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
Surgical Management and Clinical Outcomes in Recurrent Glioma
Background: Recurrent gliomas, particularly glioblastomas, present significant treatment challenges due to high recurrence rates, aggressive behavior, and limited standardized management options. Repeat surgical resection is a potential therapeutic approach but carries risks of neurological complications. To evaluate the clinical characteristics, surgical management, postoperative outcomes, and complications in patients undergoing reoperation for recurrent brain gliomas. Methods & Materials: This prospective observational study included 30 patients who underwent reoperation for recurrent gliomas at Dhaka Medical College and Green Life Hospital from January 2021 to December 2023. Data on demographics, comorbidities, tumor histology, extent of resection, tumor location, time to recurrence, pre- and postoperative Karnofsky Performance Scale (KPS), and postoperative complications were collected and analyzed using SPSS-26. Results: The mean age was 48.7 years, with 63.3% males. Glioblastoma multiforme was the most frequent initial histology (53.3%), followed by diffuse astrocytoma (20%) and anaplastic astrocytoma (13.3%). Gross total resection was achieved in 53.3% of primary surgeries. At recurrence, hemiparesis (43.3%) and convulsions (36.7%) were most common; 66.7% had KPS ≥70. Early recurrence (<6 months) occurred exclusively in GBM patients, while low-grade gliomas recurred later. Postoperative KPS improvement was observed in 75% of patients with preoperative KPS ≥70, compared to only 20% of those with KPS <70.Conclusion: Reoperation for recurrent gliomas is feasible and can improve functional outcomes, particularly in patients with higher preoperative KPS. Glioblastoma recurs earlier than low-grade gliomas. While complications are common, careful patient selection based on functional status, tumor characteristics, and comorbidities can optimize surgical outcomes.
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Determination of sensitivity and specificity of Magnetic Resonance Spectroscopy (MRS) in evaluation of rim enhancing brain lesions
Background: Rim-enhancing brain lesions present a diagnostic challenge due to overlapping imaging features between neoplastic and non-neoplastic pathologies. Accurate preoperative differentiation is crucial for appropriate management. This study aimed to determine the sensitivity and specificity of Magnetic Resonance Spectroscopy (MRS) in differentiating high-grade gliomas from cerebral abscesses, using histopathology as the reference standard. Methods & Materials: A cross-sectional study was conducted at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, from July 2022 to June 2023. Twenty-nine patients with suspected rim-enhancing brain lesions underwent conventional MRI and single-voxel proton MRS. Metabolites including N-acetylaspartate (NAA), choline (Cho), creatine (Cr), and lactate were analyzed. Histopathological examination of surgical specimens served as the gold standard. Diagnostic performance of MRS was evaluated using sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV). Results: The mean age of participants was 41.23 ± 15.07 years, with a male predominance (55.2%). Headache, nausea, vomiting, and seizures were the most common presenting symptoms. High-grade gliomas constituted 51.7% and cerebral abscesses 48.3% of MRS diagnoses. MRS demonstrated elevated Cho/Cr ratios in gliomas (2.94 ± 1.83) and higher NAA/Cr ratios in abscesses (1.89 ± 0.69), both statistically significant (p < 0.05). Sensitivity, specificity, and accuracy of MRS were 100%, 82.2%, and 93.1% for cerebral abscesses, and 100% for all parameters in high-grade gliomas. Conclusion: MRS is a reliable, non-invasive adjunct to conventional MRI for differentiating rim-enhancing brain lesions, with excellent diagnostic accuracy. Incorporation of metabolite ratios enhances lesion characterization and guides clinical decision-making. Further multicenter studies with larger cohorts are recommended.
Magnetic Resonance Spectroscopic (MRS) Correlation of Diffusely Infiltrating Astrocytomas with Histological Grading
Background: Diffusely infiltrating astrocytomas are common primary brain tumors with variable histopathological grades. Accurate preoperative grading is crucial for treatment planning. Magnetic resonance spectroscopy (MRS) provides a non-invasive means to evaluate tumor metabolism, potentially aiding in grading. Objective: To evaluate the correlation between MRS findings and histological grading in diffusely infiltrating astrocytomas. Methods & Materials: This observational cross-sectional study included 30 patients diagnosed with diffusely infiltrating astrocytomas at multiple tertiary centers in Dhaka, Bangladesh, from June 2010 to April 2012. MRS parameters—choline (Cho) peak, N-acetyl aspartate (NAA) peak, creatine (Cr) peak, and Choline/Creatine (Cho/Cr) ratio—were measured preoperatively. Tumor specimens were collected during surgery for histopathological grading according to WHO criteria. Data were analyzed using SPSS, and ANOVA was used to compare metabolite peaks across tumor grades. Results: The mean age was 37.77 ± 13.16 years, with male predominance (70%). Histopathology revealed 33.3% grade II, 20% grade III, and 46.7% grade IV astrocytomas. Cho peak increased from grade II to IV, NAA decreased from grade II to III but rose in grade IV, and Cr showed variable trends. The Cho/Cr ratio progressively increased with tumor grade (Grade II: 1.997 ± 0.42; Grade III: 2.312 ± 1.07; Grade IV: 2.961 ± 1.08) and demonstrated a significant correlation with histological grade (F = 3.444, p = 0.047). No significant correlation was observed for Cho, NAA, or Cr peaks individually. Conclusion: The Cho/Cr ratio is a reliable MRS biomarker for differentiating low- and high-grade diffusely infiltrating astrocytomas. Absolute metabolite peaks alone may be insufficient due to variability and overlap. MRS can aid in preoperative tumor grading, particularly for patients unfit for surgical intervention.
