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
Temporal Onset and Duration of Pulmonary Haemorrhage – Impact on Survival Outcomes in Neonates
Introduction: Pulmonary haemorrhage is a catastrophic neonatal condition associated with extremely high mortality. The timing of onset and duration of bleeding play crucial roles in determining outcomes. The present study aimed to evaluate the impact of temporal onset and duration of pulmonary haemorrhage on survival outcomes in neonates. Methods & Materials: This prospective cohort study was conducted at Bangladesh Shishu Hospital & Institute, Dhaka, from July 2019 to June 2021. Seventy neonates (gestational age 28–42 weeks) who developed pulmonary haemorrhage during hospitalisation were enrolled. Demographic, clinical, and temporal data were recorded. Survival outcomes were compared between survivors (n=8) and non-survivors (n=62) using the unpaired Student’s t-test and Fisher’s Exact test. Statistical analysis was performed using SPSS version 22.0. Results: Mortality was 88.5%. Survivors had significantly earlier onset of haemorrhage (3.00 ± 1.69 days) compared with non-survivors (8.12 ± 7.07 days; p=0.046). Similarly, onset during hospitalisation was earlier (3.37 ± 1.18 days vs. 6.64 ± 3.44 days; p=0.007), and duration was markedly shorter in survivors (4.50 ± 0.53 h vs. 9.48 ± 0.56 h; p=0.001). Clinical appearance differed significantly (p=0.044), with dyspneic presentations dominating among survivors, whereas lethargy predominated in deaths. Conclusion: Temporal variables—particularly early onset and shorter duration—are strong survival predictors in neonatal pulmonary haemorrhage. Prompt recognition and early hemostatic intervention within the first few hours are crucial for improving prognosis and guiding clinical management.
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Prevalence and Patterns of Migraine among Adults Attending Tertiary Hospitals in Bangladesh
Introduction: Migraine is a disabling, recurrent primary headache disorder characterized by moderate-to-severe recurrent head pain associated with nausea, photophobia, and phonophobia. The research aims to quantify the prevalence and pattern of migraine among adults presenting at Bangladeshi tertiary hospitals. Methods & Materials: This was a cross-sectional observational study conducted among 58 adult patients who were seen in the Neurology Outpatient Departments of Neurology, Gopalganj Medical College, Gopalganj, Bangladesh between January 2024 and December 2024. Adults aged 18 years or more who met the ICHD-3 criteria for migraine and were willing to participate were included. Data were analyzed using SPSS version 26.0. Result: The female sex (74.1%) and age 26–35 years (41.3%) were predominant among the 58 patients. Migraine without aura was most frequent (72.4%), with 4–9 attacks per month and 4–12 hours' duration being most common. The most frequent precipitating factors were stress (69.0%), disturbance of sleep (65.5%), and exposure to noise (50.0%). Most frequent associated symptoms were nausea/vomiting (72.4%), photophobia (69.0%), and phonophobia (65.5%). Conclusion: This study establishes migraine as a prevalent neurological disorder in adults who are presenting to tertiary centres in Bangladesh, with extreme female predominance and highest prevalence in the age group of 26–35 years. Migraine without aura was present in most cases, and precipitating factors were stress, inadequate sleep, and sound exposure. In most patients, attacks lasted 4–12 hours, and were accompanied by nausea, photophobia, and phonophobia.
Burden of Chronic Suppurative Otitis Media and Hearing Loss among Primary and Secondary School Children – A Cross-Sectional Study
Introduction: Chronic suppurative otitis media (CSOM) is a chronic inflammation of the middle ear with perforation of the tympanic membrane and frequent or continuous discharge from the ear, typically resulting in hearing loss. The aim of this study is to ascertain the burden of hearing loss and chronic suppurative otitis media in children in primary and secondary schools. Methods & Materials: It was a cross-sectional survey conducted between January 2024 to December 2024 in 76 children who were 6-16 years of age, studying in primary and secondary schools, in North Bengal Medical College & Hospital to assess the burden of chronic suppurative otitis media (CSOM) and hearing loss following it. Data analysis was performed using SPSS version 26.0. Result: In the current study of 76 school children with a mean age of 10.8 ± 2.9 years, 35.5% of them had chronic suppurative otitis media (CSOM) with a majority being unilateral (81.5%) and tubotympanic type (77.8%). Duration of discharge from the ear was 2.4 ± 1.1 years. In 92.6% of the infected children, impaired hearing was described primarily as mild to moderate conductive impairment (85.2%), averaging 38.4 ± 9.2 dB in hearing threshold, indicating heavy disease burden and accompanying auditory deficit in this subgroup. Conclusion: This study sets a colossal burden of chronic suppurative otitis media (CSOM) and associated hearing loss in primary and secondary school children with a prevalence rate of 35.5% and hearing impairment observed in 92.6% of the cases.
Pleural Fluid Cytology and Biochemical Profiles in Pediatric Pleural Effusion
Introduction: Pleural effusion, the accumulation of excess fluid in the pleural cavity, is a common cause of respiratory morbidity in children and can result from a variety of infectious and non-infectious conditions. In the pediatric population, parapneumonic effusion and tuberculous pleural effusion are among the most frequently encountered causes, each with distinct cytological and biochemical profiles. This study aims to evaluate the pleural fluid cytology and biochemical parameters in children with pleural effusion. Methods & Materials: This cross-sectional study was conducted at the Department of Pediatric Respiratory Medicine, Bangladesh Shishu Hospital and Institute, Dhaka, from July 2019 to January 2022. A total of 58 children from 1 to 18 years of age admitted with pleural effusion were selected as study subjects. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 26.0. Result: Among the 47 study patients, parapneumonic effusion (63.8%) was the most common cause of pleural effusion, followed by tuberculous pleural effusion (36.2%). Pleural fluid analysis showed that TPE cases had significantly lower total cell counts and polymorph percentages, but higher lymphocyte percentages compared to non-TPE cases (P <0.001). Glucose levels were also significantly lower in TPE (P <0.001), while protein and LDH levels did not differ significantly between the groups. Conclusion: Analysis of pleural fluid cytology and biochemical profiles in pediatric pleural effusion revealed that tuberculous pleural effusion is characterized by significantly higher lymphocyte percentages and lower polymorphonuclear cell counts, along with reduced glucose levels and lower total cell counts, compared to non-tuberculous effusions.
