Medico Research Chronicles

Surgical Management of Congenital Diaphragmatic Hernia in Newborn

Dr. MD. Shahjahan — 2024-09-30

Background: Congenital diaphragmatic hernia (CDH) is a life-threatening condition in newborns that requires prompt surgical intervention. This study aims to evaluate the outcomes of surgical management of CDH in newborns, focusing on survival rates, complications, and long-term prognosis.

Objectives: To assess the survival rate of newborns with congenital diaphragmatic hernia (CDH) who undergo surgical management.

Methods: This retrospective study was conducted at Dhaka Shishu Hospital from 2021 to 2023, involving 57 newborns diagnosed with CDH who underwent surgical repair. Preoperative stabilization, surgical techniques, postoperative care, and complications were documented. The primary outcome was survival rate, while secondary outcomes included the incidence of postoperative complications, duration of mechanical ventilation, and overall hospital stay

Result: Among the 57 newborns, among them 56.1% male and 43.8% are female. Mild genetic variant 1.3% and severe 1.2%. Cardiac malformation mild (61.4%) and severe (38.5%). Diaphragmatic defect size A and B (66.6%), C and D (22.8%). Caesarean section delivery is higher (61.4%) The most common long-term complications were thoracic deformity, intestinal obstruction and GERD. Surgical approach through abdomen (78.9%) is higher than other surgical approach. Outcome of the congenital diaphragmatic hernia of type A (38.59%)is higher among other types. Newborns with isolated CDH had a better prognosis compared to those with associated anomalies. Early surgical intervention within the first 48 hours of life was associated with improved survival rates.

Conclusion: The surgical management of CDH in newborns can lead to favorable outcomes, particularly when performed early and supported by comprehensive preoperative and postoperative care. Despite the challenges associated with CDH, prompt surgical intervention and meticulous postoperative management significantly contribute to improving survival rates and reducing complications. Further studies are needed to optimize treatment protocols and improve long-term outcomes for these patients

Comparative Evaluation of Transmittance Between Zirconium Di-Oxide Crown and Human Natural Tooth Crown: An In-Vitro Study

Mohammad Abid — 2024-09-30

Background: The transmittance/translucency of a dental crown is a crucial property that affects the color of a dental crown. The characteristics of the crown material and background contrast affect the transmittance of the value of the crown material.

Objective: This study was aimed to evaluate and compare the transmittance between zirconium dioxide crown and natural human tooth crown.

Methods: An in-vitro study was conducted at Department of Prosthodontics, Bangabandhu Sheikh Mujib Medical University. A total of 20 specimens/crowns prepared with zirconium di-oxide and 20 specimens/crowns of natural human tooth crown. A total of 40 crowns/specimens were included for testing transmittance/ translucency individually. The thickness of outer layer of these specimens was uniform in accordance with the American Dental Association (ADA) specifications. The zirconia crown preparation on model was done. The outer layer of both group of crown specimens was 2 mm in thickness. Fourier-transform infrared spectroscopy (FTIR) test was used to evaluate the transmittance/ translucency value of samples. This test was carried out using the FTIR test at Chemical Engineering Department of Bangladesh University of Engineering and Technology. A FTIR test was used to measure the contrast ratio, which is indicative of transmittance level. The transmittance of the specimens was recorded with the help check list. The transmittance values were analyzed by One Sample T Test to determine the mean value with its standard deviation for each group. To compare between two groups, P≤0.05 was considered.

Results: The mean transmittance value (409.4±.7) cm-1 wavelength of natural tooth crown is less than zirconium di-oxide crown (467.2±.8) cm-1 wave length when intact form of sample was tested and it was significant (P 0.001). In addition, the mean of transmittance value (560.6±) cm-1 wavelength of natural tooth crown was lower than zirconium di-oxide crown (596.18) cm-1 wavelength when grinded form of sample was tested and it was also significant (P 0.001).

Conclusion: To conclude, the zirconia crown in both intact and grinded form showed more transmittance/ translucency when compared with the natural human tooth crown or enamel. So, it is expected that this study will help the dental professional to choose the zirconia as crown material to fulfill the patient’s satisfaction.

