Author: ssnimc

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ssnimcj2025v10i1s1

Editorial

Artificial Intelligence (AI) in Clinical Medicine: Potential and Progress

*Das DC

Artificial intelligence (A.I.) is intelligence demonstrated by machines mimicing cognitive functions, such as learning and problem solving.1 It significantly influences the practice of medicine and the delivery of healthcare in the near future. It has shown remarkable improvement in tasks such as diagnostics, data analysis and is already being applied in areas ranging from patient triage to cancer detection.2 A.I. is an interdisciplinary field spanning computer science, psychology, linguistics, and philosophy, among others.

The recent availability of AI to the public, including language models like ChatGPT, DeepSeek etc.has increased awareness and its potential capabilities in medicine. The continued growth of AI has inspired interest and debate concerning its use in patient care.ChatGPT successfully passed the USMLE and can solve internal medicine case files, indicating its versatility and potential for future clinical applications. In fact, Google and DeepMind developed the Med-PaLM language model trained on several existing medical Q&A datasets to offer “safe and helpful answers” to questions posed by health care professionals and patients.3

Medical-grade AI language models for consultations, receiving valuable insights and assistance in various aspects of patient care are as follows –

  • Provide advice on the diagnosis and treatment for symptoms.
  • Create a personalized treatment plan based on the patient’s age and lifestyle.
  • Analyze X-ray to detect abnormalities.
  • Identify risk factors from patient’s electronic health record.
  • Write a letter explaining the medical necessity of treatment.

Physicians can improve the quality of care by leveraging these powerful tools, while saving time on tasks that can be automated with AI. With further development and refinement, AI technology could play an important role in enhancing the standard of healthcare.4,5

 Physician-Machine Collaboration in Medicine

There is utterance about AI eventually replacing physicians, particularly in fields like radiology, pathology, and dermatology, where AI’s diagnostic ability can match or even exceed that of clinicians. However, research suggests that physician-machine collaborations will outperform either one alone.It’s unlikely that AI will completely replace physicians anytime soon. The human aspects of care, including empathy, compassion, critical thinking, and complex decision-making, are invaluable in providing holistic patient care beyond diagnosis and treatment decisions.So, rather than fully replacing physicians, AI will likely empower the practice of medicine, with physicians exploiting the technology to enhance clinical care. To this point, the American Medical Association recommends that technology be used to augment, rather than replace, human intelligence.1

AI also has the potential to address physician burnout by automating repetitive and monotonous administrative tasks, allowing physicians to focus on patient care. Moreover, AI could play a valuable role in improving access to care and addressing clinician workforce shortages.As AI advances, physicians may be relied upon for higher-level decision-making, patient interaction, and interdisciplinary collaboration while working alongside AI systems.1,4

Consideration of AI in Health Care

Despite the potential advantages of AI in health care, there are significant safety, privacy, reliability, and ethical considerations. Furthermore, without appropriate precautions, AI may perpetuate instinctive biases in diagnosis and treatment. Doctors will likely continue to play a critical role in ensuring that the ethical and moral implications of medical decisions are carefully considered and that patients receive the highest quality of care.To achieve this, physicians must be prepared to take on new roles and responsibilities in the era of AI, including expanded opportunities in medical informatics. Physicians can also guide patients on how to use AI to obtain reliable health information and receive appropriate care.5

 Enhancing Medicine with AI

AI has the potential to transform health care for the better. When complemented with physician’s expertise, its will be a powerful tool that can lead to better patient outcomes. AI can also facilitate scientific discovery and breakthroughs in disease prevention and treatment through vast data analytics. Integrating AI into routine clinical practice will require careful validation, training, and ongoing monitoring to ensure its accuracy, safety, and effectiveness in supporting physicians to deliver care for patients.

While AI can be an important and valuableasset in the medical field, it cannot replace the human element. However, AI can and should be used to enhance the practice of medicine, empowering doctors with the latest technological tools to serve our patients better.AI and machine learning will not put health professionals out of business; rather, they will help health professionals to do their jobs better as well as leave time for the human–human interactions that make medicine the rewarding profession we all value.

