenting with fresh diaphyseal fractures of femur, treated with closed reduction and internal fixation by titanium elastic nailing. These patients were prospectively evaluated over a period of at least 18 months. Fractures were classified according to Association of Orthopaedics (AO) classification of shaft of femur fractures. According to AO classification, all were A1, A2, A3 fractures. Average age of the patients was 11±2.7 years; range was 6 to 16 years. There were 15 males and 5 females. Out of 20 cases treated with this method, stable fixation and union was achieved in all of them. Radiological union was achieved at an average of 10±2.3 weeks (8-15 weeks). The results were excellent in twelve patients (60%), successful in five (25%) and poor in three patients (15%) as per the scoring criteria for TEN. The effective treatment of diaphyseal fractures of the femur is intramedullary fixation by titanium elastic nailing in patients of the 6-16 years age group.

A cross sectional study was conducted to demonstrate the value of Computed Tomographic (CT) scan in clinically suspected 114 COVID-19 patients with emphasis on identifying and characterizing the most common findings of chest CT. The CT findings were compared and correlated with the results of Reverse Transcriptase Polymerase Chain Reaction for corona virus disease. This study was conducted in the Department of Radiology and Imaging, Bangabandhu Sheikh Mujib Medical University, Dhaka with clinically COVID-19 suspected patients. This cross sectional study was performed from July 7 to August 7, 2020 where both chest HRCT and RT-PCR test were included, keeping RT-PCR as the reference standard. Of the 114 patients 104(91.22%) patients had ground glass opacities (with no consolidation), 50(43.85%) patients had ground glass opacity and consolidation. Along with ground glass opacities 60(52.63%) patients had associated crazy paving appearance, 44(39.59%) patients had reverse halo sign, 76(66.66%) patients had vascular thickening and 60(52.63%) patients had fibrotic shadows. Most patients (94%) (98/104) had bilateral chest CT findings. Out of 114 patients, 96 (84%) patients had positive RT-PCR results and 18(15.7%) patients had negative RT-PCR results. Out of 96 RT-PCR positive patients, 90 patients had positive chest CT findings, where was 06 patients had negative CT findings. On the other hand, out of 18 RT-PCR negative patients, 14 patients had positive chest CT findings while 4 patients had negative chest CT findings. To conclude, chest CT imaging has high sensitivity for diagnosis of COVID-19, Data and analysis from our study suggests that chest CT ought to be considered for the COVID-19 as a primary diagnostic tool for early detection of COVID-19 patients where awaited RT-PCR results.

Variety of conditions may be responsible for low back pain but lumber spinal canal stenosis is an important cause of low back pain. Lumber spinal canal stenosis usually presents with low backache with neurogenic claudication and shortness of walking distance in adult patient. Surgical management of lumbar spinal canal stenosis by decompression surgery is effective method. This prospective interventional study was performed in patient with clinical features like low back pain with radicular pain, neurogenic claudication, signs of root compression, positive MRI findings attending in department of Orthopaedic Surgery Mymensingh Medical College Hospital and Private Hospital from July 2016 to June 2019. Thirty patients were evaluated among those 20(66.6%) were 50 years and above. The mean age was 47.5±1.6 years. Male to female ratio was roughly 8:1. Almost all of the patients had low backache with radiation to the back of the thigh and leg with motor weakness (60%). About 66.6% of the patients had sensory deficit and 83.3% had neurogenic claudication. Majority (80.0%) of the patients at presentation had a suffering of 12 or >12 months. The mean duration of suffering was 14.7±5.1 months. About 55% of the patients were able to perform heel-walking and 36.0% tip-toe walking. Nearly 57% of the patients had sensory deficit along the distribution of 1st sacral nerve and 53.3% along the distribution of lumber 5 nerves. Diagnosis shows that 16.6% of patients had L4 lesion, 50% L5, 10.0% patients had L4 & L5 and 46.6% S1. Laminectomy was done in 26.6% of patients, laminectomy and disectomy in 33.3% and laminectomy, discectomy & foraminal decompression in 40.0% of patients. Twenty five (83.5%) of patients was free from symptoms. Eighty percent (80.0%) of patients shows minimal disability and 20.0% moderate disability on the basis of Oswestry Disability Index, while by MacNab criteria, most (80%) of patients was excellent, 10% good and another 10% fair. Repeated measure ANOVA statistics showed that mean Oswestry score decreased significantly from 54.5% at baseline to 22% at the end of 1 year (p<0.001).

