Background : Inguinal hernia repair is very common in day to day general surgical practice. Result of surgical repair is often satisfactory but recurrences following surgery are troublesome both for the surgeon and the patient. Lichtenstein technique is now the most widely performed technique in groin hernia repair.Objective : The aim of this study was to assess short term outcome of complete variety of inguinal hernia repair by Lichtenstein technique. Methodology :This was a prospective observational study in which 30 complete variety of inguinal hernia repairs were performed by Lichtenstein technique between January 2014 and December 2017 by same surgical team in surgery department, Holy Family Red Crescent Medical College Hospital (HFRCMCH). Patients were scheduled for follow up visits at the end of first week, third month and sixth month after operation in out-patient department. The main outcome measures were postoperative complications, early recurrence, groin pain. Result :In this study age of the patients ranged from 30 years to 78 years, the mean age was 51.93 (±SD 10.12) years. Most of the hernia were of indirect type 18(60%) followed by direct type 9(30%). In indirect type (55.6%) of the hernias was right sided and the rest (44.4%) were left sided. On an average each operation lasted for 1.18 hours and oral feeding started 12.69 hours after the operation, Postoperative mean hospital stay that was 2.27 days. Postoperative complications were 2(6.7%) had a prolonged recovery and presented with abdominal distention after operation and 3(10%) patients developed postoperative urinary retention. Scrotal haematoma formation was observed in 2(6.7%) cases and other post operative complications were local haematoma or seroma formation in incision site, periincisional skin echymosis, postoperative pyrexia, superficial wound infection and post operative pain were found in 1 (3.3%) cases. Regarding outcome no recurrence or mesh rejection or mesh infection were observed within short time postoperative follow up period. Conclusion :In this study no recurrence or mesh rejection or mesh infection were observed within short time postoperative follow up period and patient's compliance was good with minimum morbidity. Therefore, Lichtenstein's technique of inguinal hernia repair considered as a safe and effective procedure.

Introduction :Hospital acquired Infections (HAIs) are called those infections that were not present at the time of patient' hospitalization in a hospital and have been acquired after hospitalization. Nurses are an important part of the any healthcare team who play a unique role in the control of Hospital acquired infections.Objective : The aim of this study was to investigate the level of knowledge, attitudes, and practices of staff nurses about preventing the spread of hospital acquired infections (HAIs) at tertiary care Hospital of Dhaka city. Methods and Materials :This descriptive cross-sectional study was done among nurses having two years experience from two tertiary level hospitals in Dhaka city during January to June 2017. Self administered questionnaire containing different set of questions regarding knowledge, attitude and practice on HAI were used as a tool for data collection.Questionnaire was supplied to all staff nurses available at different in-patient wards of these two hospitals. Only 234 staff nurses who completed and returned the questionnaire were included in this study. Data were analyzed using Microsoft excel 2013 software.Result : Staff nurses were found to have good knowledge, moderately positive attitude but poor practice in prevention of hospital acquired infections. About 95% of the participants considered that prevention of HAIs were a valuable part of their role. About 65% of the staff nurses had received formal training regarding hand hygiene. The 100 % of participants felt that they would be less likely to transmit infection to the patients if they performed hand-hygiene. About 64% of them argued that hand hygiene agents were not readily available in current settings. Regarding practice, only 6% performed hand hygiene before patients contact and 27% of the staff nurses reported that they often forgot to perform hand hygiene. Conclusion :The finding of this study revealed a good knowledge of infection prevention among the majority of participants with relatively minimal level of practice. For strengthening the knowledge, attitude and practice towards HAIs, there is in need of developing regular training program and monitoring on performance feedback regarding hand hygiene is recommended.

Background: Port site pain remains prevalent complaint of early postoperative period after laparoscopic cholecystectomy. Objectives: to see the analgesic efficacy of port-site infiltration of bupivacaine in laparoscopic cholecystectomy. Methodology: This randomized controlled clinical trial was conducted in the Department of Surgery, Sylhet MAG Osmani Medical College Hospital, Sylhet from September 2017 to March 2018. Sixty patients underwent laparoscopic cholecystectomy were randomized into experimental group and control group by odd and even number respectively. Infiltration of 0.5% bupivacaine was at port sites subcutaneously in experimental group and none in control group. Postoperative pain intensity was measured using Numeric Rating Scale (NRS) at 6, 12, 24 and 48 hours. Results: Pain score was lesser in experimental group compared to control group at 6, 12, 24 and 48 hours (p< 0.001). The amount of opioid analgesic needed (p=0.006) and hospital stay (p=0.048) were significantly lesser in experimental group. Less frequent nausea/vomiting (p=0.034) and bladder dysfunction (p=0.012) were in experimental group. Conclusion:Port-site infiltration of bupivacaine is effective in reduction of postoperative pain in laparoscopic cholecystectomy.

