Introduction: Cerebral palsy is a heterogeneous disorder that makes the child handicapped. The incidence is about 2 per 1000 live births with the highest rates in premature babies and those of multiple births. It should be treated in a multi-disciplinary approach with the combination of a pediatrician, neurologist, or orthopaedic surgeon & physiotherapist. Aim of the study: The aim of the study was to assess the outcome of single-stage multilevel surgery of spastic Cerebral Palsy (CP). Methods: This prospective Experimental Study (quasi experimental Study) was conducted from July 2012 to June 2014 at the Department of Orthopaedics, Dhaka Medical College Hospital, and different clinics in Dhaka city. Twenty patients with diplegic and hemiplegic spastic cerebral palsy were recorded. Preoperative and post operative GMFCS and gait pattern of each patient were recorded for evaluation of results. Among them 12-patient were diplegic and 08 patients were hemiplegic. Data was collected and recorded sequentially and analyzed by SPSS computer software program, version 20 and MS-Excel 2016. Results: Mean follow up time was 13 months. There were 15 (75%) excellent, 5 (25%) good results assessed clinically by comparing preoperative and post operative gait pattern and GMFCS scoring system. Complications including superficial skin infection in 4 cases. There was no recurrence. Conclusion: Single-stage multilevel soft-tissue surgery in the lower limb(s) in children with spastic CP yields good results for locomotion and good trunk control.
Original Research Article Femoral shaft non-union is a functional and economical challenge for the patient as well as a treatment dilemma for the surgeon. The Association for Osteo-synthesis (AO)' as a means of preventing the development of fracture disease and early recovery. Intramedullary (IM) nailing is the gold standard for the management of femoral shaft fractures. To find out the Functional outcome in exchange nailing with autogenous cancellous bone graft for aseptic nonunion of femoral shaft. From July 2015 to June 2017, more than 30 patients of femoral shaft aseptic nonunion were treated with this technique at Pabna Medical College Hospital and clinics in Pabna, Bangladesh. 21 patients were finally recorded for study. Among them 1(one) patient was lost after 04 weeks before fracture healing. Culture of the 1st reaming materials revealed growth in 2 cases. So, final outcome, analysis and test of significance were done with 18 patients. Mean age 41.95 Years; SD ± 13.11; Male: Female = 3.3:1 Among 18 fractures nonunion, 15 fractures (83.33%) were united and 3 fractures (16.67%) were not united after exchange nailing with autogenous bone graft in aseptic condition. Confidence Interval at 95% level 66.08%-100%. Mean union time was 26.00 ±4.5 weeks where 95% confidence interval was 23.49±28.51weeks including both static and dynamic mode of fixation. In static mode mean union time were 29.33±3.01 weeks whereas in early dynamic it was 21.33±1.63 weeks. It was also calculated that after late dynamization mean union time was 28.67±2.309 weeks. Among complications unacceptable Angle deviation 5.6%, Limb length discrepancy 5.6%, Pain-Swelling 5.6%, Infection 11.12%, Joint motion restriction 5.6%, Implant failure 5.6%. There was a strongly positive correlation between age and union time; that means more the age more the union time. In this study, it was found that smoking and NSAIDs both had significant relation (p<0.05) with fracture union time. Highly strong (+) ve correlation was found between non union period and union time after exchange nailing. Final outcome according to modified Thoresen's score was Satisfactory78%; according to modified Silvia's score was 10.83 ± 2.203. In fracture united cases postoperative SF-MFAS Function Index was achieved 2.5 ±1.7and Bother index was achieved 1.89±1.08.There was a highly significant (p<0.001) difference between pre operative and post operative functional outcome after exchange nailing with open bone graft as a whole. Exchange nailing with autogenous cancellous bone graft seems to be an effective method of treatment in femoral shaft nonunion after intramedullary nailing. It provides a good scope to reinforce the optimum mechanical stability by a larger diameter nail and locked if necessary; as well as biological stimulation by reaming and open bone grafting.
Original Research ArticleIntroduction: Femoral shaft fractures are most common fractures in paediatric age group having different options to treat them. Elastic stable intramedullary nailing is one for treating these fractures and has a reliable methodology. Objective: The aim of this study is to evaluate the short term clinical, functional and radiological outcome of intramedullary fixation of displaced femoral shaft fractures in skeletally immature children using titanium elastic nails. Material and Methods: 36 femoral shaft fractures in 36 children aged 6-14 years were fixed with titanium intramedullary elastic nail between July 2017 and December 2018 in the department of Orthopaedics, Shaheed Ziaur Rahman Medical College Hospital, Bogura, and in some private hospitals in Bogura, Bangladesh. Two nails of proper and equal diameter were used for fracture fixation. No external splint was used after surgery. Outcomes assessed on the basis of Flynn et al. scoring criterion. Results: All patients achieved complete healing at a mean of 9.1 (Range 8-10) weeks. 31 fractures were reduced by closed means but 5 needed open reduction. No major complication was recorded. Most common minor complication was entry site skin irritation recorded in 4 patients. 86% had excellent result and 14% had satisfactory. Conclusion: Elastic stable intramedullary nailing is the method of choice for the femoral shaft fractures in paediatric patients, because it is minimally invasive and shows very good functional and cosmetic result. It allows early ambulation and shorter hospital stay and higher parent satisfaction. It also provides flexural, translational and rotational stability as well.
