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 Body Mass Index and Serum Lipid Profile Among the School Children
Background: Childhood obesity is an increasing global health concern and is expected to impose a substantial burden on individuals and healthcare systems. Obesity is a complex condition influenced by multiple genetic, environmental, and lifestyle factors and is associated with abnormal lipid profiles in children, increasing the risk of future cardiovascular disease. The aim of this study was to evaluate the association between high body mass index (BMI) and dyslipidemia among school children. Methods & Materials: This cross-sectional study was conducted from January to December 2019 in the Department of Biochemistry, Dhaka Medical College, Dhaka. School children aged 12-17 years were purposively selected based on history, physical examination, and relevant investigations. BMI and BMI percentile were assessed, and fasting serum lipid profile (TC, TG, LDL-C, and HDL-C) was measured using enzymatic methods. Written informed consent was obtained from participants and their parents. Data were collected using a pre-designed data sheet and analyzed with SPSS version 22.0. Statistical significance was set at p < 0.05. Results: Mean ± SD age of the study subjects was 13.5 ± 1.4. Among 12- to 17-year-olds, 3% were obese, 16.4% were overweight and 26.9% were underweight. The prevalence of hypercholesterolaemia, hypertriglyceridaemia, high level of low-density lipoprotein cholesterol (LDL-C) and low level of high-density lipoprotein cholesterol (HDL-C), were: 8.2%, 21.6%, 6.7% and 31.3% respectively. Increased level of serum level of TC, TG, LDL-C were found significant correlation with BMI and HDL-C showed a significant negative correlation with increased BMI. Conclusion: This study revealed overweight and obesity is common among the study subjects and those with higher BMI tend to have abnormal lipid profile.
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Anatomical Site Distribution of Histopathologically Confirmed Intestinal Tuberculosis in Surgically Managed Patients
Introduction: Intestinal tuberculosis is one of the common forms of extrapulmonary tuberculosis in endemic countries and frequently presents with nonspecific clinical features, making early diagnosis challenging. Knowledge of the common anatomical sites of involvement is important for accurate diagnosis, appropriate surgical planning, and effective patient management. The present study was undertaken to determine the anatomical site distribution of histopathologically confirmed intestinal tuberculosis in surgically managed patients. Methods & Materials: This descriptive cross-sectional observational study was conducted in the Department of Surgery of Uttara Adhunik Medical College Hospital (UAMCH) and Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh, from January 2015 to December 2015. Purposive sampling was employed, and 30 histopathologically confirmed intestinal tuberculosis patients were included in the study. Data were analysed using the Statistical Package for Social Sciences (SPSS) version 20.0. Result: The mean age of the patients was 31.1 ± 9.7 years (range: 15-58 years), with the highest 40.0% belonging to the 21-30-year age group. Abdominal pain (83.3%), weight loss (76.7%), and fever, malaise, and anorexia (60.0%) were the most common presenting symptoms, while pallor (86.7%), distended abdomen (63.3%), and abdominal tenderness and palpable abdominal mass (56.7% each) were the predominant physical signs. The ileocaecal region was the most frequently involved anatomical site (56.7%), followed by the ileum (20.0%), whereas isolated involvement of the caecum (10.0%), colon (10.0%), and jejunum (3.3%) was relatively uncommon. Conclusion: The ileocaecal region was identified as the most commonly involved anatomical site, followed by the ileum, whereas isolated lesions of the caecum, colon, and jejunum were relatively infrequent. These findings reaffirm the characteristic predilection of intestinal tuberculosis for the ileocaecal region and highlight the importance of maintaining a high index of suspicion in patients presenting with lesions at this site.
Histopathological Patterns of Renal Injury in Gentamicin-Exposed Wistar Rats Following Turmeric Essential Oil and Losartan Treatment
Introduction: Gentamicin-induced nephrotoxicity is characterized by proximal tubular degeneration, necrosis, inflammatory infiltration, vascular congestion, and interstitial changes. Turmeric-derived preparations and losartan have been investigated as potential modifiers of renal injury, although direct histopathological evidence concerning turmeric essential oil remains limited. Aim: To describe and compare renal histopathological patterns in gentamicin-exposed Wistar rats treated with turmeric essential oil or losartan. Methods & Materials: This experimental animal study was conducted at the Department of Pharmacology and Therapeutics, Sir Salimullah Medical College, Dhaka, Bangladesh, from July 2019 to June 2020. Twenty-five adult male Wistar rats were randomly allocated to five groups of five animals. Group A received normal saline. Group B received gentamicin 80 mg/kg/day intraperitoneally on days 8-14. Groups C and D received turmeric essential oil at 50 and 100 mg/kg/day orally, respectively, for 14 days, together with gentamicin on days 8-14. Group E received losartan 10 mg/kg/day orally for 14 days, together with gentamicin on days 8-14. Renal sections were stained with haematoxylin and eosin and assessed for inflammatory-cell infiltration, vascular congestion, proximal tubular injury, epithelial regeneration, and interstitial vacuolation using ordinal grades from 0 to 4. Results: The gentamicin-treated group showed inflammatory-cell infiltration grade 4, vascular congestion grade 3, proximal tubular injury grade 3, and interstitial vacuolation grade 2. Tubular necrosis and desquamation involved more than 50% of proximal tubules, and regeneration was absent. With turmeric essential oil at 50 mg/kg/day, inflammation was grade 2, while congestion, tubular injury, and vacuolation were grade 1. With turmeric essential oil at 100 mg/kg/day and losartan, all four injury domains were grade 1. Tubular epithelial regeneration was present in all three intervention groups. Conclusion: Turmeric essential oil and losartan were associated with lower renal histopathological lesion grades than gentamicin alone. The findings were descriptive and did not establish statistical superiority or equivalence between treatments. Assistant Professor, Department of Pharmacology, Jamalpur Medical College, Jamalpur, Bangladesh mazpramanik@gmail.com (ORCID: 0009-0006-2838-8790) Lecturer, Department of Pharmacology, Jamalpur Medical College, Jamalpur, Bangladesh Assistant Professor (In situ), Department of Pharmacology, Jamalpur Medical College, Jamalpur, Bangladesh INTRODUCTION Despite its recognized nephrotoxicity, gentamicin remains widely used against serious Gram-negative infections because of its rapid bactericidal activity, clinical familiarity, and relatively low cost. Following glomerular filtration, gentamicin is taken up preferentially by proximal tubular epithelial cells, where intracellular accumulation is associated with lysosomal dysfunction, mitochondrial injury, reactive oxygen species generation, inflammatory signalling, apoptosis, and necrosis [1]. Structurally, gentamicin-associated injury is expressed predominantly in the renal cortex and includes tubular epithelial swelling, vacuolation, degeneration, desquamation, necrosis, luminal cellular debris, interstitial inflammatory-cell infiltration, vascular congestion, and subsequent regenerative activity. In Wistar rats, progressive cortical tubular degeneration, necrosis, cytolysis, desquamation, mesangial alterations, and capillary congestion were observed with increasing gentamicin dose and duration [2]. Likewise, progression from focal inflammatory-cell collections and tubular basophilia to more evident degeneration, necrosis, casts, and interstitial inflammation was documented after repeated gentamicin exposure [3]. More recently, tubular degeneration, necrosis, inflammatory infiltration, congestion, and interstitial changes have continued to be used as principal structural indicators of gentamicin-associated injury, often alongside molecular and urinary biomarkers [4,5]. Consequently, histopathological examination provides direct evidence of lesion location, type, and severity and remains central to the evaluation of structural renal injury. Unlike isolated serum measurements, tissue examination can distinguish predominantly tubular, interstitial, vascular, or glomerular involvement and can document coexisting degeneration and regeneration within the same experimental model. Because oxidative stress and inflammation are closely associated with gentamicin-induced tubular damage, turmeric-derived preparations have been investigated as potential modifiers of renal tissue injury. Following turmeric administration in gentamicin-exposed rats, lower histopathological injury grades and less severe tissue disruption were reported than with gentamicin alone [6]. Similarly, reductions in tubular degeneration, necrosis, inflammatory abnormalities, and apoptosis were observed with curcumin treatment in experimental gentamicin nephrotoxicity [7]. Additionally, mitochondrial integrity was preserved, and gentamicin-induced renal cortical injury was attenuated following curcumin administration [8]. More recently, conventional and liposomal curcumin were both associated with improved renal cytoarchitecture, while formulation-dependent differences in histopathological protection were identified [9]. Furthermore, dose-related reductions in renal injury, oxidative stress, endoplasmic reticulum stress, and apoptosis were reported with curcumin pretreatment, although incremental benefits became smaller at higher doses [10]. Nevertheless, turmeric essential oil is chemically distinct from whole turmeric and curcumin-rich preparations. Within the