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
Association of Insulin Resistance and Elevated Androgen Levels in Patients with Polycystic Ovarian Syndrome (PCOS)
Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder in reproductive-aged women characterized by hyperandrogenism, ovulatory dysfunction, and insulin resistance. Insulin resistance and elevated androgen levels are closely interrelated in PCOS, though their association varies across populations. Objective: The aim of the study was to determine the association between insulin resistance and elevated androgen levels in patients with polycystic ovarian syndrome (PCOS). Methods & Materials: This cross-sectional observational study was conducted at the Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from January to December 2024, including 110 women with PCOS selected by purposive sampling. After excluding other endocrine disorders and hormonal therapy, BMI and fasting insulin, glucose, and testosterone were measured; insulin resistance was assessed using HOMA-IR and elevated androgens by laboratory reference ranges. Statistical analysis was performed with p < 0.05 considered significant. Results: The study included 110 women with PCOS, with most aged 21–30 years (61.8%) and a mean age of 26.5 ± 7.2 years. Overweight/obesity was present in 68.2% of participants. Insulin resistance and elevated androgen levels were observed in 65.5% and 70.9% of patients, respectively. A significant association was found between insulin resistance and elevated androgen levels (p < 0.001), with higher fasting insulin, HOMA-IR, and total testosterone in insulin-resistant patients (p < 0.001). Conclusion: Insulin resistance is significantly associated with elevated androgen levels in women with polycystic ovarian syndrome, highlighting a strong interrelated metabolic–endocrine link in its pathophysiology.
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Dinoprostone is More Effective than Misoprostol in Induction of Vaginal Delivery
Background: Induction of labour is frequently performed to reduce maternal and neonatal complications when continuation of pregnancy poses risk. Prostaglandins are widely used for cervical ripening and labour induction. Dinoprostone and misoprostol are commonly used pharmacological agents, but comparative evidence regarding their effectiveness and safety remains inconsistent. Objective: This study aimed to compare the effectiveness and safety of dinoprostone and misoprostol for induction of labour in term pregnancy. Methods & Materials: This randomized controlled trial was conducted at the Department of Obstetrics and Gynecology, Bangladesh Medical University, Dhaka, Bangladesh, from December 2024 to December 2025. A total of 250 term pregnant women requiring labour induction were randomly assigned into dinoprostone group (n=125) and misoprostol group (n=125). Primary outcomes included induction to active labour interval, induction to delivery interval, Bishop score improvement and vaginal delivery within 24 hours. Maternal and neonatal outcomes were also evaluated. Statistical analysis was performed using SPSS version 25.0. Results: Dinoprostone showed significantly shorter induction to active labour interval (11.8±4.1 vs 13.2±4.6 hours; p=0.01) and shorter induction to delivery interval (17.4±5.8 vs 19.6±6.2 hours; p=0.003). Bishop score improvement was significantly higher with dinoprostone (7.9±1.8 vs 6.8±1.9; p<0.001). Vaginal delivery within 24 hours was higher in the dinoprostone group (74.4% vs 64.0%; p=0.048). Uterine tachysystole was significantly lower in the dinoprostone group (8.8% vs 20.8%; p=0.006). Other maternal and neonatal outcomes were comparable. Conclusion: Dinoprostone is more effective than misoprostol for induction of labour, with better cervical ripening, shorter labour duration and lower uterine tachysystole.
Vitamin D deficiency and its effects-a consequence of lack of knowledge and neglect - an editorial
Serum Vitamin D and Lipid Profile in Patients with Psoriasis in Bangladesh: A Cross-Sectional Comparative Study
Background: Psoriasis is a chronic immune-mediated inflammatory disorder increasingly seen as a systemic disease with metabolic and cardiovascular comorbidities. Vitamin D plays immunomodulatory roles, and deficiency may exacerbate disease activity and metabolic issues such as dyslipidemia. Evidence from Bangladesh is limited. This study evaluates serum 25(OH)D levels and lipid profiles in Bangladeshi psoriasis patients against matched healthy controls. Methods & Materials: This cross-sectional study at Sir Salimullah Medical College Mitford Hospital, Dhaka, from July 2021 to June 2022, enrolled 120 participants: 60 confirmed psoriatic patients and 60 matched healthy controls, selected via purposive convenience sampling. Serum 25(OH)D was measured by immunofluorescence immunoassay, and lipid profiles were assessed enzymatically. Group comparisons used Student’s t-test and Chi-square test; Pearson correlation analyzed relationships among vitamin D, lipids, and psoriasis duration. Results: Psoriatic patients had significantly lower serum 25(OH)D levels (14.55 ± 5.89 vs. 33.22 ± 6.82 ng/mL; p = 0.001) and higher total cholesterol (219.00 ± 20.21 vs. 159.53 ± 14.50 mg/dL), triglycerides (169.60 ± 32.75 vs. 112.47 ± 20.34 mg/dL), and LDL-C (146.75 ± 17.74 vs. 93.43 ± 15.55 mg/dL), with lower HDL-C (38.15 ± 3.47 vs. 43.63 ± 4.69 mg/dL) (all p = 0.001). Vitamin D deficiency (<20 ng/mL) was in 83.5% of psoriatic patients vs. 1.7% of controls. Serum vitamin D negatively correlated with total cholesterol (r = −0.699), triglycerides (r = −0.630), LDL-C (r = −0.687), disease duration (r = −0.462), and positively with HDL-C (r = +0.569) 0.001). Conclusion: Patients with psoriasis in Bangladesh exhibited significant vitamin D deficiency and dyslipidemia. Low vitamin D was linked to an atherogenic lipid profile, suggesting a role in cardiometabolic risk.