Distinguishing Suicidal Hanging from Homicidal Ligature Strangulation – A Diagnostic Accuracy Study of Autopsy and Scene Findings
Introduction: Differentiating suicidal hanging from homicidal strangulation remains a critical challenge in forensic pathology due to overlapping scene findings, ligature patterns, and internal neck injuries. Accurate classification is essential for justice, mortality reporting, and public health surveillance. This study aimed to evaluate the diagnostic accuracy of autopsy, internal neck injury, and scene findings in distinguishing suicidal hanging from homicidal strangulation. Methods & Materials: This observational, cross-sectional autopsy-based forensic study analyzed 120 cases (95 suicidal and 25 homicidal) after excluding incomplete or decomposed cases. The study was conducted at the Department of Forensic Medicine at Dhaka Medical College from January 2022 to July 2022. The manner of death was determined through combined scene evidence, police inquest, and autopsy consensus. Data were collected using a structured pro forma, and statistical analysis was performed using SPSS (version 26.0). Results: Suicidal hangings were marked by oblique, non-continuous ligature marks above the thyroid cartilage, parchmentization, and no defense injuries, while homicidal cases showed horizontal marks, fractures, and signs of struggle. Sedatives were found only in homicides. The predictive model accurately distinguished suicides from homicides (AUC = 0.97, sensitivity = 97%, specificity = 92%). Conclusion: Careful assessment of the scene and autopsy findings can effectively differentiate suicidal hangings from homicidal strangulations. Oblique, non-continuous ligature marks above the thyroid cartilage and absence of defense injuries indicate suicide, while horizontal marks, internal trauma, and struggle signs suggest homicide.
Pregnancy Outcome in Women with and without Diabetes Mellitus – A Comparative Study
Background: Diabetes during pregnancy, both gestational and pre-existing, is an increasing concern in South Asia, linked to higher risks of preeclampsia, cesarean delivery, macrosomia, and neonatal hypoglycemia. This study compared maternal and neonatal outcomes between diabetic and non-diabetic pregnancies in a tertiary hospital. Methods & Materials: This comparative cross-sectional study was carried out in the Department of Gynecology and Obstetrics, Gazi Medical College Hospital, Khulna, Bangladesh, from January to December 2024. A total of 320 pregnant women (160 with diabetes and 160 without) were enrolled to compare maternal and neonatal outcomes. Participants were ≥28 weeks gestation with singleton pregnancies. Data on demographics, antenatal complications, delivery, and neonatal outcomes were collected using a structured questionnaire. Gestational diabetes was diagnosed per IADPSG/WHO 2013 criteria, and analyses were performed using SPSS v26.0. Results: Among 320 pregnant women, most diabetics had gestational diabetes diagnosed at 26 weeks, with 70% achieving good glycemic control. Diabetic mothers showed higher rates of polyhydramnios, caesarean delivery, macrosomia, and shoulder dystocia. Their infants had greater birthweight, more hypoglycaemia, NICU admissions, and longer hospital stays. Adverse maternal (21.3% vs. 11.3%) and neonatal (36.3% vs. 21.3%) outcomes were significantly higher in diabetics. Diabetes, maternal age ≥35 years, and hypertension independently predicted poor outcomes. Conclusion: This study found that diabetes during pregnancy, whether gestational or pre-existing, significantly increases the risk of adverse maternal and neonatal outcomes, including hypertension, cesarean delivery, macrosomia, and neonatal hypoglycemia. Even with reasonable glycemic control, complications remained more common among diabetic mothers than non-diabetic ones.
Comparative Evaluation of Ketamine–Propofol versus Ketamine–Diazepam for Total Intravenous Anesthesia in ERAS-Guided Day Case Surgery
Introduction: ERAS protocols in day-case surgeries reduce stress and promote faster recovery. TIVA is favored for its controllable depth and quick emergence. This study compares ketamine–propofol and ketamine–diazepam anesthesia regarding perioperative stability and recovery outcomes in ERAS-guided day-case surgeries. Methods & Materials: This one-year prospective comparative study (July 2024–June 2025) at Gazi Medical College, Khulna, included 60 adults undergoing ERAS-guided day-case surgery. Patients were randomized into two groups: Group A (Ketamine + Propofol) and Group B (Ketamine + Diazepam). Perioperative parameters, recovery, PONV, pain, complications, and hospital stay were analyzed using SPSS v26.0, with p < 0.05 considered significant. Results: Both groups were comparable in demographics, ASA status, types of surgery, and intraoperative parameters. Group A (ketamine–propofol) demonstrated significantly better hemodynamic stability, smoother recovery from anesthesia, and a lower incidence of PONV (p < 0.05). Recovery was faster in Group A, with earlier oral intake and ambulation, shorter PACU stay, and reduced hospital stay (all p <0.001). Intraoperative complications were also lower in Group A. Conclusion: The study concludes that the ketamine–propofol combination offers superior recovery outcomes compared to ketamine–diazepam for total intravenous anaesthesia in ERAS-guided day-case surgeries. It provides better postoperative analgesia, reduces PONV, and ensures smoother and faster recovery without compromising hemodynamic stability. This regimen aligns well with ERAS principles, making it a more effective choice for ambulatory anesthesia.
Association between Elevated HbA1c Levels and Risk of Trigger Finger in Diabetic Patients
Background: Diabetes mellitus is a chronic metabolic disorder that not only causes vascular complications but is also associated with musculoskeletal manifestations such as trigger finger, which are often underrecognized. The purpose of the study was to assess the association between elevated HbA1c levels and the risk of developing trigger finger among diabetic patients. Aim of the study: The aim of the study was to assess the association between elevated HbA1c levels and the risk of developing trigger finger among diabetic patients. Methods & Materials: A cross-sectional study at the Medicine Outpatient Department of BIRDEM General Hospital, Dhaka, Bangladesh (Nov 2018–Apr 2019) included 354 type 2 diabetic patients with hand complaints, and demographic and clinical data were collected to assess associations with trigger finger using SPSS and chi-square tests (P < 0.05). Results: Among 354 diabetic patients, trigger finger affected 177 (50%). Age and sex were similar between groups, while diabetes duration >5 years was higher in trigger finger patients (114, 64.4% vs 91, 51.4%; P = 0.018). Hypertension was present in 122 (68.9%) trigger finger patients. HbA1c >6.5% was seen in 122 (68.9%) with trigger finger and 119 (67.2%) without (P = 0.733), showing no significant association. Conclusion: Trigger finger is the most common hand complication in diabetic patients, associated with longer diabetes duration but not with elevated HbA1c levels.
