Search

Background: Adhesive capsulitis also termed as frozen shoulder is a condition characterized by painful and limited active and passive range of motions of the shoulder. It can adversely affect activities of daily living and consequently impair quality of life. The aim of the study was to estimate the prevalence of adhesive capsulitis among diabetic individuals and to study its relationship with age, gender, involved shoulder, body mass index (BMI) and glycaemic control Method: A cross-sectional observational study was done in 290patients attending outpatient department of BIRDEM hospital during the period fromlst April 2023 to 30th September 2023. Convenient type of sampling technique was applied. Patients with shoulder pain and restricted active andpassive shoulder joint movements were diagnosed as having adhesive capsulitis. Data were statistically analyzed. Results: Adhesive capsulitis was present in 54 (18.62%) of patients with diabetes. It was found that adhesive capsulitis was higher in increasing age, predominant in female 34(63.0%), more involve in left shoulder 27(50%). Statistically significant association was found with poor glycaemic status. Conclusion: Adhesive capsulitis is a common problem in diabetic patients. Its occurrence was found to be prevalent with poorly controlled glycaemic status. [ABSTRACT FROM AUTHOR]

Introduction: Soft tissue defects around the ankle and posterior heel need stable flap coverage for proper healing and satisfactory recovery of function. Constant and reliable vascular supply of reverse sural island flap (RSIF) have made it a popular choice for reconstruction of these defects. In this study, the outcome of RSIF with few modifications in the pedicle area were discussed. Methods: This prospective study was carried out in National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka duing April 2019 to June 2020. Total 31 patients with soft tissue defect around ankle and posterior heel were reconstructed with reverse sural artery island flap. The soft-tissue defects were located, infront of ankle in 3 cases, over lateral malleolus in 7 cases, over medial malleolus in 5 cases, over tendoachilles in 12 cases, involving two or more areas of posterior heel, tendoachilles and lateral malleolus in 4 cases. Average Flap length and width were 9.67(+1.60) cm & 6.38(+0.76) cm respectively. Pedicle area of flap was modified by including a 2 cm skin extension in the middle along with additional adipofascial tissue on both sides to improve venous return. Pedicle length to width ratio was maximum of 3:1. Average length of pedicle was 7.2 + 1.7 cm. Results: All flaps except three survived completely without any complications. One patient (3%) had partial necrosis and another one (3%) had marginal necrosis of flap due to venous congestion. Epidermolysis was observed in 3% cases. Conclusions: The distally based superficial sural artery island flap is a versatile, reliable procedure useful in reconstruction of the lower extremity. Modifying the design of pedicle area increases safety by reducing venous congestion which ultimately leads to increase flap survivability. [ABSTRACT FROM AUTHOR]

In Bangladesh, the incidence of dengue infection continues to rise, and it has been related to severe maternal and infant morbidity during pregnancy. After presenting with an initial onset of fever at 37 weeks' gestation, an 18-year-old pregnant woman ended up being diagnosed with dengue fever. The rapidly declining platelet count, 18,000/mm³ on the third day, necessitated a blood transfusion. On day six of her illness, while her platelet count was 23,000/mm³, she developed pre-labor rupture of membranes with labor pain. The labor became prolonged, with signs of obstruction. A prompt caesarian section was carried out under general anesthesia. She was discharged from the hospital on the 4th Journal of Bangladesh College of Physicians and Surgeons Vol. 41, Dengue Fever Supplement Issue, October 2023 post-operative day without any negative sequelae. After birth, the newborn was diagnosed with dengue IgG by potential vertical transmission. Early detection and treatment are necessary for dengue during pregnancy. However, physicians must exercise extra caution when treating a pregnant dengueinfected patient by maintaining their physiological state, preventing shock, and, at the same time, taking care of the fetus, which may develop distress. [ABSTRACT FROM AUTHOR]