Incidence of Typhoid Bacterimia in Infants and Young Children in a Tertiary Care Hospital
Background: Typhoid fever is a severe bacterial infection triggered by Salmonella Typhi, primarily spread via contaminated food and water. It frequently occurs in developing nations and primarily impacts young kids. Blood culture confirms the diagnosis, while prevention relies on hygiene, sanitation, and vaccination. This study evaluates the occurrence and clinical characteristics of typhoid in young children. Methods & Materials: This cross-sectional study, conducted in a hospital setting in Dhaka, Bangladesh (Jan 2024–Jun 2025), involved 150 children aged ≤5 years who had suspected enteric fever. Blood samples were obtained prior to antibiotic administration for culture and sensitivity testing following standard procedures and the Kirby–Bauer method (CLSI). Data analysis was conducted with SPSS v25, and the chi-square test was utilized (p < 0.05). Approval for ethical considerations and informed consent was secured. Results: Among 150 children, 28.0% (42/150) tested positive for typhoid, primarily S. Typhi (81.0%, 34/42). Age had a significant correlation with infection (p = 0.048), whereas sex did not (p = 0.46). Fever was widespread, accompanied by typical gastrointestinal symptoms. Ceftriaxone (95.2%) and azithromycin (90.5%) exhibited the greatest sensitivity. The majority recovered without issues (85.7%), however, complications were associated with prolonged hospital stay (>7 days) (p = 0.032). Conclusion: Enteric fever primarily impacted preschoolers, with S. Typhi being the most frequent isolate. Infection was significantly linked to age, whereas sex showed no association. Ceftriaxone and azithromycin proved to be the most effective, with the majority of cases recovering without complications.
Proximal humerus Fracture treated by Modified MIROS technique: Clinical Results
Background: Proximal humerus fractures involving the surgical neck are common injuries in elderly patients with osteoporotic bone. The Minimally Invasive Reduction and Osteosynthesis System (MIROS) offers a less invasive fixation option, but evidence from South Asian populations remains limited. This study evaluated clinical, functional, and radiological outcomes of surgical neck fractures treated with MIROS. Methods & Materials: This observational study was conducted at National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh, over a one-year period from January 2024 to December 2024. A total of 20 consecutive patients with closed comminuted surgical neck fractures of the humerus treated using MIROS. Patients were followed at 6, 12, and 18 months. Primary outcome was union versus non-union. Secondary outcomes included shoulder range of motion measured by goniometry and documented complications. Results: The cohort comprised 55% females with 60% aged 66-75 years. Mechanism of injury included falls (55%) and road traffic accidents (45%). Union was achieved in 16 patients (80%) while 4 (20%) developed non-union. At 18 months, the union group demonstrated significantly better shoulder range of motion compared to non-union: forward flexion 162.4° ± 10.5° versus 92.5° ± 16.8° (p<0.001) and abduction 155.2° ± 11.6° versus 78.5° ± 15.2° (p<0.001). Complications occurred in 10 patients (50%), with shoulder stiffness (20%) and pin tract infection (10%) being most common. Pin tract infection led to early MIROS removal in 50% of non-union cases. Conclusion: MIROS fixation achieves favorable union rates and functional outcomes in surgical neck fractures of the humerus. Pin tract infection represents a preventable cause of non-union, highlighting the importance of rigorous pin site care protocols.
Functional Outcome after Posterior Decompression and Instrumented Fusion in Lumbar Spinal Stenosis
Background: Lumbar spinal stenosis (LSS) is a common degenerative disorder characterized by narrowing of the lumbar spinal canal and neural foramina, leading to neurogenic claudication, radiculopathy, and functional disability. Surgical intervention is indicated when conservative management fails or neurological deficits progress. Aim of the study: This study aimed to evaluate the functional outcomes, patient satisfaction, and complication profile following posterior decompression with instrumented fusion in patients with symptomatic LSS. Methods & Materials: A prospective observational study was conducted at the Department of Orthopedic Surgery, Bangladesh Medical University, Dhaka, Bangladesh from January 2024 to December 2024, enrolling 38 adult patients with MRI-confirmed LSS. All participants underwent posterior decompression and pedicle screw–based instrumented fusion. Baseline demographic and clinical data were recorded. Functional outcomes were assessed preoperatively and at 3 months postoperatively using the Oswestry Disability Index (ODI) and Roland–Morris Disability Questionnaire (RMDQ). Clinical success was defined as an ODI reduction ≥15%. Patient satisfaction and postoperative complications, including reoperation, implant-related issues, adjacent segment degeneration, and infection, were documented. Statistical analysis was performed using paired t-tests, with significance set at p<0.05. Results: The mean age was 60.3 ± 11.4 years, with 81.6% female and 63.2% single-level stenosis. Mean ODI decreased significantly from 48.6 ± 12.4 preoperatively to 24.3 ± 10.2 postoperatively (p<0.001), and RMDQ scores improved from 15.2 ± 4.3 to 7.1 ± 3.5 (p<0.001). Clinically successful outcomes were achieved in 63.16% of patients, and 94.74% reported satisfaction. Complications were minimal, with reoperation in 5.26% and other complications ≤2.63%. Conclusion: Posterior decompression with instrumented fusion provides significant functional improvement and high patient satisfaction with an acceptable safety profile, supporting its use in carefully selected LSS patients.
Implication of DM on ICU Admitted Patients: A Study of 582 Cases
Background: Diabetes in Intensive Care Unit patients is linked to metabolic and organ complications and can affect clinical results. While overall death rates may not consistently be elevated in diabetics, they frequently face increased risks associated with glycemic issues and other health conditions. This study intends to assess the effects of diabetes on ICU results, such as mortality, duration of stay, complications, and to determine significant predictors of unfavorable prognosis in critically ill individuals. Methods & Materials: This cross-sectional research in a Bangladeshi ICU incorporated 582 patients to evaluate the effects of diabetes on ICU results, complications, and antibiotic usage. Medical records were used to gather data, analyzed through SPSS, and ethical approval along with patient confidentiality was maintained. Results: Out of 582 ICU patients, 55.3% were diagnosed with diabetes, with prevalence rising as age increased. ICU results were comparable, with 58.2% improved or discharged and 52.6% fatalities among diabetics. Complications were more frequent in diabetics: acute kidney injury 77.8% and metabolic crises 69.4%, whereas neurological emergencies occurred more often in non-diabetics 78.8%. The use of antibiotics was generally alike, although non-diabetics had higher use of cephalosporins and antifungals. Conclusion: Diabetes frequently occurred in ICU patients and was associated with complications; however, ICU duration, mortality rates, and antibiotic use were comparable to non-diabetics, highlighting the importance of vigilant monitoring and customized management.