oil, volatile sesquiterpenes, particularly ar-turmerone, α-turmerone, and β-turmerone, predominate, whereas curcuminoids are generally absent or present only in negligible quantities [11]. In a cadmium-induced rat model, turmeric essential oil was associated with improved renal-function indicators and modulation of inflammatory cytokines, supporting possible renal activity of the oil itself, although gentamicin-associated renal histopathology was not examined [12]. Alongside botanical interventions, losartan has been evaluated as a pharmacological comparator. Reduced renal damage was reported when losartan at 10 mg/kg/day was administered with gentamicin at 80 mg/kg/day, whereas worsening nephrotoxicity was reported with a substantially higher losartan dose [13,14]. Thus, evidence concerning losartan appears dependent on dose and experimental conditions. Given the limited preparation-specific evidence for turmeric essential oil and the scarcity of direct histopathological comparisons with losartan, the present study described renal lesion patterns across normal control, gentamicin-exposed, turmeric-essential-oil-treated, and losartan-treated Wistar rats. METHODS & MATERIALS Study design and setting Between July 2019 and June 2020, a controlled experimental animal study was conducted in the Department of Pharmacology and Therapeutics, Sir Salimullah Medical College, Dhaka, in collaboration with the Institute of Nutrition and Food Science, University of Dhaka. Ethical approval was obtained from the Institutional Ethics Committee of Sir Salimullah Medical College, Dhaka. Experimental animals and sample size A total of 25 healthy adult male Wistar albino rats (Rattus norvegicus), aged approximately 10-12 weeks and weighing 150-200 g, were obtained from the animal house of the Department of Pharmacology, Bangabandhu Sheikh Mujib Medical University, Dhaka. By applying the resource-equation method, the error degrees of freedom were calculated as E=N−G=25−5=20, where N represented the total number of animals and G represented the number of experimental groups. Following a seven-day acclimatization period, the animals were randomly allocated to five groups of five rats each. Throughout the experiment, the rats were maintained in labelled metallic cages measuring approximately 38×23×15 cm, with each experimental group housed separately. Under a 12-hour light and 12-hour dark cycle, the animal room was maintained at approximately 26-28°C. Standard laboratory feed and drinking water were provided ad libitum. Regular cage cleaning, waste removal, and daily observation were undertaken throughout the study. Preparation of turmeric essential oil Fresh turmeric (Curcuma longa) rhizomes were collected locally and authenticated by the Institute of Nutrition and Food Science, University of Dhaka. After washing, surface drying, and slicing, 500 g of rhizomes were mixed with 1 L of distilled water and subjected to hydrodistillation at approximately 105°C for four hours. Subsequently, the essential oil was separated from the upper layer of the distillate, transferred to a tightly sealed amber bottle, and stored in a dark place until administration. Experimental interventions All oral interventions were administered once daily through an orogastric tube. To induce renal injury, gentamicin was administered intraperitoneally at 80 mg/kg/day from days 8 to 14 in Groups B, C, D, and E. Details of the experimental groups and treatment schedules are presented in (Table I). Table I: Distribution of experimental rats and treatment schedule Group Experimental designation n Treatment during days 1-7 Treatment during days 8-14 A Normal control 5 Normal saline, 20 mL/kg/day orally Normal saline, 20 mL/kg/day orally B Gentamicin-treated control 5 No active treatment Gentamicin, 80 mg/kg/day intraperitoneally C Turmeric essential oil, 50 mg/kg group 5 Turmeric essential oil, 50 mg/kg/day orally Turmeric essential oil, 50 mg/kg/day orally, plus gentamicin, 80 mg/kg/day intraperitoneally D Turmeric essential oil, 100 mg/kg group 5 Turmeric essential oil, 100 mg/kg/day orally Turmeric essential oil, 100 mg/kg/day orally, plus gentamicin, 80 mg/kg/day intraperitoneally E Losartan-treated group 5 Losartan, 10 mg/kg/day orally Losartan, 10 mg/kg/day orally, plus gentamicin, 80 mg/kg/day intraperitoneally
Factors Associated with Delayed Presentation Among Patients with First-Episode Psychosis in Bangladesh
Introduction: First-episode psychosis is a critical stage in the course of psychotic disorders, and timely initiation of treatment is associated with better clinical and functional outcomes. In Bangladesh, evidence regarding the determinants of delayed presentation in first-episode psychosis remains limited. Therefore, this study aims to assess the factors associated with delayed presentation among patients with first-episode psychosis in Bangladesh. Methods & Materials: This observational analytical cross-sectional study was conducted among patients with first-episode psychosis attending the Department of Psychiatry in Combined Military Hospital, Dhaka, Bangladesh, from January 2022 to December 2022. A total of 104 patients fulfilling the diagnostic criteria for first-episode psychosis were included using purposive sampling. Data were analyzed using SPSS version 26.0. Results: 64 (61.5%) had delayed presentation to psychiatric services, with a median duration of untreated psychosis of 9 months (IQR 4-16 months). Most patients were 25-34 years old (44.2%), male (59.6%), from rural areas (63.5%), and had schizophrenia-spectrum disorders (71.2%). Traditional or religious healers were the most common first source of help (40.4%), while stigma (34.6%) and lack of awareness (28.8%) were the leading perceived barriers. Delayed presentation was significantly associated with rural residence (75.8% vs 36.8%, p=0.001), primary or lower education (76.5%, p=0.015), unemployment (73.1%, p=0.026), insidious onset of symptoms (85.0%, p<0.001), first consultation with traditional or religious healers (81.0%, p<0.001), and perceived stigma (83.3% vs 50.0%, p=0.002), whereas substance use showed no significant association (p=0.397). Conclusion: This study found that delayed presentation was frequent among patients with first-episode psychosis in Bangladesh, with almost two-thirds not receiving treatment within six months of symptom onset. Longer delays were significantly linked to rural residence, lower levels of education, unemployment, gradual onset of symptoms, first seeking care from traditional or religious healers, and the presence of stigma related to mental illness.
Clinical Outcome of Ilizarov External Fixation in Gustilo-Anderson Type III Open Tibial Fractures
Background: Open tibial fractures, particularly Gustilo-Anderson type III lesions, present formidable challenges due to high infection and nonunion risks. The Ilizarov technique provides stable mechanical fixation while promoting osteogenesis, yet regional outcome data remain sparse. Objective: To assess the bone union rate and functional recovery following Ilizarov external fixation in these severe fractures. Methods & Materials: This prospective cohort study was performed at National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka, from January 2023 to December 2025. A total of 47 purposively selected patients with type III open tibial fractures underwent Ilizarov frame application. Postoperative follow-up continued until union or for at least 12 months. Bone and functional outcomes were graded using the ASAMI scoring system. SPSS v23.0 was used for analysis. Results: Primary union occurred in 42 patients (89.4%), with a mean consolidation time of 4.8 months (range 3.2-7.5). ASAMI bone scores showed 31 excellent (66.0%) and 11 good (23.4%) outcomes. Functional outcomes were excellent in 28 (59.6%) and good in 13 (27.7%). Superficial pin-site infections developed in 9 cases (19.1%), and malunion in 5 (10.6%). Conclusion: The Ilizarov method demonstrates high efficacy for managing Gustilo-Anderson type III open tibial fractures, achieving robust bone healing and acceptable function with manageable complications in our cohort.
Diagnostic Accuracy of Ultrasonography Compared with Magnetic Resonance Imaging for Rotator Cuff Pathologies of the Shoulder: A Cross-Sectional Study
Background: Rotator cuff disorders are common causes of shoulder pain and functional impairment. Accurate imaging is important for identifying tendon abnormalities and guiding appropriate management. Ultrasonography (USG) is a readily available, non-invasive, and cost-effective imaging modality, whereas magnetic resonance imaging (MRI) provides comprehensive multiplanar assessment of soft-tissue structures. This study evaluated the diagnostic accuracy of USG compared with MRI for detecting rotator cuff pathologies of the shoulder. Methods & Materials: This cross-sectional study included 40 participants with clinically suspected shoulder musculotendinous pathology. We compared USG findings with MRI findings to detect rotator cuff abnormalities, particularly involving the supraspinatus, subscapularis, and infraspinatus tendons. Diagnostic performance was assessed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, and Cohen's kappa agreement. Results: The mean age of participants was 50.1 ± 10.8 years, and 70.0% were male. USG demonstrated high diagnostic performance for supraspinatus abnormalities, with sensitivity ranging from 91.7% to 100.0%, specificity from 95.5% to 97.2%, and accuracy from 95.0% to 97.5%. For subscapularis lesions, sensitivity ranged from 92.9% to 100.0%, specificity from 96.2% to 100.0%, and accuracy from 95.0% to 100.0%. Infraspinatus lesions showed comparatively lower sensitivity, particularly for partial-thickness tears (66.7%) and tendinosis (75.0%), although specificity remained high. Conclusion: USG demonstrated high diagnostic accuracy and substantial-to-almost-perfect agreement with MRI for most rotator cuff pathologies. It may therefore serve as a useful first-line imaging modality, while MRI remains valuable for equivocal or complex lesions.
