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
Zero Complications in 2675 Laparoscopic Gynecological Operations – Reasons for Success
Background: Laparoscopic gynecological surgery, while minimally invasive, carries inherent risks of complications. Achieving a zero-complication rate in a large series is a significant benchmark for surgical safety and quality, yet it is rarely reported in the literature. Objective: To analyze the factors contributing to the absence of major complications in a large, multicenter cohort of patients undergoing laparoscopic gynecological procedures. Methods & Materials: A retrospective, multicenter study was conducted from January 2012 to June 2025 at Comilla Trauma Centre, two CMHs, and two other hospitals in Bangladesh. Data from 2,675 consecutive patients were analyzed using MS Office tools. The study cohort comprised women of reproductive age presenting with infertility, pelvic pain, or abnormal bleeding. All patients were managed under a strict, standardized protocol from preoperative assessment through postoperative follow-up. Results: Analysis of 2,675 procedures demonstrated a 0.0% major complication rate. The cohort (mean age 32.4 ±6.1 years) most frequently presented with infertility (58.5%) and chronic pelvic pain (25.2%). Procedures were efficient, with a mean operative time of 42.5 ± 18.3 minutes and a mean blood loss of 35.2 ± 22.1 mL, resulting in a 98.1% discharge rate within 24 hours. The surgical distribution was led by Diagnostic Laparoscopy (64.0%), followed by Ovarian Cystectomy (15.8%) and Endometriosis Surgery (12.2%); complex hysterectomies collectively constituted 1.1%. Conclusion: The zero-complication rate underscores the success of a holistic protocol integrating stringent preoperative assessment, meticulous operative technique with advanced instrumentation, judicious antibiotic use, and systematic postoperative follow-up, ensuring patient safety at every stage
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Obesity and Its Relationship with Menstrual Irregularities and PMS-Related Psychological sand Behavioral Symptoms Among Medical Students
Background: Premenstrual Syndrome (PMS) involves recurring emotional and behavioral symptoms before menstruation, often intensified by stress, anxiety, depression, and poor sleep. While previous studies show significant impacts, many lacks broader applicability. This study aimed to examine the association between obesity, menstrual irregularities, and PMS-related psychological and behavioral symptoms among medical students. Methods & Materials: This cross-sectional study at Dhaka Medical College Hospital included 80 female students (18–25 years) with regular cycles, divided into non-obese and obese groups. Data on socio-demographics, reproductive history, lifestyle, and psychological factors were collected via questionnaire, and PMS severity was assessed using a validated tool. Analysis used SPSS 26 with appropriate statistical tests (p < 0.05). Ethical approval and informed consent were obtained. Results: Obese participants had higher age, weight, and BMI, longer and heavier menstrual flow, and greater PMS severity (PMSS 113.83 ± 12.54 vs. 62.5 ± 14.31). Psychological symptoms (anxiety 85% vs. 50%, depression 97.5% vs. 47.5%) and behavioral issues (social withdrawal 60% vs. 22.5%, impaired work 77.5% vs. 35%) were also more frequent, showing a strong link between obesity and PMS severity. Conclusion: Obesity was associated with higher PMS severity, more psychological and behavioral symptoms, longer and heavier menstrual flow, and increased clinical complaints, highlighting the need for weight management and supportive interventions to improve well-being.
Determinants of Carotid Artery Stenosis in Patients Undergoing Coronary Artery Bypass Grafting – A Logistic Regression Approach
Background: Extracranial carotid artery stenosis (CAS) is a significant risk factor for perioperative stroke in coronary artery bypass graft (CABG) patients. CAS ≥50% occurs in up to one-third of patients, with severe stenosis (≥70%) in 7–11%. Stroke risk and mortality rise with stenosis severity. Key predictors include advanced age, hypertension, prior stroke, peripheral vascular disease, and left main coronary disease. CAS increases the risk of cerebral hypoperfusion and postoperative neurological complications. Preoperative screening of high-risk patients is recommended to enable timely management, reduce perioperative stroke, and improve CABG outcomes. Methods & Materials: This hospital-based study at BSMMU, Dhaka (March 2017–Feb 2019) included 112 CABG patients, grouped by carotid artery stenosis (CAS) status. Demographic, clinical, and comorbidity data were collected, and preoperative carotid Doppler assessed CAS. Data analysis used SPSS v23 with Chi-square/Fisher’s tests and multivariate logistic regression to identify independent CAS predictors (p<0.05). Results: Among 112 CABG patients, those with CAS were older and had higher rates of hypertension, diabetes, and smoking. Logistic regression identified age, smoking, hypertension, and diabetes as independent risk factors for CAS, while LMCAD and CKD were not significant predictors. Conclusion: Age, smoking, hypertension, and diabetes were independent predictors of carotid artery stenosis (CAS) in CABG patients, while LMCAD and CKD were not. These findings emphasize the need for targeted preoperative CAS screening in older, hypertensive, diabetic, and smoking patients to reduce perioperative cerebrovascular complications.
