CASE REPORT | July 3, 2021
Pott's Puffy Tumor Complicating Frontal Sinusitis: About A Case
Mohamed Sahli, Bouchaib Hemmaoui, Noureddine Errami, Fouad Benariba
Page no 181-182
Pott's puffy tumor is a relatively rare condition and mainly affects children and young adults. It is often secondary to frontal sinusitis with the potential of serious endocranial complications. We report the case of a young adult of 18 years treated for frontal sinusitis and in whom the evolution was marked by an erosion of the external table of the frontal sinus and the development of a subperiosteal abscess. The patient underwent emergency surgical exploration. The rapid diagnosis and the very early stage of our patient allowed us to perform a minimally invasive supra-eyebrow Lynch approach. Considering the risk of dangerous complications, the diagnosis of Pott's puffy tumor must be evoked in front of any inflammatory frontal swelling.
ORIGINAL RESEARCH ARTICLE | July 3, 2021
Salivary Gland Tumors, Clinical Epidemic Study
Sefrioui Taha Ismail, Rahim Hanae, Ait Taleb Hajar, Nitassi Sophia, Bencheikh Razika, Oujilal Abdelilah, Benbouzid Mohamed Anas, Essakalli Leila
Page no 183-185
Salivary gland tumours affect the parotid gland in 80% of cases, the submandibular gland in 10-15% of cases, while the sublingual gland is rarely affected (in 5-10% of cases) [1, 2]. 80% of parotid gland tumours and 50% of submandibular gland tumours are benign. This is a retrospective descriptive study within the Department of Otorhinolaryngology of the Specialty Hospital of the CHU Ibn Sina of Rabat, involving 84 patients hospitalized for management of a tumor of the main salivary glands (parotid and submandibular) over a 4-year period from September 2015 to September 2019.The median age of our patients was 42 years with extremes of 7 and 80 years. The average age of patients with a benign tumour was 40 years. The average age of patients with a malignant tumour was 54 years. The sex ratio was 0.58. We didn’t find any specific risk factors in our patients. The average time between onset of symptoms and consultation was 38 months with extremes ranging from 2 to 120 months (10 years). In malignant tumours of the salivary glands, there is no predominance of sex, and the average age of discovery is between 55 and 65 years. For Dale , the majority of parotid cancers occur between the ages of 50 and 60, 2% of these tumours occur in children and 16% in subjects under the age of 30. Through our literature review, we found no risk factors specific to parotid tumours. Some authors report a risk of salivary gland tumours from exposure to silica dust . Salivary gland tumours are common, but most often they are benign. 80% of parotid gland tumours and 50% of submandibular gland tumours are benign. Parotid involvement is dominated by pleomorphic adenoma, and submandibular involvement is dominated by chronic lithiasic maxillite.
CASE REPORT | July 3, 2021
Neglected Microphone in the Ear: About A Case
Sefrioui Taha Ismail, Ait Taleb Hajar, Boumendil Ikram, Nitassi Sophia, Bencheikh Razika, Oujilal Abdelilah, Benbouzid Mohamed Anas, Essakalli Leila
Page no 186-188
Stranger bodies (EC) of the middle ear are among the emergencies least encountered by otolaryngologists (ENT). A 16-year-old patient with no otological history had seen a right chronic otorrhee with otalgia and hypoacousia for 6 months. Microscopic examination of the diseased ear had resulted in purulent secretions with inflammation of the external auditory canal. After aspiration, a blackish appearance was observed occupying the lower quadrants of the eardrum with associated myringitis. The gentle mobilization with the suction cannula and a spike revealed a fixed, painful CE, impacting the tympanic membrane and deeply introduced into the middle ear. The extraction of the EC could be carried out without difficulty (fig. 2), completed by myringoplasty with an aponevrotic graft. The first observation of a Tallic CE of the middle ear has been neglige for more than 20 years reported to you in 1883 by Lucius Holland . Since then, few cases have been written down. Syms and Nelson reported 4 cases of EC in the middle ear with chronic otitis media . Average EC penetrants from the ear are relatively rare. They may go unnoticed, especially in children, to reveal themselves later by complications. Hence the interest of prevention and diagnosis precoce allowing a simple extraction.
