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Comparative study of non-contrast and post-contrast MR fistulogram in the evaluation of fistula in Ano
Get PDFBackground: Fistula in ano is a common inflammatory condition with significant morbidity. To evaluate the disease before planning any treatment, MRI has become a cornerstone involving both non-contrast and post contrast imaging as a routine protocol.
Aim: The current study has aims to evaluate the diagnostic efficacy of non-contrast MRI over post contrast MRI in the evaluation of perianal fistulas.
Methods: 122 patients of perianal fistulas were included in this observational study who had undergone contrast-enhanced MRI prior to surgery. Non-contrast data sets were compared with the post-contrast data sets.
Results: The sensitivity of delineating Grade 1 perianal fistulas, as per St James university classification, on non-contrast imaging was found to be 81.03 %. The sensitivity was found to be 75%, 88.66% and 91.30% for Grade 2, 3, and 4 fistulas respectively, which increases to 100% in Grade 5 perianal fistulas.
Conclusion: On comparison of the non-contrast data set with the post-contrast images, the findings were found comparable. In higher grades of perianal fistulas, the sensitivity of evaluating the disease on non-contrast images is at par with post-contrast imaging. Contrast study, being more expensive, time-consuming and risky modality should be avoided as a routine and could be considered in low-grade perianal fistulas on case to case basis
Prevalence and the outcome of peptic ulcer disease- A retrospective study
Get PDFIntroduction: Peptic ulcer disease (PUD) occurs due to an imbalance between stomach acid-pepsin and mucosal defense mechanisms. It affects 4 million people worldwide annually. About 10%-20% of patients with PUD will have complications and 2%-14% of the ulcers will perforate causing an acute illness. Objective: To assess the prevalence and the outcome of peptic ulcer disease. Materials and Methods: A retrospective study was conducted at the Department of Gastroenterology, Khulna Medical College, Khulna, Bangladesh from January to June 2022. In total, 120 patients who underwent emergency surgery for perforated peptic ulcer were included in this study. The clinical Data regarding age, gender, complaints, time elapsed between onset of symptoms and hospital admission, physical examination findings, co-morbid diseases, laboratory and imaging findings, operative methods, post-operative complications, length of hospital stay, morbidity and mortality were collected retrospectively. Results: Out of 87 (72.5%) patients were male and 33 (27.5%) were female patients and the mean age was 60 years. The mean time for presentation to the hospital was 32 hours. While 29 (24.4%) of the patients had shock at presentation, 49 of them (40.8%) were identified to have at least one comorbid disease. It was identified that perforation was most frequent in the pre-pyloric region (86 patients, 71.6%). The length of hospital stay was longer in patients who developed morbidities. In the post-operative period, 46 patients (38.3%) developed morbidity. The most frequent morbidity was wound infection. 33 (27.5%) patients died. The most frequent reason for mortality was sepsis. In our study age over 60 years, presence of co-morbidities late time at presentation of more than 24 hrs. from the onset of symptoms, shock at presentation were noted as independent risk factors influencing morbidity and mortality. Conclusion: In spite of the developments in peptic ulcer disease treatment, peptic ulcer perforation remains a serious surgical problem. Patients above the age of 60, with a time to presentation longer than 24 hours, presence of shock at the time of presentation and concomitant diseases, are patients at high risk for post-operative morbidity and mortality, close monitoring of which can help reducing mortality and morbidity. Early diagnosis, prompt resuscitation and urgent surgical intervention are essential to improve outcomes.
