In terminal illness careful control to avoid long-term complications is not required. Management of diabetes during terminal illness will not only depend on the type of diabetes, but also on prognosis, oral intake and the presence of co-existing disease such as renal and hepatic impairment. All dietary restrictions relating to diabetes are removed from the early stage of terminal illness. In both T1DM and T2DM, glucose monitoring should be reduced to an acceptable minimum. In the case of a patient treated with insulin, this may be 2–3 times per week and for a patient treated with oral agent’s blood glucose could be monitored 1–2 times per week., only in case of special situation frequent monitoring is advisable. This may include: hypoglycaemia, poor food intake, nausea and vomiting, enteral or parenteral feeding or corticosteroid use. The clear aim is to avoid hypoglycaemia and osmotic symptoms, so the recommendations suggest a target blood glucose range between 10 and 15 mmol/l in the early stage of terminal illness with a more liberal range of 5–20 mmol/l in the later stages. Subsequently there are no agreed, evidence-based strategies to manage diabetes at the end of life or during terminal illness. Therefore, in this review I will try to uncover some of the challenges and discuss the available guidelines associated with managing diabetes at the end of life and terminal illness from the available scientific evidence.
Background: In the dynamic part of the spinal column the lumbar vertebra are the largest vertebra that support the maximum body weight and exhibit the greatest degree of degenerative changes. Pedicles of the vertebra act as a port to perform procedures inside the bodies of the vertebra such as biopsies, vertebroplasties or kyphoplasties. Pedicle screw fixation is a technically demanding procedure. Accurate anatomical knowledge of the morphometry of vertebral pedicle are also important for preoperative procedure, planning and in the design and manufacture of pedicle screws. The objective of this study to observe the morphometry of lumbar pedicles to determine the size of the screw in transpedicular screw fixation on the perspective of Bangladesh. Materials and methods: A descriptive observational study was conducted at Southern Medical College and Hospital in the Department of Anatomy on 65 dry adult human lumbar vertebra from December 2020 to May 2021. Width height of pedicle along with antero-posterior diameter of lateral recess (Depth) were observed by using digital Vernier Calipers and after recording data were analysed. Results: The study shows that there is gradual increase in the mean width of the pedicles on both right and left side from L1 to L5. Mean height of the pedicle and antero-posterior diameter of lateral recess both showed decrease at the level of L3 both on the right and left side. Conclusions: The measured data will give a gross measurement of pedicle of lumbar vertebra on Bangladeshi people, hope to provide the clinicians a better support during working with pedicles. IAHS Medical Journal Vol 4(2), December 2021; 51-54
Background: Ascites is a common clinical condition encountered by physician in day-to-day practice. It will be an understatement to state that ascites is common in our country rather it is safe to say that ascites is one of the most common mode of presentation in the hospital wards in our country. The aim of the study was to find out the common causes of ascites by evaluating the clinical presentations along with the ascitic fluid study and other routine and related investigations followed by observing the short-term outcome of the patients with ascites during their hospital tenure. Materials and methods: It is a descriptive observational study carried out in Medicine Department of Chittagong Medical College Hospital (CMCH) over a period of one year (October 2008- September 2009). Hundred consecutive adult patients admitted in different units of Medicine Department, CMCH with ascites were the subjects of this study. After selection of cases detailed clinical history was taken and elaborate physical examination was done. Common criteria for data collection were followed in every case. Ascitic fluid was collected and examined in all 100 cases. Selected investigations were designed considering the symptomatology and systems affected and reserved for those cases where symptoms and signs were strongly in favour of the diagnosis that needs to be investigated accordingly. All the data were computed and analysed with proper statistical methods. Results: Data analysis of the present study reveals that Cirrhosis of liver is the commonest cause of ascites (50%). Next two major causes are Tubercular Peritonitis (21%) and Congestive Cardiac Failure (14%). Other important causes include hepatocellular carcinoma (7%) Su-bacute Hepatic Failure (3%) Intra-abdominal malignancy (Except hepatocellular Carcinoma) (3%) and Nephrotic Syndrome (1%). Clinical presentations have shown that most of the patients had multiple and variable presentations. Serum ALP, AST, ALT, Ascitic Fluid Total Protein (AFTP) (F=5.04, p=0.0009 <0.05) Serum Ascitic Fluid Albumin Gradient (SAAG) are found to be statistically significant. Total 76% patients improved with treatment, condition of 11% patients were static and 1% deteriorated. 9% patients of this study died during hospital stay in spite of appropriate treatment measures. 3% of them died of grade IV hepatic encephalopathy, 2% died of complications of very late stage of congestive cardiac failure. Rest 4% were case of hepatocellular carcinoma on top of cirrhosis of liver. Conclusion: Results of this study offers an overview of aetiology, clinical presentation and short-term outcome of the patients with ascites reporting to a tertiary level hospital in this zone. IAHS Medical Journal Vol 4(2), June 2021; 56-62