Acetabular fracture usually occurs as a result of high velocity injury and often affects the young and economically productive population. Previously, treatment of acetabular fracture was grossly inadequate and many patients were left with incapacitating pain, limitation of movement. Proper management should be given in our set-up to save lives and to minimize long term complications and related disabilities. This study was done to evaluate the outcome of open reduction and internal fixation of posterior wall fracture of acetabulum. This prospective observational study was carried out in Dhaka Medical College Hospital, Dhaka, Bangladesh from July 2016 to June 2018. Total twenty five cases were selected. Radiological and functional outcome were evaluated six months after surgery according to Matta radiographic criteria and Merle d Aubigne and Postel criteria respectively. Effect of age, gender, hip dislocation, displacement of fracture fragment, associated injury, reduction quality, trauma to surgery time, complication of operation on the functional outcome was evaluated. Age range was 18-60 years. The mean age was 38±11 years. Male 23 and female 2, male and female ratio was 11.5:1. Mean follow up 8.5±1.7 months, range 6-12 months. According to Matta radiographic criteria, 6 months after surgery, 10 patients had excellent, 10 patients had good, 3 patients had fair and 2 patients had poor radiological outcome. According to Merle d Aubigne and Postel criteria, 6 months after surgery, 11 patients had excellent, 10 patients had good, 3 patients had fair and 1 patient had poor functional outcome. Overall functional outcome of the study population revealed that 21 patients (84%) belonged to satisfactory (Excellent + Good) and 4 patients (16%) belonged to unsatisfactory (Fair + Poor) outcome. AVN (avascular necrosis) of femoral head had been occurred in two patients, post-operative wound infection had been occurred in two patients and myositis ossificans around hip joint had been occurred in two patients. Twenty (20) patients were achieved anatomic (0, 1mm) reduction, 3 patients were achieved imperfect (2, 3mm) reduction and 2 patients were achieved poor (>3mm) reduction. This study concludes that open reduction and internal fixation of posterior wall fracture of acetabulum is a satisfactory method of treatment.

Acute occlusive thrombosis of the coronary artery is the principal cause of myocardial infarction where platelets play an important role. Large size platelets, easily measured by mean platelets volume (MPV) are thrombogenic and commonly seen after ST-segment elevation myocardial infarction (STEMI). ST segment resolution has been shown as a simple non-invasive marker that reflects both epicardial and myocardial reperfusion following thrombolysis. The present study intended to investigate whether MPV on admission correlated with ST segment resolution following thrombolysis in STEMI patient. This cross-sectional analytical study was conducted in the department of cardiology, Mymensingh Medical College and Hospital (MMCH), Mymensingh, Bangladesh from December, 2016 to June, 2018. Total 284 patients with first attack of STEMI were included after considering inclusion and exclusion criteria. Sample population was divided into two groups, Group I - Patients with successful ST segment resolution (≥50%). Group II - Patients with impaired ST segment resolution (<50%). MPV on admission was estimated during estimation of Complete Blood Count (CBC) by Automated Haematology Analyzer & compared between two groups. Successful ST segment resolution (≥50%) was seen in 67% of patients after thrombolysis. Admission MPV was higher in patients with impaired ST segment resolution (<50%) group than patients with ≥50% ST-segment resolution group (12.42±0.89fl vs.10.35±0.77fl respectively, p=0.001). Statistically significant strong negative correlation between MPV and ST segment resolution percentage (r = -0.742, p=0.001) suggesting that the higher the level of MPV, the lower the ST segment resolution percentage in first attack of STEMI patients. Multivariate regression analysis found MPV level on admission as an independent predictor of ST segment resolution. The study concluded that high MPV on admission correlate with impaired ST segment resolution following thrombolysis in STEMI patients.