Prevalence, Sociodemographic Determinants, and Association of Urinary Tract Infections with Premature Rupture of Membranes in Pregnant Women
Background: Urinary tract infections (UTIs) frequently occur during pregnancy because of anatomical and physiological alterations, raising the risk of premature rupture of membranes (PROM), which may result in complications for both the mother and newborn. UTIs can happen irrespective of a mother’s age or number of previous births, emphasizing the importance of routine screening. This research seeks to evaluate the occurrence of UTIs in pregnant women and investigate their connection to PROM. Methods & Materials: A cross-sectional study took place (July 2023–June 2024) at Dhaka Medical College with pregnant women (≥28 weeks, single pregnancy) suspected of having a UTI. Samples of data and urine were gathered for analysis via microscopy and culture. PROM was tracked until delivery, and its correlation with UTI was evaluated using Fisher’s exact test and odds ratios (p<0.05) in SPSS v25. Results: The research involved 152 expectant mothers, primarily aged 27–34 years (44.1%), with the majority being housewives (73.7%) and repeat pregnancies (78.9%). Microscopic analysis revealed that 85.5% exhibited notable pyuria (>5 pus cells/HPF), with a predominance of Gram-negative bacteria (91.2%). PROM was noted in 53.9% of suspected UTI instances, increasing to 60.8% in cases with significant pyuria and 61.3% in culture-positive UTIs. A significant link was identified between UTI and PROM, as 61.3% of culture-positive cases experienced PROM, in contrast to none in culture-negative cases (OR 2.58; 95% CI: 2.06–3.24; p=0.001). Conclusion: UTIs in pregnancy are strongly linked to PROM, highlighting the need for early detection and treatment.
Assessment of Laparoscopic Surgical Procedures and Anaesthesia Outcomes
Background: Laparoscopic surgery is a minimally invasive approach for procedures like cholecystectomy and hysterectomy, offering less pain, faster recovery, and fewer complications. Anaesthetic challenges from CO₂ pneumoperitoneum exist, but studies show both general and regional anaesthesia are safe, with regional techniques often improving outcomes. This study assessed anaesthetic results and the effect of pneumoperitoneum duration on recovery and complications. Methods & Materials: This observational study involved 110 adults classified as ASA I–III who were scheduled for elective surgical laparoscopy. Intraoperative monitoring along with CO₂ pneumoperitoneum was employed, and patients were categorized based on the duration of pneumoperitoneum (<120 min vs. ≥120 min). Postoperative results encompassed extubation, PACU/hospital duration, pain levels, and complications. Data analysis was conducted with SPSS-27 (p < 0.05). The research received IRB approval and obtained informed consent. Results: In a study of 110 patients (average age 48 years; 80% male), Intraoperative complications were primarily temporary, including hypotension (20%) and hypercapnia (11%). Postoperative recovery was swift (extubation 10.8 min, PACU 69.4 min, hospital 3.6 days), pain reduced from VAS 3.4 to 2.2, and PONV happened in 20.9%. Pneumoperitoneum lasting ≥120 min led to greater hypercapnia, lower blood pressure, longer recovery times, and increased early pain. Conclusion: This study involves ASA I–III patients undergoing laparoscopy, demonstrating that the procedure is safe with mostly temporary complications; however, extended pneumoperitoneum raises risks, necessitating diligent monitoring.
Diagnostic Performance of Computed Tomography Angiography for the Detection of Intracranial Ruptured Aneurysms in Patients with Spontaneous Subarachnoid Hemorrhage: Compared with Digital Subtraction Angiography
Background: Subarachnoid hemorrhage (SAH) is a significant cause of morbidity and mortality. Early and accurate aneurysm detection and evaluation are essential for effective treatment planning. Computed tomography angiography (CTA) provides a rapid, non-invasive diagnostic option, but its accuracy needs comparison with digital subtraction angiography (DSA), which remains the gold standard. Objective: To compare the diagnostic accuracy of CTA with DSA for detecting intracranial aneurysms in patients with spontaneous SAH. Methods & Materials: Thirty patients with spontaneous SAH were enrolled following IRB approval and informed consent. All underwent CTA at BMU and DSA at DMCH within 48–72 hours. DSA served as the gold standard. The sensitivity, specificity, PPV, NPV, and accuracy of CTA for aneurysm detection were calculated against DSA. Results: The mean age was 52.2 ± 9.8 years (range 32–72), with the highest incidence in the 51–60-year group (36.7%). Females predominated (63.3%), yielding a male-to-female ratio of 1:1.7. Hypertension (76.7%) was the most common risk factor, followed by smoking (33.3%). The leading presenting features were thunderclap headache and neck stiffness (63.3% each). CTA detected 31 aneurysms in 27 patients (90.0%). DSA detected 34 aneurysms in 28 patients (93.3%). Diagnostic performance of CTA demonstrated 96.4% sensitivity, 100% specificity, 100% PPV, 66.7% NPV, and 96.7% diagnostic accuracy. Conclusion: CTA demonstrated excellent diagnostic accuracy, comparable to invasive DSA, in detecting intracranial aneurysms among spontaneous SAH patients.
Comparison of Dual Plating versus Single Lateral Plating in Bicondylar Proximal Tibial Fractures
Background: Bicondylar proximal tibial fractures are complex injuries often caused by high-energy trauma, posing challenges in achieving stable fixation and good functional outcomes. Evidence comparing dual plating and single lateral plating remains inconclusive, especially in South Asian populations, highlighting the need for further study. Objective: The aim of the study was to compare the clinical, radiological, and functional outcomes of dual plating versus single lateral plating in patients with bicondylar proximal tibial fractures. Methods & Materials: This prospective comparative study at the Department of Orthopaedic & Traumatology, Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh (July–December 2025) included 50 patients with bicondylar proximal tibial fractures (Schatzker V–VI) to compare dual versus single lateral plating. Patients were evaluated preoperatively, underwent standard fixation, and followed for radiological, functional, and complication outcomes. Data were analyzed using SPSS with p < 0.05 considered significant. Results: In 50 patients (25 dual, 25 single lateral plating), baseline characteristics were comparable. Dual plating had longer operative time (112 ± 15 vs 85 ± 12 min), higher blood loss (310 ± 60 vs 220 ± 50 mL), and longer hospital stay (8.4 ± 2.1 vs 6.2 ± 1.8 days; all p < 0.001). Radiological outcomes, functional scores, knee ROM, and complications were similar between groups, indicating comparable healing and safety despite greater surgical demands with dual plating. Conclusion: Both dual plating and single lateral plating provide satisfactory outcomes for bicondylar proximal tibial fractures, with dual plating offering slightly better stability but increased surgical demands.
