Study of Serum Electrolytes (Sodium and Potassium) Abnormalities in Acute Stroke

Stroke is the common cause of death and disability worldwide, as well as in Bangladesh. Serum electrolytes abnormalities or dyselectrolytaemia is one of the major acute complications of stroke. Dyselectrolytaemia or serum electrolytes (sodium and potassium) abnormalities are more common in patients with acute stroke that can be easily measured. The study was planned to find out the serum electrolytes (sodium and potassium) abnormalities in acute stroke patients. This cross-sectional study was conducted in the Department of Neurology and Medicine, Mymensingh Medical College and Hospital from January 2019 to June 2020. Total 84 purposively selected patients with acute strokes were evaluated following informed written consent. Diagnosis was confirmed by neuroimaging of brain. Moreover, serum electrolytes level was measured for each patient. Data were collected by interviews, clinical examinations & laboratory investigations of the patients using a case record form and analysis was carried out by the help of SPSS 25.0. Mean age of the patients with acute strokes were 57.65±15.79 years. About two thirds (60.7%) of the patients were male and the remaining (39.3%) were female. Sodium imbalances were observed in 32.2% and potassium imbalances in 25.0% cases. About 66.7% haemorrhagic strokes patients and 42.2% ischaemic strokes patients had dyselectrolytaemia (p<0.05). More than twenty eight percent (28.6%) of all stroke patients had hyponatraemia, which was more common (35.9%) among haemorrhagic strokes patients (p<0.05). Of all stroke patients 21.4% had hypokalaemia, which was more common (28.2%) in haemorrhagic strokes patients (p<0.05). This study reveals that, serum electrolytes (sodium and potassium) abnormalities are more common in haemorrhagic than ischaemic strokes, which is mainly hyponatraemia and hypokalaemia.

The role of diffusion-weighted MRI in the accurate diagnosis of vertebral compression fractures: A comparative study

INTRODUCTION

Accurately distinguishing between benign and malignant vertebral compression fractures is crucial for clinical management. This study evaluated the predictive accuracy of diffusion-weighted imaging (DWI) in differentiating the cause of vertebral fractures using MRI.

METHODS

A longitudinal cross-over study was conducted at Jinnah Postgraduate Medical Centre (JPMC) Karachi from July 2018 to January 2021. Patients with vertebral compression fractures underwent T1-weighted, T2-weighted, and DWI imaging with ADC mapping on a 1.5 T MRI scanner. Imaging findings were compared with histopathologic results and clinical follow-up. Sensitivity, specificity, and ROC curve analyses were performed.

RESULTS

The study enrolled 303 patients with a mean age of 43.6 ± 10.9 years, of whom 118 were male. DWI demonstrated high accuracy in predicting the cause of vertebral compression fractures, with a sensitivity of 96.2 %, a specificity of 76.2 %, and an area under the ROC curve of 0.857. The optimal ADC cut-off value was 0.82 × 10˄-3 mm˄2/s, which yielded a positive predictive value of 79.7 % and a negative predictive value of 95.4 %.

CONCLUSIONS

DWI is a safe and non-invasive imaging modality with excellent predictive accuracy in differentiating between benign and malignant vertebral compression fractures. Iso- or hypointensity of collapsed vertebral bodies on DWI suggests a benign lesion, while T2-weighted hyperintensity is highly indicative of malignancy. Low signal on ADC is also highly indicative of malignant vertebral fractures. Incorporating DWI improves accuracy in assessing vertebral lesions, especially when standard sequences are inconclusive.

IMPLICATIONS FOR PRACTICE

DWI revolutionizes vertebral compression fracture diagnosis, distinguishing between benign and malignant cases. This precision guides treatment decisions, minimizing the necessity for invasive procedures like biopsy. As a safe and reliable imaging method, DWI elevates patient care, ensuring accurate diagnostics and improved outcomes.

Women's Overall Satisfaction with Childbirth Experience in a Tertiary Level Hospital of Bangladesh

Women's satisfaction with care in labour is a positive indicator for the woman herself, as well as healthcare organization as a whole. This study was aimed to find out the women's satisfaction with their childbirth. It also tried to identify significant differences across various mode of delivery and satisfaction related to women's childbirth experience. It was a descriptive type of cross-sectional study conducted among 278 post-natal mother who give live birth at government tertiary hospital namely Mymensingh Medical College Hospital, Bangladesh. The study was conducted in the department of Obstetrics and Gynaecology during the period of January 2020 to December 2020. Data were collected from the respondents by face to face interview using a self-administered semi-structured questionnaire including Salmon's Item List. Level of overall satisfaction with childbirth was assessed by Salomon's Item List. Data analysis was carried out by SPSS version 25.0. The dimension of physical discomfort, emotional distress and fulfilment had a Cronbach's alpha of 0.746, 0.966 and 0.982 respectively. The internal consistency of each dimension was found to be acceptable and reliable. The mean scores of the dimensions in Salmon's Item List for Fulfilment, Emotional distress and Physical discomfort was found to be 69.20, 50.85 and 50.40 respectively. Higher total scores indicate a more positive evaluation of the childbirth experience and lower scores indicate a more negative evaluation. In this study the Overall mean scores of the three dimensions was 50.75. The mean scores of 'fulfillment' was higher in normal vaginal delivery (NVD) and scores of both "emotional distress" and "physical discomfort" were higher in lower uterine cesarean section (LUCS). Among all the three dimensions, mean scores of 'fulfillment' was higher in NVD indicating more satisfaction with NVD than LUCS and instrumental delivery. On the other hand, scores of "physical discomfort" and "emotional distress" were lower in NVD indicating less satisfaction with NVD than LUCS.

Effects of Virtual Reality Training Using Xbox Kinect on Balance, Postural Control, and Functional Independence in Subjects with Stroke

Purpose: To determine the effects of virtual reality training using Xbox Kinect on balance, postural control, and functional independence in subjects with stroke. Methods: The parallel double-blind randomized control trial was conducted on 41 individuals based on selection criteria. Participants were divided into two groups by concealed envelope method. Intervention group received exergaming by Xbox Kinect, and control group was given exercises comprising balance training, upper limb strengthening, and core strengthening. Berg balance scale (BBS), functional independence measure (FIM), trunk impairment scale (TIS), and timed up and go (TUG) were the outcome measures. Data were analyzed using SPSS v21. Results: Mean age of the participants of Xbox and exercise group were 58.6 ± 3.3 and 58.1 ± 4.3 years, respectively. Within group improvement was observed in both groups from baseline to 8 weeks postintervention; BBS: 34 ± 4.7 to 40.9 ± 4.9 in intervention group and 34.1 ± 4.4 to 38.1 ± 7.6 in control group, TUG: 25.6 ± 3.9 to 21.4 ± 3.8 and 28.6 ± 5.0 to 25.9 ± 4.7, TIS: 15.2 ± 1.8 to 19.2 ± 1.3 and 13.2 ± 1.7 to 15.3 ± 1.6 and FIM: 58.7 ± 7.7 to 52.5 ± 7.8 and 66.2 ± 7.6 to 62.6 ± 7.2 in intervention and control group, respectively. Between group improvement was observed in TUG, TIS, and FIM in experimental group with P-values 0.003, <0.001, and <0.001, respectively. Conclusions: Wii Fit improved functional mobility, independence, and trunk coordination extension in the stroke patients, whereas balance could be equally improved from Wii Fit and exercises. Trial Registration Number: ACTRN12619001688178.

Burnout Rates in Clinical Radiation Oncology and Variations across Professional Subgroups

PURPOSE/OBJECTIVE(S)

Physician and medical professional burnout has emerged as an important issue in clinical medicine and has been shown to negatively affect patient outcomes. The aim of this study is to determine how rates of burnout vary between different radiation oncology professional subgroups.

MATERIALS/METHODS

Participants were selected from those employed in one of the professional subgroups (radiation therapists, nurses, physicists, dosimetrists, and physicians) at two institutions that cover a total of seven sites. 126 individuals were recruited to participate. In addition to demographics, participants were asked to respond to questions regarding professional burnout utilizing the Maslach Burnout Inventory (MBI). Responses were on a seven-point Likert scale with subcategories of Exhaustion, Depersonalization, and Personal Achievement. Each participant's score per subcategory was categorized as either low, moderate, or high. For our primary outcome, frequencies and proportions were reported and Fisher's Exact Test was used to evaluate whether there was a statistically significant difference in proportions in categorized burnout scores across professional subgroups. Secondary analyses were performed comparing burnout across sex, age, and categorized years in position. An alpha level of 0.05 was used for all analyses.

RESULTS

In total, 55 participants responded to the survey: 12 nurses, 8 dosimetrists, 12 physicians, 5 physicists, and 18 radiation therapists for a response rate of 43.6%. Demographics were consistent across professional subgroups with the exception of participant sex (p = .0397), which had a greater proportion of females (72.22%) in the Radiation Therapist subgroup. Among the three subcategories, only Exhaustion had a significant difference between groups (p = .0494) with Dosimetrists (62.50%) and Physicists (40.00%) experiencing the highest level of burnout. For Depersonalization, at least one individual in each subgroup identified high burnout with higher rates among the Dosimetrists (25.00%) and Physicists (40.00%). Similarly, at least one person in each subgroup reported high burnout in Personal Achievement, but the highest response was among Dosimetrists (37.50%). In total, at least 12.75% of participants reported high burnout in at least one subcategory. No statistically significant differences in burnout were detected in our secondary analyses across sex, age, and years in position.

CONCLUSION

Our study showed that burnout rates are moderate in members of the radiation oncology team, with dosimetrists and physicists displaying the highest levels of burnout. In order to better estimate professional burnout, larger studies should be conducted to determine causes of burnout. Furthermore, wellness programs should be encouraged and incentivized to help reduce burnout and improve workplace morale, occupational fulfillment, and effective patient care.