Coronary heart disease (CHD) is the most common cause of heart disease and serious cause of early death in developed countries around the world. Stress hyper-glycaemia has a bad prognostic implication in hospital outcomes in acute ST elevated myocardial infarction patients. It serves as a marker of myocardial damage, provides information about complications of acute MI and bad prognosis. The aim of this cross-sectional descriptive study was to find out prognostic implications of Stress hyper-glycaemia in non diabetic patients with first attack of acute ST elevated myocardial infarction underwent thrombolysis and conducted in the department of Cardiology in Mymensingh Medical College Hospital, Mymensingh, Bangladesh from June 2017 to May 2018. Total 249 first attack of Acute STEMI patients were included considering inclusion and exclusion criteria. The sample population was divided into two groups: Group I: Patients with first attack of acute STEMI underwent thrombolysis with non diabetic stress hyper-glycaemia (Blood sugar >7.8mmol/L and HbA1c <6.5), Group II: Patients with first attack of acute STEMI underwent thrombolysis with non diabetic normo-glycaemia (Blood sugar <7.8mmol/L and HbA1c <6.5). In this study, in non diabetic Stress hyperglycemic patients' death was 5.7% and in non diabetic normo-glycemic patients death was 0.6%. It was statistically significant (p<0.05). In non diabetic stress hyperglycemic patients, heart failure was 78.31% patients and in non diabetic normo-glycemic patients, it was 21.6%. It was statistically significant (p<0.01). Echocardiography showed that patients with non diabetic Stress hyper-glycaemia had mean ejection fraction (LVEF) was 44.01±4.93 and patients with non diabetic normo-glycaemia had mean ejection fraction (LVEF) was 47.70±5.71. It was statistically significant (p<0.01). In this study, in non diabetic Stress hyperglycaemic patients, cardiogenic shock was 16.1% and in non diabetic normo-glycemic patients, it was 3.7%. It was statistically significant (p<0.05). Mean duration of hospital stay, in non diabetic Stress hyperglycaemic patients was 5.07±0.566 and in non diabetic normo-glycemic patients, it was 3.52±0.850. It was statistically significant (p<0.001). In conclusion, the incidence of death, heart failure, cardiogenic shock and hospital stay were higher in non diabetic Stress hyperglycaemic patients than non diabetic normo-glycemic patients who admitted with first attack of acute ST elevated myocardial infarction.

Distal humeral fractures are relatively rare injuries that constitute approximately 2% of all fractures which occur due to high energy trauma in young males. Because they involve the articular surface and usually cause an instable elbow, surgical treatment is necessary for the recovery of elbow functions in the majority of cases. The principles of absolute stabilization and early mobilization in the elbow are of more importance than in any other joint. As the AO classification, nonunion and implant loosening is more common in type C fractures of the distal humerus involving the joint surface. Aim of this prospective study was to evaluate the outcome of "Double Tension Band wiring" method for the treatment of intercondylar fractures of humerus and was conducted in a tertiary hospital of Bangladesh from July 2017 to June 2019. Twenty five patients, all presenting with fresh fractures of the distal humerus, treated with double tension band wiring. These patients were prospectively evaluated over a period of at least 6 months. Fractures were classified according to Jupiter classification and AO classification of distal humeral fractures. Due to AO classification, total fractures were C1 fractures. Average age of the patients was 56.20 years (32-70 years). There were 20 males and 5 females. Out of 25 cases treated with this method, rigid fixation and union was achieved in all of them. The average tourniquet time was 69 minutes range was minimum 50 minutes and maximum 120 minutes. Radiological union was achieved at an average of 14.2 weeks (10-18 weeks). Average range of motion was 112.8 degrees (107-116). Excellent to good results were seen in almost 86% of cases as per the Mayo Elbow performance score at 6-month follow-up. Wound infection had been occurred in 2(8%) cases, ulnar nerve neuropathy had been occurred in 1 case, delayed union of olecranon process of ulna had been occurred in 1(4%) case, implant failure had been occurred in 2(8%) cases, heterotrophic ossification had been occurred in 2(8%) cases, varus valgus instability had been occurred in 1(4%) case, gun stock deformity had been occurred in 2(8%) cases. Double tension band wiring is a reliable, less demanding and cost effective method of fixation of intercondylar fractures of humerus.

Neonatal sepsis is one of the most common reasons for admission to neonatal units in developing countries. It is also a major cause of mortality in both developed and developing countries. The type and pattern of organisms that cause neonatal sepsis changes over time and vary from one hospital to another hospital, even in the same country. In addition the causative organisms have developed increased drug resistance for the last two decades. Maternal, neonatal and environmental risk factors have contributed for the development of sepsis. To study the risk factors, causative organism and bacterial sensitivity pattern in cases of neonatal sepsis. This cross-sectional study was conducted over a period of six months. The study included 100 patients admitted at the neonatal ward of Department of Pediatrics, Community Based Medical College Bangladesh, Mymensingh, Bangladesh. Blood samples for culture were taken aseptically before starting antibiotic therapy. Microorganisms were isolated and identified by standard microbiological processes and antimicrobial sensitivity patterns were performed against amikacin, gentamicin, ceftriaxone, ciprofloxacin and ceftazidime. The factors which carried a significant risk for development of neonatal sepsis were low birth weight, preterm neonates, meconium stained liquor and prolonged rupture of membrane (>18 hours). Gram negative organisms predominated (68.8%) with Escherichia coli (33.3%) being the commonest. The gram negative bacteria which were isolated sensitive to amikacin, gentamicin and ceftriaxone. The organisms also relatively more sensitive to ciprofloxacin and highly sensitive to ceftazidime. The Gram positive bacteria showed sensitivity against only the antibiotic Ceftriaxone and Ciprofloxacin. The overall mortality was 9%. The outcome of the study will contribute to preventing and treating neonatal sepsis in the hospital.

