Risk Assessment of Acute Upper Gastrointestinal Haemorrhage with Rockall Score In DMCH

Introduction: Rockall score is used for risk assessment in acute upper gastrointestinal haemorrhage for intervention and prediction for risk of rebleeding and mortality.Methods: This is a cross sectional hospital based observational study carried out among patients presented with haematemesis with or without melaena in the department of Medicine, Dhaka Medical College Hospital from April, 2013 to March 2014 in one hundred consecutive cases. Rockall score done before and after endoscpy.Results:Patients mean age found 45.12±14.9 years with 4:1 male to female ratio. Service holder were (26.0%) and 91.0% were married. Almost half (48.0%) was educated. Combined haematemesis and melaena was presenting feature in 62.0% patients among them 72.0% arrived in hospital within 24 hours of onset. Comorbidity was found in 42.0% cases and 13% took NSAID. Oesophageal varix was found in 25.0%. No death observed in 18% haematemesis patients, one died from melaena (1 of 5) but most died (4 out of 5) from combined haematemesis and melaena. All the 5 death occurred in 89% rebleeding cases. No death observed in 34% patients having pre endoscopic Rockall Score d” 2; as well as in 44% cases post endoscopic Rockall score d”5 score. Mean duration Hospital stay was 6.36±4.5 days.Conclusions: Rockall score is useful in predicting outcomes in acute upper gastrointestinal haemorrhage.Bangladesh J Medicine Jan 2018; 29(1) : 13-25

Vertical Transmission of Hepatitis B Virus is the most Important Route of Transmission in Asymptomatic Carriers in Bangladesh

To find out the route of the transmission of HBV in asymptomatic carrier and build up awareness against the transmission of HBV. It was a prospective study in the Dept. of Medicine (IPD & OPD) and Transfusion Medicine in Rajshahi Medical College Hospital from June 2005 to July 2007. 300 asymptomatic carriers of HBV were included. HBsAg was detected incidentally during routine screening tests done for blood donation programme, foreign mission and courses abroad. All the HBsAg positive patients were confirmed by doing HBsAg (ELISA) tests after 6 months. All were positive. Among 300 asymptomatic carriers male 270 and female 30. Age between 15 to 35 yrs. HBeAg positive only in 15 patients. ALT above 60 U/L in 17 patients, HBV-DNA (PCR) detectable in 15 patients, coarse liver echotexture in 20 patients, Oesophageal Varix small size in 02 patients. Serum Albumin, PT, AFP all were normal range. Screening of all the family members of the carriers was done. Among the 300 index cases 130 (43.33%) family members most likely mother,father, brother, sister or cousin were HBVmarkers positive. Liver related death was present in 50 families (16.66%} HBV transmission is preventable. Mass education is required about the transmission of HBV. Screening of HBV should be mandatory in all pregnant women. Bangladesh Government has integrated the HBV vaccination in EPI. DOI: 10.3329/taj.v22i1.5027 TAJ 2009; 22(1): 97-100