Background: We have very few data regarding the Postoperative Outcome of patients with Trochanter Fracture of Femur. Trochanter fractures of the femur remains one of the most challenging fractures faced by orthopaedic surgeons. Fracture of the proximal part of the femur are an important cause of morbidity and mortality in all age groups, especially the elderly. Proximal femoral nail and dynamic hip screw system are two widely used methods in treating trochanter fracture of femur. Objective: The aim of this study was to evaluate Postoperative Outcome of the patients with Trochanter Fracture of Femur. Methods: The present prospective comparative study has been done in Department of Orthopedic Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU) Dhaka, Bangladesh during the period from July 2017 to June 2019. During this period obeying inclusion and exclusion criteria 30 patients of unstable intertrochanteric fractures of femur were finalized as the study people. Among them 14 cases were treated with PFN and 16 with DHS. All statistical analysis of different variables was analyzed according to standard statistical method by Fisher’s Exact Test and Student t-Test and done by using SSPS method in computer. Results: In this study 63.3% of the subjects were 65 or above 65 years and 10% below 50 years of age. Sixty percent (60%) were male whereas 40% were female. House-wife comprised the main bulk (40%) as occupation. Other occupants were service holders (13.3%), businessman (13.3%), farmer (10%) and day-laborer (3.3%). The rest 20% were involved with other informal jobs. Causes of injury revealed that 26.7% trochanter fractures were caused by RTA and 36.7% by fall from height and 36.7% by accident at home. Two-third (66.7%) of the injuries had right-sided involvement. More than half (53.3%) of subjects were operated within 7 days of the incident. Conclusion: In this study, the highest cases of Trochanter Fracture of Femur were found from aged people. Involvement of male patients was higher than female. Involvement of housewives was also alarming. Twothird portion of involvement of right sided fractures was also noticeable in this study.

Introduction: An emergency laparotomy is a lifesaving procedure undertaken mostly in acute cases without much preparation of the patient. Despite being one of the most common urgent surgical procedures, it still proves to be a challenge for the surgeons of the world. Objective: To find out the post-operative complications and outcome of non-traumatic emergency laparotomy. Methods: This prospective study was carried out in 200 patients different surgery units of Dhaka Medical College Hospital with an initial diagnosis of acute abdomen of nontraumatic origin who underwent emergency laparotomy to evaluate different causes of laparotomy and the morbidity & mortality associated with it. Acute abdominal pain was the constant symptom with different degree of severity, presenting either locally or diffusely. In conditions with peritonitis either local or diffuse, muscle guarding, rigidity or diminished bowel sound were found. PlainX-ray abdomen was the most frequently used investigation alone with blood count, serum amylase and ultrasonogram of abdomen. Clinical diagnosis was made depending on clinical findings and the results of investigations. Results: Two hundred cases of nontraumatic emergency laparotomy patients werestudied in Dhaka Medical College Hospital during the period of July 2007to June 2008. The peak age incidence was found in the third decade of life (34%). Overall male-female ratio was 2.3:1, but there were disease specific variations. Age ranged from 12 to 75 years. Most of them were in the age group of 10 to 50 years of age. Most common operation performed was appendectomy, 74 cases. Next repair of duodenal ulcer perforation and thorough peritoneal toileting, 46 cases. After Appendicectomy 5.94% of the patient had complication. In case of duodenal ulcer perforation 17.65% had post-operative complication. Post-operative complication among the patients of resection and anastomosis of small gut perforation was 16.66% and for resection and anastomosis of sigmoid volvulus was 16.66%. Early post-operative complication ranges from minor chest infection to death of the patient. Commonest post-operative complication was wound infection. Some of the patients developed more than one complication. Out of 200patients most of them were case of acute appendicitis and under wentappendicectomy. Six patients (3%) died postoperatively. Conclusion: Post-operative complications are more common after emergency laparotomies. Maximum complications were found in patients of delayed presentation or in patients having any associated co morbidities. Therefore early detection, immediate intervention with better postoperative care can minimise the postoperative complications. The present study suggests that proper awareness among rural populations, adequate health education to seek prompt medical aid, a good referral and efficient transportation can reduce the delayed presentation which in turn will prevent postoperative complications following emergency laparotomy.