Introduction: Shoulder pain comes next to back and knee pain, considering the frequency of musculoskeletal ailments. The Shoulder Pain and Disability Index (SPADI) is considered a highly specific questionnaire for assessing shoulder pain and functions. The objective of the study was to assess the validity and reliability of the Bangla version of SPADI (B-SPADI) among the Bangla-speaking patients. Materials and Methods: The B-SPADI was developed using a designed process that included forward translation and backward translation, authentication, response, and final rectification. Validity and reliability were conducted in 48 patients with shoulder pain. The reliability was appraised by executing internal consistency and test-retest analyses. Its validity was assessed by comparing the SPADI with the SF- 36, Disabilities of the Arm, Shoulder, and Hand (DASH), and American Shoulder and Elbow Surgeons (ASES) questionnaire. Results: The cross-cultural adaptation method was flawlessly aligned with the content or language. Internal consistency (Cronbach’s alpha) was 0.97 for the total SPADI score. Intraclass Correlation Coefficient (ICC) was 0.95 for the total SPADI with 0.92 for pain subtotal and 0.96 for disability subtotal. The SPADI total score showed a correlation of 0.63–0.71 with the SF-36 physical scales, of 0.89 with the DASH and of 0.94 with the ASES. All of the items were statistically significant (P<0.001). Conclusion: The B-SPADI came out as an appropriate valid, and reliable instrument for measuring pain and disability in patients with shoulder afflictions. [ABSTRACT FROM AUTHOR]

Craniopagus is a condition of conjoined twins that are fused at the cranium. After birth, 25% of craniopagus twins survive and can be considered for surgical separation. It is a complex multistage, multidisciplinary team involvement exercise needing detailed evaluation, planning and preparation beforehand. A harmonious collaboration from the clinical, administrative as well as logistic point of view is mandatory for successful management of such complex condition. The honorable prime minister of Bangladesh picked up "Rabeya and Rukaiya", a craniopagus twins, the first ever case in the history of Bangladesh and handed them over to an expert team from Hungary and Bangladesh for successful management. The noble joint exercise known as "Operation Freedom" took place in home and abroad through multiple procedures/interventions in different institutions by a group of experienced panels of medical and non-medical professionals. In this article we will highlight the events of this monumental achievement. [ABSTRACT FROM AUTHOR]

Bangladesh College of Physicians and Surgeons has been the pioneer in developing post-graduate medical education in this country. The curriculum offers guidelines for selecting versatile candidates to become future specialist, training particulars and learning outcomes and set criteria expected of them at the exit. In general, the curriculum is the guideline for the trainees and training facilities including the assessment system to fulfill the conditions to facilitate creation of specialist in different disciplines. To document the hard works done by the fellows in last 50 years to establish curriculum in different specialities. All the available data regarding development of curriculum found are analyzed to document the struggles did previously to develop curriculum in different specialities of BCPS. FCPS part-1 syllabus was printed in different subject in the year 2000. Between 2000-2005 most of the subject developed printed part-I syllabus. Changes in the structure of postgraduate medical education and training of the BCPS was initiated in 2012 by holding a workshop to discuss the way forward with participation of experts from the Royal College of Physicians and Surgeons of Glasgow, College of Physicians and Surgeons of Pakistan, experts from the USA together with leading members of the Faculties of BCPS. This resulted in the decision that individual Faculties need to develop a curriculum. To ensure competency based training a common frame work was approved by the Council of the College in 2016. In 2017 another important change was approved that FCPS course will be for 5 years from January 2020. On the back ground of those decisions of the council curriculum and log book development committee work hard to developed new curriculum and log book. Several Workshops involving leading Faculty members on the development of the curriculum were held in the following months starting on 2019. In the year 2020 and 2021 this committee with the help and different faculties and administration able to published new curriculum in 42 specilities. Dynamicity of the curriculum makes it possible to incorporate recent advancements in the subject. This updated curriculum includes relevant new developments in different specialties. [ABSTRACT FROM AUTHOR]