ORIGINAL RESEARCH ARTICLE | July 4, 2021
An Evaluation of the Effectiveness of Entecavir in Patients with Acute Chronic Hepatitis B liver Failure
Dr. Sharker Mohammad Shahadat Hossain, Dr. Mamun Al Mahtab, Professor Salimur Rahman, Dr. S.K.M.Nazmul Hasan, Dr. Lucky Siddiquei
Page no 189-197
Background: Entecavir has been shown to be effective in randomized controlled trials in highly selected patients with hepatitis B virus infection. Entecavir does not cure HBV and may not prevent complications of hepatitis B such as cirrhosis of the liver or liver cancer. The dose is double for people who have persistent hepatitis viremia (the presence of virus in the blood) while taking lamivudine or have lamivudine reesistance. It’s recommended to take entecavir on an empty stomach, two hours before or after a meal. For some people, hepatitis B infection become chronic, meaning it lasts more than six months. Having chronic hepatitis B increases your risk of developing liver failour, liver cancer or cirrhosis a condition that permanently scares of the liver. Aims: This study aimed to evaluate the efficacy of in cronic hepatitis B patients in the real world setting. Methodology: In this study a total of 32 acute on chronic Hepatitis B liver failure patients (age > 18 years with both sexes but male predominant) were included in Hepatology department of Bangabandhu Sheikh Mujib Medical University, Dhaka during January 2013 to December 2015. The patients were randomized into two groups: Entecavir group (N=32) and followed at least for 03 months. Result: Table I shows the Majority 26(81.3%) patients were male and 6(18.7%) patients were female in entecavir group. Altered level of consciousness was found 14(43.8%) in entecavir group. Moderate ascites was found 26(81.3%) in entecavir group. Encephalopathy was found 16(50.0%) in entecavir group. The entecavir not statistically significant (p>0.05) of the groups. Table II shows Baseline investigation of the study patients (n=32). It was observed that mean total countwas found 10181.3±3594.1 /mm3 in entecavir group. Mean serum bilirubinwas found 22.0±5.7 mg/dl in entecavir group. Mean Rank ALT was found 18.0 U/L in entecavir group. Mean Rank AST was found 17.8 U/L in entecavir group. Mean prothrombin time was found 23.1±4.2 secant in entecavir group. Mean international normalized ratio was found 2.0±0.3 in entecavir group. Mean serum albumin was found 2.3±0.5 gm/dl in entecavir group. Mean serum creatinine was found and 0.85±0.31 mg/dl in entecavir group. Mean serum sodium was found 134.1±5.2 mmol/l in entecavir group. Mean serum potassium was found 3.7±1.0 mmol/l in entecavir group. Mean MELD scorewas found 26.5±2.0 in entecavir group. Mean Child Pugh scorewas found 12.0±1.5 in entecavir group. The mean entecavir was not statistically significant (p>0.05) of the groups. Liver function, Child Pugh score and MELD score improvement by three months after entecavir therapy: In entecavir patients, mean serum bilirubinwas found 22.0±5.7 mg/dl in pretreatment and 5.1±1.7 mg/dl at 90 days. Mean international normalized ratio was found 2.0±0.3 in pretreatment and 1.4±0.2 at 90 days. Mean serum albumin was found 2.3±0.5 gm/dl in pretreatment and 3.1±0.3 gm/dl at 90 days. Mean Child Pugh scorewas found 12.0±1.5 in pretreatment and 9.3±0.9 at 90 days. Mean MELD scorewas found 26.5±2.0 in pretreatment and 17.0±2.1 at 90 days. Negative Mean Ranks ALT was found 4.0 U/L and sum of Ranks 28.0 U/L. Positive mean rank and sum of rank 0.The difference were statistically significant (p<0.05) between two groups. Table VIII: Entecavir induced improvement of liver function, Child pugh score and MELD score three months after therapy (n=16). Conclusion: In conclusion entecavir is very potent anti-HBV drug with a high genetic barrier to resistance, highly effective in lamivudine-naïve CHB patients and most promising for their long term treatment but not very suitable for CHB patients harboring LAM resistant HBV mutants.
ORIGINAL RESEARCH ARTICLE | July 15, 2021
Iron Deficiency and Behavioral Disorders in Children with Congenital Heart Disease
Eman Mohamed Khaled, Marwa Elhady Abd EL Moneim, Nadia Youssef Riad, Mai Mohamed Saber
Page no 198-205
Introduction: Congenital heart disease (CHD) is the most common birth defect. Emotional and behavioral problems are among the most prevalent chronic health conditions of childhood and often have serious negative consequences for a child’s academic achievement and social development. Iron deficiency is one of the most common nutrient deficiencies. Aim of The Work: To determine the effect of iron deficiency and congenital heart disease on the behavior of children. Subjects and Methods: This is a case control study of 90 children, 60 children had congenital heart disease they divided into two groups: 30 cyanotic and 30 acyanotic. All studied children subjected to the following: Assessment of behavioral disturbance using an adapted Arabic translation of. Conners’ PARENT rating scale and specific laboratory investigations including: serum ferritin, serum iron, total iron binding capacity, transferrin saturation capacity. Results: Behavior disorders were more frequent among congenital heart disease patients (33, 3%) compared to controls (13.3%) regardless the type of congenital heart disease either. Iron deficiency was more prevalent among children with congenital heart disease 25 (41.6 %) in comparison to control group 4 (13.3%) specially in cyanotic heart disease as we found 43.3% had iron deficiency in comparision to cyanotic heart disease (33%) . .There was slight increase in behavioral disorder in children with iron deficiency specially in those with cyanotic heart disease. Conclusion: Children with CHD are at higher risk of behavioural disorder specially those how suffering from iron deficiency.