Trends and Patterns of COVID-19–Negative Gynecologic Admissions in a Tertiary Care Hospital in Bangladesh
Background: COVID-19 significantly disrupted healthcare systems worldwide, affecting access to essential medical services. Obstetric and gynecological care is a critical healthcare service that must continue during public health emergencies. The pandemic has influenced hospital admission patterns and healthcare utilization globally. Objective: This study analyzed trends in Covid-19 negative gynecologic admissions to a tertiary university hospital in Bangladesh during the COVID-19 pandemic. Methods & Materials: This retrospective observational study was conducted at the Department of Obstetrics and Gynecology, Bangladesh Medical University, Dhaka, from January 2021 to December 2022. The study included 1235 RT-PCR–negative patients admitted with suspected COVID-19. Sociodemographic characteristics, clinical diagnosis, illness severity, admission trends across pandemic waves and vaccination status were obtained from hospital records. Data were analyzed using SPSS version 25.0. Results: The mean age of the participants was 31.4 ± 8.7 years, with most patients aged 20–29 years (42.6%). Uterine fibroids were the most common diagnosis (32.7%), followed by pelvic organ prolapse (20.2%), adenomyosis (15.5%) and ovarian cysts (15.5%). Mild conditions accounted for 41.9% of admissions, while moderate and severe conditions accounted for 38.1% and 20% of admissions, respectively. The highest number of admissions occurred during the third pandemic wave (27.1%). Regarding vaccination status, 36.3% were unvaccinated, whereas 63.7% had received at least one vaccine dose. Conclusion: Obstetric and gynecological services continued throughout the COVID-19 pandemic, although admission patterns varied across waves. Ensuring the continuity of essential reproductive healthcare is crucial during global health crises.
Spectrum of Clinical Profile of Dengue Syndrome Admitted in Dengue Referral Center
Introduction: Dengue fever is one of the most rapidly spreading mosquito-borne viral infections worldwide, caused by four serotypes of dengue virus and transmitted mainly by Aedes aegypti. The disease presents with a wide spectrum of clinical manifestations ranging from mild febrile illness to severe complications such as dengue shock syndrome, hemorrhage, and multi-organ dysfunction. Aim of the Study: To evaluate the spectrum of clinical presentations, laboratory findings, complications, and outcomes among dengue-confirmed patients admitted to a dengue referral center. Methods & Materials: This hospital-based observational study was conducted at the Dhaka North City Corporation (DNCC) Dedicated COVID-19 and Dengue Referral Hospital in Dhaka, Bangladesh. The study was conducted over six months from August 2025 to January 2026 to evaluate the spectrum of clinical profiles among 60 dengue-confirmed patients. The diagnosis was confirmed by NS1 antigen testing or dengue IgM/IgG serology, according to the WHO 2009 criteria. Sociodemographic data, clinical features, warning signs, laboratory parameters, complications, and outcomes were recorded using structured data sheets. Data were analyzed using SPSS version 26. Results: Most patients were aged 50–60 years (45%), 70% were male, and 75% were from urban areas. Fever and headache were present in 100% of cases, while arthralgia and fatigue (93.3%), nausea (91.7%), and myalgia (81.7%) were common symptoms. The most frequent warning sign was a rising hematocrit with a rapid fall in platelets (85%), followed by clinical fluid accumulation (63.3%). Laboratory findings showed leukopenia, thrombocytopenia, and elevated liver enzymes. The most common complication was dengue hepatitis (76.7%), followed by acute kidney injury (31.7%) and dengue shock syndrome (28.3%). The recovery rate was 98.3%, with a mortality rate of 1.7%. Conclusion: Dengue infection in hospitalized patients showed diverse clinical manifestations. Gastrointestinal symptoms were prominent, with diarrhea emerging as the most frequent manifestation, while rash was observed less commonly. These findings suggest a shift toward gastrointestinal-predominant presentations of dengue in Bangladesh and emphasize the importance of early recognition of atypical symptoms for timely diagnosis and management.
Clinical and Demographic Patterns of Patients Presenting with Neck Swelling in a Tertiary Otolaryngology Centre
Background: Neck swellings are a common clinical presentation in otolaryngology, arising from diverse anatomical structures and encompassing benign, inflammatory, and malignant conditions. This study aimed to describe the clinical, demographic, and pathological patterns of patients presenting with neck swellings in a tertiary ENT center. Methods & Materials: A descriptive cross-sectional study was conducted among 100 patients presenting with neck swellings in the Department of Otorhinolaryngology, Faridpur Medical College, Faridpur, Bangladesh, during the period from January 2024 to December 2024. Demographic data, clinical features, FNAC results, and histopathological findings were recorded and analyzed using descriptive statistics. Results: Most patients were young to middle-aged adults, with the largest proportion in the 15–30-year group (37%). Thyroid-origin swellings (42%) and lymph-node lesions (35%) were the predominant anatomical sites. Pain (84%), fever (78%), and lymphadenopathy (60%) were the most frequent symptoms. Cytology identified nodular goitre (22%), Hashimoto’s thyroiditis (15%), reactive hyperplasia (14%), and granulomatous lymphadenitis (8%) as major diagnoses. Histopathology confirmed that 73% of masses were benign or inflammatory, while 27% were malignant, predominantly metastatic carcinoma (7%) and lymphomas (8%). FNAC demonstrated 87% overall diagnostic accuracy, correctly identifying 64 benign and 23 malignant cases. Conclusion: Benign and inflammatory conditions form the bulk of neck swellings in tertiary ENT practice, with FNAC providing reliable, efficient diagnostic guidance. A structured diagnostic approach remains essential to ensure timely detection of malignant lesions.
Association of Insulin Resistance and Elevated Androgen Levels in Patients with Polycystic Ovarian Syndrome (PCOS)
Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder in reproductive-aged women characterized by hyperandrogenism, ovulatory dysfunction, and insulin resistance. Insulin resistance and elevated androgen levels are closely interrelated in PCOS, though their association varies across populations. Objective: The aim of the study was to determine the association between insulin resistance and elevated androgen levels in patients with polycystic ovarian syndrome (PCOS). Methods & Materials: This cross-sectional observational study was conducted at the Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from January to December 2024, including 110 women with PCOS selected by purposive sampling. After excluding other endocrine disorders and hormonal therapy, BMI and fasting insulin, glucose, and testosterone were measured; insulin resistance was assessed using HOMA-IR and elevated androgens by laboratory reference ranges. Statistical analysis was performed with p < 0.05 considered significant. Results: The study included 110 women with PCOS, with most aged 21–30 years (61.8%) and a mean age of 26.5 ± 7.2 years. Overweight/obesity was present in 68.2% of participants. Insulin resistance and elevated androgen levels were observed in 65.5% and 70.9% of patients, respectively. A significant association was found between insulin resistance and elevated androgen levels (p < 0.001), with higher fasting insulin, HOMA-IR, and total testosterone in insulin-resistant patients (p < 0.001). Conclusion: Insulin resistance is significantly associated with elevated androgen levels in women with polycystic ovarian syndrome, highlighting a strong interrelated metabolic–endocrine link in its pathophysiology.