Assessment of Aesthetic Outcomes Following Late Surgical Release of Syndactyly in Pediatric Patients
Background: Syndactyly is one of the most common congenital anomalies of the hand, characterized by the fusion of adjacent digits due to incomplete separation during embryonic development. Early surgical correction is generally recommended to achieve optimal functional and cosmetic outcomes. However, delayed presentation and late surgical intervention are still common in many developing countries. This study aimed to assess the aesthetic outcomes following late surgical release of syndactyly in pediatric patients. Methods & Materials: This hospital-based descriptive observational study was conducted in the Department of Orthopaedic Surgery at Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh, from November 2024 to October 2025. A total of 30 pediatric patients who underwent late surgical release of syndactyly were included using purposive sampling. Results: The majority of patients were aged 5–7 years (36.7%) and males constituted 56.7% of the study population. Most participants were from rural areas (63.3%). The right hand was most commonly affected (46.7%) and simple syndactyly was the predominant type (70.0%). The third web space was most frequently involved (40.0%). The dorsal rectangular flap with skin graft was the most commonly used surgical technique (60.0%). Most patients had no postoperative complications (70.0%). Regarding aesthetic outcomes, excellent results were observed in 40.0% of patients, good outcomes in 33.3%, fair outcomes in 20.0% and poor outcomes in 6.7%. Conclusion: Late surgical release of syndactyly in pediatric patients can achieve satisfactory aesthetic outcomes with a relatively low rate of postoperative complications when appropriate surgical techniques and postoperative care are applied.
Analysis of the Clinical Profile and Fate of Retained Placenta in Comilla Medical College Hospital, Comilla
Background: Retained placenta is a potentially life-threatening condition that significantly contributes to postpartum haemorrhage (PPH) and maternal mortality, especially in women from disadvantaged socioeconomic backgrounds. Identifying predisposing factors and ensuring timely management during antenatal care and the third stage of labour are crucial to reducing morbidity and improving maternal outcomes. Objective: The aim of the study was to determine the clinical characteristics and outcomes of patients with retained placenta. Methods & Materials: This cross-sectional study at the Department of Obstetrics and Gynaecology, Comilla Medical College & Hospital (Jan–Jun 2013) included 100 vaginal deliveries with retained placenta. Cases ≥28 weeks’ gestation were included, while caesarean deliveries and <28 weeks were excluded. After informed consent, clinical, demographic, obstetric, management, and outcome data were collected using a structured form. Ethical approval was obtained, and data were analyzed with SPSS 15 using descriptive statistics. Results: Among 3,126 obstetric admissions, 107 (3.42%) had retained placenta. Of 100 patients, most were 21–30 years (62%), primarily educated (39%), housewives (92%), para 2–4 (60%), and 79% unbooked. Deliveries were mostly home (74%) by untrained dais (62%). Common complications were PPH (52%) and genital trauma (30%). Manual removal was needed in 91%, transfusion in 72%. Outcomes: recovery 72%, severe anaemia 16%, infection 6%, renal failure 2%, maternal death 4%. Conclusion: Retained placenta remains a serious obstetric complication, with outcomes largely dependent on timely hospital care, skilled delivery management, and appropriate interventions.
Role of Normal Saline Irrigation Prior to Closure of Surgical Wound to Reduce Surgical Site Infection in Gynaecologic Oncologic Surgery
Background: Surgical site infection (SSI) is a major cause of postoperative morbidity and increased healthcare burden in gynaecologic oncologic surgery. Patients with gynaecological malignancies face a higher SSI risk due to prolonged surgery, tissue dissection and immune compromise. Wound irrigation with saline before closure may reduce bacterial contamination and prevent SSI; however, evidence from low- and middle-income countries remains limited. Objective: This study evaluated the role of normal saline wound irrigation in reducing SSI among patients undergoing gynaecologic oncologic surgery. Methods & Materials: A comparative observational study was conducted at the Department of Gynecological Oncology, Bangladesh Medical University (BMU), Dhaka, from June 2024 to July 2025. The study included 100 patients: 50 receiving preoperative normal saline wound irrigation and 50 controls. Sociodemographic, clinical, operative and postoperative data were analyzed using SPSS version 25.0. Results: The groups were comparable in terms of baseline characteristics, surgery type and operative factors. The SSI rate within 30 days was lower in the irrigation group (10%) than in the control group (30%) (p=0.012). SSI at 10 days (8% vs. 26%, p=0.018) and 30 days (6% vs. 22%, p=0.027), wound discharge (6% vs. 20%, p=0.034), febrile illness (8% vs. 24%, p=0.028), additional antibiotics (6% vs. 22%, p=0.027) and hospital stay (4.8 ± 1.3 vs. 6.4 ± 1.9 days, p=0.001) were reduced with irrigation. Conclusion: Normal saline wound irrigation before closure significantly reduced SSI rates and complications in gynaecologic oncologic surgery, representing an effective preventive measure.
Association between Prolonged QRS Duration (>110 milliseconds) and In-hospital Outcomes of Patients with Heart Failure: Data from the Medical Registry of a Tertiary Hospital in Bangladesh
Background: Heart failure is a major cause of morbidity and mortality worldwide. Electrocardiographic parameters, particularly QRS duration, may provide important prognostic information in patients with heart failure. This study aimed to evaluate the relationship between QRS duration on admission ECG and in-hospital outcomes among patients admitted with heart failure. Methods & Materials: This retrospective observational study was conducted in the Department of Cardiology at Dhaka Medical College Hospital, Dhaka, from 01 January to 31 December 2025. A total of 100 adult patients admitted with a primary diagnosis of heart failure were included. Results: The mean age of the study population was 59.27 ± 11.63 years and 67% were male. Sinus rhythm was observed in 93% of patients. Hypertension and diabetes mellitus were present in 50% and 54% of patients respectively, while ischemic heart disease was highly prevalent (88%). Patients with prolonged QRS duration (>110 ms) had higher rates of in-hospital mortality (10.00% vs 4.00%), cardiogenic shock (36.00% vs 18.00%), requirement of intravenous inotropic/vasopressors support (36.00% vs 18.00%) and need for mechanical ventilation (12.00% vs 4.00%) and p = 0.269 compared with those with normal QRS duration (≤110 ms). The mean hospital stay was also longer in the prolonged QRS group (10.66 ± 6.647 vs 7.52 ± 5.686 days; p = 0.013). Conclusion: Prolonged QRS duration on admission ECG is associated with poorer in-hospital outcomes among patients with heart failure. QRS duration may serve as a simple and useful marker for early risk stratification in hospitalized heart failure patients.
