Kowsar Hospital

This case report describes management of refractory thyroid eye disease in 2 patients using the Janus kinase 1/3 inhibitor tofacitinib.

Background: Cardiovascular diseases (CVDs), particularly coronary artery disease (CAD), remain a leading cause of global mortality. While coronary artery bypass grafting (CABG) is a standard treatment, patients with diffuse CAD often require adjunctive techniques to achieve complete revascularization. Objectives: Coronary endarterectomy (CE) has emerged as a valuable adjunct to CABG, aiming to improve blood flow in severely diseased arteries. This study aimed to evaluate the clinical outcomes, changes in blood biomarkers, and postoperative complications in patients undergoing adjunctive CE with CABG. Methods: This retrospective cohort study included 50 patients who underwent CE with CABG between 2012 and 2021. We extracted data on demographics, comorbidities, pre- and postoperative biomarkers, ejection fraction (EF), length of ICU stay, number of grafts, endarterectomized vessel, and postoperative outcomes from medical records. Data were analyzed using descriptive statistics, chi-square tests, independent samples t-tests, and Mann-Whitney U tests. Statistical significance was set at P < 0.05. Results: The mean ± SD age of patients was 63.96 ± 9.35 years, with 66% being male. Hypertension (HTN) was the most prevalent comorbidity (66%). The mean ± SD hospital stay was 147.12 ± 51.51 hours. A significant decrease in mean EF was observed postoperatively (48% ± 8.77 to 44% ± 9.28, P = 0.002). Postoperatively, significant increases were noted in white blood cell (WBC) counts, blood urea nitrogen (BUN), creatinine, prothrombin time (PT), partial thromboplastin time (PTT), and international normalized ratio (INR; all P < 0.001, except creatinine P = 0.002), while hemoglobin (Hb) levels significantly decreased (P < 0.001). The majority of patients (46%) received four grafts, and the left anterior descending (LAD) artery was the most common site for endarterectomy (44%). The in-hospital mortality rate was 2%. Acute kidney injury (AKI) was the most frequent complication (38%), followed by dyspnea (28%) and pulmonary edema (20%). Conclusions: Adjunctive CE was associated with a low in-hospital mortality rate and an acceptable complication profile, representing a viable surgical strategy for patients with diffuse CAD, particularly when complete revascularization is challenging. Further large-scale, multi-center prospective studies with long-term follow-up are warranted to validate these findings and explore the influence of specific patient characteristics on long-term outcomes.

BackgroundA common disorder among women during reproductive age is dysmenorrhea. It has a chronic cyclic nature and a positive association with psychological distress.AimThe aim of the present study was to determine the effect of desensitization based on eye movement desensitization and reprocessing (EMDR) on dysmenorrhea intensity.MethodsA randomized controlled trial comprising 88 female university students randomly divided in two groups of intervention (EMDR therapy for two 60-min sessions, and control) was conducted based on the balanced blocks randomization method. The main outcome assessed was intensity of dysmenorrhea. Other outcomes were menstrual pain duration, menstrual distress, and the need to take analgesics. All outcomes were assessed at three time points (before intervention, and one and two months after the intervention). Data were evaluated using analysis of variance for repeated measures, Cochran test, and McNemar test (at p < .05).ResultsRepeated measures ANOVA–ANCOVA analysis indicated that EMDR significantly reduced dysmenorrhea intensity in the intervention group compared to controls at both follow-ups (p < 0.001), with a large group-by-time interaction effect (F = 16.99, p < 0.001). Pain duration also decreased significantly at the second two-month follow-up (p = 0.003). Menstrual phase distress showed marked improvements post-intervention (p < 0.001). The need to take analgesics was also reduced for participants in EMDR group compared to control group (p < .001).ConclusionThese findings suggest EMDR is effective in alleviating key dysmenorrhea symptoms, particularly pain intensity, menstrual phase-specific distress, and the need to take analgesics.Trial registrationIranian Center of Clinical Trials registration with reference code of IRCT20180823040851N1 in 06-10-2018.