Phacoemulsification In Eyes with High and Normal Axial Length – A Study of 100 Cases
Background: Axial length plays a critical role in cataract surgery outcomes. Patients with high axial length are often at increased risk of intraoperative complications and suboptimal visual recovery. This study aimed to evaluate the intraoperative complications of cataract surgery with phacoemulsification in eyes with high and normal axial length. Methods & Materials: A total of 100 cataract patients were divided into two groups: Group I (normal axial length, 21–24.5 mm) and Group II (high axial length, ≥26 mm), with 50 patients in each group. Data on age, gender, occupation, axial length, intraoperative complications, refractive error, and visual acuity on the first postoperative day and after six weeks were collected and analyzed. Results: The majority of patients were aged 61–80 years (55%) and male (66%). Group I had a mean axial length of 22.95 ± 0.90 mm, while Group II had a significantly longer mean of 27.76 ± 1.10 mm (p < 0.05). Intraoperative complications were more frequent in Group II (6.00%) compared to Group I (4.00%), with posterior capsule tear being significantly higher in the high axial length group (p = 0.03). Refractive status differed significantly between the groups, with Group II showing higher degrees of myopia (p < 0.05). Postoperative visual acuity was better in Group I at both the 1st POD and 6-week follow-up, with more patients achieving 6/6–6/9 vision compared to Group II. Conclusion: Patients with high axial length undergoing phacoemulsification are more prone to intraoperative complications and demonstrate poorer visual and refractive outcomes compared to those with normal axial length. Proper preoperative assessment and surgical precautions are essential to optimize outcomes in high axial length eyes.
Preoperative Risk Profile and Clinical Characteristics of Bangladeshi Patients Undergoing Isolated CABG
Background: Understanding the preoperative clinical profile of patients undergoing coronary artery bypass grafting (CABG) is essential for surgical planning and outcome prediction; however, population-specific data from Bangladesh are limited. Objective: This study aimed to describe the demographic, anthropometric, comorbidities, renal, and cardiac characteristics of Bangladeshi patients undergoing isolated CABG at a tertiary cardiac center. Methods & Materials: A comparative cross-sectional study was conducted at the National Heart Foundation Hospital and Research Institute in Dhaka between September 2020 and August 2022. Five hundred consecutive patients scheduled for isolated CABG were enrolled in this study. Data were collected from medical records and assessments using standardized forms. Descriptive statistics were performed using SPSS (version 26). Results: The mean age was 60.2 ± 7.5 years, with 81.8% male patients. Over half (51.6%) were overweight (BMI 23–27.5 kg/m²), and hypertension (63.6%) and diabetes (44.2%) were the most common comorbidities. Normal renal function (serum creatinine < 1.4 mg/dL) was found in 91.2% of patients, with a mean creatinine clearance of 85.9 ± 13.4 mL/min. Most patients were NYHA class III (62%), with 70.6% having had a recent myocardial infarction and 77.6% showing an ejection fraction of 31–50%. Elective CABG comprised 75.4% of cases, while 1% were emergent. Conclusion: Bangladeshi CABG patients typically present as middle-aged males with high rates of hypertension, diabetes, and moderate ventricular dysfunction. Recognizing these preoperative characteristics is crucial for optimizing care and tailoring risk models for regional populations.
Role of Epidural Steroid Injection in Pain Reduction and Functional Recovery in Prolapsed Lumbar Intervertebral Disc (PLID)
Introduction: Prolapsed lumbar intervertebral disc (PLID) is a leading cause of low back pain and radiculopathy, significantly influencing patients' quality of life. ESIs reduce inflammation and nerve root irritation, offering short-term pain relief and improved mobility. Methods & Materials: This one-year retrospective study (January 2022–December 2023) at Gazi and Khulna Medical Colleges, Bangladesh, included 50 adults (20–60 years) with MRI-confirmed lumbar disc prolapse unresponsive to ≥4 weeks of conservative therapy. Patients received interlaminar or transforaminal epidural steroid injections. Pain (VAS), disability (ODI), complications, and satisfaction were evaluated at baseline, 1 week, 1 month, and 3 months. Result: The study included 50 patients with a mean age of 41.6 years; 56% were male, and 60% had sedentary occupations. The most common disc prolapse level was L4-L5 (56%), and protrusion was the predominant type (44%). Interlaminar ESI was most frequently used (60%) with methylprednisolone (64%), and 60% received a single injection. Significant reductions in pain and disability were observed, with VAS scores dropping from 7.6 to 2.8 and ODI scores from 58.2% to 24.3% at 3 months (p<0.001). Complications were minimal and mild, and 76% of participants reported excellent or good satisfaction following the intervention. Conclusion: Epidural steroid injections (ESIs) effectively manage prolapsed lumbar intervertebral disc (PLID) by providing significant pain relief and functional improvement. This study showed marked reductions in VAS and ODI scores, with minimal complications and high patient satisfaction, supporting ESIs as a safe, effective, and non-surgical treatment option for PLID.