 References

  1. Ted A James. How Artificial Intelligence is Disrupting Medicine and What it Means forPhysicians. Trends in Medicine. Harvard Medical School.April 13, 2023. Available at <https://postgraduateeducation.hms.harvard.edu/trends-medicine/how-artificial-intelligence-disrupting-medicine-what-means-physicians> [Accessed 15 Nov 2024].
  2. Meskó B, Görög M. A short guide for medical professionals in the era of artificial intelligence.NPJ Digit Med. 2020 Sep 24;3:126. doi: 10.1038/s41746-020-00333-z. PMID: 33043150;PMCID: PMC7518439.
  3. Kung TH, Cheatham M, Medenilla A, Sillos C, De Leon L, Elepaño C, Madriaga M, AggabaoR, Diaz-Candido G, Maningo J, Tseng V. Performance of ChatGPT on USMLE: Potential forAI-assisted medical education using large language models. PLOS Digit Health. 2023 Feb9;2(2):e0000198. doi: 10.1371/journal.pdig.0000198. PMID: 36812645; PMCID:PMC9931230.
  4. Lee P, Bubeck S, Petro J. Benefits, Limits, and Risks of GPT-4 as an AI Chatbot for Medicine. N Engl J Med. 2023 Mar 30;388(13):1233-1239. doi: 10.1056/NEJMsr2214184. PMID: 36988602.
  5. Haug CJ, Drazen JM. Artificial Intelligence and Machine Learning in Clinical Medicine, 2023. N Engl J Med. 2023 Mar 30;388(13):1201-1208. doi: 10.1056/NEJMra2302038. PMID: 36988595.

*Dr. Dulal Chandra Das, MBBS, FCPS (Medicine), Assistant Professor, Department of Medicine, Shaheed Syed Nazrul Islam Medical College, Kishoreganj. Email: dr.dulaldas@yahoo.com.

[Shaheed Syed Nazrul Islam Med Col J 2025, Jan; 10 (1):1-2]

DOI: https://www.doi.org/10.69699/ssnimcj2025v10i1s1

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ssnimcj2025v10i1s2

Original Article

Clinical and Socio Demographic Aspects of Congestive Heart Failure Patients

 *Mia MR,1 Rahman M,2 Rahman MM,3 Uddin MJ,4 Azad MS,5 Ahmed N6 

  1. *Dr. Mohammed Razzak Mia, Associate Professor, Department of Medicine, Dhaka Medical College, Dhaka. mrazzakmia1974@gmail.com
  2. Dr. Mojibur Rahman, Associate Professor (CC), Department of Cardiology, Shaheed Syed Nazrul Islam Medical  College, Kishoreganj.
  3. Dr. ANM Mizanur Rahman, Superintendent & Senior Consultant Cardiology, 100 Bedded District Hospital, Narsingdi.
  4. Dr. Md. Jashim Uddin, Assistant Professor, Department of Pediatrics, Sheikh Hasina Medical College, Habiganj
  5. Dr. Mohammad Bhuiyan Abdus Samad Azad, Senior Consultant Cardiology Madaripur 250 Bed General Hospital
  6. Dr. Nadim Ahmed, Junior Consultant (CC) Medicine, Upazila Health Complex, Monohardi, Narsingdi

 *For Correspondence

Abstract

Background: Congestive heart failure (CHF) is a growing issue for healthcare systems throughout the developing world. Many factors have been linked to an increase in mortality in CHF patients. Despite heterogeneity in the research groups, several demographic and clinical variables appear to be consistently associated with a poor prognosis in congestive heart failure patients.

Objective: To investigate the clinical and sociodemographic aspects of congestive heart failure patients.

Methods:  This descriptive observational study was conducted by the Department of Medicine at 100- bed district hospital, Narsingdi from July 2021 to June 2022. Purposive sampling was used to select 120 women and men with congestive heart failure from the cardiac center of 100-bed district hospital, Narsingdi, Bangladesh. Daily consecutive admissions were screened to identify eligible patients who arrived in the cardiac emergency room, Department of Cardiology. Patients with an  admission diagnosis of congestive heart failure  were enrolled in this study on the basis of inclusion and exclusion criteria with a history of at least one well documented hospitalization for congestive heart failure.

Results: Rheumatic heart disease was identified in 38(31.7%), cardiomyopathy was found in 30(25.0%), hypertension was found in 21(17.5%) cases, pericardial disease was found in 16(13.3%), and ischaemic heart disease was found in 3(2.5%). Factors related with congestive heart failure were 25 (20.8%) inadequate therapy, 25 (20.8%) arrhythmia, 23 (19.2%) respiratory diseases, 17 (14.2%) anaemia, and 23 (19.2%) infective endocarditis. The majority of patients (75.5%) had NYHA class II, 38.7% had class III, and 5.8% had class IV. In conjunction with medical and demographic characteristics, major socio-environmental factors increased the likelihood of readmission due to congestive heart failure.

Conclusion: Socio-environmental factors may increase risk of hospital admission in heart failure patients.