Background: Inguinal hernia repair is a commonly performed general surgical procedure that constitute more than 95% of all groin hernia repairs. However, in developing countries, quite a considerable percentage of it is not repaired or delayed repaired and that lead to a higher incidence of morbidity and mortality. so, we planned to conduct this study to understand the clinic-epidemiologic profile of inguinal hernia in a tertiary care hospital of Bangladesh. Objective: To evaluate the clinical, epidemiological profile and associated risk factors for inguinal hernia. Methodology: This observational study was conducted among 100 patients during January 2018 to January 2019 who admitted in the surgery department of a tertiary care center for inguinal hernia surgery . All the study subjects were examined and their clinical and epidemiological profiles studied, tabulated and analyzed. Result: Among the 100 patients, most of them (94%) were men with a age of 57.02 ± 12.87, farmer (36%) by occupation.61% patients were in low saocio-ecenomic status. Most of the patients (60%) were in the age group of 40-60 years followed by less than 30 years (21%). On query regarding symptoms of inguinal hernia, all of them (100%) complaints of groin swelling. More than half of the patients complaints of groin pain and sensation of heaviness in groin. On clinical examination, right sided, left sided, bilateral hernias were found in 49%,45% and 6% study patients respectively. Direct hernias, indirect, pantaloons hernias were seen in57%,30%,7% study patient respectly. Most of hernias (81%) were reducible and were incomplete (88%). Most of the patients (75%) presented late to the health care center due to the lack of awareness of the disease and were initially treated by homeopath medicine. During query about risk factors for inguinal hernia,46% patients were more than 50 years of age and 26% patients were smoker. In this study, most common hernia repair procedure was Lichtenstein's procedure (63%) followed by modified Bassini's procedure (11%). Total open procedure were 93% and laparoscopic hernia repairs were done only in 7% patients.

Background: Generalized peritonitis as a result of gastrointestinal perforation is a common surgical emergency and one of important morbidity is surgical site infection (SSI). Objectives: to evaluate the incidence of SSI after emergency laparotomy for perforation peritonitis.

Laparoscopic appendectomy for uncomplicated appendicitis is associated with good outcomes but the role of laparoscopy in complicated appendicitis is more controversial because of high incidence of infectious complications. The aim of this current study is to evaluate the efficacy and safety of laparoscopic appendectomy in complicated appendicitis in children. This interventional study was carried out during the period from January 2015 to May 2018 in Holy Family Red Crescent Medical College Hospital. The study included 43 patients, age ranges from 3 years to 15 years who underwent laparoscopic appendectomy for complicated acute appendicitis. The following variables were analyzed : age, sex, operative findings, operative time, return of bowel function, resumption of oral feeds, length of hospital stay, postoperative complications such as deur, wound infection and intraabdominal abscess etc. The mean age of studied cases was 7.1 years. In 41 patients (95.3%) the procedure was completed laparoscopically. Two (4.7%) patients required conversion to open appendectomy. The operative time was 83.5+,25.8 minutes. Two patients (4.6%) had post-operative ileus. Four patients (9.7%) developed superficial wound infection. Three patients (7.3%) developed infra-abdominal collections. One (2.4%) patients were readmitted because of recurrent abdominal pain One patients (2.4%) developed postoperative pyrexia due to pneumonitis and Three patients (7.3) developed gastroenteritis. The mean length of hospital stay was 5.8±2.1 days. No mortality was recorded.Laparoscopic appendectomy can be the first choice for cases of complicated appendicitis in children. It is a feasible, safe procedure and is associated with acceptable post-operative morbidity with rapid recovery and better cosmetic results.