Prolapsed Lumbar Intervertebral Disc (PLID)
Regional Anesthesia as a Primary Technique for COVID-19 Surgical Patients – Experience from a COVID Dedicated Hospital in Bangladesh
Introduction: The COVID-19 pandemic has reshaped anesthetic practice, with general anesthesia (GA) carrying increased risks due to airway manipulation and aerosol generation. Regional anesthesia (RA) offers a safer alternative by reducing viral transmission, preserving respiratory function, and providing superior postoperative analgesia with fewer pulmonary complications. Methods & Materials: This retrospective observational study was conducted in the Department of Anesthesiology in Mugda Medical College and Hospital, Dhaka, Bangladesh, over one year, from March 2020 to April 2021, enrolling 80 adult surgical patients with confirmed or suspected COVID-19 and underwent elective or emergency procedures under regional anesthesia (spinal, epidural, combined spinal-epidural, or peripheral nerve blocks). Data were analyzed using SPSS v26.0, with results presented as mean ± SD for continuous variables and percentages for categorical variables. Results: Among 80 COVID-19 surgical patients, the mean age was 45.2 ± 12.8 years, with male predominance (65%) and most classified as ASA II (57.5%). RT-PCR positivity was 80%, and 65% were symptomatic; hypertension (30%) and diabetes (25%) were common comorbidities. Elective surgeries comprised 75%, predominantly general surgery (45%). Spinal anesthesia was most frequent (65%), with 95% block success and 5% conversion to general anesthesia. Intraoperative hypotension (25%) and bradycardia (10%) were noted, while desaturation was rare (5%). Conclusion: This study highlights regional anesthesia as a safe and effective primary technique for COVID-19 surgical patients, ensuring stable intraoperative conditions, superior analgesia, and minimal complications. Its use reduces postoperative morbidity and healthcare provider exposure, supporting its role as the preferred anesthetic approach in pandemic surgical care
Impact of Body Mass Index on Acne Severity – Findings from a Hospital-Based Cross-Sectional Study (100 Cases)
Background: Acne vulgaris is a common chronic inflammatory disorder of the pilosebaceous unit, mainly affecting adolescents and young adults. Its pathogenesis involves hormonal, genetic, and microbial factors, with recent evidence suggesting a possible role of metabolic parameters like Body Mass Index (BMI). However, the association between BMI and acne severity remains inconsistent across studies. Objective: To evaluate the relationship between BMI and acne severity among patients attending the dermatology outpatient department of a tertiary care hospital. Methods & Materials: A hospital-based cross-sectional study was conducted on 100 clinically diagnosed acne vulgaris patients aged 15–35 years. Demographic and anthropometric data were recorded, and BMI was calculated as weight (kg)/height (m²) and categorized per WHO standards. Acne severity was assessed using the Global Acne Grading System (GAGS). Data were analyzed using SPSS version 26, applying chi-square and Pearson’s correlation tests. A p-value <0.05 was considered significant. Results: The mean age was 21.8 ± 3.4 years, with a female-to-male ratio of 1.38:1 and a mean BMI of 24.3 ± 3.7 kg/m². Moderate acne was most common (40%), followed by mild (29%), severe (22%), and very severe (9%). A significant positive association was found between higher BMI and greater acne severity (χ² = 12.87, p = 0.01), with a moderate positive correlation (r = 0.32, p = 0.01). Conclusion: Elevated BMI is significantly associated with increased acne severity, highlighting the potential role of weight management in acne control.
Evaluation of Lower Tibial Metaphyseal Plate Osteosynthesis with or without Fixation of Lateral Malleolar Fracture – A Prospective Study
Background: Distal tibial metaphyseal fractures, with or without associated lateral malleolar fractures, are common injuries resulting from high-energy trauma. The role of fibular fixation in improving stability and outcomes remains debated. Objective: To evaluate the functional and radiological outcomes of plate osteosynthesis of distal tibial metaphyseal fractures with or without fibular fixation in 40 patients. Methods & Materials: A prospective study was conducted on 40 patients with distal tibial metaphyseal fractures, managed by plate osteosynthesis. Patients were divided into two groups: Group A (n=20) – tibial fixation only; Group B (n=20) – tibial fixation with fibular plating. Functional outcome was assessed using the American Orthopaedic Foot & Ankle Society (AOFAS) score and radiological union was monitored over 12 months. Results: Mean union time in Group A was 19.2 weeks vs. 17.6 weeks in Group B. Malalignment (>5°) occurred in 4 patients (Group A: 3, Group B: 1). Mean AOFAS scores at final follow-up were 84.3 (Group A) vs. 88.6 (Group B). Complications included superficial infection (3 cases), delayed union (2 cases), and ankle stiffness (2 cases). Conclusion: Fibular fixation in addition to tibial plating provides better alignment and marginally faster union, with improved functional outcomes. However, differences were not statistically significant. Selective fibular fixation may be considered, especially in cases with instability or comminution.
Prevalence of incidental findings in CT scan of paranasal sinuses
Background: The use of computed tomography (CT) scans has become a common diagnostic tool for evaluating the paranasal sinuses (PNS), particularly in patients presenting with symptoms such as chronic sinusitis, nasal obstruction, or facial pain. CT imaging offers detailed visualization of sinus anatomy and pathology, often leading to accurate diagnosis and management. Incidental findings (IFs) are unintentional discoveries unrelated to the imaging purpose. Imaging exams on people with suspected intracranial diseases may detect IFs in the PNS. Objectives: The aim of the study was to evaluate the prevalence of incidental abnormalities on computed tomographic scans of the paranasal sinuses. Methods & Materials: This cross-sectional study was carried out in the Department of Radiology & Imaging, Uttara Adhunik Medical College & Hospital, Dhaka, Bangladesh during January 2023 to December 2023. A total of 120 patients were participated in the study. Statistical analyses of the results were be obtained by using window-based Microsoft Excel and Statistical Packages for Social Sciences (SPSS-24). Results: The age distribution showed that (14.16%) patients were under 20 years old, (20.0%) were between 21 and 40 years old and 48 (40.0%) were over the age of 61. The majority of the patients were male (58.33%) and (41.66%) being female. According to employment status, (15.83%) of patients were housewives, (10%) were businessmen, (7.5%) were retired officers and (34.16%) were service members. According to socioeconomic level, (58.33%) of the patients come from middle-class families, (24.16%) from low-income families and (17.60%) from middle-class families. Conclusion: Incidental abnormalities on paranasal sinus CT scans are common, though most findings are minor and unlikely to require intervention. Awareness of these incidental findings is essential to avoid unnecessary follow-up and treatment, particularly when abnormalities do not correlate with symptoms. Further research is warranted to evaluate the clinical significance of specific types of incidental findings.