Association Between CT Scan Findings of the Head and Motor Impairment Patterns in Paediatric Cerebral Palsy
Introduction: Cerebral palsy (CP) comprises a group of permanent movement and posture disorders resulting from non-progressive disturbances in the developing brain. Neuroimaging, especially CT scans, plays a vital role in determining etiology, particularly in resource-limited settings where it remains a primary diagnostic tool. Objective: To categorize the CT findings of the head and examine their correlation with the types of motor disturbances in children with CP. Methods & Materials: Conducted at the Paediatric Neurology unit of BSMMU between July 2009 and July 2010, this cross-sectional study included 120 children with CP. These children were randomly selected, and each underwent a brain CT scan. The CT findings were then correlated with the patients' motor disturbances. Results: The study involved 120 children with CP, with a male-to-female ratio of 1.4:1. Most children were aged 49-60 months (29.2%). Abnormal CT scans were present in 85.0% of patients, whereas 15.0% had normal results. Cerebral atrophy was identified as the most frequent abnormality (55.8%). Hemiplegia was the most common form of motor disturbance (30.0%), with 86.1% showing abnormalities on CT. The highest incidence of cerebral atrophy was seen in hemiplegic (32.8%), hypotonic (20.9%), and diplegic (19.4%) types. Additionally, diplegic CP showed the highest rate of cerebral infarction (6 cases), while dyskinetic CP had the lowest abnormality rate (15.4%). Bilateral involvement was observed in 4.2% of cases despite unilateral clinical signs. Conclusion: The findings suggest that the clinical pattern of motor disturbance correlates with brain CT results. Generally, more abnormal CT findings indicate a higher likelihood of motor impairment in children with CP.
Assessment of Efficacy and Safety of Tirofiban in Acute Coronary Syndrome Patients Following Percutaneous Coronary Intervention: A Prospective Observational Study
Background: Cardiovascular disease ranks as a top global cause of mortality, with acute coronary syndrome (ACS) necessitating urgent treatment like percutaneous coronary intervention (PCI) to lower complications. Glycoprotein IIb/IIIa inhibitors such as tirofiban efficiently avert thrombotic occurrences during PCI while maintaining a positive safety profile. Although there is international evidence, data from Bangladesh are scarce; this study assesses the effectiveness and safety of tirofiban in ACS patients receiving PCI in a Bangladeshi coronary care unit. Methods & Materials: This observational study at Khwaja Yunus Ali Medical College Hospital, Sirajganj, Bangladesh (Nov 2024–Oct 2025) assessed the effectiveness and safety of Inj. Tirofiban for ACS patients receiving PCI. Adult patients treated with Tirofiban were included, and data on demographics, risk factors, clinical presentation, angiography, stents, procedural results, and complications were gathered. Ethical clearance was secured, and data were examined descriptively with SPSS v26. Results: Among 120 ACS patients undergoing PCI with Inj. Tirofiban, primarily involved males between the age group of 50 and 59. Hypertension, smoking, and diabetes were the most prevalent risk factors, with NSTEMI and STEMI being the main manifestations. Angiographically, single-vessel disease was the most common. All procedures were successfully finished, with minor thrombus occurring in 2.7% of cases and resolved using tirofiban, while complications related to the procedure were minimal, restricted to 2.5% of minor gum bleeding. Conclusion: Tirofiban is both safe and effective for ACS patients receiving PCI, ensuring a high success rate in procedures, effective control of thrombus, and few complications.
Assessment of Renal Function Status and Electrolyte Imbalances in Paediatric Patients with Acute Glomerulonephritis
Background: Acute glomerulonephritis (AGN) is a frequent glomerular disease in children, which is associated with hematuria, proteinuria, high blood pressure, and edema that can cause severe renal failure and electrolyte imbalances. Early detection of renal function status and electrolyte profiles is the key to the maximum benefit of clinical outcomes in the vulnerable population. This study aimed to determine the renal function condition and electrolyte imbalance among children with acute glomerulonephritis. Methods & Materials: This study was conducted at the Department of Pathology, Parkview Medical College & Hospital, Sylhet, from January 2025 to June 2025. A total of 60 children aged between 1 and 14 years and diagnosed with acute glomerulonephritis participated in the study by the purposive sampling method. Demographic information, clinical data, and laboratory data such as serum creatinine, blood urea, estimated glomerular filtration rate (eGFR), and serum electrolytes (sodium, potassium, calcium, and phosphate) were collected and entered into SPSS version 26 for further analysis. Chi-square tests and Fisher's exact tests were used to identify links between renal impairment and electrolyte imbalances. Results: The age of the participants was 8.7±3.1 years, and a majority of them were males (60%). Hematuria (100 percent) and periorbital edema (86.7 percent) were very common and hypertension (68.3 percent) was the most common clinical feature. 65% Of patients had a raised serum creatinine; 70% of patients had a lowered eGFR under 90 ml/min/1.73m2. The most common electrolyte imbalance was hyponatremia (46.7%), then hyperphosphatemia (35%) and hyperkalemia (31.7%). Impaired renal function was strongly linked with hyponatremia (p = 0.04) and hyperkalemia (p = 0.02). Conclusion: Renal dysfunction and electrolyte imbalances are very common in paediatric acute glomerulonephritis patients. Timely and regular laboratory check-ups, especially of sodium and potassium levels, are required to avoid life-threatening complications in children with the disease.