 
Histopathological evaluation of staging, grading and prognostic factors of renal cell carcinoma
Get PDFIntroduction: Renal cell carcinoma (RCC) is a malignancy with an adverse prognosis for the majority of the patients. Renal cell carcinoma accounts for 80% to 85% of malignant kidney tumors. Despite that an increasing number of patients incidentally are diagnosed, still around 25–30% of patients with new diagnosed disease already have metastatic disease. Of the remaining patients with nonmetastatic disease, about 30–40% will progress with distant metastases or local recurrent RCC. Objective: To assess the prognosis of age, sex, race, tumor size, pathological staging, grading and prognostic factors of Renal Cell Carcinoma. Material and Methods: In the retrospective study was done in Department of Urology, Sir Salimullah Medical College, Mitford, Dhaka, Bangladesh from June 2021 to July 2022. A total number of 101 nephrectomy specimens were analyzed and 22 diagnosed cases of renal cell carcinoma were included in the study. The age and sex distribution of renal cell carcinomas diagnosed were study. Histopathological evaluation of renal cell carcinomas was carried out correlating with old records, histopathology slides, special stains and immunohistochemistry. Results: Total 101 nephrectomy specimens were analyzed and 22 diagnosed cases of renal cell carcinoma were included in the study. Maximum numbers of cases were seen in 40-49 years’ age group (31.8%) and also in 60-69 years’ age group (31.8%). Histological subtypes of renal cell carcinoma diagnosed were Clear cell type, papillary type, Chromophobe type and Collecting duct type. Maximum numbers of cases diagnosed were of Clear cell type renal cell carcinoma (59.09%). Least common subtype diagnosed was Collecting duct type renal cell carcinoma (4.5%). Least common subtype diagnosed was Collecting duct renal cell carcinoma (4.5%). Tumor size was >4cm in maximum number of cases i.e. 20 (72.8%). Most of the subtypes of renal cell carcinoma had Fuhrman nuclear grades 2 and 3. Out of 22 cases of renal cell carcinoma, sarcomatoid differentiation was observed histologically in 3 cases (13.6%) within the tumor tissue. 2 cases of Clear cell type and 1 case of papillary type of renal cell carcinoma had sarcomatoid differentiation. Conclusion: In concluded, the underscores the importance of nuclear grading in predicting survival of renal cell carcinoma patients. There is strong correlation between grade, tumor size, and stage. Nuclear grading is important in predicting survival of patients with renal cell carcinoma. Nuclear grading is strongly related to both tumor size and stage. Nuclear grading and staging of the histological subtypes strongly influences the survival of patients, as thus proven in this study
Study of endocrinological complications in children with beta-thalassemia major: A hospital base study.
Get PDFBackground: Beta thalassemia major (TM) is the most common inherited genetic disorder worldwide. Patients are at risk of iron overload, which leads to various forms of tissue damage, including endocrinopathies.
Aim of the study: The aim of this study was to evaluate the prevalence and risk factors of endocrine disorders in Adolescent patients.
Methods: A prospective analytical study done was done at Bangladesh Shishu Hospital & Institute, Dhaka, Bangladesh from 1st October 2021 to 1st July 2022 among the diagnosed cases of Beta Thalassemia Major.
Result: Among 80 TM children, 32(44.19%) patients were female and 48(55.81%) were male. The mean (SD) patient age at the time of the study was 11.34 (2.27), range: 2–18 years and 11.12 (2.01) range: 2–12 in males and females, respectively. In those who received combined therapy, 6 of 17 (32.14%) cases had endocrine disorders, compared with 34 of 63 (53.97%) cases who did not have endocrine disorders.
Conclusion: Endocrinological complications in adolescent children with thalassemia major were mild in severity in our study and observed when the serum ferritin went beyond 2500 ng/ml. Early identification and multidisciplinary management are necessary for early recognition,treatment as well as prevention of endocrinological complicationsin patients with Thalassemia Major
A case of A large Mucinous Cystadenoma of the Right Ovary: Mucinous Cystadenoma by U/S
No full textA single 22 girl unmarried came to the hospital with her parent suffering from an abdominal distension, lower abdominal and pelvic pain radiating to the right side. In clinical examination the doctor feel a very large abdmino-pelvic mass extending from the symphysis pubis to the xiphoid process of the sternum. Then he requested an abdmino-pelvic ultrasound U/S. After that computerized tomography (CT) with contrast media was done as a further radiological investigation
Ethionamide in MDR TB: The fall of a legend
Get PDFThe prime focus of this small review article is about an anti-tubercular drug which in spite of being a well-known and good second line bactericidal drug against multi-drug resistant (MDR) strains of Mycobacterium Tuberculosis (MTB) has been relegated amongst the last but second of the Group C drugs in the current WHO-recommended Classification of drugs for designing a Multi-Drug Resistant (MDR) TB regimen. We now discuss this startling fall of a legendary anti-tubercular drug in the arsenal against fighting the scourge of MDR TB
Synchronous presentation of two dentigerous cysts and ameloblastoma: Eight-years follow-up.
Get PDFDentigerous cysts are benign lesions mainly related to the crown of a tooth, early diagnosis is essential (which is almost always done radiographically and sometimes clinically) these not usually causing symptoms unless these are large and generate compression on nerve structures, the possibility of transformation or the evolution of these lesions to ameloblastomas has been described in the literature, possibly due to cellular and protein changes, among others, which are still under study. Ameloblastomas, on the other hand, are aggressive benign tumors and their possible formation from a dentigerous cyst has been described. It is important to have a good histopathological diagnosis since sometimes similarities can be observed and these can generate controversy or confusion between them. The present clinical case is representative because it involves both lesions in the same site, the importance lies in the fact that conservative treatment was provided through enucleation and curettage of the lesions performed at the Maxillofacial Surgery at "La Raza" National Medical Center. And then the patient was kept under control, showing clinical and radiographic results at eight years of follow-up, without recurrences, with adequate evolution and a good prognosis
An evaluation of Ilizarov technique in treating patients with open fractures of Tibia
Get PDFIntroduction: Open fracture of the tibia is a very common incidence in the orthopedic treatment arena. Ilizarov method is a popular method of treating open fractures of the tibia after debridement and open reduction. It is comparatively a newer method in Bangladesh and has many advantages. We have very little research-oriented data regarding the effectiveness of this technique in treating open fractures of the tibia.
