The Insight is the official journal of Gopalganj Medical College, Gopalganj, Bangladesh and accepts articles for publication from home and abroad. This is a quarterly peer-reviewed journal and aims to publish work of the highest quality from all branches of medical science. The aim of the publication is to promote research and serves as a media for the dissemination of scientific information and recent knowledge among the readers. e-ISSN: 2789-6897 ISSN: 2663-9491
Socio-demographic and Reproductive Factors Influencing Contraceptive Use among Women with Rheumatoid Arthritis and Systemic Lupus Erythematosus
Introduction: Rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) are chronic autoimmune diseases predominantly affecting women of reproductive age, presenting significant reproductive health challenges including infertility, reduced family size, and teratogenic medication exposure. Despite recommendations for effective contraception, evidence suggests low and inequitable contraceptive uptake among these patients. Aim of the Study: To examine the socio-demographic and reproductive factors influencing contraceptive use among women with RA and SLE attending rheumatology clinics in Bangladesh. Methods & Materials: This cross-sectional study was conducted from July 2022 to April 2023 at Bangladesh Medical University (formerly BSMMU), enrolling 83 married women aged 18-49 years with confirmed RA (n=42) or SLE (n=41). Data were collected on socio-demographic variables, reproductive factors, contraceptive practices, and contraceptive counselling receipt. Multivariable logistic regression was used to identify factors associated with contraceptive use. Results: The mean age was 30.75±5.32 years. Contraceptive prevalence was 74.7% (71.4% in RA, 78.0% in SLE). Condoms (31.3%) and oral contraceptive pills (25.3%) were the most common methods, with 54.2% receiving contraceptive counselling. High rates of unwanted pregnancy (43.4%) and abortion (30.1%) were documented. Multivariable analysis identified age ≥30 years as the sole significant predictor of contraceptive use (AOR=2.38, 95% CI: 1.03-5.50; p=0.042). No significant associations were found for BMI, education, residence, reproductive history, or disease type. Conclusion: Contraceptive use among women with RA and SLE in Bangladesh is comparable to the general population, with age ≥30 years as the key determinant. However, high rates of unwanted pregnancy and abortion, and predominant reliance on barrier methods, indicate critical gaps in reproductive healthcare. Targeted contraceptive counselling within rheumatology clinics is essential to improve outcomes in this vulnerable population.
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Effectiveness of Quadriceps Strengthening Exercise in Patients with Knee Osteoarthritis
Background: Knee osteoarthritis is a common degenerative joint disease and a major cause of pain and disability, particularly in older adults, with the knee being the most frequently affected joint. Quadriceps weakness is a key contributor to pain, instability, and functional limitation in knee OA, making quadriceps strengthening an essential part of its conservative management. Objective: The aim of the study was to evaluate the effectiveness of quadriceps strengthening exercise in improving pain, physical function, knee range of motion, and quadriceps muscle strength in patients with knee osteoarthritis. Methods & Materials: This quasi-experimental study was conducted at the Department of Physical Medicine and Rehabilitation, Bangladesh Medical University (BMU), Dhaka, Bangladesh, from January to December 2025 among 70 patients with knee osteoarthritis. Pain, functional status, knee range of motion, and quadriceps muscle strength were assessed before and after a quadriceps strengthening exercise program. Data were analyzed using SPSS version 26.0, with p < 0.05 considered statistically significant. Results: Among 70 patients with knee osteoarthritis (mean age 57.4 ± 8.7 years), most were female (62.9%) and had Kellgren-Lawrence grade II disease (51.4%). Following quadriceps strengthening exercise, significant improvements were observed in pain, WOMAC scores, knee range of motion, and quadriceps muscle strength (all p < 0.001). Overall, 57.1% of patients showed moderate improvement, 28.6% marked improvement, and 14.3% mild improvement, with no patient showing no improvement. Conclusion: Quadriceps strengthening exercise significantly improved pain, physical function, knee range of motion, and quadriceps muscle strength in patients with knee osteoarthritis, supporting its role as an effective non-pharmacological treatment modality.
Per-operative Evaluation of Patient Related Difficulties of Laparoscopic Cholecystectomy
Background: Gallstone disease is a common cause of morbidity, with an estimated prevalence of 5-22% in the general population. In settings where delayed presentation is frequent due to limited healthcare access and low patient awareness, laparoscopic cholecystectomy can be technically challenging because of difficulties with abdominal access, pneumoperitoneum creation, dissection of the gallbladder, and specimen retrieval. Methods & Materials: This descriptive study was performed in the Chittagong Medical College Hospital General Surgery wards from August 2016 to January 2017. In this study, 100 patients who underwent laparoscopic cholecystectomy during the study period were included by purposive consecutive sampling meeting the inclusion criteria. Data were analyzed using chi-square and Student t-tests as appropriate. Results: Among the 100 patients who underwent laparoscopic cholecystectomy, 12 cases were categorized as difficult, primarily due to prolonged operative time exceeding 50 minutes, although all were completed laparoscopically. The average operative duration was 36.53 minutes. Difficulties were more frequent among females (66.7%) and patients aged 40-60 years. Significant predictors of operative difficulty included intra-abdominal adhesion of the gallbladder to the gut (p<0.001, OR=29.40), short and wide cystic duct (p=0.008, OR=5.79), and adhesion at Calot's triangle (p=0.041, OR=3.90). Two cases required conversion to open surgery due to unclear anatomy and risk of common bile duct injury. Conclusion: Laparoscopic cholecystectomy is a common operation, but sometimes it becomes difficult due to several factors. Adhesion of GB with gut, short, wide cystic duct, and adhesion at Calot's triangle are challenging to operate upon and increase the operating time.