Background: Acute kidney injury (AKI, previously known as acute renal failure) is a frequent complication that affects a substantial number of hospitalized patients annually. However, the relationship between severity of AKI and in-hospital outcomes in the setting of acute Acute ST-Elevation Myocardial Infarction (STEMI) has not been well- documented. Chronic kidney disease is a strong predictor of in-hospital mortality in the acute myocardial infarction setting. Objective: To evaluate the Outcome of admitted patients of acute ST elevation myocardial infarction with renal function. Methods: The Prospective observational study was carried out at the Cardiology Department, Bangabandhu Sheikh Mujib Medical College and Hospital, Faridpur, Bangladesh from July 2020 to June 2021. 100 patients of STEMI diagnosed by clinical, biochemical and ECG criteria were included in the study. After getting serum creatinine level from them, eGFR was calculated and patients having <60ml/min were selected for the further studies. Results: In the STEMI patients, the ratio of male patients 76% and females’ patients (35%) was 3.34:1 with mean ± SD of age was 52.84 ±8.40 year. Among the 101 patients, chart indicating the outcome of the study patients where cardiogenic shock was found in 10.8% patients, heart failure was found in 24.7%, arrhythmias were found in 69.3% and death occurred in 5.9% of cases. Table 5 showing Stratification of patients by in relation with eGFR where different pattern and frequency of outcome was observed in relation with level of eGFR described. After calculating levels of eGFR, all the outcomes showed statistically significant (P < 0.05) except cardiogenic shock which didn’t show significance (P > 0.05. Conclusion: In concluded, that those who have renal impairment previously or develop after acute STEMI have inverse outcomes. As renal impairment is associated with an increased risk of coronary artery disease and stroke, the cardiovascular disease may develop early in the course of renal dysfunction.
Original Research Article Background: Carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA) have been well recognized as tumor markers for colorectal cancer. Previous studies suggested that body mass index is inversely associated with the screening of CEA and CA19-9 levels and may reduce screening sensitivity. Objective: To assess the relation between CEA & CA 19-9 level and body mass index in colorectal carcinoma. Methods: A Prospective Observational Study was carried out at Department of Surgery, Dhaka Medical College Hospital (DMCH) from January, 2016 to December, 2016 (12 months). Cases were purposively selected according to inclusion criteria. Patients are divided group of on the basis of values of CEA level < 7 ng/dl and ≥ 7 ng/ml, CA 19-9 <37 ng/ml and ≥37 ng/ml. Body mass index divided three groups which are <18.5, 18.5-24.0 and >24 kg/m 2. The quantitative observations were indicated by frequencies and percentages. P values <0.05 were considered as statistically significant. Results: Total 50 cases majority patients belonged to age 41-50 years in both groups (CEA <7 ng/ml and ≥7 ng/ml). The mean age was found 42.5±11.3 years in CEA (<7 ng/ml) group and 40.7±12.1 years in CEA (≥7 ng/ml) group. Male was found 15 (40.5%) in CEA (<7 ng/ml) group and 06 (46.2%) in CEA (≥7 ng/ml) group. Regarding histological type of the patients that tubular adenocarcinoma was 27 (73.0%) in CEA (<7 ng/ml) group and 10 (76.9%) in CEA (≥7 ng/ml) group. Majority patients had tumor size ≤5 cm in both groups, which was 23 (62.2%) in CEA (<7 ng/ml) group and 07 (53.8%) in CEA (≥7 ng/ml) group. Colon tumor was 16 (43.2%) in CEA (<7 ng/ml) group and 07 (53.8%) in CEA (≥7 ng/ml) group. Peritoneal metastasis was 04 (2.7%) in CEA (<7 ng/ml) group and 03 (23.1%) in CEA (≥7 ng/ml) group. Liver metastasis was 02 (5.4%) in CEA (<7 ng/ml) group and 02 (15.4%) in CEA (≥7 ng/ml) group. Regarding TNM staging of the patients CEA (<7 ng/ml) group majority 19 (51.4%) patients had TNM stage II and CEA (≥7 ng/ml) group 07 (53.8%) patients had TNM stage III. Majority patients had moderate histological differentiation in both groups, which was 31 (83.8%) in CEA (<7 ng/ml) group and 10 (76.9%) in CEA (≥7 ng/ml) group. Mean age was found 43.7±10.5 years in CA 19-9 (<37 ng/ml) group and 41.9±11.1 years in CA 19-9 (≥37 ng/ml) group. Colon tumor was 17 (42.5%) in CA 19-9 (<37 ng/ml) group and 06 (60.0%) in CA 19-9 (≥37 ng/ml) group. Peritoneal metastasis was 02 (5.0%) in CA 19-9 (<37 ng/ml) group and 02 (20.0%) in CA 19-9 (≥37 ng/ml) group. Liver metastasis was 03 (7.5%) in CA 19-9 (<37 ng/ml) group and 01 (10.0%) in CA 19-9 (≥37 ng/ml) group. CA 19-9 (<37 ng/ml) group majority 19 (47.5%) patients had TNM stage II and CA 19-9 (≥37 ng/ml) group 06 (60.0%) patients had TNM stage III. Almost two third (62.5%) patients was found tubular adenocarcinoma in CA 19-9 (<37 ng/ml) group and 03 (30.0%) in CA 19-9 (≥37 ng/ml) group. Majority patients had moderate histological differentiation in both groups, which was 32 (80.0%) in CA 19-9 (<37 ng/ml) gr...
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