Medico Research Chronicles

Comparative Evaluation of Conventional Cytology, Liquid-Based Cytology and Cell Block Technique for Cytopathological Analysis of Pleural Aspirates

Chinyelu Uchenna Ufoaroh — 2024-11-13

Objective: To compare the diagnostic accuracy, practicality, and utility of conventional cytology (CC), liquid-based cytology (LBC), and cell block (CB) techniques in the cytopathological evaluation of pleural aspirates, aiming to determine the most effective method for diagnosing pleural effusion (PE), particularly in distinguishing between benign and malignant conditions.

Methods: A cross-sectional descriptive study involving sixty-eight patients aged over 18 years with non-traumatic pleural effusion confirmed by clinical evaluation and chest X-ray was conducted at Nnamdi Azikiwe University Teaching Hospital from January 31, 2020, to January 31, 2022. Pleural fluid samples were processed using three cytological techniques: CC, LBC, and CB. The slides were evaluated and categorized into five diagnostic categories: non-diagnostic, negative for malignancy, atypia of undetermined significance, suspicious for malignancy, and malignant. Statistical analysis was performed using SPSS version 22.

Results: The study included 40 males (58.8%) and 28 females (41.2%), with a mean age of 51.6 ± 17.12 years. Malignant effusions were observed in 23 patients (33.8%). The CB technique demonstrated superior performance with a sensitivity of 82.6%, specificity of 88.9%, and an accuracy of 1. In contrast, LBC showed a sensitivity of 65.2% and specificity of 55.6%, while CC had the lowest sensitivity (17.4%) and specificity (51.1%). The CB method also achieved the highest negative predictive value (NPV = 1), outperforming LBC (NPV = 0.956) and CC (NPV = 0.852).

Conclusion: The CB technique was found to be the most reliable method for the cytopathological evaluation of pleural aspirates, exhibiting the highest sensitivity, specificity, and diagnostic accuracy. The study highlights the importance of selecting advanced cytological methods such as CB to enhance diagnostic precision in clinical practice, particularly in the differentiation of malignant from benign pleural effusions.

Use of the Robson classification to assess, normal delivery and caesarean section trends in a Tertiary Care Hospital

Shohela Perveen — 2024-11-08

Background: Robson ten-group classification system is recommended by WHO (World health organization) as a global standard for assessment and monitoring caesarean section (CS) rates. This classification is simple and robust. It is prospective, easily reproducible and clinically relevant. The Robson classification, or Ten Group Classification System (TGCS), is a widely recognized framework for evaluating caesarean section rates and delivery trends in maternity care settings. By categorizing women into ten distinct groups based on key obstetric characteristics, the classification allows for a standardized and systematic approach to monitoring and comparing delivery practices. Objectives: The aim of the study was to evaluate the use of the Robson classification to assess, normal delivery and caesarean section trends in a tertiary care hospital. Methods: This cross-sectional observational study was conducted over one year at OGSB Hospital and Institute of Reproductive & Child Health, Dhaka, Bangladesh during January 2023 to December 2023. All pregnant women admitted for delivery at ≥28 weeks of gestation were included and categorized into ten groups according to the TGCS based on specific obstetric characteristics. Data were collected using a structured questionnaire and extracted from medical records. Descriptive statistics were used to analyze the distribution of women across the Robson groups, group-specific CS rates, and the contribution of each group to the overall CS rate. Statistical analyses of the results were be obtained by using window-based Microsoft Excel and Statistical Packages for Social Sciences (SPSS-24). Results: The group of Nullipara single cephalic ≥ 37 weeks spontaneous labor (Group 1) had 150 CS and 320 deliveries. The group size, CS rate, and absolute group contribution to overall CS were 0.41%, 0.132%, and 0.211%, respectively. Another notable category includes nulliparous women with single cephalic pregnancies at 37 weeks or more who had induced labor or a CS before labor (category 2), which accounted for 0.03% of deliveries, had a high CS rate of 0.30%, and contributed 0.23% to the total rate. Conclusion: The utility of the Robson classification in identifying areas where caesarean sections may be overused, particularly in low-risk groups, and in evaluating the effectiveness of clinical interventions aimed at promoting normal deliveries. The regular use of the Robson classification in clinical practice can provide valuable insights into delivery trends, support evidence-based decision-making, and contribute to improved maternal and neonatal outcomes in tertiary care settings.