REVIEW ARTICLE | July 15, 2021
Endobronchial Tuberculosis: Diagnostic and Therapeutic Challenges for Interventional Pulmonologist
Trilok Chand, Jamsak Tscheikuna
Page no 206-210
Pulmonary tuberculosis is the second most common infectious killer, claiming more than one million lives each year. The tuberculosis is common worldwide, but it is endemic in some parts of the world, such as Asia and Africa. The documented cases of endobronchial tuberculosis are less than that the magnitude of the problem because bronchoscopy and high resolution computed tomography is usually not performed in all cases of suspected or confirmed pulmonary tuberculosis. The complications and late sequelae are major challenges where infrastructure and expertise in Interventional bronchoscopy are warranted.
ORIGINAL RESEARCH ARTICLE | July 16, 2021
Profile Analysis of Apheresis Platelet Donors and Receivers: An Observational Study in a Tertiary Care Cancer Hospital in Dhaka Bangladesh
Dr. Farhana Islam, Dr. Fantasir Md. Shibly Al- Amin, Dr. Tasia Sultana Rahman, Dr. Zereen Mosfeqa Rahman, Md. Wasim Mollah, Md. Rabiul Islam
Page no 211-215
Background: Apheresis is a blood transfusion process that allows a donor to give specific blood components like platelets, RBCs, or plasma to the receivers. During this procedure, the rest blood components are returned to the donors. For safe and effective apheresis platelet transfusion, profiling of donors and receivers or primary information of them is very important. In Bangladesh, we have not enough research-based information regarding these issues. Aim of the study: The aim of this study was to analyze the profile of apheresis platelet donors and receivers who were cancer patients. Methods: This was a retrospective observational study which was conducted in the Department of Transfusion Medicine, National Institute of Cancer Research and Hospital (NICRH), Mohakhali, Dhaka, Bangladesh during the period from January 2018 to December 2019. In total 210 platelet donors and 210 platelet receivers through apheresis procedure were enrolled as the study population. The ethical committee of the mentioned hospital had approved this study. Before starting data collection, properly written consent was taken from all the participants. All data were processed, analyzed, and disseminated by MS Office and SPSS version 20 as per need. Result: In this study, the mean age of the donor was 26.62 ± 5.86 years. Only one donor was female (0.5%) whereas 95.5% of donors were male. As platelet count, below 2 lacs, above 2 lacs, above 3 lacs, and above 4 lacs were in 10%, 72.4%, 16.7%, and 1% donors respectively. For 100% donors, it was a single donation. On the other hand, the mean age of the receivers was 26.94 ± 15.55 years. We observed, 69% of receivers were male whereas 31% were female. In this study, as platelet count of receivers, we found <10,000/lac, 10,000-30,000/lac and 30,001-50,000/lac platelets among 15.7%, 61.9% and 22.4% receivers respectively. The majority of the receivers were with AML (Acute Myeloid Leukemia) which was found among 68%. As a total number of apheresis, a single number was found in 13% and multiple numbers were found in 36% of receivers. In 82% of receivers, history of chemotherapy and in 18% receiver’s history of chemotherapy as well as radiotherapy were found. Conclusion: In Bangladesh basically males are the prominent part of platelet donation through apheresis procedure. Although young males play a vital role in apheresis platelet donation, younger children and adolescents are the basic receivers here, a large number of healthy young women as potential blood donors are still out of platelet donation procedure in Bangladesh. Necessary motivational education could make them interested as platelet donors in the mainstream blood transmission system in near future.