Assessment of Glycosylated Fibronectin Level in Maternal Serum as a Predictor of Gestational Diabetes Mellitus
Background: Gestational diabetes mellitus (GDM) is associated with substantial maternal and neonatal risks, yet conventional screening at 24–28 weeks identifies hyperglycemia only after metabolic alterations are established. Early biomarkers may improve detection and intervention. Glycosylated fibronectin, a glycoprotein involved in cellular adhesion and endothelial function, has been suggested as a potential early predictor. Objective: This study aimed to assess maternal serum glycosylated fibronectin levels measured at 10–15 weeks of gestation as a predictor of subsequent GDM. Methods & Materials: A prospective cohort study was conducted at Dhaka Medical College Hospital from December 2020 to November 2021. Ninety-five pregnant women met the inclusion criteria after initial recruitment of 100 participants. Sociodemographic and clinical data were collected and serum glycosylated fibronectin levels were measured using ELISA. Participants underwent OGTT at booking, 24–28 weeks, with repeat testing at 34–36 weeks when required. Statistical analyses included ROC curve estimation and calculation of sensitivity, specificity, predictive values and relative risk. Results: GDM developed in 12.6% of participants. Mean glycosylated fibronectin was significantly higher in GDM compared with non-GDM women (226.7 ± 73.3 vs 114.2 ± 57.9 μg/ml). ROC analysis yielded an AUC of 0.895 (95% CI: 0.822–0.967). A cut-off value ≥145 μg/ml provided 83.3% sensitivity, 89.2% specificity and an accuracy of 88.4%. Women with elevated levels had a 20-fold increased risk of developing GDM. Conclusion: Elevated glycosylated fibronectin in early pregnancy is a strong predictor of GDM and may serve as a valuable biomarker for early screening.
Factors Influencing Maternal Preference for Mode of Delivery in an Antenatal Clinic
Background: Maternal choices regarding the mode of childbirth have become a topic of growing interest worldwide, particularly due to rising caesarean section rates and their implications for maternal and neonatal health. The purpose of the study was to identify and analyze the factors influencing women’s preference for mode of delivery in an antenatal clinic. Methods & Materials: This cross-sectional study at the Department of Obstetrics and Gynecology, Government Employee Hospital, Dhaka, Bangladesh (June 2024–July 2025) included 100 consenting pregnant women (≥18 years, ≥20 weeks gestation) to assess factors influencing delivery preference, with data on demographics, pregnancy history, perceptions, and counseling analyzed using SPSS v25, and associations tested by chi-square/Fisher’s exact test (p ≤ 0.05) while maintaining confidentiality. Results: Among 100 participants (mean age 26.9 ± 4.7 years), 44% were 19–25 years and 81% lived in urban areas. Gravida distribution was 39% primigravida, 42% two pregnancies, and 19% ≥3; 25% had a previous cesarean. Most preferred normal delivery (78%), 11% preferred cesarean, and 11% were undecided; 72% considered it safer for mother and baby. Key influencing factors were safety (50%), fear of operation (22%), and previous experience/labor pain (28%). Women with previous cesarean or fear of operation were more likely to prefer cesarean (27.3% vs 3.0%; 36.4% vs 3.8%; p ≤ 0.001). Conclusion: Maternal delivery mode preference is mainly influenced by perceived safety, prior birth experience, and counseling, with previous cesarean and fear of surgery increasing cesarean preference.
Prevalence and Outcomes of Left Ventricular Failure and Cardiomyopathy in a District Level Hospital
Background: The global prevalence and incidence of heart failure have been steadily rising, approaching epidemic levels, with a substantial impact on morbidity, mortality, and healthcare costs, and Bangladesh is experiencing a parallel rise in cardiovascular disease amid epidemiological transition. The purpose of the study is to determine the prevalence and clinical outcomes of left ventricular failure and cardiomyopathy in patients admitted to a tertiary care hospital. Objectives: The aim of the study was to determine the prevalence and clinical outcomes of left ventricular failure and cardiomyopathy in patients admitted to a tertiary care hospital. Methods & Materials: A retrospective study at the Department of Cardiology, Noakhali Medical College, Noakhali, Bangladesh (July 2024–June 2025) included 250 adults with left ventricular failure or cardiomyopathy, collecting demographics, clinical features, comorbidities, echocardiography, hospital stay, mortality, and complications; data were analyzed using SPSS v26 with descriptive statistics. Results: Among 250 patients (mean age 55.1 years; 70.4% male), left ventricular failure was most common (64.8%), dyspnoea was the predominant symptom (84%), and hypertension the leading comorbidity (52.8%). The mean LVEF was 38.9%, LV dilatation occurred in 52.8%, and the median hospital stay was 4 days. In-hospital mortality was 7.2%, with arrhythmias (10.4%), renal impairment (8.4%) and hyponatremia (15, 6.0%) being the major complications. Conclusion: Left ventricular failure and cardiomyopathy remain major causes of tertiary hospital admissions, presenting with typical heart failure features and comorbidities, and leading to measurable complications and mortality despite standard inpatient management.
