Effect of preoperative oral bisoprolol on intraoperative outcomes in endoscopic sinus surgery

Background: Endoscopic sinus surgery (ESS) presents challenges in managing intraoperative bleeding and hemodynamic stability. This study evaluates the efficacy of pre-operative oral bisoprolol in improving surgical conditions and outcomes in ESS. Methods: This study was conducted between March 2021 and June 2022 at the department of anaesthesia, Bangabandhu Sheikh Mujib medical University, Dhaka, Bangladesh. This randomized controlled trial was conducted with 50 participants undergoing elective ESS, divided into bisoprolol and placebo groups. Result: The study involved 50 participants undergoing elective ESS, with 25 in the bisoprolol group and 25 in the placebo group. While demographic characteristics, such as age, weight, height, and gender distribution, showed no statistically significant differences between the groups. The placebo group experienced significantly higher estimated blood loss (421.72 ml vs. 156.24 ml, p<0.001) and postoperative hemoglobin levels (12.88 g/dl vs. 11.07 g/dl, p<0.001) compared to the bisoprolol group. Hemodynamic parameters, particularly heart rate, exhibited significant differences at various time points, with the bisoprolol group maintaining a higher heart rate post-premedication, intra-operatively, and post-operatively (p<0.05 for all). In the assessment of intraoperative bleeding using the Fromme-Boezaart scale, the placebo group demonstrated higher incidences of severe bleeding grades (3 and 4) compared to the bisoprolol group, with these differences being statistically significant (p<0.001). Conclusions: Pre-operative oral bisoprolol in ESS patients significantly reduces intraoperative bleeding and anesthetic requirements while maintaining hemodynamic stability. These findings suggest bisoprolol as a beneficial pre-operative medication in ESS, warranting further research to optimize surgical outcomes.

Prospective Study of Bronchial Asthma.

Bronchial asthma is an atopic disease characterized by chronic airway inflammation and hyper-responsiveness. Severe acute asthma is a medical emergency and sometimes difficult to treat. This prospective study was done at Dhaka Medical College Hospital from January 1997 to January 1998. Total 30 patients of bronchial asthma were included in this study. Diagnosis was established on the basis of symptoms, evidence of airflow obstruction and its reversibility by bronchodilator therapy. The age range was 18 to 80 years with a mean 36.64±4.91. Of them, 63% were male and 37% were female. It revealed that all patients had classical triad of dyspnoea, wheeze and cough. Almost all patients (80%) had some precipitating agents for their attack. Regarding treatment of severe acute asthma - Nebulized salbutamol is superior to conventional intravenous aminophylline, as p value of nebulized salbutamol group is <0.001 which is significant. So, severe acute asthma should be managed with nebulized salbutamol instead of intravenous aminophylline.

Comments on Evaluation of Endoscopic Findings and Detection of H. pylori Antibody by Serum IgG ELISA.

Bangladesh is a developing country with high prevalence of peptic ulcer disease and H. pylori infection. During the period of January 2007 to December 2007, a cross sectional study was conducted. In this study, serum samples were collected from 86 dyspeptic patients undergoing upper GIT endoscopy to determine anti-H. pylori IgG antibody by serum ELISA and was evaluated with endoscopic findings. Out of 86 study patients, gastro-duodenal mucosa was found normal in 58.14%, gastritis in 11.63%, duodenitis 2.33%, reflux oesophagitis 4.65%, peptic ulcer 17.44% and carcinoma of stomach 5.81%. Among 86 study population, 68 were serum IgG ELISA positive and 20 were negative.

A Comparative Study Among Different Invasive Methods For The Diagnosis Of Helicobacter Pylori.

H. pylori infection occurs worldwide. Approximately 50% of the world population is infected with this organism. A cross-sectional study was conducted on 81 dyspeptic patients attending at Dhaka Medical College Hospital, for diagnostic endoscopy. H. pylori infection was measured by three invasive methods: culture, rapid urease test & histopathology. Among study patients maximum (34.57%) H. pylori infected were in 21-30 years age group, bearing male female ratio 1: 92.86. Forty four (54.32%) out of 81 were culture positive, 61 (75.31%) were rapid urease test positive and 62 (76.54%) were histopathology positive. By using ‘gold standard’ definition, 64 (79.02%) were H. pylori infected, 17 were un-infected. Finally comparing among three invasive methods, all are highly sensitive and specific to diagnose H. pylori infection.

Aetiology Of Pyrexia With Hepatosplenomegaly: Study Of 50 Cases In MMCH (Bangladesh).