Outcome of Removal of Biliary Stent Prior to Pancreaticoduodenectomy

Dr. Md. Mustafizur Rahman — 2024-11-09

Background: Obstructive jaundice is the commonest manifestation in patients with periampullary carcinoma. Pancreaticodudenctomy is the only curative procedure for resectable tumor. But raised serum bilirubin level may cause the postoperative events. For that reason, preoperative biliary drainage is an important step to reduce the overall postoperative complications. The main aim of this study is to assess the rate of post-operative complications, length of hospital stays and death between patients undergoing pancreaticoduduenectomy with or without removal of biliary stent. Methodology: This prospective cross-sectional study was conducted into department of Surgery and Hepatobiliary, pancreatic and liver transplantation Surgery of BSMMU from July,2017 to June 2018. Initially all the patient diagnosed as periampullary carcinoma and underwent preoperative biliary drainage were enrolled in the study by purposive sampling. Surgery was planned 4-6 weeks after stenting. The analysis was done by student’s t test here. Cross tabulation and chi square test were done to analyze the categorical data. p value was considered as significant at <0.05. Data analysis was done using the software statistical package for social science (SPSS-23. Results: Patients with biliary stent in situ till pancreaticoduodenectomy was significantly associated with positive bile culture (P=0.025) and, E. coli (45.45%) is the most common organism. Post-operative woundinfection was significantly high (p=0.035) in Group A than Group B. From the point of view of postoperative morbidity Group B showed better results than Group A. Microscopic findings of bile duct showed disruption of mucosal epithelium in all 11 (100%) patients in Group A in contrast it was in 3 (33.33%) patients in Group B, which was statistically significant (P value <0.05). Conclusion: Removal of biliary stent before surgery who already underwent preoperative biliary decompression for improvement of liver function showed relatively better outcome after surgery in comparison to those patients in whom pancreaticoduodenectomy was done with keeping stent in situ.

Neonatal Effects of Thyroid Diseases in Pregnancy and Approach to The Infant With Increased TSH in A Tertiary Care Hospital In Dhaka

Dr. Salma Hossain — 2024-11-11

Background: Thyroid stimulating hormone (TSH) plays a crucial role in embryonic and fetal development from early pregnancy. Both maternal hypothyroidism and hyperthyroidism can significantly impact fetal and neonatal thyroid function, potentially leading to adverse developmental outcomes.

Objective: The aim of this study is to assist pediatricians, neonatologists, and pediatric endocrinologists with the assessment, diagnosis, and treatment of thyroid function disorders and thyroid diseases in the fetus and baby during pregnancy and the neonatal period.

Methods: This prospective cohort study was nested within a larger investigation conducted in Ashiyan Medical College Hospital, Dhaka, Bangladesh.. Pregnant women were recruited between November 2017 and October 2023. Of 1237 invited participants, 266 pregnant women were enrolled, with 4,26 providing blood samples during their first prenatal visit (approximately week 13). Thyroid function was assessed by measuring TSH, free T3 (fT3), and free T4 (fT4) levels across all trimesters.

Results: Mean TSH levels showed a progressive increase across trimesters (first: 1.31±0.51 mU/L; second: 1.67±0.77 mU/L; third: 2.36±0.58 mU/L). Child loss was significantly associated with elevated maternal TSH levels, with 41% experiencing miscarriage, 37% fetal death, and 22% neonatal death. The relationship between TSH levels and adverse outcomes persisted even within the normal reference range and after adjusting for confounding factors including parity, smoking, diabetes mellitus, and hypertension.

Conclusions: Elevated maternal TSH levels during pregnancy are associated with increased risk of adverse neonatal outcomes, even in women without overt thyroid dysfunction. These findings suggest that maintaining optimal maternal TSH levels throughout pregnancy is crucial for fetal and neonatal well-being, and support considering treatment for women with even mildly elevated TSH levels. Regular thyroid function monitoring during pregnancy may help identify at-risk cases and improve perinatal outcomes.

A Prospective Study on the Relationship Between Cervical Dilatation at Initial Presentation in Labor and Subsequent Outcome

Dr. Tamanna Rahman — 2024-11-26

Background: Cervical dilatation at the initial presentation in labor is an important factor in predicting labor progression, maternal and neonatal outcomes. This relationship helps clinicians to assess the likelihood of a timely delivery, the need for medical interventions, and possible complications. Objectives: The aim of the study was to evaluate the relationship between cervical dilatation at initial presentation in labor and subsequent outcome. Methods: This prospective study was carried out in the Department of Obstetrics & Gynaecology, Dhaka Medical College & Hospital, Dhaka, Bangladesh, during July 2006 to June 2007. A total of 100 patients were selected at random basis admitted with labor pain. Statistical analyses of the results were be obtained by using window-based Microsoft Excel and Statistical Packages for Social Sciences (SPSS-24). Results: The age distribution of the patients was (1%) 11 to 15 years, (25%) 16 to 20 years, (40%) 21 to 25 years, (22%) 26 to 30 years and (9%) 31 to 35 years. And (3%) were older than 36 years. The majority of the population ranges in age from 21 to 25 years. In our study, Group I: Cervical dilatation (os) <4 cm and Group II: Cervical dilatation (os) > 4 cm. Dilatation of Cervix on admission where 54(54%) were Group – I <4 cm, 46(46%) ware Group – II ≥ 4cm. Most of the populations belong to Group – I <4 cm group. According to Parity distribution of the patients, 38 (79.2%) group I and 10 (20.8%) group II patients were nulliparous, whereas 16 (30.8%) group I and 36 (69.2%) group II patients were multiparous. Conclusion: Cervical dilatation at the initial presentation in labor is a crucial factor in determining labor management and predicting outcomes. Advanced dilatation is generally associated with quicker labor progression, fewer interventions, and better maternal and neonatal outcomes, while minimal dilation may require more vigilant monitoring and management to ensure safe delivery.