Acute myocardial infarction (AMI) patients constitute a large proportion of admissions in coronary care unit and their management and risk stratification is of immense importance. A decrease in serum albumin concentration might be associated with an increased risk in the incident of both cardiovascular diseases and worse hospital outcome. We assessed whether serum albumin levels at admission was associated with in-hospital adverse outcome in patients with first attack of acute myocardial infarction (AMI). The aim of the study was to evaluate association of serum albumin level with in-hospital outcome in patients with first attack of acute myocardial infarction. This cross-sectional analytical study was conducted in the department of cardiology in Mymensingh Medical College Hospital, Mymensingh, Bangladesh from March 2017 to February 2018. Total 374 patients of first attack of acute myocardial infarction included considering inclusion and exclusion criteria. The sample population was divided into two groups: Group I (Patients with acute myocardial infarction with serum albumin <3.5gm/dl) and. Group II (Patients with acute myocardial infarction with serum albumin ≥3.5gm/dl). Serum albumin level was measured within 24 hours of admission and the incidence of in-hospital major cardiac outcomes was observed. In this study mean±SD serum albumin level of Group I, Group II were 3.02±0.12gm/dl, 4.48±0.50gm/dl respectively. In Group I patient, 52(59.80%), 7(8.00%), 10(11.50%), developed heart failure, cardiogenic shock, arrhythmias respectively and 8(9.20%) died and in Group II patient 20(7.90%), 7(2.80%), 8(3.20%) developed heart failure, cardiogenic shock, arrhythmias respectively and 4(1.60%) died out of them and all of these outcome were statistically significant. Mean±SD duration of hospital stay of the study population according serum albumin level, in Group I, 5.76±1.83 days, in Group II, 4.40±1.22 days which was statistically significant (p<0.05). In conclusion, patient with first attack of acute myocardial infarction serum albumin level below 3.50gm/dl increased the risk of worse in-hospital outcome.

The tubercular infections (TB) are most important cause of morbidity and mortality in SLE patients worldwide and an ongoing alarming issue in developing countries. This observational study was carried out in SLE clinic of BSMMU, Bangladesh from April 2015 to March 2016 after taking ethical clearance from IRB to observe frequency and risk factors of tuberculosis in SLE patients. A total 230 consecutive SLE patients were enrolled. Patient's clinical characteristics, history of TB, SLEDAI score, cumulative doses of immunosuppressants were recorded. In clinically suspected cases tuberculin test, chest X-ray, spot and first morning sputum for AFB, Gene Xpert MTB/RIF, ADA, FNAC and tissue biopsy were requested along with routine tests. The multivariate logistic regressions were done for risk factors. Out of 230 patients TB was documented in 23 (10%) subjects. Among TB cases 16 women and 7 men. Mean age of patients was 27.56±9.3 years and mean duration of occurrence of tuberculosis after SLE diagnosis was 4.26±5.38 years. Present and past TB was observed in 10 and 13 cases respectively. Cough, night sweat, fever, anorexia were significant presenting features. Fifteen and 8 patients had pulmonary and extra pulmonary TB respectively. Organ involvement pattern was multi-lobed lungs, joint, meninges, lymph nodes, peritoneum and pleura. High disease activity disease (SLEDAI score >12), total intake of prednisolone >1000mg were risk factors of TB. Frequency of tuberculosis was high (10%) in SLE patients. Awareness including prevention of flares and judicious use of steroids might reduce the rate of TB.