Biplane Double-Supported Screw Fixation for Femoral Neck Fractures – Radiological and Early Functional Outcomes
Background: Hip fractures are a major cause of disability worldwide, and intracapsular femoral neck fractures often lead to nonunion, avascular necrosis, and fixation failure. Biplane double-supported screw fixation uses two oblique planes with a dual cortical buttress to improve stability during early mobilization. Methods & Materials: This prospective observational study was conducted at NITOR, Dhaka, from July 2018 to June 2020. Thirty-one adults with recent closed femoral neck fractures (Garden I–II and Garden III–IV in patients <65 years) underwent biplane double-supported screw fixation. Patients were followed for six months, with outcomes assessed by radiological union, complications, pain, hip range of motion, and the Harris Hip. Results: Among 31 patients (mean age 42.7 years; 61.3% male), most fractures were due to motor vehicle accidents (83.9%), with Garden I–II fractures comprising 87.1%. Radiological union was achieved in 96.8% of cases, with a mean union time of 17.9 weeks, occurring faster in Garden I–II than Garden III fractures. Complications were infrequent (16.1%), including wound infection, delayed union, and one case of nonunion, with no deep vein thrombosis. Functional outcomes were favorable, with a mean Harris Hip Score of 86.5 and 74.2% of patients achieving good-to-excellent results, alongside minimal limp, limited need for walking support, and preserved hip motion. Conclusion: Biplane double-supported screw fixation demonstrated high rates of early union, prompt radiological healing, and favorable early functional outcomes with a low incidence of nonunion in adult femoral neck fractures. BDSF represents an effective head-preserving intervention for appropriately selected patients.
Impact of Diabetes Mellitus on the Development of Trigger Finger among Patients attending at a tertiary care hospital
Background: Hand disorders are common yet often under-recognized complications among patients with type 2 diabetes mellitus (DM). Trigger finger is one of the most frequent manifestations and its association with glycemic control and duration of diabetes remains clinically important. This study aimed to determine the impact of diabetes mellitus on the development and characteristics of trigger finger among patients attending a tertiary care hospital. Methods & Materials: This cross-sectional observational study was conducted in the Medicine Outpatient Department of BIRDEM General Hospital over six months from November 2018 to April 2019. A total of 354 type 2 DM patients presenting with hand complaints were included using purposive convenient sampling. Data were analyzed using descriptive statistics and chi-square tests, with p<0.05 considered significant. Results: Among 354 diabetic patients with hand complaints, the mean age was 56.48±8.06 years and 44.07% were between 51–60 years. Trigger finger was the most common condition (50%), followed by carpal tunnel syndrome (16.1%) and De Quervain’s tenosynovitis (15.8%). Among trigger finger patients, 64.41% had diabetes for more than 5 years and 68.93% had HbA1C >6.5% (mean 7.1±2.6). Unilateral involvement was predominant (86.44%), mostly affecting the right hand (49.15%). Grade-2 severity was most frequent (57.1%). Duration of DM was significantly associated with trigger finger (p<0.02), while HbA1C distribution showed no significant difference (p=0.733). Conclusion: Trigger finger is highly prevalent among diabetic patients, particularly those with longer disease duration. Early screening and better metabolic control may help reduce its burden.
Frequency of Erectile Dysfunction in Type 2 Diabetic Male and its Association with Glycemic Status
Background: Erectile dysfunction (ED) has a high prevalence (20-85%) in men with diabetes, conferring a threefold increased risk. Its onset is age-dependent and occurs 10-15 years earlier in diabetic patients. In type 2 diabetes (T2DM), key risk factors include age, disease duration, sedentary lifestyle, and glycemic control. This study aims to determine the frequency of ED and its association with glycemic status in males with T2DM. Methods & Materials: This cross-sectional study was conducted in the Department of Dermatology and Venereology and Endocrinology at Bangabandhu Sheikh Mujib Medical University, Dhaka, with IRB approval. Enrolled were randomly selected married male T2DM patients, aged 21-59 years, with a stable spousal relationship. Erectile function was assessed using the validated Bengali IIEF-5 questionnaire. ED severity was classified into no ED (score ≥26), mild (17-25), moderate (11-16), and severe (≤10). Glycemic control was categorized as controlled (HbA1c <7.0%) and uncontrolled (HbA1c ≥7.0%). Result: Among 382 diabetic men, 41.4% had ED (17.8% mild, 13.4% moderate, 10.2% severe). Severe ED was most frequent (59.0%) in the 50-59-year age group. Men with ED had significantly higher glycemic parameters and triglycerides. A diabetes duration of over 10 years was associated with a threefold greater likelihood of ED. Diabetes duration was a key factor, as those with T2DM for more than 10 years were over three times more likely to have ED. Conclusion: Glycemic measures, BMI, age, and longer diabetes duration all showed a strong connection to ED severity, highlighting the need for targeted management.
NASH vs MASH - a Paradigm Shift from Exclusion to Pathophysiology
Ocular Cystinosis-Bilateral Corneal Crystals and Macular Atrophy in a Child
Introduction: Cystinosis is a rare autosomal-recessive lysosomal storage disorder caused by CTNS gene mutations, leading to cystine accumulation in multiple organs. Ocular involvement often precedes systemic disease and provides critical diagnostic clues. Case Presentation: We describe a 7-year-old child presenting with photophobia, bilateral corneal crystals, and visual decline. Slit-lamp examination revealed dense, refractile stromal deposits, while fundus evaluation showed macular atrophy and mild optic disc pallor. Systemic evaluation identified growth retardation and rickets-like deformities, consistent with nephropathic cystinosis. Laboratory and genetic testing confirmed the diagnosis. Discussion: This case emphasizes the correlation between ocular and systemic manifestations in cystinosis. Corneal and retinal findings serve as accessible biomarkers for disease burden and treatment adherence. Early ophthalmic recognition enables timely initiation of cysteamine therapy and systemic management, mitigating renal and skeletal complications. Conclusion: Ocular cystinosis, though rare, offers a unique diagnostic window for systemic disease. Routine slit-lamp screening in children with photophobia or growth failure and interdisciplinary management can significantly improve visual and systemic prognosis.