[Shaheed Syed Nazrul Islam Med Col J 2025, Jan; 10 (1):3-10]

DOI: https://www.doi.org/10.69699/ssnimcj2025v10i1s2

Keywords: Congestive Heart Failure, Socio-demographi, Profile; Co-morbidity,  NYHA functional classification

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ssnimcj2025v10i1s3

Original Article
Psychiatric Morbidities and Socioeconomic Background – An Evaluation from a District Level Government Hospital

*Bashar MK,1 Kulsum U,2 Talukder MM,3 Mitu MR,4 Naser MJ,5 Sultana N,6 Hasan MK7

 

  1. *Dr. Md. Khairul Bashar, Associate Professor, Psychiatry, Shaheed Syed Nazrul Islam Medical College, Kishoreganj. kabashar47@gmail.com
  2. Dr. Umme Kulsum, Assistant Professor, Psychiatry, Shaheed Syed Nazrul Islam Medical College, Kishoreganj.
  3. Dr. Muhammad Moinul Alam Talukder, Assistant Professor, Pharmacology, Shaheed Syed Nazrul Islam Medical College, Kishoregonj,
  4. Dr. Marshia Rahman Mitu, FCPS (Medicine), OSD, DGHS, Mohakhali, Dhaka.
  5. Dr. Mohammad Jamal Abdel Naser, Associate Professor (C.C), Department of Microbiology, Shaheed Syed Nazrul Islam Medical College, Kishoreganj.
  6. Dr. Nadia Sultana, MPH, National Institute of Preventive and Social Medicine (NIPSOM), Mohakhali, Dhaka.
  7. Dr. Md. Kamrul Hasan, Assistant Professor, Department of Anesthesia, BSMMU, Dhaka.

 *For correspondence

Abstract

Background: Sociodemographic variations exert a profound influence on treatment-seeking behavior among mental health patients, shaping patterns of access, utilization, and engagement with mental health services. This study aimed to observe the socioeconomic presentation of patients attending district level government hospital for psychiatric treatment.

Methods: The medical records of patients attending the outpatient department (OPD) at Shaheed Syed Nazrul Islam Medical College in Kishoreganj, Bangladesh, between February 2023 and November 2023, were reviewed. Data on demographic details and psychiatric diagnoses were extracted from records that were complete and accessible. Patients with incomplete records were excluded. Diagnostic categorization followed the guidelines of the International Classification of Diseases, 10th Revision (ICD-10).

Result: This study observed cases of 521 patients, the majority of whom were aged between 20 and 40 years (60.50%). Females constitute 67.20% of the sample. Educational attainment of the sample showed that, 16.70% had no literacy, 24.80% had completed primary education, 29.94% had studied up to secondary or higher secondary level, and 28.60% hold a graduate degree or studied higher. 64.10% of the sample resided in urban areas and 53.20% were married. About half of the sample (52.40%) had a monthly income between BDT 16,000 to 30,000. “Anxiety, Stress-Related, Somatoform, and Other Nonpsychotic Mental Disorders (F40-F48)” and “Mood [Affective] Disorders (F30-F39)” accounted for majority of the cases (40.31% and 22.26% respectively. Females were more affected than males in almost all categories, however, phobic anxiety disorders (55.56%), obsessive-compulsive disorder (OCD) (52.94%), and substance abuse disorders (62.50%) were more common in men.

Conclusion: This study demonstrated district level presentation of patients with psychiatric morbidity and their socioeconomic diversities where anxiety, stress, and mood-related disorders were common with a female predominance. It is essential to achieve a more comprehensive representation of socioeconomic backgrounds by including participants from diverse settings beyond government district hospitals, such as private healthcare facilities, community health centers, and house-to-house visits to understand the general situation of mental health disorders in Bangladesh.

[Shaheed Syed Nazrul Islam Med Col J 2025, Jan; 10 (1):11-22]

DOI: https://www.doi.org/10.69699/ssnimcj2025v10i1s3

 Keywords: Psychiatric morbidity, OPD presentation, Socioeconomic background, ICD-10 category

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ssnimcj2025v10i1s5

Original Article

Changes in Serum Sodium Level in Patients with Acute Myocardial Infarction

 

*Taufiq-Ul-Alam M,1 Diluara K,2 Chowdhury NM,3 Tasnim N,4 Hassan ST,5 Yesmin F6

 

  1. *Dr. Mohammad Taufiq-Ul-Alam, Assistant Professor, Department of Biochemistry, Shaheed Syed Nazrul Islam Medical College, Kishoreganj, Bangladesh, taufiqbd93@gmail.com.
  2. Dr. Khadiza Diluara, Assistant Professor, Department of Biochemistry, President Abdul Hamid Medical College, Kishoreganj, Bangladesh,
  3. Dr. Nafisa Marzan Chowdhury,  Assistant Professor, Department of Biochemistry, Central Medical College, Cumilla, Bangladesh.
  4. Dr. Nafisa Tasnim, Lecturer, Department of Biochemistry, Anwar Khan Modern Medical College, Dhaka, Bangladesh.
  5. Dr. S. M. Tauhid Hassan, Assistant Professor (C.C), Department of Biochemistry, Shaheed Syed Nazrul Islam Medical College, Kishoreganj, Bangladesh.
  6. Dr. Farjana Yesmin, Assistant Professor (C.C), Department of Biochemistry, Shaheed Syed Nazrul Islam Medical College, Kishoreganj, Bangladesh.