p16 Immunohistochemistry Improves Treatment Decision-Making in See-and-Treat Management of Cervical Intraepithelial Neoplasia
Background: The “see-and-treat” approach is commonly used in cervical cancer prevention programs to reduce loss to follow-up by providing immediate treatment after colposcopic diagnosis. However, discrepancies between colposcopic impressions and histopathological findings may affect treatment decision-making. p16 immunohistochemistry has emerged as a biomarker associated with oncogenic human papillomavirus–induced cellular transformation and may improve diagnostic accuracy. This study evaluated the association between p16 expression and clinicopathological characteristics and examined its implications for treatment decision-making in the management of cervical intraepithelial neoplasia (CIN). Methods & Materials: This cross-sectional study included 72 women aged 30-60 years diagnosed with high-grade lesions on colposcopy using the Swede scoring system attending the colposcopy clinic of Bangladesh Medical University (BMU), Shahbagh, Dhaka in 2022-2023. All participants underwent colposcopy-guided cervical biopsy followed by histopathological examination. Histological diagnoses were categorized as CIN I, CIN II, CIN III, or benign lesions such as chronic cervicitis. p16 immunohistochemistry staining was performed and interpreted as diffuse/block positivity, focal staining, or negative expression. Treatment modalities and treatment adequacy were analyzed. Results: Histopathology revealed CIN I in 29.2%, CIN II in 23.6%, CIN III in 33.3%, and chronic cervicitis in 13.9% of cases. Overall, 43.1% of colposcopic high-grade lesions were not confirmed as high-grade on histology, indicating potential overtreatment risk in a see-and-treat setting. Diffuse p16 positivity was observed in 52.7% of cases. Overtreatment occurred in 13.9% of patients and was exclusively associated with p16-negative lesions, whereas undertreatment occurred in 22.2% of cases and was observed only among p16-positive lesions (p < 0.001). Conclusion: Substantial discordance exists between colposcopic impressions and histopathological findings. p16 immunohistochemistry may improve treatment decision-making in see-and-treat management by helping identify lesions requiring definitive treatment while avoiding unnecessary procedures.
Prevalence and Risk Factors of Umbilical Hernia among Female Patients Attending in A Tertiary Hospital
Background: An umbilical hernia occurs when abdominal contents bulge out at the navel, frequently observed in adult women because of pregnancy, obesity, or ongoing straining. Diagnosis is made clinically, imaging is used for confirmation if necessary, and surgical treatment is employed, as complications may arise if left unaddressed. This study seeks to fill the gap in gender-specific data among adults in Bangladesh. Methods & Materials: This cross-sectional research conducted at Shikder Women’s Medical College Hospital (Jan–Dec 2025) involved 420 consenting women aged 18 years or older. Information regarding demographics, obstetric background, and risk factors was gathered through interviews and clinical assessments, including BMI measurement. Analysis employed SPSS-26 and Chi-square tests (p < 0.05). Approval for ethical standards and the confidentiality of participants were guaranteed. Results: Among 420 women, most were 40–49 years (29.5%), rural residents (58.8%), and housewives (70.5%). Umbilical hernia was found in 14.8%. Common risk factors included heavy lifting, chronic constipation, obesity, prior abdominal surgery, and chronic cough. Hernia was significantly associated with obesity, heavy lifting, chronic cough, chronic constipation, and multiparity (≥3 children), indicating these as key contributors in this population. Conclusion: Umbilical hernia impacted 14.8% of participants and showed a significant correlation with obesity, heavy lifting, chronic cough, chronic constipation, and multiparity, emphasizing the importance of modifiable and physiological risk factors in preventing it.
Risk Factors and Presentation Pattern of Laryngeal Cancer
Background: Laryngeal carcinoma accounts for about 1% of all cancers and 30–40% of head and neck malignancies worldwide, with significant gender disparity and regional variation, including in Bangladesh [1–3]. In view of its strong association with tobacco, alcohol, and betel quid chewing and the frequent late-stage presentation locally, this study was conducted to evaluate the risk factors and presentation patterns of laryngeal cancer. Objective: The aim of the study was to evaluate the risk factors and clinical presentation patterns of laryngeal cancer among affected patients. Methods & Materials: This prospective observational study was conducted at the Department of Otolaryngology–Head & Neck Surgery, Bangladesh Medical University (BMU), Dhaka, Bangladesh, from January 2025 to December 2025, including 80 patients with newly diagnosed laryngeal cancer. Demographic details, risk factors, clinical symptoms, tumor location, and TNM stage were recorded. Data were analyzed using SPSS version 26.0, with categorical variables expressed as frequencies and percentages and continuous variables as mean ± standard deviation. Results: Among 80 patients, the mean age was 56.2 ± 11.1 years, with the majority aged 50–69 years, and males predominating (81.3%). The most common risk factors were combined smoking with betel use (53.8%) and smoking alone (31.3%). Hoarseness of voice was the predominant symptom (56.3%). Tumors were primarily located in the glottic region (52.5%), and most patients presented at advanced stages (62.5%). Conclusion: Laryngeal cancer predominantly affects older males with high exposure to tobacco and betel use, commonly presents with hoarseness and glottic involvement, and is often diagnosed at advanced stages, emphasizing the need for early detection and targeted risk factor mitigation.
Histomorphological Spectrum of Benign Breast Lumps in a Tertiary Care Center
Background: Benign breast diseases comprise diverse pathological conditions that present as palpable breast lumps and account for many breast-related clinical consultations. These non-malignant lesions often mimic breast cancer clinically and radiologically, creating anxiety for patients and diagnostic challenges for clinicians. Histopathological evaluation is critical in identifying these lesions' nature and guiding appropriate management. This study aimed to evaluate the histomorphological spectrum of benign breast lumps in patients at a tertiary care center. Methods & Materials: This cross-sectional observational study was conducted in the Department of Surgery at Bangladesh Medical University, Dhaka, Bangladesh, from January to December 2025. A total of 175 patients with clinically suspected benign breast lumps who underwent surgical excision or biopsy were included. Histopathological examination was performed using standard hematoxylin and eosin staining techniques. Data were analyzed using SPSS version 25.0. Results: The majority of patients were younger than 40 years (70.9%), with a mean age of 35.1 ± 11.0 years. Inflammatory and infectious lesions were the most common category, accounting for 59.4% of cases, with chronic breast abscess being the most frequent diagnosis. Fibrocystic changes constituted 21.1% of lesions, while benign neoplasms accounted for 16.0%. Fibroadenoma was the most common benign tumor, representing 12.6% of cases. A small proportion of cases consisted of other rare benign lesions including epidermal inclusion cyst and granulomatous inflammation. Conclusion: Benign breast lesions show a wide histomorphological spectrum, with inflammatory conditions being the most prevalent. Histopathological examination remains essential for accurate diagnosis and appropriate clinical management of breast lumps.