Influence of Antiretroviral Therapy on Lipid Profile in HIV Patients
Background: As dyslipidemia is associated with an elevated risk of cardiovascular disease, it represents significant health issues for HIV-positive patients receiving antiretroviral therapy (ART). There is limited information regarding ART treatment and its influence on lipid profiles manifest in HIV infected persons in Bangladesh. To determine the pattern and characteristic of lipid profile among HIV patients on WHO recommended firstline antiretroviral therapy, the study was performed. Methods & Materials: A total 51 HIV patients receiving ART for >1 year (group A) and 51 treatment naïve patients (group B) were enrolled in this study. Written informed consent was obtained from all subjects. Each patient was subjected to a full clinical examination, history-taking and lipid profile determination. After collection of the required data, analysis was performed in SPSS 27.0. Results: The mean age was 35.52±11.55 (SD) years among total study population and more than two third (77.5%) patients were male altogether. Majority of HIV infected patients had history of unprotected sex (89.2%) and 17.7% had history of transmission of HIV from partner. Mean values of serum lipid profile was found significantly higher among treatment receiver groups (TC=176.7±37.1, HDL=36.7±6.7, LDL=104.46±32.9, TG=196.86±88.91) compared to treatment naive patients (TC=151.9±35.6, HDL=31.9±10.6, LDL=87.8±25, TG=158.7±67.4). Being on ART for three or more years was associated with higher levels of TC and LDL-c (p<0.05). Conclusion: The present study findings have suggested an association between antiretroviral therapy (ART) and lipid abnormalities. However, further large multi-centre study is recommended.
Demographic Characteristics and Injury Patterns in Patients with Flail Chest Trauma
Background: Flail chest is a serious form of blunt thoracic trauma associated with significant respiratory compromise and frequently accompanied by other thoracic injuries. Understanding the demographic characteristics and injury patterns of affected patients is important for timely diagnosis and management. Methods & Materials: This cross-sectional study was conducted in the Department of Thoracic Surgery, National Institute of Diseases of the Chest and Hospital (NIDCH), Dhaka, Bangladesh, from January 2010 to December 2010. A total of 60 patients with flail chest were included. Patients were divided into Group I (Central Flail Chest, n=22) and Group II (Other Flail Chest, n=38). Results: The mean age was 38.3 ± 14.4 years in Group I and 41.4 ± 18.2 years in Group II (p=0.471). Male patients predominated in both groups, accounting for 81.8% and 65.8% of Group I and Group II, respectively (p=0.184). Chest pain was present in all patients. Respiratory distress occurred in 72.7% of Group I and 57.9% of Group II patients, while cyanosis was observed in 40.9% and 15.8%, respectively. The mean number of fractured ribs was significantly higher in Group I than in Group II (9 ± 2 vs. 5 ± 1; p<0.001). Road traffic accidents were the leading cause of injury in both groups. Haemopneumothorax was the most common associated condition, followed by lung contusion and surgical emphysema. Conclusion: Flail chest trauma predominantly affected males and was most commonly caused by road traffic accidents. Central flail chest was associated with a higher number of rib fractures and more severe clinical manifestations.
Clinical Presentation and Biochemical Parameters of Childhood Lupus Nephritis and Its Correlation with Underlying Renal Histopathology: A Cross-sectional Study
Background: Lupus nephritis is a major concern in patients with systemic lupus erythematosus. Clinical presentation and biochemical parameters are usually correlated with histopathological classes of lupus nephritis; however, patients with mild clinical features may have moderate to severe glomerular injury, while severe presentations may sometimes show less severe damage. The aim of this study was to assess clinical presentation and biochemical parameters of childhood lupus nephritis and their correlation with renal histopathology. Methods & Materials: This cross-sectional observational study was conducted in the Department of Pediatric Nephrology, Bangladesh Shishu Hospital & Institute (BSH&I), from October 2022 to March 2024. A total of 44 children aged 4-18 years who fulfilled the 2019 ACR/EULAR criteria. Results: Among 44 participants, mean age was 10.6 years with a female-to-male ratio of 3.4:1. About 81.81% had nephritis with systemic features and 18.19% had isolated lupus nephritis. Class IV was the most common histopathological class (32%). Proteinuria was present in 97.3%, of whom 56.8% had nephrotic-range proteinuria. Other findings included hematuria, anasarca, hypertension, and acute kidney failure. Anasarca, nephrotic-range proteinuria, acute kidney failure, reduced eGFR, increased spot uPCR, hypoalbuminemia, SLEDAI, and renal SLEDAI were significantly higher in Class IV LN. However, 18.18% of Class II LN also had nephrotic-range proteinuria. Non-nephrotic proteinuria was significantly higher in Class II LN (p=0.005), but was also seen in 22.22% of Class III, 14.28% of Class IV, and 33.33% of Class V LN. Conclusion: Clinical and biochemical severity is greater in advanced lupus nephritis, especially Class IV LN.
Serum β-hCG as an Indicator for Persistence in Gestational Trophoblastic Neoplasia
Background: Gestational trophoblastic neoplasia (GTN) is a potentially aggressive trophoblastic disorder in which persistent elevation or abnormal regression of serum beta-human chorionic gonadotropin (β-hCG) after molar evacuation may indicate persistent disease. Early identification of persistent GTN is essential to reduce morbidity and improve treatment outcomes. Aim of the study: To evaluate the role of serial serum β-hCG levels as an indicator for predicting persistence in gestational trophoblastic neoplasia during post-evacuation follow-up. Methods & Materials: This prospective observational study was conducted in the Department of Gynecological Oncology at Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh, from January 2021 to December 2021. Fifty patients with histopathologically confirmed hydatidiform mole who underwent suction evacuation were enrolled consecutively. Serial serum β-hCG levels were measured 48 hours after evacuation and monitored weekly for at least 8 weeks. Patients were categorized into persistent GTN (Group A, n=7) and spontaneous remission (Group B, n=43). Statistical analyses included chi-square test, unpaired t-test, ROC curve analysis, and multivariate logistic regression. Result: Persistent GTN developed in 14.0% of patients. Younger age, low socioeconomic status, low BMI, previous molar pregnancy, thyrotoxic features, uterine enlargement, expulsion of grape-like vesicles, large theca lutein cysts, and vesicular uterine appearance on ultrasonography were significantly associated with persistent GTN. All patients with persistent GTN had 48-hour post-evacuation β-hCG levels >100,000 mIU/mL (p=0.011). Mean log β-hCG values became significantly higher in persistent GTN cases from the 5th week onward (p=0.001). Diagnostic performance improved progressively over time, with the highest predictive accuracy observed at the 8th week (cutoff 1.59; sensitivity 97.7%, specificity 100%, AUC 0.997). Multivariate logistic regression identified younger age and elevated 48-hour β-hCG levels as independent predictors of persistent GTN. Conclusion: Serial serum β-hCG monitoring is a highly effective tool for early detection of persistent GTN following molar evacuation. Elevated 48-hour β-hCG levels and delayed decline of β-hCG after the 5th post-evacuation week are strong predictors of persistence. Regular β-hCG surveillance may facilitate timely intervention and improve clinical outcomes in patients with gestational trophoblastic disease.