 

*For correspondence

Abstract

Background: Acute myocardial infarction (AMI) is defined as the death of cardiac muscle due to prolong ischemia. It is more commonly known as heart attack, is a medical emergency and the leading cause of death for both men and women all over the world. There is a correlation between changes in the serum sodium in acute myocardial infarction. Changes in serum sodium in AMI have not been studied extensively and paucity of information in the literature in this regard.

Objectives: This study was undertaken to evaluate the changes in serum sodium status in patients with acute myocardial infarction.

Methods: The present cross sectional study was carried out in the Department of Biochemistry, Mymensingh Medical College, Mymensingh with the collaboration of the Department of Cardiology, Mymensingh Medical College Hospital, Mymensingh, during the period of July-2019 to June 2020. A total of 100 subjects were included in this study among them, 50 were diagnosed AMI patients denoted as case group & 50 were normal healthy individuals denoted as control group. Serum Sodium was determined by colorimetric method by using electrolyte analyzer for each sample. All statistical analysis was done by using SPSS (statistical package for social science) windows package version 21. P value <0.05 was considered significant.

Results: The mean ± SD values of serum sodium were 136.78 ± 1.63 mmol/L and 130.28 ± 1.82 mmol/L in control group and case group respectively. The analysis showed that, there was highly significant decrease in mean serum sodium level between two groups (p<0.001).

Conclusion: This was a cross sectional study. Analyzing the findings of the present study, highly significant decrease in serum sodium level were observed in AMI patients. A large scale prospective study with the application of more sophisticated technology may be planned to find out the relationship of this biochemical variables with AMI.

[Shaheed Syed Nazrul Islam Med Col J 2025, Jan; 10 (1):34-38]

DOI: https://www.doi.org/10.69699/ssnimcj2025v10i1s5

Keywords: Serum sodium, Acute myocardial infarction

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ssnimcj2025v10i1s4

Original

Disease Patterns and Outlook with Coronary Artery Bypass Grafting

*Hossain MI,1 Talha MA,2 Tabassum N,3 AhmedY,4 Shadman R,5 Sharifuzzaman M6

 

  1. *Dr. Md. Ibrahim Hossain, Surgical Resident, Department of Cardiac Surgery, NHFH & RI, Darus-Salam, Dhaka, Bangladesh. dr.ebrahim.bd@gmail.com.
  2. Dr. Md. Abu Talha, Registrar, PCICU, NHFH & RI, Darus-Salam, Dhaka, Bangladesh.
  3. Dr. Nazia Tabassum, MPH Fellow, Department of Occupational and Environmental Health (OEH), National Institute of Preventive and Social Medicine (NIPSOM), Mohakhali, Dhaka 1212, Bangladesh.
  4. Dr. Yeahyea Ahmed, MPH Fellow, Department of Maternal and Child Health (MCH), National Institute of Preventive and Social Medicine (NIPSOM), Mohakhali, Dhaka 1212, Bangladesh.
  5. Dr. Rashik Shadman. MPH Fellow, Department of Occupational and Environmental Health (OEH), National Institute of Preventive and Social Medicine (NIPSOM), Mohakhali, Dhaka 1212, Bangladesh.
  6. Dr. Mohammad Sharifuzaman, Senior Consultant, Cardiac Surgery Dept. NHFH & RI, Darus-Salam, Dhaka, Bangladesh.

 

*For correspondence

Abstract

Background: Outcomes of Coronary Artery Bypass Grafting (CABG) are often measured by mortality and morbidity rates. This study aims to analyze disease patterns, graft types, surgical techniques, and post-operative outcomes of CABG, comparing pre-operative findings, past history, and major morbidity and mortality as defined by the Society of Thoracic Surgeons (STS)), USA.

Methods: A retrospective comparative study was conducted with 390 patients, who were underwent CABG. The data were collected from January 2017 to December 2020 where CABG of these patients done within January 2014 to December 2016.