Correlation between Physical Activity Level and Disease Activity in Axial Spondyloarthritis
Background: Axial spondyloarthritis is a chronic inflammatory rheumatic disease associated with pain, stiffness, functional impairment, and reduced quality of life. Although physical activity is a key component of non-pharmacological management and has beneficial effects on disease outcomes, patients with axSpA are generally less physically active, and higher disease activity may be associated with lower physical activity participation. Objective: The aim of the study was to assess the correlation between physical activity level and disease activity among patients with axial spondyloarthritis. Methods & Materials: This cross-sectional observational study was conducted at the Department of Physical Medicine and Rehabilitation, Bangladesh Medical University (BMU), Dhaka, Bangladesh, from January 2025 to December 2025. Eighty patients with axial spondyloarthritis were enrolled. Disease activity, functional status, and physical activity level were assessed using BASDAI, BASFI, and IPAQ-SF, respectively. Data were analyzed using SPSS version 26.0, with p <0.05 considered statistically significant. Results: Among 80 patients with axial spondyloarthritis, moderate physical activity was the most common level (46.3%), while 60.0% had active disease. Mean BASDAI scores decreased significantly with increasing physical activity, from 5.6 ± 1.4 in the low-activity group to 3.6 ± 1.2 in the high-activity group (p < 0.001). Physical activity showed significant negative correlations with BASDAI (r = −0.52) and BASFI (r = −0.44), both p < 0.001. The mean BASDAI, BASFI, BASMI, and pain scores were 4.8 ± 1.6, 4.3 ± 1.5, 4.2 ± 1.4, and 5.3 ± 1.7, respectively, while the mean CRP and ESR levels were 11.8 ± 8.6 mg/L and 28.4 ± 17.2 mm/hr, respectively. Conclusion: Higher physical activity levels were significantly associated with lower disease activity and better functional status among patients with axial spondyloarthritis.
Seasonal Variance in the Incidence Rate of Epistaxis: An Observational Study
Background: Epistaxis is a common otorhinolaryngological emergency with variable etiological factors. Seasonal influences on its incidence remain underreported in tropical regions like Bangladesh, where climatic conditions fluctuate markedly. Objective: To determine the seasonal variance in the incidence rate of epistaxis among patients presenting to a tertiary care hospital in Bangladesh. Methods & Materials: A prospective observational study was conducted at Department of ENT, Mymensingh Medical College Hospital, Mymensingh, Bangladesh, from January 2024 to December 2025. A total of 143 patients with epistaxis were enrolled using purposive sampling. Data were analyzed using SPSS version 23.0. Seasonal categorization followed the standard Bangladeshi pattern: winter (December-February), summer (March-May), monsoon (June-September), and autumn (October-November). Incidence rates across seasons were compared. Results: Of 143 patients, the highest incidence of epistaxis occurred in winter (n=66, 46.2%), followed by summer (n=38, 26.6%), monsoon (n=22, 15.4%), and autumn (n=17, 11.9%), with a statistically significant seasonal difference (p<0.001). The bimodal age distribution showed peaks at 6-15 years (n=51, 35.7%) and 51-70 years (n=47, 32.9%). Anterior bleeding predominated (n=124, 86.7%). Male preponderance was observed (n=88, 61.5%). Conclusion: Epistaxis in Dhaka demonstrates significant winter predominance. The bimodal age distribution and anterior bleeding pattern align with global literature. These findings support seasonal resource allocation and preventive strategies during high-risk winter months.
Prevalence of Cardiometabolic Risk Factors and Estimated 10-Year ASCVD Risk among Rural Older Adults in Bangladesh
Introduction: Cardiometabolic risk among older adults in rural Bangladesh is poorly characterised. Understanding the prevalence of cardiovascular risk factors and overall cardiovascular risk is important for targeted prevention. Objectives: To determine the prevalence of cardiometabolic risk factors and estimate the 10-year risk of atherosclerotic cardiovascular disease (ASCVD) among older adults living in rural Bangladesh. Methods & Materials: We conducted a community-based cross-sectional study among 405 adults aged 60-74 years from six rural villages in Dohar, Bangladesh, from February 2019 to March 2020. Sociodemographic, lifestyle, anthropometric, blood pressure, and biochemical data were collected. The 10-year ASCVD risk was estimated using the 2013 ACC/AHA Pooled Cohort Equations. Results: Dyslipidemia (60.7%), hypertension (37.5%), microalbuminuria (36.5%), diabetes mellitus (20.0%), and chronic kidney disease (9.6%) were common. Overall, 90.6% of participants had at least one cardiovascular risk factor or marker. A high estimated 10-year ASCVD risk (≥20%) was present in 22.5% of participants and was associated with male sex, age >65 years, current smoking, and unemployment or dependency. Conclusion: Cardiometabolic risk factors were highly prevalent among older adults in rural Bangladesh. Community-based cardiovascular risk assessment and targeted management of modifiable risk factors are needed. Interpret ASCVD risk estimates cautiously because the Pooled Cohort Equations have not been locally validated.
Clinical Spectrum and Presenting Features of Presumptive Tuberculous Meningitis in Children
Introduction: Tuberculous meningitis (TBM) is a severe childhood tuberculosis that causes serious neurological problems and high death rates in low-resource settings. It is hard to diagnose early because symptoms are nonspecific and tests have low sensitivity with scarce CSF samples. Delays in diagnosis are common and lead to worse outcomes. Objective: This study aimed to describe the demographic, clinical, CSF, and imaging profiles and severity patterns in children with presumptive TBM. Methods & Materials: This descriptive cross-sectional study was carried out at Dhaka Medical College Hospital over one year, involving 96 children aged 1 month to 12 years with suspected TBM. The assessments encompassed clinical examination, GCS scoring, CSF cytology and biochemistry, brain MRI, and chest X-ray. Results: Children under 5 years made up 67.7%, with a mean age of 3.82 years, mostly male (1.5:1) and from rural areas (72.9%). Fever was universal (100%), followed by irritability (55.2%), altered consciousness (44.8%), and convulsions (42.7%). GCS indicated moderate (46.9%) and severe (17.7%) impairment. Severity was related to convulsions (p=0.042), altered consciousness (p=0.001), focal deficits (p=0.008), and neck rigidity (p=0.045). CSF showed lymphocytic dominance, high protein (87.8 mg/dl), and low glucose (51.2 mg/dl). MRI findings included basal enhancement (53.7%), infarcts (14.9%), and hydrocephalus (10.4%). Chest X-ray was normal in 71.9%. Contact history was noted in 17.7%. Only 30.2% were probable TBM, with 69.8% possible. Conclusion: Young males from rural families are at the highest risk. Persistent fever, altered consciousness, and seizures should alert clinicians in endemic areas. The prominence of TBM cases underscores the urgent need for better rapid diagnostics and targeted actions to cut mortality and prevent disabilities.
Association of Sociodemographic Factors with Severity of Substance Use Risk among Bangladeshi Adolescents
Background: Adolescent substance use is a growing public health concern, strongly influenced by sociodemographic and family-related factors, leading to varying degrees of risk severity. Aim of the study: To assess the association between sociodemographic factors and severity of substance use risk among Bangladeshi adolescents. Methods & Materials: This cross-sectional study was conducted over two years (October 2020-September 2022) in tertiary psychiatric and de-addiction centers in Bangladesh. A total of 140 adolescents aged 12-19 years were selected using purposive sampling. Data were collected through a structured questionnaire, and substance use risk was assessed using a CRAFFT-based categorization (low, moderate, high, very high). Statistical analysis was performed using chi-square test and multivariable logistic regression, with p<0.05 considered significant. Result: Most participants were male (93.6%), aged 17-19 years (50.0%). Low, moderate, high, and very high risk were 51.4%, 30.7%, 14.3%, and 3.6%, respectively. Significant associations were observed between substance use severity and age (p=0.018), gender (p=0.041), residence (p=0.027), education (p=0.033), family income (p=0.012), parental education (p<0.05), family conflict (p=0.001), and peer influence (44.3%). Multivariable analysis identified peer influence (AOR=3.12), family conflict (AOR=2.41), and low parental education (AOR=1.95) as key predictors. Conclusion: Sociodemographic and family-related factors significantly influence the severity of substance use risk among Bangladeshi adolescents. Peer influence, family conflict, and parental education emerged as the strongest determinants. Early identification of high-risk groups and targeted family- and school-based preventive interventions are essential to reduce adolescent substance use burden.
Predictors of Worsening Renal Function in Patients Hospitalized with Acute Heart Failure
Background: Worsening renal function (WRF) is a frequent and clinically important complication among patients hospitalized with acute heart failure (AHF), leading to increased morbidity, prolonged hospitalization, and poor clinical outcomes. Early identification of patients at high risk of WRF may facilitate timely intervention and improve prognosis. Aim of the study: To identify the predictors of worsening renal function in patients hospitalized with acute heart failure and evaluate its association with in-hospital clinical outcomes. Methods & Materials: This prospective observational study was conducted in the Departments of Nephrology and Cardiology at Bangladesh Medical University, Dhaka, Bangladesh, from June 2023 to March 2025. A total of 58 adult patients admitted with acute heart failure and baseline serum creatinine <1.3 mg/dL were enrolled. Worsening renal function was defined as an increase in serum creatinine of ≥0.3 mg/dL within 48 hours or ≥1.5 times the baseline value within seven days. Demographic, clinical, laboratory, echocardiographic, and biomarker data, including urinary TIMP-2×IGFBP-7, were collected. Independent predictors of WRF were identified using multivariable logistic regression analysis. Result: Worsening renal function developed in 23 (39.7%) patients. Patients with WRF more frequently had diabetes mellitus (60.9% vs. 31.4%, p=0.027), previous heart failure admission (65.2% vs. 37.1%, p=0.034), NYHA class IV symptoms (69.6% vs. 51.4%, p=0.048), lower estimated glomerular filtration rate, lower serum albumin, higher inflammatory markers, elevated NT-proBNP, and markedly increased urinary TIMP-2×IGFBP-7 levels (all p<0.05). Hospital stay was significantly longer (9.2±3.1 vs. 6.4±2.3 days, p<0.001), and ICU admission was more frequent among patients with WRF (43.5% vs. 17.1%, p=0.030). Multivariable logistic regression identified diabetes mellitus (adjusted OR=2.74, p=0.048), previous heart failure admission (adjusted OR=2.96, p=0.044), serum albumin <3.5 g/dL (adjusted OR=3.41, p=0.046), eGFR <70 mL/min (adjusted OR=3.84, p=0.026), NT-proBNP >5000 pg/mL (adjusted OR=3.67, p=0.032), and urinary TIMP-2×IGFBP-7 >0.312 (adjusted OR=13.94, p<0.001) as independent predictors of WRF. Conclusion: Worsening renal function occurred in nearly two-fifths of hospitalized patients with acute heart failure and was associated with adverse in-hospital outcomes. Diabetes mellitus, previous heart failure admission, impaired renal function, hypoalbuminemia, elevated NT-proBNP, and particularly increased urinary TIMP-2×IGFBP-7 independently predicted WRF. Early risk stratification using these clinical and biomarker-based predictors may improve patient monitoring and optimize management strategies.
