PAHMC Journal

Background: Urinary tract infection (UTI) is a significant cause of morbidity and mortality in both developing and developed countries, representing a leading reason for antibiotic prescriptions, particularly in developing regions like Bangladesh.

Objective: This study aimed to identify the etiology and antibiotic resistance patterns of community-acquired urinary tract infections (CAUTIs) in a district-level community clinic in Bangladesh.

Methods: A cross-sectional study was conducted at Shodesh Hospital in Mymensingh, prospectively collecting urine samples from 341 patients between January 2022 and December 2022. Isolated bacteria were tested for antibiotic susceptibility using the disc diffusion method.

Results: The study revealed a culture growth rate of 26.98% (92 out of 341 samples), with a higher prevalence among female patients (68.47%). The most common pathogen identified was Escherichia coli, accounting for 54.0% of the positive cultures. Cefuroxime exhibited the highest resistance rate at 55.43%, followed by Ciprofloxacin at 13.50%.

Conclusion: These findings underscore the necessity for clinicians to make more informed and selective antibiotic choices in the treatment of CAUTIs, thereby potentially reducing patient morbidity and mortality.

Keywords: Urinary tract infection, Antibiotic resistance, Community-acquired, Bangladesh

Background: Epilepsy represents the most frequent neurological condition in the pediatric population, frequently necessitating extended, and occasionally permanent, medical management. Valproic acid (VPA), also known as sodium valproate, is a widely used, broad-spectrum antiepileptic medication for children.

Objective: This investigation aimed to assess alterations in thyroid hormone concentrations in epileptic children following six months of VPA treatment.

Methods: A prospective observational study was conducted in the pediatrics department at Mymensingh Medical College Hospital. Eighty children with epilepsy, treated exclusively with VPA, were enrolled. Thyroid function tests (FT3, FT4, TSH) were performed before initiating VPA and again six months later.

Results: Among the 80 participants, 49 (61.3%) were male and 31 (38.8%) female. At the six-month follow-up, 19 out of 80 children (23.8%) exhibited subclinical hypothyroidism (TSH >6.63 IU/ml), a statistically significant finding (p<0.001). Only 7.5% of children had FT3 levels below the normal range after six months of therapy.

Conclusion: This study concludes that treatment with VPA carries a risk of inducing subclinical hypothyroidism.

Keywords: Epilepsy, Valproic Acid, Subclinical Hypothyroidism, Antiepileptic drug, Growth retardation

Background: Acute kidney injury (AKI) is a rising health issue that claims the lives of millions of people across the globe each year. Understanding its incidence, causes, and outcomes in a developing nation such as Bangladesh is critical to provide appropriate care and direct resources.

Aim: To determine the etiology, clinicopathological characteristics, and prognosis of AKI patients in the Nephrology Center at the Community-Based Medical College in Bangladesh.

Methods: An analytical cross-sectional study was conducted from January to December 2023, involving 65 AKI patients. Demographic data, clinical details, biochemistry profile, treatment regimens, and outcomes were obtained using structured questionnaires and medical records.

Results: The mean age of the patients was fifty-six years, with a male preponderance (61.5%). Pre-renal azotemia was identified in 38.5% of cases and renal azotemia in 30.8%. The odds of a poor outcome were 5% higher per year of age (OR = 1.05, 95% CI: 1.01–1.10). Hypovolemic pre-renal etiology was associated with more favorable outcomes (OR: 2.00, 95% CI: 1.00–4.00).

Conclusion: Early recognition and treatment of pre-renal factors, especially in elderly patients, can lead to better outcomes. The high recovery rate indicates that improved results can be achieved even in resource-limited centers.

Keywords: AKI, Nephrology, Etiology, Renal azotemia

Background: The cricothyroid joint is an important anatomical structure of the larynx and its morphometric variation with age and sex has clinical relevance.

Methods: A descriptive cross-sectional study was carried out to evaluate the distance between the cricothyroid joints relative to age and gender in cadaveric samples from Bangladesh. Sixty human larynges were collected postmortem over six months — forty-five from autopsied individuals aged 9 to 60 years, and fifteen from stillborn fetuses (gestational age 28–40 weeks). Distance was measured in millimeters using slide calipers.

Results: The mean distance between the cricothyroid joints was 9.40 mm in the fetal group, 20.44 mm in the pediatric group, and 24.07 mm in the adult group. The differences among all age groups were statistically highly significant.

Conclusion: The distance between the cricothyroid joints increases progressively with age, showing significant variation among fetal, pediatric, and adult larynges.

Keywords: Larynx, Laryngeal cartilages, Joints, Cricothyroid articulation, Morphometry, Distance

Extreme microphthalmia and anophthalmia are rare congenital ocular anomalies that may occur as isolated defects or in association with systemic abnormalities. We report a rare case of bilateral extreme microphthalmia in a full-term male newborn delivered at President Abdul Hamid Medical College Hospital, Kishoreganj, Bangladesh. The baby presented with sunken, deep-seated orbits and absent palpable globes since birth, with no history of maternal infection, teratogenic exposure, or familial congenital anomalies. Systemic evaluation, including TORCH screening, chest X-ray, abdominal ultrasonography, and echocardiography, revealed no abnormalities. Computed tomography confirmed poor development of the globes and orbits with a normally developed brain. The patient was referred for further management. This case highlights the importance of early neonatal ocular examination, advanced imaging, and the need for improved antenatal diagnostic facilities in resource-limited settings. To our knowledge, this is one of the few documented cases of bilateral extreme microphthalmia reported from Bangladesh.

Keywords: Bilateral extreme microphthalmia, Anophthalmia, Congenital ocular anomaly, SOX2 mutation

Journal club is an important learning activity of educational institutions, contributing to upgraded medical knowledge and directly improving patient outcomes within a department or institution. As evidence-based practice grows in importance, a formal journal club facilitates discussion and evaluation of research and its application to clinical practice. However, journal clubs often fail to achieve their intended role when discussions remain superficial. The advantages of a journal club include keeping current with new knowledge, learning to evaluate the strength of evidence, promoting implementation of new knowledge into practice, and improving patient outcomes. A journal club is defined as an educational meeting in which a group of individuals discuss current articles, providing a forum for a collective effort to keep up with the literature.

Keywords: Journal club, Evidence based practice, Teaching-learning Activity, Medical education