Assessment of Knowledge and Practices Regarding Shoulder Mobilizing Exercises Among Frozen Shoulder Patients
Background: Frozen shoulder (adhesive capsulitis) is a common musculoskeletal condition characterized by pain and restricted shoulder movement. Adequate knowledge and consistent practice of shoulder exercises are essential for improving pain and mobility. This study aimed to assess patients’ knowledge and practice regarding shoulder exercises and to examine their association with patient-reported improvement. Methods & Materials: A cross-sectional descriptive study was conducted among 140 patients diagnosed with frozen shoulder at the Department of Physical Medicine and Rehabilitation, BIRDEM General Hospital, Dhaka, Bangladesh, from January to June 2024. Data were collected using a semi-structured questionnaire assessing socio-demographics, knowledge, and practice of shoulder exercises. Knowledge and practice levels were categorized as good, moderate, or poor. exercise adherence was assessed both via self-report and observation. Associations between education, knowledge, practice, and patient-reported improvement were analyzed using Chi-square tests, with p < 0.05 considered statistically significant. Results: The majority of participants were middle-aged (45–54 years, 40%) and female (58.6%). Overall, 32.1% had good knowledge, 51.4% moderate, and 16.4% poor knowledge regarding shoulder exercises. Regarding practice, 25.0% demonstrated good practice, 47.9% moderate, and 27.1% poor practice. Higher education was significantly associated with better knowledge (p = 0.02) and practice (p = 0.01). Patient-reported improvement was significantly associated with both knowledge (p = 0.011) and practice (p = 0.001), with 62.2% of patients with good knowledge and 71.4% of patients with good practice reporting improvement in pain or mobility. Conclusions: Although most patients had moderate knowledge and practice, better knowledge and adherence were strongly associated with improvement in frozen shoulder symptoms. Strategies to enhance patient education, guided exercise sessions, and adherence support are essential to optimize functional outcomes.
Exploring the Relationship between Dysmenorrhea and Mental Health Disorders in Young Women
Background: Dysmenorrhea, or painful menstruation, is a common gynecological condition among young women that can significantly affect their physical and psychological health. Emerging evidence suggests a potential link between dysmenorrhea and mental health disorders, yet limited data exist in the Bangladeshi context. Objective: To explore the relationship between dysmenorrhea and symptoms of depression, anxiety, and stress among young women attending outdoor in 250 Beded Sadar Hospital, Sirajganj. Methods & Methods: A cross-sectional study was conducted among 224 female respondents aged 16–24 years using a structured questionnaire. Dysmenorrhea severity was assessed using a Visual Analog Scale (VAS), and mental health status was evaluated using the Depression, Anxiety, and Stress Scale (DASS-21). Data were analyzed using SPSS version 25 with descriptive statistics and chi-square tests to assess associations. Results: The prevalence of dysmenorrhea was 91.5%, with 45.9% reporting moderate and 33.7% reporting severe pain. Among participants with moderate-to-severe dysmenorrhea, 62.4% had symptoms of depression, 71.3% had anxiety, and 59.6% reported stress. Statistically significant associations were found between dysmenorrhea severity and all three mental health domains (p < 0.05). Conclusion: The study reveals a strong association between dysmenorrhea and mental health disorders among young women. These findings highlight the need for integrated health strategies focusing on both menstrual and psychological well-being. Early screening, mental health counseling, and improved menstrual health education are essential to reduce the burden of dysmenorrhea-related mental health issues.
Evaluation of Psychiatric Types of Morbidities among the Caregivers with Dementia
Background: Globally, an estimated 30 million people suffer from dementia, a number expected to quadruple every 20 years. Dementia patients often require high levels of care, predominantly provided by unpaid family caregivers. Without caregivers, patients face lower quality of life, earlier institutionalization, and increased societal and economic burden. Objective: To assess the evaluation and types of psychiatric morbidities among caregivers of patients with dementia. Methods & Materials: A cross-sectional observational study was conducted from July 2022 to June 2023 at the Psychiatry departments of National Institute of Neuro Sciences & Hospital (NINS) and National Institute of Mental Health (NIMH) & Hospital, Dhaka. A total of 107 caregivers were recruited using purposive sampling. Data were collected via face-to-face interviews with a semi-structured questionnaire. Psychiatric morbidity was assessed using DSM-5 criteria and confirmed clinically. Data were analyzed with SPSS v24 using descriptive statistics and Chi-square tests for associations. Results: Most caregivers were female (68.2%), aged 28–37 years (52.3%), with the majority being housewives (36.4%). Most had no prior experience in caregiving for patients with dementia (88.8%) and were not physically abused by the patient (86%). Overall, 75.7% of caregivers had psychiatric morbidity. The most common conditions were Major Depressive Disorder (54.3%), Obsessive-Compulsive Disorder (16%), Generalized Anxiety Disorder (9.9%), Panic Disorder with Agoraphobia (7.4%), and Panic Disorder without Agoraphobia (3.7%). Social Phobia, Somatoform Disorders, and Eating Disorders were less frequent. No significant association was found between socio-demographic characteristics and psychiatric morbidity. Conclusion: Caregivers of dementia patients experience a high prevalence of psychiatric morbidity, particularly depression and anxiety, highlighting the need for targeted mental health support and interventions.
Vitamin D Deficiency among Children Visiting Outpatient Department in Bangladesh Shishu Hospital & Institute
Background: Vitamin D plays a crucial role in bone mineralization, immune function, and overall growth. Deficiency is a widespread public health concern, particularly among children in South Asia, including Bangladesh. Limited sun exposure and dietary insufficiency are recognized contributors, but the prevalence and associated risk factors remain underreported in pediatric outpatient populations. Aim of the study: To determine the prevalence, risk factors, and clinical impact of vitamin D deficiency among children attending outpatient departments of Bangladesh Shishu Hospital & Institute. Methods & Martials: A cross-sectional study was conducted from From January 2024 to December 2024 on 210 pediatric patients (<18 years) using purposive sampling. Demographic, clinical, and lifestyle data were collected via structured questionnaires. Serum 25-hydroxyvitamin D [25(OH)D] was measured using chemiluminescent immunoassay and classified as deficient (<20 ng/mL), insufficient (20–29 ng/mL), or sufficient (≥30 ng/mL). Associations with age, sex, BMI, sunlight exposure, and season were analyzed using chi-square tests and multivariable logistic regression. Result: Vitamin D deficiency was observed in 59.5% of participants, and 26.2% had insufficient levels. Deficiency was most prevalent during winter and spring and was significantly associated with limited sunlight exposure (<2 hours/day). Age, sex, and BMI were not independent predictors of deficiency. Conclusion: Vitamin D deficiency is highly prevalent among children attending outpatient departments in Dhaka. Environmental and lifestyle factors, particularly inadequate sunlight exposure and seasonal variation, are key contributors. Routine screening, safe sun exposure, and dietary or supplemental interventions are recommended to prevent adverse musculoskeletal and immune outcomes.
