Background: Cervical cancer is the second most common cancer in women throughout the world, and it is the leading cause of cancer death among women in underdeveloped countries like Bangladesh is preventable and curable if detected at and early stage using proper screening tools. This study was done to see the effectiveness of VIA and find out the CIN and introduce as a complementary to cytology for diagnosing precancerous form of cervix. Materials & Methods: A total 175 subjects were studied & relevant data of cervix related patients have been collected. The data regarding Pap smear, VIA and biopsy have been taken and collected data was analysis by SPSS. Results: Out of 175 Patients VIA positive 53 (30.3%), Pap smear reports, 84 (48.0%) had inflammatory findings and 38 (21.7%) had dysplasia and biopsy result 41(23.4%) CIN positive. Sensitivity of VlA was 90.2%, specificity 88.1%, PPV 69.8%, NPV 96.7% and accuracy 88.6%. Sensitivity of Pap smear reports was 80.5%, specificity 96.3%, PPV 86.8%, NPV 94.2% and accuracy 92.6%. Conclusion: Visual inspection of cervix after application of acetic acid (VIA) is valid as cytology test for the identification of pre-invasive cervical cancer (CIN). Thus VIA is a useful screening method of Cervical Intraepithelial Neoplasia lesion as Pap smear. TAJ 2018; 31(1): 15-20
Background: Bangladesh recently became a middle income country and despite of its relatively low skilled birth attendance (26.5%) nevertheless experience a rise in caesarean section (CS) rate. But now the rate of CS increased almost seven fold from 3.5% in 2004 to 23% in 2016. Objective: To find out the cause and incidence of caesarean section among the primigravid mother in Rajshahi medical college hospital performed in between January 2017 to December 2017. Methods: This prospective type of observational study was performed in Rajshahi Medical College Hospital (RMCH) over a period of one year from January 2017 to December 2017. All primigravida who underwent caesarean section in RMCH were included. Result: During the study period there were 11018 deliveries. Overall CS rate was 40.98%. The rate in primi was 30.70% and last year it was 25.58%. Conclusion: The vast majority of CS was not medically indicated. A number of policies and program had been launched to counteract this increasing rate of CS but virtually there was no impact. TAJ 2018; 31(2): 54-58
Fetal gastroschisis and omphalocele are congenital defects of abdominal wall that are often diagnosed by prenatal ultrasound done for routine screening or for obstetric indications such as evaluating an elevated maternal serum alpha fetoprotein (AFP).Regular antenatal checkup and Prenatal ultrasound could potentially identify the overwhelming majority of abdominal wall defects and accurately distinguish omphalocele from gastroschisis. But in a developing country like Bangladesh neglected patients fail to seek antenatal visit and prenatal diagnosis. Here we report a case of gastroschisis and omphalocele diagnosed incidentally during last trimester.TAJ 2015; 28(2): 64-65
Fetal gastroschisis and omphalocele are congenital defects of abdominal wall that are often diagnosed by prenatal ultrasound done for routine screening or for obstetric indications such as evaluating an elevated maternal serum alpha fetoprotein (AFP).Regular antenatal checkup and Prenatal ultrasound could potentially identify the overwhelming majority of abdominal wall defects and accurately distinguish omphalocele from gastroschisis. But in a developing country like Bangladesh neglected patients fail to seek antenatal visit and prenatal diagnosis. Here we report a case of gastroschisis and omphalocele diagnosed incidentally during last trimester.TAJ 2014; 27(2): 58-62
Background & objective: Of the many pharmacological options for the management of postpartum hemorrhage, oxytocin is the first line of treatment. The newer drug carbetocin is getting popularity among obstetricians, although there is as yet not enough evidence about its safety and efficacy. The present study attempted to compare oxytocin with carbetocin for the routine prevention of postpartum hemorrhage (PPH) following caesarean section. Methods: The present comparative clinical trial was conducted in the Department of Obstetrics and Gynaecology in Rajshahi Medical College Hospital (RMCH), Rajshahi over a period of one year between March 2017 to February 2018. Pregnant women undergoing cesarean section under regional anaesthesia and do not have known hypersensitivity to oxytocin and carbetocin and known bleeding disorders were included in the study. A total of 96 such subjects were consecutively included and were randomly assigned to either Oxytocin (n = 48) and Carbetocin (n = 48) Groups. The outcome was evaluated in terms of incidence of PPH (loss of blood > 1000 ml), blood transfusion needed to compensate for lost blood, additional oxytocics needed to manage PPH and adverse effects encountered by the subjects. Result: The mean age of the subjects was around 25 years and the age distribution between the study groups was almost similar. In terms of obstetric characteristics multigravida was predominant in the Oxytocin group than that in the Carbetocin group. The current pregnancy profile like gestational age, ANC received, number of foetus in utero and placental position all were comparable between the groups. Antenatal conditions/diseases deemed to have influence on PPH were no different between the study groups. Past history of caesarean section was higher in Oxytocin group (43.8%) than that in the Carbetocin group (22.9%). There were negligible incidences of past PPH and myomectomy in either group. The mean haemoglobin level in the former and the latter groups were 9.5 and 10 gm/dl respectively with majority of the subjects being mildly anaemic. More than 80% of the subjects in either group underwent emergency caesarean section. The outcome showed that 83% in the Oxytocin group and 90% in