Background: HRCT Chest is an important tool in both diagnosis and management of COVID-19 patient, as well as it is an important complement to the reverse-transcription polymerase chain reaction (RT-PCR) tests. Purpose: The purpose of this study is to assess different patterns of manifestation in HRCT chest in COVID-19 infection & to grade the severity by observing a sample of 128 after the symptoms began. Method: From 11 April 2020 to 27 May 2020, 128 patients who were admitted in Combined Military Hospital Dhaka and underwent both HRCT chest and RT-PCR for COVID- 19 were included. Distribution and patterns of pulmonary lesions like ground glass opacity (GGO), consolidation, reverse halo sign, crazy paving, thickened vascular marking, lymphadenopathy and pleural effusion were evaluated. Result: Total 128 patients diagnosed (RT-PCR Positive) with COVID-19 were included. Among them, 112(87.5%) patients had fever, and 58(45.31%) patients had fatigability. The most frequent CT abnormality was ground glass opacity in 123(96.09%) cases. Amongst them 81(63.28%) cases had GGO plus consolidation and ground glass opacity alone were 42(32.81%) cases. Crazy-paving pattern was in 65(50.78%) cases. Most patients had multiple lesions and involved all the 5 lobes in 96(75.00%) cases. The lesions were mostly peripheral (123,96.09%) and posterior (103,80.47%) and in 65(50.78%) cases the distribution were diffuse but predominantly peripheral. Most commonly involved lobe is right lower lobe (120,93.75%) and left lower lobe(117,91.41%). Conclusion: HRCT chest can play an important role in the early diagnosis and prompt management of this global health emergency. J Bangladesh Coll Phys Surg 2020; 38(0): 21-28

Introduction: Abdominal Ultrasonography (USG) is the most commonly used method for diagnosing acute appendicitis the most common surgical cause of acute abdomen. In this study, we observed the reliability of USG for diagnosing acute appendicitis. Objectives:To evaluate the role of ultrasonography in the diagnosis of acute appendicitis. Methods:In this study, we performed abdominal USG of 100 patients admitted with lower right abdominal pain and diagnosed as acute surgical abdomen according to the physical examination and laboratory findings. These patients were surgically treated by appendecectomy, and excised specimens were sent for histopathological examination. Results:One hundred patients were assessed in this study. Out of them 82.0% patients had acute appendicitis and diameter of their appendices were more or equal to 6 mm. Twenty nine percent of the patients were below 21 years of age. Intraluminal fluid was present in 81% of patients and peri-appendicular fluid was present in 66.7% of patients. Leucocytosis was present in 49% of the cases and neutrophilia in 84% of the cases. All of the patients presented with lower abdominal pain with migration of pain in 52% cases and they had right iliac fossa tenderness. The sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and accuracy rate of ultrasonography was 76.8%, 88.9%, 96.9%, 45.7% and 79.0%, respectively. Conclusion: Acute appendicitis is a common indication for emergency abdominal surgery. Proper clinical assessment is the mainstay of diagnosis in acute appendicitis and addition of routine abdominal ultrasound by graded compression technique can improve the diagnostic accuracy and adverse outcome.

IgG4 related disease is a multi-organ immune-mediated condition which links many disorders previously regarded as isolated, a single-organ disease without any known underlying systemic condition. It may mimic anymalignant, infectious and inflammatory disorders. It was recognized as a unified entity only 10 years ago. Histopathology is the key to diagnosis. The three central pathology features of IgG4 related disease are lymphoplasmacytic infiltration, stroriform fibrosis, and obliterative arteritis. It is important to promptly diagnose IgG4 related disease because this disease commonly manifests as swelling of the affected organs, which must be differentiated from true neoplasms. Periaortitis or periarteritis is one of the clinical features of IgG4 related diseases. IgG4 related arterial lesions occur mainly in the aorta and its main branches and radiologically characterized by homogeneous arterial wall thickening corresponding to pathological features of IgG4 related sclerosing inflammation in the adventitia. There are 5 types of IgG4 related peri-aortitis, out of which Type 2 is most common. IgG4 related peri-aortitis generally respond to glucocorticoids in its inflammatory stage, but recurrent or refractory cases are common. Greater awareness of this disease is needed to ensure earlier diagnoses to prevent severe organ damage. A 38-year-old male was diagnosed as Type 2 IgG4 related periaortitis 2 years ago in CMH, Dhaka. He was treated with oral steroid and Azathioprine with a rewarding outcome. Journal of Armed Forces Medical College Bangladesh Vol.14 (2) 2018: 217-219

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Introduction: A cross-sectional prospective clinical study was done to evaluate the inner ear anomalies in candidates undergoing cochlear implantation. Materials and Methods: Study was carried out over a period of 07 years (Jan 2013 to Dec 2019) at Cochlear Implant Centre, Combined Military Hospital Dhaka. A total 206 deaf candidates, both pre and post lingual, were included in convenient sampling method. Result: The sample consisted of 206 candidates, of whom 117 (56.80%) were female and 89 (43.20%) were male. All candidates had severe to profound bilateral deafness. 182 (88.35%) of them were pre and 24 (11.65%) were in post lingual group. All patients diagnosed audiologically as profound deafness underwent HRCT scan of temporal bone with 3D reconstruction of cochlea and MRI of internal auditory canal & brain. Radiological examination revealed that 36 (17.47%) candidates had ear anomalies. Mondini deformity 14 (06.80%), cochlear ossification 11 (5.34%), large vestibular aqueduct 04 (1.94%), high jugular bulb 04 (1.94%) and anteriorly placed sigmoid sinus 03 (1.45%) were noted. During intervention, 42 (20.39%) candidates had anomalous intra operative findings. Among them CSF gusher 19 (9.23%), ossification of basal turn 12 (5.83%), isolated rotated Cochlea 02 (0.97%), high jugular bulb 04 (1.94%), anteriorly placed sigmoid sinus 03 (1.45%), and very high facial nerve 02 (0.97%) were observed. During surgery, electrode insertion difficulty due to high CSF gusher was experienced in19 (9.23%) cases, full length of electrode insertion was not possible due to ossified basal turn 12 (5.83%), difficult to find out round window membrane due to rotated cochlea 02 (0.97%), prevented direct visualization of the round window due to high jugular bulb 04 (1.94%), difficult to approach round window due to very high facial nerve 02 (0.97%). and approach to round window membrane was compromised due to anteriorly placed sigmoid sinus 03 (1.45%). Most of these difficulties were effectively managed during surgery. Conclusions: This study highlights the importance of preoperative radiological scanning in the assessment of patients undergoing cochlear implantation. It provides vital information on cochlear status and in ruling out non cochlear causes where cochlear implantation is not feasible. Detection of anatomical abnormalities with appropriate evaluation, specially imaging should be mandatory in every patient undergoing cochlear implantation. J Dhaka Med Coll. 2021; 30(2) : 167-175