Background: Inguinal hernia repair are very common in day to day general surgical practice. Results of surgical repair are often satisfactory but recurrences following surgery is troublesome both for surgeon and patient. Lichtenstein technique is now the most widely performed technique in groin hernia repair. The aim of this study was to assess short term outcome of inguinal hernia repair by Lichtenstein technique. Methods and materials: In this prospective study, 30 inguinal hernia repairs were performed by Lichtenstein technique between January 2015 and December 2017 in surgery department of Holy Family Red Crescent Medical College Hospital. Patients were scheduled for follow up visits at 1st week, three months and six months in out- patient department. The main outcome measure was early recurrence, groin pain and other complications. Results: In this study age of the patients ranged from 30 years to 78 years, The mean age was 51.93 (±SD 10.12) years. Regarding personal habit, more than half of the patients of inguinal hernia were found to be non-smoker and about 37% of the patients were current smokers. Most of the hernia were of indirect type (18/30) followed by direct type (9/30). In indirect type 55.6% of the hernias were in the right side and the rest were in left side. On an average each operation lasted for 1.18 hours and oral feeding started 12.69 hours after the operation. Two patients (6.7%) had a prolonged recovery and presented with abdominal distention after operation. Postoperative hospital stay that was 2.27 days. 6 (20%) patients developed postoperative urinary retention. Scrotal haematoma formation was observed in 5(17%) cases and local haematoma or seroma formation in incision site was reported in 4 (13%) cases. In 6 patients (20%) we used suction drain tube at tissue plane where mesh was placed for draining of blood or seroma and that drain tube was removed 2nd or 3rd postoperative period. Periincisional skin echymosis, abdominal distension and superficial wound infection, postoperative pyrexia were the other complications reported. No recurrence or mesh rejection or mesh infection were observed within short time postoperative follow up period. Conclusion: Lichtenstein technique is easy to learn, simple to perform and very rationale to perform and recurrence rate is low. Multi-centre studies with larger sample and longer duration of study and more sound study design could bring more insight regarding this issue. Anwer Khan Modern Medical College Journal Vol. 10, No. 1: Jan 2019, P 62-69

Background: Multiple Myeloma (MM) accounts for 1% of malignant tumors and 10%–15% of hematopoietic neoplasms. Bortezomib, a first in class proteasome inhibitor, induces apoptosis and growth arrest and reverse chemoresistence in Myeloma cell and has demonstrated no irreversible adverse effect on haemopoietic stem cell. Dexamethasone increases the response rate. Thus, Bortezomib plus dexamethasone represent highly effective regimen for previously untreated Multiple Myeloma cases and significantly higher response rates approximately 70%– 90% have been observed.This combination thus may serve the basis of future strands of care in Multiple Myeloma patients. Objective: The aim of the study was to assess the efficacy , safety and tolerability of Bortezomib in newly diagnosed cases of Multiple Myeloma patients in Bangladesh. Materials & Methods: This prospective observational study was carried out in the Haematology department of BSMMU from June 2017 to December 2018. Patients received inj. Bortezomib (1.3mg/m2 ) 4 cycles as an intravenous bolus on days 1,4,8,11 in a three week cycle (twice weekly administration) in indoor and same patients as day care basis in outpatients department. Dexamethasone at 40 mg was given intravenously or orally on the day of and day after inj Bortezomib.A self administered questionnaire containing different set of questions regarding Multiple Myeloma were used for data collection. Results: Among the study population, 93% of patients had anaemia followed by bone pain (86%) and renal impairment (39%). Out of 25 patients,complete response achieved in 13 patients (52%), where 4 patients(16%) showed partial response,6 (24%) showed very good partial response and 2 (8%) patients showed no response. The overall response rate was 92% belonged to partial,very goofd partial and no respone respectively. Death occurred in 3 cases (12%). 5 patients (20%) developed Bortezomib induced peripheral neuropathy.Life threatening intracranial haemorrhage occurred in two patients (8%). Death occurred in 3 cases (12%),2 patients due to intracranial haemorrhage and another from cardiac arrest. In this study,S. creatinine, â2 microglobulin and bony lesion variables showed significant association with treatment response. Conclusion: Bortezomib plus dexamethasone is a highly effective and safe regimen for previously untreated multiple myeloma patients. This novel therapy in myeloma represent a new trearment paradigm targeting both tumor and microenvironment which has markedly improve overall response(OR), long progression free survival (PFS) and overall survival (OS)across in all risk groups. Moreover,it can be administered safely in the outpatient setting provided by clinicians. J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 34-41