Asymptomatic Cardiac Arrhythmias in Maintenance Hemodialysis – Frequency, Causes, and Patterns
Background: Cardiac arrhythmias are a major cause of morbidity and mortality in patients undergoing maintenance hemodialysis (MHD). Many arrhythmias remain asymptomatic and undetected, contributing to sudden cardiac death. Understanding their frequency, patterns, and predictors is crucial for improving patient outcomes. Aim of the study: To determine the frequency, types, and possible clinical and biochemical predictors of asymptomatic cardiac arrhythmias among patients receiving maintenance hemodialysis. Methods & Materials: This cross-sectional observational study was conducted at the Department of Nephrology, BSMMU, Dhaka, from April 2023 to September 2024. A total of 49 adult MHD patients meeting inclusion criteria underwent 24-hour Holter monitoring and echocardiographic evaluation. Demographic, clinical, and biochemical parameters were recorded and analyzed using SPSS (version 26). Logistic regression was applied to identify predictors of arrhythmia. Result: Asymptomatic arrhythmias were detected in 77.6% (PACs), 71.4% (PVCs), 59.2% (bradycardia), and 65.3% (tachycardia) of patients. Most events occurred during or immediately after dialysis. Lower post-dialysis magnesium (OR 0.007, 95% CI: 0.00–0.77, p=0.039) and potassium levels (OR 0.11, 95% CI: 0.01–0.84, p=0.033) were significant predictors for ventricular ectopy. Other factors, including age, diabetes, hypertension, and LVMI, were not independently associated. Conclusion: Asymptomatic cardiac arrhythmias are common in MHD patients, with electrolyte fluctuations—particularly reduced post-dialysis magnesium and potassium—serving as key contributors. Routine Holter monitoring and individualized dialysis prescriptions may help in early detection and prevention of fatal arrhythmias.
Clinicopathological Profile of Pediatric Outpatients at Bangladesh Shishu Hospital & Institute – A Cross-Sectional Study
Background: Pediatric outpatient departments (OPDs) are critical for early diagnosis and management of childhood illnesses. Understanding the clinicopathological profile of pediatric outpatients is essential for guiding effective healthcare strategies and improving child health outcomes in resource-limited settings. Aim of the study: To analyze the clinicopathological profile of pediatric outpatients at Bangladesh Shishu Hospital & Institute, Dhaka, identifying prevalent diseases, clinical presentations, laboratory findings, nutritional status, and outcomes. Methods & Matrials: A hospital-based cross-sectional study was conducted over six months, enrolling 310 children below 15 years attending the pediatric OPD. Demographic data, clinical complaints, provisional diagnoses, laboratory findings, and nutritional status were recorded. Outcomes were categorized as conservative management, hospital admission, or specialist referral. Data were analyzed using SPSS version 26, with p≤0.05 considered statistically significant. Result: The mean age was 5.41 ± 3.97 years, with 55.5% males and 62.6% from urban areas. Fever (41.3%) and cough/cold (32.9%) were the most common complaints. Respiratory tract infections (36.1%) and gastrointestinal disorders (25.2%) predominated. Laboratory abnormalities were observed in hemoglobin (43.2%), WBC count (32.9%), and ESR (38.1%). Nutritional assessment revealed 41.3% of children were underweight, stunted, or wasted. Most children (69.0%) were managed conservatively, while 23.2% required admission. Conclusion: Respiratory and gastrointestinal illnesses remain the leading causes of pediatric outpatient visits, with a substantial burden of malnutrition and laboratory abnormalities. These findings emphasize the need for targeted preventive, diagnostic, and management strategies to optimize pediatric healthcare outcomes in Bangladesh.
Functional Outcomes of Closed Tibial Shaft Fractures Treated with Suprapatellar Intramedullary Nailing – A Prospective Study
Background: Tibial shaft fractures are among the most common long bone fractures with high incidence in young adults. Intramedullary nailing is the gold standard of fixation, and the suprapatellar approach has gained popularity due to technical advantages. Evidence on functional outcomes in closed fractures is still lacking, however. Objectives: The aim of this study was to assess the functional outcomes of closed tibial shaft fractures treated with suprapatellar intramedullary nailing. Methods & Materials: This prospective observational study was conducted in the Department of Orthopaedics, National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Sher-E-Bangla Nagar, Dhaka, Bangladesh, for one year period from March 2022 to March 2023. Total 33 adult patients with closed tibial shaft fractures were enrolled. Results: In this study, mean age was 38.3 ± 11.6 years with male predominance (69.7%). Fractures of AO type 42A were most common (54.5%). The mean knee ROM at last follow-up was 130.3 ± 8.6°. The majority of patients (72.7%) had fair functional outcomes, 18.2% good, and 9.1% poor. The average VAS was 0.5, and anterior knee pain was complained of by only 15.2%. Lysholm scores improved significantly from 83.1 at 6 months to 93.8 at 12 months (p<0.001). Conclusion: Suprapatellar nailing for closed tibial shaft fractures produces good functional outcomes, few complications, and gradual improvement, justifying its use as a safe and effective method of fixation.