Post-Vaccination Immune Status Against the Hepatitis B Virus Amongst Doctors Working in a Tertiary Care Hospital
Background: Doctors face a high occupational risk of Hepatitis B. Vaccination provides protection, but the durability of this immunity is uncertain. This study assesses long-term vaccine-induced immunity in this vulnerable group. Objective: To assess the post-vaccination immune status against HBV among doctors in a tertiary care hospital and identify associated factors. Methods & Materials: This cross-sectional study was conducted at Sylhet MAG Osmani Medical College & Hospital from July to December 2018. Using simple random sampling, 75 doctors aged 23-59 years who were vaccinated against HBV ≥5 years prior were enrolled. Serum Anti-HBs antibody titers were measured using ELISA. Protective immunity was defined as an Anti-HBs titer ≥10 mIU/mL. Data were analyzed with SPSS v20; a p-value <0.05 was considered significant. Results: The mean age was 32.3±6.0 years; 64% were male. All 75 doctors received three vaccine doses. Time since vaccination exceeded five years for all: 36% at 6-10 years and 36% at 11-15 years. Protective Anti-HBs titers (≥10 mIU/mL) were found in 89.3% (64% >100 mIU/mL, 25.3% 10-100 mIU/mL), while 10.7% were non-protective (<10 mIU/mL). A significant association existed between titer and age (p = 0.032), but not with sex, BMI, time since vaccination, or booster history (p > 0.05). Conclusion: A decade after the primary series, most doctors maintain protective antibody levels, though 10.7% remain susceptible. These findings support the importance of post-vaccination testing and targeted booster strategies.
Thyroid Function Status in Women of Reproductive Age with Abnormal Uterine Bleeding
Background: Abnormal uterine bleeding (AUB) is a prevalent gynecological concern among women of reproductive age, often linked to various underlying etiologies. Thyroid hormones are crucial for maintaining normal reproductive physiology. Thyroid dysfunction, which is highly prevalent in women, can significantly impact menstrual function, often leading to menstrual irregularities that may precede a formal diagnosis. Objective: To evaluate the thyroid function status in reproductive-aged women presenting with abnormal uterine bleeding. Methods & Materials: This cross-sectional observational study was conducted in the Department of Obstetrics and Gynaecology at Sylhet MAG Osmani Medical College Hospital, Sylhet. The study included women of reproductive age who presented with AUB. Participants were selected using a convenience sampling method based on predefined inclusion criteria. Data were collected through face-to-face interviews using a structured questionnaire after obtaining informed written consent. Statistical analysis was performed using SPSS version 22.0. Results: The mean age of the 81 participants was 37.19 years, with the majority (82.7%) aged between 30 and 40 years. Overall, thyroid dysfunction was identified in 30.8% of women with AUB. Specifically, 12.3% of patients had hyperthyroidism, while 18.5% had hypothyroidism. The study observed a higher prevalence of menstrual abnormalities among patients with thyroid disorders. Conclusion: Both hypothyroidism and hyperthyroidism are common findings in women presenting with AUB, with hypothyroidism being slightly more prevalent. Timely diagnosis and appropriate management of thyroid dysfunction in these patients can prevent unnecessary and ineffective diagnostic procedures and treatments.
Predictors of Malignancy in Patients Presenting with Breast Lumps: A Multivariable Analysis from a Tertiary Surgical Center
Background: Breast cancer is the prevalent type of cancer among women globally and in Bangladesh. While the majority of breast lumps are non-cancerous, identifying malignant tumors can be difficult. Clinical and ultrasound characteristics can aid in predicting cancer, whereas histopathology offers a conclusive diagnosis. Data on independent factors predicting cancer in breast lump patients in Bangladesh is still scarce. This research sought to determine clinical and imaging factors independently linked to malignancy through multivariable analysis. Methods & Materials: An analytical observational study based in a hospital took place at Bangladesh Medical University from March 2025 to February 2026, involving 244 patients aged 18 years and older with noticeable breast lumps. Demographic, clinical, imaging, and histopathological information was gathered. Histopathological evaluation confirmed malignancy, and independent predictors were determined through multivariable logistic regression. Statistical significance was established at p<0.05. Results: Among 244 patients, 70 (28.7%) had malignant lesions, with invasive carcinoma NST being the predominant histological type. Multivariable analysis identified older age, positive family history, larger lump size, skin/nipple changes, and BI-RADS 4-5 as independent predictors of malignancy. BI-RADS 4-5 showed the strongest association (aOR 11.21, 95% CI: 4.72-26.62; p<0.001), followed by age >50 years (aOR 4.57) and lump size ≥5 cm (aOR 3.91). Conclusion: Older age, positive family history, larger breast lump size, skin/nipple changes, and BI-RADS 4-5 were independent predictors of malignancy. Integrating these clinical and imaging features may improve early identification and timely diagnosis of breast cancer among patients presenting with breast lumps.
Socio-Demographic and Lifestyle Predictors of Triple-Negative Breast Cancer in Bangladeshi Women
Background (including objective): Triple-negative breast cancer (TNBC) is an aggressive molecular subtype of breast cancer with distinct epidemiology and high burden among South Asian women. Objective: To determine the association of socio-demographic factors, reproductive characteristics, and lifestyle patterns with TNBC. Methods & Materials: This cross-sectional study was conducted at Bangladesh Medical University from January to December 2023. A total of 116 female patients (58 TNBC; 58 non-TNBC) were enrolled through purposive sampling. Data on socio-demographic, reproductive, and lifestyle factors were collected using semi-structured questionnaires and clinical checklists. TNBC status was confirmed by immunohistochemistry. Statistical analyses were performed using SPSS v.26. Chi-square tests and multivariable logistic regression were used to identify predictors of TNBC (p < 0.05 considered significant). Results: TNBC-positive patients were younger than non-TNBC patients (39.79 ± 8.98 vs. 45.22 ± 11.22 years; p = 0.005) and more frequently resided in urban areas (43.86% vs. 22.41%; p = 0.015). Non-modifiable risk factors (early pregnancy, breastfeeding, early menarche, early menopause) and modifiable factors (OCP use, processed food consumption) were not significantly associated with TNBC. Moderate-intensity physical activity was more common in TNBC patients (96.6% vs. 82.8%). Multivariable logistic regression identified urban residence (OR = 2.704; 95% CI: 1.204-6.073; p = 0.016) and moderate-intensity physical activity (OR = 5.833; 95% CI: 1.218-27.937; p = 0.027) as independent predictors of TNBC. Conclusion: In this population, TNBC was more prevalent among younger, urban-residing women. Urban residence and lifestyle factors may play a role in TNBC pathogenesis.
Comparison of Clinical Outcomes Between Hypertensive and Non-Hypertensive Intracerebral Hemorrhage
Background: Intracerebral hemorrhage (ICH) is associated with high mortality and disability. Hypertension is the leading cause of spontaneous ICH, while non-hypertensive ICH has diverse etiologies with distinct clinical features and outcomes. However, comparative data from Bangladesh are limited. This study aimed to compare the clinical outcomes of hypertensive and non-hypertensive ICH among Bangladeshi patients. Methods & Materials: This hospital-based comparative observational study included 120 patients with CT-confirmed spontaneous intracerebral hemorrhage (74 hypertensive and 46 non-hypertensive) admitted to a tertiary care hospital in Bangladesh between January and December 2025. Clinical and radiological data were collected prospectively, and functional outcome at discharge was assessed using the modified Rankin Scale (mRS). Statistical significance was set at P < 0.05. Results: Among 120 patients with spontaneous ICH, 74 (61.7%) had hypertensive ICH and 46 (38.3%) had non-hypertensive ICH. Non-hypertensive ICH was associated with significantly larger hematoma volume (36.9 ± 15.8 vs. 29.7 ± 13.4 mL; P = 0.011), more frequent lobar hemorrhage (50.0% vs. 17.6%; P < 0.001), and higher mRS score at discharge (4.2 ± 1.5 vs. 3.7 ± 1.4; P = 0.048). Hypertensive ICH predominantly involved deep brain regions (78.4% vs. 39.1%; P < 0.001). Although non-hypertensive ICH showed higher rates of surgery, ICU admission, complications, and in-hospital mortality, these differences were not statistically significant. Admission GCS ≤8 (AOR 2.89, 95% CI: 1.31-6.38; P = 0.009) and hematoma volume >30 mL (AOR 2.63, 95% CI: 1.22-5.66; P = 0.014) were independent predictors of poor functional outcome. Conclusion: Non-hypertensive ICH showed poorer functional outcomes, while low admission GCS and larger hematoma volume independently predicted poor prognosis, emphasizing early risk assessment and management.
