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A case of acute calculous cholecystitis with contained gall bladder perforation with pericholecystic collections extending to liver parenchyma
Get PDFGall bladder perforation is a serious complication of acute cholecystitis and represents an advanced stage of the disease. Its clinical presentation is varied and can range from non-specific symptoms to acute generalized peritonitis. In many cases, GB perforation in diagnosis during exploratory laparotomy for peritonitis and with no definite source identified. The presentation of gall bladder perforation can be indistinguishable from uncomplicated acute cholecystitis. A 60 yrs. old male with no known comorbidities presented to a tertiary care hospital with diffuse pain abdomen associated with vomiting and constipation of 04 days’ duration. Clinical evaluation revealed icterus and tenderness in right hypochondrium and generalized peritonitis. Lab investigations revealed conjugated type hyperbilirubinemia and elevated serum Lipase levels and normal Amylase levels. Initial USG revealed Acute acalculous cholecystitis with normal IHBR and normal CBD. Later NCCT abdomen and MRCP were done which revealed calculous cholecystitis with sealed off GB perforation IHBR, CBD, and normal pancreas. The patient was managed non-operatively and responded well. The inflammatory reaction of the peritoneum in bile peritonitis increases the absorption of the spilled conjugated bile from the peritoneal cavity. The conjugated type hyperbilirubinemia without dilatation of the bile duct on imaging examination was the sign of bile leakage into the peritoneal cavity
Correlation of duration of IV Ceftriaxone to mean fever clearance time in children with enteric fever
Get PDFContext: Enteric fever is one of the most common and serious infections in a developing country like India. IV ceftriaxone remains the mainstay of therapy in its management. But in a resource-limited setting, the long duration of therapy requiring inpatient admission is not a viable option. The minimum duration of IV ceftriaxone to be given before switching to an oral alternative like cefixime is poorly understood. Fever clearance is one indicator that can be used as a guide for shifting to oral antibiotics. Aims and Objective: To study the minimum duration of IV ceftriaxone before switching to oral cefixime in cases with enteric fever in a resource-limited setting.
Materials and Methods: We performed a cross-sectional study on pediatric patients who were admitted with enteric fever. 170 children admitted to the pediatric ward as enteric fever cases or subsequently diagnosed post fever workup were included in the study. Statistical analysis used: Statistical testing was conducted with the statistical package for the social science system version SPSS 23.0.
Results: Our study showed that only 2.4% of patients had fever beyond one week of ceftriaxone therapy. The mean fever clearance time after initiating IV ceftriaxone was 3.58 days (SD-1.49). No mortality was reported as a complication of enteric fever.
Conclusion: Seven days of IV ceftriaxone followed by seven days of oral cefixime is a reasonable alternative for the treatment of enteric fever in the pediatric population in resource-limited settings
Sufferings of Covid 19 positive patients regarding major symptoms: A prospective observational study
Get PDFBackground: First COVID-19 cases were detected in Bangladesh in Dhaka city on the 8th March of 2020. Till then the number of Covid-19 patients is being increased. It is a newer version of a viral disease and it has a ferocious nature of affecting a large number of people within a couple of days. So, to save billions of people we have to acquire clear ideas about the symptoms, sufferings, comorbidities, and treatment options of this disease. In Bangladesh, we have very limited research-oriented data regarding those issues of Covid-19. Aim of the study: The aim of this study was to assess the sufferings of Covid 19 positive patients regarding major symptoms.
Methods: This was a prospective observational study which was conducted in the Department of Medicine Shree-E-Bangla Medical College and Hospital (SBMCH), Barisal, Bangladesh during the period from July 2020 to December 2020. In total 75 RT-PCR (Reverse Transcription Polymerase Chain Reaction) confirmed Covid19 patients who attended the mentioned hospital were selected as the study people. The ethical committee of the mentioned hospital approved this study. Properly written consent was taken from all the participants before starting data collection. A pre-designed questionnaire was used in patent data collection. Data were analyzed and disseminated by MS Office and SPSS version 24.0.