Cleidocranial dysplasia (CCD) is an uncommon autosomal inheritant congenital skeletal defect that primarily affects the bones and teeth, and shows an autosomal inheritance. A 13-year-old Bangladeshi girl presented with delayed eruption of the permanent anterior teeth. She was short-statured, well-oriented young girl with narrow, drooped shoulders, malformed or absent clavicles, brachycephalic head with frontal and parietal bossing, hypoplasticzygomatic bones, bulging calvarium, and depressed nasal bridge with a broad alar base. Intraoral examination revealed persistence of the primary dentition, delayed eruption of the permanent teeth, an Angle class III malocclusion, negative overjet, bilateral posterior crossbite. This rarecase of CCD is so far the first case from Bangladesh to be documented in perspective to dental surgery and orthodontics. [ABSTRACT FROM AUTHOR]

Introduction: According to the vascular theory arterial overflow in the superior haemorrhoidal arteries would lead to dilatation of the haemorrhoidal venous plexus. The technique helps to promote the obliteration of the terminals of the superior rectal artery. The objective of this study is to describe the results of 100 patients with hemorrhoidal disease treated by the Hemorrhoidal LASER Procedure technique. Method: Under SAB anesthesia terminal arteriole of the upper rectal arteries were fulgurated by fiber laser diode, causing interruption of hemorrhoidal flow. This procedure is repeated circumferentially, following the clockwise positions. This procedure can be performed as a day care surgery. Results: Between January 2018 to January 2019, 100 patients underwent the Hemorrhoidal LASER Procedure technique for hemorrhoidal disease grades I, II and III. Total 100 patients were treated with HeLP procedure. Among them number of men was 81 and female was 19.The procedure proved to be successful at 3 month follow up of 92% patient. No major adverse effects or complications were reported. Post operative minor pain that required medication was 5 cases (5% patient). Postoperative minor bleeding was observed in 3 cases that were managed conservatively. At 3 month after procedure resolution of symptoms were observed in 88% cases with overall satisfaction rate was 89%. Significantly higher quality of life was observed in laser haemorrhoidal procedure. Conclusion: Hemorrhoidal LASER Procedure is a painless outpatient technique. It is a safe, effective, improve symptoms & chance of cure is high compared to other conventional surgery. Similar benefits are seen for patient with severe anal spasm, external thrombosis, fissure and sentinel tags & fistula. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the pattern of individual traits of malocclusion, including sagittal molar relationship, overbite, overjet, crowding, spacing, cross bite, missing tooth, impacted tooth and extra tooth of upper and lower jaws in patients attended in Orthodontic Department of a Tertiary Level Hospital. This cross-sectional study included orthodontic patients who visited the department of Orthodontics and Dentofacial Orthopedics in Sapporo Dental College and Hospital from January 2013 to February 2018. Among the study population comprised of 371 patients the females were 57.1% and the males were 42.1%.Among them, 6.7% belonged to 6 to 11 years, 20.5% belonged to 12 to 17 years and the remaining 72.8% were of 18-35 years of age. Angles Class I malocclusion was seen to be the most prevalent (64.2%). In incisor classification, Class I malocclusion was seen to be the most prevalent (38.3%). Increase in overjet, deep overbite, crossbite, crowding and spacing were found in 35.34%, 40.3%, 24.3%, 58.2% and 38.5% of the patients respectively. [ABSTRACT FROM AUTHOR]

Objective: To identify the incidence and related factors for pulmonary complications and its impact on outcome in patients subjected to surgery for congenital heart disease (CHD). Methods: The sample comprised 141 patients of both genders, subjected to surgery for CHD, during 3 months period from 1st July 2014 to 30th September 2014. The data were obtained from newly improvised Congenital Heart Surgery Database. Results: Twenty eight (20%) patients developed some form of pulmonary complications. Age, weight, length and body surface area are significantly low among them (p <0.05). They also have higher Aristotle score & RACHS score, higher CPB time and aortic cross clamp time (p <0.01). Patients who had pulmonary complications had significantly higher (p <0.01) vasoactive inotrope score, prolonged mechanical ventilation, longer post operative ICU stay and post operative hospital stay. There was no mortality. Conclusions: Pulmonary complications are common after surgery for CHD which is more common in small children and complex surgeries. It significantly affects outcome including duration of mechanical ventilation and length of stay but no effect in mortality. [ABSTRACT FROM AUTHOR]