Aim of the study: The aim of this study was to evaluate the Ilizarov technique in the treatment of open fractures of the tibia.
Methods: This was a prospective observational study which was conducted in the Department of Orthopedics, Shaheed Ziaur Rahman Medical College, Bogura, Bangladesh during the period from January 2019 to December 2019. In total 27 patients with open tibial fractures were selected as the study population. Before starting the intervention, the written consents of the participant were taken and this study was approved by the ethical committee of the mentioned hospital. All data were processed, analyzed, and disseminated by MS Office and SPSS program as per need.
Results: According to the Karlstrom and Olerud criteria outcomes were assessed. Among total participants, the majority portion got \u27excellent’ results which were 66.67%. Then 22.22%, 7.41%, and 3.70% participants got ‘Good’, ‘Fair’ and ‘Poor’ results respectively. As postoperative complications, local pain with motion and local edema was seen in 3 cases and painful tenting of skin in 5 cases. Delayed complications included pin tract infection in 6 patients, loss of 80 ankle dorsiflexion in 2 cases, shortening of 1 cm was seen in 1 case, 2 cases (5%) of united in 70 recurvatum as calculated radiologically, 2 cases of muscle wasting of the leg from 0.4 to 1.5 cm were found. No case developed the deep infection, non-union, or unacceptable malunion. Only one patient got 2 weeks more treatment than all the others patients.
Conclusion: In this current study, no case developed a deep infection, non-union, or unacceptable mal-union. The Ilizarov device is used worldwide for the treatment of several types of fractures. Low blood loss, prompt healing, and minimum complications may be considered as some good features of Illizarov technic for the treatment of open fracture of the tibia
To Study about prescription patterns for bronchial asthma by allopathy doctors in Agra region
No full textBackground: Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. Patients with asthma require lifelong treatment and multiple anti-asthmatic drugs at the same time. Drug utilization audits are quality assurance programs to ensure that drugs are used correctly and safely. This study was done by conducting prescription audits and identifies irrationality in drug prescribing.
Material and Methods: To assess the prescription pattern of bronchial asthma by allopathic doctors of the Agra region among patients visiting Sarojini Naidu medical college, Agra. Data were collected from patients suffering from bronchial asthma having, at least one written prescription by previous treating doctors. The sample size of the study was 122.
Results: In this study, Assessment of prescription pattern of bronchial asthma by allopathy doctors, among 122 prescriptions, most of the prescriptions 64% belong to general practitioners and 36% belong to specialists. In this study, Assessment of prescription pattern of bronchial asthma by allopathy doctors, among 122 bronchial asthma patients prescriptions, most of the prescriptions 62% prescriptions were not according to GINA and 38%prescriptions were according to GINA.
Conclusion: In conclusion, National Asthma Education Program will be beneficial as an initial step, in improving asthma knowledge and increasing awareness in the medical community, on current therapy. This study may be more meaningful to improve further the prescriptions through successful implementation of the interventional programs in the health care centers
Application of Data Envelopment Analysis (DEA) in choosing the proper Magnetic Resonance Imaging (MRI) machine: DEA in choosing proper MRI machine
No full textThis study is aimed to apply one of the decision-making tools, Data Envelopment Analysis (DEA) in the field of imaging in health care for choosing the most efficient model of Siemens MRI machines for clinical purposes. A list of Siemens MRI machines with their corresponding details such as price and technical characteristics were collected as mentioned in the machine booklets and through consultation with Siemens representative in the country. Variables were defined and categorized as input and output and the linear mathematical model for each machine was written and calculated using the super-efficiency model to find the most efficient Siemens MRI machine and rank the available models using DEA. The results showed that the most efficient model of Siemens MRI is Prisma (Super-efficiency score = 2.009302) followed by Skyra (Super-efficiency score = 1.697531) and Sola (Super-efficiency score = 1.683571).
Data Envelopment Analysis (DEA) is recommended as the decision-making tool for selecting advanced technologies in healthcare since it can handle substantial number of variables as input and output and unlike other decision-making tools such as Analytic Hierarchy Process (AHP) which is widely used in this industry, the weight of each variable is determined by the linear mathematical model which makes it reproduceable and reliable