Non-Hypertensive Intracerebral Hemorrhage
Clinical Patterns and Management Challenges of Endometriosis in Women of Reproductive Age
Background: Endometriosis is a long-lasting condition where tissue similar to the endometrium develops outside the uterus, leading to pain, infertility, or no symptoms at all. It impacts 6-10% of women of reproductive age, has various contributing factors, and is primarily diagnosed through laparoscopy. Management involves both medical and surgical interventions; however, recurrence is frequent, and diagnosis is often postponed, particularly in resource-constrained environments such as Bangladesh. Methods & Materials: A cross-sectional study conducted at BIRDEM General Hospital-2 in Dhaka (July 2024-June 2025) involved 132 women (ages 18-45) diagnosed with endometriosis. Information regarding clinical, diagnostic, and treatment factors was gathered through questionnaires and records and examined using SPSS v25. The chi-square test was applied (p < 0.05). Ethical consent and informed approval were secured. Results: Of 132 women with endometriosis, the majority were aged 25-34 years (~46%) and experienced frequent symptoms such as dysmenorrhea (~84%), pelvic pain (~68%), and infertility (~35%). Stage II-III disease occurred most commonly (~66%), ultrasound was utilized in ~89%, and ~72% received medical therapy, whereas ~28% had surgery. Severe disease showed a significant association (p < 0.05) with age ≥30, rural living, low education levels, and infertility (OR ≈ 4.9), while advanced stages (III-IV) were connected to surgical procedures. Conclusion: Endometriosis was prevalent among women aged 25-34, primarily Stage II-III, presenting with pain and infertility, primarily managed through medical treatment; advanced stages and surgical intervention were associated with older age, living in rural areas, lower education levels, and infertility.
Educational Preparedness and Perceived Challenges for the Development of Forensic Odontology in Bangladesh: Perspectives of Medical and Dental Graduates and Undergraduates
Background: Forensic odontology uses dental expertise in legal cases, such as identifying individuals, estimating ages, analyzing bite marks, and providing expert witness accounts. In many countries, including Bangladesh, challenges such as insufficient resources, limited practical training, and inadequate educational exposure persist in medicolegal practice despite its significance. This research intended to evaluate educational readiness, experience, and perceived difficulties related to the advancement of forensic odontology among medical and dental students and alumni in Bangladesh. Methods & Materials: A cross-sectional study was carried out involving medical and dental students as well as graduate interns in Dhaka, Bangladesh. Data were gathered through a validated questionnaire evaluating knowledge of forensic odontology, educational readiness, attitudes, career outlooks, and perceived obstacles. Data analysis was conducted using SPSS version 29.0, employing Chi-square tests for group comparisons. Ethical approval was acquired, and all participants provided written informed consent. Results: Out of 402 participants, there was a strong understanding of forensic odontology, yet advanced knowledge and formal education were minimal. Merely 4.5% underwent formal training, with increased exposure noted among dental students and graduate interns (p<0.001). While 72.1% expressed interest in workshops, just 16.9% viewed it as a career choice. Insufficient infrastructure (87.8%) constituted the primary challenge, whereas dental students and graduate interns exhibited enhanced preparedness and career awareness (p<0.05). Conclusion: Although medical and dental students possess solid foundational knowledge in forensic odontology, their educational readiness is insufficient because of restricted formal instruction, practical experience, and career prospects. Enhancing curricula, offering organized training, and upgrading forensic infrastructure are crucial for the progress of forensic odontology in Bangladesh.
Effects of Nephrotic Syndrome in Children
Background: Chronic disorders, particularly nephrotic syndrome, are linked to psychological stress. In children with nephrotic syndrome, glucocorticoid medication can cause a variety of side effects, including behavioral issues. Aim of the study: The purpose of this study was to examine the effects of nephrotic syndrome in children. Methods & Materials: From June 2017 to May 2018, this prospective case control study was conducted at various institutes and medical college hospitals in Dhaka as well as Bogura. This study comprised 100 cases of nephrotic syndrome aged 4-17 years from a purposive sampling approach, as well as 100 age and gender matched control subjects. The behavior of children with nephrotic syndrome was assessed using SDQ grading. A data collecting sheet was created, and the Bengali version of the SDQ format was employed. Variables were measured using various methods. SDQ was compared to these variables, and data were analyzed using SPSS (version 22). Results: The case and control groups had mean ages of 7.86 ± 2.98 and 7.19 ± 2.77 years, respectively. There was no discernible difference in age between the cases and controls. The emotional symptoms scale, conduct difficulties scale, and peer relationship problem were significantly higher in cases than in controls, whereas the pro-social behavior scale was significantly lower. The total SDQ score did not differ significantly between kinds of nephrotic syndromes. However, the IFRNS had a greater SDQ level when compared to the other clinical variants. There was no association between SDQ score and father's or mother's occupation. There was no link between SDQ score and age, disease duration, or monthly household income in patients. Males made up the majority of both categories. Conclusion: This study discovered that children with nephrotic syndrome had much higher levels of emotional symptoms, conduct problems, and peer interaction issues than healthy children, whereas pro-social behavior was significantly lower. Overall, children with nephrotic syndrome had significantly more psychological problems than the control group.
Accelerated Versus Standard Ponseti Method for Idiopathic Congenital Clubfoot: Impact on Treatment Duration, Healthcare Visits, and Clinical Outcomes
Background: Congenital idiopathic clubfoot is a common pediatric deformity affecting 1-2 per 1000 live births and can lead to long-term disability if untreated. The Ponseti method is the standard treatment, while the accelerated protocol uses more frequent cast changes to reduce treatment duration. However, evidence comparing these approaches remains limited in Bangladesh. This study aims to compare accelerated and standard Ponseti methods regarding correction outcomes, treatment efficiency, and healthcare burden. Methods & Materials: A prospective comparative study was conducted at NITOR, Dhaka, involving 30 infants with untreated idiopathic congenital clubfoot. Patients received either accelerated Ponseti (twice-weekly casts, n=15) or standard Ponseti (weekly casts, n=15) treatment following standard Ponseti principles. Outcomes assessed included number of casts required, treatment duration, healthcare visits, caregiver burden, and Pirani scores. Data were analyzed using SPSS version 25.0, with p<0.05 considered statistically significant. Results: Among 30 infants, baseline demographic and clinical characteristics, including age, sex, bilateral involvement, and Pirani score, were comparable between groups. The accelerated Ponseti group showed significantly shorter treatment duration (36.4 vs. 50.8 days), fewer hospital visits (7.1 vs. 9.8), and reduced caregiver work-loss days (7.8 vs. 10.6) (p<0.001). Final Pirani scores and overall clinical outcomes were comparable between groups, demonstrating effective deformity correction with reduced treatment burden and improved convenience using the accelerated method. Conclusion: The accelerated Ponseti method provides correction outcomes comparable to the standard Ponseti method while significantly reducing treatment duration, healthcare visits, and caregiver burden. It may serve as an effective and efficient alternative for managing idiopathic congenital clubfoot.