Result: In analyzing the sufferings of patients because of fever, we observed, the peak numbers of patients with mild, moderate, and severe fever were found on the first day of this study which were 27, 9, and 3 respectively. From mild, moderate and severe fever, those patients got relieved on the day 13, 4 and 3 respectively. On the other hand, the peak numbers of patients with mild, moderate and severe cough were found on the day 11, 1 and 2 of this study which was 33, 12 and 6 respectively. From mild, moderate and severe cough, those patients got relieved on the day 16, 6 and 4 respectively. Besides this, the peak numbers of patients with mild, moderate and severe breathlessness were found on the day 4, 1 and 2 of this study which was 18, 15 and 6 respectively. From mild, moderate and severe breathlessness, those patients got relieved on the day 15, 6 and 4 respectively. The peak numbers of patients with sore throat were found on day 3 which was 18 and from this symptom those patients got relieved on day 13. On the first day, the SpO2 percentage was found 96.12±2.64 which was increased up to 97.47±1.18 on the last day of this study.
Conclusion: In this study fever, cough, breathlessness, and sore throat were found as the major symptoms among the Covid-19 positive patients. But we observed fever could be absent in a significant part of patients at initial presentation. Among all the participants, lymphopenia and bilateral alterations at chest CT were very common between patients with COVID-19 and could be helpful in identifying suspected cases
Study of clinical profile and surgical outcome of pterygium in adult patients at rural tertiary care hospital.
Get PDFIntroduction: Pterygium is a benign, degenerative condition of the subconjunctival tissue, for which many surgical techniques ranging from McReynaud’s operation to conjunctival autograft and amniotic membrane graft, have been discussed in the literature. Grafts prevent a recurrence, acting as a barrier, and have proven to be the gold standard. Here we have studied the clinical profile and surgical outcome of pterygium surgery by various techniques at a Rural tertiary care hospital (RTCH).
Aims/ Objectives: Our primary aim was to study demographical factors and clinical profile of pterygia along with the surgical outcome and postoperative complications of pterygium surgery by various techniques, at RTCH.
Materials and Methods: In this, hospital-based observational descriptive longitudinal study, we studied 75 patients, with primary progressive pterygium, who underwent pterygium surgery from September 2019- March 2021 and recorded their pre-operative, intraoperative, and postoperative data with a follow-up period of 3 months. Results: 74.6% of the population were females, with a bimodal peak incidence in 31-40 years and 61-70 years (22.6%). Most common presentation in both eyes (46.6%) with 97.3% cases presenting with nasal pterygium. 66.6% of patients presented with a grade 2 pterygium. 50 patients had a pre-operative “with the rule astigmatismâ€. Pre-operative keratometry readings could not be assessed for 5 patients due to excessive distortion of the corneal surface. 37 patients underwent graft fixation with no suture no glue while 38 patients underwent graft fixation with sutures. The most common complication was graft edema which was seen in 53 patients, while recurrence was seen in 2 patients.
Conclusion: The occurrence of pterygium is very common in rural areas, which in most cases, is neglected due to lack of awareness. Surgical excision with conjunctival autograft continues to be the gold standard of treatment for the same
Fracture penis in a male in the seventh decade of life in a pandemic setting
Get PDFPenile fracture is considered a urological emergency caused due to direct trauma to an erect penis. Fracture penis is usually encountered in a young patient and is exceeding uncommon in a patent in the seventh decade of life. The mechanism of injury depends on socio-cultural habits. Diagnosis is mostly made by clinical assessment but at times ultrasonography or MRI may be resorted to establishing a diagnosis. There is no role for conservative treatment in this condition and prompt surgical management remains the mainstay of treatment irrespective of age and ensures near-normal erectile function thereafter
Premature rupture of membrane and perinatal outcome
Get PDFObjective: To find out the complications of a pregnant woman with premature rupture of membrane (PROM) and assess the outcome of it. Materials and
Methods: This prospective study was carried out at the Department of Obstetrics & gynecology of Coronel Malek Medical College Hospital, Manikgonj, Bangladesh from January 2020 to December 2020. All pregnant women admitted with PROM during this period were taken as the study population. After taking proper history they were categorized as a term or preterm PROM on the basis of duration of gestation estimated from 1st day of last menstrual period (LMP), previous antenatal records, clinical examination & also previous ultrasonography (USG) reports. Out of sociodemographic characteristics, age distribution and gravidity were noted. The diagnosis was done on the basis of examination and investigations. All the women with PROM were then followed up, management was given according to protocol and a cesarean section was performed according to indication. Birth weight and Apgar score of newborns were noted after delivery.