Evaluation of Caesarean Section Rates at Sylhet MAG Osmani Medical College Hospital Using the Robson Ten Group Classification System

Dr. Mahbuba Khan — 2024-09-30

Background: The rising rates of Cesarean Section (CS) globally, and particularly in Bangladesh, have sparked concerns about the overuse of this surgical intervention, which may lead to adverse maternal and neonatal outcomes. The World Health Organization (WHO) recommends a population-based CS rate of 10-15%; however, the rates in many regions far exceed this threshold.

Objectives: The aim of the study was to evaluate the CS rates at Sylhet MAG Osmani Medical College Hospital (SOMCH) using the Robson Ten Group Classification System (TGCS), to identify the key factors contributing to the high prevalence of CS, and to provide evidence-based recommendations for reducing unnecessary procedures.

Methods: This cross-sectional observational study was conducted at SOMCH during July 2022 to June 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 overall CS rates were reported at Sylhet MAG Osmani Medical College Hospital (SOMCH), 57.43% with 2849 CS cases among 4960 admitted women. The group size, CS rate, and absolute group contribution to overall CS were 24.29%, 36.29%, and 8.81%, respectively in group 1. Another important group includes nulliparous women with single cephalic pregnancies at 37 weeks or more who had induced labor or a CS before labor, which accounted for 11.85% of deliveries with a high CS rate of 72.61% and contributed 8.60% to the overall CS rate. Similarly, multiparous women without a previous CS who received induction or a CS before to labor (Group 4) have a CS rate of 75.83%, accounting for 5.06%.

Conclusion: The study highlights the need for targeted interventions to reduce unnecessary CS procedures at SOMCH. Key recommendations include promoting Vaginal Birth After Cesarean (VBAC), optimizing labor induction practices, and standardizing clinical decision-making processes. Continuous monitoring and evaluation using the TGCS will be essential to ensure that CS is used judiciously, ultimately improving maternal and neonatal health outcomes.

Effect of Elective Inguinal Hernia Repair on Urinary Symptoms in Men

Dr. Tazin Ahmed Adnan — 2024-09-30

Background: Urinary symptoms are frequently associated with inguinal hernias and urinary complications occur frequently following repair. Systematic assessment of post-operative urinary symptom burden in patients undergoing elective inguinal hernia repair was not evaluated yet. Therefore, the study was planned to determine the prevalence of urinary symptoms in men undergoing elective inguinal hernia repair.

Methods: This prospective observational study was conducted at the department of surgery in Dhaka Medical College Hospital (DMCH), for 12 months period. Patients with inguinal hernia who were admitted in DMCH were approached and selected in according to the inclusion & exclusion criteria. Before interviewing and before surgical procedure, informed consent was taken from each subject and ethical issues were ensured properly. The researcher did physical examination and assessment of urinary symptoms. Data were collected from a total 100 patients and recorded into a structured questionnaire. Collected data was analyzed by the SPSS 21.

Results: Mean age of the study populations was 60.36 ± 6.87 SD (years) [age range 41-73 years]. About 74% had unilateral inguinal hernia and other 26% had bilateral hernia. Out of 100 patients, 35% patients used perioperative catheter. Only 4% patients had post-operative complications and 2% patients had the history of retention following surgery. The overall median preoperative AUASS score was 6 (range 3 – 28) which increased to 13 (5-33) 48 hours after operation. The increase was statistically significant (p<0.001). The increase in AUASS score noted across all categories of age, BPH, hernia, surgery, anesthesia and surgical technique. During 30 days post-operative follow up, eight patients were lost from follow-up and comparison between preoperative and 30 days post-operative AUASS score showed statistically significant improvement (p<0.001).

Conclusion: Significant improvements of urinary symptoms are seen following elective inguinal hernia repair. However, larger cohort study is needed to finalize the comment.

