Background: Portal hypertension is the hemodynamic abnormality frequently associated with serious liver disease, although it is recognized in a variety of extrahepatic diseases also. Portal hypertension is an important cause of morbidity and mortality in Bangladeshi children. Development of esophageal varices and bleeding is one of the major complications of CLD. The mortality from each episode of variceal bleeding is 30-50% depending on the clinical status of the patient. All conditions that interfere with blood flow at any level within the portal system can lead to portal hypertension. For better management of this disorder, it is important to determine the underlying cause. Objective: To assess the portal hypertension in children at the Department of Pediatric Gastroenterology & Nutrition, BSMMU, Dhaka, Bangladesh. Methods: This cross-sectional descriptive study was conducted at the Department of Pediatric Gastroenterology & Nutrition, BSMMU during the period Jan 2018 to July 2019. 50 patients who were diagnosed as portal hypertension were determined by Upper GI Endoscopy. Doppler USG was also done for supporting the diagnosis of Portal HTN as well as to differentiate between extrahepatic Portal HTN and CLD with portal HTN. Demographic data and other related information regarding etiology and complications were recorded in a standard datasheet. Results: Results: A total of 50 cases were included in this study. Their age range was 1.5-16 years. It was observed that 21 (42.0%) patients belonged to age group 6-10 years. The mean age was 9.22±9.85 years with ranged from 2.5 to 16 years. It was observed that almost two third 31 (62.0%) patients were male and 19 (38.0%) were female. Among 50 patients 29 were diagnosed as extrahepatic portal hypertension and 21 were diagnosed as CLD with portal HTN. Shows the etiology of portal hypertension of studied patients. Extrahepatic portal hypertension was the most common etiology (58.0%). Among CLD patients Wilson disease was the most common (13; 26.0%). Two (4.0%) patients were cryptogenic CLD and two (4.0%) were Budd Chiari Syndrome. One patient was Biliary cirrhosis and one patient had Auto immune hepatitis. Conclusion: We concluded that Extrahepatic Portal HTN is the most common cause of portal hypertension in children in this center. Among the intrahepatic causes of portal HTN Wilson disease was the most commonest.

Introduction: Children who are critically ill typically suffer from a disease process that impacts many organ systems. To improve the outcome, these children are treated in a pediatric intensive care unit. The primary focus of intensive care medicine is the care of patients who are facing immediate life-threatening conditions. The aim of this study was to determine the acid- base status & electrolyte imbalance in critically ill ventilated infants. Methods: This was a prospective observational study and was conducted in the Department of Intensive Care Unit (ICU) of Bangladesh Shishu Hospital & Institute, Dhaka, Bangladesh during the period from January 2020 to December 2020. In our study, we included 50 critically ill ventilated young infants in ICU of Bangladesh Shishu Hospital & Institute. Results: In our study, we found that almost three fourth (74.0%) patients died and 13(26.0%) patients survived. Majority of our patients were ≤ 15 days and male. We found 22(59.5%) patients had PH level <7.25 in death group and 6(46.2%) in survival group and PH level ≥7.15 was (81.1%) in death group and 10(76.9%) in survival group. Before extubation & death metabolic acidosis was 19(51.4%) in dead group and 2(15.4%) in survival group. Significant relation was found between serum sodium level <135 and outcome of ventilated patients [p=0.039, OR=0.19(0.04-0.89)]. Imbalance of single & more than one electrolyte was found 43.24% & 56.76% in death group and 61.5% & 38.5% in survival group respectively. Conclusion: We found that arterial blood gas analysis & serum electrolytes level provide valuable information for correction of acid–base imbalance associated with a pathological condition. Electrolyte imbalance, regardless of the basic disease etiology, is a significant prognostic indicator that must be rapidly treated in critically ill children to get a good outcome.