Radiological Outcomes of Mini-Plate versus K-Wire Fixation in Metacarpal Shaft Fractures
Background: Metacarpal shaft fractures are common hand injuries, and optimal fixation remains controversial. Mini-plate and Kirschner wire (K-wire) fixation are widely employed, yet comparative radiological outcomes are sparsely reported. Aim of the study: To prospectively compare radiological healing, alignment, and complication rates between mini-plate and K-wire fixation in patients with metacarpal shaft fractures. Methods: This prospective comparative study was conducted at the Department of Orthopaedic Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, from January 2023 to March 2025. A total of 28 adult patients (age 18–50 years) with closed metacarpal shaft fractures were enrolled and assigned to either mini-plate (n = 14) or K-wire fixation (n = 14). Standardized surgical techniques and postoperative protocols were applied. Radiological assessments included time to union, angular and rotational alignment, malunion, and implant-related complications. Data were analyzed using appropriate statistical tests, with p < 0.05 considered significant. Result: The mini-plate group demonstrated a significantly shorter mean time to union (7.86 ± 1.03 weeks) compared to the K-wire group (8.14 ± 1.66 weeks, p = 0.044). Early union (≤8 weeks) was achieved in 100% of mini-plate cases versus 78.6% in K-wire cases (p = 0.048). Angular deformity was lower in the mini-plate group (1.9° ± 1.2° vs. 3.8° ± 2.1°, p = 0.032). Malunion, loss of reduction, and non-union occurred exclusively in the K-wire group, although the overall complication rate difference (14.3% vs. 42.9%) did not reach statistical significance (p = 0.094). Conclusion: Mini-plate fixation offers superior radiological outcomes, including faster union and better angular alignment, with fewer complications compared to K-wire fixation in metacarpal shaft fractures. These findings support the use of rigid internal fixation with mini-plates for enhanced mechanical stability and predictable radiological healing.
Predictors of Functional Recovery after Arthroscopic Anterior Cruciate Ligament Reconstruction
Background: Arthroscopic anterior cruciate ligament reconstruction (ACLR) is a standard procedure to restore knee stability and function after ACL rupture. Functional recovery is influenced by multiple surgical, physiological, and psychosocial factors, yet predictors of optimal outcomes remain incompletely defined. Aim of the study: To identify clinical, surgical, and psychosocial predictors of excellent functional recovery following arthroscopic ACL reconstruction. Methods & Materials: A prospective observational study was conducted at Bangabandhu Sheikh Mujib Medical University, Dhaka, from September 2022 to March 2025. Forty-four patients with isolated ACL tears were enrolled and categorized into early (<3 weeks) and delayed (>3 weeks) surgery groups. All patients underwent standardized arthroscopic ACLR and rehabilitation. Functional outcomes were evaluated using Lysholm and Tegner scores and range of motion (ROM). Predictor variables included BMI, smoking, graft diameter, rehabilitation compliance, quadriceps strength, psychological readiness, prehabilitation, and time to return to sport. Data were analyzed using SPSS version 26, including descriptive statistics, chi-square tests, t-tests, univariate analysis, and multivariable logistic regression to identify independent predictors of excellent functional recovery. Result: The overall rate of excellent functional recovery was 56.8%. Multivariable analysis revealed that good rehabilitation compliance (OR 4.56, p<0.001), graft diameter ≥7.5 mm (OR 3.84, p=0.002), quadriceps strength ≥80% (OR 3.78, p=0.004), high psychological readiness (OR 4.01, p=0.001), non-smoking status (OR 3.42, p=0.003), and prehabilitation (OR 2.96, p=0.012) were significant independent predictors. Early surgery showed a positive trend but did not reach statistical significance (OR 2.14, p=0.069). Postoperative complications were minimal and comparable between groups. Conclusion: Functional recovery after ACLR is multifactorial, with rehabilitation adherence, graft size, quadriceps strength, psychological readiness, smoking status, and prehabilitation being key predictors of excellent outcomes. Integrating structured rehabilitation, preoperative conditioning, and psychological support is essential to optimize recovery, facilitate return to activity, and maintain long-term knee stability.
Prostate Volume and PSA Trends – Clinical Predictors of Malignancy in Benign and Malignant Prostatic Diseases
Background: Prostate volume (PV) and prostate-specific antigen (PSA) are widely used clinical parameters in evaluating prostatic diseases. While PSA levels may increase in both benign and malignant conditions, smaller prostate volumes combined with elevated PSA improve malignancy prediction. Identifying reliable predictors is essential for timely diagnosis and appropriate management. Aim of the study: To evaluate the role of prostate volume and PSA trends as clinical predictors of malignancy in patients presenting with benign and malignant prostatic diseases. Methods & Materials: A prospective study was conducted at BIRDEM General Hospital, Dhaka, Bangladesh from July 2017 to June 2019. A total of 110 men aged ≥50 years with suspected prostatic disease underwent clinical assessment, transabdominal ultrasonography for prostate volume estimation, serum PSA measurement, and systematic prostate biopsy. Histopathology served as the diagnostic reference standard. Data were analyzed using SPSS version 26.0. Logistic regression identified independent predictors of malignancy. Diagnostic performance was evaluated through sensitivity, specificity, PPV, NPV, and accuracy. Result: Malignancy was confirmed in 15.45% of participants. Malignant cases had significantly higher mean PSA levels (25.48±11.62 ng/mL) and larger PV (57.4±16.2 mL). PSA >10 ng/mL was the strongest predictor (OR 27.8; p<0.001), followed by PV Grade III/IV (OR 3.2; p=0.02). PSA >10 ng/mL demonstrated high specificity (94.6%) and accuracy (89.1%), while combining PSA >10 with PV Grade III/IV increased specificity to 97.8%.