Surgical Outcome of Short Segment Instrumentation including Fracture Vertebrae of Thoracolumbar Burst Fracture

Dr. Md. Rashedul Islam — 2024-09-12

Background: Fractures of the thoracolumbar region are the most common injuries of the spine; among them burst fractures are the most frequent. Several studies were done to see the surgical outcome in thoracolumbar burst fracture hence surgery was recommended for better outcome. So, the current study was aimed to evaluate the clinical, functional and radiological outcome of short-segment pedicle screw fixation including the fractured vertebral body. Objectives: The aim of the study was to evaluate the surgical outcome of short segment pedicle screw fixation including fracture vertebrae of unstable thoracolumbar burst fracture with incomplete spinal cord injury. Methods: In this prospective observational study, a total of 62 cases were studied from May 2019 to May 2021 through non randomized purposive sampling. All the patients were between 15 to 60 years of age and operated within 21 days of fracture by posterior decompression & stabilization by short-segment pedicle screw fixation including the fractured vertebral body. Postoperative functional outcome was assessed clinically by ASIA, ODI, VAS, Denis Work Scale, Macnab criteria and radiologically by Cob’s kyphotic angle, kyphotic deformation, Beck index & Bridwell criteria. Postoperative follow up was conducted at 6^th, 12^th & 24^th weeks. Statistical analyses of the results were be obtained by using window-based Microsoft Excel and Statistical Packages for Social Sciences (SPSS-24). Results: The mean age was 31.42±11.2 years with male dominancy (74.19%). Most of the cases were manual workers (51.61%). FFH was the most common cause of injury (80.65%) and L1 was the most common level of injury (54.84%). The mean duration between injury and operation time was 14.45±3.72 days. Regarding improvement of ASIA grade, 1 grade in 46 (74.19%) cases, 2 grade in 2 (3.23%) case, no improvement in 14 (22.58%) cases were seen. Complications were hemorrhage 2(3.23%), dural tear 2(3.23%), CSF leak 2(3.23%), urinary retention 4(6.45%), skin infection 2(3.23%) and bed sore 2(3.23%). Conclusion: Thoracolumbar burst fracture with incomplete spinal cord injury can be treated with short-segment pedicle screw fixation including the fractured vertebral body effectively. This method offered a better kyphosis correction, no instrument failures, appraisable clinical and functional recovery, reduce pain and improve working status with early rehabilitation.

Role of Pre-operative Physiotherapy in Reducing Post-operative Complications in Joint Arthroplasty

Dr. Uma Maheshwar — 2024-10-10

Background: Postoperative complications following total hip and knee arthroplasty remain a significant concern. This study aimed to evaluate the effectiveness of a structured preoperative physiotherapy program in reducing complications and improving outcomes in patients undergoing joint arthroplasty.

Methods: In this randomized controlled trial, 200 patients scheduled for primary total hip or knee arthroplasty were randomly assigned to either a 6-week preoperative physiotherapy program (intervention group, n=100) or standard care (control group, n=100). The primary outcome was the incidence of postoperative complications within 30 days of surgery. Secondary outcomes included length of hospital stay, time to achieve functional milestones, pain scores, and functional outcomes at 3 months post-surgery.

Results: The intervention group demonstrated a significantly lower incidence of postoperative complications compared to the control group (11.6% vs 22.6%, p=0.041). Mean length of hospital stay was shorter in the intervention group (3.2 ± 1.1 days vs 4.1 ± 1.5 days, p<0.001). The intervention group achieved functional milestones earlier, reported lower pain scores, and showed improved functional outcomes at 3 months post-surgery (p<0.05 for all comparisons).

Conclusion: A structured preoperative physiotherapy program significantly reduces postoperative complications and improves functional outcomes in patients undergoing total hip and knee arthroplasty. These findings support the integration of prehabilitation into standard care pathways for joint replacement surgery.