Dinoprostone is More Effective than Misoprostol in Induction of Vaginal Delivery
Background: Induction of labour is frequently performed to reduce maternal and neonatal complications when continuation of pregnancy poses risk. Prostaglandins are widely used for cervical ripening and labour induction. Dinoprostone and misoprostol are commonly used pharmacological agents, but comparative evidence regarding their effectiveness and safety remains inconsistent. Objective: This study aimed to compare the effectiveness and safety of dinoprostone and misoprostol for induction of labour in term pregnancy. Methods & Materials: This randomized controlled trial was conducted at the Department of Obstetrics and Gynecology, Bangladesh Medical University, Dhaka, Bangladesh, from December 2024 to December 2025. A total of 250 term pregnant women requiring labour induction were randomly assigned into dinoprostone group (n=125) and misoprostol group (n=125). Primary outcomes included induction to active labour interval, induction to delivery interval, Bishop score improvement and vaginal delivery within 24 hours. Maternal and neonatal outcomes were also evaluated. Statistical analysis was performed using SPSS version 25.0. Results: Dinoprostone showed significantly shorter induction to active labour interval (11.8±4.1 vs 13.2±4.6 hours; p=0.01) and shorter induction to delivery interval (17.4±5.8 vs 19.6±6.2 hours; p=0.003). Bishop score improvement was significantly higher with dinoprostone (7.9±1.8 vs 6.8±1.9; p<0.001). Vaginal delivery within 24 hours was higher in the dinoprostone group (74.4% vs 64.0%; p=0.048). Uterine tachysystole was significantly lower in the dinoprostone group (8.8% vs 20.8%; p=0.006). Other maternal and neonatal outcomes were comparable. Conclusion: Dinoprostone is more effective than misoprostol for induction of labour, with better cervical ripening, shorter labour duration and lower uterine tachysystole.
Vitamin D deficiency and its effects-a consequence of lack of knowledge and neglect - an editorial
Serum Vitamin D and Lipid Profile in Patients with Psoriasis in Bangladesh: A Cross-Sectional Comparative Study
Background: Psoriasis is a chronic immune-mediated inflammatory disorder increasingly seen as a systemic disease with metabolic and cardiovascular comorbidities. Vitamin D plays immunomodulatory roles, and deficiency may exacerbate disease activity and metabolic issues such as dyslipidemia. Evidence from Bangladesh is limited. This study evaluates serum 25(OH)D levels and lipid profiles in Bangladeshi psoriasis patients against matched healthy controls. Methods & Materials: This cross-sectional study at Sir Salimullah Medical College Mitford Hospital, Dhaka, from July 2021 to June 2022, enrolled 120 participants: 60 confirmed psoriatic patients and 60 matched healthy controls, selected via purposive convenience sampling. Serum 25(OH)D was measured by immunofluorescence immunoassay, and lipid profiles were assessed enzymatically. Group comparisons used Student’s t-test and Chi-square test; Pearson correlation analyzed relationships among vitamin D, lipids, and psoriasis duration. Results: Psoriatic patients had significantly lower serum 25(OH)D levels (14.55 ± 5.89 vs. 33.22 ± 6.82 ng/mL; p = 0.001) and higher total cholesterol (219.00 ± 20.21 vs. 159.53 ± 14.50 mg/dL), triglycerides (169.60 ± 32.75 vs. 112.47 ± 20.34 mg/dL), and LDL-C (146.75 ± 17.74 vs. 93.43 ± 15.55 mg/dL), with lower HDL-C (38.15 ± 3.47 vs. 43.63 ± 4.69 mg/dL) (all p = 0.001). Vitamin D deficiency (<20 ng/mL) was in 83.5% of psoriatic patients vs. 1.7% of controls. Serum vitamin D negatively correlated with total cholesterol (r = −0.699), triglycerides (r = −0.630), LDL-C (r = −0.687), disease duration (r = −0.462), and positively with HDL-C (r = +0.569) 0.001). Conclusion: Patients with psoriasis in Bangladesh exhibited significant vitamin D deficiency and dyslipidemia. Low vitamin D was linked to an atherogenic lipid profile, suggesting a role in cardiometabolic risk.
Assessment of Aesthetic Outcomes Following Late Surgical Release of Syndactyly in Pediatric Patients
Background: Syndactyly is one of the most common congenital anomalies of the hand, characterized by the fusion of adjacent digits due to incomplete separation during embryonic development. Early surgical correction is generally recommended to achieve optimal functional and cosmetic outcomes. However, delayed presentation and late surgical intervention are still common in many developing countries. This study aimed to assess the aesthetic outcomes following late surgical release of syndactyly in pediatric patients. Methods & Materials: This hospital-based descriptive observational study was conducted in the Department of Orthopaedic Surgery at Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh, from November 2024 to October 2025. A total of 30 pediatric patients who underwent late surgical release of syndactyly were included using purposive sampling. Results: The majority of patients were aged 5–7 years (36.7%) and males constituted 56.7% of the study population. Most participants were from rural areas (63.3%). The right hand was most commonly affected (46.7%) and simple syndactyly was the predominant type (70.0%). The third web space was most frequently involved (40.0%). The dorsal rectangular flap with skin graft was the most commonly used surgical technique (60.0%). Most patients had no postoperative complications (70.0%). Regarding aesthetic outcomes, excellent results were observed in 40.0% of patients, good outcomes in 33.3%, fair outcomes in 20.0% and poor outcomes in 6.7%. Conclusion: Late surgical release of syndactyly in pediatric patients can achieve satisfactory aesthetic outcomes with a relatively low rate of postoperative complications when appropriate surgical techniques and postoperative care are applied.