Early Postoperative Outcome after Evacuation of Acute Subdural Haematoma – A Comparison of Craniotomy with Decompressive Craniectomy
Background: Acute subdural hematoma represents a major clinical entity in traumatic brain injury. The mortality of traumatic acute subdural haematoma is high. Craniotomy and decompressive craniectomy are two commonly used surgical techniques for treatment of traumatic acute subdural hematoma but which one is better surgical technique is still under debate. Objective: This study was done to evaluate the surgical outcome of traumatic acute subdural hematoma and to compare the surgical outcome between craniotomy and decompressive craniectomy with evacuation of hematoma. Methods & Materials: A hospital based randomized clinical trial was conducted from July 2016 to December 2017. Total 36 patients with traumatic acute subdural hematoma with pre-operative GCS 5-13, thickness of hematoma more than 10 mm, midline shift more than 5 mm and at least one pupil was reacting to light were included in this study. Data were collected by specially designed case record form and analysed usingStatisticalPackage for Social Sciences (SPSS) version 22.0). Results: Regardless of surgical technique used that is craniotomy (CR) or decompressive craniectomy (DC) with evacuation of hematoma, good recovery (GOS score-5) was 33.3%, moderate disability (GOS score= 4) 19.4%, severe disability (GOS score-3) 5.6%, persistent vegetative state (GOS score-2) 5.6%, and 36.1% patient died after surgery. In CR group according to Glasgow outcome scale (GOS) good recovery was 33.3%, moderate disability 11.1%, severe disability 11.1%, persistent vegetative state 5.6% and 38.9% patients died. In DC group, good recovery was 33.3%, moderate disability 27.8%, severe disability 0%, persistent vegetative state 5.6% and 33.3% patients died. Conclusion: Patients with traumatic acute subdural hematoma with GCS ≥ 9, bilateral reacting pupil and surgery within 24 hours craniotomy (CR) may be an alternative surgical option considering the possible complications of decompressive craniectomy as craniotomy and decompressive craniectomy showed no difference. But patients with poor clinical status and surgery after 24 hours primary decompressive craniectomoy (DC) may be more effective than craniotomy.
Risk of Endometrial Cancer after Insufficient Endometrial Biopsy – A Retrospective Cohort Study at NICRH
Background: Endometrial biopsy is the first-line diagnostic tool for abnormal uterine bleeding (AUB) and suspected endometrial pathology. However, insufficient biopsy is a common challenge and may delay diagnosis or mask underlying malignancy. Data from Bangladesh on the clinical significance of inadequate biopsy are limited. Objective: To evaluate the association between insufficient endometrial biopsy and the risk of endometrial cancer, and to assess diagnostic delays among the screened women of different ages who underwent endometrial biopsy. Methods & Materials: This retrospective cohort study included 320 women who underwent outpatient or inpatient endometrial biopsy at the Department of Gynecology and Obstetrics in National Institute of Cancer Research and Hospital (NICRH), Dhaka, Bangladesh, between Decembers 2023 to November 2024. Participants were categorized into adequate biopsy (n=240) and insufficient biopsy (n=80) groups. Baseline characteristics, histopathological outcomes, and time to final diagnosis were collected from hospital and pathology records. Descriptive statistics were calculated, and differences between groups were assessed using t-tests and chi-square tests. Logistic regression was performed to estimate crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for endometrial cancer, adjusting for age, menopausal status, BMI, and diabetes. Statistical significance was set at p < 0.05. Results: The mean age of women was 53.7 ± 8.9 years; 214(66.9%) women were ≥50 years, and 198 (61.9%) were postmenopausal. Insufficient biopsy samples were significantly more common in older and postmenopausal women had higher BMI (p<0.05). Endometrial cancer was diagnosed in 54 (16.9%) women, with a higher incidence in the insufficient biopsy group (26/80; 32.5%) versus the adequate biopsy group (28/240; 11.7%) (p<0.001). Insufficient biopsy was independently associated with endometrial cancer (adjusted OR 3.12; 95% CI: 1.62–5.99 (p<0.001). Median time to diagnosis was longer in the insufficient biopsy group (45 vs. 18 days; (p<0.001), and 70% experienced delays >30 days. Age ≥50 years and postmenopausal status were additional independent predictors. Conclusion: Insufficient endometrial biopsy is a strong predictor of endometrial cancer diagnosis and is associated with significant diagnostic delays. Prompt repeat evaluation and standardized follow-up protocols are essential to ensure early detection and timely management in high-risk patients.