Selective Neck Dissection in N0 Papillary Thyroid Carcinoma

Dr. Shahed Hasan — 2024-10-19

Background: Papillary thyroid carcinoma is the most common form of well differentiated thyroid cancer and constitutes 1% of all solid tissue cancers with a female predominance. Surgical intervention helps in removal of lesion. Lymph node metastasis in cervical compartments is the main reason of recurrence of disease. Personalized risk stratified prophylactic neck dissection at initial thyroidectomy in Papillary thyroid carcinoma with no clinical, sonographic or per-operative evidence of lymph node metastasis has been advocated, though not unanimously. Compartment oriented lymph node dissection in patients with PTC reduces recurrence and improves survival. Objectives: The aim of this study is to determine the Role of selective neck dissection in case of N0 papillary thyroid carcinoma. Methods: A cross-sectional prospective study was conducted in the Dept of Otolaryngology and Head neck surgery, BSMMU, Dhaka for one and a half years from September/2021 to February/2023, with 35 patients underwent total thyroidectomy with selective neck dissection (level VI, III, IV, II) for N0 Papillary thyroid carcinoma. All patients were evaluated by complete clinical head & neck examination, thyroid hormone profile, ultrasonography finding, fine needle aspiration cytology, radiology and histopathology report were recorded. Data were analyzed statistically by using by Statistical Package for Social Scientist (SPSS-24). Results: The age was ranged from 22 to 70 years with mean age was 47.77±14.8 years. Male to female ratio was 1:2.2. 17.4% patients had multiple number of nodules and 82.86% patients had solitary nodule. 11.43 % patients had involvement of both lobes, 31.43 % had involvement of left lobe, 57.14% had involvement of right lobe. More than three-fourth (88.57%) patients, tumor size >4 cm and in case of 11.43% patients, tumor size is within 0- 4 cm. 8.6% patients had mixed echo consistency and 91.4% had solid echo consistency. Conclusion: Most of the patients were in 6th and above decade and female predominant. Solitary nodule, right lobe involvement, size more than 4cm and solid echo consistency were more frequent. Regarding selective neck dissection; 17.1% had metastasis at level VI and no metastasis at level II, III, IV. In brief, 17.1% patients had metastasis on histopathology after neck dissection and 82.9% patients had no metastasis on histopathology after neck dissection. It can be said that, Central compartment neck dissection has role in detecting metastasis at N0 stage of Papillary thyroid carcinoma but Lateral neck dissection has no role in detecting metastasis at N0 stage of Papillary thyroid carcinoma.

Incidence and Risk Factors for Pneumonia and Diarrhea in Children under 5 in a Secondary Care Hospital

Dr. Mohammad Ismail Hossain — 2024-10-17

Background: Pneumonia and diarrhoea are two of the leading causes of morbidity and mortality, particularly in children under five years of age, especially in low- and middle-income countries. Both conditions are preventable and treatable, yet they remain significant health issues globally.

Objectives: The aim of the study was to evaluate the incidence and risk factors for pneumonia and diarrhea in children under 5 in a secondary care hospital.

Methods: This cross-sectional study was carried out in the Upazila health complex Matlab Uttar, Chandpur, Bangladesh, during January 2023 to December 2023. A total of 150 patients were participated in the study. Among them 60 were pneumonia patients (Group-A) and 90 were patients with diarrhea (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: The age distribution of the study population revealed that (53.33%) of patients in group A were between the ages of one month to one year, while (53.33%) in group B. In addition, 6.66% of the patients in group A were between the ages of 3 and 4 years old, while 10% were in group B. In group A, the bulk of the patients were male (63.33%), while group B had 51 (56.66%). There was no statistically significant difference (p>0.05) between the groups.

Conclusion: The need for targeted interventions to improve vaccination coverage, nutritional support, and sanitation practices to reduce the burden of pneumonia and diarrhoea in young children. Strengthening primary healthcare systems to provide early detection and management of these conditions is also essential in mitigating their impact.

Comparative Study on Evaluation of Results of DHS/PFN in Management of Intertrochanteric Fracture of Femur

Kazi Mohammad Hannanur Rahman — 2024-10-11

Introduction: 38–50% of all femur fractures and 5–20% of fractures in their entirety are intertrochanteric fractures. The prevalence of these fractures is 180/10000, making them prevalent in the senior population. While intramedullary devices like PFN are thought to be superior implants for unstable intertrochanteric fractures, dynamic hip screws are still the gold standard for managing intertrochanteric fractures. Their function in treating these fractures remains questionable.