the Carbetocin group did not develop PPH, but the difference was not significant. The mean blood lost was somewhat lower in the carbetocin group (630 ml) than that in the Oxytocin group (685 ml). The number of patients needed to be transfused and the mean amount of blood transfused to them in each group was fairly comparable. Oxytocin group received additional oxytocic drugs, such as, Metherspan and Misoprostol more frequently than the Carbetocin group did, but the differences did not turn significant. A few patients in both groups developed adverse effects but they were comparable. The mean 24-hours urine output was > 2000 ml in either group). Conclusion: The study concluded that the incidence of PPH, the amount of blood lost, number of patients transfused, amount of blood transfused and the additional amount of oxytocics required for the prevention and treatment of PPH were broadly comparable between the two study groups. Ibrahim Card Med J 2021; 11 (1): 71-78
Objective: To determine the prevalence of cervical intra epithelial neoplasia (CIN) among sexually active married women in Rajshahi division of Bangladesh. Study Design: It is a prospective cross sectional type descriptive study. Place and Duration: This study is population based & carried out in 4 selected Upazilla from 4 different districts of Rajshahi Division. Total 1050 patient were enrolled in the study. Study period was 6 months from 1st December 2014 to 31st May 2015. Subject and Method: All sexually active woman between age group 25 to 55 years in selected Upazilla. In UHC of preselected Upazilla who fulfilled the inclusion criteria enrolled in the study after taking the consent. Frequency & risk factors for CIN were analyzed after entering in predesigned proforma. Result: During study period of 6 months among 1050 enrolled patients 90 patient were VIA positive and 91 patients were colposcopically abnormal and among these 33 patients were CIN positive & 58 patients had chronic cervicitis with or without squamous metaplasia. Mean age of CIN positive were 36.75 years, 92.2% patient were housewife & 7.8% patient were service holder and in 64.6% patients education level up to XII class, in 55.5% patients husband was day labour from poor socioeconomic condition. Conclusion: VIA and Colposcopy can differentiate a normal cervix from a precancerous cervix with reasonable accuracy. Till now, a good number of studies had been carried out in different countries of world & it is now well established that sensitivity of the test is very good. From the present study we can conclude that it will give very good information about the prevalence of CIN in our country and by follow up study this might help us in reducing the incidence of carcinoma cervix. TAJ 2018; 31(2): 1-5
This was a hospital based case control study. The study included patients attending in outdoor and indoor Department of Obstetrics and Gynaecology of Rajshahi Medical College, Hospital since July 2014 to June 2016. The aim of this study was to determine thyroid antibodies is a risk factor for recurrent pregnancy loss. Sixty seven pregnant or non pregnant women with history of recurrent miscarriage during 1st trimester were selected as case group and another sixty seven pregnant women who reached their 12 weeks uneventfully with no history of recurrent miscarriage were selected as control group. Patients with other cause of recurrent miscarriage such as metabolic or endocrinologic disorders, genital organ anomaly, uterine fibroid were excluded from the study. Thyroid function test and thyroid antibodies (FT4, TSH and TPO-Ab) were measured for the two groups. The result of this study showed that the percentage of positive TPO-Ab in target and control group is 67.16% and 5.95% respectively. The study observed that the mean serum concentrations of FT4 in the control subject was significantly higher than the mean of the target group (p-value <0.05). The TSH concentration was increased in miscarriage women with positive antibodies compared with the concentration of TSH in the control group with positive antibodies. The conclusions are that there is a deficiency in thyroid hormones or thyroid’s functional capacity is unable to meet the extra demands of pregnancy which may be one of the causes of recurrent miscarriage. Moreover positive thyroid antibodies pregnant women can reach term and have babies when the concentration of TSH is low during the first trimester, so the risk of miscarriage could be high in positive thyroid antibodies.TAJ 2017; 30(1): 49-55
Endometriosis is a common gynaecological condition and presents mainly with involvement of the pelvic organs. However umbilical endometriosis is uncommon. A correct differential diagnosis can be difficult and the use of epiluminescence and MRI is suggested for the accuracy of preoperative diagnosis. This case report was experienced at a tertiary care hospital at Rajshahi. The patient was 42 years old multigravid woman presented with umbilical swelling and pain during menstruation for last 6 years with cyclical bleeding from the umbilical region for same duration. The patient had regular menstrual bleeding since the time of menarche. The patient had no previous history of endometriosis, dysmenorrhea or dyspareunia. Physical examination showed a hyperpigmented tender paraumbilical swelling with bloody discharge through umbilicus. Clinical examination together with the use of high resolution ultrasonography and fine needle aspiration cytology led to an accurate pre-operative diagnosis of umbilical endometriosis. The surgical approach to umbilical endometriosis represented an important step in achieving a satisfying result. The lesion to be excised and adequate umbilical repositioning was done. The patient was asymptomatic at the follow-up visit (12 months after surgery). A natural-looking umbilicus was observed with minimal visible scars.TAJ 2015; 28(1): 48-51
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