Results: There were 297 cases of PROM recorded among 4461 admitted obstetrical patients over one year period. The hospital incidence of PROM was found to be 6.6%. Among them, 57.6% of patients were admitted at term and 42.4% of patients came before 37 completed weeks of gestation. Most of the pregnant women were between 20-24 years of age (43.7%), 43.2% were primigravida (56.6%) were multigravida. About 48.5% of women presented with different complications associated with PROM. Among which 15.7% of patients had oligohydramnios, 8.5% of patients presented with chorioamnionitis suggested by culture report of the high vaginal swab. Urine for culture and sensitivity was also done. About five (5.2%) developed premature labor before the 37th week of gestation. About 10% of women developed obstetric complications (failed trials) associated with medical diseases. Seventy-seven patients were delivered by cesarean section, 16.2% vaginally, 4.04% patients responded to conservative management and 2.5% patients were referred to a tertiary center for extreme prematurity with associated complicating factors. Most of the babies (38.4%) were born with birth weight between 2.1- 2.5kg and 10.3% of babies were less than 1.5kg.
Conclusion: Term PROM was more in comparison to PPROM and most of them were multigravida. The cesarean section rate was high. Most common complication of was subclinical urogenital infection (53%) next oligohydramnios (25%) & (13.5%) women presented with chorioamnionitis
Study of CSF flow physics and its parameters at the level of aqueduct in normal individuals
Get PDFPhase-contrast MRI (PC-MRI) is a rapid, simple, and non- invasive technique, and is sensitive to CSF flow. It has been available for some time and been used in the past decade in the evaluation of cranial and spinal CSF flow, demonstrating a mechanical ‘coupling between cerebral blood and CSF flows throughout the cardiac cycle and the temporal coordinated succession of these flows’ in normal people. The technique led to a better understanding of the pathophysiological basis of diseases with dysfunction of CSF flow.
The aim of the study is to study the physics of the CSF flow and to establish the normal parameters of the CSF flow at the level of the aqueduct. MRI brain with CSF flow study was done in 40 patients. These patients were in the age group of 20-60 years and came with no significant clinical complaints.
Phase-contrast MRI scanning was used following the CSF Quantitative flow protocol and CSF_ DRIVE protocol was followed. Forward flow volume, Backward flow volume, regurgitate fraction, absolute stroke volume, Stroke volume was calculated at the level of cerebral aqueduct provides the best understanding of CSF flow physics and normal CSF parameters.
The stroke volume of 55 % of individuals was seen in the range of 2.0 to 3.0 and 45% of individuals was seen in the range of 1.0 to 2.0 and Absolute stroke volume of maximum individuals i.e. 72.5% was seen in the range of the 3.6 to 4.5 ml/min
Efficacy and safety of rivaroxaban in the treatment of deep vein thrombosis.
Get PDFObjectives: This study aims to present the clinical results of patients administered rivaroxaban for the treatment of deep vein thrombosis (DVT) in terms of efficacy and safety. \
Methods: A total of 50 patients (30 males, 20 females age range 25 to 88 years) diagnosed with DVT had received rivaroxaban treatment in the department of medicine, Chhattisgarh Institute of Medical Science (CIMS) Bilaspur Chhattisgarh India. between September 2018 and august 2020 were included in the study. Deep vein thrombosis diagnoses of the patients were confirmed by Doppler ultrasonography. The patients’ epidemiological and biochemical values were evaluated. Major- minor bleeding and recurrence that occurred during rivaroxaban treatment was investigated.