Diagnostic Accuracy of FNAC Compared with Histopathology in Patients with Palpable Breast Masses Attending a Tertiary Care Hospital
Background: Breast masses are common, and accurate differentiation of benign and malignant lesions is essential. FNAC is a rapid, minimally invasive, and cost-effective diagnostic method, while histopathology remains the reference standard. However, recent Bangladeshi evidence on the diagnostic accuracy of FNAC is limited. This study aimed to evaluate the sensitivity, specificity, predictive values, and overall accuracy of FNAC compared with histopathology in diagnosing palpable breast masses. Methods & Materials: A hospital-based diagnostic accuracy study was conducted at Bangladesh Medical University, Dhaka, from January to December 2025, involving 94 patients with palpable breast masses. FNAC findings were compared with histopathology as the reference standard. Sensitivity, specificity, PPV, NPV, diagnostic accuracy, and Cohen's kappa were calculated using SPSS. Ethical approval and informed consent were obtained. Results: Among 94 patients, the mean age was 42.5 ± 11.6 years. Histopathology identified 39 (41.5%) malignant and 55 (58.5%) benign lesions, with fibroadenoma being the most common benign lesion and invasive ductal carcinoma/NST the predominant malignancy. FNAC correctly identified 34 malignant and 53 benign lesions, with 2 false-positive and 5 false-negative results. FNAC showed 87.2% sensitivity, 96.4% specificity, 94.4% PPV, 91.4% NPV, and 92.6% diagnostic accuracy. Agreement with histopathology was very good (κ=0.845, p<0.001). Conclusion: FNAC demonstrated high diagnostic accuracy, sensitivity, and specificity in differentiating benign from malignant palpable breast masses, with very good agreement with histopathology. It can therefore serve as a reliable, rapid, minimally invasive initial diagnostic tool, while histopathology remains essential for confirmation of difficult or suspicious lesions. Assistant Professor, Department of Surgery, Officer on Special Duty (OSD), Directorate General of Health Services (DGHS), Dhaka, Bangladesh draklima1981@gmail.com (ORCID: 0009-0001-2102-1586) Associate Professor, Department of General Surgery, Bangladesh Medical University, Dhaka, Bangladesh sayemfaizi@gmail.com (ORCID: 0009-0002-2861-3864) INTRODUCTION Breast masses are common among women and are mostly benign; however, accurate evaluation is essential to exclude malignancy. Breast cancer is the most commonly diagnosed cancer among women worldwide, emphasizing the need for accessible, reliable, and cost-effective diagnostic methods for evaluating breast masses. Lumps are common in all ages, but clinical diagnosis may be misleading [1,2]. Clinical evaluation of a palpable breast mass includes history and physical examination, but clinical findings alone cannot reliably distinguish benign from malignant lesions. Therefore, accurate diagnosis requires triple assessment, combining clinical examination, imaging, and pathological evaluation, which provides greater diagnostic accuracy than any single modality [3,4]. Fine-needle aspiration cytology (FNAC) is a quick, cost-effective, minimally invasive, and easily tolerated technique for assessing palpable breast lumps. It offers early cytological diagnosis and can assist in directing further treatment, especially in settings with limited resources. Research has demonstrated high diagnostic effectiveness, supporting FNAC as a reliable and dependable diagnostic method for evaluating breast lesions when properly performed, interpreted, and correlated with clinical findings[5,6]. FNAC is constrained by its lack of capability to evaluate tissue structure, rendering certain fibroepithelial, papillary, atypical, and low-grade malignant lesions hard to identify. Its precision also relies on appropriate sampling, method, and the skill of the cytopathologist [7,8]. Histopathological examination evaluates both tissue architecture and cellular features, making it an important reference standard for definitive diagnosis. It assesses lesion architecture, invasion, tumor classification, and grading. Therefore, comparing FNAC findings with histopathology is essential for evaluating FNAC diagnostic accuracy [9,10]. The research results indicated that FNAC was an effective and trustworthy diagnostic technique for assessing palpable breast lesions, exhibiting a strong correlation with histopathological analysis. FNAC successfully distinguished benign lesions from malignant ones and offered a quick, minimally invasive diagnosis. Nonetheless, histopathology continued to be more effective for verifying challenging or borderline lesions, as it offers intricate tissue structure. In general, the research backed FNAC as a successful primary diagnostic method, while histopathology acted as the conclusive reference standard for confirming the final diagnosis [1,11,12]. The studies in Bangladesh found that FNAC effectively differentiated benign and malignant palpable breast lesions and showed good correlation with histopathology. FNAC was a rapid, minimally invasive, and useful initial diagnostic tool, while histopathology remained the definitive method for confirmation [13,14]. In Bangladesh, there is scant recent evidence regarding the diagnostic precision of FNAC for palpable breast lumps in comparison to histopathology. Consequently, this research intends to evaluate the sensitivity, specificity, predictive values, and overall accuracy of FNAC compared to histopathology in distinguishing between benign and malignant breast lesions. METHODS & MATERIALS Study design and setting A hospital-based diagnostic accuracy study was conducted to evaluate the diagnostic performance of fine-needle aspiration cytology (FNAC) in comparison with histopathological examination among patients presenting with palpable breast masses. The study was carried out at Bangladesh Medical University (BMU), Dhaka, Bangladesh, over a 12-month period from January 2025 to December 2025. Study population and participants The study included patients presenting to BMU with a clinically palpable breast mass during the study period. Patients were recruited consecutively according to predefined eligibility criteria. A total of 94 patients were included in the final analysis. Patients were eligible if they had a clinically palpable breast mass, were willing to undergo FNAC followed by histopathological examination, and provided informed consent. Patients with a previously diagnosed breast malignancy who were receiving treatment or follow-up, recurrent malignancy at a previously treated site, inadequate or unsatisfactory cytological material, absence of histopathological confirmation, or refusal to participate were excluded. Data collection and diagnostic procedures Demographic and clinical information was collected using a structured data collection form. Variables included age, duration of the breast lump, presence of breast pain, nipple discharge, and clinically palpable axillary lymphadenopathy. All eligible patients underwent FNAC of the palpable breast lesion under standard aseptic precautions. Cytological specimens were processed and examined by experienced pathologists, and the lesions were categorized as benign or malignant based on the cytological findings. Patients subsequently underwent surgical excision or biopsy of the breast lesion according to the treating surgeon's clinical assessment and standard management practice. The obtained tissue specimens were processed and examined histopathologically by qualified pathologists. Histopathological examination was considered the reference standard for establishing the final diagnosis. The FNAC findings were compared with the corresponding histopathological diagnoses. A malignant lesion correctly identified as malignant by FNAC was considered a true-positive result, whereas a benign lesion correctly identified as benign was considered a true-negative result. Malignant lesions reported as benign by FNAC were considered false-negative results, while benign lesions reported as malignant were considered false-positive results. Study outcomes The primary outcome was the diagnostic accuracy of FNAC for identifying malignant breast lesions using histopathology as the reference standard. Diagnostic performance was assessed by calculating sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), overall diagnostic accuracy, positive likelihood ratio (LR+), and negative likelihood ratio (LR−). Agreement between FNAC and histopathological diagnosis was additionally assessed using Cohen's kappa coefficient. Statistical analysis Data were entered, checked for completeness, and analyzed using IBM SPSS Statistics. Categorical variables were expressed as frequencies and percentages, whereas continuous variables were summarized using mean and standard deviation. A 2×2 contingency table was constructed to compare FNAC results with histopathological findings. Sensitivity, specificity, PPV, NPV, diagnostic accuracy, and likelihood ratios were calculated using standard diagnostic accuracy formulas. The association between FNAC and histopathological diagnosis was assessed using the chi-square test, and the degree of agreement between the two diagnostic methods was evaluated using Cohen's kappa (κ). A two-sided p-value <0.05 was considered statistically significant. Ethical considerations The study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Ethical approval was obtained from the appropriate institutional ethical review committee of Bangladesh Medical University before commencement of the study. Written informed consent was obtained from all participants. Confidentiality of participant information was maintained throughout the study, and data were used exclusively for research purposes. RESULTS Table I shows total of 94 patients with palpable breast masses were included in the study. The mean age of the participants was 42.5 ± 11.6 years, with an age range of 19-71 years. The largest proportion of patients belonged to the 41-50-year age group (31.9%), followed by those aged 31-40 years (26.6%). Most patients presented with a breast lump of ≤6 months' duration. Breast pain was reported by 31.9% of patients, while nipple discharge was present in 11.7%. Clinically palpable axillary lymphadenopathy was detected in 19.1% of the patients. Table I: Demographic and clinical characteristics of the study participants (n=94) Characteristics Frequency (n) Percentage (%) Age (years) ≤30 14 14.9 31-40 25 26.6 41-50 30 31.9 51-60 17 18.1 >60 8 8.5 Mean age ± SD 42.5 ± 11.6 Duration of breast lump ≤3 months 34 36.2 >3-6 months 27 28.7 >6-12 months 19 20.2 >12 months 14 14.9 Breast pain Present 30 31.9 Absent 64 68.1 Nipple discharge Present 11 11.7 Absent 83 88.3 Clinically palpable axillary lymph nodes Present 18 19.1 Absent 76 80.9 Table II presents all 94 patients underwent FNAC followed by histopathological examination of the breast lesion. Histopathological examination was considered the reference standard for determining the final diagnosis. On FNAC, 36 (38.3%) lesions were classified as malignant and 58 (61.7%) as benign. In comparison, histopathological examination identified 39 (41.5%) malignant and 55 (58.5%) benign lesions. Table II: