Prophylactic drainage of wounds is aimed to reduce the wound complications and thereby morbidity. Obese patients are at more risk. Wound management is a basic practice in surgery, especially after an elective abdominal surgery. Our task after surgery is to avoid and thereby to reduce the adverse effects of wound complications. Objective: To determine whether subcutaneous drainage can reduce such complications in patients undergoing elective and emergency abdominal surgery. Materials and Methods: It is a prospective open comparative study carried out Department of obstetrics and gynecology, in two hospitals Al-Hera Hospital, Mawna, Chowrasta, Sreepur, Gazipur and Shaheed Tajuddin Ahmad Medical College Hospital, Gazipur, Bangladesh over a period of six (6) months August 2021 to January 2022. Patients were randomized before surgery and divided into two groups by systemic random sampling. Total sample size 150 with 75 in each group. All patients will receive same preparations. Results: Wound complications observed in 2 patients with subcutaneous drain which forms 8% of the total patients with subcutaneous drain. Wound complications observed in 25 patients without subcutaneous drain which forms 33.3% of the total patients without subcutaneous drain. Comparing these two data found to be statistically significant with P value < 0.05. Thus the incidence of wound complication is low in those with subcutaneous drain than those without drain. Conclusion: Subcutaneous drain when kept in obese individuals with more subcutaneous fat thickness who undergo elective abdominal surgeries had lesser incidence of local wound complications and lesser hospital stay when compared to those patients without subcutaneous drain.

Background: Accurately predicting the nature and differentiating of various grades of Phyllodes tumor, the diagnosis may vary by different pathologists1, as there is no standard interpretation of the histologic cut-point criteria and therefore. In this study, we evaluated the impact of CD117 expression on Phyllodes tumor of breast and usefulness of this marker to differentiating benign from malignant phyllodes tumors. Methods: This cross-sectional observational study was conducted in the Department of Pathology, Dhaka Medical College. The study includes mastectomy/lumpectomy specimens received from surgery and surgical oncology departments and diagnosed as phyllodes tumor histopathological. Tissue processing and staining were performed using standard protocol. Histopathological typing and grading were done according to WHO recommended criteria 2012. Immunostaining for CD117 done on all 50 cases. Toluidine blue staining was performed on CD117 immunostaining positive cases, to see presence of mast cells. Result: This study consists of 50 cases of phyllodes tumor of breast. In all the cases immunohistochemistry was done with markers CD117. Histological Grading of phyllodes tumor was done using stromal cellularity, nuclear pleomorphic, stromal overgrowth, mitotic rate, margin of tumor. Statistical analysis was done and results were compared with various available previous studies. This study showed that most of benign/low grade phyllodes tumors belonged to the age group of 35-46 years and most of malignant phyllodes tumors belonged to the age group of 30.50-47.50 malignant phyllodes tumor in this study was 40 years. Overall 44% (22 out of 50) of the cases showed positivity for CD117 in the stroma. Among them 85% cases of malignant Phyllodes tumors of breast shows stromal expression of CD117. This study shows association of CD117 expression with malignant phyllodes tumor. Epithelial CD117 positivity was found in 69.5% cases of benign/low grade Phyllodes tumors of breast. Current study also shows association of CD117 epithelial expression with benign phyllodes tumor the result of our study show strong correlation between CD117 expression and histopathological grade. Conclusion: In conclusion, we can report an association of CD117 protein expression in borderline/malignant tumors and which may be associated with worse prognosis. So we can suggest for targeted therapy for these patient group having Phyllodes Tumor with positive CD117 expression.