Heart failure is a major public health issue with a current prevalence of over 23 million worldwide. Epidemiologic studies suggest that nearly one-half of patients with heart failure have a normal ejection fraction that is now termed HFpEF. Prevalence of HFpEF is approximately 50% (range 40-71%). Most pathophysiologic abnormalities in patients with HFpEF are related to diastolic function. Doppler echocardiography is the choice of investigation for evaluation of Diastolic function. Tissue Doppler Imaging is a new dimension in this concept. Natriuretitic peptides are widely accepted biomarker in HFrEF patients. Now a days, it is also considered for HFpEF patients for diagnostic & prognostic purpose. Aim of this study was to find out the association of Diastolic dysfunction with N-terminal Pro B-type Natriuretic Peptide level in HFpEF patients. This cross-sectional analytical study was conducted in the department of Cardiology in Mymensingh Medical College Hospital, Mymensingh, Bangladesh from October 2016 to September 2017. Total 120 HFpEF patients were included after considering inclusion and exclusion criteria. Sample population was divided into two groups, Group I: HFpEF patients with normal Diastolic function. Group II: HFpEF patients with diastolic dysfunction in this study mean NT-pro BNP value of Group I and Group II were 104.07±7.2pg/ml and 943.19±112.51pg/ml respectively, which was statistically significant (p value <0.05). Among the echocardiographic parameters LV hypertrophy, Left atrial volume index (LAVI), TDI derived mitral annular velocity, e' septal velocity, E/e' (septal) ratio, Decelaration time were statistically significant. In this study, it was also shown that the levels of NT-proBNP had positive correlation with Doppler parameters. Statistically significant moderate positive correlation was observed between NT-proBNP level and LAVI value, correlation coefficient (r=0.553, p=0.001) suggesting that the higher the level of NT Pro BNP level, the higher value of the LAVI value. Statistically significant moderate positive correlation was also observed between NT-proBNP level and E/e' (septal), correlation coefficient (r=0.526, p=0.001) suggesting that the higher the level of NT Pro BNP level, the Higher value of the E/e' (septal) value in HFpEF patients with diastolic dysfunction. In subgroup analysis of Group II ,mean NT-proBNP level showed affirmative relation with severity of diastolic dysfunction grades ranging from grade I (340.76±24.42) to grade III (3727.83±306.50) Diastolic dysfunction is associated with elevated NT-proBNP level in HFpEF patients & NT-proBNP value rises with gradual deterioration of Diastolic dysfunction among the HFpEF patients.

Tuberculosis (TB) is a progressive granulomatous infectious disease caused by the gram positive, acid fast bacilli classified under the genus Mycobacterium. Tuberculosis in human is mostly by Mycobacterium tuberculosis and primarily affects lungs causing pulmonary tuberculosis. It can also affect intestine, meninges, bones, joints, lymph nodes, skin and other tissues of the body causing extra-pulmonary tuberculosis. Human TB is transmitted mainly through droplet infection and droplet nuclei. Infection of human with M. avium and M. africanum is very rare. M. microti is not known to cause TB in human, while M. bovis has a wider host range. Human may be infected by M. bovis through milk and milk products or meat of an infected animal. It is estimated that in some developing countries up to 10% of human tuberculosis is due to bovine TB. Tuberculosis causes more than 2 million deaths annually and the death toll is worsened by the emergence of drug resistant Mycobacterium tuberculosis. The South East Asia Region accounts for 39% of global burden of TB in terms of incidence. It is estimated that about 3.4 million new cases of TB continue to occur each year in this region, most of them in India, Bangladesh, Indonesia, Myanmar and Thailand. Tuberculosis is a social disease with medical aspects. It has also been described as a barometer of social welfare. The social factors include poor quality of life, poor housing, overcrowding, population explosion, under-nutrition, smoking, alcohol abuse, lack of education, large families, early marriages, lack of awareness regarding cause and transmission of TB. These factors are interrelated and contribute to the occurrence and transmission of tuberculosis. It is estimated that approximately 10% of total TB is occurred in children. Childhood deaths from TB are usually caused by tuberculous meningitis or disseminated disease. The number of individuals infected with both HIV and TB is increasing worldwide. The HIV affects the body's immune system and enhances the speed at which TB progresses from a innocuous infection to life threatening condition. TB is a major cause of death of HIV positive individuals. Diabetes has been shown to be an independent risk factor for tuberculosis in community based studies from south India and multiple studies globally. It is suggested that diabetes accounts for 14.8% of all tuberculosis and 20.8% of smear positive TB. Understanding of epidemiology of tuberculosis is essential for its effective control. This review tried to summarize the epidemiological aspects of tuberculosis in global, regional and Bangladesh perspectives. For this review article, data available in books and at the official websites of WHO, MBDC, NTP, DGHS, The Ministry of Health and Family Welfare, Government of Bangladesh were consulted through PubMed central and Google scholar search engines. This paper has been written with an aim to offer general education to health professionals, policy makers, patients and the public.