Background: Pregnant women with immunological and cardiopulmonary system abnormalities may experience more severe symptoms from respiratory virus infections. Objectives: The aim of this study was to assess the management of anesthesia in pre eclamptic patients with covid 19 infection. Methods: This cross-sectional descriptive study was carried out in the Department of Anaesthesia, Uttara Adhunik Medical College Hospital, during October 2020 to September 2021. A total of 50 pregnant women with pre-eclampsia and had positive polymerase chain reaction (PCR) test for COVID-19 with nasopharyngeal swabs were included in the study irrespective of age and patients who were not willing to participate were and who were clinically suspected (such as a clinical situation or travel history) but tested negative for COVID-19 excluded from this study. Statistical analyses of the results were be obtained by using window based Microsoft Excel and Statistical Packages for Social Sciences (SPSS-22), where required. Results: The mean age of the patients was 26± 2.0 years. 36% patients were within 26-31 weeks of gestational age, 40% patients were within 32-36 weeks of gestational age, 20% patients were within 37-42 weeks of gestational age, and only 4% had more than 42 weeks of gestational age. About 60% patients had mild pre-eclampsia and 40% had severe pre-eclampsia. 98% patients had given spinal anesthesia and 2% had given epidural type of anesthesia. The indication for caesarian section was 50% for severe pre-eclampsia, 25% for uterine rupture in pre-eclampsia and 25% for previous caesarean section. The mean Hemoglobin was 12.17 ± 1.70, mean Aspartate aminotransferase was 28.05 ± 21.11, mean Alanine aminotransferase, was 17.06 ± 12.98, mean Creatine was 0.68 ± 0.71, mean C-reactive protein was 2.10 ± 2.33 and mean D-Dimer was 3.00 ± 2.26. About 60% of the patients were fit to discharge within 4 days and 40% within 5 days. Conclusion: Preeclampsia as one of pregnancy related complications is a notable burden of adverse health. Regional anaesthesia is not considered to be prohibited by the diagnosis of COVID-19 alone. In conclusion, COVID-19-infected pregnant women should be managed by specialised teams in a multidisciplinary facility, and all medical personnel involved in the caesarean section should be careful to use Level-3 PPE equipment. Due to the increased risk of infection and morbidity in general anaesthesia in pregnant women with COVID-19, regional anaesthesia becomes more prevalent. We also noted that there is no umbilical chord transmission from mother to child.

Introduction: The effectiveness of dexamethasone (DEX) in reducing complication rates following paediatric tonsillectomy is still up for debate. The incidence of postoperative nausea and vomiting (PONV) and the severity of pain following paediatric tonsillectomy were examined by comparing concentrations of DEX 0.15 and DEX 0.5 mg/kg, respectively. Aim of the study: The aim of the study is to assess the effect of Dexamethasone in management of postoperative nausea, vomiting and pain after tonsillectomy where the targeted patients are of 3 to 10 years children. Methods: This prospective cross sectional study was conducted in the Department of Paediatric Anaesthesiology and Surgical ICU in Bangladesh Shishu Hospital and Institute, Dhaka, Bangladesh during July 2019 to June 2022. This study included 123 children undergoing elective tonsillectomy. The Institutional Ethics Committee approved this study and informed parental written consent was obtained from the parents before collecting the patients’ information. Results: The prevalence of early PONV was lower in both DEX groups (DEX 0.15: 22%; DEX 0.5: 26%; placebo: 48%; P=0.001). On the second day after surgery, the DEX groups had a lower rate of severe pain (DEX 0.15: 20%; DEX 0.5: 5%; placebo: 47%; P<0.001). The study was not conducted to assess a difference between the two dose groups of Dexamethasone. Conclusions: The frequency of early and late PONV and the level of pain on the second postoperative day were both reduced by an i.v injection of DEX during the induction of anesthesia. To reduce the incidence of PONV, it appeared that a dose of DEX 0.15 mg/kg was just as effective as a dose of DEX 0.5 mg/kg.

Background: Otitis media (OM) is an infection of the middle ear and mastoid cavity. In many studies, hearing loss is described as a consequence of otitis media (OM); the degree of hearing loss can be analyzed by biologically calibrated AA 222 diagnostic audiometer. But in Bangladesh, we have not enough research-based information regarding this issue. Aim of the Study: The aim of the study was to evaluate the correlation of the degrees of hearing loss between male and female patients with otitis media. Methods: This was a prospective observational study and was conducted in the Department of Otolaryngology & Head Neck Surgery, Bashundara Ad-Din Medical College and Hospital, Dhaka, Bangladesh during the period from January 2022 to December 2022. A total of 64 patients with chronic otitis media (COM) suffered for the past three months or more attended the mentioned hospital were enrolled in this study as the study population. Among them 32(50%) were male and other 32(50%) were female patients. Ear drums of patients were inspected on both sides suction under microscope wherever necessary. The patient’s hearing levels in decibel were tested by a biologically calibrated AA 222 diagnostic audiometer. All data were collected, processed and analyzed by using MS Office and SPSS version 23.0 programs as per need. In comparison student’s T-tests were also performed. Results: In this study, in analyzing the hearing loss status of the patients regarding ear involvement we observed that, 6(18.8), 14(43.7) and 12(37.5) male participants on the other hand 10(31.2), 11(34.4) and 11(34.4) female patients right, left and both ears were found involved respectively. In comparing the ear involvement in hearing loss between the male-female groups, we did not find any significant correlation (P=0.427). In comparing the right dB grading, left dB grading, right ear comments and left ear comments of the patients in both groups we did not find any significant correlation; the P- value were 0.932, 0.983, 0.228 and 0.618 respectively. Conclusion: As per the findings of this study we can conclude that, there was no significant correlation of degrees of hearing loss between male and female patients with otitis media.

