Combined Military Hospital CMH

Dhaka, Bangladesh

Combined Military Hospital CMH

Dhaka, Bangladesh

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Mansoor J.,Combined Military Hospital CMH | Umair B.,Combined Military Hospital CMH
Journal of the College of Physicians and Surgeons Pakistan | Year: 2013

Primary pancreatic tuberculosis is an extremely rare entity, even in tuberculosis endemic areas. A 22-year-old male presented with features of obstructive jaundice. Ultrasonography and computed tomography scan showed mass in the pancreatic head for which he underwent a pancreatoduodenectomy. Histological examination of the specimen showed caseating granulomas. Antituberculous medicines were started and he remained well 18 months after surgery. Pancreatic tuberculosis is rare and is frequently confused with pancreatic cancer on clinical presentation as well as on imaging studies. A high index of suspicion is vital to avoid surgeries in this medically treatable, often misdiagnosed condition. © 2013 College of Physicians and Surgeons Pakistan.


Habib A.,Combined Military Hospital CMH
Journal of the College of Physicians and Surgeons Pakistan | Year: 2016

Objective: To determine clinical profile of vitiligo in children. Study Design: A descriptive study. Place and Duration of Study: Combined Military Hospital, Abbottabad, from January 2010 to June 2013. Methodology: All new patients below the age of 15 years, clinically diagnosed to have vitiligo, were included in the study. A detailed history was obtained, thorough physical examination was performed, and findings were recorded on a specially designed proforma for each patient separately. Computer programme SPSS-14 was used to manage and analyze the data. Results: Out of 157 children, 68 (43.3%) were males and 89 (56.7%) were females. Mean age at onset was 6.55 ±3.43 years. The disease started before 10 years of age in 123 (78.3%) children. Average duration of the disease was 1.48 ±1.87 years. Average duration of the disease was 1.73 ±2.09 years in male children and 1.29 ±1.67 years in female children. Generalized vitiligo was the commonest type (n = 83, 52.9%). The disease started most commonly from head and neck (n = 75, 47.8%). A family history of vitiligo was found in forty-nine (31.2%) children, Koebner phenomenon in 39 (24.8%) children and associated autoimmune or endocrine diseases in 8 (5.1%) patients. Conclusion: Majority of the children developed the disease before 10 years of age. Generalized vitiligo was the commonest type. Childhood vitiligo was more common in female children.


Murtaza B.,Combined Military Hospital CMH | Alvi S.,Combined Military Hospital CMH
Journal of the College of Physicians and Surgeons Pakistan | Year: 2016

Objective: To assess the clinical presentation of forgotten ureteral stents and highlight the etiological factors resulting in the retention of these stents. Study Design: Observational study. Place and Duration of Study: Department of Urology, Armed Forces Institute of Urology, Rawalpindi, from January 2010 to June 2011. Methodology: Thirty-eight patients, with forgotten ureteral stents, retained for more than 6 months duration, were enrolled. A detailed evaluation was performed, along with the questions regarding the patients' opinion about the ureteral stents. They were specially asked whether they knew about the stents or were they formally informed regarding the stents. Subsequently, the patients were managed according to their clinical condition. Results: The male to female ratio was 2.1:1 aged 23 - 69 years, mean being 40.24 ±12.59 years. The time of presentation after the ureteral stenting was 7 - 180 months (mean = 28.89 ±33.435 years). Seven patients (18.4%) reported with chronic kidney disease, including ESRD in two cases. Recurrent UTI was seen in 28 cases (73.6%), calculus formed over the stents in 20 cases (52.6%), and stent fragmented in 5 patients (13.1%). Majority of patients, (n = 23, 60.5%), were not even aware of the placement of these stents while 8 (21.0%) knew but were reluctant about its removal. In 3 cases (7.8%), the relatives knew about the stent but never informed the patients. The stent had been removed in 2 cases (5.2%), but the other broken fragment was missed. One case (2.6%) each had a misconception about the permanent placement of the stents like cardiac stents and regarding degradation of the stents in situ. Conclusion: Forgotten ureteral stents produce clinical features ranging from recurrent UTI to ESRD. This preventable urological complication is primarily due to the unawareness or ignorance of the patients and their relatives regarding the stent.