Results: Demographics & Risk Factors: 89.7% were male. No significant differences in BMI or other risk factors distribution (hypertension most common, followed by diabetes, smoking, and hyperlipidemia) (P>0.05). Cardiac Function & Disease Severity: LVEF%: Group A: 51.18 ± 8.76%, Group B: 51.85 ± 8.73% (P>0.05). Triple vessel disease: Group A: 81.5%, Group B: 83.6% (P>0.05). Grafting & Surgery: No significant difference in conduit types or graft use (LAD grafts: Group A: 99%, Group B: 99.5%) (P>0.05). Off-pump surgery was more common (49.49% in Group A, 48.46% in Group B). Postoperative Complications: AKI (Group A: 7.7%, Group B: 16.9%, significant), LOS (Group A: 0.5%, Group B: 4.1%, significant), mortality (Group A: 37.5%, Group B: 62.5%, P>0.05). Surgical Outcome Comparison: Off-pump surgery: mortality 3.4% (13/382), on-pump beating heart surgery: mortality 37.5% (3/8) (P=0.003, significant). Mortality Correlation: Multi-organ failure (strongest predictor), COPD & stroke (moderate), AKI, LOS, EF, old MI, syncope (weak), hyperlipidemia & renal dysfunction (weak). LV dysfunction had a significant negative impact.

Conclusion: Syncope and certain major morbidities differed between the groups, but overall mortality rates were similar. The study highlights specific pre-operative and post-operative factors affecting CABG outcomes.

[Shaheed Syed Nazrul Islam Med Col J 2025, Jan; 10 (1):23-33]

DOI: https://www.doi.org/10.69699/ssnimcj2025v10i1s4

 

Keywords: Disease pattern, Postoperative outcome, Coronary artery bypass grafting, Cardio-vascular diseases.

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ssnimcj2025v10i1s6

Original
Relationship of Interpregnancy Interval with Ultrasonographic Measurement of Lower Uterine Segment Caesarean Scar Thickness

*Sarker B,1 Haque N,2 Sikdar K,3 Akter F,4 Shormin N,5 Rowshan A6

1. *Dr. Binita Sarker, Resident Surgeon, Department of Gynaecology & Obstetrics, Shaheed Syed Nazrul Islam Medical College Hospital, Kishoreganj, Bangladesh. sark.nita@gmail.com
2. Dr. Nazma Haque, Professor, Department of Gynaecology & Obstetrics, Dhaka Medical College Hospital, Dhaka, Bangladesh.
3. Dr. Koushik Sikdar, Registrar, Department of Surgery, Shaheed Syed Nazrul Islam Medical College Hospital, Kishoreganj, Bangladesh.
4. Dr. Fatema Akter, Registrar, Department of Gynaecology & Obstetrics, Shaheed Syed Nazrul Islam Medical College Hospital, Kishoreganj, Bangladesh.
5. Dr. Nusrat Shormin, Assistant Registrar, Department of Gynaecology & Obstetrics, Shaheed Ziaur Rahman Medical College, Bogra, Bangladesh.
6. Dr Afsana Raushan, MBBS, FCPS (Gynae & obst), MPH, Associate Professor, Department of Gynaecology & Obstetrics. Mymensingh Medical College & Hospital.

*For correspondence
Abstract
Background: There is a rise in the caesarean section rates throughout the world due to which obstetricians see more women with caesarean section scar. As a result of this operation, late scar dehiscence may occur leading to uterine rupture in a subsequent pregnancy. Abundant works have been done regarding complication and outcome of caesarean section. However, very limited work is noticed regarding the relationship of interpregnancy interval with caesarean scar thickness.
Objective: To find out the relationship of interpregnancy interval (IPI) with ultrasonographic measurement of lower uterine segment caesarean scar thickness at 3rd trimester.
Methods: This cross-sectional analytical study was conducted at the Department of Gynaecology and Obstetrics in Sir Salimullah Medical College and Mitford Hospital (SSMC & MH) for a period of six months. Pregnant women of 36 to 40 weeks with history of 1 previous caesarean section were approached for inclusion in the study. Eighteen (18) months interpregnancy interval were used to categorize the study population into two groups. Group I is ≥ 18 months IPI & group II is < 18 months IPI. Written informed consent was taken from each subject and ethical issues were ensured properly. Data collection was done with an aid of a preformed questionnaire. Collected data was analyzed by the SPSS 23.
Results: Among 50 study participants, mean age was 23.53±3.65 (SD) years in group I and 23.54±3.95 (SD) in group II. Majority of study population were well-nourished (62.20% in group I and 56.43% in group II). About 64% of patients’ IPI was ≥ 18 months (group I) and 36% patients’ IPI was < 18 months (group II). In group II, majority patients (88.90%) scar thickness was <2.5 mm and in group I only 6.20% patients’ scar thickness was <2.5 mm. Scar tenderness was also associated with IPI where most of the patients of group II were observed to be present with scar tenderness.
Conclusion: Short interpregnancy interval is proportionately associated with scar thickness in our settings. However, further study with larger sample size is recommended.

