UHC

Objective : To compare the safety and efficacy of percutaneous nephrolithotomy (PCNL) and open surgery in the treatment of patients having large kidneystone (>2 cm ). Materials & Methods: This comparative study included 80 patients diagnosed with kidney stone disease admitted in the NIKDU during the period of Jan’ to Dec’2009 were divided conveniently into two groups. Intervention was done in the form PCNL(40) and open surgery (40). Clinical outcome like, perioperative complications,duration of surgery, mean hospital stay ,convalescence period, amount of analgesia required to relief pain, stone clearance rate were reviewed and compared between the groups. There was no significant difference in preoperative variables such as age,sex, stone size in cm, stone number- single/multiple and stag horn Stone. Results: There were statistically significant difference in the parameters between the groups,( PCNL vs opensurgery[mean ± SD]): duration of operation (min), 97.90±24.89 vs 136.62±23.54, postoperative hospitalstay (days) ,4.77 ± 3.98 vs 9.55 ± 3.65, mean time return to work (days), 3.09 ± 1.21vs 6.25 ± 1.53, ( p value is <0.001). Intraoperative complications like bleeding requiring blood transfusion are significantly lower in PCNL (11 cases 34.1%) than in open surgery( 18 cases 45.0%), (Chi-square = 4.82; p =0.049). The amount of analgesia required to relief pain was significantly reduced in PCNL vs open procedure (no patient required > 2 doses vs 27 patient required 3 or >3 doses ), p value is<0.001. The rate of stone clearance in percutaneous procedure,(25 cases,80%) is approaching to that of open procedure,(34 cases 85%), (p>0.05). Conclusion: PCNL is relatively safe& better treatment option than open surgery in the treatment of large renal calculi, It has almost similar stone free rate at discharge home but has definite advantages of lower morbidity, shorter convalescence and more rapid return to work. Bangladesh Journal of Urology, Vol. 16, No. 2, July 2013 p.51-56

Background: Stroke (ischaemic & haemorrhagic) is a major cause of mortality and morbidity in the developed as well as in the developing countries. Perihaematoma oedema and haematoma expansion are two important points to be considered when deciding outcome of patients with ICH. Brain damage due to haematoma may be irreversible but the injury from perihaematoma oedema may be reversible. It has been seen that S. ferritin is the most reliable indicator of body iron. Treatment with iron chelators may give better outcome after ICH. Objective: This study was under taken to assess the association between serum ferritin and relative perihaematoma oedema volume. Methodology: This study was a cross sectional observational study that was conducted in the Departments of Neurosurgery & Neurology, Bangabandhu Sheikh Mujib Medical University (BSMMU) and Dhaka Medical College Hospital (DMCH) from 1st March, 2014 till 30th September, 2015 on 32 patients (32) who fulfilled the selection criteria were enrolled in this study. Results: In this study, male female ratio was 1:1 and the mean age was 56±15 years. Most of the ICH patients fell in the age group between 41-60 years (53%). During admission, grade-1 (GCS 3- 8) level of consciousness was reported among 45% of patients. All the patients in this study presented with motor deficit that include hemiplegia 20 (62.5%) and hemiparesis 12 (37.5%). Mean value of serum ferritin was found elevated on day 4 (344±406 μg/L) in comparison to day 1 (213.4±123.5μg/ L). Mean value of relative perihaematoma oedema was elevated on day 4 (4±2.7) than day 1 (1.9±1) but it was not statistically significant. Conclusion: In this study after statistical analysis by Pearson’s correlation test we found that there was no significant association between serum ferritin concentration and relative perihaematoma oedema on day-1 and day-4. Bang. J Neurosurgery 2019; 8(2): 77-86