Functional Outcomes of Closed Tibial Shaft Fractures Treated withSuprapatellar Intramedullary Nailing
Comparative Outcomes between Off-Clamp and On-Clamp Nephron-Sparing Surgery – A Retrospective Analysis
Objective: To compare perioperative and functional outcomes between off-clamp and on-clamp techniques during nephron-sparing surgery (NSS). Methods & Materials: A retrospective study of 70 patients who underwent NSS for renal tumors between January 2020 and July 2025. Patients were divided into two groups: Off-Clamp NSS (Group A, n=34) and On-Clamp NSS (Group B, n=36). Data on operative time, estimated blood loss (EBL), warm ischemia time (WIT), complications, and renal functional outcomes (eGFR changes) were analyzed. Results: Group A showed significantly higher EBL (p=0.02) but better postoperative renal function preservation (mean eGFR drop: 5.6% vs 11.4%, p<0.001). Group B had shorter operative times and less intraoperative bleeding. No significant difference was observed in complication rates or oncologic margin positivity. Conclusion: Off-clamp NSS offers superior renal functional preservation compared to on-clamp NSS at the expense of higher blood loss. Patient selection remains crucial, and off-clamp NSS may be particularly beneficial in younger patients with baseline impaired renal function.
Laparoscopic versus Open Surgical Repair Techniques in Duodenal Ulcer Perforation – A Prospective Observational study
Background: Perforated duodenal ulcer is a common surgical emergency. Traditionally managed with open repair, laparoscopic techniques have emerged as a minimally invasive alternative. This study compares the clinical outcomes of laparoscopic versus open repair of duodenal ulcer perforation. Methods & Materials: A prospective observational study was conducted on 60 patients diagnosed with duodenal ulcer perforation between [study period]. Patients were divided into two groups: laparoscopic repair (n=30) and open repair (n=30). Data collected included operative time, postoperative pain (VAS score), time to ambulation, resumption of oral feeds, length of hospital stay, postoperative complications, and mortality. Results: The mean operative time was slightly longer in the laparoscopic group (90±20 min vs. 60±15 min, p<0.05). However, laparoscopic repair was associated with lower postoperative pain scores, earlier ambulation (1.5 vs. 3.0 days), faster initiation of oral feeding (2.0 vs. 3.5 days), and shorter hospital stay (5 or 6 days, p<0.01). The complication rate was lower in the laparoscopic group (13.3% vs. 26.6%), though not statistically significant. Mortality one in open group, none in the laparoscopic group (1 case each). Conclusion: Laparoscopic repair of duodenal ulcer perforation, though technically more challenging and requiring longer operative time, is associated with faster recovery, less postoperative pain, and reduced hospital stay compared to open repair. It should be considered the preferred approach in stable patients where expertise and facilities are available.
Epidural Labour Analgesia and Programmed Labour Analgesia in Controlling Labour Pain – A Study of 60 Cases
Background: Labour pain is one of the most severe forms of pain experienced by women. Analgesia during labour is a crucial component of modern obstetric practice. Epidural labour analgesia is considered the gold standard, but newer methods such as programmed labour analgesia (PLA) are increasingly being explored for efficacy, maternal satisfaction, and neonatal outcomes.Objective: To compare the efficacy, maternal satisfaction, and obstetric/neonatal outcomes of epidural labour analgesia versus programmed labour analgesia in controlling labour pain. Methods & Materials: This prospective comparative study was conducted on 60 parturients admitted for vaginal delivery. Thirty women received epidural analgesia (Group A), while thirty received programmed labour analgesia (Group B). Pain relief was assessed using a Visual Analogue Scale (VAS). Maternal hemodynamic parameters, labour duration, mode of delivery, maternal side effects, neonatal outcomes (APGAR score), and overall maternal satisfaction were recorded and compared. Results: Both groups demonstrated significant reduction in VAS scores after initiation of analgesia. Group A (epidural) achieved superior pain relief with mean VAS scores consistently <3 during active labour, while Group B (PLA) showed moderate pain relief with mean VAS scores around 4–5. Duration of first stage of labour was slightly prolonged in the epidural group compared to PLA. Maternal hypotension occurred more frequently in the epidural group (20%) versus PLA (6.6%). No significant differences were observed in APGAR scores between groups. Maternal satisfaction was high in both groups, but significantly greater in the epidural group (p<0.05). Conclusion: Both epidural labour analgesia and programmed labour analgesia are effective in controlling labour pain, but epidural analgesia provides superior pain relief and higher maternal satisfaction at the expense of slightly prolonged labour and increased maternal hypotension. Programmed labour analgesia may be considered as a safe alternative where epidural services are limited.
Analysis of Biochemical and Hematological Parameters of Chronic Kidney Disease Patients with Hemodialysis
Background: Chronic Kidney Disease (CKD) poses a significant public health burden worldwide, especially in low- and middle-income countries like Bangladesh. Hemodialysis (HD), the most common renal replacement therapy in the region, is associated with a wide range of biochemical and hematological disturbances that impact patient outcomes. Aim of the study: To evaluate and compare biochemical and hematological parameters in CKD patients undergoing maintenance hemodialysis with healthy controls to identify key abnormalities for better clinical management. Methods & Materials: A cross-sectional analytical study was conducted at Dhaka Medical College Hospital from October 2018 to September 2019 involving 90 participants: 45 CKD patients on hemodialysis and 45 age- and sex-matched healthy controls. Various biochemical, hematological, and liver enzyme parameters were analyzed using standardized laboratory methods. Statistical analysis was performed using SPSS v22.0, with a p-value ≤ 0.05 considered significant. Result: Significant differences were observed between the case and control groups in several parameters. CKD patients showed elevated levels of creatinine, urea, phosphate, and ALP, and reduced calcium levels. Hematological analysis revealed lower hemoglobin, hematocrit, red blood cell count, platelet count, and total leukocyte count. Liver enzymes ALT and AST were significantly lower in CKD patients, while ALP was markedly higher (p < 0.001 for all). Conclusion: CKD patients on hemodialysis experience profound biochemical and hematological alterations, underscoring the need for routine monitoring to improve patient outcomes and inform treatment strategies.