Background: Decrease in amniotic fluid is known as "Oligohydramnios". It is correlated with adverse maternal and perinatal outcomes in terms of intrauterine growth retardation, me conium aspiration syndrome, low birth weight, low APGAR scores, congenital anomalies and increase rate of caesarean deliveries. Early detection of Oligohydramnios and its management may help in reduction of maternal andperinatal morbidity and mortality. Objective: To find out maternal and fetal outcome of oligohydroamnios. Methods: This was a cross-sectional observational study conducted in the Indoor patient Department of Obstetrics & Gynecology in Tairunnessa Memorial Medical College and Hospital, Gazipur, Bangladeh from January 2016 to June 2016. The study was conducted in oligohydroamniotic patient admitted in the same ward. Fifty patients Included in your study. Complete history was taken from patients and their accompanying attendants. Thorough clinical examination was done. Relevant investigations report was collected. All the information was recorded in the fixed protocol. Collected data was classified, edited, coded and entered into the computer for statistical analysis by using SPSS-19. Results: Out of 50 cases mean age was 24.56 (±4.71) years, majority 27(54%) were primigravida and 23(46%) were multi gravida. Majority 27(54%) delivered bycaesarean section and 23(46%) were delivered by normal vaginal delivery. Mainindication for caesarean section 25.93% fetal distress, 18.52%malpresentation, 18.52% previous LSCS and 37.03% severe Oligohydramnios. Prevalence of SGA babies (62%) is almost double than AGA babies (38%). Factor associated with oligohydramnios were PIH, malpresentation, chronic abruption, prolong pregnancy, post term pregnancy, fetal congenital anomalies were 16%,04%, 18%, 28%, 06%, 20% and 18% respectively Eighty two percents pregnant women were borderline oligohydramnios and 18% were severe oligohydramnios. Most of 88% patients had confirmed by ultrasonographically. The various perinataloutcomes, including Low birth weight, IUGR babies, perinatal death, APGAR score< 7 at 5 min, admission in neonatal ward etc. Among 50 babies, low birth babies were 62%, APGAR score < 7 was found in 18% of babies, 26% babies wereadmitted in neonatal intensive care unit. Among 50 babies perinatal death (Stillbirth+Neonatal death) was 10% and 1 baby born with congenital anomaly (2%). Conclusion: In conclusion majority delivered by caesarean section, main indication forcaesarean section was fetal distress, malpresentation, previous LSCS and severe Oligohydramnios. Factor associated with oligohydramnios were PIH, malpresentation, chronic abruption, prolong pregnancy, Post term pregnancy, fetalcongenital anomalies. Eighty two percents pregnant women were borderline oligohydramnios. Various perinatal outcomes, including Low birth weight, IUGRbabies, perinatal death, APGAR score < 7 at 5 min, admission in neonatal ward. Perinatal death (Still birth+Neonatal death) was 10% and 1 baby born with congenital anomaly.