Analysis of the Clinical Profile and Fate of Retained Placenta in Comilla Medical College Hospital, Comilla
Background: Retained placenta is a potentially life-threatening condition that significantly contributes to postpartum haemorrhage (PPH) and maternal mortality, especially in women from disadvantaged socioeconomic backgrounds. Identifying predisposing factors and ensuring timely management during antenatal care and the third stage of labour are crucial to reducing morbidity and improving maternal outcomes. Objective: The aim of the study was to determine the clinical characteristics and outcomes of patients with retained placenta. Methods & Materials: This cross-sectional study at the Department of Obstetrics and Gynaecology, Comilla Medical College & Hospital (Jan–Jun 2013) included 100 vaginal deliveries with retained placenta. Cases ≥28 weeks’ gestation were included, while caesarean deliveries and <28 weeks were excluded. After informed consent, clinical, demographic, obstetric, management, and outcome data were collected using a structured form. Ethical approval was obtained, and data were analyzed with SPSS 15 using descriptive statistics. Results: Among 3,126 obstetric admissions, 107 (3.42%) had retained placenta. Of 100 patients, most were 21–30 years (62%), primarily educated (39%), housewives (92%), para 2–4 (60%), and 79% unbooked. Deliveries were mostly home (74%) by untrained dais (62%). Common complications were PPH (52%) and genital trauma (30%). Manual removal was needed in 91%, transfusion in 72%. Outcomes: recovery 72%, severe anaemia 16%, infection 6%, renal failure 2%, maternal death 4%. Conclusion: Retained placenta remains a serious obstetric complication, with outcomes largely dependent on timely hospital care, skilled delivery management, and appropriate interventions.
Role of Normal Saline Irrigation Prior to Closure of Surgical Wound to Reduce Surgical Site Infection in Gynaecologic Oncologic Surgery
Background: Surgical site infection (SSI) is a major cause of postoperative morbidity and increased healthcare burden in gynaecologic oncologic surgery. Patients with gynaecological malignancies face a higher SSI risk due to prolonged surgery, tissue dissection and immune compromise. Wound irrigation with saline before closure may reduce bacterial contamination and prevent SSI; however, evidence from low- and middle-income countries remains limited. Objective: This study evaluated the role of normal saline wound irrigation in reducing SSI among patients undergoing gynaecologic oncologic surgery. Methods & Materials: A comparative observational study was conducted at the Department of Gynecological Oncology, Bangladesh Medical University (BMU), Dhaka, from June 2024 to July 2025. The study included 100 patients: 50 receiving preoperative normal saline wound irrigation and 50 controls. Sociodemographic, clinical, operative and postoperative data were analyzed using SPSS version 25.0. Results: The groups were comparable in terms of baseline characteristics, surgery type and operative factors. The SSI rate within 30 days was lower in the irrigation group (10%) than in the control group (30%) (p=0.012). SSI at 10 days (8% vs. 26%, p=0.018) and 30 days (6% vs. 22%, p=0.027), wound discharge (6% vs. 20%, p=0.034), febrile illness (8% vs. 24%, p=0.028), additional antibiotics (6% vs. 22%, p=0.027) and hospital stay (4.8 ± 1.3 vs. 6.4 ± 1.9 days, p=0.001) were reduced with irrigation. Conclusion: Normal saline wound irrigation before closure significantly reduced SSI rates and complications in gynaecologic oncologic surgery, representing an effective preventive measure.
Association between Prolonged QRS Duration (>110 milliseconds) and In-hospital Outcomes of Patients with Heart Failure: Data from the Medical Registry of a Tertiary Hospital in Bangladesh
Background: Heart failure is a major cause of morbidity and mortality worldwide. Electrocardiographic parameters, particularly QRS duration, may provide important prognostic information in patients with heart failure. This study aimed to evaluate the relationship between QRS duration on admission ECG and in-hospital outcomes among patients admitted with heart failure. Methods & Materials: This retrospective observational study was conducted in the Department of Cardiology at Dhaka Medical College Hospital, Dhaka, from 01 January to 31 December 2025. A total of 100 adult patients admitted with a primary diagnosis of heart failure were included. Results: The mean age of the study population was 59.27 ± 11.63 years and 67% were male. Sinus rhythm was observed in 93% of patients. Hypertension and diabetes mellitus were present in 50% and 54% of patients respectively, while ischemic heart disease was highly prevalent (88%). Patients with prolonged QRS duration (>110 ms) had higher rates of in-hospital mortality (10.00% vs 4.00%), cardiogenic shock (36.00% vs 18.00%), requirement of intravenous inotropic/vasopressors support (36.00% vs 18.00%) and need for mechanical ventilation (12.00% vs 4.00%) and p = 0.269 compared with those with normal QRS duration (≤110 ms). The mean hospital stay was also longer in the prolonged QRS group (10.66 ± 6.647 vs 7.52 ± 5.686 days; p = 0.013). Conclusion: Prolonged QRS duration on admission ECG is associated with poorer in-hospital outcomes among patients with heart failure. QRS duration may serve as a simple and useful marker for early risk stratification in hospitalized heart failure patients.
Association Between CT Scan Findings of the Head and Motor Impairment Patterns in Paediatric Cerebral Palsy
Introduction: Cerebral palsy (CP) comprises a group of permanent movement and posture disorders resulting from non-progressive disturbances in the developing brain. Neuroimaging, especially CT scans, plays a vital role in determining etiology, particularly in resource-limited settings where it remains a primary diagnostic tool. Objective: To categorize the CT findings of the head and examine their correlation with the types of motor disturbances in children with CP. Methods & Materials: Conducted at the Paediatric Neurology unit of BSMMU between July 2009 and July 2010, this cross-sectional study included 120 children with CP. These children were randomly selected, and each underwent a brain CT scan. The CT findings were then correlated with the patients' motor disturbances. Results: The study involved 120 children with CP, with a male-to-female ratio of 1.4:1. Most children were aged 49-60 months (29.2%). Abnormal CT scans were present in 85.0% of patients, whereas 15.0% had normal results. Cerebral atrophy was identified as the most frequent abnormality (55.8%). Hemiplegia was the most common form of motor disturbance (30.0%), with 86.1% showing abnormalities on CT. The highest incidence of cerebral atrophy was seen in hemiplegic (32.8%), hypotonic (20.9%), and diplegic (19.4%) types. Additionally, diplegic CP showed the highest rate of cerebral infarction (6 cases), while dyskinetic CP had the lowest abnormality rate (15.4%). Bilateral involvement was observed in 4.2% of cases despite unilateral clinical signs. Conclusion: The findings suggest that the clinical pattern of motor disturbance correlates with brain CT results. Generally, more abnormal CT findings indicate a higher likelihood of motor impairment in children with CP.