Khondker L.,Bangabandhu Sheikh Mujib Medical University | Islam Khan M.S.,Combined Military Hospital CMH
Journal of Pakistan Association of Dermatologists | Year: 2015

Objective To compare the adverse effects of low-dose oral prednisolone and oral mini pulse dexamethasone in patients of vitiligo. Methods A clinical trial was carried out from January 2013 to December 2013. Total sixty patients of vitiligo were enrolled and 30 of group A patients were treated with low dose oral prednisolone (0.3 mg/kg body weight) daily and 30 of group B patients were treated with oral dexamethasone pulse therapy (10 mg per week) for 16 weeks. Results During 12 week follow-up, increased body weight, headache, dyspepsia and fatigue were more frequent in group A as compared to group B. Similarly, in group A other side effects noted were acne (33.3%), mooning of face (26.6%), striae (26.6%), hypertrichosis 13.2%, purpura (6.7%) and among the female patients, menstrual abnormality (71.4%) whereas in group B, no patient developed these problems from baseline to follow-up period (p<0.05). Conclusion Low dose oral prednisolone was found to be associated with more adverse effects than oral dexamethasone pulse therapy in treating vitiligo.


Khondker L.,Bangabandhu Sheikh Mujib Medical University | Khan M.S.I.,Combined Military hospital CMH
Journal of Pakistan Association of Dermatologists | Year: 2014

Objective: To find out the clinical profile of cutaneous drug reactions in a tertiary level hospital. Methods: In this cross-sectional study, carried out for a period from January 2011 to December 2011, data were collected from the Department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Patients suffering from adverse drug reactions were the study population and within the period of data collection, twenty patients were selected. Results: Out of total twenty patients, 9 (45%) had fixed drug eruptions, 4 (20%) urticaria, 3 (15%) Stevens-Johnson syndrome, 2 (10%) morbilliform rashes and 2 (10%) had erythema multiforme. The most common clinical presentation was hyperpigmented macule/patch in 5 (25%) cases, followed by urticarial plaque 4 (20%), erosive lesion 3 (15%) and loss of skin in sheets <10% body surface area 3 (15%) and morbilliform rashes and target lesions in 2(10%) each. 6 (30%) patients developed mucosal involvement only and majority of them 8 (40%) had oral involvement. The most common type of offending drug causing the drug reactions were sulfur containing drugs in 8 (40%) cases, followed by NSAIDs in 6 (30%), quinolones 3 (15%), metronidazole and anticonvulsants in a few. Conclusion: The common types of cutaneous drug eruptions are fixed drug eruptions, urticaria, Stevens-Johnson syndrome, morbilliform rashes and erythema multiforme.


PubMed | Combined Military Hospital CMH
Type: Evaluation Studies | Journal: Journal of the College of Physicians and Surgeons--Pakistan : JCPSP | Year: 2016

To determine clinical profile of vitiligo in children.A descriptive study.Combined Military Hospital, Abbottabad, from January 2010 to June 2013.All new patients below the age of 15 years, clinically diagnosed to have vitiligo, were included in the study. A detailed history was obtained, thorough physical examination was performed, and findings were recorded on a specially designed proforma for each patient separately. Computer programme SPSS-14 was used to manage and analyze the data.Out of 157 children, 68 (43.3%) were males and 89 (56.7%) were females. Mean age at onset was 6.55 3.43 years. The disease started before 10 years of age in 123 (78.3%) children. Average duration of the disease was 1.48 1.87 years. Average duration of the disease was 1.73 2.09 years in male children and 1.29 1.67 years in female children. Generalized vitiligo was the commonest type (n = 83, 52.9%). The disease started most commonly from head and neck (n = 75, 47.8%). A family history of vitiligo was found in forty-nine (31.2%) children, Koebner phenomenon in 39 (24.8%) children and associated autoimmune or endocrine diseases in 8 (5.1%) patients.Majority of the children developed the disease before 10 years of age. Generalized vitiligo was the commonest type. Childhood vitiligo was more common in female children.