Background : There is a large spectrum of variations in the disposition of coronary arteries. Many of these variations are 'normal' and not considered as 'anomalous'1 . These variations mainly occur in the Left Coronary Artery (LCA) 2 . While some of these are benign and have no clinical consequences, other variants can cause important clinical manifestations including sudden death of the individual 3 . Lack of knowledge of such variations can pose difficulties in percuteneous coronary arteriography, coronary artery bypass surgery or prosthetic valve replacement. A cadaveric study in unsuspected population can help to understand the variations that will be useful to determine the prevalence of certain variations. Thus the objective of this study was to analyze the characteristics of LCA that may be used in the diagnosis and treatment of its pathologies. Methods: The study was carried out in the Department of Anatomy, Chittagong Medical College (CMC) Chittagong over a period between Jan 2012 to Dec 2013 with ethical clearance. A detailed dissection of LCA and its branches in 50 cadaveric human hearts, fixed in 10% formalin was carried out to study normal and variant anatomy of LCA. The length of the main stem of LCA was measured by slide calipers. Results: The LCA was found to arise from the Left Posterior Aortic Sinus (LPAS) of the ascending aorta in 100% cases. The level of the ostia (Opening of coronary artery) was above the free margin of the aortic cusps in 98% cases. In all samples ostia were present below sinutubular ridge (A slight circumferential thickening separating bulbar aortic sinus and proximal ascending aorta). The length of the main stem of LCA (From origin to the point of termination into main branches) was found to range from 0.5-2 cm. The LCA showed bifurcation in 74%, trifurcation in 26% of cases. Left Anterior Descending artery (LAD) was found to terminate at the apex of the heart in 68% and at the posterior interventricular groove in 32% cases. The Left Circumflex artery (LCx) was terminated at the crux of the heart in 52%, near the crux in 44% and by crossing the crux in 4% cases. The Left Marginal Artery (LMA) which was present only in 34% cases, found to terminate nearer to the apex of the heart. 0% Left dominance of heart was observed. Conclusion: Simple attention to potential variations in the origin, number, level of ostia, length of the main stem, branching pattern, termination and distribution of LCA can greatly enhance clinical outcomes.
Background: Sex determination from bones is of vital importance in anthropological studies and medico-legal cases. Sacrum is one of the bones, which exhibits sex differences. Literature available on this bone shows that not much study has been done in the population of Bangladesh. In the present study, an attempt has been made to test the validity of the parameters that are useful in differentiating male and female sacra. The present study was conducted to see the sexual dimorphism and morphometry of sacrum in adult Bangladeshi people. This study will be useful for anatomists, experts in forensic medicine and physical anthropologist for more accurate sexing of sacra. Materials and methods: Descriptive, cross-sectional study was conducted in the Department of Anatomy, Chittagong Medical College, Chattogram on 100 dry human sacra of known (Male-46, female-56) sex during January 2014 to December 2014. The measurements included for the study were maximum length, maximum width, mid ventral curved length, transverse diameter of first sacral vertebra, length of ala, maximum length of auricular surface and indices like curvature index, sacral index, corporo-basal index, alar index, index of body of S1, auricular index were calculated and statistically analyzed. Results: In the present study the male sacrum showed significantly higher values for ventral straight length, ventral curved length, transverse diameter of S1 and antero-posterior diameter of S1 than the female sacrum, while the female sacral index showed higher value compared with the values of male. Conclusion: From the above parameters and indices in the present study revealed demarking points for each have statistical significant role in determining the male and female sacrum. IAHS Medical Journal Vol 4(2), June 2021; 2-4
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