Materials and Methods: The study was conducted on 100 patients with intertrochanteric fracture of femur attending the outpatient and emergency department of National Institute of Traumatology & Orthopedic Rehabilitation (NITOR), Dhaka between May 2019 to April 2020. Following a clinical and radiological evaluation, the patients were split into two groups at random, A and B. Patients in group A received treatment by ORIF using a dynamic hip screw, whereas patients in group B received treatment via closed/open reduction and internal fixation with PFN. The working proforma below contains the following information of the patient: personal information, clinical findings, radiological findings, and follow-up findings. The outcomes were assessed and contrasted.

Results: The mean age in both the groups was 58.88 ± 15.76 years, In DHS group, there were 8(16%) females and 42(84%) males. In PFN group, there were 15(30%) females and 35(70%) males. There was a male preponderance in both the groups in comparison to the females. In PFN group, there were 24(48%) patients who injured because of fall, while 26(52%) were injured due to RTA. In PFN group, higher number of fall patients were there, while in DHS group, higher number of RTA patients were there. The comparison of mean blood loss in both the groups showed a statistically significant difference (P < 0.0001), with a higher mean blood loss in DHS group in comparison to PFN group. In DHS group, 48(96%) patients had no complications, 2(4%) had DVT and 1(2%) had cut out of screw, 3(6%) had infection. In PFN group, 2(4%) had infection, 48(96%) shows no complication. The difference in mean union time was significant (P < 0.0001) with a higher union time in DHS group in comparison to PFN group. DHS group functional outcome assessment by Harris Hip score, there were 22(44%) patients had Excellent and the PFN group functional outcome assessment by Harris Hip score, there were 26(52%) patients had Excellent.

Conclusion: PFN provides stability and aids in biological reduction. Excessive collapse and limb shortening are avoided by PFN. As a result, it aids in obtaining a positive functional outcome overall. PFN is a load-bearing implant that provides stability to the fracture area both proximally and distally. As such, it is a more biomechanically sound implant option for fixing peri-trochanteric femoral fractures. When it comes to bleeding during surgery and the early stages of recovery, PFN is a superior implant option than DHS. Consequently, we support the use of PFN rather than DHS in intertrochanteric fractures, with the exception of fractured trochanteric entry points for the PFN.

A Newly Emerging Clinical Presentation of Lupus Vulgaris- Case Report of a Bangladeshi Patient

Dr. Farzana Afroz — 2024-09-11

Lupus vulgaris (LV) is more common among all forms of cutaneous tuberculosis (TB). It usually occurs in previously sensitized individuals with moderate high immunity either by direct exogenous inoculation of tubercle bacilli or by hematogenous or lymphatic spread from an underlying focus of infection endogenously. Our patient was a 55year old woman presented with asymptomatic, gradually spreading erythematous plaque over the dorsal surface of the right hand for 1.5 years. Her lesion started as a pus-filled cavity which she could squeezed out and underwent repeated excisions followed by antibiotic therapy, but recurrence occurred every time. Then she was referred to Dermatology department. Her cutaneous examination revealed multiple erythematous papules coalescing to form plaque which was asymptomatic. Diascopy of the lesion revealed brownish yellow colouration but her tuberculin test was negative. As our provisional diagnosis was lupus vulgaris, we proceed for lesional skin biopsy for histopathology which unveiled granulomatous inflammation in mid dermis consistent with lupus vulgaris. Our focus of reporting the case to enlighten the diagnostic challenges, emphasizing the significance of clinical suspicion despite of negative tuberculin test specially in endemic zone of tuberculosis and initiation of early treatment to reduce the morbidity and also sharing knowledge contributing to new

Unusual Cause of Congestive Heart Failure with Severe Mitral Regurgitation

P. S. Seshadrinathan — 2024-10-19

Sub mitral aneurysm is a rare cardiac anomaly with varied clinical manifestations, usually due to congenital defect adjacent to posterior leaflet of mitral valve. We report 50-year-old male patient with submitral aneurysm who presented with features suggestive of congestive heart failure and severe mitral regurgitation. Echo cardiography and cardiac MRI aid in precise non-invasive diagnosis.