Phase 2 Trial of Anti-PD1 and 8 Gy in 1 Fraction for Relapse/Refractory Myeloma

PURPOSE/OBJECTIVE(S)

Relapsed, refractory multiple myeloma is associated with poor outcome. Role of radiotherapy is mainly for palliation. Anti-PD1 inhibitors have failed to show efficacy in relapsed refractory myeloma patients. A phase 2 trial (NCT03267888) was conducted to see if radiotherapy (8 Gy in 1 fraction) and anti-PD1 (Pembrolizumab) could provide early signals of safety and response.

MATERIALS/METHODS

A prospective single-center phase 2 trial involving patients >18 years of age with ECOG 0-1 was conducted after obtaining IRB approval. Patients had to have ISS stage I-III multiple myeloma that was either relapsed or refractory, an osseous and/or extraosseous lesion that could be radiated, and who were candidates for pembrolizumab. Patients had to have either measurable disease per the International Myeloma Working Group Criteria (IMWG) and/or had to have progressive disease on imaging. Radiotherapy was given on day 0, cycle 1 followed by pembrolizumab (200 mg/kg iv on day 2 or 3, then every 3 weeks +/- 7 days) on day 2-3 for at least 2 years or until progression. Primary endpoint was toxicity. Secondary endpoints were IMWG response, abscopal response, overall survival, and immunological changes in patient's blood. Patients were assessed at 3 months, 6 months, and 12 months IMWG criteria as well as serial PET/CT based imaging. Patients with stable disease or better were continued on the trial. Patients that progressive were removed. Standard statistical analysis was performed, and included Kaplan-Meier to estimate OS and PFS.

RESULTS

From June, 2018 until October, 2021, 32 patients were screened and 25 were enrolled. Of the enrolled patients, 76% were Caucasian, 64% had ECOG 1, and the mean age was 60 years. Prior to enrollment, the mean number of prior lines of therapy that the patients had failed was 5.20 (range: 2 - 11), suggesting a cohort with poor expected outcome. These cohort also had limited alternative options. Toxicity, as its primary endpoint, was acceptable. There were no grade 2 or higher radiation related toxicity within the irradiated volume. Only one case of grade 3 or higher pembrolizumab-related toxicity was noted amongst the 25 patients. Abscopal response was noted in 5 of 25 patients (20% patients). Several patients showed robust reductions in the paraproteins and other myeloma labs, suggesting response to radiotherapy and anti-PD1 combination. These patients were also associated to have a robust CD 8 T cell activation and an abscopal response. The secondary outcomes were better than expected for this cohort.

CONCLUSION

Combination therapy of single-fraction, low-dose radiation therapy with pembrolizumab in patients with relapsed or refractory multiple myeloma is worth assessing in future trials.

Phase wise evaluation of teachers by the students in Mymensingh Medical College, Bangladesh

Students' evaluations of teachers are used to ensure quality in medical education and as a tool for faculty development. Teacher evaluation is also one of the performance measurements of the Annual Performance Agreement (APA). The objective of this research was to evaluate teachers of four phases of MBBS program by the students of corresponding phase. This cross sectional descriptive type of observational study was conducted in Mymensingh Medical College (MMC), Bangladesh during the period of January 2023 to March 2023. A total of 40 purposively selected teachers engaged in either lecture, tutorial or clinical bedside classes were evaluated by 469 randomly selected students using a self-response evaluation form provided by Centre for Medical Education (CME) which contains 16 statements of 5 points: 1=Never, 2=Once in a while, 3=Sometimes, 4=Most of the time and 5=Almost always. Data were analyzed in SPSS, version 22.0. Ten (10) teachers from each phase were included in the study. Among the students 169(36.0%) were from phase I followed by each 100(21.3%) from phase II, III and IV. Out of 80, total mean score of phase I was 64.11±9.187. Total mean score of phase II was 72.08±7.520 and that of phase III was 72.19±6.510. Highest total mean score (76.95±5.032) was found in phase IV. Overall mean score of teachers of MMC irrespective of phase was 70.27±9.017. Mean scores of teachers in individual statement of phase I, II, III and IV were 4.02±0.847, 4.49±0.706, 4.51±0.614 and 4.81±0.482 respectively. Mean scores in individual statement of every phase were between "Most of the time (4)" and "Almost always (5)" indicating positive performance of evaluated teachers. All of the 40 teachers had a median score of more than 4 in the explicit issues indicating that most of the students agreed that the teachers taught their core subjects well. They had a median score of more than 4 in the implicit issues too which indicated that the students felt that all of the teachers gave importance to the core values. Moreover, 21(52.5%) teachers had a median score of 5 in both explicit and implicit issues indicating highly positive performance of those evaluated teachers. Teachers of Mymensingh Medical College performed admirably across all phases. This type of feedback evaluation should be applied throughout every institute as it will help faculty members enhance their abilities and academic performance, leading to overall faculty development. As a result, quality of medical education will be ensured.

Mental Health among the Infertile Women Attending Tertiary Level Hospital in Bangladesh

Infertility is a global public health issue and is a low control stressor often leading to increased level of depression, anxiety and stress. It is a severely distressing experience for many couples and it may significantly affect the physical and mental life of infertile individuals. The study was to assess the level of mental health state (depression, anxiety and stress) among the infertile women in tertiary level hospital in Bangladesh. This cross sectional descriptive study was conducted at two tertiary level hospitals in Bangladesh named BSMMU and CARe Medical College. Three hundred and fifty-two (352) infertile women were taken as a sample and a semi-structured questionnaire which contains question with related variables and DASS 21 was used. The study results revealed that, the mean age of the respondents was 29.32 years. Almost three-fourth 260(73.86%) of the respondents were Muslim and 349(99.14%) respondents were educated. Two-third 223(63.35%) of the respondents were from rural area and 177(50%) were housewife. About 229(65.05%) were live in a joint family and 205(58.23%) had an abortion history. Majority 312(88.63%) of the respondents had monthly income BDT <30000 Taka. According to DASS 21, 175(49.71%) had depression, 212(60.22%) had anxiety and 157(44.60%) suffered from stress. There was a significant association (p<0.05) found between mental health state with age, religion, residence and occupation. This finding reinforces the need of attention counseling and others advance psychological interventions for positive impact on outcome during treatment of this group of women.

Combined Analysis of a Phase III Randomized Trial and Phase II Prospective Trial with Blind Control Matching of Patients Receiving Whole-Lung, Low-Dose Radiation for COVID-19: Full Results and Immunologic Correlates of the RESCUE 1-19 Trial

PURPOSE/OBJECTIVE(S)

Whole-lung, low-dose radiation (LD-RT) for COVID-19 requires randomization and biologic correlates to determine causality and mechanism.

MATERIALS/METHODS

A phase III trial randomized COVID-19 patients to physician's choice of drug therapy with or without LD-RT. Primary endpoint was intubation-free survival (IFS). The trial was designed with 80% power (two-sided log rank, alpha 0.05) to detect a hazard ratio of 0.3 after 12 intubation events. Estimating a 25% event rate, the planned sample size was 84 patients plus 25 to account for declining intubation rates and screen failures. Due to hospitalization declines and other barriers, the trial closed prematurely. Available randomized data were analyzed by intention-to-treat and combined with phase II results and immunologic correlates, using one-sided significance and an alpha of 0.1 to inform future trial design.

RESULTS

From Jun 2020-Jun 2022, 14 patients were randomized on a phase III trial. From Apr 2020-Dec 2020, 42 patients were enrolled on a phase II trial and blindly matched to 40 controls from contemporaneous trials. 96 total patients and 193 blood samples were available for analysis. Mean hospital duration with LD-RT was 12.9 vs 15.4 days in controls (p = 0.12). Oxygen flow rate >15 L/min (26% vs 38%, p = .27), high-flow oxygen >30 L/min (24% vs 38%, p = 0.18), non-invasive positive-pressure >60 L/min (9% vs 27%, p = 0.03), and mechanical ventilation (9% vs 24%, p = 0.05) reduced with LD-RT. Mean supplemented oxygen volume was 171,759 vs 547,626 liters in controls, with daily means of 10 vs 23 L/min (p = 0.03). Radiographs worsened in 43% vs 71% of controls (p = 0.03). Arterial blood gas mean P/F ratios improved 22% after LD-RT vs declined 8% in controls (p = 0.12). Mean days febrile were 1.8 vs 2.9 in controls (p = 0.10). Rate of myocardial injury was 47% vs 40% in controls (p = 0.77). Flow cytometry revealed 4-fold and 30-fold larger expansions, respectively, in CD8- and CD4-positive CD3+PD1+Ki67-high proliferating cytotoxic T-cells (300% vs 75% expansion, p = 0.07) and helper T-cells (200% expansion vs 6% contraction, p = 0.03) at day 7. In the randomized cohort, mean oxygen volume fell 75% with LD-RT to 78,336 vs 316,786 liters in controls (p = 0.13), mean flow rates were 5.1 vs 18.4 L/min (p = 0.13), radiographs worsened in 50% vs 100% (p = .17), P/F ratios improved 31% vs declined 68% in controls (p = 0.03), hospital duration was 8.9 vs 11.5 days (p = 0.22), and zero LD-RT patients vs one control intubated.

CONCLUSION

Combined analysis of a phase II/III randomized trial suggests that LD-RT prevents ventilation, reduces supplemental oxygen need, improves clinical course, and enhances immune response. LD-RT may have both immediate direct effects and delayed enhanced immunity in COVID-19. Larger multi-institutional trials are justified.

Phase II Multi-Institutional Study of a Low-Dose (4 Gy) Palliative Response-Adapted Radiotherapy Regimen for Symptomatic Bone Metastases from Multiple Myeloma: Planned Interim Analysis of First 40 Patients

PURPOSE/OBJECTIVE(S)

Painful bone lesions are common in patients with multiple myeloma (MM). Radiotherapy (RT) is effective in providing pain relief from MM bone lesions in over 80% of patients. There is no consensus as to the most effective dose or fractionation for palliation. Shorter courses of therapy are not only more convenient for patients, but they also have less impact on timing of systemic therapies. There is precedent for using 4 Gy in the palliation of lymphomas, which have similar radiosensitivity to myeloma. The primary objective of this trial is to determine whether treatment with a total dose of 4 Gy to a painful myeloma bone lesion achieves patient-reported pain reduction comparable to historical controls at 4 weeks.