Association of Vitamin B12 with Gestational Diabetes Mellitus

Dr. Nusrat Jahan Khan — 2024-11-13

Background: Gestational diabetes mellitus is one of the most common metabolic disorders during pregnancy and associated with increased maternal and neonatal morbidities. Low serum vitamin B 12 level have been associated with the risk of developing gestational diabetes mellitus (GDM). Objectives: The aim of this study was to find out any association of serum vitamin B12 with GDM. Methods: This cross-sectional comparative study was conducted in the department of Obstetrics and Gynaecology, BSMMU during October, 2017 to February, 2020. A total of 86 pregnant women between 18 to 40 years of age attended antenatal clinic and admitted in hospital in their 29 to 40 weeks of pregnancy were included in this study from 211 pregnant women. Among them 43 diagnosed cases of GDM were considered as group A and rest 43 without GDM were considered as group B. Statistical analyses of the results were be obtained by using window-based Microsoft Excel and Statistical Packages for Social Sciences (SPSS-24). Results: Serum vitamin B12 concentration was measured. The mean serum vitamin B12 level was 148.88±13.91 in group A and 182.70±27.16 in group B. The mean vitamin B12 level was statistically significantly low in GDM group than non GDM group (p=0.001). There was a significant negative correlation of serum vitamin B12 level with fasting plasma glucose (r=-0.561, p<0.001) and plasma glucose 2 hours after 75g glucose in GDM patient (r=-0.258, p=0.017). Therefore, low serum vitamin B12 can be regarded as a significant risk factor for the development of GDM. Conclusion: The association of Vitamin B12 with gestational diabetes mellitus (GDM) generally highlights that low Vitamin B12 levels may be associated with an increased risk of developing GDM. Vitamin B12 levels during pregnancy may play a role in reducing the risk of GDM. Regular monitoring and possible supplementation in deficient women could be beneficial as part of prenatal care.

Colposcopic Findings of Cervix in Visual Inspection of the Cervix After Acetic Acid Application (VIA) Positive Cases Attending Colposcopic Clinic at Chittagong Medical College Hospital (CMCH)

Dr. Dilruba Yasmin — 2024-11-16

Background: Colposcopy is an essential diagnostic tool used to evaluate abnormalities of the cervix, particularly after a positive Visual Inspection with Acetic Acid (VIA) areas of dysplasia or neoplasia, which may appear white (acetowhite) after application. Objectives: The aim of the study was to evaluate the role of VIA technique in the early detection of carcinoma. Methods: Diluted acetic acid (3-5%) was applied to the cervix during routine gynaecological examination. Women with positive result were referred for colposcopy. Women with both positive and negative results found in colposcopic examination underwent colposcopy guided biopsy. Then both sensitivity and specificity of colposcopy was determined and the result was compared with other studies of home and abroad. Statistical analyses of the results were be obtained by using window-based Microsoft Excel and Statistical Packages for Social Sciences (SPSS-24). Results: A prospective study was conducted from July 2007 to June 2008 on 100 women attending at the "Colposcopy Clinic" of CMCH, Chittagong. Only VIA positive cases were taken into consideration of the study. Colposcopy evaluated 62 cases as CIN (CINI 31 %, CIN II-17%, CIN-III 14%) and 3.0% as invasive lesions. Biopsy evaluated 36% as CIN (CIN 1- 17%, CIN- II 10%, CIN-III 9%) and 1% as invasive lesions. The sensitivity and specificity of colposcopy were 81.08% and 44.44% respectively. Conclusion: VIA is an important method in low resource settings and it is simple and easy to perform. Colposcopy is an indispensable procedure in the evaluation of unhealthy cervix though it requires considerable training and experience. It has got high sensitivity and negative predictive value.

The Frozen Frontier: Who Owns Your Embryos?