Clinicopathological and Radiological Features of Unilateral Nasal Mass in Adults - A Tertiary Care Hospital Experience
Abu Zafar Saleh1*, Mostafa Kamal2 Introduction: Aim and objectives of the study were to analyze and study the diverse presentations of unilateral nasal mass and to identify the suggestive features of neoplastic pathology in adult's population at a tertiary referral hospital. Aim of the study: Aim and objectives of the study were to analyze and study the diverse presentations of unilateral nasal mass and to identify the suggestive features of neoplastic pathology in adult's population at a tertiary referral hospital. Methods: This prospective observational study was conducted in the Department of ENT, Khulna Medical College and Hospital, Khulna, Bangladesh. The study period was between January 2021 and December 2021. The parameters include patient history, clinical assessments and histopathological examinations, which were supplemented with radiological investigations. In addition, demographic information and histopathological examinations for patients, who underwent surgical excision was analyzed for correlation with clinical diagnosis. Result: The reported cases are 55 males and 35 females with a median follow-up period of 12 months, ranging from 2-72 months. Nasal obstruction is the major symptom 34 (38%), 25 (27.8%) cases were reported with nasal mass and clinical diagnosis indicates 18 (20%) cases of malignancy. Type of disease and gender demonstrates low significance (p=0.023), whereas the diagnosis with age is highly significant (p=0.005). Conclusion: Carcinoma, inflammatory polyposis, inverted papilloma and allergic fungal sinusitis were the highest histological diagnosis. The clinical diagnosis and the suggestive features of radiological findings mostly resembled the histological findings. In contrary to the resemblance, the histological finding reveals the general diagnosis of nasal mass to the precise diagnosis, especially the fatal conditions like carcinoma. The high rate of malignancy and its suggestive radiological findings indicates that the specialists should consider the cases with caution to carryout histological analysis to rule out the probability of neoplasm.
Prediction of the consistency of intracranial meningioma by MRI: Correlation with peroperative finding
Background: Meningiomas constitute 13-26% of primary intracranial tumors and commonly occur in the fourth to sixth decades of life, with a female-to-male ratio of approximately 1.8:1. Preoperative prediction of tumor consistency aids neurosurgeons in planning the surgical approach and anticipating technical challenges. The aim of this study was to evaluate the correlation between T2-weighted MRI signal intensity and the peroperative consistency of intracranial meningiomas. Methods & Materials: This study involved 31 patients with MRI-confirmed intracranial meningiomas. T2-weighted MRI signal intensity was categorized as isointense, hypointense, or hyperintense compared to cortical gray matter, with hyperintense tumors predicted as soft and iso-/hypointense tumors as firm. Intraoperative tumor consistency was classified as soft or firm based on surgical handling. The study assessed correlation, agreement, and diagnostic performance of MRI in predicting tumor consistency. Results: T2-weighted MRI showed 18 isointense, 1 hypointense, and 12 hyperintense tumors. Peroperatively, 19 tumors were firm and 12 softs. Iso/hypointense tumors predicted as firm were confirmed in 17/19 cases, while 10/12 hyperintense tumors predicted as soft were confirmed. Correlation between MRI signal intensity and tumor consistency was significant (p < 0.001). Agreement analysis showed a Kappa value of 0.6 (fair agreement). For predicting firm tumors, MRI sensitivity was 90%, specificity 83.3%, positive predictive value 89.5%, negative predictive value 83.3%, and accuracy 87%. For soft tumors, sensitivity was 83.3%, specificity 89.5%, PPV 83.3%, NPV 89.5%, and accuracy 87%. Conclusion: T2-weighted MRI can reliably predict meningioma consistency, with hyperintense tumors likely soft and iso- or hypointense tumors likely firm, aiding preoperative surgical planning.
An Analysis of Medical Undergraduates' Performance on Problem-based Objective Written Questions Compared to Traditional Objective Written Questions on Circulatory System and Lymphoid Organs in Histology
Background: Histology is a fundamental component of undergraduate medical education, with assessment methods significantly influencing student learning and skill development. Problem-based objective written questions (PBQ) aim to assess higher-order cognitive skills, while traditional objective written questions (TQ) primarily evaluate recall and understanding. Objective: To compare medical undergraduates' performance in problem-based objective written questions and traditional objective written questions in histology, focusing on the circulatory system and lymphoid organs. Methods & Materials: This cross-sectional analytical study was conducted in the Department of Anatomy, Bangladesh Medical University (BMU), Dhaka, from September 2024 to August 2025. A total of 220 medical undergraduate students were included, with 110 students in the problem-based question (PBQ) group and 110 students in the traditional question (TQ) group. A structured test comprising 100 objective written questions was administered under standardized conditions. Only responses related to the circulatory system and lymphoid organs were analyzed. Data were analyzed using SPSS version 27.0, and statistical significance was set at p ≤ 0.05. Results: The mean score of the PBQ group was 31.59 ± 19.29, while the TQ group achieved a higher mean score of 38.48 ± 18.68. The difference between the two groups was statistically significant (p = 0.00). The 95% confidence interval (-7.29 to -7.06) confirmed significantly poorer performance in the PBQ group compared to the TQ group. Conclusion: Medical undergraduate students performed significantly poorer in PBQ than in TQ in Histology, particularly on the circulatory system and lymphoid organs. These findings suggest that students may require greater exposure and training in problem-based assessment formats to improve their application-level cognitive skills.
Perinatal Risk Factors of Seizures in Pediatric Patients: A Hospital Based Study
Background: Seizures in neonates and young children are emergencies, primarily caused by hypoxic-ischaemic encephalopathy, infections, metabolic issues, and intracranial bleeding. Key risks involve premature birth and asphyxia at birth, particularly in low-resource areas such as Bangladesh. They are associated with higher mortality rates and long-term neurodevelopmental issues, yet comprehensive data on perinatal risk factors are still scarce. Methods & Materials: This study took place in the Department of Emergency, Observation & Referral of Bangladesh Shishu Hospital & Institute, Dhaka (March 2025-February 2026) involving 110 children (0-14 years) experiencing seizures. Information regarding perinatal factors and seizure characteristics was gathered through interviews and examination of records. Analysis was conducted utilizing SPSS-26 (p<0.05 significant), with ethical approval and informed consent maintaining confidentiality. Results: A total of 110 children experiencing seizures were examined (average age 4.9 ± 3.1 years; 56.4% male). Perinatal risk factors were observed in 50.9%, primarily low birth weight (23.6%) and preterm delivery (18.2%). Generalized seizures were the most prevalent, while focal seizures were comparatively more frequent among exposed cases. Strong correlations were identified between perinatal risk factors and extended seizures (42.9% vs 18.5%, p=0.04) and their recurrence (50.0% vs 25.9%, p=0.05). Low birth weight and premature birth were strongly associated with more severe seizure results. Conclusion: Perinatal risk elements, particularly low birth weight and preterm delivery, are prevalent in pediatric seizures and correlate with more severe consequences, including extended and recurring seizures. These results emphasize the significance of perinatal health in the intensity of seizures and the necessity for enhanced maternal and neonatal care to decrease morbidity.