BackgroundMetabolic syndrome (MetS) is a multifactorial condition linked to increased risk of cardiovascular disease and type 2 diabetes. The Single-Point Insulin Sensitivity Estimator (SPISE), a non-invasive index calculated via 600 × HDL-C^0.185 / (TG^0.2 × BMI^1.338), offers a practical alternative. This systematic review and meta-analysis aim to evaluate the accuracy of SPISE as an indicator for MetS.MethodsWe conducted a systematic review and meta-analysis following PRISMA guidelines. We searched databases such as MEDLINE, Scopus, Web of Science, and Embase, focusing on studies evaluating SPISE's screening accuracy for MetS. Eligible studies were observational, reporting mean SPISE values and its predictive performance. Meta-analyses were performed using Hedges' g standardized mean differences (SMD) and pooled area under the curve (AUC) estimates.ResultsSeven studies comprising 12,919 participants were included, with an age range of 9.2 ± 2.1 to 52.4 ± 11.0. Individuals with MetS had significantly lower SPISE scores than controls (SMD = -0.94, 95% CI: -1.25 to -0.63). The pooled AUC for SPISE as a predictor of MetS was 0.86 (95% CI: 0.83 to 0.90), surpassing other insulin resistance indices like HOMA-IR and the triglyceride/HDL-C ratio. Meta-regression showed that systolic and diastolic blood pressure were potential sources of heterogeneity and age, gender, BMI, waist circumference, fasting blood glucose, triglyceride, and HDL did not contribute to heterogeneity.ConclusionsSPISE is a highly accurate and non-invasive tool for predicting MetS, potentially outperforming traditional indices like HOMA-IR. Its ease of use and precision make it a valuable clinical screening tool, especially in diverse populations.

Purpose:To determine the functional outcomes of chandelier-assisted scleral buckling (CSB) in rhegmatogenous retinal detachment (RRD) and compare them to standard scleral buckling (SSB).Methods:A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Searches were performed in PubMed, Scopus, Web of Knowledge, and Embase up to March 2024. Studies reporting functional outcomes, particularly best-corrected visual acuity (BCVA), after CSB were included. Risk of bias was assessed using standardized tools. Meta-analysis were conducted for BCVA improvement, change in BCVA (ΔBCVA), and operation time. Publication bias and heterogeneity were evaluated using funnel plots, Egger’s test, and I2 statistics.Results:A total of 27 studies were analyzed. Meta-analysis of 1258 eyes revealed significant BCVA improvement postoperatively (mean difference [MD]: −0.51; 95% confidence interval [CI]: −0.64 to −0.38; P < 0.001). Comparative analyses of six studies showed no significant difference in ΔBCVA or anatomical outcomes between CSB and SSB, but operation time was significantly shorter for CSB (MD: −18.87 min; 95% CI: −22.70 to −15.3; P < 0.001). Meta-regression identified macular detachment and preoperative BCVA as the only factors significantly associated with postoperative visual outcomes.Conclusions:CSB significantly improves BCVA and offers comparable functional and anatomical outcomes to SSB while reducing surgical duration. This approach mitigates the limitations of traditional scleral buckling, making it a viable and efficient option for managing RRD.

Background: To assess neonatal mortality, many validated scores have been developed. The modified sick neonatal score (MSNS) is an easy, less complex suitable for both term and preterm neonates. This study was conducted to predict mortality upon admission to a NICU using the MSNS score. Methods: An observational study was conducted in the Department of Neonatology, BSMMU, Dhaka, over a period of one year. Parameters for MSNS score were collected from data sheet. Outcome expressed as survived or expired. All data were analyzed using SPSS 20. To determine the cutoff value for predicting mortality, a receiver operating curve was generated. The cutoff score’s sensitivity, specificity, positive predictive value, and negative predictive value were calculated. Results: Among the enrolled 114 neonates, mean gestational age and mean birth weight were 34.22±3.10 weeks and 1967.87±752.33g respectively. About 75.4% neonates were &lt;2500 grams and 70.2% of babies were preterm. During the study period, two third (69.3%) baby survived. The mean MSNS among survived neonate was 11.77± 2.29 and in expired neonates was 9.66±2.32 which was statistically significant (p-&lt;0.01). The area under the ROC curve was 0.740 (95% CI: 0.645- 0.835). The optimal cutoff value obtained to predict mortality was 11.50. With this cutoff score the sensitivity and specificity were 80% and 58%. Positive predictive value and negative predictive value were 46% and 87% respectively. Conclusions: MSNS tools can be used to predict early mortality with early referrals and prompt treatment to reduce neonatal mortality. Bangladesh J Child Health 2023; Vol 47 (2) : 72-77