Background: Gall bladder carcinoma (GBC) is the most common biliary tract cancer. Delayed presentation and early spread of tumor made it one of the lethal tumors with poor prognosis. Objective: The objective of this study is to find out the incidence of GBC in thick walled gall bladder (GB) in comparison with that of normal wall thickness. Methods: This prospective study was carried out in Combined Military Hospital (CMH) Dhaka, CMH Momenshahi and CMH Ghatail during the period of June 2007 to June 2014. A total 300 patients underwent cholecystectomy were studied retrospectively. Diagnosis was confirmed by histopathological examination. Results: Out of 300 patients 254 (84.88%) were female (male : female = 1:5.52), age range 28 to 79 years. Maximum number of the patients fall into fourth and fifth decades. 42 (14%) patients were found to have thick walled GB by preoperative sonography and during surgery. Histopathologically 13 (4.33%) patients were diagnosed as GBC. Maximum patient (52.33%) had chronic cholecystitis. Incidence of malignancy were higher (84.62%) in patients having thicke walled GB. Conclusion: GBC may present as focal or diffuse asymmetric wall thickening or even in GB having normal wall thickness. As early diagnosis and effective treatment can significantly reduce the morality and morbidity all specimen should be examined histopathologically. [ABSTRACT FROM AUTHOR]

We report the case of a newborn with Down's syndrome associated with transient acute myeloid leukemia (AML). The leukemic presentation resolved spontaneously without treatment just 4 weeks after birth. A 2 days old newborn presented with respiratory distress, lethargy, poor suck and mild hepatosplenomegaly with features of Down's syndrome. Total white cell count was 144,000/cmm with blasts 92%. Other Septic work up was negative. Peripheral blood smear revealed hyper leukocytosis and presence of blast cells. Flow cytometric analysis revealed acute myeloid leukemia. The peripheral blast cells persisted for 4 weeks, after which the hemogram and the differential WBC count returned to normal and a final diagnosis of transient acute myeloid leukemia was made. Only few cases of congenital leukemia with Down's syndrome have been reported in the literature. In Down's syndrome, AML whether transient or not, generally shows cytogenetic and molecular aspects that differ from those of adult acute leukemias. [ABSTRACT FROM AUTHOR]

Anterior tooth discrepancy, an important clinical orthodontic tool to manage malocclusions, may vary on different race, ethnicity and gender. Therefore this study on anterior tooth discrepancy of Bangladeshi malocclusion groups were formulated to calculate and set up a standard norm, and to evaluate the gender discrepancy. A cross sectional type study was done among 207 pretreated dental casts (60 male, 147 female) of malocclusion patient at the Department of Orthodontics, Faculty of Dentistry, BSMMU, Bangladesh. Bolton anterior ratio were measured and compared statistically (in the Angle's group of malocclusion). No significant anterior discrepancy was observed between Bangladeshi male and female groups. A similar value for anterior discrepancy was observed in neighboring countries. [ABSTRACT FROM AUTHOR]

Renal cell carcinoma (RCC) is the commonest primary tumor of the kidney which may invade through the renal vein into the inferior vena cava (IVC), and then it can extend intraluminally with subsequent tumor-thrombus formation. Here we report a case involving excision of a primary RCC with tumor-thrombus involving IVC up to right atrium with the use of extracorporeal circulation. Single stage surgical procedure was performed in collaboration with a urological team aiming complete resection of primary tumor, para-aortic lymphadenectomy and removal of IVC thrombus extending to right atrium with the help of cardiopulmonary bypass. After arresting heart, RA was opened and the mass was removed through RA from IVC and hepatic vein level. Abdominal IVC was opened and the entire residual mass was removed from below also small amount of thrombus removed from left renal vein. Postoperative venous doppler showed no residual thrombus in venous system. Histopathology report confirmed papillary renal cell carcinoma. The patient was discharged from hospital in the 12th post-operative day without any complication. [ABSTRACT FROM AUTHOR]