Association of Insulin-Like Growth Factor level in maternal serum as a predictor of Gestational Diabetes Mellitus
Background: Gestational Diabetes Mellitus (GDM) is a well-known complication in which spontaneous hyperglycemia develops during pregnancy. Insulin resistance is the key pathophysiological mechanism of GDM. The aim of this study was to assess the association of Insulin-Like Growth Factor-I (IGF-I) in maternal serum as a Predictor of GDM. Methods & Materials: Prospective cohort study was conducted in the Department of Obstetrics & Gynecology, Dhaka Medical College Hospital, Dhaka, Bangladesh during December 2020 to November 2021. Results: The age, parity and BMI of study population were not statistically significant (p>0.05) when compared with Insulin–Like Growth Factor-I. The mean serum Insulin –Like Growth Factor-I was significantly higher in patients with GDM than non GDM (387.4±110.5 vs 254.1±73.8 ng/ml). ROC analysis of Insulin –Like Growth Factor-I to predict GDM among the pregnant women found an AUC value of 0.875 (95% CI, 0.763-0.986) which was statistically significant (p<0.001). A cut-off value of ≥352.1 showed the highest youden index (0.771) with 85.7% sensitivity and 91.4% specificity, 90.5% accuracy, 63.2% PPV and 97.4% NPV. Increased serum Insulin –Like Growth Factor-I was found in 12(85.7%) in GDM group and 7(8.6%) in non GDM group with RR 24.0, 95% CI (5.86-98.31%). The difference was statistically significant (p<0.05) between GDM and non GDM groups. Conclusion: These findings revealed that increased maternal serum Insulin –Like Growth Factor-I at 8-12 weeks of gestation is associated with subsequent development of GDM. Elevated maternal serum Insulin –Like Growth Factor-I at 8-12 weeks of gestation can be used as a biomarker for prediction of GDM.
Clinicopathological Profile of Head Neck Cancer in A Tertiary Care Hospital
Background: Cancers of the head and neck represent a significant worldwide health concern, primarily impacting men above 50 years old, with tobacco, alcohol, and betel chewing being major risk contributors. The most prevalent variety is squamous cell carcinoma, whereas lymphomas and sarcomas occur with less regularity. This study examines clinicopathological characteristics to enhance diagnosis and treatment. Methods: This retrospective analysis at Bangladesh Medical University (July 2023–June 2025) involved 80 patients diagnosed with head and neck cancer. Information regarding demographics, risk factors, tumor location, histology, and stage was gathered from medical records and evaluated using SPSS v26. Approval for ethical considerations was secured, and confidentiality was upheld. Results: The majority of patients were men (71.2%) within the age range of 51–60 years (33.8%). The frequent risk factors were smoking (53.8%) and the use of smokeless tobacco (48.8%). The most common tumor location was the oral cavity (36.2%), where squamous cell carcinoma was the most prevalent (83.8%). The majority of cases were shown at later stages (Stage III–IV, 75%). Conclusion: Cancers of the head and neck primarily impact middle-aged males, frequently affect the oral cavity, are typically squamous cell carcinoma, and often appear at advanced stages, highlighting the importance of early diagnosis.
Endoscopic and Histopathological Patterns of Gastric Adenocarcinoma with Reference to Helicobacter pylori Infection
Background: Gastric adenocarcinoma remains a leading cause of cancer-related mortality worldwide, with Helicobacter pylori recognized as the principal etiological agent. This study aimed to evaluate the endoscopic and histopathological patterns of gastric adenocarcinoma in relation to H. pylori infection. Methods & Materials: A hospital-based cross-sectional study was conducted on 56 patients with histologically confirmed gastric adenocarcinoma. All patients underwent upper gastrointestinal endoscopy with lesion classification according to the Paris classification. Biopsy specimens were examined for histopathological typing (Lauren and WHO classifications), precursor lesions, and H. pylori status using Giemsa staining. Associations between variables were analyzed using the Chi-square test, with p < 0.05 considered statistically significant. Results: The study included 36 males (64.3%) and 20 females (35.7%), with a mean age of 57.6 ± 11.4 years. H. pylori infection was detected in 38 patients (67.9%). Intestinal-type adenocarcinoma (69.6%) was more common than diffuse-type (30.4%). A significant association was observed between H. pylori infection and intestinal-type tumors (82.1% vs. 35.3%; p < 0.001). Superficial depressed lesions (Paris 0-IIc) were strongly associated with diffuse-type adenocarcinoma (71.4%; OR 12.5; p=0.006). Precursor lesions (chronic atrophic gastritis and intestinal metaplasia) were significantly more prevalent in H. pylori-positive patients (89.5% and 78.9%, respectively; p < 0.001). H. pylori-negative patients presented with more advanced disease (77.8% Stage III/IV vs. 50.0%; p=0.04) and poorly differentiated tumors (66.7% vs. 36.8%; p=0.03). Conclusion: H. pylori infection is strongly associated with intestinal-type gastric cancer, precursor lesions, and distal tumor location. Depressed endoscopic lesions predict diffuse-type adenocarcinoma. H. pylori-negative patients present with advanced disease, suggesting an aggressive pathway. These findings support H. pylori eradication for prevention and emphasize meticulous endoscopic surveillance.
Effect of Vitamin D Deficiency on the Progression of Diabetic Retinopathy – A Cross-Sectional Study in a Tertiary Care Hospital
Background: Diabetic retinopathy is one of the most common microvascular complications of diabetes mellitus and a major cause of visual impairment worldwide. Vitamin D plays an important role in immune regulation, vascular health and anti-inflammatory processes and its deficiency has been suggested to contribute to the development and progression of diabetic complications. This study aimed to evaluate the effect of vitamin D deficiency on the progression of diabetic retinopathy. Methods & Materials: This cross-sectional observational study was conducted in the Department of Ophthalmology and Community Ophthalmology at Bangladesh Medical University and at Bangladesh Eye Hospital over a six-month period from July 2025 to December 2025. Results: The majority of participants were aged 50–59 years (32.5%). Vitamin D deficiency was observed in 42.5% of patients, while 27.5% had insufficient levels and 30.0% had sufficient vitamin D levels. Moderate NPDR was the most common stage of diabetic retinopathy (30%), followed by mild NPDR (25%) and severe NPDR (22.5%). Patients with vitamin D deficiency showed relatively higher proportions of moderate and severe NPDR. However, the association between vitamin D status and severity of diabetic retinopathy was not statistically significant (p = 0.793). Conclusion: Vitamin D deficiency was common among patients with diabetic retinopathy, but no significant association was found between vitamin D status and the severity of diabetic retinopathy. Further large-scale studies are recommended to clarify the potential role of vitamin D in the progression of diabetic retinopathy.