Pyrexia with hepatosplenomegaly is a common problem in medical practice globally, specially in tropical countries. In Bangladesh several tropical diseases as well as hematological malignancies are responsible for such clinical syndrome. Again different tropical diseases vary in endemicity in different regions in Bangladesh. In Present study 50 hospitalized cases of pyrexia with hepatosplenomegaly of 15-50 years of age are included from 01.01.2002 to 30.06.2002 in MMCH to find out their aetiologies. Fever with only hepatomegaly, or with only splenomegaly or hepatosplenomegaly without fever was not included in this study. Duration of fever was two weeks to three months. 35(70%) cases were male and 15(30%) were female. 27(54%) cases were visceral leishmaniasis (kala-azar), 8 (16%) malaria, 6 (12%) Acute leukemia (ALL, AML), 3 (6%) Lymphoma, 3(6%) Enteric fever, 2(4%) CML, 1(2%) Disseminated TB. Although kala-azar and malaria are tow common causes of fever with hepatosplenomegaly, haematological malignancies and tuberculosis should be in mind.

Kikuchi-fujimoto disease.

A 14 year-old Bangladeshi girl presented with high fever, painful swellings in the neck, anorexia, weight loss and night sweating. On examination she had multiple enlarged and tender cervical lymph nodes. Other systems were normal. Laboratory investigations for sepsis and autoimmune diseases were negative. Initial fine needle aspiration and cytology of affected lymph node was suggestive of tubercular lymphdenitis. But she did not respond to anti-tubercular treatment. Kikuchi-Fujimoto disease was diagnosed from the histopathological appearance of excised lymph node. She completely recovered with symptomatic treatment. Kikuchi-Fujimoto disease, also called Kikuchi's disease or histiocytic necrotizing lymphadenitis is a rare, benign but enigmatic disease of unknown aetiology. The disease is self-limited and has an excellent prognosis. Its recognition is crucial because it can be mistaken for systemic lupus erythematosus, malignant lymphoma, tubercular lymphadenitis or even, for metastatic adenocarcinoma. Clinicians' and pathologists' awareness of this disease may help prevent misdiagnosis and inappropriate treatment.

Outcome of management of differentiated thyroid carcinoma.

A prospective study was done on 93 cases of differentiated thyroid carcinoma to find out the outcome of management according to the protocol followed in the Department of ENT-Head and Neck Surgery of Bangabandhu Sheikh Mujib Medical University Hospital. Here Papillary carcinoma is more common (76.35%) than follicular carcinoma. Papillary carcinoma affected in the younger patients more commonly than the follicular carcinoma with a mean age of 34.37years (SD=12.81) for papillary carcinoma and 44.93 years (SD=16.01) for follicular carcinoma; but age as a risk factor showed no significant difference between two histological types (p>0.05). Female was the predominant sex with a ratio of 3.04:1. In this series majority of patients were categorized as high risk group (75.27%). There is strong association between histological type & risk group (P<0.05). High risk group is more common in follicular carcinoma (95.45% Vs 69.01%). There was a significant differences between the two histological types for extrathyroidal extention and distant metastasis as risk factors (p<0.01 and p<0.001); but tumour size and lymphatic metastasis showed no significant difference (p>0.05). All low risk patients were treated by hemithyriodectomy followed by life long thyroxine. All high risk cases were treated with total thyroidectomy with (35.71%) or without (62.86%) different types of neck dissection (according to the degree of lymph node involvement) followed by radioiodine ablasion and lifelong thyroxine therapy routinely. Overall rate of complication of thyroid surgery was 23.08%. The commoner complications were vocal cord palsy (5.5%), hypoparathyroidism (5.5%) and haemorrhage (4.4%). Less common complications were laryngeal oedema (2.2%), wound infection (2.2%), tracheal injury (1.1%) and death (2.2%). Many cases lost to follow up. Sixty seven cases (73.64%) responded well for follow-up. Mean duration of follow up was 3.40 years (SD=1.41). There was recurrence in thyroid remnant in 9.09% of hemithyroidectomy cases and were treated by completion thyroidectomy followed by radioiodine ablasion. Regional lymphatic metastasis was seen in six cases and was treated by different types of neck dissection. Recurrence at distal site was seen in 4 cases (18.18% of follicular carcinoma). These were treated by radioiodine ablation; two of them died during the period of follow-up.

Change of serum protein level during pregnancy and the impact of parity and diet on it.

Serum protein level in the three trimesters of pregnancy and the impact of parity and dietary protein on it were studied in 154 pregnant women. The mean total serum protein during first, second and third trimesters were found to be 6.85, 6.60 and 6.81 gm% respectively whick were lower than the mean value obtained in a group of nonpregnant women (7.55 gm%). The level of serum protein depends on intake of dietary protein and influenced by parity in pregnant women. While primigravidae with adequate protein intake had higher serum protein level than primigravidae with inadequate protein consumption, multigravidae with adequate protein intake had lower serum protein level than primigravidae with adequate protein intake.