Assessment of Efficacy and Safety of Tirofiban in Acute Coronary Syndrome Patients Following Percutaneous Coronary Intervention: A Prospective Observational Study
Background: Cardiovascular disease ranks as a top global cause of mortality, with acute coronary syndrome (ACS) necessitating urgent treatment like percutaneous coronary intervention (PCI) to lower complications. Glycoprotein IIb/IIIa inhibitors such as tirofiban efficiently avert thrombotic occurrences during PCI while maintaining a positive safety profile. Although there is international evidence, data from Bangladesh are scarce; this study assesses the effectiveness and safety of tirofiban in ACS patients receiving PCI in a Bangladeshi coronary care unit. Methods & Materials: This observational study at Khwaja Yunus Ali Medical College Hospital, Sirajganj, Bangladesh (Nov 2024–Oct 2025) assessed the effectiveness and safety of Inj. Tirofiban for ACS patients receiving PCI. Adult patients treated with Tirofiban were included, and data on demographics, risk factors, clinical presentation, angiography, stents, procedural results, and complications were gathered. Ethical clearance was secured, and data were examined descriptively with SPSS v26. Results: Among 120 ACS patients undergoing PCI with Inj. Tirofiban, primarily involved males between the age group of 50 and 59. Hypertension, smoking, and diabetes were the most prevalent risk factors, with NSTEMI and STEMI being the main manifestations. Angiographically, single-vessel disease was the most common. All procedures were successfully finished, with minor thrombus occurring in 2.7% of cases and resolved using tirofiban, while complications related to the procedure were minimal, restricted to 2.5% of minor gum bleeding. Conclusion: Tirofiban is both safe and effective for ACS patients receiving PCI, ensuring a high success rate in procedures, effective control of thrombus, and few complications.
Assessment of Renal Function Status and Electrolyte Imbalances in Paediatric Patients with Acute Glomerulonephritis
Background: Acute glomerulonephritis (AGN) is a frequent glomerular disease in children, which is associated with hematuria, proteinuria, high blood pressure, and edema that can cause severe renal failure and electrolyte imbalances. Early detection of renal function status and electrolyte profiles is the key to the maximum benefit of clinical outcomes in the vulnerable population. This study aimed to determine the renal function condition and electrolyte imbalance among children with acute glomerulonephritis. Methods & Materials: This study was conducted at the Department of Pathology, Parkview Medical College & Hospital, Sylhet, from January 2025 to June 2025. A total of 60 children aged between 1 and 14 years and diagnosed with acute glomerulonephritis participated in the study by the purposive sampling method. Demographic information, clinical data, and laboratory data such as serum creatinine, blood urea, estimated glomerular filtration rate (eGFR), and serum electrolytes (sodium, potassium, calcium, and phosphate) were collected and entered into SPSS version 26 for further analysis. Chi-square tests and Fisher's exact tests were used to identify links between renal impairment and electrolyte imbalances. Results: The age of the participants was 8.7±3.1 years, and a majority of them were males (60%). Hematuria (100 percent) and periorbital edema (86.7 percent) were very common and hypertension (68.3 percent) was the most common clinical feature. 65% Of patients had a raised serum creatinine; 70% of patients had a lowered eGFR under 90 ml/min/1.73m2. The most common electrolyte imbalance was hyponatremia (46.7%), then hyperphosphatemia (35%) and hyperkalemia (31.7%). Impaired renal function was strongly linked with hyponatremia (p = 0.04) and hyperkalemia (p = 0.02). Conclusion: Renal dysfunction and electrolyte imbalances are very common in paediatric acute glomerulonephritis patients. Timely and regular laboratory check-ups, especially of sodium and potassium levels, are required to avoid life-threatening complications in children with the disease.
p16 Immunohistochemistry Improves Treatment Decision-Making in See-and-Treat Management of Cervical Intraepithelial Neoplasia
Background: The “see-and-treat” approach is commonly used in cervical cancer prevention programs to reduce loss to follow-up by providing immediate treatment after colposcopic diagnosis. However, discrepancies between colposcopic impressions and histopathological findings may affect treatment decision-making. p16 immunohistochemistry has emerged as a biomarker associated with oncogenic human papillomavirus–induced cellular transformation and may improve diagnostic accuracy. This study evaluated the association between p16 expression and clinicopathological characteristics and examined its implications for treatment decision-making in the management of cervical intraepithelial neoplasia (CIN). Methods & Materials: This cross-sectional study included 72 women aged 30-60 years diagnosed with high-grade lesions on colposcopy using the Swede scoring system attending the colposcopy clinic of Bangladesh Medical University (BMU), Shahbagh, Dhaka in 2022-2023. All participants underwent colposcopy-guided cervical biopsy followed by histopathological examination. Histological diagnoses were categorized as CIN I, CIN II, CIN III, or benign lesions such as chronic cervicitis. p16 immunohistochemistry staining was performed and interpreted as diffuse/block positivity, focal staining, or negative expression. Treatment modalities and treatment adequacy were analyzed. Results: Histopathology revealed CIN I in 29.2%, CIN II in 23.6%, CIN III in 33.3%, and chronic cervicitis in 13.9% of cases. Overall, 43.1% of colposcopic high-grade lesions were not confirmed as high-grade on histology, indicating potential overtreatment risk in a see-and-treat setting. Diffuse p16 positivity was observed in 52.7% of cases. Overtreatment occurred in 13.9% of patients and was exclusively associated with p16-negative lesions, whereas undertreatment occurred in 22.2% of cases and was observed only among p16-positive lesions (p < 0.001). Conclusion: Substantial discordance exists between colposcopic impressions and histopathological findings. p16 immunohistochemistry may improve treatment decision-making in see-and-treat management by helping identify lesions requiring definitive treatment while avoiding unnecessary procedures.