Introduction: Subclinical hypothyroidism (ScH) is an endocrine alteration that is related to cardiovascular risk factors, including those categorized as components of the Metabolic Syndrome (MS). However, findings in prior reports regarding an association between these alterations are inconsistent. Metabolic syndrome is now considered as global epidemic and for last few decades MetS is highly prevalent in Bangladesh. Objective: To determine the metabolic syndrome is associated with subclinical hypothyroidism. Materials & Methods: The present case-control study was conducted in the Department of Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh over a period of one year between January 2020 to February 2021. Patients of metabolic syndrome were considered as case, while apparently healthy individuals (having no hypertension, central obesity or dyslipidaemia) were taken as control. Metabolic syndrome was defined as having at least three criteria out of five criteria, as recommended by NCEP: ATPIII Diagnostic Criteria for Metabolic Syndrome, while subclinical hypothyroidismwas defined, when TSH ranges from 4-20 mU/L with normal FT3 and FT4. During the study period, while friends and relatives of cases of similar age and sex were selected as control. Results: A total of 71 cases and 71 controls were consecutively included in the study. In the present study out of 71 cases 49(69.01%) had central obesity (waist circumference > 90 cm for male and > 80 cm for female), 57(81.4%) had raised triglycerides (TG ≥ 150 mg/dl), 61(87.1%) had raised blood pressure (≥130/85), 60(84.51%) had hyperglycemia (fasting blood glucose ≥ 100 mg/dl) and only 12(16.90%) had reduced HDL (< 40 mg/dl for male and < 50 mg/dl for female) three factors, namely subclinical hypothyroidism , BMI and socioeconomic status were observed to be significantly associated with metabolic syndrome in univariate analysis. After adjustment by binary logistic regression analysis, all these three variables remained to be significantly associated with metabolic syndrome with risk of having the condition being 2.3(95% CI = 0.9–5.8) times more in patients with subclinical hypothyroidism, 2.3(95% CI = 1.4–8.1) times higher in overweight/obese individuals and 2.8(95% CI = 1.3–5.8) times higher in affluent socioeconomic class (p=0.038, p=0.007 and p=0.006 respectively). The present study revealed that subclinical hypothyroidism significantly associated with MetS. Subclinical hypothyroidism carries more than 2-fold higher risk of having MetS.Conclusion: The study found that factors, namely subclinical hypothyroidism, BMI and socioeconomic status to be significantly associated with metabolic syndrome in univariate analysis. After adjustment by binary logistic regression analyses, patients of metabolic syndrome carry more than 2.7-fold higher risk of having subclinical hypothyroidism.

Background: Tibia being a large bone in humans anatomically is always prone to fracture in cases of trauma owing to its capacity to bear load the recovery can be complicated easily by instability, delayed recovery, and long illness. Tibial shaft fractures are often the result of high-energy injuries in younger peoples. Intramedullary nailing is one widely used form of fixation with excellent results. Objective: To assess the functionality in tibial shaft fracture using intramedullary interlocking nailing technique in patients coming with tibial shaft fracture. Methodology: A prospective observational study was conducted in the Department of ortho & Spine surgery, National Institute of Traumatology & Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh over a period of one year between June 2018 to July 2020. A total of 59 participants were evaluated who met the inclusion criterion for the study of which data for 56 were available for analysis as 3 patients didn’t completed the follow up. They were included only after satisfying the laid down inclusion criterion while after performing routine procedures they were given the treatment of intramedullary interlocking nailing if indicated. Data collected on excel sheets were analyzed using SPSS for tests of association and measures of central tendency. Results: 56 participants were there who were offered the treatment of intramedullary nailing with interlocking nailing majority of them were males from BPL. Most of the injury was of type A from Motor vehicle accidents involving proximal shaft. John Wruh’s criterion was used to assess the functional outcomes with 47% having excellent results. Only 3 (5%) of the patients had poor results. Conclusion: Interlocking Intramedullary nailing for tibial shaft fractures is an excellent method of surgical management. Intramedullary nailing decreases the occurrence of complications such as infection thus by decreasing the time to recover in patients receiving such injuries.

Background: Chronic Rhinosinusitis and nasal polyps proposed the criteria for diagnosis of chronic rhinosinusitis in adults as 12 or more weeks of persistent symptoms (nasal blockage, discharge, facial pain, reduction of smell) and signs (polyps, mucopurulent discharge, mucosal edema) with no complete resolution. This debilitating disease causes negative impact on quality of life (QOL) of patients. Functional endoscopic sinus surgery (FESS) is the mainstay of surgical treatment for patients and improves QOL of patients. Objective: to assess improvement in quality of life (QOL) after functional endoscopic sinus surgery through questionnaire sino-nasal outcome test (SNOT)-22. Methods: The present study was conducted on 51 patients in ENT department of Mission General Hospital, Nilphamary, Bangladesh. The study period was from January 2020 to March 2020. All the patients with age ≥18 years who failed to respond to medical therapy (3 months) and underwent functional endoscopic sinus surgery (FESS) were included in the study. SNOT-22 questionnaire was used to assess the improvement. Results: In our study, preoperative SNOT scores were higher (54±8.05) but after FESS they reduced significantly at 1st (16.47±5.51), 3rd (13.86±4.19), 6th months (12.9±8.05) post operatively. Chronic rhinosinusitis (CRS) with nasal polyposis group had greater mean difference of SNOT-22 scores (43.93) between preoperative period and 3 months postoperative period than patients grouped as CRS without nasal polyposis (41.47). Conclusions: We concluded that FESS is the best surgical intervention for chronic rhinosinusitis. It significantly improves the quality of life of patients of chronic rhinosinusitis.