Distribution of breast lesions according to FNAC and histopathological diagnosis (n=94) Diagnosis FNAC, n (%) Histopathology, n (%) Benign lesions 58 (61.7) 55 (58.5) Malignant lesions 36 (38.3) 39 (41.5) Table III shows histopathological examination showed that fibroadenoma was the most common benign lesion, accounting for 24.5% of all cases, followed by fibrocystic disease (11.7%) and benign proliferative disease (9.6%). Among malignant lesions, invasive ductal carcinoma/no special type was the predominant histopathological diagnosis, accounting for 36.2% of all patients. Table III: Histopathological diagnosis of breast lesions (n=94) Histopathological diagnosis Frequency (n) Percentage (%) Benign lesions Fibroadenoma 23 24.5 Fibrocystic disease 11 11.7 Benign proliferative disease 9 9.6 Intraductal papilloma 4 4.3 Benign phyllodes tumor 3 3.2 Other benign lesions 5 5.3 Total benign 55 58.5 Malignant lesions Invasive ductal carcinoma/NST 34 36.2 Invasive lobular carcinoma 3 3.2 Other malignant lesions 2 2.1 Total malignant 39 41.5 Total 94 100.0 Table IV presents comparison of FNAC findings with the histopathological reference standard demonstrated that 34 of the 39 histopathologically confirmed malignant lesions were correctly identified as malignant by FNAC, resulting in 34 true-positive cases. Five malignant lesions were incorrectly classified as benign, representing false-negative results. Among the 55 histopathologically confirmed benign lesions, 53 were correctly identified as benign, while 2 were incorrectly reported as malignant. Thus, FNAC yielded 34 true-positive, 2 false-positive, 5 false-negative, and 53 true-negative results. Table IV: Comparison of FNAC findings with histopathological diagnosis (n=94) FNAC result Histopathology malignant Histopathology benign Total FNAC malignant 34 (True positive) 2 (False positive) 36 FNAC benign 5 (False negative) 53 (True negative) 58 Total 39 55 94 Table V shows FNAC demonstrated a sensitivity of 87.2% (95% CI: approximately 73.4-94.9%) and a specificity of 96.4% (95% CI: approximately 87.7-99.0%) for detecting malignant breast lesions. The positive predictive value was 94.4%, while the negative predictive value was 91.4%. The overall diagnostic accuracy of FNAC was 92.6%. The positive likelihood ratio was approximately 24.0, whereas the negative likelihood ratio was approximately 0.13. Table V: Diagnostic accuracy of FNAC compared with histopathology (n=94) Diagnostic parameter Value Sensitivity 87.2% Specificity 96.4% Positive predictive value 94.4% Negative predictive value 91.4% Diagnostic accuracy 92.6% Positive likelihood ratio 24.0 Negative likelihood ratio 0.13 Table VI shows there was a high level of agreement between FNAC and histopathological diagnosis. The overall observed agreement was 92.6%, and the Cohen's kappa coefficient was 0.845, indicating very good agreement between the two diagnostic methods. The association between FNAC findings and histopathological diagnosis was statistically significant (χ²=68.0, p<0.001). Table VI: Agreement between FNAC and histopathological diagnosis Parameter Value Observed agreement 92.6% Cohen's kappa (κ) 0.845 Interpretation Very good agreement Chi-square (χ²) 68.0 p-value <0.001 Among the 39 histopathologically confirmed malignant lesions, FNAC correctly identified 34 (87.2%), while 5 (12.8%) were reported as benign. Conversely, among the 55 histopathologically confirmed benign lesions, 53 (96.4%) were correctly classified by FNAC and 2 (3.6%) were incorrectly classified as malignant. The false-negative cases were mainly observed in lesions with limited cytological material or atypical/proliferative features that were difficult to distinguish from malignancy on FNAC alone. Overall, FNAC demonstrated high diagnostic performance in distinguishing malignant from benign palpable breast masses, with a sensitivity of 87.2%, specificity of 96.4%, and overall diagnostic accuracy of 92.6%. The high positive predictive value and very good agreement with histopathology indicate that FNAC was a reliable diagnostic modality for the evaluation of palpable breast masses in this study population. DISCUSSION Our study indicated that noticeable breast lumps were more prevalent in middle-aged women, with an average age of 42.5 ± 11.6 years and the largest percentage in the 41-50-year range. This discovery aligns with earlier Bangladeshi research indicating a prevalence of breast lesions in adult females. The majority of patients sought help within 6 months, whereas breast pain, nipple discharge, and axillary lymphadenopathy occurred less frequently. These results highlight the importance of prompt and structured assessment of noticeable breast lumps [15,16]. This study indicated that the majority of breast lesions were benign, as determined by FNAC and histopathology, while malignant lesions represented 38.3% and 41.5%, respectively. This result aligns with earlier research, which indicated a prevalence of benign breast lesions in symptomatic individuals. The minor distinction between FNAC and histopathology emphasizes the necessity of histopathological validation [17]. The current study identified fibroadenoma as the most prevalent benign lesion, followed by fibrocystic disease, with invasive ductal carcinoma/NST being the leading malignant lesion. This result aligns with earlier research that indicated fibroadenoma as a common benign breast lesion and invasive ductal carcinoma as the leading malignant histopathological type. The results emphasize the broad range of breast lesions and the significance of histopathological analysis for a conclusive diagnosis [18]. The current study showed a significant relationship between FNAC and histopathology in distinguishing benign from malignant breast lesions. This observation aligns with earlier research, which indicated strong clinicopathological correlation and endorsed FNAC as an effective preliminary diagnostic approach, although histopathology is crucial for definitive validation [19]. The current research showed 87.2% sensitivity, 96.4% specificity, and 92.6% diagnostic accuracy for FNAC. This result aligns with previous research, which indicated that FNAC has strong diagnostic effectiveness in comparison to histopathology. The findings endorse FNAC as a dependable, minimally invasive first approach for assessing palpable breast lesions [1,20]. The current research demonstrated a 92.6% observed agreement and a Cohen's kappa of 0.845, reflecting a strong correlation between FNAC and histopathology, with a statistically significant relationship. This result resembles earlier research, which indicated a strong relationship between FNAC and histopathological results in breast lesions. The strong consensus reinforces FNAC as a dependable initial diagnostic method, though false-negative instances can arise in atypical or poorly sampled lesions [12,20]. In summary, FNAC showed excellent diagnostic precision and strong correlation with histopathology, endorsing its role as a trustworthy, quick, and minimally invasive primary diagnostic approach for palpable breast lesions. CONCLUSION FNAC showed excellent diagnostic precision, sensitivity, and specificity in distinguishing between benign and malignant palpable breast lumps, with a strong correlation with histopathology. Its quick, minimally invasive, economical, and dependable characteristics advocate for its application as a primary diagnostic tool, especially in settings with limited resources. Histopathological analysis is still crucial for validating FNAC results, especially in cases that are suspicious, atypical, or difficult to diagnose. REFERENCES
Thyroid Dysfunction and Autoantibody Positivity in Relation to Clinical Severity of Psoriasis
Background: Psoriasis is a chronic immune-mediated inflammatory disease, and other comorbidities that may be linked to psoriasis through the mechanisms of systemic autoimmune disorders. In patients with psoriasis, autoimmune thyroid disease has been observed more commonly, but the link between thyroid abnormalities and severity of psoriasis is not fully elucidated. Methods & Materials: A total of 63 patients with clinically and histopathologically diagnosed palmoplantar psoriasis (case) as well as apparently healthy age- and sex-matched controls were inducted into the study. Pasi and body surface area (BSA) were used to assess psoriasis severity. The laboratory examination consists of serum FT3, FT4, TSH, anti-TPO, anti-TG and TRAb. Results: The age of 35.8±16.7 years in DH and 35.4±16.9 in controls 78.0% of patients had chronic plaque psoriasis, and 73.0% had PASI >12, whereas 66.7% were reported with BSA involvement >10%. While most participants were euthyroid, thyroid function abnormalities were noted in 28 (44.4%) psoriasis patients. Patients of psoriasis with elevated anti-TPO antibodies (34.9%) and elevated anti-TG antibodies (46.0%). In patients with anti-TPO antibodies ≥5 IU/mL, 77.3% had PASI >12 and 81.8% had BSA >10%. Of these, 79.3% of those with anti-TG antibodies had PASI >12 and 75.9% had BSA >10%. Conclusion: In this study, the prevalence of thyroid dysfunction was high in patients with psoriasis and detection rates of thyroid autoantibodies were also elevated. Altered thyroid function was correlated with larger BSA involvement and relatively high serum levels of anti-TPO and anti-TG were mostly identified in patients with extensive and severe psoriasis.
Association between Immunohistochemical markers and MRI features in patients with glioblastoma multiforme underwent surgery
Background: Glioblastoma multiforme (GBM) is a common and fatal primary brain tumor. Magnetic resonance imaging (MRI) is an important tool used for diagnosing GBM. Tumor biology lights on nature and behavior of tumor which is a prime prognosticator of disease and treatment outcome and easily understood by immunohistochemical markers. If the association between Immunohistochemistry and MRI features could be established. Objectives: To investigate and find out association between immunohistochemical markers namely p53, Ki-67, MGMT and MRI features including Contrast tumor enhancement/T2 ratio, percentage of tumor necrosis/tumor volume, peritumoral edema. Materials & Methods: MRI features were taken as Contrast tumor enhancement/T2 ratio, percentage of tumor necrosis, peritumoral edema.Then associations were evaluated between p53, Ki-67, MGMT and Contrast tumor enhancement/T2 ratio, percentage of tumor necrosis/tumor volume, peritumoral edema in chi- square (χ2) test. Results: The results showed the mean age (±SD) of the population was 46.4+13.6. The age range started from minimum 13 years to maximum 70 years. Male: Female ratio was 1.75:1. Most common symptoms were headache, seizures and hemiparesis. The association between MRI features and immunomarkers in some extents were significant. The association between CTE/T2 ratio and p53 (p value 0.035), between percentage of tumor necrosis and Ki-67 (p value 0.018) and between tumor edema and MGMT (p value 0.010) were statistically significant. Conclusion: Imaging features of brain Glioblastoma such as CTE/T2, tumor necrosis percentage, degree of edema has a close association with tumor molecular pathology indicators such as the P53, Ki-67 and MGMT.