Clinical management of non-growing adult patients with dentofacial deformity could be provided with better outcome when approach in-combined with orthodontic and orthognathic surgery than that of single approach alone. This study describes a case of a 26years old Bangladeshi female presented with bimaxillary protrusion treated with the combination of orthodontic and orthognathic surgery. [ABSTRACT FROM AUTHOR]

A female newborn baby presented with the features of Rhizomelic chondrodysplasia Punctata (RCDP) characterized by rhizomalic shortening with contracture of lower extremities, ichthyosis, microcephaly, dysmorphic facial features including a depressed nasal bridge, hypoplastic midface, full cheeks & low set ear, breathing difficulties and anthropometric measures below the expected indexes for her age. The patient also presented congenital heart disease, a less common manifestation of the syndrome. Radiological features include epiphyseal stippling & multiple calcification in the epiphyseal cartilage, metaphyseal flaring and clefts in vertebral bodies. It is a rare autosomal recessively inherited skeletal dysplasia. The prognosis is bad and death usually occurs within the first year of age. We report a case of neonatal RCDP which was diagnosed based on the typical clinical and radiological features. [ABSTRACT FROM AUTHOR]

Temporalis myofascial flap holds great promise for the reconstruction of various defects of the maxillofacial region for its dependable blood supply, proximity to the maxillofacial region, possibility to mobilize it to the oral cavity and its fanned out nature. The purpose of the study was to evaluate the efficacy of temporalis myofascial flap in maxillofacial reconstruction. This cross sectional study was carried out in the Department of Oral and Maxillofacial Surgery, Dhaka Dental College and Hospital from January 2011 to December 2011. Nineteen patients (10 male and 9 female), age ranging from 19 to 55 years with medium to large defect (>8cm)were selected for this study. After surgical resection of the pathological lesion, the TMF was exposed by a hemicoronal incision with a preauricular extension. The muscle was rotated to oral cavity and sutured with defect margin. Post-operatively the patient were clinically evaluated at 1, 2, 3 weeks and 1 and 3 months. Complete flap take was observed in 84% cases where as partial flap take was seen in 16% cases. Mouth opening restriction were 2-3 mm in 10 cases and 5-8 mm in 5 cases. Temporalis myofascial flap is a useful, reliable and versatile option for reconstruction of moderate to large sized defects. This flap provide abundant tissue, with minimum to no functional morbidity or esthetic deformity in donor site. [ABSTRACT FROM AUTHOR]

Background: Acute pancreatitis (AP) is an acute inflammatory condition of the pancreas that may extend to local and distant extrapancreatic tissues. It is a life-threatening disease that has many causes, few effective treatments, numerous serious complications, and an often unpredictable course. The objectives of this study are to develop our knowledge about presentation and diagnosis of acute pancreatitis, to assess the patient with acute pancreatitis accurately and to develop a standard management protocol. Methods: This observational study was carried out in Combined Military Hospital (CMH) Dhaka, CMH Momenshahi and CMH Ghatail during the period of June 2007 to December 2010. A total 25 patients of Acute Pancreatitis were studied retrospectively, evaluated and managed. Results: In this study 25 patients 19 (76%) were male (male : female = 3.17:1), age range 08 to 55 years, Mean age - 38.92 years. Maximum number of the patients fall into fourth and fifth decades. All patients presented with abdominal pain, specially in upper abdomen. Laboratory test revealed leucocytosis and high serum and urinary amylase, positive findings in Ultrasonogram and CT scan found in all patients. Gall stone was the leading cause 14 (56%). 20 (80%) patient developed some form of complications. 24 patients were treated conservatively. Average hospital stay was 15.52 days. Serious regional and systemic involvement in Acute Pancreatitis causes multiple organ or system failure. Conclusion: Early diagnosis and effective treatment can significantly reduce the morality and morbidity. [ABSTRACT FROM AUTHOR]