[Shaheed Syed Nazrul Islam Med Col J 2025, Jan; 10 (1):39-46]
DOI: https://www.doi.org/10.69699/ssnimcj2025v10i1s6

Keywords: Interpregnancy interval (IPI), Caesarean scar thickness, Caesarean scar tenderness.

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ssnimcj2025v10i1s7

Original
Haematological Parameter Changes in Per-operative Early Ligation of Splenic Artery during Splenectomy in Children with Hypersplenism

*Sikdar K,1 Hossain AZ,2 Mahammad N,3 Shimon MS,4 Sarker B,5 Hasan GJ 6

1. *Dr. Koushik Sikdar, Registrar, Department of Surgery, Shaheed Syed Nazrul Islam Medical College Hospital, Kishoreganj, Bangladesh. sikdar.9463@gmail.com,
2. Dr. AKM Zahid Hossain, Professor, Department of Paediatric Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
3. Dr. Noor Mahammad, Assistant Professor, Department of Paediatric Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
4. Dr. Md. Samiul Huq Shimon, Assistant Registrar, Department of Surgery, Kushtia Medical College Hospital, Kushtia, Bangladesh.
5. Dr. Binita Sarker, Resident Surgeon, Department of Gynaecology & Obstetrics, Shaheed Syed Nazrul Islam Medical College Hospital, Kishoreganj, Bangladesh.
6. Dr. Gazi Jakir Hasan, Assistant Registrar, Department of Surgery, Shaheed Syed Nazrul Islam Medical College Hospital, Kishoreganj, Bangladesh.
*For correspondence

Abstract
Background: Hypersplenism is a clinical syndrome characterized by splenomegaly and reduction in the number of one or more types of blood cells and improvement of cytopenias after splenectomy. Splenic function accelerates and even sequestrates up to 90% of body platelets and 40-50% of the Red cellsresulting in increased demand of blood and blood product transfusion.
Purpose: To evaluate the changes of blood components per-operatively after early splenic artery ligation during splenectomy in children with hypersplenism.
Methods: This quasi experimental study was conducted at the Department of Paediatric Surgery, BSMMU, Dhaka, Bangladesh without interrupting standard care practiced in the department during March 2021 to August 2022. Proper clinical history, physical examinations, initial investigation reports and pre-operative blood transfusion data were recorded in a standard data sheet. Per-operative blood samples just prior to splenic artery ligation and at 5th & 30th minutes after arterial ligation before ligation of splenic vein were collected from peripheral venous blood. Samples were analyzed in the department of Laboratory Medicine, BSMMU. Statistical analyses of the result were obtained by using window based computer software devised with Statistical Packages for Social Sciences (SPSS).
Results: Total 16 patients undergoing splenectomy was included and mean age was 9.12 ± 3.25 years and range was 6-14 years. No blood and blood products were transfused in these patients up to 7 days prior to surgery. At 5th and 30th minutes after splenic artery ligation the mean haemoglobin change was 0.69 ± 0.85 gm/dl and 1.53 ± 2.06gm/dl, mean haematocrit change was 1.85 ± 2.84 % and 4.36 ± 6.70 %, mean RBC count change was 0.27 ± 0.40 x 1012/L and 0.58 ± 0.94 x 1012/L, mean TLC change was 7.49 ± 5.98 x 109/L and 7.91 ± 6.26 x 109/L, mean platelet count change was 46.44 ± 49.3 x 109/L and 86.7 ± 86.4 x 109/L. All the parameters analysed depicted significant gain of blood parameters proportionate to allocated time after splenic artery ligation.
Conclusion: Early splenic artery ligation during splenectomy in hypersplenism results in auto-transfusion and significant increase of different haematological parameters (Haemoglobin, RBC, Haematocrit, Total leukocytes and Platelets) and helps in reducing blood and blood products transfusion in peri-operative period.