Pattern and Distribution of Pelvic Pathologies Detected by Transvaginal Sonography and Laparoscopy among Subfertile Women in a Tertiary Care Hospital
Background: Subfertility affects 10-15% of couples, and pelvic diseases are key etiological factors in women. Transvaginal sonography (TVS) is used as first-line imaging, with laparoscopy remaining the gold standard for thorough pelvic examination. This study aimed to assess the pattern and distribution of pelvic diseases found by TVS and laparoscopy in subfertile women, as well as the diagnostic association between these modalities. Methods & Materials: This cross-sectional study was carried out at BIRDEM General Hospital in Dhaka from January 2023 to June 2024. 66 subfertile women had TVS on day 9 of their menstrual cycle, followed by diagnostic laparoscopy with chromopertubation in the post-menstrual phase. Data were entered and analyzed using SPSS version 26, with Fisher's exact test measuring correlation between findings (p<0.05). Results: The mean age was 29.1±3.9 years, the mean duration of subfertility was 4.48±3.3 years, and 69.7% had primary subfertility. 60.6% of individuals had irregular menstrual periods. The most prevalent conditions were PCOS (53.1% on TVS and 56.1% on laparoscopy), ovarian cysts (18.2% vs. 15.2%), and endometriosis (13.6% vs. 12.1%). Only laparoscopy revealed peritubal adhesions (4.5%) in laparoscopy only. Normal results were uncommon (3.1% on laparoscopy, 10.6% on TVS). For individual disorders, there were no statistically significant changes between modalities (p>0.05). TVS-detected diseases were substantially predicted by irregular menstrual cycles (adjusted OR=3.21, p=0.048). Conclusion: Subfertile women have a high prevalence of pelvic disease, with the most common being polycystic ovarian syndrome, while peritubal adhesions were detected exclusively by laparoscopy. While TVS and laparoscopy have statistically similar results, laparoscopy is still required to detect peritoneal pathologies. A supplementary technique improves diagnostic accuracy in subfertility evaluation.
Comparative Effects of Letrozole 7.5 mg versus 5.0 mg on Follicular Growth in Sub-fertile Women with Polycystic Ovary Syndrome
Background: PCOS is a common cause of anovulatory subfertility in reproductive-aged women. Letrozole is a first-line ovulation induction agent, but the optimal starting dose is unclear. The study aims to compare letrozole 7.5 mg versus 5.0 mg for follicular growth in subfertile women with PCOS. Methods and materials: This quasi-experimental study (June 2023 to January 2025) was conducted in the Department of Obstetrics and Gynecology, BIRDEM General Hospital. Eighty subfertile women aged 18–35 years with Rotterdam-diagnosed PCOS, on metformin, were enrolled and allocated into two groups: letrozole 5 mg/day or 7.5 mg/day from cycle day 2–6. Follicular growth was measured by transvaginal ultrasound on day 2 and day 12, response was categorized by follicle size, and adverse effects were recorded. Results: Baseline characteristics were comparable between groups, with no significant differences in age, BMI, subfertility type, or subfertility duration. On Day 12, letrozole 7.5 mg produced a significantly larger leading follicle than 5 mg (16.81 ± 5.06 vs 13.28 ± 6.92 mm; p<0.001), with higher optimal response (67.5% vs 42.5%) and more dominant follicles (67.5% vs 42.5%; p=0.025), and fewer non-responders (12.5% vs 35.0%). Follicular size increased significantly from Day 2 to Day 12 in both arms (p<0.001 for 5 mg, p=0.003 for 7.5 mg). Adverse effects were infrequent and similar across doses, and most participants reported no side effects (90.0% vs 85.0%; p=0.74). Conclusion: Letrozole 7.5 mg achieved better Day 12 follicular growth and more dominant follicles than 5 mg, with similar adverse effects, supporting 7.5 mg as a more effective starting dose under ultrasound monitoring in PCOS subfertility.
The Effect of Single Dose Dexamethasone on Postoperative Pain after Tonsillectomy
Introduction: Tonsillectomy is a frequently performed ENT surgery, which is mostly done for recurrent tonsillitis or obstructive tonsillar hypertrophy. This study aimed to investigate the influence of a single dose of dexamethasone on postoperative pain intensity. Methods & Materials: This was a prospective randomised controlled study conducted in the Department of Anaesthesiology at Faridpur General Hospital, during the period from January 2025 to December 2025. A total of 100 patients scheduled for tonsillectomy surgery due to recurrent tonsillitis or tonsillar hypertrophy were included in the study. Data were analysed using the computer software SPSS version 26.0. Result: Dexamethasone brought down third, day post, surgery pain by nearly a half scale on the VAS scale (4.8 vs 6.2 at 6 h; 2.0 vs 3.1 on day 5, p < 0.001), and helped reduce the need for rescue analgesia by more than half (36% vs 68%, p = 0.002). Dexamethasone also helped patients return to normal oral intake sooner (60% vs 32% within 6 h, p = 0.01). There were fewer cases of postoperative nausea and vomiting (12% vs 36%), and the overall rate of complications was lower (14% vs 40%, p = 0.01) despite the groups being matched for age, gender, and haemorrhage rates. Conclusion: The trial revealed that a single dose of dexamethasone during surgery greatly improved post-tonsillectomy recovery. Patients who received dexamethasone had less pain at all times, used fewer pain medications (36% vs 68%), started oral intake earlier (60% vs 32% in 6 hours), had less nausea and vomiting (12% vs 36%), and had no significant difference in postoperative bleeding (2% vs 4%).