Fenugreek seeds are rich in various essential compounds and these components play a significant role in healing and treating diseases by regulating several biological activities. The purpose of this study was to evaluate the metabolic effects of fenugreek seed (FS) and its bioactive compounds such as Fenu pulse (FP), Fenu fiber (FF), Diosgenin (Dsg) in High Fructose High Fat (HFHF) induced diabetic rats.After hyperglycemia was confirmed in HFHF rats compared with controls, further HFHF groups were supplemented with FS, FP, FF, Dsg, and combinations of these compounds. The HFHF diet was given for 4 months which increased the body weight, body fat percentage, and decreased lean body mass (LBM) and fat-free mass (FFM) percentage compared with controls rats. The diet combination was continued for another four months and it did not show any further effect on their body composition. There was a significant but marginal effect on fasting glucose and insulin, so the animals did not have overt hyperglycemia, let alone be diabetic. The FS or its components individually or in combination within a diet-induced rat model of diabetes showed no significant antidiabetic effect (glucose tolerance/metabolic parameters), both in the fasting and fed states wherein it elevated the levels of total and HDL cholesterol but not triglycerides (TG) upon continuous feeding for four months. The reduced effect of FS and its components appears due to moderate hyperglycemia in the HFHF rats.

Background: Live related kidney transplantation is the most preferred form of renal replacement therapy worldwide including Bangladesh. However, it is challenging and also rewarding both for patients and treating physicians. BSMMU hospital has given maximum effort for its greater success. The aim of this study was to share our ten years’ experience regarding some aspects of live related renal transplantation. Methods: This retrospective study was conducted in nephrology department of BSMMU hospital from January 2002 to December 2015. Data were collected from hospital records and some previously conducted study on these transplant recipients. Results: A total of 360 live related kidney transplant recipients were evaluated during this period. Recipients Male: Female ratio was 1.57:1. Mean age of recipients were 39.58 ± 10.46 years. The causes of ESRD were chronic glomerulonephritis 220(61.60 %), diabetic nephropathy 58(16.24%), hypertensive nephrosclerosis 22 (6.16 %), chronic interstitial nephritis 11 (3.08 %), SLE 10(2.8%), ADPKD 6(1.68 %), unknown 19(5.32 %). Most of the donors were mother (21.84% %) followed by spouse mostly wife (20.44%) and sister (18.76 %). Almost all recipients were on MHD 352(97.78%), 2 were on CAPD and 06 were pre-emptive transplantation. Triple immunosuppressive protocol Cyclosporine or Tacrolimus, MPA or Azathioprine and Prednisolone were used in each patient. Recipients with poor HLA matching received Baciliximab in standard dose. CMV prophylaxis was given in selected patients and each patient received pneumocystis jirovecii prophylaxis. Common complications during post-operative period were ATN 41(11.48%), DGF 23(6.44%), Acute rejection 50(14%) and infection mainly urinary tract infection 46(12.88%) and RTI 14(3.92) followed by wound infection and other surgical complication. Presence of BK virus infection was studied in 29 transplant recipient and it was found to be positive in 6(20.7%) cases. Protocol biopsy was done in 37 transplant recipient in the 2008-2009 on day 14, and day 90 to see subclinical rejection and early graft dysfunction. On day 14th biopsy report showed 21(56.7%) normal histology, 5(13.5%) had subclinical rejection, 5(13.5%) had clinical rejection, 4(10.8 %) developed ATN, 2(5.2 % ) cyclosporine toxicity, and report at 3 month showed normal histology 18(48.60%), subclinical rejection 7(18.90%), clinical rejection 5(10.80%). Leading cause of chronic allograft dysfunction was chronic allograft nephropathy (CAN) 60(19.80%) followed by chronic cyclosporine toxicity 37(12.21%) and de-novo or recurrent glomerulonephritis. Mean post-transplant hospital stay was 18.46 ± 5.56 days. Mean duration of normalization of serum creatinine after surgery was 7.38 ± 3.88 days. At discharge 74.40% patients had normal renal function with mean serum creatinine 1.10 ± 0.26 mg/dl and 21.34% patients showed gradual improvement of renal function with mean serum creatinine 2.12 ± 0.97 mg/dl. In our study 1 year and 5 years’ graft survival was 93.88% and 75.16% respectively and 1 year and 5 years’ patient’s survival was 346(96.08%) and 290(81.2%). Conclusion: Our report shows that short and long term graft and patient survival is encouraging and comparable to other centers of both developing and some developed countries with limited resources and facilities.