MATERIALS/METHODS

Patients with a known diagnosis of MM and a painful bone lesion that was not at the base of skull, in need of stabilization, or causing cord compression were treated with 4 Gy (2 Gy x 2 or 4 Gy x 1). Patients' pain was measured using the brief pain index (BPI) prior to treatment and at 2, 4, 8 weeks and 6 months following treatment. Pain response was determined by the international consensus on palliative radiotherapy and considered change in BPI and oral morphine equivalent dose (OMED). A planned interim analysis for futility was completed after 40 patients. Reirradiation with clinician choice regimens could be considered at ≥4 weeks following initial treatment for indeterminate pain response or pain progression.

RESULTS

Forty patients were treated at 6 institutions between 2019 and 2022. Median age was 65 years with 40% women and 88% with an ECOG of 0-1. A complete response (CR) was defined as a BPI score of 0 with no concomitant increase in OMED. A partial response (PR) was defined as BPI reduction in 2 or more without analgesic increase, or an OMED reduction of 25% or more without an increase in pain. An indeterminate response (IR) was any response that is not captured by a CR, PR or pain progression. A CR was achieved in 48%, a PR in 38% of patients, an IR in 13% with 1 patient who refused participation. Pain response was achieved in 86% of patients. Seven patients (18%) requested reirradiation at ≥4 weeks. Median BPI at baseline and 4 weeks after RT for patients with CR, PR, and IR were 3.75 and 0, 4.00 and 1, and 5.25 and 4.75, respectively. Median change of BPI between baseline and 4 weeks after RT for all responders (CR and PR) was -3.25. The median PTV volume (cc) for patients with CR, PR and IR were 81, 140 and 226, respectively. Based on these results, the futility threshold was not met, and the recommendation by the DSMC is to continue the trial.

CONCLUSION

In the first 40 patients who received 4 Gy palliation for painful bone lesions from multiple myeloma, there were 86% that had a pain response (48% CR, 38% PR). This low dose, response-adapted treatment, led to reirradiation in less than 20% of patients.

The Impact of Hypertension, Coronary Heart Diseases and Diabetes on COVID-19 Illness

This study tried to understand the impact that hypertension, coronary heart diseases and diabetes can have on the intensity of coronavirus within the human body. This study was conducted using a systematic review process where secondary data have been collected from 10 previously published research papers. Most of the individuals contracting COVID-19 are also suffering from diabetes, cardiovascular diseases and hypertension. The studies used to carry out this systematic review have exhibited a pattern that indicates a strong correlation. That being said, because of the possibility of extraneous variables, most of the studies at this point have significant drawbacks. Many of such variables for example, smoking behavior or level of fitness have not been considered while selecting sample for most of the studies. Therefore, more highly targeted studies need to be carried out for understanding this disease and the long- and short-term impact it can have.

Comparison of Wet Mount Microscopy and Giemsa Staining to PCR in the Diagnosis of Vaginal Trichomoniasis in a Tertiary Level Hospital of Bangladesh

Trichomonas vaginalis (T vaginalis) is the most prevalent non-viral sexually transmitted infection of the reproductive age group, which may lead to various complications, if left untreated. This study aimed to diagnose Trichomonas vaginalis infection by different diagnostic procedures and to evaluate the efficacy of different diagnostic procedures. This cross-sectional descriptive study was conducted among 102 women with vaginal discharge at the Department of Obstetrics & Gynecology at Mymensingh Medical College Hospital (MMCH) from July 2019 to December 2020. Three ectocervical swabs were collected from each patient. Saline wet mount microscopy, giemsa staining and PCR were performed for each patient. Data were collected using a structured questionnaire and analyzed using Excel 2007, statistical package for social sciences (SPSS) version 26.0. The PCR assay detected Trichomonas vaginalis positivity in 6(5.9%) of 102 patients, followed by Giemsa staining 4.9% and Wet mount examination 2.9%. Wet mount microscopy showed less sensitivity 33.33%, but high specificity 98.95%, 66.67% positive predictive value, 95.96% negative predictive value and accuracy 95.09%. The sensitivity, specificity, PPV, NPV and accuracy of Giemsa staining were 66.67%, 98.96%, 80.0%, 97.94% and 97.06% respectively. Statistical significance was observed when both WMM and Giemsa staining were compared to gold standard test PCR. In resource limited settings, a wet mount is a good option for diagnosis of T vaginalis infection as giemsa staining requires heavy T vaginalis infection to be positive. But wherever facilities are available, PCR should be performed.

Impact of COVID-19 Pandemic on Family Life of Undergraduate and Postgraduate Medical Students

The COVID-19 pandemic has taken a heavy toll in people's life all over the world. Not only it effected the physical aspect of normal life, it also affected the day to day life in every country. The objective of this study was to assess the impact of COVID-19 pandemic in family life of undergraduate and postgraduate medical students. This observational research was carried out on undergraduate and postgraduate students at Mymensingh Medical College in Bangladesh, and it is of a cross-sectional descriptive research design. This study enrolled 218 undergraduate and 94 postgraduate students of Mymensingh Medical College. A self-administered semi-structured questionnaire survey was conducted to gather the views of participants on the impacts of COVID-19 pandemic. The pandemic had negatively impacted student's family life. The study found that a total of 173(79.3%) undergraduate and 73(77.7%) postgraduate students reported that bondage among family member was strengthened; 101(46.3%) undergraduate and 42(44.7%) postgraduate students reported their monthly family income had decreased remarkably; 156(71.6%) undergraduate and 55(58.5%) postgraduate students reported their household expenditure had increased; 145(66.5%) undergraduate and 55(58.5%) postgraduate students believed that the overall emotional wellbeing of their families had deteriorated during the pandemic; 166(76.2%) undergraduate and 73(77.6%) postgraduate students reported that stress among their family members had increased; 174(79.8%) undergraduates and 75(79.8%) postgraduates reported that uncertainties resulting from the COVID-19 pandemic developed a sense of anxiety among their family members.This study found that conflict among family members had increased during COVID-19 pandemic. Among undergraduate students 131(60.1%) agreed and among postgraduate students 44(46.8%) agreed to this; 127(58.2%) undergraduate and 54(57.4%) postgraduate students responded the same that they became more concerned about the health of their family members.

Domestic Violence against the Female Garment Workers in Selected Area of Bangladesh

Domestic violence is a global problem and it affects millions of people and often results in physical, sexual and emotional injuries and even deaths. The study was to assess the prevalence, form and reasons of domestic violence among the female garment workers in Dhaka, Gazipur and Narayanganj of Bangladesh. This Cross sectional descriptive study was conducted at four Garments in Bangladesh named Tusuka Fashions Limited Dhaka, Ananta Casual Wear Limited, Gazipur, Spectra Sweaters Limited, Dhaka and Modele de capital Limited Narayanganj from January 2019 to December 2019. Three hundred and six (306) female garment workers were taken as sample. A semi-structured questionnaire and Abuse Assessment Screen was used. Then in-depth interviews were conducted. The study results revealed that the mean age of the respondents was 29.85 years and almost two-third (69.0%) of the respondents was Muslim. About 246(81.0%) were married and 164 (64.06%) had 1-2 children. Two third respondents (63.0%) were married for 5-15 years and 72.0% lived in nuclear families and the majority (39.5%) of the respondents had monthly income of BDT 15000-30000 where mean monthly income was BDT ±23,529. Proportion of Domestic Violence was 15.4% and all of them (100.0%) were the victim of both physical and mental violence. Husband was the perpetrators in 98.0% cases and most of the cases (43.0%) reason of domestic violence was relationship doubt with another person. Significant difference (p<0.05) found between domestic violence with religion and marital status, duration of marriage, number of children and family monthly income. The study findings demand an intensified effort should be made towards creating awareness about the domestic violence and solved this to improve their quality of life.

Hormonal Parameters in Diverse Phenotypes of Polycystic Ovarian Syndrome

Polycystic ovary syndrome (PCOS) is a polygenic and multifactorial condition, regarded as the most common endocrine abnormality of women in reproductive period. It is commonly assumed that insulin resistance, hyperandrogenism and obesity significantly influence the pathophysiological process of PCOS. This study was designed to estimate hormonal parameters in different phenotypes of PCOS. The cross sectional descriptive type of observational study was carried out at Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2018 to June 2019. Data were collected from purposively selected 107 patients with PCOS by interview, clinical examination and laboratory investigations using a pretested case record form. Data were analyzed by computer software, SPSS-version 22.0. Hormonal parameters in different phenotypes of PCOS were compared with ANOVA test. Phenotype A was found in highest number (59.8%) followed by phenotype B (14.9%), phenotype D (14.0%) and phenotype C (11.2%). Biochemical hyperandrogenism was observed highest in phenotype A (57.8%) followed by phenotype B (36.4%) and phenotype C (6.1%). Biochemical or clinical hyperandrogenism was not observed among patients of phenotype D. Altered LH:FSH ratio was high in phenotype A (14.1%) and Phenotype B (2.8%). Increased serum prolactin level was found highest in phenotype A (10.3%) and increased serum TSH was found highest in phenotype D (4.7%). Statistically significant difference was observed among levels of serum testosterone of different phenotypes (p<0.001). Hormonal derangements among different phenotypes reflect the severity of reproductive dysfunction and metabolic aberrations. Screening for metabolic risks of diverse phenotypes is important to detect and prevent long term health consequences of PCOS.