Background: Intensive care units provide care to patients with severe or life-threatening illnesses and injuries, which require constant support, close supervision from life support equipment and medication in order to ensure normal bodily functions. It is staffed by highly trained physicians, nurses and respiratory therapists who specialize in caring for critically ill patients. ICUs are also different from general hospital wards by a higher staff-to-patient ratio and access to advanced medical resources and equipment that is not routinely available somewhere else. Common conditions include acute respiratory distress syndrome, septic shock, and other life-threatening conditions that are treated within ICUs. Aim of the study: The aim of the study was to assess the operational power, existing facilities, bed requirement, patients source and follow up and to determine and analyze the mortality in the ICU of this institution. Methods: It was a retrospective study conducted in the General Intensive Care Unit of Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh from January 2019 to December 2019. A total of 607 patients who had been taken admission in General ICU unit of the hospital was recruited as study population. According to the criteria of analysis already informed, data were collected from admission register and mortality record books. We divided the total number of patients into 4 age groups, 10-30 years, 31-45 years, 46-65 years and above 65 years. We calculated patients’ mortality and male female ratio. We also considered patients coming from different specialties those who were referred to the ICU. We observed the relationship of mortality with number of organ failure too. We categorized the patients as single, double or more organs involvement and its relationship with mortality. Duration of stay in the ICU was defined as the number of days between the admission in ICU and discharge with a minimum stay of one day and also more. Relationship with mortality and number of staying days was noticed. All data were collected within data collection sheets. Result: Hospital ICU mortality in an average was 45%. Patients with long ICU stay have higher mortality than shorter stay. Nonsurvivors were older than survivors. Patients from outside have a higher mortality (85%) than those from ward, postoperative and emergency (35%).25% of patients were in the intensive care unit for more than 3 days and shared 80% of bed occupancy. Much mortality was due to inappropriate early discharge, lack of meticulous attention before admission and inadequate care after discharge. Conclusion: So strengthening of facilities may be provided by appropriate transport system and acute medicine service at emergency and also by step down units or high dependency unit in ICU surroundings. Resources and study should be directed towards the low probable mortalities to improve the ICU outcome and to decrease the mortality percentage. Continuous advice and follow up should be provided to the patients after transferring to the ward, cabin or home.

Background: Stroke is an important health issue for individuals and society. Early identification of risk factors of stroke patients helps take measures to prevent the development of further stroke. C-reactive protein is a marker of acute infection as well as acute inflammation. A high level of CRP may be associated with poor outcomes because they reflect either an inflammatory reaction or tissue damage (den Hertog HM et al., 2009). Increase in inflammatory parameters correlated significantly with lesion volume and stroke severity (Audebert HJ et al., 2004). Aim of the study: To see the Correlation between CRP level and stroke volume. And to see the CRP level as a prognostic marker in 3 months follow-ups in ischemic stroke. Methods: This was a descriptive cross-sectional study undertaken in the neurology department of a medical college hospital in Bangladesh. A total of 130 patients were included in the study group who met the inclusion and exclusion criteria. Out of 130 patients, 63 were ischemic strokes and 67 were hemorrhagic strokes. Results: In our study, the estimated level of mean CRP level in acute haemorrhagic stroke was 8.6 mg/L. and in acute ischemic stroke was 21.6mg/L. In this study, there was a statistically significant relationship between the size of the infarct and the level of estimated CRP in ischemic stroke. There was no correlation between CRP level and volume of hemorrhage in hemorrhagic stroke. In this study, the mean CRP value was 19.1 mg/L in those patients who were alive and 28.4 mg/L in those patients who died of ischemic stroke. The difference between the two groups was not statistically significant (p-value 0.30) though the mean CRP in patients who died were much higher than in those who were alive. Conclusion: In conclusion, we believe that these data support two main conclusions. First, the elevation of CRP is common in ischemic stroke. Second, advanced CRP levels were associated with larger infarct size in cases with acute ischemic stroke. These results suggest that elevated CRP levels, reflecting a large infarct size, may serve as a helpful serologic marker in the evaluation of inflexibility of acute ischemic stroke.