Clinical and Demographic Characteristics of Patients with Intracranial Meningiomas: A Descriptive Analysis
Background: Intracranial meningiomas are common primary central nervous system tumors with variable clinical presentation and demographic distribution. Understanding their clinical and demographic profile is essential for early recognition and appropriate management. Methods & Materials: A cross-sectional study was conducted in the Department of Neurosurgery, National Institute of Neurosciences & Hospital (NINS&H), Agargaon, Dhaka, from April 2021 to September 2022 among 67 consecutive patients with radiologically and clinically diagnosed intracranial meningioma who underwent surgical treatment. Results: The majority of patients were in the 41-50 years age group (31.3%), followed by 31-40 years (23.9%) and 51-60 years (19.4%), with a mean age of 43.55±11.76 years (range 19-65 years). Females comprised 67% of cases, with a female-to-male ratio of 2:1. Headache was the most common presenting symptom (81.1%), followed by weakness (40.3%), visual disturbance (35.8%) and vomiting (11.9%). Neurological findings included motor signs in 40.3%, cranial nerve involvement in 38.8%, altered consciousness in 6%, aphasia/dysphasia in 9%, sensory signs in 9%, cerebellar signs in 4.5%, autonomic dysfunction in 7.5% and other signs in 7.5%. Convexity meningiomas were most frequent (34.3%), followed by falcine/parasagittal (31.3%) and skull base lesions (25.4%), with sphenoid wing being the most common skull base subtype. Conclusion: Intracranial meningiomas predominantly affect middle-aged females and most commonly present with headache and focal neurological deficits. Convexity and parasagittal regions are the most frequent tumor locations. These findings highlight characteristic clinical and demographic patterns that may aid early diagnosis and management.
Characterization of Bacterial Isolates from Bronchoalveolar Lavage and Their Antimicrobial Resistance Patterns in a Tertiary Care Hospital in Bangladesh: A VITEK 2-Based Cross-Sectional Study
Background: Lower respiratory tract infections (LRTIs) cause significant morbidity and mortality. Bronchoalveolar lavage (BAL) helps identify pathogens and guide therapy. This study determined the bacteriological profile and antimicrobial resistance patterns of BAL isolates in a Bangladeshi tertiary care hospital. Methods & Materials: This retrospective laboratory-based study was conducted at Bangabandhu Sheikh Mujib Medical University, Dhaka, from January 2024 to December 2024. A total of 245 BAL specimens from patients with suspected pulmonary infections were processed. Bacterial identification and antimicrobial susceptibility testing were performed using the VITEK 2 automated system and interpreted per CLSI guidelines. Results: Of 245 BAL specimens, 161 (65.7%) showed significant bacterial growth. Culture positivity was higher in males (55.9%) and in the 51-60 years age group (29.2%). Gram-negative bacteria comprised 98.1% of isolates. Pseudomonas aeruginosa (49.1%) was most common, followed by Klebsiella pneumoniae (26.7%), Escherichia coli (13.0%), Acinetobacter baumannii (6.8%), Enterobacter cloacae (2.5%), and Staphylococcus aureus (1.9%). Colistin showed 100% susceptibility among Gram-negatives. Amikacin and imipenem were the most active non-polymyxin agents. High resistance was seen to cephalosporins and ciprofloxacin. All S. aureus isolates were methicillin-sensitive and fully susceptible to vancomycin and linezolid. Conclusions: Gram-negative bacteria, especially P. aeruginosa, predominate in BAL isolates from pulmonary infection patients. High antimicrobial resistance highlights the need for routine surveillance, local antibiograms, and antimicrobial stewardship. BAL remains valuable for targeted therapy.
Impact of Hemodialysis Duration and Clinical Factors on Health-Related Quality of Life in Chronic Kidney Disease Patients
Background: Chronic kidney disease (CKD) progressing to end stage renal disease (ESRD) is an increasing global health burden with high prevalence and significant mortality, including in Bangladesh. In ESRD patients, maintenance hemodialysis is the main life-sustaining therapy that improves survival but imposes a substantial physical and psychosocial burden, thereby reducing health-related quality of life. Objective: The aim of the study was to assess the impact of hemodialysis duration and clinical factors on health-related quality of life in chronic kidney disease patients. Methods & Materials: This observational cross-sectional study was conducted in the Department of Nephrology, Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh, over six months after ethical approval. A total of 100 CKD patients on maintenance hemodialysis were selected by purposive sampling to assess the impact of dialysis duration and clinical factors on health-related quality of life. Data were collected through face-to-face interviews using a structured questionnaire and the validated Bangla SF-36 tool, and analyzed using SPSS version 20.0, with p < 0.05 considered significant. Results: The study included 100 maintenance hemodialysis patients, mainly aged 61-70 years (33.0%) and male (76.0%). Diabetic nephropathy was the leading cause of CKD (32.0%), and most had serum creatinine 5-7 mg/dl (42.0%). Most patients were on dialysis for 1-5 years (56.0%). SF-36 scores were lowest for general health perception and highest for pain. Longer dialysis duration (>5 years) was significantly associated with lower scores in multiple SF-36 domains (p < 0.05). Conclusion: Maintenance hemodialysis is associated with significantly impaired quality of life, which progressively worsens with longer treatment duration.