Dr. Anju Choudhary — 2024-12-08

This research article examines the intricate legal, ethical, and fraudulent dimensions associated with eggs, sperm, and embryos within the framework of In Vitro Fertilization (IVF) facilities. This examination addresses the legal status of embryos, ethical issues surrounding reproductive materials, and the rising incidence of illicit activities such as embryo and egg theft, smuggling, and fraud in the global IVF sector, particularly in India. The report emphasizes the pressing necessity for regulatory reforms and stringent enforcement measures to address the obstacles associated with fertility clinics and reproductive technology, focusing on issues of ownership, consent, and the disposition of surplus embryos.

Prevalence of Asthma and COPD Overlap in Patients With Chronic COPD

Dr. Santosh Kumar — 2024-12-20

Background: Asthma-COPD Overlap (ACO) represents a significant yet underrecognized clinical entity within the spectrum of chronic airway diseases. Understanding its prevalence and characteristics among chronic COPD patients is crucial for optimizing patient care and healthcare resource allocation.

Objective: This study aimed to determine the prevalence of ACO in patients with chronic COPD and characterize its clinical, functional, and inflammatory features compared to COPD alone.

Methods: We conducted a cross-sectional observational study across multiple respiratory care centers between January and December 2023. A total of 312 patients with confirmed COPD underwent comprehensive assessment, including spirometry, inflammatory biomarker measurement, and clinical evaluation. ACO was diagnosed based on standardized GINA/GOLD criteria, requiring both major and minor criteria fulfillment.

Results: Among 312 COPD patients, 87 (27.9%) met the diagnostic criteria for ACO. ACO patients were significantly younger (61.2 ± 7.9 vs 64.3 ± 8.9 years, p=0.006) and had lower smoking burden (28.4 ± 12.6 vs 35.7 ± 15.3 pack-years, p=0.001) compared to COPD-alone patients. ACO patients demonstrated higher bronchodilator reversibility (18.4% vs 7.2%, p<0.001), elevated blood eosinophils (385 ± 142 vs 198 ± 89 cells/μL, p<0.001), and increased FeNO levels (42 vs 22 ppb, p<0.001). They experienced more frequent exacerbations (median 2 vs 1 per year, p<0.001) and required more hospitalizations (median 1 vs 0 per year, p=0.002).

Conclusions: ACO affects a substantial proportion of COPD patients and presents with distinct clinical and inflammatory characteristics. The higher exacerbation frequency and healthcare utilization in ACO patients emphasize the importance of early recognition and appropriate therapeutic intervention. These findings support the implementation of systematic screening approaches and individualized treatment strategies for this unique patient population.

Frequency and Clinical Presentation of Asthma-COPD Overlap in COPD Patients

Dr. Santosh Kumar — 2024-12-17

Background: Asthma-COPD Overlap (ACO) represents a unique clinical phenotype that poses significant diagnostic and therapeutic challenges. Despite its clinical importance, limited data exists regarding its prevalence and characteristics in single-center settings.

Objective: To investigate the frequency of ACO among COPD patients and characterize its clinical presentation in a single-center study.

Methods: This cross-sectional study enrolled 60 consecutive COPD patients. ACO was diagnosed based on GINA/GOLD consensus criteria. Comprehensive clinical assessment included spirometry with bronchodilator reversibility testing, blood eosinophil counts, and detailed symptom evaluation. Clinical characteristics, laboratory parameters, and healthcare utilization patterns were compared between ACO and non-ACO COPD patients. Results: ACO was identified in 18 patients (30% of the cohort). ACO patients were significantly younger (62.4 ± 8.3 vs. 68.7 ± 7.2 years, p=0.002) and demonstrated higher blood eosinophil counts (385 ± 158 vs. 182 ± 124 cells/μL, p<0.001) compared to non-ACO COPD patients. They exhibited greater bronchodilator reversibility (18.4 ± 5.2% vs. 8.7 ± 3.8%, p<0.001) and experienced more frequent exacerbations (2.8 ± 1.4 vs. 1.6 ± 1.2 per year, p=0.002). ACO patients also showed higher rates of emergency department utilization (1.9 ± 1.1 vs. 1.2 ± 0.9 visits per year, p=0.014). Conclusion: ACO affects a substantial proportion of COPD patients and is characterized by distinct clinical features, including enhanced bronchodilator reversibility and increased exacerbation frequency. These findings emphasize the importance of systematic screening for ACO features among COPD patients to facilitate appropriate management strategies.

A Case of Paroxysmal Supraventricular Tachycardia Clinical and Electrocardiographic Appraisal

P S Seshadrinathan — 2024-11-10

Paroxysmal supraventricular tachycardia refers to a clinical syndrome characterized by rapid regular tachycardia with abrupt onset and termination which originates from or conducts through the atria or atrio-ventricular node. (1) We report 40- year- old male patient who underwent mitral valve replacement for rheumatic heart disease severe mitral stenosis with St Jude’s Valve who presented with recurrent palpitations. Systematic clinical and electrocardiographic analysis aids in precise non- invasive diagnosis prior to detailed electrophysiological studies.