Results: Patients were treated for 3, 6, or 12, months, according to flow up and result. When anticoagulant treatments of the patients were examined, 15 patients (30%) were treated with rivaroxaban as initial treatment and 35 patients (70%) had transitioned from warfarin to rivaroxaban treatment. In patients using rivaroxaban, one patient had hypermenorrhea and two patients had epistaxis. Major bleeding was not detected. While three patients had alanine aminotransferase levels up to two times higher than the normal limit, none of the patients had clinically significant liver or kidney failure. Recurrent DVT or pulmonary embolism was not detected in the patients.
Conclusion: According to the current guidelines and literature findings novel oral anticoagulants could be used safely and efficiently as first-line drug therapy in DVT patients due to their non-inferior effectiveness to warfarin and lower side effect profile
Etiological Profile Of Viral Hepatitis In North India: A Cross Sectional Study
Get PDFIntroduction: Viral hepatitis continues to remain an important public health concern, particularly in developing nations like India. Majority of such cases present with a mild anicteric illness in children. Severe illness, including progression to acute liver failure, is also known to occur.
Objective: To study the seroprevalence of markers of viral hepatitis in children less than 5 years, who present with jaundice.
Materials and methods: We performed a cross-sectional study on 397 children less than 5 years of age who presented with jaundice to the hospital. The study population was screened for serological markers of the hepatotropic viruses. A structured questionnaire was drafted to enquire about the immunization status and source of potable water. Statistical analysis used: Statistical analysis was performed using the Epi Info software 3.5.4 version 2012.
Results: Our study showed that Hepatitis A was the commonest cause of acute viral hepatitis in children less than 5 years of age, followed by Hepatitis E virus. Hepatitis A and E co-infection was the most common type of co-infection. Conclusion: The efficacy of vaccination against Hepatitis A and B has been reiterated in our study. Using any method of water filtration protects against Hepatitis A and E infection
Knowledge, Attitudes and Practices (KAP) Towards COVID-19 and Importance of Hand Hygiene: A Cross-Sectional Study.
Get PDFBACKGROUND: Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) has accursed the world since December 2019 when it was first diagnosed in Wuhan, China. As it quickly spread to almost all the corners of the world, WHO later declared it as a global pandemic. Effective non-pharmaceutical measures to control it depend upon the knowledge and practice of basic principles of hygiene and the use of facemasks. Hence educating the public about it has an immense role in controlling this contagious disease.
MATERIAL AND METHODS: This cross-sectional study was conducted in Chittagong from June 2020 to December 2020 with a study population of 1489 participants. Adults with a good physical and mental condition and those who agreed to participate were included while unwilling and sick people were excluded from the study.
RESULTS: Out of 1489 participants, the mean age was 28.81±8.64 years with a range from 12 to 70 years. More than half (51%) of the participants were females and about 773(51.9%) participants completed above X education level. Knowledge about the disease, its causative agent, main symptoms, ultimate fate, and its mode of transmission was considerably high. The majority of the participants were accustomed to preventive measures such as social distancing, isolation of the patients, home quarantine, and avoidance of large gatherings. Knowledge directly affected both attitudes and practices as the survey revealed that the majority (91-89%) of the participants achieved a good knowledge-attitude score and 83.75% achieved a good knowledge-practice score. Overall achieved knowledge score regarding the importance of hand hygiene translated on attitude and practices.
CONCLUSION: Our findings insinuated that the Bangladeshi population substantiated a decent knowledge about COVID-19 and knowledge about hand hygiene was above par and that too translated on attitude and practices. Hence widespread targeted health education program that incorporates considerations of KAP modifying factors is further needed to prevent subsequent waves of the infection