Proportion of Risk Factors among Women Attending Antenatal Checkup Unit of A Tertiary Level Hospital of Bangladesh

Women constitute a large population group in any country and they are the vulnerable or special risk group. The risk is associated with child-bearing. The purpose of antenatal care is to detect early the high risk cases from a large group of antenatal women and to arrange special skilled care for them. Aim of this cross sectional descriptive type of observational study was to find out the proportion of risk factors among women attending antenatal checkup unit of a tertiary level hospital and carried out in the antenatal checkup unit of Model Family Planning Clinic of Mymensingh Medical College Hospital, Bangladesh from January 2022 to June 2022. Data were collected from purposively selected 403 women seeking antenatal care by face to face interview, clinical examination and necessary laboratory investigations. Data were analyzed by using SPSS version 26.0. More than three forth (320, 79.4%) of the respondents were in the age group of less than 30 years and the remaining (83, 20.6%) were in the age group of 30 years and over. Mean age of the pregnant women was 24.7 years with a standard deviation of 4.7 years. Most of the pregnant women were housewives (350, 86.8%); 41(10.2%) were students and 12(3.0%) were service holders. Among the respondents rural women (254, 63.0%) were more than urban women (149, 37.0%). Seventy seven (19.1%) respondents were interviewed during 1st trimester; 140(34.7%) during 2nd semester and 186(46.2%) during 3rd semester. It was found that 12 (3.0%) women were elderly primi and 6(1.5%) were short statured primi. Eighteen (4.5%) pregnant women had malpresentations- 17(94.4%) had breech presentation and 1(5.6%) had transverse lie. Each 18(4.5%) had threatened abortion and antepartum haemorrhage. Pre-eclampsia was found in 4(1.0%) and anaemia in 14 (3.5%); twin pregnancy was found in 4 (1.0%) and hydramnios in 9(2.2%) pregnant women. Thirty one (7.7%) women had previous history of either still birth or intrauterine death or manual removal of placenta. One (0.2%) pregnant women was categorized as elderly grand multiparas. Prolonged pregnancy was found in 4(1.0%) women and 76(18.9%) women had the history of previous caesarean or instrumental delivery. Nine (2.2%) pregnant women had general diseases along with pregnancy- 5(55.6%) had asthma, 3(33.3%) had diabetes mellitus and 1(11.1%) had cardiovascular disease. Four (1.0%) women got pregnant after treatment for infertility and 2 (0.5%) women had history of three or more spontaneous consecutive abortions. Finally all the pregnant women under study were categorized on the basis of criteria of "high risk cases" and 97(24.1%) women had high risk pregnancy and the remaining 306 (75.9%) had normal pregnancy. Proportion of women with high risk pregnancy in this study is 24.1% who needs special attention and skilled care in addition to continuing better Maternal and Child Health (MCH) services for all pregnant women.

Relationship of Conduction Defects and In-Hospital Outcome after Acute ST Segment Elevation Myocardial Infarction

The presence of conduction defects complicating acute myocardial infarction (MI) is relatively frequent and is associated with increased short and long term mortality. Thrombolytic therapy has been established to reduce the mortality in acute MI, however its role in reducing the incidence of conduction defects is less clearly defined. Morbidity and mortality associated with conduction defects also remain unchanged. This study was aimed to assess the correlation between conduction defects and adverse in-hospital outcome of patients with acute ST segment elevation MI. This cross sectional descriptive type of observational study was conducted among 100 purposively selected patients with acute ST segment elevation MI in the coronary care unit (CCU) of Mymensingh Medical College Hospital, Bangladesh from June 2012 to March 2013. The patients were divided into two groups depending on the presence or absence of conduction defects namely Group A- 40 patients with conduction defects and Group B- 60 patients without conduction defects. Highest number of the patients (36.0%) was in the age group of 45-55 years. In case of inferior MI, age groups 45-55 years and 55-65 years had equal number of patients (30.4%). Only 2.0% patients were in age group of 75-85 years and this group had only inferior MI. Total number of female patients were 16(16.0%). Female patients had more inferior MI (17.4%) than anterior MI (15.9%). Number of MI patients was slightly more in inferior MI (46.0%) than anterior MI (44.0%). Group B had equal number of patients in both anterior and inferior MI. Conduction defects were more common in inferior MI (43.5%) than anterior MI (40.9%). Atrio-ventricular conduction defects were more common in inferior MI whereas intra-ventricular conduction defects were more common in anterior MI. Complete heart block (CHB) was more prevalent in inferior MI. Complications were more common in Group A (65.0%) than Group B (18.3%). In terms of complications the difference between two groups were significant (p<0.001). Group A showed higher rate of mortality (20.0%) than Group B (3.3%). In cases of anterior MI difference in mortality between Group A and Group B was highly significant (p<0.001). Conduction defects in the setting of acute MI are a common finding. Atrio-ventricular conduction defects occur more frequently in inferior MI whereas intra-ventricular conduction defects were more frequently encountered in anterior MI. Patients with conduction defects had more complications than those without conduction defects. Presence of conduction defects significantly increases the mortality of patients with anterior MI.

Distribution and Pattern of Anti-Tubercular Drug Resistance in Patients with Pulmonary Tuberculosis in Mymensingh Region of Bangladesh

Globally, the emergence of multidrug-resistant strains of Mycobacterium tuberculosis is an increasing problem that adversely affects patient care and public health. This cross sectional descriptive study was carried out in the Department of Microbiology, Mymensingh Medical College from January 2010 to December 2010 to isolate M. tuberculosis from smear-positive sputum samples by Lowenstein-Jensen (L-J) media and investigate the drug resistance pattern. Among 101 smear-positive cases 80(79.20%) yielded growth of Mycobacteria, 5(4.95%) were contaminated and 16(15.84%) showed no growth. Among 80 isolates 76(95.0%) were M. tuberculosis and the remaining 4(5.0%) were Non-tuberculous Mycobacteria (NTM). Out of 76 M. tuberculosis 27(35.52%) were resistant to at least one drug, 4(5.26%) to Isoniazid (INH), 1(1.32%) to Rifampicin (RMP), 8(10.53%) to Streptomycin (SM) and 0(0.0%) to Ethambutol (EMB) and multi-drug resistant tuberculosis (MDR-TB) was 9(11.84%). The present study creates the impression that fairly high rate of anti-tuberculosis drug resistance among the tuberculosis cases and also high MDR-TB (Resistant to both Rifampicin and Isoniazide). The emergence of MDR-TB poses significant trouble to TB control activities throughout the world. The complexity of MDR-TB operation makes it essential to produce new skills to design, plan, application and monitor interventions for the management of MDR-TB. More surveillance and immediate remedial interventions should be performed to combat the trouble of MDR-TB to the general population.

Platelet Count as a Prognostic Factor in Stage IV Non-Small Cell Lung Cancer

Increase platelet count can accompany various cancers including lung cancer. This finding has recently been suggested to indicate poor prognosis. In patients with malignancies, thrombocytosis has previously been related disease stage, histological type and survival. In this study, the prevalence of thrombocytosis and the prognostic information provided by platelet count were analyzed in patients with stage IV Non-Small Cell Lung Cancer (NSCLC) with an aim to assess elevated platelet count as a prognostic factor in patients with stage IV NSCLC and to investigate whether there is relationship between thrombocytosis, other clinico-pathologic factors and median survival. This prospective observational study was conducted in National Institute of Cancer Research and Hospital (NICRH), Dhaka, Bangladesh from September 2019 to August 2020. A total of 108 patients were enrolled purposively. Detail history taking, thorough physical examination was done along with relevant investigations. Data were collected by semi structured questionnaire and analysis was done with the help of Statistical Package for Social Science (SPSS), version 21.0. The mean age of the patients was found 56.4±12.2 years with range from 35 to 75 years. Majority (79.6%) patients were male, 52.8% patients came from low income and 36.1% were farmer. Majority (40.7%) were symptomatic; in bed >50.0% of day. Almost two third (59.3%) had <5.0% weight loss. Almost three fourth (69.4%) had squamous cell carcinoma. At the time of first assessment 75(69.4%) patients had normal and 33(30.6%) had elevated platelet count level. Age, sex and histological type were statistically not significant between normal and elevated platelet count level groups. But performance status, weight loss were statistically significant (p<0.05) between two groups. According to univariate analysis, age, performance status at presentation, weight loss more than 10.0% for 3 months and platelet count prior the start of treatment were all significant predictors for the overall survival. In multivariate analysis age, performance status at presentation and initial thrombocytosis were independent prognostic determinants for overall survival. Median survival time was significantly higher for the normal platelet count group and elevated platelet count group (7.5 months versus 5.5 months) respectively (95% CI, 5.5-7.5), p<0.001. The frequency of thrombocytosis in patients with stage-IV NSCLC at first presentation was 30.6% and median survival time in these patients was significantly shorter compared in patients without thrombocytosis. These results concluded that an elevated platelet count could be a useful prognostic factor for survival in patients with stage-IV NSCLC.

Pattern of Fetal Congenital Anomalies and Its Relation with Maternal Factors

Congenital anomalies are one of the four leading causes of neonatal mortality in Bangladesh. The risk factors which are predictive of congenital anomaly in babies vary from country to country. In a developing country like Bangladesh many possible factors are present which should be identified & frequency needs to be assessed to understand the burden. The aim of this study was to determine the patterns and related maternal factors of fetal congenital anomaly. This cross-sectional type of comparative study was conducted at Department of Obstetrics & Gynecology in Mymensingh Medical College Hospital, Mymensingh, Bangladesh from September 2019 to August 2020. All the births occurring in the labor room were recorded. All newborn babies born with congenital anomalies were identified & included in this study. The rate of congenital anomalies was estimated and common types of congenital anomalies were noted. This study was conducted involving all women who had babies with congenital anomalies and the same number whose babies had no congenital anomalies. A structured questionnaire was used during data collection. Data was analyzed by Chi square test, bivariate analysis & multivariate logistic regression using statistical package for social sciences (SPSS) version 26.0. During the study period, 11479 deliveries were conducted. Among them 87 cases with congenital anomalies were identified. Frequency of congenital anomaly was 0.8%. Central nervous system was the predominant system involved (49.4%). Regarding risk assessment, Maternal age >30 years (OR 2.96, 95% CI 1.10-7.93, p value 0.032), consanguinity (OR 7.73, 95% CI 1.79-33.39, p value 0.006), first degree relative with history of congenital anomaly (OR 35.52, 95% CI 4.31-292.86, p value 0.001) and no intake of folic acid (OR 15.99, 95% CI 5.28-48.52, p value <0.001), passive smoking (OR 6.45, 95% CI 1.66-25.09, p value 0.007) were independent risk factors for congenital anomalies.