The projects of the IT industry are considered successful when they are completed within the timeline, budget, and client satisfaction on a specific project. Although client relationship is not given much importance in the delay of a project, through several studies it has been seen that the project is delayed in the IT industry due to a lack of awareness about the project to the client. The objective of this study is to inspect the impact of client relationships on project delay. Drawing on stakeholder theory and agency theory, this study investigates how client relationship influences project delay through project awareness and the role of project governance as moderator. A deductive approach of reasoning was used to test the hypotheses formulated under the current research work and proceed by using the quantitative method. This study employed a cross-sectional research design, where data was collected at a specific point in time through a survey strategy. Data was collected from the sample of 288 respondents from the IT companies of Rawalpindi and Islamabad. The data was collected using a convenience sampling technique. The demographics of the respondents were analyzed through the IBM-SPSS software program. The assumptions and the reliability of the model were also tested in SPSS. In this study, it was discovered that effective management of client relationships significantly reduces project delays, with project awareness being a crucial factor in this mitigation process. The results revealed that client relationship was negatively associated with project delay and project awareness. Whereas this linkage was mediated by project awareness. This study concludes that adequate project awareness and fruitful project governance reduce project delays and lead to positive client relationships.

Background: Cooling the uterus during cesarean section has emerged as one of the non-pharmacological management for blood loss during cesarean section. The aim of this study was to evaluate the effect of uterine cooling during the cesarean section on decreasing postpartum hemorrhage.Methods: In this single-blinded randomized clinical trial, a sample of 300 women with a singleton pregnancy, at 37 to 40 weeks gestation, who were scheduled for cesarean section, was divided into two groups of 150 participants. In the intervention group after placental delivery, the uterus was covered with cold saline-soaked surgical sponges at 0-4°C at the time of hysterotomy repair, and the control group received standard cesarean section. The volume of blood loss, the hemoglobin level before surgery and 24 h after surgery, the need for additional oxytocin therapy, and the incidence of adverse effects were recorded.Results: The bleeding volume and hemoglobin concentration reduction were significantly lower in the intervention group than in the control group (260.86± 150.25 Vs 214.35± 83.51, P<0.0001 and 1.24±0.75 Vs 1.54±0.92, P = 0.007 respectively). There were no statistically significant differences between the two groups in the frequency of need for additional uterotonic drugs. (18% vs. 21.33%, P = 0.475.)Conclusion: The use of uterine cooling during cesarean section reduced the volume of blood loss and the rate of decline in hemoglobin concentration.

Introduction: Chronic obstructive pulmonary disease (COPD) ranks as the fourth leading cause of global mortality, with anticipated increases in prevalence and mortality in the future. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) highlights the importance of considering COPD diagnosis in patients with relevant symptoms or risk factors, confirmed through spirometry. While COPD is preventable and treatable, it often presents with significant extra-pulmonary effects, particularly cardiac manifestations. Echocardiography offers a rapid, noninvasive method to assess these cardiac complications. Objective: This study aimed to investigate the clinical profiles and echocardiographic changes in COPD patients and their correlation with disease severity. Method: Conducted as an observational cross-sectional study, the research took place in the indoor departments of Medicine and Respiratory Medicine at Sir Salimullah Medical College &amp; Mitford Hospital, Dhaka, between May 25th, 2017, and November 24th, 2017; enrolling 105 diagnosed COPD patients aged e”18 years. Data collection involved a structured questionnaire covering socio-demographic details, risk behavior, and respiratory complaints. Physical examinations, spirometry, and echocardiography were conducted for diagnosis, severity grading, and cardiac evaluation, respectively. Statistical analysis employed SPSS software (version-22), presenting results through frequency, percentage, tables, graphs, and figures. Result: The study population was predominantly male (88.6%) with a mean age of 64.1 years. Most patients (94.2%) were smokers with a mean pack-year history of 22.03. All patients presented with cough and shortness of breath, and 88.5% had wheezing. Spirometry revealed moderate COPD in 40% of patients, with a distribution across all severity grades. Echocardiography showed abnormalities in 52.4% of patients, with tricuspid regurgitation, pulmonary hypertension, and right ventricular dilatation being the most frequent findings. A significant correlation was observed between C OPD severity and the presence of these echocardiographic abnormalities. Conclusion: Clinical examination unveiled common respiratory findings, while echocardiography demonstrated diverse cardiac manifestations in COPD patients. A significant proportion of patients exhibited normal findings on X-ray and echocardiography. The study highlights the prevalence of moderate COPD severity and the association between very severe COPD and specific cardiac complications, emphasizing the importance of comprehensive assessment and management strategies for COPD patients. J MEDICINE 2024; 25: 115-120