Background: Severe pneumonia remains a common and serious condition worldwide. The mortality from severe pneumonia remains high and is one of the leading causes of morbidity and mortality in under-fives. Objective: To Identify clinical profile and outcome Of Children with Severe Pneumonia. Materials and Methods: This study was a prospective observational cohort study was carried out at 250 Beded General Hospital, Noakhali, Bangladesh from December 2020 to May 2021. Children under 5 years of age admitted with severe pneumonia. One Hundred Fifty included, Due to time limitation collection of this huge amount of sample was not possible within 6 months period. So the total number patients admitted in hospital in this period were included in this study. Results: The mean age was found 9.49±6.83 months with range from 2 months to 36 months and Male to female ratio was 2:1. The duration of hospital stay was >5 days in almost two third (62.7%) of the patients. More than a half (54.7%) of the patients lived in an overcrowded environment at home. The mean age of the mothers was 24.67±4.19 years. Most of the mother had no institutional background, where 22.7% mother cannot read and write at all and 33.3% mother can only read and write. More than two third (66.7%) of the family member of the patients were smoker, 50.7% of the patients got exclusive breast feeding, 9.3% had low birth weight, 6.7% were not completely immunized up to age. Head nodding was more common clinical presentation, which was 92(62.7%) of the study patients, positive blood culture was found in 20(13.3%) and abnormal CXR in 108(72.0%) of the patients. Among 150 study patients, 98(65.3%) needed a change in antibiotics, 94(62.7%) patients needed more than 5 days hospital stay, 30(20.0%) needed mechanical ventilation and 18(12.0%) died. Conclusion: In conclusion to identify the Clinical profile and outcome of children hospitalized with severe pneumonia. Lack of exclusive breast feeding, overcrowding, head nodding on presentation, leukocytosis, positive blood culture, abnormal CXR and exclusive breast feeding were significantly that may reduce their hospital stay. Additional Clinical profile and mortality were anaemia, leukocytosis and positive CRP. So, patients presenting with these factors should preferably be admitted in a paediatric intensive care unit for close monitoring and management that could reduce their mortality.

Background: Hypotension is an important serious side effect of spinal anesthesia. Spinal anesthesia is a very popular technique for cesarean delivery in healthy pregnant women. However, hypotension secondary to the sympathetic vasomotor block associated with spinal anesthesia remains a common complication. Objective: To compare between crystaloied and colloid for spinal anesthesia for elective cesarean delivery to prevent hypotension. Materials and Methods: This prospective, randomized, controlled, double-blind study was performed at Upazilla Health Complex, Rupganj, Narayanganj, Bangladesh from January to June 2019. The study included 102 spinal anes¬thesia patients (ASA-I&II) who underwent elective cesarean surgery in 4 groups. In groups 1 and 2, 7 cc/kg of colloid solution was injected 20 min before and during spinal anesthesia, respec¬tively. In groups 3 and 4, 15 cc/kg of Hart Mann solution was injected 20 min before and during spinal anesthesia, respec¬tively. The BP, heart rate changes, vasopressor dose, nausea, vomiting, chest discomfort, and Apgar score were evaluated. Results: The BP decreased significantly when the patients changed position from supine to seating position (P = .001) and in the third minute after injecting the local anesthetic (P = .031) in all groups. Group 4 (24%) patients exhibited signif¬icant hypotension, whereas group 2 (16%) patients showed less hypotension. However, there was no statistically significant difference between the 4 groups (P = .31). There were no statis¬tical differences between the 4 groups in the Apgar of the fifth minute, vomiting, vertigo, and chest discomfort. Conclusions: Owing to high cost and probable side effects, colloid solutions are not recommended; and emergency cesareans need not be postponed to perform hydration before spinal anesthesia. The use of 1000 mL crystalloid co-load has similar effect to 500 mL colloid preload in reducing the incidence of hypotension after spinal anesthesia for elective cesarean delivery. Neither technique can totally prevent hypotension and should be combined with vasopressor use.