Oncologic emergencies are complications resulting from cancer itself or from treatment of cancer requiring immediate attention & reversal. It is an acute life threatening event, may be the first sign of disease or may indicate disease progression. Cancer patients presenting with oncologic emergencies should be approached in a similar way to those without cancer. The care of cancer patients with oncologic emergencies is a challenge not only to oncologists but also to clinicians involved in emergency medicine. It requires rapid intervention to avoid death or severe permanent damage. The overall goal is to prevent, reverse or minimize life threatening complications through prophylaxis, early detection and specific management. [ABSTRACT FROM AUTHOR]

Neonatal sepsis is one of the most important causes of mortality and morbidity especially in developing countries. Management of such cases is difficult, costly and need expert centers in many cases. Therefore, identification of the risk factors and their predictive values may help optimizing its management. With the above idea this case-control study was done to see the effects of maternal and neonatal risk factors and to find their predictive values in the development of neonatal sepsis. Fifty cases and fifty suitably matched controls were enrolled in the study and different maternal, natal and newborn factors were compared. Many risk factors were found to have influence in the development of neonatal sepsis. Among them the maternal intrapartum fever, foul smelling liquor, young mother (< 20 yrs), poor income group, prolonged labor, unclean vaginal examination (UVE) and primi mother were much associated with the occurrence of sepsis. Also the neonatal factors, like prematurity, resuscitation at birth and low APGAR score carried the significant risk of developing sepsis. But when relative influence of these risk factors were analyzed over neonatal sepsis in detecting their predictive values, it was found that irregular antenatal check up, prematurity, resuscitation at birth, and maternal intrapartum fever had influenced most in the development of neonatal sepsis in chronological order. [ABSTRACT FROM AUTHOR]

Background: Tropical sprue (TS) is a common cause of malabsorption in the tropics. No report has yet been published on TS in Bangladesh. This report aimed to describe clinical picture of TS patients in a tertiary care hospital. Methods : The data were collected from the admission and discharge registers and register of follow-up clinic of Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University during the period of 1981- 2004. Results: A total of 23 patients with a mean age of 36.42 years were diagnosed to have TS (8 females and 15 males). Mean duration of their symptoms was eight months. Important presenting features were loose motions (82.6%) and progressive weight loss (73.91. Approximately 43.47% patients presented with abdominal discomfort or pain, 26.02% with fever and 26.03% with skin changes. Mean hemoglobin and serum albumin levels were 9.71gm/dl and 31.16 gm/dl respectively. Fecal fat was positive in only eight cases. Contrast X-ray showed dilatation of small intestinal loops in four cases and flocculation of dye in two cases. Duodenal biopsy showed partial (16cases) or subtotal (four cases) villous atrophy with chronic inflammatory cell infiltrate in lamina propria in 91.3 % cases. Patients treated with tetracycline or ciprofloxacin along with folic acid showed good initial response with improvement of bowel motions, weight gain and anemia. Only two patients presented with recurrent attacks. In conclusion, TS is also prevalent in our country. A good number of TS patients presented with abdominal responses were pain and fever along with diarrhoea and weight loss. Small intestinal mucosal changes and treatment typical to TS. [ABSTRACT FROM AUTHOR]

Metastatic tumor in oral region is uncommon and may occur in the oral soft tissues or in the Jaw bone. Because of their rarity, metastasis in oral cavity are challenging to diagnose and treat. Oral metastasis is associated with poor prognosis. This case report is of a 45 year old female with a small pedunculated swelling on the left side of the hard palate in the molar region for 30 days. Incisional biopsy revealed metastatic leiomyosarcoma with possible primaries in the uterus. Metastasis in the right lung and liver was also diagnosed. Palliative chemotherapy was started but the patient died after two weeks of diagnosis after receiving the first cycle of chemotherapy. [ABSTRACT FROM AUTHOR]