Vitamin D Deficiency in Patients with Systemic Lupus Erythematosus: Prevalence and Clinical Associations
Background: Systemic lupus erythematosus (SLE) is a complex autoimmune disease characterized by multisystem involvement and significant morbidity. Vitamin D, known for its immunomodulatory properties, has been increasingly linked to disease activity and clinical outcomes in autoimmune conditions, including SLE. Despite abundant sunlight in Bangladesh Objectives: This study aimed to determine the prevalence of vitamin D deficiency in Bangladeshi patients with SLE and to explore its association with disease activity and organ involvement. Methods & Naterial: This cross-sectional study was conducted over one year at Dhaka Medical College Hospital and included 130 adult patients diagnosed with SLE according to the ACR 1997 criteria. Participants were categorized based on serum 25(OH)D levels into three groups: deficient (<20 ng/mL), insufficient (20–29 ng/mL), and sufficient (≥30 ng/mL). Results: Vitamin D deficiency was present in 64.6% (n=84) of patients. Deficient patients showed significantly higher disease activity scores (mean SLEDAI 14.2±3.9 vs. 9.8±2.7, p<0.001), increased renal involvement (46.4% vs. 16.7%, p=0.043), and higher anti-dsDNA positivity (76.2% vs. 50.0%, p=0.037) compared to sufficient patients. Complement levels (C3 and C4), ESR, and CRP were significantly lower in deficient patients. Conclusion: Vitamin D deficiency is highly prevalent in Bangladeshi SLE patients and is significantly associated with increased disease activity and renal involvement. Routine assessment and supplementation of vitamin D may serve as a simple, cost-effective adjunct in the management of SLE to potentially reduce disease severity and improve outcomes.
Impact of Hemodialysis Duration and Clinical Factors on Bone Mineral Density
Background: Patients with end-stage renal disease (ESRD) on maintenance hemodialysis face increased risk of bone mineral density loss due to disrupted mineral metabolism and chronic inflammation. Identifying key determinants of low BMD is crucial for effective prevention and management. Aim of the study: To evaluate the impact of hemodialysis duration and associated clinical factors on bone mineral density at different anatomical sites in patients with end-stage renal disease (ESRD). Methods & Materials: This cross-sectional study included 60 hemodialysis patients. BMD and T-scores at the spine, hip, and forearm were measured using DEXA. Clinical, biochemical, and inflammatory factors were analyzed using correlation and regression to identify predictors of low BMD. Result: The mean age was 52.4 ± 10.3 years, with a mean dialysis duration of 48.6 ± 22.8 months. BMD was lower in patients with longer dialysis duration, with correlations of −0.412 (spine), −0.389 (hip), and −0.498 (forearm) (p < 0.01). Male gender and absence of diabetes were linked to higher BMD (p < 0.05). Elevated phosphate and PTH, and reduced vitamin D correlated with lower BMD (p < 0.05). Regression identified dialysis duration (β = −0.362, p = 0.003), PTH (β = −0.298, p = 0.007), phosphate (β = −0.251, p = 0.016), and CRP (β = −0.209, p = 0.030) as key predictors. Conclusion: Our findings indicate that longer dialysis duration, high PTH, phosphate, and inflammation predict low BMD in ESRD patients, highlighting the need for early bone health management.
Assessment of Serum Phosphate, Calcium, and Parathyroid Hormone Levels in Relation to Metabolic Disturbances in Maintenance Hemodialysis Patients
Background: Maintenance hemodialysis (MHD) is the primary treatment for end-stage renal disease (ESRD), but it is associated with significant metabolic disturbances. Serum phosphate, calcium, and parathyroid hormone (PTH) imbalances contribute to chronic kidney disease-mineral and bone disorder (CKD-MBD), which increases morbidity and cardiovascular risks. Understanding the relationship between these biochemical parameters and metabolic disturbances is crucial for improving patient management. Aim: To assess the relationship between serum phosphate, calcium, and PTH levels with metabolic disturbances in MHD patients in Bangladesh. Methods & Materials: A cross-sectional study was conducted at Dhaka Medical College Hospital with 80 MHD patients. Clinical and biochemical data, including serum phosphate, calcium, iPTH, and lipid profiles, were analyzed using SPSS (version 26). Correlation analysis was performed to examine associations between metabolic disturbances and biochemical markers. Results: Mean serum phosphate, calcium, and iPTH levels were 5.56±1.36 mg/dl, 8.74±1.30 mg/dl, and 274.59±150.34 pg/ml, respectively. Significant correlations were found between metabolic disturbances and serum phosphate (r=0.652, p<0.001), iPTH (r=0.725, p<0.001), and LDL-C (r=0.382, p=0.008), while serum calcium showed a negative correlation (r=-0.320, p=0.012). Conclusion: Hyperphosphatemia, secondary hyperparathyroidism, and dyslipidemia contribute to metabolic disturbances in MHD patients. Effective biochemical management is crucial for improving patient outcomes. Further studies with larger cohorts are recommended to validate these findings.
Parathormone as a Risk Factor for Cardiac Dysfunction in Individuals Undergoing Hemodialysis
Background: Elevated parathyroid hormone (iPTH) levels have been associated with adverse cardiovascular outcomes in hemodialysis patients. This study aims to explore the relationship between elevated iPTH levels and cardiac dysfunction, with a focus on left ventricular ejection fraction (LVEF), left ventricular hypertrophy (LVH), and other cardiovascular markers. Objectives: To explore the role of parathyroid hormone (PTH) as a potential risk factor for cardiac dysfunction in individuals undergoing hemodialysis. Methods & Material: A total of 215 hemodialysis patients were enrolled and categorized into elevated iPTH and normal iPTH groups. Demographic data, dialysis duration, biochemical markers, and cardiovascular parameters, including LVEF, LVH, B-type natriuretic peptide (BNP), and carotid intima-media thickness (CIMT), were assessed. Logistic regression and multivariate linear regression were used to evaluate the relationship between iPTH and cardiovascular outcomes. Result: The elevated iPTH group had significantly lower LVEF (50.1% vs. 56.4%, p<0.001), higher prevalence of LVH (70% vs. 48.2%, p=0.002), and elevated BNP and CIMT levels (p<0.001). Multivariate analysis revealed that iPTH levels were independently associated with reduced LVEF and increased cardiovascular risk (adjusted OR: 2.34, p=0.012). Serum calcium and phosphorus imbalances were also significant predictors of cardiovascular dysfunction. Conclusion: Elevated iPTH levels are significantly associated with adverse cardiovascular outcomes, including reduced LVEF, increased LVH, and elevated BNP and CIMT, in hemodialysis patients. These findings highlight the critical role of iPTH in cardiovascular pathology and suggest that controlling iPTH levels could improve cardiovascular health in this population.