Hemodynamic Profile and Postoperative Pain Following Propofol-Remifentanil and Isoflurane-Remifentanil Anaesthesia in Laparoscopic Cholecystectomy
Background: Laparoscopic cholecystectomy is the standard approach for cholelithiasis, offering reduced postoperative pain and faster recovery compared to open surgery. General anaesthesia is routinely used, and the choice of technique plays a key role in ensuring haemodynamic stability and optimal perioperative outcomes. Objective: The aim of the study was to compare the hemodynamic profile and postoperative pain outcomes between propofol-remifentanil and isoflurane-remifentanil anesthesia in patients undergoing laparoscopic cholecystectomy. Methods & Materials: This quasi-experimental study was conducted in the operation theatre of the Department of General Surgery, Bangladesh Medical University, Dhaka, Bangladesh (October 2024-September 2025). Seventy-two patients undergoing elective laparoscopic cholecystectomy were purposively sampled and equally allocated to Group PR (propofol-remifentanil) and Group IR (isoflurane-remifentanil) to compare perioperative haemodynamic parameters and postoperative pain outcomes. Standardized anaesthetic protocols were applied, and data were analysed using SPSS version 29.0. Results: A total of 72 patients (36 per group) were included, with comparable baseline demographic and clinical characteristics between the PR and IR groups (p > 0.05). Heart rate remained similar throughout the perioperative period, while systolic and diastolic blood pressures were significantly lower in the PR group (p < 0.01). Postoperative pain was significantly reduced in the PR group at early time points, and opioid requirement was markedly lower (27.8% vs. 77.8%; 28.6 ± 12.3 vs. 46.9 ± 15.8 mg; p < 0.001), with differences resolving by 24 hours. Conclusion: Propofol-remifentanil anesthesia offers better hemodynamic stability and postoperative pain control than isoflurane-remifentanil anesthesia in laparoscopic cholecystectomy.
Comparative study of sonology-guided nerve root block versus conservative treatment of radiculopathy
Background: Radiculopathy is a common disabling condition characterized by pain and functional impairment due to nerve root compression. Ultrasound-guided nerve root block has emerged as a minimally invasive treatment option for symptomatic relief. This study aimed to compare the effectiveness of sonoguided nerve root block with conservative treatment in patients with radiculopathy. Methods & Materials: This comparative interventional study was conducted in the Department of Physical Medicine & Rehabilitation of Bangladesh Medical University from January 2025 to December 2025 among 41 patients with cervical radiculopathy. Participants were divided into sonoguided nerve root block group (n=21) and conservative treatment group (n=20). Pain intensity was assessed using Visual Analogue Scale (VAS) and functional disability using Oswestry Disability Index (ODI). Data were analyzed using SPSS version 25. Results: The majority of patients belonged to the 41-50 years age group (36.6%) and males constituted 61.0% of participants. After 12 weeks, the mean VAS score was significantly lower in the sonoguided group compared to the conservative group (2.6 ± 1.1 vs 4.8 ± 1.4; p=0.001). ODI score also improved significantly in the intervention group (18.4 ± 5.6 vs 29.7 ± 6.3; p=0.002). Patient satisfaction was higher in the sonoguided group (85.7%) than the conservative group (50.0%). Conclusion: Sonoguided nerve root block was more effective than conservative treatment in reducing pain and improving functional outcome among patients with radiculopathy.
Clinical Spectrum, Comorbidities, and Quality of Life among Patients with Psoriasis: A Hospital-Based Outpatient Study in Bangladesh
Background: Psoriasis is a chronic immune-mediated inflammatory skin disease with systemic, metabolic, psychological, and quality-of-life impacts. In Bangladesh, hospital-based evidence on its clinical spectrum and associated comorbidities remains limited. Objective: To assess the clinical spectrum, comorbidities, disease severity, and quality of life among psoriasis patients in Bangladesh. Methods & Materials: This hospital-based retrospective study included 160 adult psoriasis patients attending Bangladesh Multicare Hospital, Rampura, Dhaka, from June to November 2025. Data were collected from medical records using a structured form. Disease severity was assessed by PASI, and quality of life by DLQI. Results: Plaque psoriasis was the most common clinical type (65.0%). Most patients had mild (41.3%) or moderate (36.3%) disease, while 22.5% had severe psoriasis. Hypertension (32.5%), diabetes mellitus (27.5%), depression/anxiety (25.0%), obesity (23.8%), and dyslipidemia (21.3%) were common comorbidities. Severe psoriasis was significantly associated with these conditions. Obesity was the strongest independent predictor of severe disease, and PASI scores showed a strong positive correlation with DLQI impairment. Conclusion: Psoriasis substantially affects physical and psychosocial well-being, requiring integrated care, routine comorbidity screening, and quality-of-life assessment.
Outcomes of Primary percutaneous coronary intervention Across Three Distinct Clinical Settings: A Single Operator’s Clinical Journey
Background: Global disparities in evidence-based care continue to exist. In ST-elevation myocardial infarction (STEMI), primary PCI is the favored approach, yet results differ due to patient characteristics, delays, hospital capabilities, and operator skill. In Bangladesh, PCI achievements are significant, but results vary, particularly among high-risk patients and in cases with system delays. This research examines PCI outcomes in three environments under one operator, concentrating on procedural effectiveness and in-hospital outcomes. Methods & Materials: This retrospective analysis encompassed 500 adult STEMI patients who received primary PCI from a singular operator at three centers in Bangladesh (2010–2026). Information on clinical and procedural factors was gathered from records. The main result was mortality during hospitalization. The analysis employed SPSS along with suitable statistical tests, and ethical approval was acquired. Results: In this study of 500 STEMI patients (n = 100, 200, 200), baseline features were comparable (p > 0.05) with the exception of smoking (p < 0.05), and approximately 60% had single-vessel disease. Pre-dilatation showed variability (~50.8%, p < 0.05), whereas other procedural aspects were similar. In-hospital mortality was minimal (3.2%) with no difference among centres (p > 0.05). Univariate analysis revealed no notable associations, whereas multivariate regression found diabetes to be the sole independent predictor (AOR ≈ 0.306, 95% CI: 0.105–0.889, p < 0.05). The clinical environment showed no considerable impact (AOR ≈ 1). Conclusion: Primary PCI demonstrated comparable results in all centers, exhibiting low mortality rates and no significant differences. Diabetes was the sole negative predictor, whereas the hospital environment had no effect.