Exploring the Medico-Legal System in Bangladesh – Perspectives of Doctors from Public Hospitals in Dhaka
Background: The medico-legal system plays a critical role in supporting justice and ensuring accountability in healthcare. In Bangladesh, doctors in public hospitals frequently perform medico-legal duties despite systemic constraints. This study explored the roles, challenges, and systemic gaps experienced by doctors involved in medico-legal practice in Dhaka. Methods & Materials: A descriptive qualitative study was conducted over a one-year period (January to December, 2024) in three public hospitals in Dhaka—Dhaka Medical College Hospital, Sir Salimullah Medical College Hospital and Shaheed Suhrawardy Medical College Hospital. Eighteen doctors involved in medico-legal work were selected using purposive sampling. Data were collected through semi-structured key informant interviews and document review. Thematic analysis was used to identify major themes, challenges, and improvement opportunities. Results: Participants (n=18) included 6 forensic specialists and 12 lecturers with a mean of 8.5 ± 4.2 years of medico-legal experience. Doctors reported performing core medico-legal tasks such as post-mortem examinations, injury assessment, and providing expert legal opinions. Key challenges included high workload (67%), limited forensic specialist availability (50%), insufficient training (56%), and coordination gaps with police and courts (61%). Systemic issues included lack of standardized protocols (78%), inadequate infrastructure (67%), weak enforcement of medical negligence laws (56%), and limited legal awareness among healthcare providers (56%). Participants recommended expanding training, recruiting more forensic specialists, and strengthening inter-agency coordination. Conclusion: The medico-legal system in Bangladesh faces substantial structural and operational limitations that hinder effective medico-legal practice. Strengthening training, infrastructure, legal frameworks, and standardized protocols is essential for improving medico-legal service quality and supporting justice delivery.
Pattern and Causes of Death in Medicolegal Autopsies – A Descriptive Study from Dhaka Medical College Mortuary
Background: Medicolegal deaths, often sudden or unnatural, are examined through autopsies to determine cause, manner, and circumstances. Young adult males are most affected, with road accidents, homicide, and suicide common. This study reviews such deaths at Dhaka Medical College Mortuary from January to October 2023 to inform legal and public health planning. Methods & Materials: A descriptive cross-sectional study was conducted at Dhaka Medical College Mortuary from January to October 2023, including all 135 medicolegal deaths. Data on demographics, cause of death, and residence were extracted from mortuary registers and analyzed using descriptive statistics. Ethical approval and anonymization ensured confidentiality, and charts were used to illustrate key findings. Results: Among 135 medicolegal autopsies, 88 (65.2%) were male and 47 (34.8%) females. Ages ranged from 0 days to 80 years, with a mean of 31.8 ± 16.2 years; most cases were in the 21–40-year age group. Leading causes of death were road traffic accidents, poisoning, burns, hanging, and unexplained sudden deaths. Young adult males were most affected, highlighting risks from accidents, violence, and self-harm, and emphasizing the need for traffic safety, mental health support, and strengthened forensic investigations. Conclusion: Between January and October 2023, most medicolegal autopsies at DMC involved unnatural deaths, predominantly among young adult males. Leading causes were road traffic accidents, poisoning, and hanging, reflecting environmental risks and psychosocial stressors. These findings highlight the need for stronger road safety measures, toxic substance regulation, expanded mental health services, and improved mortuary data systems to support prevention and public health planning.
Comparison of Phenylephrine and Ephedrine in Treatment of Spinal Induced Hypotension in Emergency Cesarean Section
Background: Spinal-induced hypotension is a common complication during emergency cesarean section, affecting up to 70% of parturients and potentially impacting maternal and fetal outcomes. Phenylephrine and ephedrine are widely used vasopressors to manage hypotension, yet their comparative efficacy and safety remain under investigation. Objective: This study aimed to compare the efficacy and safety of phenylephrine versus ephedrine in managing spinal-induced hypotension during emergency cesarean sections. Methods & Materials: This observational comparative study was conducted at the Department of Anaesthesia and ICU, Kurmitula General Hospital (KGH), Dhaka, Bangladesh, from January-2025 to June 2025. A total of 60 patients aged 18–40 years who underwent emergency cesarean section under spinal anesthesia were enrolled in this study and the enrolled patients were divided equally into two groups with 30 patients in each. Group-1 received intravenous phenylephrine (initial dose 100 mcg, titrated as needed), and Group-2 received intravenous ephedrine (initial dose 5 mg, titrated as needed). Maternal hemodynamics, neonatal Apgar scores, and adverse effects were recorded. Hypotension was defined as systolic blood pressure (SBP) <90 mmHg or ≥20% decrease from baseline. Data were analyzed using Statistical Package for Social Sciences (SPSS) version-23.0. Results: A total of 60 parturients undergoing emergency cesarean section under spinal anesthesia were included, with 30 patients in each group. The mean age was 27.8 ± 4.2 years in the phenylephrine group and 28.1 ± 4.6 years in the ephedrine group (p=0.78). Mean height (155.6 ± 5.4 vs. 156.3 ± 5.1 cm; p=0.62) and weight (63.8 ± 7.5 vs. 64.9 ± 7.1 kg; p=0.54) were similar. ASA physical status was comparable, with ASA I comprising 12 (40%) vs. 11 (36.7%) and ASA II 18 (60%) vs. 19 (63.3%) in the phenylephrine and ephedrine groups, respectively. Indications for cesarean delivery were evenly distributed between the groups: failure to progress in 9 (30%) vs. 10 (33.3%), cephalopelvic disproportion in 8 (26.7%) vs. 7 (23.3%), previous cesarean in 7 (23.3%) vs. 6 (20%), and other indications in 6 (20%) vs. 7 (23.3%) in the phenylephrine and ephedrine groups, respectively.. Phenylephrine provided significantly higher systolic blood pressure at all measured time points (5 min: 112.4 ± 8.6 vs. 105.2 ± 9.3 mmHg); (p=0.003) and lower maternal heart rates (10 min: 82.7 ± 7.6 vs. 94.3 ± 9.1 bpm;( p<0.001) compared with ephedrine. Neonatal outcomes, including one- and five-minute Apgar scores, were similar between the groups (p>0.05). Adverse effects were infrequent; bradycardia occurred more often in the phenylephrine group (16.7% vs. 3.3%, (p=0.09), while nausea and vomiting were slightly more common in the ephedrine group without statistical significance (P>0.05). Conclusion: Phenylephrine provides superior systolic blood pressure stability and lower maternal heart rates compared with ephedrine during spinal-induced hypotension in emergency cesarean sections, with similar neonatal outcomes and overall safety. These findings support phenylephrine as the preferred vasopressor in obstetric anesthesia for managing spinal-induced hypotension.