Estimation of Serum Lipid Profile among Patients Admitted with Myocardial Infarction in a Tertiary Level Hospital of Bangladesh

Different studies worldwide showed that dyslipidaemia is involved in the pathogenesis of ischemic heart diseases (IHD). This cross sectional descriptive type of observational study was carried out at Mymensingh Medical College Hospital during the period of six months from January 2021 to September 2021 to estimate the lipid profile among patients admitted in the coronary care unit (CCU) with myocardial infarction (MI). Data were collected from purposively selected 343 patients with MI by face to face interview and laboratory investigations using a case record form. Informed written consent of participants was taken prior to interview. Data were analyzed by using SPSS version 21.0. The study results revealed that mean age of the patients with myocardial infarction was 53.16 years with a standard deviation of 11.68 years. Majority of them (284, 82.8%) were male and the remaining (59, 17.2%) were female. Proportion of risk factors for ischaemic heart disease (IHD) were estimated and found that 244(71.1%) patients were smoker; 150(43.7%) had hypertension and 110(32.2%) had family history of IHD. Ninety nine (28.9%) patents were obese with BMI ≥25kg/m². Eighty three (24.2%) patients had diabetes mellitus; 66(19.2%) lead sedentary life and 61(17.8%) patients with myocardial infarction had dyslipidaemia. Mean LDL of patients with myocardial infarction was 103.65±39.73mg/dl; mean total cholesterol (TC) was 189.44±45.41mg/dl; mean TG was 243.11±205.19mg/dl and mean HDL was 39.29±8.98mg/dl. LDL was increased in 10(2.9%) patients; total cholesterol was raised in 121 (35.3%) patients and TG was raised in 195(56.9%) patients. HDL was raised in 26(7.6%) patients and it was lowered in 57(16.6%) patients. Mean LDL, TC, TG and HDL of younger (≤45 years) and older (>45 years) patients were compared and t-test showed no significant difference (p>0.05). Similarly mean LDL, TC, TG and HDL of male and female were compared and again t-test showed no significant difference (p>0.05). Though the pattern of lipid profile was found similar in younger and older patients and in males and females, a significant number of patients (61, 17.8%) with MI had dyslipidaemia which should be address by dietary and lifestyle modification.

Chest HRCT Severity Scores among Hospitalized Patients with COVID-19

Corona Virus Disease 2019 (COVID-19) was declared a pandemic in March 2020. This global health crisis caused thousands of pneumonia related death all over the world since December 2019. RT-PCR is the primary test for diagnosis of COVID-19, though its sensitivity and specificity is variable. Several studies revealed that chest HRCT complements RT-PCR in highly suspected cases or in false negative RT-PCR and helps to gauge disease severity. This study was carried out with an aim to find out the severity scores of chest HRCT in hospitalized patients with COVID-19. This cross sectional descriptive type of observational study was carried out at COVID-19 unit of Sylhet Women's Medical College Hospital, Bangladesh from April 2021 to September 2021. Data were collected from purposively selected 204 patients with COVID-19 by face to face interview, chest HRCT and necessary laboratory investigations. Informed written consent was taken from the participants of the study at the beginning of the interview. Data were analyzed by using SPSS version 21.0. The results of the study showed that mean age of the patients with COVID-19 was 57.9 years with a standard deviation of ±15.8 years. Majority of them (121, 59.3%) were female and the remaining (83, 40.7%) were male. Regarding co-morbidities it was found that each 115 (56.4%) patients were hypertensive and diabetic. Thirty five (16.2%) had ischemic heart disease; 3(1.5%) had congestive cardiac failure and 2(1.0%) had asthma. One (0.5%) patient has atrial fibrillation. In case of 160(78.4%) RT-PCR confirmed patients with COVID-19, chest HRCT was found positive and in 44(21.6%) it was found negative. Among the positive cases mild (7 or less) chest HRCT score was found in 26(12.7%) patients; moderate (8-17) score was found in highest number of patients (128, 62.7%) and severe (18 or more) chest HRCT score was found in 6(2.9%) patients with COVID-19. Chi-square test was carried out to assess the relation of chest HRCT scores with age group, sex, troponin-I, D-Dimer and clinical outcomes within CCU but statistically significant relation was not found (p>0.05). The negative scans were highest (20, 9.8%) in the age group of 41-60 years. Mild, moderate and severe chest HRCT scores was found highest in the age group of 61-80 years (13, 6.4%; 51, 25.0% and 5, 2.5% respectively) (p=0.508). Chest HRCT scans were negative in 18(8.8%) male and 26(12.7%) female. Mild scores were equally distributed between each sex i.e. male 13(6.4%) and female 13(6.4%). Both moderate and severe scores were found more in female (77, 37.7% and 5, 2.5% respectively) than male (51, 25.0% and 1, 0.5% respectively) (p=0.492). Negative chest HRCT scans, mild, moderate and severe scores-all were found more in patients with elevated D-Dimer (p=0.194). Among 204 patients one (0.5%) died in the CCU who had mild score of chest HRCT (p=0.076) but highly elevated Troponin-I (21.70ng/mL). Chest HRCT was found positive among 78.4% of patients with COVID-19 confirmed by RT-PCR. Chest HRCT can help physicians to detect suspected cases and to assess the severity and outcome of the disease. However, further research is recommended to clarify the role of chest HRCT in assessing severity of COVID-19 and prediction of prognosis.

Candida glabrata infection of a pancreatic pseudocyst in a COVID-19 patient: A case report and review of the literature

Introduction

Pancreatic pseudocysts remain a feared complication of acute or chronic pancreatitis and are often characterized by collections of fluids due to underlying damage to the pancreatic ducts, culminating in a walled-off region bereft of an epithelial layer but surrounded by granulation tissue. While fungal infections of pancreatic pseudocysts are rarely encountered, candida albicans remains the most frequently implicated organism.

Case presentation

A 55-year-old male presented with pain in the left-hypochondriac region, accompanied by non-bilious emesis and nausea. Interestingly, the patient also tested positive for a COVID-19 infection. Investigative workup divulged enhancing pancreatic walls with a radiologic impression consistent with a pancreatic pseudocyst. An ultrasound-guided external drainage was performed; the drainage was conducted unremarkably, with the resultant fluid collection revealing the presence of Candida Glabrata. The patient was commenced on antifungal therapy and continues to do well to date.

Discussion

Infectious ailments of pancreatic pseudocysts remain a widely known complication of acute pancreatitis. While it is rare, fungal infection is a crucial consideration for patients with pancreatic pseudocysts, especially in the context of a lack of an adequate response to antibiotics, deterioration, comorbidities, and immunocompromised states.

Conclusion

Rapid identification of the microbe responsible for pancreatic pseudocyst infection is vital for time-sensitive treatment and a more rapid recovery, curbing associated morbidity and mortality.

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Fungal infections of pancreatic pseudocysts remain a rare but well-characterized complication, culminating in significant morbidity and mortality.

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Telltale signs include unresponsiveness to antibiotics and worsening clinical symptoms.

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Rapid identification of the responsible microbe is vital for time-sensitive treatment and a more rapid recovery.

Crack Initiation Mechanism and Life Prediction of Ti60 Titanium Alloy Considering Stress Ratios Effect in Very High Cycle Fatigue Regime

Ultrasonic fatigue tests were performed on Ti60 titanium alloy up to a very high cycle fatigue (VHCF) regime at various stress ratios to investigate the characteristics. The S-N curves showed continuous declining trends with fatigue limits of 400, 144 and 130 MPa at 10⁹ cycles corresponding to stress ratios of R = −1, 0.1 and 0.3, respectively. Fatigue cracks found to be initiated from the subsurface of the specimens in the VHCF regime, especially at high stress ratios. Two modified fatigue life prediction models based on fatigue crack initiation mechanisms for Ti60 titanium alloy in the VHCF regime were developed which showed good agreement with the experimental data.

Hemodialysis Catheter-Related Infections: Incidence in Temporary Catheters locked with Vancomycin and Heparin vs. Heparin-only

Background: The increasing incidence of end stage renal disease (ESRD) patients initiating hemodialysis (HD) through a temporary HD catheter has caused the rise in catheter related infections and associated morbidity and mortality. An antibiotic lock solution (ALS) for the prevention of catheter-related bacteraemia is a promising strategy. The present randomized control study has evaluated the efficacy and safety of vancomycin as an ALS in 54 patients who required temporary double lumen catheters for HD. Methods: The patients were randomized to receive either (A) an ALS (vancomycin 5 mg/ml + heparin 5000 IU/ml) – group A; or (B) unfractionated heparin (5000 IU/ml) alone as a catheter lock control – group B. The study duration was of three months and was conducted at the Department of Nephrology, PIMS, Islamabad. Results: The primary endpoint of the study was catheter related blood stream infection (CRBSI). The vancomycin group (A) had one episode of infection (CRBSI rate = 1.23/1000 days) compared with six episodes in the heparin-locked control group (B) (CRBSI rate = 8.55/1000 days). Mean catheter survival was significantly (p<0.05) more in group A (30.48 ± 5.7days) compared to group B (26 ± 6.5 days). No thrombotic episodes or side effects were recorded. Conclusion: Vancomycin appeared to be a safe and effective ALS, preventing CRBSI and increasing survival of catheter in HD patients.