Clinico-Epidemiological Study of Poisoning – A Descriptive Study
Background: Acute poisoning is a major public health and clinical emergency in Bangladesh, yet prospective data characterizing its epidemiological pattern, clinical presentation and outcomes at a tertiary level remain limited. Objective: To describe the clinico-epidemiological profile, pattern of poisoning agents and immediate outcomes of acute poisoning cases admitted to Dhaka Medical College Hospital (DMCH). Methods & Materials: A prospective observational study was conducted in two medicine units of DMCH from July to December 2010. A total of 600 consenting adult poisoning patients were enrolled after applying predefined inclusion and exclusion criteria. Data on demographic profile, poisoning agent, clinical features, investigations, treatment and outcome were recorded on a structured case record form. Statistical analysis was performed using SPSS version 17.0. Results: Poisoning accounted for 21.45% of hospital admissions. The majority of patients were aged 21–30 years (43.3%), with a male predominance (60.2%). Pesticides (29.2%) were the most common agents, followed by travel-related poisoning (27.3%) and benzodiazepines (20.2%). Suicidal intent was present in 66.2% of cases. Common clinical features included nausea/vomiting (62.7%) and drowsiness (55.7%). Most patients (73.3%) recovered, while 3% died. Mortality was highest among pesticide poisoning cases. Lower Glasgow Coma Scale scores on admission were strongly associated with increased mortality. Conclusion: Acute poisoning predominantly affects young adults, with pesticide and travel-related poisoning as the dominant agents. Lower GCS on admission is a significant predictor of mortality. Strengthening public awareness, legislative control of toxic agrochemicals and improved emergency care infrastructure are urgently needed.
Cemented Versus Uncemented Total Hip Arthroplasty in Elderly Patients: A Comparative Outcome Study
Introduction: Total hip arthroplasty (THA) is a widely performed procedure for managing advanced hip pathology in elderly patients, including osteoarthritis, femoral neck fractures, and avascular necrosis. With increasing life expectancy, the choice between cemented and uncemented fixation has become crucial, as bone quality and comorbidities can influence outcomes. This study aimed to compare clinical, functional, and early postoperative outcomes of cemented versus uncemented THA in elderly patients. Methods & Materials: This prospective comparative study was conducted from January 2025 to December 2025 in the Department of Orthopedics, National Institute of Traumatology & Orthopaedic Rehabilitation. A total of 60 patients aged ≥65 years requiring primary THA were enrolled and equally divided into cemented (n = 30) and uncemented (n = 30) groups. Data were analysed using SPSS version 25.0. Result: Primary osteoarthritis was the most common indication. Cemented THA had longer operative time and greater blood loss but no intraoperative fractures, whereas uncemented THA had 10% intraoperative femoral fractures. Postoperative complications were higher in the uncemented group (26.7% vs 13.3%), with periprosthetic fractures occurring only in uncemented THA. At 6 months, cemented THA showed superior functional outcomes (Harris Hip Score 88.6 ± 6.4 vs 84.2 ± 7.1) and a shorter hospital stay (6.8 vs 7.9 days) with fewer early revisions (3.3% vs 13.3%). Conclusion: This study shows that in elderly patients, cemented total hip arthroplasty provides superior early functional outcomes, fewer postoperative complications, shorter hospital stays, and lower rates of early revision compared with uncemented procedures.
Accidental Hot Water Scald as the Most Common Cause of Burn Injury in Children: A Hospital-Based Study
Burn injuries are a significant cause of morbidity and mortality among children, particularly in low- and middle-income countries. Young children are especially vulnerable due to developmental and environmental factors. Scald burns are commonly reported as the leading cause, often occurring in domestic settings. Understanding epidemiological patterns is essential for prevention and management. This study aimed to assess the socio-demographic characteristics, etiology, environmental factors and clinical outcomes of pediatric burn injuries. This hospital-based retrospective observational study was conducted at the Department of Plastic and Reconstructive Surgery, KPJ Specialized Hospital, Dhaka, Bangladesh, from December 2017 to November 2025. A total of 505 pediatric burn patients were included. Data were collected from medical records and analyzed using SPSS version 25.0. The majority of patients were aged 1–4 years (49.9%) and male (59.0%). Most cases were from rural areas (65.5%). Scald burns were the predominant cause (65.1%), followed by flame burns (21.4%). Among scald burns, the most frequent specific agents were hot rice starch (42.2%), hot water (35.9%), and hot milk/tea (21.9%). Most injuries occurred at home (85.3%) and were unsupervised (60.8%). The majority of burns involved less than 10% Total Body Surface Area (41.8%; comprising 7.5% with <1% TBSA and 34.3% with 1-10% TBSA), while 24.8% exceeded 20% TBSA. Superficial burns were most common (68.9%) and 73.7% of patients recovered without complications. Severe burns were significantly associated with older age, rural residence and flame injuries. Pediatric burns remain a preventable public health issue, with scald injuries being the leading cause. Improved supervision, safer household practices and targeted prevention strategies are essential to reduce incidence and severity.
Association of Clinical Features, Laboratory Findings and Treatment Responses in Preeclampsia Cases
Background: Preeclampsia is a significant hypertensive disorder of pregnancy associated with increased maternal and perinatal morbidity and mortality worldwide. It is characterized by hypertension and proteinuria after 20 weeks of gestation and may progress to severe complications if not managed appropriately. Early identification of clinical and laboratory markers is crucial for improving outcomes. Objective: This study aimed to evaluate the association between clinical features, laboratory findings and treatment responses among preeclampsia patients. Methods & Materials: A prospective observational study was conducted at Rangpur Medical College Hospital, Bangladesh, from January to December 2025. A total of 140 patients were included in this study. Data were collected using structured forms and analyzed using SPSS version 25.0. Results: The majority of patients were aged 25–30 years and 62.9% were diagnosed at ≥34 weeks of gestation. Common clinical features included pedal edema (74.3%) and headache (68.6%). Severe preeclampsia was observed in 58.6% of cases. Laboratory findings revealed significant associations between disease severity and thrombocytopenia (p=0.003), elevated creatinine (p=0.006), hyperuricemia (p=0.001), elevated ALT (p=0.014) and proteinuria ≥+3 (p=0.032). Labetalol was the most commonly used antihypertensive and 61.4% of patients underwent caesarean section. Conclusion: Clinical features combined with laboratory parameters play a critical role in assessing disease severity and guiding management. Early detection and appropriate intervention can significantly reduce maternal complications.