ORIGINAL RESEARCH ARTICLE | July 30, 2021
Evaluation of Anxiety and Depression among Patients with Obstructive Airway Disease
Dr. Khondekar Mustaq Adnan, Prof. Krishna Chandra Ganguly, Prof. Muhammad Mahmudur Rahman, Dr. Md. Hasanur Rashid, Dr. Md. Rustom Ali
Page no 216-222
Background: Psychiatric symptoms which constitute a major and growing public health problem of anxiety, depression, and cognitive dysfunction often occur in patients suffering from somatic conditions like asthma and chronic obstructive pulmonary disease (COPD). In Bangladesh, we have very little research-oriented information regarding these issues. Aim of the study: The aim of this study was to determine the association of anxiety and depression with asthma and COPD. Methods: This cross-sectional observational study was conducted at the Department of Respiratory Medicine in the National Institute of Diseases of the Chest and Hospital from March 2018 to February 2019. A total of 160 cases of Asthma and COPD were enrolled in this study as study. Statistical analyses of the results were obtained by using Windows-based computer software devised with Statistical Packages for Social Sciences (SPSS-23.0). Results: In this study in total 98 (61.3%) patients had COPD and 62 (38.7%) had asthma. Among 98 COPD patients 10 (10.2%) had mild, 29 (29.6%) had moderate, 40 (40.8%) had severe and 19 (19.4%) had very severe COPD. Among 62 asthmatic patients 22 (35.5%) had mild, 16 (25.8%) had moderate, 11 (17.7%) had severe and 13 (21.0%) had very severe asthma. Among total participants, the mean Beck depression inventory score was found 95.6±12.6, the mean anxiety rating scale score was found 61.0±11.7 and the mean HADS score was found 12.1±1.5. In COPD patients, the mean Beck depression inventory score was found at 99.9±10.7, the mean anxiety rating scale score was found 57.1±10.7 and the mean HADS score was found 11.8±1.3. On the other hand, in asthmatic patients, the mean Beck depression inventory score was found 88.8±12.4, the mean anxiety rating scale score was found 67.4±10.3 and the mean HADS score was found 12.6±1.7. Conclusion: We can conclude that the Beck depression inventory score, anxiety rating scale score, and HADS score were statistically significant when compared to the level of severity of COPD and asthma. Excluding other risk factors for anxiety and depression, still, COPD & asthma patients remain at risk of both anxiety and depression.
ORIGINAL RESEARCH ARTICLE | July 30, 2021
Correlation of Serum Ascites Albumin Gradient and Endoscopic Parameters of Portal Hypertension in Chronic Liver Disease
Dr. Forhad Hossain Md. Shahed, Professor Mamun Al Mahtab, Professor Nooruddin Ahmed, Professor Mobin Khan, Dr. Noor Jahan Alam Chowdhury
Page no 223-229
Background: Chronic liver disease denotes the disease of the liver which lasts over a period of 6 months or more. The serum ascites albumin gradient (SAAG) is a formula that is used to assist in determining the etiology of ascites. It is also used in detecting ascites of portal hypertension in the adult population. We don’t have any research-based information regarding the correlation between serum ascites albumin gradient and endoscopic parameters of portal hypertension in chronic liver disease. Aim of the study: The aim of this study was to assess the correlation between serum ascites albumin gradient and endoscopic parameters of portal hypertension in chronic liver disease. Methods: This prospective observational study was conducted in the Department of Hepatology, BSMMU, Dhaka, Bangladesh during the period from January 2005 to December 2005. In total 50 patients with cirrhosis with ascites with high SAAG values (>1.1 gm/dl) were included as the study people. The age of the patients was 15 to 70 years. Both males and females were included in the study. All data were entered into a personal computer, thoroughly checked for any possible error, and then processed and analyzed by the SPSS program. The significance of the test was tested by the chi-square test. P-value of <0.05 was taken as statistically significant. Correlation analysis was done by the Pearson correlation test. Result: In this study, there were three SAAG groups. In SAAG group 1.10-1.49gm/dl, 53.33% of patients had mild grades of PNG, and 33.33% of patients had a severe grade of PNG. In the SAAG group, 1.50-1.99 gm/dl, 44.44% of patients had mild grade and 33.33% had a severe grade of PNG and in the SAAG group >2 gm/dl, 42.30% had mild grade and 49.99% had a severe grade of PNG. But there had not been any significant correlation among the groups regarding SAAG values and PHTN grades because the p-value was greater than 0.05. Conclusion: It was shown in this study that, oesophageal varices were present in 49 patients, sensitivity was 98%; portal hypertensive gastropathy in 44 patients, sensitivity 88%, and both oesophageal varices and gastropathy in 43 patients, sensitivity 86%. So high SAAG value can be used as an indicator of the presence of portal hypertensive changes especially oesophageal varices and gastropathy in the upper gastrointestinal tract. A weak positive correlation was found in this study between SAAG values and grades of oesophageal varices (r=0.358, p=0.011) and gastropathy (r-0.139, p--0.33) but no correlation was found between SAAG and gastric varices (p=0.4).