We examined the hypothesis that the cross mattress for chest drain insertion site security is better than that of polypropylene horizontal mattress in chest trauma patient required tube thoracostomy at the Department of Casualty Surgery, Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2016 to June 2016. Accordingly we prospectively studied 50 consecutive patients who needed chest tube insertion. In 25 consecutive cases chest drain insertion site was secured with polypropylene horizontal mattress technique (Control- Group A) and another 25 consecutive patients had a cross-mattress with non-absorbable suture materials (Experimental- Group B). All chest tubes were inserted into the triangle of safety to following the BTS guideline. A baseline x-ray chest was compared with post-procedure chest x-ray. Male preponderance and young adults were comprised in both the groups; mean age in Group A and Group B was 38.7±15.5 and 37.3±14.1 respectively. Haemo-pneumothorax was the most common cause of tube thoracostomy among the trauma victims. This study shows that, polypropylene horizontal mattress results in increased chest tube site infection 52% in Control Group vs. 12% in Experimental Group (p=0.002). Although there was similar incidence of blood loss between the groups, the length of Hospital stay was significantly higher in Control Group. We conclude that cross mattress for chest drain insertion site security showed a better clinical outcome, less wound complications and less hospitalization.

This prospective study was conducted to assess the response of proliferative lupus nephritis with pulse cyclophosphamide therapy during induction period in the department of Nephrology of Dhaka Medical College, Dhaka, Bangladesh from December 2012 to November 2013. A total of 35 clinically diagnosed SLE patients of class III/IV lupus nephritis were included. But 3 patients were dropped out during follow-up, therefore finally 32 patients (class III = 4, class IV = 28) were studied. The patients were evaluated for response on the basis of proteinuria, serum creatinine & active sediment in urine after 6th cycle of cyclophosphamide and 62.5% patients achieved complete response, 25% patients achieved partial response & 12.5% patients achieved no response. The factors favored complete response was early clinical presentation (7 months duration), proteinuria ≤3gm/day& normal renal function during their initial presentation. And higher anti ds DNA titre was an independent predictor for partial response/no response.

Pneumonia is the leading cause of morbidity and mortality in children less than 5 years of age in developing countries like Bangladesh. Although WHO guideline classified severe pneumonia by symptoms and signs of the patients, radiological and laboratory investigations were not studied well. There was increasing number of cases of bronchiolitis which meet the criteria of WHO classified severe pneumonia are reported. The objective of the study was to assess the clinical and radiological parameters of severe pneumonia in 2 months to 59 months hospitalized children according to WHO guideline. This cross sectional study was conducted in pediatrics department of Mymensingh Medical College Hospital, Mymensingh, Bangladesh from July, 2015 to December 2015. Total 150 patients were included in this cross sectional study according to their clinical symptoms. Firstly, the chest x-ray was done in all the patients and radiographs were reviewed by an expert radiologist who was blind about the cases. Then the patients were classified as pneumonia and bronchiolitis according to the clinical features and radiology findings. Majority of the patients 83(55.3%) were between 2-6 months of age and mean age was 7.52±8.87. Maximum 105(70%) patients were male and 45(30%) were female. Most of them 70(47%) came from low middle class family. Regarding clinical features, all patients 150 had cough and chest indrawing. Ronchi found in 135(90%) patients, difficult breathing and fast breathing found in 130(87%) patients, crepitation in 122(81%) patients, wheeze in 93(62%) patients, dull on percussion in 36(21%) patients, bronchial breath sound in 25(17%) patients. Regarding radiological features, lobar consolidation was found in 18(12%) patients, patchy opacities in 42(28%) patients, which were radiological findings of pneumonia, while hyperinflation of lung present in 90(60%) patients, increased translucency in 82(54.6%), increased interstitial marking in 88(58.6%) patients, which were radiological findings of bronchiolitis. A total of 60(40%) admitted cases were diagnosed as pneumonia and 90(60%) cases diagnosed as bronchiolitis radiologically, which were predominant in WHO classified severe pneumonia (p<0.05). Wheeze was present in case of hyperinflation of lung in 78(83.8%), increased translucency in 67(72%) and increased interstitial marking in 70(75.2%) patients among radiological bronchiolitis (n=90). From above results we can concluded that Bronchiolitis was predominant among WHO guideline classified severe pneumonia.