Maternal and Fetal Outcomes of Preeclampsia and Eclampsia: A Hospital-Based Observational Study
Background: Hypertensive disorders of pregnancy, including preeclampsia and eclampsia, are major causes of maternal and neonatal morbidity and mortality worldwide. These conditions are characterized by hypertension and multi-organ involvement, often leading to severe complications if not managed promptly. The burden is particularly high in low- and middle-income countries due to limited access to quality antenatal care and delayed clinical intervention. Objective: To assess maternal and fetal outcomes associated with preeclampsia and eclampsia in a tertiary care hospital in Bangladesh. Methods & Materials: This prospective observational study was conducted among 120 pregnant women diagnosed with preeclampsia or eclampsia at Rangpur Medical College Hospital between January and December 2025. Data were collected using structured questionnaires and clinical records. Maternal complications and fetal outcomes were recorded and analyzed using SPSS version 25.0. Statistical significance was determined at p<0.05. Results: Among the participants, 51.7% were aged 20–29 years and 61.7% were from rural areas. Preeclampsia accounted for 70.0% of cases, while eclampsia accounted for 30.0%. Severe hypertension, HELLP syndrome, acute kidney injury, ICU admission and maternal mortality were significantly higher in the eclampsia group (p<0.05). Preterm birth occurred in 56.7% of cases and 66.7% of neonates had low birth weight. Adverse fetal outcomes were significantly more common in eclampsia (83.3%) compared to preeclampsia (50.0%) (p=0.001). Conclusion: Eclampsia is associated with significantly higher maternal and fetal complications compared to preeclampsia. Early diagnosis, improved antenatal care and timely management are essential to reduce adverse outcomes.
Clinical and Demographic Predictors of Preeclampsia Outcomes Among Hospitalized Pregnant Women in Bangladesh
Preeclampsia is a major contributor to maternal and perinatal morbidity and mortality worldwide, particularly in low-resource settings. It is characterized by hypertension and proteinuria after 20 weeks of gestation and is associated with significant complications. Despite advances in obstetric care, identifying predictors of adverse outcomes remains a clinical challenge. This study aimed to assess clinical and demographic predictors of preeclampsia outcomes among hospitalized pregnant women in a tertiary care hospital in Bangladesh. This prospective observational study was conducted at Rangpur Medical College Hospital from January to December 2025, including 150 pregnant women diagnosed with preeclampsia. Data on socio-demographic, obstetric, and clinical characteristics were collected using structured tools. Maternal and perinatal outcomes were recorded. Statistical analysis was performed using SPSS version 25.0, and logistic regression was applied to identify predictors of adverse maternal outcomes. The majority of participants were aged 20–29 years and resided in rural areas. Severe preeclampsia was observed in 62.7% of cases. Caesarean delivery was performed in 61.3% of women. Maternal complications included eclampsia (14.7%) and postpartum hemorrhage (12.0%). Low birth weight was noted in 45.3% of neonates, and 40.0% required NICU admission. Significant predictors of adverse maternal outcomes included age ≥30 years (AOR 2.41), severe preeclampsia (AOR 6.72), gestational age <34 weeks (AOR 4.96), and history of hypertension (AOR 3.60). In conclusion, early identification of high-risk women based on clinical predictors is essential for improving maternal outcomes in preeclampsia.
Factors Influencing the Conversion to Open Surgery in Patients Undergoing Elective Laparoscopic Cholecystectomy
Background: Conversion from laparoscopic to open cholecystectomy remains an important quality and safety indicator. Identifying factors influencing conversion in elective cases can improve patient counseling and intraoperative decision-making. Methods & Materials: This observational study was conducted in the Department of Hepatobiliary and Pancreatic Surgery, Shaheed Suhrawardy Medical College & Hospital, Dhaka, Bangladesh, from January 2023 to December 2023. The study included 100 patients undergoing elective laparoscopic cholecystectomy at a tertiary hospital in Bangladesh. Demographic, clinical, imaging, and intraoperative data were recorded and analyzed descriptively to determine factors associated with conversion. Results: Most patients were aged 31–40 years (36%) with a female predominance (59%). Symptomatic cholelithiasis was the main indication (90%). Hypertension (56%) and diabetes (20%) were the most common comorbidities. Preoperative risk features were present in 16% of cases, with thickened gallbladder wall (5%) being the most frequent. Conversion to open surgery occurred in 2 patients (2.0%, 95% CI: 0.6–7.0), both due to intraoperative complications-bile duct injury and hemorrhage. The converted cases were older (mean 62.5 ± 3.0 years), suggesting age and intraoperative events as dominant risk factors. Conclusion: Conversion during elective laparoscopic cholecystectomy remains infrequent and primarily reflects intraoperative judgment in high-risk or elderly patients. Early recognition of technical difficulty and readiness to convert safely are essential to prevent major complications.
Effectiveness of Ultrasound-Guided Regional Blocks in Reducing Postoperative Pain
Background: Inadequate control of acute postoperative pain leads to increased patient morbidity, delayed recovery, and greater opioid dependence, making effective pain management a critical component of modern surgical care. Therefore, this study was conducted to evaluate the effectiveness of ultrasound-guided regional blocks in reducing postoperative pain and improving analgesic outcomes in adult surgical patients. Methods & Materials: This prospective comparative study was conducted at the Department of Anaesthesia, Analgesia, Palliative & Intensive Care Medicine, National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh, from July to December 2025. Sixty-four adult surgical patients were equally assigned to ultrasound-guided regional block (n = 32) and control (n = 32) groups. The intervention group received ultrasound-guided blocks, while the control group received standard analgesia. Outcomes included VAS scores, analgesic use, recovery parameters, and complications, analyzed using SPSS version 26.0 with p < 0.05 considered significant. Results: A total of 64 patients (32 per group) had comparable baseline characteristics. The USG block group showed significantly lower VAS scores at all time points (2.1–3.8 vs 4.6–5.6), longer time to first analgesic (8.6 vs 3.2 h), reduced opioid use (48.5 vs 82.7 mg), fewer rescue analgesia requirements (28.1% vs 68.8%), and earlier mobilization (14.2 vs 18.6 h; p < 0.001). Postoperative complications were also lower, including nausea/vomiting (15.6% vs 43.8%) and sedation (9.4% vs 34.4%), with minimal block-related events (3.1% vs 0%). Conclusion: Ultrasound-guided regional blocks effectively improve postoperative analgesia, reduce opioid consumption and complications, and enhance overall recovery.