[Shaheed Syed Nazrul Islam Med Col J 2025, Jan; 10 (1):47-53]
DOI: https://www.doi.org/10.69699/ssnimcj2025v10i1s7
Keywords: Hypersplenism, Portal hypertension (PHTN), extra-hepatic portal vein obstruction (EHPVO), splenectomy

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ssnimcj2025v10i1s8

Original

Knowledge, Attitude and Practice of Oral Care of Critically Ill Child by Intensive Care Nurses at Pediatric Critical Care Unit

 *Talha MA,1 Tabassum N,2 Hossain MI,2 Munjerin M,3 Rony RH,4 Hasan NA5

 

  1. *Dr. Md. Abu Talha, Registrar, PCICU, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh.talha45@gmail.com
  2. Dr. Nazia Tabassum, MPH Fellow, Department of Occupational and Environmental Health (OEH), National Institute of Preventive and Social Medicine (NIPSOM), Mohakhali, Dhaka 1212, Bangladesh.
  3. Dr. Mohammad Ibrahim Hossain, Surgical Resident, Cardiac Surgery, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh.
  4. Dr. Maimuna Munjerin, Registrar, Pediatric Cardiology, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh.
  5. Dr. Rifath Hasan Rony, Medical Officer, PCICU, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh.
  6. Dr. Nurul Akhter Hasan, Associated Prof and Head, PCICU, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh.

 *For correspondence

Abstract

Background: Oral care is a critical aspect of nursing for critically ill children in Pediatric Intensive Care Units (PICU). Poor oral hygiene in intubated patients can lead to complications such as biofilm buildup, ventilator-associated pneumonia (VAP) and impacting patient outcomes. An effective oral care programmed influence overall good intensive care outcome and influenced by several factors regarding the understating, belief and importance of good oral environment. Assessing nurses’ knowledge, attitudes, and practices towards oral hygiene is vital to identify gaps and enhance training efforts for optimal patient care.

Methods: A cross-sectional study was conducted with 80 nurse sat National Heart Foundation Hospital and Research Institute, Mirpur, Dhaka who were working in Pediatric cardiac ICU. The data were collected from November 2023 to December 2023.

Results: This study examines the knowledge, attitudes, and practices of intensive care nurses regarding oral care for critically ill children in a Pediatric Cardiac Intensive Care Unit (PCICU). The mean age of nurses was 25.43±2.83 years, with most aged 25-29 and having an average nursing experience of 3.44±2.84 years but most of them have less experience in PICU. Although 95% recognized oral care as essential, knowledge gaps were noted, particularly about oral biofilm (35%) and VAP (70%). Barriers to care included patient non-cooperation (61.3%), intubation (45%), and limited staff (27.5%). While 71.3% used forceps and gauze, and 83.8% used normal saline, more than 50% of nurses expressed a need for biannual training to improve care delivery. The findings underscore the need for regular training to address barriers and improve oral care quality in PCICU settings.

Conclusion: The study provided useful findings regarding oral hygiene knowledge, thought and practices of nurses caring for critically ill patients. The study highlights gaps in oral care knowledge, attitudes, and practices among intensive care nurses, emphasizing the need for regular training.

[Shaheed Syed Nazrul Islam Med Col J 2025, Jan; 10 (1):54-62]

DOI: https://www.doi.org/10.69699/ssnimcj2025v10i1s8

 Keywords: Oral care, critical care nurses, knowledge, attitudes and practice, pediatric intensive care unit (PICU), PCICU

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ssnimcj2025v10i1s9

Original

Effect of Pre-existing Ischemic Heart Disease on 30-Days Mortality in COVID-19 Patients

 Iqbal MH,1 *Moontaha H,2 Sarker BK,3 Paul MR,4 Chowdhury AW5

 

  1. Dr. Md. Hasan Iqbal, MBBS, Department of Cardiology, National Institute of Cardiovascular Disease (NICVD), Dhaka, Bangladesh
  2. *Dr. Hashiba Moontaha, MBBS, FCPS (Gynaecology& Obstetrics), Department of Gynaecology& Obstetrics, Dhaka Medical College &Hospital, Dhaka, Bangladesh;hashibapriom@gmail.com
  3. Dr. Bikash Kumar Sarker, Infectious Diseases Hospital, Mohakhali, Dhaka, Bangladesh
  4. Dr. Mira Rani Paul, Rajshahi Medical College Hospital, Rajshahi, Bangladesh.
  5. Professor Dr. Abdul Wadud Chowdhury, Director, National Institute of Cardiovascular Disease, Dhaka, Bangladesh.

 *For correspondence

Abstract

Background: COVID-19 has emerged as a multisystem inflammatory disorder with significant cardiovascular implications. Patients with pre-existing cardiovascular conditions may be particularly vulnerable to severe outcomes, yet data from developing countries regarding the impact of pre-existing ischemic heart disease (IHD) on COVID-19 outcomes remains limited.

Objective: To investigate the effect of pre-existing ischemic heart disease on 30-day mortality in COVID-19 patients at a tertiary care hospital in Bangladesh.