Background: The principal of management of anal fistula include closure of interior opening of fistula tract, drainage of contamination or necrotic tissue, and eradication of fistulous tract with maintenance of sphincter function. The selection of surgical operation (simple fistulotomy, fistulectomy, seton placement, development flap, fibrin glue or anal plug) is decided with the aid of the route of the fistula tracts and continence status. Objectives: The aim of the study was to determine the surgical technique “core out fistulectomy with anal sphincter reconstruction and primary closure of internal opening” in the treatment of trans-sphincteric fistula (high type or long tract) or supra-sphincteric fistula in terms of fistula healing, morbidity, recurrence and anal continence. Methods: This prospective observational study was carried out in the Department of Surgery Dr Amanat khan hospital and other private hospitals, Dhaka, Bangladesh, during 5th March 2020 to 10th April 2022. A total 30 patients between the age group 20 to 70 years who were diagnosed with Fistula-in-Ano(Complex Variety) which underwent Core out Fistulectomy with Anal Spincter Reconstruction and Primary Repair of Internal Opening. This analysis was done using SPSS 24 software version. The level of significance was set to 5% (p < 0.05). Results: There were 30 (91%) men and three (9%) women with a median age of 42 years. The common anal fistula type was high transsphincteric fistula in 31 patients with deep postanal abscess in two patients and two patients were suprasphincteric fistula. Conclusions: Core out fistulectomy with anal sphincter reconstruction and major closure of inner opening is a secure and nice method for excessive trans-sphincteric fistula. It has desirable useful results and no disturbance of continence. This has to be viewed in the cure of high trans-sphincteric fistula.

Background: Medical waste has received less attention in underdeveloped nations like Bangladesh and poses a severe threat to public health. The management of medical waste therefore, has been of major concern due to potentially high risks to human health and the environment. Notwithstanding this, Bangladesh has no standards governing the management of medical waste. As a result, the focus of this research was to gather information about the waste management in several hospitals in Dhaka city, Bangladesh. Methodology: This descriptive cross-sectional study was conducted among five different types of hospitals in Dhaka to find out the waste management methods of the hospital. Purposive sampling technique was used for selecting the study place. A checklist was used to observe the current medical waste management in all the hospitals. In addition, every hospital’s record regarding waste management was reviewed to extract information in this regard. A simple descriptive statistic was applied for data analysis. Results: The Mean ± SD age for the participants were 26.63± 4.18 years where female (52%) was more than male (48%). Among the participants, the highest (40%) were medical officer and maximum (77.3%) had working experiences ≤ 3 years. According to the checklist, it was found that United and Lab aid hospital had almost all the indicators related to placement of container. In regards to the segregation of wastes according to color code, all the selected 5 hospitals had seen to observe the protocol except liquid wastes. Unfortunately, Al-Basar, Al-Manar and city hospitals’ waste handler did not use safety gear during waste transportation despite they were provided safety stuff. Conclusion: This study concludes that in order to create an effective waste management program, the government should conduct periodic oversight by establishing strong provisions in this regard.

Background: Electrical accidents (EA) are rare, but can cause serious and potentially life-threatening injuries to multiple organs. The majority of epidemiological data refers to workplace accidents which account for a significant share of such accidents in adults. Exposure to electric shock has been associated with an increased risk of developing immediate and delayed cardiac arrhythmias. Objective: To evaluate the prevalence of cardiac arrhythmias and different symptoms in patient with high voltage and low voltage electrical injury. Methods: This was observational prospective study was carried out at the Dept. of Cardiology, Bangabandhu Sheikh Mujib Medical College Hospital, Faridpur, Bangladesh from January to June 2021. 51 consecutive patients with electrical injury who were admitted. Admission criteria were age ≥15 years, loss of consciousness, cardiac arrest, electrocardiographic abnormalities, soft tissue damage and burns. Patients were categorized into high and low voltage injury group and their variables were compared. Results: The mean age of the patients was 32.3±10.4 years among them 41 (82.3%) were male. Patients who sustain high voltage electrical injury (>1000V) were 18 (35.2%) and low voltage injury (<1000V) were 33 (64.7%).Cardiac arrhythmias like sinus tachycardia (11.1% vs 6.0%, p=0.054), sinus bradycardia (11.1% vs 3.0% p=0.254), ventricular premature beats (5.6% vs3.0%, p=0.674), atrial fibrillation (11.1% vs 0%, p=0.054) were observed in high voltage and low voltage group. The commonest presenting symptoms in both groups were pain (77.8% vs 81.8% p=0.560) and fatigue (55.6% vs 39.3%, p=0.328). Conclusion: In this study few non-fatal cardiac arrhythmias were observed in both high and low voltage electrical injury group. Parameters considered to be risk factors such as known structural heart disease, loss of consciousness, high voltage electric shock, burn and soft tissue injuries were also not significant predictors of the occurrence of arrhythmias. There is no significant difference in the presenting symptoms and types of arrhythmias observed between low voltage and high voltage injury group.