Prevalence and Risk Factors of Umbilical Hernia among Female Patients Attending in A Tertiary Hospital
Background: An umbilical hernia occurs when abdominal contents bulge out at the navel, frequently observed in adult women because of pregnancy, obesity, or ongoing straining. Diagnosis is made clinically, imaging is used for confirmation if necessary, and surgical treatment is employed, as complications may arise if left unaddressed. This study seeks to fill the gap in gender-specific data among adults in Bangladesh. Methods & Materials: This cross-sectional research conducted at Shikder Women’s Medical College Hospital (Jan–Dec 2025) involved 420 consenting women aged 18 years or older. Information regarding demographics, obstetric background, and risk factors was gathered through interviews and clinical assessments, including BMI measurement. Analysis employed SPSS-26 and Chi-square tests (p < 0.05). Approval for ethical standards and the confidentiality of participants were guaranteed. Results: Among 420 women, most were 40–49 years (29.5%), rural residents (58.8%), and housewives (70.5%). Umbilical hernia was found in 14.8%. Common risk factors included heavy lifting, chronic constipation, obesity, prior abdominal surgery, and chronic cough. Hernia was significantly associated with obesity, heavy lifting, chronic cough, chronic constipation, and multiparity (≥3 children), indicating these as key contributors in this population. Conclusion: Umbilical hernia impacted 14.8% of participants and showed a significant correlation with obesity, heavy lifting, chronic cough, chronic constipation, and multiparity, emphasizing the importance of modifiable and physiological risk factors in preventing it.
Risk Factors and Presentation Pattern of Laryngeal Cancer
Background: Laryngeal carcinoma accounts for about 1% of all cancers and 30–40% of head and neck malignancies worldwide, with significant gender disparity and regional variation, including in Bangladesh [1–3]. In view of its strong association with tobacco, alcohol, and betel quid chewing and the frequent late-stage presentation locally, this study was conducted to evaluate the risk factors and presentation patterns of laryngeal cancer. Objective: The aim of the study was to evaluate the risk factors and clinical presentation patterns of laryngeal cancer among affected patients. Methods & Materials: This prospective observational study was conducted at the Department of Otolaryngology–Head & Neck Surgery, Bangladesh Medical University (BMU), Dhaka, Bangladesh, from January 2025 to December 2025, including 80 patients with newly diagnosed laryngeal cancer. Demographic details, risk factors, clinical symptoms, tumor location, and TNM stage were recorded. Data were analyzed using SPSS version 26.0, with categorical variables expressed as frequencies and percentages and continuous variables as mean ± standard deviation. Results: Among 80 patients, the mean age was 56.2 ± 11.1 years, with the majority aged 50–69 years, and males predominating (81.3%). The most common risk factors were combined smoking with betel use (53.8%) and smoking alone (31.3%). Hoarseness of voice was the predominant symptom (56.3%). Tumors were primarily located in the glottic region (52.5%), and most patients presented at advanced stages (62.5%). Conclusion: Laryngeal cancer predominantly affects older males with high exposure to tobacco and betel use, commonly presents with hoarseness and glottic involvement, and is often diagnosed at advanced stages, emphasizing the need for early detection and targeted risk factor mitigation.
Histomorphological Spectrum of Benign Breast Lumps in a Tertiary Care Center
Background: Benign breast diseases comprise diverse pathological conditions that present as palpable breast lumps and account for many breast-related clinical consultations. These non-malignant lesions often mimic breast cancer clinically and radiologically, creating anxiety for patients and diagnostic challenges for clinicians. Histopathological evaluation is critical in identifying these lesions' nature and guiding appropriate management. This study aimed to evaluate the histomorphological spectrum of benign breast lumps in patients at a tertiary care center. Methods & Materials: This cross-sectional observational study was conducted in the Department of Surgery at Bangladesh Medical University, Dhaka, Bangladesh, from January to December 2025. A total of 175 patients with clinically suspected benign breast lumps who underwent surgical excision or biopsy were included. Histopathological examination was performed using standard hematoxylin and eosin staining techniques. Data were analyzed using SPSS version 25.0. Results: The majority of patients were younger than 40 years (70.9%), with a mean age of 35.1 ± 11.0 years. Inflammatory and infectious lesions were the most common category, accounting for 59.4% of cases, with chronic breast abscess being the most frequent diagnosis. Fibrocystic changes constituted 21.1% of lesions, while benign neoplasms accounted for 16.0%. Fibroadenoma was the most common benign tumor, representing 12.6% of cases. A small proportion of cases consisted of other rare benign lesions including epidermal inclusion cyst and granulomatous inflammation. Conclusion: Benign breast lesions show a wide histomorphological spectrum, with inflammatory conditions being the most prevalent. Histopathological examination remains essential for accurate diagnosis and appropriate clinical management of breast lumps.
Association of Insulin-Like Growth Factor level in maternal serum as a predictor of Gestational Diabetes Mellitus
Background: Gestational Diabetes Mellitus (GDM) is a well-known complication in which spontaneous hyperglycemia develops during pregnancy. Insulin resistance is the key pathophysiological mechanism of GDM. The aim of this study was to assess the association of Insulin-Like Growth Factor-I (IGF-I) in maternal serum as a Predictor of GDM. Methods & Materials: Prospective cohort study was conducted in the Department of Obstetrics & Gynecology, Dhaka Medical College Hospital, Dhaka, Bangladesh during December 2020 to November 2021. Results: The age, parity and BMI of study population were not statistically significant (p>0.05) when compared with Insulin–Like Growth Factor-I. The mean serum Insulin –Like Growth Factor-I was significantly higher in patients with GDM than non GDM (387.4±110.5 vs 254.1±73.8 ng/ml). ROC analysis of Insulin –Like Growth Factor-I to predict GDM among the pregnant women found an AUC value of 0.875 (95% CI, 0.763-0.986) which was statistically significant (p<0.001). A cut-off value of ≥352.1 showed the highest youden index (0.771) with 85.7% sensitivity and 91.4% specificity, 90.5% accuracy, 63.2% PPV and 97.4% NPV. Increased serum Insulin –Like Growth Factor-I was found in 12(85.7%) in GDM group and 7(8.6%) in non GDM group with RR 24.0, 95% CI (5.86-98.31%). The difference was statistically significant (p<0.05) between GDM and non GDM groups. Conclusion: These findings revealed that increased maternal serum Insulin –Like Growth Factor-I at 8-12 weeks of gestation is associated with subsequent development of GDM. Elevated maternal serum Insulin –Like Growth Factor-I at 8-12 weeks of gestation can be used as a biomarker for prediction of GDM.