Tracking Side Effects of the COVID-19 Vaccine in Mymensingh District of Bangladesh

The Coronavirus disease 2019 (COVID-19) has turned into a worldwide human tragedy and economic devastation. There had an intensive search for an effective drug against the coronavirus but not led to any breakthrough agents. Only one choice was left namely an effective and safe vaccine. Many people are ambivalent regarding corona vaccines because they also fear possible side effects from vaccination. This study was designed to track the side effects after first and second dose of the Oxford-AstraZeneca vaccines used in Mymensingh district of Bangladesh. This cross-sectional descriptive type of observational study was conducted in Mymensingh Medical College, Mymensingh, Bangladesh during the period of five months from 1 February, 2021 to 30 June, 2021 among 293 purposively selected vaccine recipients who received two doses of the Oxford-AstraZeneca vaccines. Data were collected by face to face interview of the selected vaccine recipients using a semi-structured questionnaire. Data were inputted into SPSS version 26.0. Qualitative data were summarized by percentage and quantitative data were summarized by mean and standard deviation. Necessary bivariate and multivariate analysis was done. Mean age of the respondents was 40.3 years with a standard deviation of ±8.7 years. Among the vaccine recipients female were 159(54.3%) and male were 134(45.7%). The most of the vaccine recipients were graduate and master 256(87.3%) and more than half of the vaccine recipients (156, 53.2%) were government service holder. The most of the vaccine recipients (242, 86.0%) were from urban area and 263(89.8%) vaccine recipients were non-smoker. Sixty eight (23.2%) of the vaccine recipients had different types of co-morbidities. It was found that 217(74.1%) vaccine recipients had side effects after first dose while 162(55.3%) had side effects after second dose. The difference in occurrence of side effects of first and second dose was statistically highly significant (p<0.001). Pain on the injection site was present in 172(58.7%) vaccine recipients after first dose and in 142 (48.5%) after second dose. Fever was prevalent in 98 (33.4%) after first dose and in 61 (20.8) after second dose. Headache was in 61(20.8%) and in 22(7.5%) after first and second dose respectively. Thirty one (10.6%) vaccine recipients had loose motion after first dose and 26(8.9%) had this after second dose. First dose of vaccination caused nausea in 28(9.6%) and second dose caused it in 16(5.5%) vaccine recipients. Joint pain was prevalent in 24(8.2%) after first dose and in 15(5.1%) after second dose. Rash was present in 9(3.1%) and in 3(1.0%) after first and second dose respectively. Cough was present in 5(1.7%) after first dose and in 2(0.7%) after second dose. Each 2(0.7%) had history of fainting and bodyache and 1(0.3%) reported intense weakness after first dose only. Side effects of first dose of AstraZeneca vaccine were more prevalent in female (124, 78.0%) than male (93, 69.4%). The side effects of second dose of AstraZeneca vaccine were also more prevalent in female (103, 64.8%) than male (59, 44.0%). The study results revealed that 217(74.1%) vaccine recipients had side effects after first dose while 162(55.3%) had side effects on second dose of the Oxford-AstraZeneca vaccine. Commonly experienced side effects were pain in the injection site, fever, headache, diarrhoea and joint pain. Most of the people tolerated these side effects and did not use any medicine.

Look, but to the left: A rare case of gallbladder sinistroposition and comprehensive literature review

Left-sided gallbladder (LSGB) is a rare anatomic variation that, while benign in the context of its transposition, is of significant intraoperative importance. Due to its association with other anatomic anomalies involving key structures in the hepatobiliary system, discovering it intraoperatively as opposed to preoperatively suddenly increases the difficulty of a gallbladder procedure.

1)

Left-sided gallbladder (LSGB) is a rare anatomic variation that, while benign in the context of its transposition, is of significant intraoperative importance.

2)

Although laparoscopic cholecystectomy of a LSGB is safe, it is associated with higher risk of complications such as common bile duct injury.

3)

Most cases of a LSGB are diagnosed intraoperatively, and this sudden discovery during the procedure can increase the difficulty, duration, and stress of the procedure due to the other potential anatomic anomalies that LSGB is associated with in the hepatobiliary system.

Measurement of brain simulant strains in head surrogate under impact loading

Impact-induced traumatic brain injury (TBI) is a major source of disability and mortality. Knowledge of brain strains during impact (accelerative) loading is critical for the overall management of TBI, including the development of injury thresholds, personal protective equipment, and validation of computational models. Despite these needs, the current understanding of brain strains in humans or humanlike surrogates is limited, especially for injury causing loading magnitudes. Toward this end, we measured full-field, in-plane (2D) strains in a brain simulant using the hemispherical head surrogate. The hemispherical head was mounted on the Hybrid-III neck and subjected to impact loading using a linear impactor system. The resulting head kinematics was measured using a triaxial accelerometer and angular rate sensors. Dynamic, 2D strains in a brain simulant were obtained using high-speed imaging and digital image correlation. Concurrent finite element (FE) simulations of the experiment were also performed to gain additional insights. The role of stiff membranes of the head was also studied using experiments. Our results suggest that rotational modes dominate the response of the brain simulant. The wave propagation in the brain simulant as a result of impact has a timescale of ~100 ms. We obtain peak strains of ~20%, ~40%, ~60% for peak rotational accelerations of ~838, ~5170, ~11,860 rad/s², respectively. Further, peak strains in cortical regions are higher than subcortical regions by up to ~70%. The agreement between the experiments and FE simulations is reasonable in terms of spatiotemporal evolution of strain pattern and peak strain magnitudes. Experiments with the addition of falx and tentorium indicate significant strain concentration (up to 115%) in the brain simulant near the interface of falx or tentorium and brain simulant. Overall, this work provides important insights into the biomechanics of strain in the brain simulant during impact loading.

Norovirus Gastroenteritis Outbreaks, Genomic Diversity and Evolution: An Overview

Norovirus, often called winter vomiting bug, is the most common cause of outbreaks of acute gastroenteritis in all age groups all over the world. It was discovered in 1972; belong to the genus Norovirus in the family Caliciviridae. Based on genomic organization and phylogenetic analysis, the family Caliciviridae is divided into four genera- Norovirus, Sapovirus, Vesivirus and Lagovirus. The aim of this review article was to find out the present status of prevalence and evolution of norovirus strains in developed and developing countries. In this article various literature on norovirus from different countries was reviewed. The detection of norovirus in the lower middle income countries (LMIC) was reported 15% in cases and 8% in controls during 1997 to 2018. On the other hand, detection rate of norovirus in low income countries (LIC) was 11% in cases and 9% in controls during the same period. Overall detection rate of norovirus was 14% in LIMC and 8% in LIC during 1997 to 2018. Noroviruses are divided genetically into seven different type of Geno groups namely GI, GII, GIII, GIV, GV, GVI and GVII which are further classified into different genetic clusters or genotypes. For example, Geno group II, the most prevalent human Geno group, presently contains 19 genotypes. Among the genogroups I, II and IV infect humans, on the other hand genogroup III infects bovine species and genogroup V was isolated from mice. Several new noroviruses were reported and the number of genogroups increased to 10 (GI-GX) and the number of genotypes expanded to 49: 9 GI, 27 GII, 3 GIII, 2 GIV, 2 GV, 2GVI, 1 GVII, 1 GVIII, 1 GIX, 1 GX. Noroviruses are spread directly from individual to individual as well as indirectly via contaminated food and water. They are highly contagious, and around twenty virus particles can cause an infection. This virus usually exhibits winter seasonality. The global norovirus prevalence in under-5 years, ≥5 years and mixed age was similar (16% - 19%). Norovirus infection is characterized by diarrhea, vomiting, fever, headache and stomach pain. It may be complicated with dehydration and electrolyte imbalance. Gastroenteritis develops 12 to 48 hours after exposure and recovery typically occurs within 1 to 3 days. There is no specific treatment of norovirus gastroenteritis. Prevention includes proper hand washing and cleaning or disinfection of contaminated surfaces. Various genotypes of norovirus may be circulating around the world and can emerge either nationally or globally. In this overview, general characteristics of norovirus, current status of genomic diversity and classification, recent status of norovirus gastroenteritis outbreaks in the developed and developing countries is outlined for comprehensive understanding of the present status of prevalence and evolution of norovirus strains to develop strategies for prevention and control of norovirus infection in human.

Proportion of Low Back Pain among Physicians Working in a Tertiary Level Hospital of Bangladesh

Low back pain (LBP) is a common problem and is an important public health issue. A major proportion of LBP is concomitant with prolong and repetitive awkward postures, related with occupation like miners, health workers and professional drivers. Physicians are exposed to a wide range of occupational risk factors which results in LBP. A variety of occupational and personal factors are responsible for increased risk of low back pain among physicians. This cross sectional descriptive study was carried out at Mymensingh Medical College Hospital during the period of January 2018 to June 2018, to estimate the proportion of LBP among physicians. Data were collected from purposively selected 102 physicians of different levels by face to face interview using a case record form. Informed written consent of participants was taken prior to interview. Data were analyzed by using SPSS version 20.0. The study results revealed that majority (60.8%) of the physicians were in the age group of 31-50 years. Mean age of the physicians was 49.9 years with a standard deviation (SD) of 3.61 years. More than three fourth (79, 77.5%) of the physicians were male and 23(22.5%) were female. Out of 102 physicians more than two third (70, 68.6%) had LBP while 32(31.4%) did not have any LBP. Proportion of low back pain among physician was 68.6%. Low back pain was found in all age group. Among the physicians having low back pain, 55(78.6%) were male and 15(21.4%) were female. Among 102 physicians, 45(44.1%) had different types of comorbidities while 57(55.9%) did not have any comorbidities. Among the co-morbidities HTN, DM, Dyslipidemia, CHD and asthma were common. Results of the study concluded that 68.6% physicians had low back pain. Physicians of age group 31-60 years (88.5%) and male (78.6%) experienced LBP more. Further multi-centric large scale case control study is recommended to determine the risk factors of LBP among physicians of Bangladesh.