Association of Creatinine Clearance with Left Ventricular Ejection Fraction in Patients with Acute Coronary Syndrome
Background: Renal dysfunction is an independent predictor of adverse cardiovascular outcomes among patients with acute coronary syndrome. However, the relationship between creatinine clearance and left ventricular systolic function remains incompletely characterized. This study aimed to evaluate the association between creatinine clearance and left ventricular ejection fraction, and to assess clinical outcomes in ACS patients with varying degrees of renal function. Methods & Materials: The prospective observational study was conducted at the Department of Cardiology at Mymensingh Medical College Hospital between October 2022 and September 2023, including 100 consecutive patients with first-episode ACS within 24 hours of symptom onset. The patients were divided into two groups according to their calculated creatinine clearance: Group I (CrCl ≥ 70 ml/min, n = 31) and Group II (CrCl < 70 ml /min, n = 69). The study included a comprehensive clinical assessment, echocardiographic evaluation, and in-hospital monitoring. Data were analyzed using SPSS version 26 with appropriate statistical analysis. Results: The mean age of patients was 51.7±8.5 years, with 88% males. Patients with reduced creatinine clearance were significantly older (53.4±8.4 vs 47.8±7.2 years, p=0.002) and had a higher prevalence of diabetes mellitus (56.5% vs 22.6%, p=0.002). Mean LVEF was significantly lower in the abnormal clearance group (49.4±6.7% vs 56.5±6.0%, p=0.001). In-hospital morbidity was substantially higher in patients with CrCl <70 ml/min (84.0% vs 29.0%, p=0.001), including increased rates of heart failure (28.9% vs 9.6%, p=0.030), ventricular tachycardia (28.9% vs 6.4%, p=0.010), post-MI angina (34.7% vs 6.4%, p=0.002), and cardiogenic shock (21.7% vs 3.2%, p=0.020). Conclusion: Among ACS patients, reduced creatinine clearance is an independent correlate of lower LVEF and significantly higher in-hospital morbidity. Early recognition of renal dysfunction and aggressive risk stratification are strategies that may improve outcomes in this high-risk population.
Correlation between Ultrasonographic Vascular Patterns and Cytological Diagnosis in Thyroid Nodules – A Prospective Study
Background: Thyroid nodules are frequent clinical findings, and distinguishing benign from malignant lesions remains a diagnostic challenge. Power Doppler Ultrasonography (PDUS) and Duplex Doppler Ultrasonography (DDUS) provide hemodynamic insights that may enhance differentiation. This study evaluated the correlation between Doppler vascular flow patterns and cytological outcomes in thyroid nodules. Methods & Materials: This cross-sectional study included 60 thyroid nodules from 43 patients assessed in the Radiology & Imaging Department of Mymensingh Medical College Hospital from October 2015 to October 2016. Patients with clinically suspected thyroid swelling were referred from ENT outpatient and indoor units. All underwent gray-scale B-mode ultrasonography, PDUS, DDUS with measurement of resistivity and pulsatility indices, and fine-needle aspiration cytology (FNAC) for confirmation. Vascularity was categorized into five patterns: Pattern I (absent flow), Pattern II (perinodular flow), Pattern III (perinodular plus central flow), Pattern IV (central > perinodular flow), and Pattern V (purely central flow). Statistical correlations between Doppler findings and FNAC were analyzed using Fisher’s exact test. Results: The mean patient age was 39.3 ± 14.3 years, with a female predominance. Patterns I–III were found mainly in benign nodules (75.0%, 95.0%, and 88.9%), whereas Patterns IV and V strongly correlated with malignancy (83.3% and 100%; p < 0.001). DDUS classified 65.0% of nodules as benign and 35.0% as malignant based on Doppler indices, showing significant correlation with FNAC (p < 0.001). PDUS demonstrated high diagnostic performance, with 93.8% sensitivity, 88.6% specificity, and 90.0% accuracy. Conclusion: Central or predominantly central vascularity (Patterns IV and V) strongly predicts malignancy. Combined PDUS and DDUS serve as valuable non-invasive adjuncts to FNAC, improving diagnostic confidence and guiding biopsy decisions.