Background: Thalassemia is a common hematological disorder in our country having wide spectrum of clinical presentation. The frequency and severity of the several types of thalassemia depend on the racial background of the population. Hb-E Beta thalassemia is prevalent in our country.
 Objective: To see the clinical features of different types of Thalassemia in northern area of Bangladesh. Methods: Hundred cases were selected from Thalassemia patient admitted in department of pediatrics, on May 2012 to October 2012. A prescribed questionnaire was used to record the information. The methods were explained to the patients and consent was taken. Necessary physical examination was performed and investigations were done. The data was analyzed by standard procedure.
 Results: Out of hundred (100) cases, most (61%) were Hb-E beta Thalassemia, less common (1%) was Hb-E disease, and 1 % case was Hb-E trait. Majority (64%) manifested clinically under one year of age. 54% were male and 46% were female. The major presenting symptom was progressive pallor in 70% cases. Others presenting complaints were low grade fever (40%). Hemoglobin concentration at the time of diagnosis was below 5 gm/dl in 53.33% patients. In hemoglobin electrophoresis it was Hb-E ranged from 54.64 ± 13.02%, Hb-F 34.84±13.73%, Hb-A 23.32± 18.15% and Hb-A2 3.5± 70%. Radiological findings revealed gross bony changes occur in long standing cases. Enlarged cardiac shadow was found in those cases having severe anemia with heart failure.
 Conclusion: In countries with a high incidence of thalassemia, it is vitally important to offer prospective genetic counseling and to warn carriers about the risks of intramarriage. Nutritional and folic acid supplementation with regular blood transfusion along with iron chelation therapy is essential to improve the prognosis.
 TAJ 2018; 31(2): 6-11

Background: Strain imaging (SI) has been shown to quantify regional myocardial function in both acute ischemic myocardium and infarcted myocardium. The aim of this study is to determine the diagnostic value of SI for the detection of coronary lesions in pts with chest pain, but without apparent wall motion abnormalities. Methods: SI for advanced wall motion analysis was performed in 59 pts with suspicious stable angina (SA) and in 57 pts with suspicious unstable angina (UA), prior to coronary angiography (CAG). Longitudinal strain was measured in 3 apical views. For the identification of ischemia a magnitude parameter, being defined as a reduction of the peak systolic strain, was used. A homogenous pattern of strain was defined as relatively uniform distribution of the peak systolic strain. Heterogeneity of strain was considered abnormal; these segments were called strain (+) and the rest were called strain (-). Results: Out of the 59 SA patients, 28 had >70% stenosis (ischemic-SA) and 31 had normal coronary anatomy or 50% stenosis (normal-SA). Of the 28 patients in the ischemic-SA group, 9 patients (32%) showed a homogeneous pattern of peak systolic strain throughout the wall (strain negative) and 19 patients (67%) showed heterogeneity of strain (strain positive). 31 patients with normal coronary anatomy or <50% stenosis (normal-SA), 6 patients (19%) showed heterogeneity of strain (strain positive) and 25 patients (80%) showed a homogeneous pattern of peak systolic strain throughout the wall (strain negative). The positive predictive value of strain was 76% in the SA group. In the group of 57 UA patients, 32 had >70% stenosis (ischemic-UA), and 25 had normal coronary anatomy or 50% stenosis (normal-UA). From the 32 patients in the ischemic-UA group, 7 patients (22%) were determined to be strain negative, and 25 patients (78%) were determined to be strain positive. Out of 25 patients with normal coronary anatomy or 50% stenosis (normal-UA), 25 patients (80%) showed a homogeneous pattern of peak systolic strain throughout the wall (strain negative) and 6 patients (19%) showed heterogeneity of strain (strain positive). The positive predictive value of strain was 80.6% in the UA group. Sensitivity and specificity of 2D strain was evaluated using diagnostic test. The results were: 68% and 80.6% respectively in the stable angina group and 78% and 76% respectively in the unstable angina group.Conclusion: Ultrasound-based SI demonstrates a strong correlation with CAG and it has potential as a non-invasive diagnostic tool for detecting CAD in pts with chest pain and without wall motion abnormalities.

Familial hypoparathyroidism is a rare cause of hypoparathyroidism. It may be x-linked recessive, autosomal dominant or autosomal recessive. In autosomal dominant hypoparathyroidism there is activating mutation of the calcium sensing receptor leading to inhibition of Parathormone (PTH) secretion at inappropriately low serum ionized calcium level. The disease often manifests in the first decade but may appear later. Clinical signs primarily involving neuromuscular disturbances including generalized seizure. Management of pregnancy in hypoparathyroidism is challenging as both under treatment and over treatment is dangerous for fetus. Treatment of hypoparathyroidism in pregnancy includes combination of oral calcium supplementation with calcitriol with an aim to keep serum calcium within normal range. Here we discussed a case of 21 year pregnant lady with familial hypoparathyroidism with successful delivery of a healthy baby. Key words: Hypoparathyroidism; Hypocalcaemia; Hyperphosphataemia; Epilepsy. DOI: http://dx.doi.org/10.3329/fmcj.v6i2.9215 FMCJ 2011; 6(2): 113-115