Hyponatraemia in Adult Patients with Pneumonia in a Medical College Hospital of Bangladesh

Pneumonia is an acute on chronic infection involving the pulmonary parenchyma. Most cases are caused by microbial pathogens usually bacteria or viruses and less often fungi or parasites. Hyponatraemia on admission is associated with greater risk of death and increased length of hospital stays. Hyponatraemia is usually related to severe disease and specially occur in old aged people. This study is designed to identify proportion of hyponatraemia in patients with pneumonia and to determine the association of hyponatraemia with the severity of pneumonia. The cross sectional descriptive study was carried out at Mymensingh Medical College Hospital during the period of January 2018 to December 2018. Data were collected from purposively selected 73 admitted patients with pneumonia by interview, clinical examination and laboratory investigations using a pre-tested case record form. Data were analyzed by using SPSS version 20.0. Quantitative variables were summarized by mean and standard deviation. On the other hand qualitative variables were summarized by percentage. Necessary bivariate analysis was done. Majority (68.5%) of the patients were in the age group of 21 years to 50 years. Mean age of the patients was 41.9 years with a SD of 17.4 years. More than three fourth (57, 78.1%) were male and 16(21.9%) were female. More than two third (51, 69.9%) of the patients were smoker and 45(61.6%) was abuse of chewable tobacco or ghul. All the patients had fever (73, 100.0%); 70(95.9%) had cough, 50(68.5%) had chest pain, 10(13.5%) had respiratory distress and 8(11.0%) had haemoptysis. Vomiting was present in 9(12.3%) patients and 3(4.1%) had impaired level of consciousness. About one third of patients (32, 43.8%) had comorbidities. On chest X-ray consolidation was found in 59(80.8%) of patients with pneumonia. In 35(47.9%) patients serum Na⁺ level was normal and 38(52.1%) had different level of hyponatraemia; 26(35.6%) patients had mild hyponatraemia, 7(9.6%) had moderate hyponatraemia and 5(6.8%) had severe hyponatraemia. Majority (58, 79.5%) had lobar pneumonia and 71(97.3%) had community acquired pneumonia. Severity of pneumonia was assessed according to CURB 65. Less than half (35, 47.9%) of the patients had mild (score 0-1) pneumonia; 33(45.2%) had moderate (score 2) pneumonia and 5(6.8%) patients had severe (score ≥3) pneumonia. Average duration of hospital stay was 6.5±3.2 days. Maximum (69, 94.5%) patients were cured after treatment. In case of 3(4.1%) patients pneumonia was unresolved. One (1.4%) patients died due to pneumonia. In this study hyponatraemia was not associated with the severity of pneumonia (p>0.05) and outcome on discharge from the hospital (p>0.05). Difference in mean duration of hospital stay between patients of pneumonia with or without hyponatraemia was not significant (>0.05). The study results revealed that 52.1% patients with pneumonia developed different level of hyponatraemia. Hyponatraemia was not associated with the severity of pneumonia, duration of hospital stay and outcome of pneumonia.

Association of Low Thyroid Hormone with Migraine Headache

This cross sectional comparative study was done to investigate the association between low thyroid hormone level and migraine headache in adults patients. The study was conducted in Mymensingh Medical College Hospital, a tertiary level hospital of Bangladesh. Study period was from November 2017 to April 2018. The study subjects consisted of 50 patients with migraine headache as case, compared with 50 patients of headache other than migraine as control, seen in Neurology out patient department (OPD). Thyroid function test was performed by new automated immuno-chemiluminometric assay. Mean age was 29.80±9.87 years in migraine group and 34.18±11.82 years in non migraine group. Male female ratio was 1:2.3 and 1:1.7 in two groups. Level of TSH was significantly higher in migraine patients (3.52±2.53 vs. 2.25±2.13) than other headache patients (p=0.008). Thyroid disorder especially subclinical hypothyroidism was significantly higher (28% vs. 08%) in migraineurs than non migraineurs (p=0.032). No significant relationship was found between thyroid hormone level and headache characteristics of migraine patients (p>0.05). Migraine headache is associated with low thyroid hormone and thyroid disorder can be considered as comorbidity of migraine headache.

Ovarian Carcinoma Uncloaked by Hydatidosis: An Intraoperative Epiphany

Hydatidosis is an infective ailment that is caused by the parasite echinococcus granulosus. The parasitic infection typically produces cysts filled with excessive quantity of fluid and most commonly afflicts the liver. While secondary hydatidosis remains exceedingly rare, cases of hydatidosis in organs such as the ovaries and the fallopian tubes have been documented in the literature. In such instances, the patients present with a vague constellation of symptoms, including abdominal distension and vague abdominal pain. Herein, we elucidate the case of a female patient who presented with massive abdominal swelling on a background history significant for hydatid liver disease. Intraoperative findings included a left adnexal mass, which was eventually established to be an ovarian adenocarcinoma coexisting with secondary ovarian hydatidosis. 

Non-familial Juvenile Polyposis Syndrome Presenting as Rectal Prolapse: An Unusual Presentation of a Rare Disease

Juvenile polyposis syndrome is a rare inherited disorder that afflicts the gastrointestinal system. It usually occurs as a result of gene mutations; to date, several gene mutations, including those involving the bone morphogenetic protein receptor type IA (BMPR1A) gene, have been implicated in heralding the onset of the ailment. The disease is characterized by the infiltration of the gastrointestinal system with numerous hamartomas, which are predominantly benign. However, if left untreated, the hamartomas can undergo malignant transformations. Timely diagnosis and prompt surgical intervention are, therefore, imperative in portending favorable disease outcomes. We hereby delineate the case of a patient who presented with rectal prolapse and bleeding per rectum. Further diagnostic workup revealed the presence of polyps throughout the colon and the rectum, thereby insinuating a diagnosis of non-familial juvenile polyposis syndrome. The patient was managed through open surgery and continues to do well with no indications of disease recurrence. 

Mucoepidermoid Carcinoma of the Parotid Gland Presenting as a Fungating Exophytic Mass: A Surgical Challenge Rooted in Extensive Nerve Encasement

Parotid glands, which are predominantly composed of serous acini, are the largest salivary glands in the human body. Mucoepidermoid carcinoma (MEC) of the parotid gland is the most common parotid tumour that routinely presents as a painless, fixed mass below the ears. However, its presentation as a fungating mass remains exceedingly rare. Due to the intimate anatomical relationship between the parotid gland and the facial nerve, parotid malignancies can culminate in facial nerve palsy, posing an onerous surgical challenge. In this paper, we chronicle the case of a male who presented with a fungating/exophytic mass and facial nerve weakness. A superficial parotidectomy was performed, and the eventual histopathological workup divulged an advanced mucoepidermoid parotid carcinoma entirely encasing the marginal mandibular nerve. Consequently, the marginal mandibular nerve was sacrificed, alluding to the remarkable surgical challenge encountered. Clinically, this manifested as an impairment of the motor function in the patient's left lower lip. 

Effect of Post Weld Heat Treatment on the Microstructure and Electrochemical Characteristics of Dissimilar Material Welded by Butter Method

In the present study, the effect of post weld heat treatment (PWHT) on the microstructure and corrosion kinetics of butter welded Nickel Alloy 617 and 12Cr steel was investigated. Buttering was carried out on the 12Cr side with the Thyssen 617 filler metal. Furthermore, post weld heat treatment (PWHT) was conducted at 730 °C with a holding time of 4 h followed by furnace cooling. Optical Microscopy (OM) was conducted to study the microstructural evolution in dissimilar material welding as a result of PWHT. Moreover, Scanning Electron Microscopy with energy dispersive spectroscopy (SEM-EDS) was employed to determine the elemental concentrations in all important regions of the butter weld before and after the PWHT. In addition, the effect of PWHT on the corrosion kinetics of the butter weld was also investigated by potentiodynamic polarization measurements in 5 wt.% NaCl + 0.5 wt.% CH₃COOH electrolyte at room temperature, 30 °C, 50 °C and 70 °C. The corrosion activation parameters were also determined for both the samples by using Arrhenius plots. The results revealed the higher susceptibility of corrosion of the butter weld after PWHT, which was attributed to the reduced Cr content in the heat affected zone of the 12Cr region due to the sensitization effect of the heat treatment, resulting in higher corrosion rates.

Residual Breast Sarcoma Left to Heal by Secondary Intention Following Wide Local Excision: An Unorthodox Approach to a Rare Malignancy

Breast sarcomas remain a rare malignancy and are noted to portend a particularly dismal prognosis. Due to their high rates of recurrence, a surgical excision with negative margins remains the preferred treatment modality. Nevertheless, their sparse prevalence often poses a diagnostic conundrum. In this report, we chronicle the case of a 46-year-old female with a recurrent breast sarcoma that was treated with wide local excision. Interestingly, no flap reconstruction, skin graft surgery, or primary wound closure was performed, and the resultant wound was left to heal by secondary intention. The patient continues to do well to date, with no postoperative complications.

Primary hepatic neuroendocrine tumour masquerading as a giant haemangioma: an unusual presentation of a rare disease

Primary hepatic neuroendocrine tumour is an exceedingly rare entity. We hereby delineate the case of a 45-year-old Balti descent woman who hails from a land-locked village situated in the foothills of the Pakistani Himalayas. The patient presented to our medical centre with a hepatic mass. She underwent extensive diagnostic workup. The consistent findings of an abdominal CT scan, coupled with her clinical history, insinuated a preoperative diagnosis of atypical hepatic haemangioma. After a detailed discussion in a multidisciplinary meeting, a standard right hemihepatectomy was performed. She had an uneventful postoperative recovery and was discharged in stable condition after 1 week. Surprisingly, pathological examination and immunohistochemistry of the resected specimen divulged the diagnosis of a grade II primary hepatic neuroendocrine tumour. Her somatostatin-receptor scintigraphy and Gallium-68 DOTATATE positron emission tomography scan excluded residual hepatic or additional body lesions. Regular follow-ups over the past 4 years demonstrated unremarkable radiological findings with no recurrence to date.