PubMed | Combined Military Hospital CMH
Type: Journal Article | Journal: Journal of the College of Physicians and Surgeons--Pakistan : JCPSP | Year: 2016

To assess the clinical presentation of forgotten ureteral stents and highlight the etiological factors resulting in the retention of these stents.Observational study.Department of Urology, Armed Forces Institute of Urology, Rawalpindi, from January 2010 to June 2011.Thirty-eight patients, with forgotten ureteral stents, retained for more than 6 months duration, were enrolled. A detailed evaluation was performed, along with the questions regarding the patients opinion about the ureteral stents. They were specially asked whether they knew about the stents or were they formally informed regarding the stents. Subsequently, the patients were managed according to their clinical condition.The male to female ratio was 2.1:1 aged 23 - 69 years, mean being 40.24 ±12.59 years. The time of presentation after the ureteral stenting was 7 - 180 months (mean = 28.89 ±33.435 years). Seven patients (18.4%) reported with chronic kidney disease, including ESRD in two cases. Recurrent UTI was seen in 28 cases (73.6%), calculus formed over the stents in 20 cases (52.6%), and stent fragmented in 5 patients (13.1%). Majority of patients, (n = 23, 60.5%), were not even aware of the placement of these stents while 8 (21.0%) knew but were reluctant about its removal. In 3 cases (7.8%), the relatives knew about the stent but never informed the patients. The stent had been removed in 2 cases (5.2%), but the other broken fragment was missed. One case (2.6%) each had a misconception about the permanent placement of the stents like cardiac stents and regarding degradation of the stents in situ.Forgotten ureteral stents produce clinical features ranging from recurrent UTI to ESRD. This preventable urological complication is primarily due to the unawareness or ignorance of the patients and their relatives regarding the stent.


PubMed | Combined Military Hospital CMH and Fatima Memorial Hospital Medical College
Type: Journal Article | Journal: Journal of the College of Physicians and Surgeons--Pakistan : JCPSP | Year: 2016

The number of young medical graduates in Pakistan is increasing every year. Most of whom wish to specialize in a particular clinical field. Considering the competition faced for specialty training selection and later on for job placement, it is suggested that these young graduates should explore some alternative careers as well. Opportunities can be availed and decision made based on graduates personal interest, preference to work in Pakistan or abroad, and availability of suitable employment in local and international hospitals among other factors. Careers in the basic medical sciences, medical education, medical research, medical writing and bioethics can be considered, too. There are very few trained professionals in these fields in Pakistan and once trained, these young doctors will hopefully find rewarding employment.


PubMed | Combined Military Hospital CMH
Type: Case Reports | Journal: Journal of the College of Physicians and Surgeons--Pakistan : JCPSP | Year: 2016

Leeches are found in fresh water as well as moist marshy tropical areas. Orifical Hirudiniasis is the presence of leech in natural human orifices. Leech have been reported in nose, oropharynx, vagina, rectum and bladder but leech per urethra is very rare. We report a case of leech in urethra causing hematuria and bleeding disorder in the form of epistaxis and impaired clotting profile after use of stream water for ablution. The case was diagnosed after a prolonged diagnostic dilemma. Asingle alive leech was recovered from the urethra after ten days with the help of forceps. The hematuria and epistaxis gradually improved over next 48 hours and the patient became asymptomatic. Natives of leech infested areas should be advised to avoid swimming in fresh water and desist from drinking and using stream water without inspection for leeches.


PubMed | Combined Military Hospital CMH
Type: Journal Article | Journal: Journal of the College of Physicians and Surgeons--Pakistan : JCPSP | Year: 2016

To assess the safety of direct trocar insertion (DTI) before creating pneumoperitoneum in laparoscopic procedures.An observational study.Combined Military Hospital (CMH) Kohat, Pakistan from November 2013 to January 2015.All the cases undergoing laparoscopy at the study centre in the above duration were included in the study after approval from the Hospital Ethical Committee and informed written consent. Out of the 200 cases, DTI was successfully used to establish peritoneal access in 190 cases, while open Hassens technique (OL) was used in ten cases. Body mass index (BMI) of all the patients was calculated before surgery. All the cases were performed under general anaesthesia with adequate relaxation. A 10 mm permanent re-useable sharp metallic trocar was inserted through umbilical scar after lifting the abdominal wall using towel clamps. Studied variables included age, gender, BMI, operations, history of previous surgery, number of attempts for DTI and complications.Mean age of the patients in DTI group was 46.58 13.94 years, while 48.70 10.08 years in OL group. Female to male ratio in DTI group was 1.43:1; and 2.33:1 in OL group. Increase in BMI had a relation with number of unsuccessful attempts of DTI, so obesity was the main reason of failure of DTI.DTI is a safe and effective method of peritoneal access for laparoscopy with very low failure rate related to BMI and minimal complications.

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