Clinical and Radiographic Outcomes Following Anterior Cervical Discectomy and Fusion Using Integrated Anchor Fixation – A Single-Centre Experiences
Background: Anterior cervical discectomy and fusion (ACDF) is a widely accepted surgical intervention for cervical degenerative disc disease. Integrated anchor fixation systems have emerged as an alternative to traditional anterior plating, offering reduced soft tissue disruption and lower complication rates while maintaining biomechanical stability. Aim of the study: To evaluate the clinical and radiographic outcomes, fusion rates, and complication profiles following ACDF using an integrated anchor fixation system in patients with symptomatic cervical degenerative disc disease. Methods & Materials: This prospective observational study included 60 patients who underwent ACDF with an integrated anchor fixation device at a single tertiary center. Preoperative and 12-month postoperative outcomes were assessed using the Visual Analog Scale (VAS) for neck and arm pain, Neck Disability Index (NDI), and SF-36 Physical and Mental Component Scores. Radiographic parameters included segmental and global cervical lordosis, disc height, fusion status, and cage subsidence. Subgroup analysis was conducted between single- and two-level procedures. Result: Significant improvements were observed in all clinical metrics at 12 months: VAS-neck decreased from 7.9 ± 1.2 to 2.3 ± 1.1 (p < 0.001), VAS-arm from 7.3 ± 1.3 to 1.9 ± 1.2 (p < 0.001), and NDI from 53.2 ± 8.6% to 16.1 ± 6.3% (p < 0.001). SF-36 PCS and MCS improved by 17.2 and 16.2 points, respectively (p < 0.001). Radiographic analysis showed significant gains in segmental lordosis (2.1° to 6.0°, p < 0.001) and disc height (4.3 mm to 6.3 mm, p < 0.001). Fusion was achieved in 95% of cases. Subsidence (>2 mm) occurred in 8.3%, and dysphagia was reported in 11.7% at one month. Two-level ACDF cases had lower fusion rates (83.3% vs. 97.8%, p = 0.045) and higher dysphagia incidence (33.3% vs. 6.7%, p = 0.023) compared to single-level cases. Conclusion: ACDF with integrated anchor fixation resulted in substantial improvements in pain, function, and radiographic alignment, with high fusion rates and a low incidence of complications. These findings support the use of integrated fixation as a safe and effective alternative to traditional anterior plating, particularly in single-level procedures.
Knowledge, Attitude and Practice of Oral Contraceptive Pill Use in Multi-center Study
Background: Oral contraceptive pills (OCPs) are the most widely used modern contraceptive method in Bangladesh, yet gaps in knowledge, attitudes, and practice may affect effective use. Aim of the study: To assess knowledge, attitudes, and practices regarding OCP use in a multi-center study and to identify socio-demographic determinants of correct use and discontinuation. Methods & Materials: A multi-center based cross-sectional study was conducted among 200 women aged ≥15 years in Dhaka city of Bangladesh. Data were collected using a structured questionnaire covering socio-demographics, reproductive history, and OCP-related KAP. Descriptive statistics and chi-square tests were applied using SPSS v26. Results: Among participants, 46% had good knowledge, 64% demonstrated positive attitudes, and 44% reported good practice. Current OCP use was 63%, with 47% adhering regularly. Main reasons for irregularity or discontinuation included side effects (39.5%) and forgetfulness (25.6%). Knowledge gaps existed regarding missed pill management (43%) and emergency contraception (30%). Health workers were the primary information source for 38%. Conclusion: Despite high awareness, knowledge and consistent use of OCPs remain suboptimal. Tailored counseling, follow-up, and multi-center interventions are necessary to enhance effective OCP use and reduce unmet family planning needs in Bangladesh.
Quantitative Analyses of Diagnostic and Nondiagnostic Images in the Undergraduate Regional Anatomy Textbook
Background: Students may more effectively understand the spatial relationships and variations of anatomical structures by using diagnostic images that provide a realistic and three-dimensional view of the human body. It may be assumed that good Regional Anatomy textbooks reflect the essential aspects of the recent global trends in diagnostic image teaching, learning, and assessment. So, this research aimed to analyze the frequency of diagnostic images and nondiagnostic images in the commonly recommended Regional Anatomy textbook (Snell, 10th edition). Methods & Materials: This study is a descriptive study involving quantitative analysis of the diagnostic and nondiagnostic images and different ‘forms’ and ‘types’ of diagnostic and nondiagnostic images of the Regional Anatomy textbook. Result: 11.13% of diagnostic images and 88.87% of nondiagnostic photos were identified. Conclusion: The present study has shown that a sufficient amount of nondiagnostic images and some diagnostic images are present in the Regional Anatomy textbook. The use of diagnostic images can enhance the structural conception of the medical undergraduate students.
Comparative Outcomes of Extracorporeal Shock Wave Lithotripsy, Pneumatic Lithotripsy, and Laparoscopic Ureterolithotomy in the Management of Large Proximal Ureteral Stones
Background: Large proximal ureteral stones are difficult to manage because of low spontaneous passage rates and reduced success with non-invasive treatments. ESWL, ureteroscopic pneumatic lithotripsy, and laparoscopic ureterolithotomy are commonly used modalities, but their comparative outcomes remain unclear. The aim of this study was to compare the effectiveness of ESWL, pneumatic ureteroscopic lithotripsy, and laparoscopic ureterolithotomy in patients with large proximal ureteral stones. Methods & Materials: This prospective observational study was conducted at Bangladesh Medical University, Dhaka, from July 2023 to June 2024. A total of 120 adult patients with proximal ureteral stones ≥10 mm was divided into three equal groups: ESWL (n = 40), pneumatic URS (n = 40), and laparoscopic ureterolithotomy (n = 40). Outcomes included stone-free rate, auxiliary procedures, complications, hospital stay, and recovery time. Results: Immediate stone-free rates were highest with laparoscopic ureterolithotomy (95%), followed by pneumatic URS (75%) and ESWL (55%) (p <0.001). At 3 months, stone-free rates were 100%, 85%, and 70%, respectively (p <0.001). ESWL required significantly more auxiliary procedures, while laparoscopic ureterolithotomy was associated with longer hospital stay and delayed recovery. Conclusion: Laparoscopic ureterolithotomy provides the highest definitive stone clearance for large proximal ureteral stones. Pneumatic lithotripsy offers a less invasive alternative with good effectiveness, while ESWL remains the least invasive option but with lower success rates.