The cross sectional study was done to estimate the prevalence of various congenital malformations among the patients delivered in Community Based Medical College Hospital (CBMCH), Mymensingh, Bangladesh and corresponding risk factors were also studied from July 2014 to December 2015. A total of 2560 babies who were born at Community Based Medical College Hospital (CBMCH) were enrolled in this study. The newborn babies were examined and assessed for detection of congenital malformation, system wise distribution and risk factors attributable. Out of total 2560 deliveries, 2548 were live births and 12 were still birth. The total number of babies with congenital malformation was 52(2.03%). Four of the 52(7.69%) malformed babies were still born. Maternal age; like increased or low maternal age, maternal disease and drugs were found to have a higher risk of congenital anomalies. Alimentary system and head neck malformation (25%) were most common. All of the still birth babies were born with central nervous system (CNS) malformation. Central nervous system (21.2%), Cardiovascular (17.3%), Musculoskeletal (13.5%), Genitourinary (11.5%), Chromosomal (5.8%) and other (5.8%) abnormalities fall in descending order of frequency. Congenital anomalies are one of the major causes to infant mortality. The study shows the prevalence of congenital anomalies 20.3/1000 live birth and most commonly involved body systems were alimentary system and head neck trunk 13(25%). A good number of mothers have got some definite diseases like diabetes mellitus, infections and hypertension. Consanguinity of marriage and exposure to some drugs has some correlation with congenital malformation. Early diagnosis of diseases and proper counseling with the parents will help in early intervention and reduce mortality and morbidity of neonates.

Complication of perinatal asphyxia is a major cause of neonatal mortality & morbidity in developing countries. This comparative cross sectional study was conducted in Mymensingh Medical College Hospital, Mymensingh, Bangladesh from May 2012 to September 2012 to determine electrolytes & renal function status in perinatal asphyxia & their impact on outcome. Thirty term normal birth weight babies with perinatal asphyxia in neonatal ward were included as a case group and thirty term normal birth weight neonates of same gestational age, without perinatal asphyxia in the department of Gynae & Obs were enrolled as a control group. Necessary information was collected by clinical examination; investigation and close follow up according to predetermined plan. There was no significant different in sex distribution, number of Antenatal care (ANC), number of gravidum of mother and mode of delivery between two groups. Among perinatal Asphyxia group most common risk factor was prolonged labor. Electrolyte abnormalities were documented (16) 53.3% cases. Among 16 electrolyte abnormalities isolated hyponatremia was found in 6(37.5%) cases, hyponatremia with hyperkalaemia 1(6.25%) case, hyponatremia with hypokalaemia in 1(6.25%) case, isolated hypokalaemia in 3(18.75%) cases and isolated hyperkalaemia in 5(31.25%) cases. None case had hypernatremia. On the other hand in control group Hypokalaemia was 3(10%) cases Hyperkalaemia 1(33.33%) case and none had Hyponatraemia. Among total cases 6 (20%) had renal impairment. Serum creatinine level was higher in case group. Twenty percent (20%) case initial value >1.5mg/dl, 20% 1.2-1.5mg/dl and17% had 0.3-0.8mg/dl. On the other hand in control group 83 % had 0.3-0.8 mg/dl & none hade above 1.1 mg/dl. Among case group 8 were died (27%). There was no death in control group. Among 8 neonatal death cases 3(37.5%) had normal electrolytes, isolated hyponatraemia were in 2(25%) cases, hyponatraemia with Hyperkalaemia in 1(6.25%) case and Isolated Hyperkalaemia in 2(25%) cases. Among those death 3(37.5%) had renal impairment. Case fatality was significantly associated with renal failure 50%, isolated Hyponatraemia 33.33%, Isolated hyperkalaemia 40%, Hyperkalaemia with Hyponatremia 100%. Hospital stay was also prolonged among alive case with abnormal electrolytes. So, we can conclude that electrolyte & renal impairments are significantly associated with morbidity & mortality of perinatal Asphyxia.

Incidence of coronary artery disease (CAD) is increasing in developing countries in Bangladesh with improvement of socioeconomic status, urbanization, changes of dietary habits and lifestyle. Dyslipidaemia is one of the major contributors increase CAD risk. This study was aimed to find out the association of low level HDL-C with acute coronary syndrome. This cross sectional study was conducted in the department of cardiology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from August 2009 to May 2010. Sociodemographic characteristics, smoking, hypertension, FBS, serum total cholesterol level, HDL-C, LDL-C, Triglyceride level were important variable considered. A total number of 100 respondents consisted of 50 cases (patient) Group I and 50 healthy people (control) Group II. Investigations included ECG, Troponin-I, FBS and Fasting Lipid Profile. The data was analyzed by computer with the help of SPSS. Chi-square test, T-test, ANOVA test used as test of significance. The mean level in cases of HDL-C 39.3±5.1 and in control level HDL-C 34.2±3.4 statistically significant (p<0.0001). In both group low concentration HDL-C (<40mg/dl) risk for CAD. Un-adjusted odds ratio 95% CI determinants of ACS, HDL-C of OR was 0.2. So, HDL-C is not protective factor. In multivariate logistic regression analysis that adjusted for confounders of HDL-C level (age, sex, smoking, hypertension, TC, LDL-C, TG) associated with ACS. HDL-C was strong predictor of ACS (RR in the highest) compared with lowest quarantile = 0.02; (95% CI=0.003-0.173; P for trend <0.0001). The study reflected that low HDL-C level associated with ACS. Categorization of patients with ACS on the basis HDL-C level may be helpful for risk stratification and management.