Checklist of the dragonflies and damselflies (Insecta: Odonata) of Bangladesh, Bhutan, India, Nepal, Pakistan and Sri Lanka

A checklist of the dragonflies and damselflies occurring in Bangladesh, Bhutan, India (including Andaman and Nicobar Islands), Nepal, Pakistan and Sri Lanka is presented. In total 588 (including 559 full species) taxa are known to occur in the region of which 251 taxa (species subspecies) are single country endemics. Recent taxonomic changes relevant to the area are summarized. Sixteen taxa are synonymized and a checklist of all synonyms established since 1950 is provided. Information is given on available larval descriptions including a list of genera present in the region for which no larvae have yet been described. Numerous species occurring in the area are still poorly known and a list of genera for which a revision is urgently needed is provided.                The following new synonyms are established: Calicnemia sudhaae Mitra, 1994 = Calicnemia imitans Lieftinck, 1948 syn. nov.; Ceriagrion fallax cerinomelas Lieftinck, 1927 = Ceriagrion fallax Ris, 1914 syn. nov.; Ceriagrion fallax pendleburyi Laidlaw, 1931 = Ceriagrion fallax Ris, 1914 syn. nov.; Coenagrion kashmirus Chowdhary Das, 1975 = Ischnura forcipata Morton, 1907 syn. nov.; Enallagma insula Fraser, 1920 = Aciagrion occidentale Laidlaw, 1919 syn. nov.; Himalagrion pithoragarhicum Sahni, 1964 = Ceriagrion fallax Ris, 1914 syn. nov.; Ischnura bhimtalensis Sahni, 1965 = Ischnura rubilio Selys, 1876 syn. nov.; Onychargia indica Sahni, 1964 = Paracercion calamorum (Ris, 1916) syn. nov.; Anaciaeschna kashmirense Singh Baijal, 1954 = Anaciaeschna martini (Selys, 1897) syn. nov.; Cyclogomphus vesiculosus Selys, 1854 = Cyclogomphus ypsilon Selys, 1954 syn. nov.; Chlorogomphus brittoi Navás, 1934 = Chlorogomphus xanthoptera (Fraser, 1919) syn. nov.; Hylaeothemis indica Fraser, 1946 = Hylaeothemis apicalis Fraser, 1924 syn. nov.; Sympetrum durum Bartenef, 1916 = Sympetrum striolatum commixtum Selys, 1884 syn. nov.; Sympetrum himalayanum Navás, 1934 = Sympetrum hypomelas (Selys, 1884) syn. nov.; Sympetrum haematoneura Fraser, 1924 = Sympetrum speciosum Oguma, 1915 syn. nov.; Sympetrum speciosum taiwanum Asahina, 1951 = Sympetrum speciosum Oguma, 1915 syn. nov.                In addition, Periaeschna lebasi Navás, 1930 is regarded a nomen nudum. The following new combinations are proposed: Onychogomphus acinaces Laidlaw, 1922 is transferred to the genus Melligomphus Chao, 1990 resulting in Melligomphus acinaces (Laidlaw, 1922) comb. nov. Onychogomphus saundersii Selys, 1854 is transferred to the genus Nychogomphus Carle, 1986 resulting in Nychogomphus saundersii (Selys, 1854) comb. nov..

Early Postoperative Outcomes of Breast Cancer Surgery in a Developing Country

Background Breast cancer remains the most common cause of cancer related mortality amongst women in Pakistan. Postoperative complications can demoralize the patients and potentially delay adjuvant treatment, leading to adverse outcomes. The overarching aim of the study is to delineate the early postoperative outcomes of breast cancer surgery in Pakistan. Materials and Methods A retrospective study involving patients who underwent breast cancer surgery from June 2016 to December 2019 was conducted. Perioperative morbidities (30 days) were evaluated and documented. The results obtained were analyzed using the SPSS 23 software (IBM Corporation, Armonk, NY). Results A total of 94 patients were included in the study, with the mean age of 50±12.8 years. Breast conserving surgery was performed in 32% (n=31) of the patients, while the remaining 68% (n=63) underwent modified radical mastectomy. The most common complications were seroma formation, flap necrosis and hematoma formation and were observed in 5.3% (n=5), 4.3% (n=4) and 3.2% (n=3) of the patients, respectively. Conclusion Early postoperative complications can delay the commencement of adjuvant systemic therapy required for further management of breast cancer. These complications elicit equally grave consequences for patients undergoing breast conserving surgery and modified radical mastectomy.

Clinical and Pathological Characteristics of Soft Tissue Sarcomas: A Retrospective Study From a Developing Country

Introduction Soft tissue sarcomas remain an exceedingly rare malignancy. While soft tissue sarcomas boast a high mortality rate, their characteristics and behavior patterns are poorly understood. This study aims to evaluate the various aspects that pertain to soft tissue sarcomas, including their histology, tumor characteristics, survival rates, and therapeutic modalities. Methods A retrospective study analyzing the data from 19 patients presenting over four years with a histologically confirmed diagnosis of soft tissue sarcomas was conducted. The patients were studied for various parameters, including tumor site and the particular pathological subtypes. The data obtained were analyzed using the SPSS 23.0 statistical software (IBM Corporation, Armonk, NY), and the results were then tabulated. Results A total of 19 patients with a confirmed diagnosis of a soft tissue sarcoma were included in the study. The mean age of the patients included was 45.32 ± 16.88 years. Wide local excision was the most common surgical procedure employed for the resection of these tumors. Within the cohort, the mortality rate was noted to hover at 10.52%. Gastrointestinal stromal tumors were observed in 21% of the patients and were therefore the most common histological subtype. Of the patients included, 42.10% required blood transfusion during the perioperative time. Most of the tumors were noted to be intermediate grade, with high-grade tumors observed in 26.3% of the cases. Conclusion Soft tissue sarcomas remain a rare but potent cause of death in developing countries. The diversity of the tissues that they afflict renders their prompt detection a diagnostic challenge. A meticulous exploration of the various characteristics honed by soft tissue sarcomas, such as the particular histological subtype and the associated mortality rates, can better elucidate the prognosis and the eventual disease outcomes.

The Spectrum of Gallbladder Histopathology at a Tertiary Hospital in a Developing Country: A Retrospective Study

Background

Affections of the gallbladder remain exceedingly ubiquitous and often warrant surgical intervention. The histopathological patterns represent a spectrum, ranging from cholecystitis to gallbladder carcinoma. The present study aims to delineate the occurrence of various gallbladder histopathologies in a tertiary care hospital in Pakistan.

Methods

A retrospective study was conducted at Maroof International Hospital, Islamabad, Pakistan. Histopathological records of 442 gallbladder specimens obtained from cholecystectomy were analysed. The prevalence of various histopathological outcomes was assessed. The data were eventually analysed using the SPSS 23.0 software (Armonk, NY: IBM Corp.). Thereafter, the distribution of various gallbladder histopathologies was tabulated across gender. 

Results

Of the 442 patients included, 330 were females and 112 were males, with the mean age hovering at 45.77±14.65 years. The most common histopathological findings were chronic cholecystitis and cholesterolosis, observed in 78.6% and 32.8% of the patients, respectively. While only one case of gallbladder adenocarcinoma was observed, multiple specimens divulged premalignant lesions including reactive atypia and intestinal metaplasia.

Conclusions

Diseases of the gallbladder often mandate prompt surgical intervention. Of these, chronic cholecystitis, which is an established risk factor for gallbladder carcinoma, is exceedingly common. The employment of histopathological techniques remains imperative in the detection of premalignant and malignant lesions that might otherwise evade macroscopic detection and thus progress to adenocarcinoma.

Urachal Sinus Complicated by an Umbilical Abscess

The urachal sinus is a vestigial remnant that ensues in the aftermath of incomplete obliteration of the embryonic urachus. Urachal sinuses often remain asymptomatic, being discovered incidentally in instances where they are complicated with a superimposed infection or abscess. Due to their rare occurrence in adults, urachal sinuses are rarely included in the list of differential diagnosis surrounding umbilical pain in adult patients. We hereby delineate a unique case of a urachal sinus in a 26-year-old male patient. Due to the presence of an abscess in a hirsute male, a presumptive diagnosis of an umbilical pilonidal sinus was suspected. However, further diagnostic workup divulged an unequivocal diagnosis of a urachal sinus complicated by an abscess formation.

Gone but Not Forgotten: Ovarian Metastasis From a Colon Carcinoma in a 19-Year-Old Female

Ovarian tumors occurring secondarily to metastatic colorectal carcinoma remain a rare occurrence. Since ovarian tumors remain predominantly asymptomatic in the initial stages, they are often diagnosed incidentally. The vague, non-specific symptoms elicited by a secondary ovarian carcinoma, coupled with a histopathology remarkably similar to that evoked by primary ovarian tumors, render its ascertainment a diagnostic challenge. We hereby delineate an interesting case of a metachronous ovarian adenocarcinoma in a 19-year-old patient with a prior medical history significant for colorectal carcinoma treated with hemicolectomy. Subsequent diagnostic workup divulged a mass in her left adnexal region, which was ultimately diagnosed as a metastatic colon adenocarcinoma to the ovary. Unfortunately, the patient succumbed to the aggressive malignancy and did not survive. We therefore aim to accentuate the diagnostic and therapeutic dilemmas fomented by ovarian adenocarcinomas that arise secondarily to primary colorectal cancers.

A Wolf in Sheep's Clothing: High-Grade Ovarian Endometrioid Carcinoma Masquerading as Pregnancy

Ovarian carcinomas remain a cause of soaring mortality in the general population. Due to their anatomical location in the pelvis, malignant ovarian transformations often evade early detection, reaching astronomical proportions before eliciting clinically obvious symptoms. Epithelial ovarian carcinomas encompass a concoction of tumours derived from the ovarian surface epithelium, and are further subdivided into several subtypes ascertained primarily through histopathological workup. Of these subtypes, endometrioid ovarian carcinoma is noted to be a particularly well-differentiated tumour that often presents early in the disease course. Contrarily, advanced-stage tumours manifest a vague constellation of symptoms, such as abdominal distension and bloating, resulting in dilatory tumour detection. We hereby delineate an interesting case of a high-grade ovarian endometrioid carcinoma that, due to its vague presenting symptoms and a concomitant history of amenorrhea, was erroneously regarded as pregnancy. Subsequent diagnostic workup divulged a bilateral endometrioid ovarian carcinoma with associated serosal involvement and extensive lymph-vascular invasion.