Methods: This case-control study was conducted at Dhaka Medical College Hospital over twelve months, enrolling 120 RT-PCR-confirmed COVID-19 patients (60 with pre-existing IHD, 60 without IHD). Clinical characteristics, laboratory parameters, and treatment modalities were assessed. Outcomes included in-hospital mortality, complications, and 30-day mortality. Data analysis included chi-square tests, t-tests, and multivariable logistic regression.

Results: COVID-19 patients with pre-existing IHD showed significantly higher rates of critical disease (30.0% vs 11.6%, p=0.002), cardiac complications including acute myocardial infarction (45.0% vs 0%, p=0.001), and heart failure (28.3% vs 6.66%, p=0.001). The IHD group required more intensive care (71.6% vs 36.6%, p<0.001) and demonstrated higher in-hospital mortality (36.6% vs 10%, p<0.001) and 30-day mortality (60.0% vs 16.6%, p<0.001). After adjusting for confounders, pre-existing IHD independently predicted 30-day mortality (OR=7.25, 95% CI=2.17-24.23).

Conclusion: COVID-19 patients with pre-existing IHD experience significantly worse outcomes, including higher rates of complications and mortality. These findings emphasize the need for enhanced monitoring and aggressive management strategies for COVID-19 patients with pre-existing IHD in Bangladesh.

[Shaheed Syed Nazrul Islam Med Col J 2025, Jan; 10 (1):63-72]

DOI: https://www.doi.org/10.69699/ssnimcj2025v10i1s9

Keywords: COVID-19, Ischemic Heart Disease, Bangladesh, Mortality, Cardiovascular Complications

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ssnimcj2025v10i1s10

Original
Evaluation of Neutrophil-lymphocyte Ratio as a Predictor of Complications in Dengue Infection

*Wazib A,1 Rahman S,2 Belal MM,3 Shamme SS,4 Ahmed MR,5 Kamal FN,6 Mani SI,7 Kamal M8

 

  1. *Dr. Amit Wazib, FCPS (Medicine), MD (Neurology), Professor & Head, Department of Medicine, Shaheed Monsur Ali Medical College. amit.bcps.2552@gmail.com
  2. Dr. Shaila Rahman, FCPS (Medicine), MRCP (UK), Associate Professor, Department of Medicine, Shaheed Monsur Ali Medical College,
  3. Dr. Munshi Mohammad Belal, FCPS (Medicine),Assistant Professor, Department of Medicine, Shaheed Syed Nazrul Islam Medical College,
  4. Dr. Sheikh Shamsunnahar Shamme, FCPS (Paediatrics), Junior Consultant, Department of Paediatrics, Shaheed Syed Nazrul Islam Medical College Hospital,
  5. Dr. Md. Rayhan Ahmed, Assistant Registrar, Department of Medicine, Shaheed Monsur Ali Medical College Hospital
  6. Dr. Farah Naz Kamal, General Practitioner,
  7. Dr. Md. Shahidul Islam Mani, Intern, Department of Medicine, Shaheed Monsur Ali Medical College Hospital,
  8. Mehnaz Kamal, MPH (Epidemiology), Senior Manager, Research & Advocacy, BRAC Health Programme, BRAC

 *For correspondence

Abstract

Introduction: Dengue is an endemic infection in Bangladesh with frequent outbreaks. Severe dengue including dengue shock syndrome (DSS), severe haemorrhage and expanded dengue syndrome (EDS), is the major contributor of morbidity and mortality in dengue infection. This study aimed to assess the association of neutrophil-lymphocyte ratio (NLR) with severe dengue, DHF, DSS, severe haemorrhage and EDS in dengue fever.

Methods: This prospective study was conducted on 250 randomly selected dengue patients admitted under the Department of Medicine in Shaheed Monsur Ali Medical College Hospital, Dhaka, Bangladesh from July to December 2023. The study participants were divided into two groups – with NLR≥2 and NLR<2, on the third day of fever. Frequencies severe dengue, dengue haemorrhagic fever (DHF), DSS, severe haemorrhage and EDS were compared between the two groups.

Results: NLR ≥2 on the third day of fever was associated with a statistically significant higher frequency of DHF, DSS, EDS and severe dengue.

Conclusion: NLR can be used as a predictor of complications in dengue infection. Dengue patients with NLR ≥2 on the third day of fever possess a higher risk of developing complications, and hence need close monitoring.

[Shaheed Syed Nazrul Islam Med Col J 2025, Jan; 10 (1):73-80]

DOI: https://www.doi.org/10.69699/ssnimcj2025v10i1s10

Keywords: Neutrophil-lymphocyte ratio, dengue haemorrhagic fever, dengue shock syndrome, expanded dengue syndrome, severe dengue