Knowledge Behavior Disparity and Determinants of Smoking Among Rural Adults in Gazipur District, Bangladesh
Background: Tobacco smoking is still one of the leading public health problem in Bangladesh, which is even more complicated by socio-economic and behavioral factors in rural population. While more people are smoking due the knowledge of healthy efforts towards this behavior, some individuals still smoke which implies right now there continues to be a space between knowledge and habit. Objective: To measure the knowledge–practice gap and determine factors associated with smoking in a rural district of Gazipur District, Bangladesh. Methods & Materials: A community-based cross-sectional study was conducted 420 adults aged ≥18 years using multistage sampling. Socio-demographic characteristics, smoking behaviour, knowledge about health risks and factors affecting smoking by data collection as face to face interview using structured questionnaire. Statistical analysis was performed using SPSS version 25, and the associations were analysed by chi-square tests (significance threshold p<0.05). Results: High smoking prevalence especially among younger adults, (78.6% in 18–27 years). Smoking was significantly associated with education (p=0.001), occupation (p=0.014) and income (p<0.001). Peer influence was the most common cause of smoking initiation (93.3%). More than two-thirds (68.3%) of smokers made quit attempts but only a small number established brands as continuing users. Conclusions: Socio-economic and social contexts play an important role in smoking among rural adults, even when knowledge is accounted for. Sectoral and economic-led interventions to generate behavioral changes, peer-based approaches, and socio-economic support would seem to be most effective for the less wealthy in order to tackle tobacco use.
Smoking Habit of Rural Population of Selected Villages of Gazipur District
Background: Tobacco consumption is a global public health burden and in Bangladesh, awareness and cessation support is very low particularly for rural population. Objectives This study was conducted to examine the smoking behavioral and associated factors among rural population of selected villages in Gazipur District. Objectives: To assess smoking behavior, prevalence, influencing factors, and knowledge regarding tobacco use among rural populations in Gazipur District, Bangladesh. Methods: A descriptive cross-sectional study was conducted among the 420 rural respondents selected through purposive sampling technique. Structured interviewer-administered questionnaires were used to collect the data. The variables included socio-demographic characteristics, smoking status, pattern of smoking, factors affecting smoking behavior, spending and adverse impact-related knowledge. Results: A total of 420 members responded, out of which 75 (71.4%) were smokers and 30 (28.6%) were non-smokers. Approximately one-third of respondents were aged between 18–27 years (33.3%), and more participated as male (86.9%). 76.7% of smokers reported daily smoking behavior, and 78.3% consumed 1–10 sticks per day. The strongest influence for start smoking easily was friends (93.3%), and the reason to smoke most commonly was “just fun” (43.3%) and habit (30%). Of them, a high percentage of 68.3% had tried to stop smoking at least once. Conclusions: The overall smoking prevalence was higher in rural area of Gazipur particularly among young adult males. Despite prevalent awareness of health risks, smoking behavior is sustained by peer effect and recreational motivation. Developing cessation support and tailored community awareness interventions for them would be effective in preventing rural tobacco use.
Clinical and Functional Outcomes of Thoracolumbar Spine Fractures Managed with Short Segment Pedicle Screw Fixation in a Tertiary Care Hospital
Background: Thoracolumbar spine fractures are one of the most common and potentially devastating spinal injuries in the world. Short-segment pedicle screw fixation (SSPF) has become the surgical technique of choice in the treatment of unstable thoracolumbar fractures. The study aimed to assess clinical, functional, and radiological outcomes of thoracolumbar spine fractures treated with SSPF in a tertiary care hospital in Bangladesh. Methods & Materials: This prospective observational study was carried out at National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, Bangladesh from July, 2024 to December, 2024, recruiting 40 patients with thoracolumbar fractures (T11-L3) who underwent SSPF during an 18-month study period. The Visual Analogue Scale (VAS) of back pain and the Oswestry Disability Index (ODI) were used to measure functional outcomes preoperatively and at 3 and 6 months postoperatively. The ASIA Impairment Scale was used to assess neurological status. Prospective documentation of complications was done. Data were entered and analyzed on SPSS version 26. Results: The mean age was 36.4 years, with a high percentage of males (72.5%). The most common injury mechanisms were road traffic accidents (45%) and falls from height (40%). The most frequently fractured level was L1 (40%), and burst fractures were 60% of the cases. Significant improvements were recorded in VAS score (7.6 to 2.1) and ODI (61.8 to 23.4) at 6 months (p<0.001). Neurological improvement by at least one ASIA grade was observed in 14 patients, 35.0%, at 6 months. The Kyphotic angle decreased from 19.6 to 8.4 (p<0.001). There was no neurological worsening or death. Conclusion: SSPF is a safe and effective surgical procedure for treating unstable thoracolumbar fractures, offering significant functional recovery, neurological improvement, and reliable radiological correction with an acceptable complication profile.
Pregnancy Outcomes in Women with Diet-Controlled versus Insulin-Treated GDM
Introduction: Gestational diabetes mellitus (GDM) is one of the most frequent metabolic pregnancy disorders, involving the body's failure to regulate glucose levels adequately for the first time during pregnancy. If left untreated, it can lead to serious health problems for both the mother and the baby. This study aims to examine the differences in pregnancy results between women whose gestational diabetes was controlled by diet and those who required insulin treatment. Methods & Materials: This comparative observational study was conducted in the Department of Obstetrics and Gynecology, 250 Bedded General Hospital, Manikganj, Bangladesh, from January to December 2025. A total of 150 pregnant women with GDM were enrolled and categorized into diet-controlled GDM and insulin-treated GDM groups. Data were analyzed using SPSS version 26.0. Result: Out of 150 women diagnosed with GDM, 63.3% managed their glucose levels by diet, whereas 36.7% needed insulin treatment. Compared to the diet-controlled group, those on insulin were older, had a higher BMI, were diagnosed earlier, and had more deteriorated blood sugar levels. Besides, they displayed greatly elevated maternal problems such as preeclampsia (21.8% vs. 9.5%), preterm births (25.5% vs. 11.6%), and cesarean operations (54.5% vs. 33.7%). Newborn health was adversely affected in the insulin recipients as shown by greater birth size (3.36 vs. 3.02 kg), macrosomic infants (21.8% vs. 8.4%), newborn hypoglycemia (25.5% vs. 6.3%), NICU admissions (32.7% vs. 12.6%), and respiratory distress (23.6% vs. 7.4%). Conclusion: Women with insulin-treated GDM face substantially increased rates of negative maternal and neonatal outcomes in comparison to those who were managed with diet only. The insulin-treated women were generally older, had a higher BMI, were diagnosed earlier, and had less well-controlled blood sugar, all signs of more severe metabolic impairment.