Adenoma malignum (AM) of the uterine cervix, otherwise known as minimal deviation adenocarcinoma, is a rare variant of cervical adenocarcinoma, which represents a diagnostic challenge, due to its benign-resembling histological characteristics. We present a case of 54-year-old nullipara woman presented with menorrhagia for 2 years and that had worsened over the past few months. Transabdominal ultrasound fibroid uterus with cluster of nabothian cysts was in the cervix. Subsequently MRI was done for better characterization and showed intramural myomas in the uterine body. A large ovoid mass containing multiple cystic components in the left side of cervix communicating with a tract to the cervical canal, which was consistent with features of adenoma malignum of the cervix. Then the differential diagnosis was included tunnel cluster nabothian cysts. The patient underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy. The final histopathologic diagnosis revealed adenoma malignum of the cervix and intramural myomas. Subsequently, a review of literature was performed and the results demonstrated that early diagnosis, clinical stage and surgical protocols are the main factors affecting the prognosis of AM. Close follow-up of the cases may provide more information regarding this disease and the efficacy of the available therapeutic methods.

Neurobrucellosis is a rare (1.7-7.0% of prevalence) neurological complication of brucellosis which has neither a typical clinical picture nor specific cerebrospinal fluid (CSF) findings and mimics other neurological disorders leading to clinical diagnostic dilemmas. This study describes one elderly patient of neurobrucellosis with fever, irrelevant behavior, sweating, fatigue, drowsiness, neck stiffness inability to speak and reduced activity for about 10 days hailing from Beanibazar, Sylhet, Bangladesh admitted in Mount Adora Hospital, Sylhet, Bangladesh on 16th October 2016. The diagnosis was depended on history, clinical examination, positive brucella test, CSF examination and CT of the brain. Cerebrospinal fluid (CSF) showed an abnormal finding regarding increased cell count, elevated protein levels and low glucose while blood serology was highly reactive. The patient received a combination antibiotic therapy; meropenem (3gm/day) for 15 days, streptomycin for 21 days, doxycycline 200mg/day for 6 weeks and rifampicin 600mg/day for 3 months. The complete improvement in patient's condition after a long lasting and difficult to diagnose illness motivated author to report this case. As neurobrucellosis is a fatal condition if remained untreated and should be considered as one of the differential diagnoses in unusual cases of neurologic and psychiatric disorders and in cases of neurological dysfunction in absence of any other suitable alternative diagnosis.

Cardiovascular diseases (CVD) is the leading cause of death worldwide, responsible for one third of death, coronary artery disease (CAD) is the most common cause. Dyslipidaemiais one of the major contributors increased of CAD risk. This study was aimed to find out the relationship between triglyceride and HDL cholesterol ratio with acute coronary syndrome. This cross sectional study was conducted in the department of Cardiology, Mymensingh Medical College Hospital from August 2009 to May 2010. Smoking, hypertension, serum total cholesterol level, serum HDL-C, LDL-C, triglyceride (TG) level were important variable considered. A total number of 100 respondents consisted of 50 cases (patient) and 50 healthy persons (control). Investigations included ECG, Troponin-I, FBS and lipid profile. The data was analyzed by computer with the help of SPSS; Chi-square test, 't' test, ANOVA test used as test of significance. The mean level in cases of TG 168.2±88.0 vs. HDL 41.3±5.1 in control level TG 141.2±45.3 and HDL 34.2±3.4. TG/HDL ratio cases 4.2±1.7 and control 4.1±1.3. This ratio >4 is atherogenic for CAD. Unadjusted odds ratio TG/HDL ratio level high (>1). In multivariable regression analysis, TG/HDL ratio was strong relation with ACS. The study reflected that high TG/HDL ratio is associated with ACS. Categorization of patient with ACS on the basis of high TG/HDL ratio will be helpful for risk stratification and management.