Clinicopathological Characteristics of Diffuse Gliomas According to IDH1 Mutation Status
Background: Diffuse gliomas are the most common primary malignant tumors of the central nervous system and exhibit marked clinical, histopathological, and molecular heterogeneity. Isocitrate dehydrogenase 1 (IDH1) mutation is a key molecular marker incorporated into the World Health Organization classification of diffuse gliomas because of its diagnostic and prognostic significance. Characterizing the clinicopathological features according to IDH1 mutation status may improve disease stratification and optimize patient management. Objective: To evaluate the clinicopathological characteristics of diffuse gliomas according to IDH1 mutation status. Materials & Methods: This cross-sectional analytical study included 110 consecutive patients with histopathologically confirmed diffuse glioma who underwent surgical resection at the Department of Neurosurgery, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh, between July 2020 and December 2021. IDH1 mutation status was determined by immunohistochemistry. Demographic characteristics, clinical presentation, histopathological subtype, WHO grade, and radiological findings were recorded using a structured data collection form. Statistical analyses were performed using SPSS version 26, and a p-value <0.05 was considered statistically significant. Results: The mean age of the participants was 40.75 ± 15.68 years, and 60.0% were male. Astrocytoma was the predominant histological subtype (88.2%), while WHO grade IV tumors constituted 49.1% of cases. IDH1 mutation was detected in 93 (84.5%) patients. Patients with IDH1-mutant gliomas were younger than those with IDH1-wild-type tumors (39.6 vs. 47.1 years). IDH1-mutant tumors were more frequently associated with frontal lobe involvement and favorable clinicopathological characteristics than IDH1-wild-type tumors. Conclusion: IDH1 mutation was highly prevalent among patients with diffuse glioma and was associated with distinct clinicopathological characteristics. Incorporating IDH1 mutation status into routine evaluation may enhance the classification and clinical assessment of diffuse gliomas.
Outcome of severe head injury in Relation to basal cisterns on initial CT scan
Background: Traumatic brain injury is a serious public health issue. This injury is the leading cause of death in younger people especially in developing country. Severe head injury defined as Glasgow coma scale scores of less than 9, have a higher mortality rate and poorer outcome. Young males are the main victims. The purpose of this study was to determine prognostic value of the compressed basal cisterns on initial CT scan. Materials & Methods: Among them 22 patients with compressed basal cisterns considered as Group A and 22 patients with normal basal cisterns considered as Group B. Sample was selected purposively according to selection criteria. A pre-structured data collection sheet was used for recording patient's demographic, clinical and radiological data. Results: Most of the patients belonged to age 21-40 years and majority of the study patients are male. Road traffic accident is the major cause of trauma. Three fourth of the study population's GCS score are in 3-5 group. The most common findings in intracranial haematoma are acute Subdural Haematoma. Unfavorable outcome is seen in patients with compressed basal cisterns in Group A by GOS score. Unfavorable outcome is higher with compressed basal cisterns group in group A. Conclusion: Based on the result of this study Basal cisterns on the initial CT scan is a strong predictor of outcome in severe head injury and compressed basal cisterns are strongly related to unfavorable outcome and death.
Comparison of Accuracy of Ventricular Catheter Tip Placement by Conventional Free-Hand Method and Electromagnetic Neuronavigation Guided Ventriculoperitoneal Shunt Surgery
Background: Ventriculoperitoneal (V-P) shunt surgery has a long history and is one of the most established neurosurgeries around the world. The purpose of V-P shunt surgery is to divert an accumulation of cerebrospinal fluid (CSF) from the cerebral ventricles to the abdominal cavity. Accurate placement of ventricular catheter is depended on both proper insertion trajectory and proper catheter tip positioning. Objective: To compare the proportion of optimal ventricular catheter tip placement by two different ventriculoperitoneal shunt procedures. Methods & Materials: This cross-sectional observational study was conducted in Department of Neurosurgery, National Institute of Neurosciences & Hospital, Dhaka. 60 participants with Hydrocephalus, diagnosed by CT scan of brain and who underwent ventriculoperitoneal shunt surgery, were studied. All participants were divided into 2 groups by random lottery system. Results: Total 60 participants were included in our study among them 0-1year of age group showed maximum participants of 66.67%. 10(16.67%) belong to 1-5 years' age group among them 6(20%) participants from Group B and 4(13.33%) participants from Group A. 8.33% belongs to 6-10 years age group among them 6.67%from Group B, 10% from Group A. Study shows the majority of study participants 40 (66.67%) were male where 20 (33.33%) were female. male female ratio was 2:1. Conclusions: Frameless navigation is a valuable tool to optimize the trajectory and final position of shunt catheter in the ventricle. Mechanical malfunction and infection are the most significant problems associated with shunts for the treatment of hydrocephalus.
Association of Tumor Size and Margin in Preoperative MRI with Histological Grade Among Intracranial Meningioma Patients
Background: Meningiomas are the most common primary intracranial tumor, they are usually benign but may be atypical or sometimes anaplastic. In this study, we determined whether pre-operative magnetic resonance imaging (MRI) features could distinguish between benign and atypical meningioma. Objective: Objective of this study was to assess the relation of tumor size and margin in preoperative MRI of brain with postoperative histological grades in intracranial meningiomas. Methods & Materials: This cross-sectional type of experimental study started from January, 2020 to June, 2021 conducted at the department of neurosurgery of National Institute of Neurosciences and Hospital, Dhaka. Cases (n = 73) were selected consecutively as per selection criteria and undergone surgical excision of meningioma followed by histopathology. Quantitative data were presented as mean ±SD and qualitative data as frequency and percent. Results: Meningioma was most (24, 32.9%) common in 4th decade, mean age (± SD) =41.42 (± 12.078) years with age range from 18 to 75 years. The majority of the cases were female with male female ratio 1:3.3. Male are more susceptible for being WHO grade II and III meningioma. Association between tumor size and meningioma grade was not significant. Conclusion: This study shows that association of tumor size in preoperative MRI of brain with postoperative histological grade is not significant but that of marginal irregularity is significant. Preoperative assumption of tumor grades helps us in making surgical planning and counselling patient/party regarding possible outcomes as well as need of adjuvant therapy.
Clinical and Functional Outcome of llizarov External Fixation in the Management of Infected Tibial Nonunion
Background: Background: Infected tibial nonunion is a difficult complication characterized by persistent infection, bone loss, deformity, instability, and impaired limb function. Ilizarov external fixation offers simultaneous infection control, stable fixation, bone transport, deformity correction, and functional restoration. Aim of the study: The study aims to evaluate the clinical and functional outcomes of Ilizarov external fixation in the management of infected tibial nonunion. Methods & Materials: This descriptive observational study included 40 consecutive adults with infected tibial nonunion treated with Ilizarov external fixation at the National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka, Bangladesh, from July 2024 to June 2025. All patients underwent debridement, with acute docking, corticotomy, bone transport, or bone grafting performed as required. Clinical and radiological follow-up assessed union, eradication of infection, ASAMI bone and functional outcomes, weight-bearing status, deformity, limb-length discrepancy, and complications. Data were analyzed using SPSS and summarized as mean ± SD, frequencies, and percentages. Results: Among 40 patients, the mean age was 39.6 ± 10.8 years; 82.5% were male, 67.5% sustained road traffic injuries, and 77.5% had open fractures. Bone defects were present in 72.5%, while Staphylococcus aureus was isolated in 45.0%. Following Ilizarov treatment, radiological union was achieved in 90.0%, eradication of infection in 87.5%, and overall treatment success in 85.0%. Excellent-to-good ASAMI bone and functional outcomes were observed in 82.5% and 77.5% of cases, respectively. Pin-tract infection was the most frequent complication, occurring in 37.5% of cases. Conclusion: Overall, Ilizarov external fixation achieved high rates of bone union, eradication of infection, and favorable functional recovery in infected tibial nonunion, with mostly manageable complications. The technique appears to be an effective limb-reconstruction option for complex cases with bone loss, deformity, and chronic infection.
Outcome Comparison Between Titanium Elastic Nailing and Hip Spica Casting in Pediatric Femoral Shaft Fractures
Background: Femoral shaft fractures are one of the most frequent fractures that require hospitalization in children, and the best treatment for school-age children is still a topic of debate between operative fixation using titanium elastic nailing (TEN) and conservative treatment using hip spica casting. This study aimed to compare the functional outcome results of TEN with hip spica casting in children with femoral shaft fractures. Methods & Materials: This comparative study was conducted at from Department of Orthopedic Surgery, National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, Bangladesh July 2025 to December 2025 and comprised 60 children with femoral shaft fractures, who were equally divided into two groups: TEN group (n=30) and hip spica casting group (n=30). Demographic, injury, treatment, radiological, and functional variables were recorded and compared between the two groups. Data were entered and analyzed on SPSS version 26. Results: Both groups showed similar outcomes at baseline. The time to partial and full weight-bearing, return to school, and radiological union was shorter in the TEN group than in the hip spica group, while the hospital stay was longer in the TEN group. The overall treatment-related complications (16.7% vs. 40%) and residual deformity were lower in the TEN group, and the final functional outcome and return to normal activity by 12 weeks were better with TEN. Conclusion: The results of this study indicate that titanium elastic nailing showed better outcomes than hip spica casting in children with femoral shaft fractures in terms of functional recovery and complication rate, and should be considered as the treatment of choice in the appropriate patient population in school-age children.