Assessment of Symptom Severity and Quality of Life in Patients with Oral Lichen Planus – A cross Sectional Study
Background: Oral lichen planus is a long-lasting condition that results in oral lesions, discomfort, and functional difficulties, thereby diminishing the quality of life related to oral health. This study assesses the severity of symptoms in Oral lichen planus (OLP) patients and how it affects their quality of life. Methods & Materials: This cross-sectional study conducted at Bangladesh Medical University and Bangladesh Multicare Hospital (January–December 2025) involved 74 patients with OLP. Sociodemographic and clinical information was gathered, and the severity of symptoms was rated (0 = None to 3 = Severe). Quality of life related to oral health was evaluated using OHIP‑14, with scores classified as high (<19), medium (19–37), or low (38–56). Descriptive statistics provided an overview of the data, and Chi-square tests assessed the relationships between symptom severity and quality of life (p < 0.05). Results: Among 74 OLP patients, 55% were female, mostly aged 30–45 years (43%), with 35% housewives. Reticular lesions (39%) mainly affected the buccal mucosa (46%), and burning sensation was the most common symptom (46%). Symptom severity was mild (51%), moderate (30%), severe (12%), with a mean OHIP‑14 score of 20.9 ± 5.3. Quality of life was medium in 62%, high in 31%, low in 7%, and correlated significantly with symptom severity (χ² = 24.6, p = 0.001). Conclusion: Oral Lichen Planus impacts middle-aged individuals, presenting as reticular lesions in the mouth; the intensity of symptoms, particularly burning, correlates with diminished quality of life, highlighting the necessity for prompt treatment.
Socio-Demographic Determinants of Health Status and Healthcare-Seeking Behavior Among ENT Outpatients in a Community Population of Bangladesh
Background: Health-seeking behavior is essential for timely diagnosis and management of illnesses. Understanding sociodemographic determinants and patterns of healthcare utilization helps improve healthcare delivery for community population. This study aimed to assess the sociodemographic factors, health practices, presenting complaints, and healthcare-seeking behavior of patients attending an ENT outpatient department at Gopalganj Medical College Hospital. Methods & Materials: A cross-sectional study was conducted from January to June 2024. A total of 102 patients of all ages and sexes were selected using convenience sampling. Data on socio-demographics, personal health practices, health status, presenting complaints, healthcare-seeking behavior, and satisfaction with hospital services were collected using a pretested semi-structured questionnaire and analyzed using descriptive statistics. Results: The majority of respondents were young (30.4% aged 1–18 years) and female (58.8%), with primary or secondary education. Most lived in small households (1–5 members) and had a monthly income of 26,000–50,000 BDT. Common presenting complaints were throat pain and hearing impairment (31.4% each). Most participants sought care from pharmacies (58.8%) or UHCs (34.3%), with nearly half traveling 11–100 km to access healthcare. Despite accessibility challenges, 69.6% rated hospital services as good. Conclusion: Most community members attending the ENT OPD had generally good personal health practices, with throat and ear complaints being the most common. Healthcare was primarily sought from pharmacies and UHCs, with some traveling long distances, and the majority were satisfied with hospital services. Improving access to formal healthcare services and enhancing awareness could promote timely and appropriate care.
Assessment of the Correlation between Clinical and Electrophysiological Results and Risk Factors in Patients with a Preliminary Carpal Tunnel Syndrome Diagnosis
Background: Carpal tunnel syndrome (CTS) is a frequent upper extremity neuropathy caused by entrapment of the median nerve at the wrist. It causes discomfort, paresthesia, and sensory loss in the median nerve's sensory area, particularly at night. This study examines the correlation between risk factors, symptom severity, functional status, and electromyography (EMG) results in individuals with a preliminary diagnosis of carpal tunnel syndrome (CTS). Methods & Materials: The study included 249 patients referred to the EMG unit at the Department of Neurology, Shaheed Ziaur Rahman Medical College & Hospital, Bogura, Bangladesh (Jan–Dec 2025) with a preliminary CTS diagnosis. An experienced EMG nurse conducted interviews and administered a 14-item questionnaire on demographics, CTS risk factors, and VAS scores, while a blinded Physical Medicine and Rehabilitation professional performed and reported EMG evaluations. Results: The study included 204 (81.9%) female patients and 45 (18.1%) males. The median age was 49 years (range: 20-94). The mean total score on the BCTQ was 5.4±1.5. 53.3% of patients referred to the electrophysiology lab with a preliminary diagnosis of CTS were really diagnosed. Females, persons with a smoking history of more than 21 years, and those with diabetes mellitus were more likely to have electro physiologically confirmed CTS compared to those without. Conclusion: Risk factors, BCTQ scores, and EMG findings were complementary in patients with suspected CTS. Female gender, long-term smoking (≥21 years), and diabetes were significantly associated, highlighting their importance in early identification and management.
Perception Gaps in Informed Consent: Insights from Patients and Surgeons
Background: Informed consent is essential for patient autonomy in medical practice, but many patients—especially in low-resource settings—have limited understanding and often view it as a legal formality. Factors such as low education, language barriers, and lack of opportunity to ask questions reduce comprehension. This study evaluates patients’ understanding and perceptions of informed consent in surgical care in Bangladesh. Methods & Materials: A cross-sectional study was conducted at Ibrahim Medical College and BIRDEM General Hospital, Dhaka (July–December 2025) among 50 elective surgery patients and 25 surgeons. Data were collected via semi-structured questionnaires on patient understanding and surgeons’ consent practices. Analysis was performed in SPSS v26 using descriptive statistics and Chi-square/Fisher’s Exact tests (p<0.05). Ethical approval and written informed consent were obtained from all participants. Results: Among 75 participants (50 patients, 25 surgeons), most patients were 30–49 years (48.0%), male (56.0%), and had secondary or below education (64.0%), while most surgeons had >5 years’ experience (72.0%). Patients were mostly informed about their procedure (86.0%) but fewer understood risks (48.0%), alternatives (38.0%), had opportunity to ask questions (46.0%). Surgeons largely explained procedures (92.0%) and viewed consent as ethical (72.0%) but discussed risks (64.0%) or alternatives (40.0%) less frequently. Poor patient understanding was linked to lower education (68.8%) and lack of opportunity to ask questions (81.5%), while age and sex were not significant. Conclusion: Surgeons saw consent as routine, though is ethical and legal obligation. The patients’ understanding was low, especially regarding risks and alternatives, highlighting the need for clearer, patient-centered practices.