Clinical Profile of Adenosine Deaminase and Age and Sex Related Variations in Pleural Effusion – A Study of 100 Cases
Background: Pleural effusion is a common clinical condition with varied etiologies. Adenosine Deaminase (ADA) has been recognized as a useful diagnostic biomarker, especially in differentiating tuberculous pleural effusion from other causes. However, the influence of patient age and sex on ADA levels remains an area of ongoing investigation. Objective: To study the profile of ADA levels in pleural effusion and assess the impact of age and female sex on ADA levels. Methods & Materials: This prospective observational study was conducted on 100 consecutive patients diagnosed with pleural effusion. ADA levels were estimated in pleural fluid. Patients were stratified according to age (<40 years vs. ≥40 years) and sex (male vs. female) for subgroup analysis. Clinical correlation with diagnosis was performed. Results: Mean ADA level was significantly higher in tuberculous pleural effusion (72.3 ± 15.2 U/L) compared to malignant (34.5 ± 10.6 U/L), parapneumonic (42.8 ± 11.5 U/L), and transudative effusions (18.6 ± 5.3 U/L) (p < 0.001). Younger patients (<40 years) had significantly higher ADA values (65.2 ± 20.4 U/L) compared to older patients (≥40 years, 49.8 ± 18.7 U/L; p = 0.01). Females demonstrated slightly higher ADA levels than males (58.9 ± 19.6 U/L vs. 53.4 ± 18.2 U/L; p = 0.04). Conclusion: ADA remains a reliable marker for tuberculous pleural effusion. Younger age and female sex were associated with relatively higher ADA levels, suggesting the need for cautious interpretation in these groups.
Surgical Versus Conservative Management of Paediatric Femur Fractures – A Comparative Study
Background: Paediatric femoral shaft fractures represent a major cause of morbidity in children, with management varying widely between conservative and surgical approaches. Determining the most suitable treatment requires evaluation of demographic characteristics, fracture patterns and clinical outcomes within specific healthcare contexts. Objective: This study compared the treatment outcomes between conservative and surgical management of paediatric femoral shaft fractures in a tertiary center in Bangladesh. Methods & Materials: This comparative observational study was conducted in the Department of Orthopedic Surgery, Ideal Health City, Rangpur, Bangladesh, from January 2021 to December 2024. A total of 100 children aged 2–14 years with diaphyseal femoral fractures were included and assigned to conservative (n = 50) or surgical (n = 50) groups. Data were collected from clinical records and radiographs. Descriptive statistics summarized baseline variables and group comparisons were performed using t-tests and chi-square tests, with significance set at p ≤ 0.05. Results: Surgical treatment was more frequently performed in older children and those sustaining high-energy trauma. Transverse fractures predominated in the conservative group, whereas oblique and spiral patterns were more common surgically. Surgical treatment demonstrated significantly shorter time to radiographic union, reduced hospital stays and earlier full weight-bearing. Limb length discrepancy and malunion occurred more frequently with conservative treatment, while infection and re-intervention were observed only in surgically managed children. Conclusion: Surgical fixation offers faster recovery and fewer alignment-related complications in older children, whereas conservative treatment remains appropriate for younger patients with stable fractures.
Predictive Value of D-Dimer to Diagnose a Patient with Cerebral Venous Sinus Thrombosis (CVST)
Background and Objective: Cerebral venous sinus thrombosis (CVST) is a rare but potentially life-threatening condition with diverse clinical presentations, often leading to delayed diagnosis. D-dimer, a fibrin degradation product, has shown promise as a biomarker in various thrombotic conditions. This study aimed to evaluate the predictive value of D-dimer levels in diagnosing CVST and to determine optimal cut-off values for clinical decision-making. Methods & Materials: This prospective observational study included 80 consecutive patients with clinical suspicion of CVST. All patients underwent comprehensive neuroimaging with CT/MR venography and D-dimer measurement within 24 hours of symptom onset. CVST diagnosis was confirmed by neuroimaging according to established criteria. D-dimer levels were measured using a quantitative immunoturbidimetric assay. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis, and optimal cut-off values were determined using the Youden index. Results: Of the 80 patients enrolled, 42 (52.5%) were diagnosed with CVST and 38 (47.5%) served as controls. The mean age was 34.2 ± 12.8 years, with a female predominance (62.5%). D-dimer levels were significantly higher in CVST patients compared to controls (median: 2,340 ng/mL [IQR: 1,450–4,280] vs. 420 ng/mL [IQR: 280–680], p < 0.001). ROC curve analysis showed an area under the curve (AUC) of 0.891 (95% CI: 0.823–0.959). The optimal cut-off value of 1,200 ng/mL provided a sensitivity of 88.1%, specificity of 86.8%, positive predictive value of 88.1%, negative predictive value of 86.8%, and overall diagnostic accuracy of 87.5%. Only 2 patients (4.8%) with confirmed CVST had normal D-dimer levels, both presenting with isolated cortical vein thrombosis. Patients with multiple sinus involvement had significantly higher D-dimer levels compared to those with single sinus thrombosis (p = 0.012). Conclusions: D-dimer demonstrates excellent diagnostic performance for CVST, with high sensitivity and specificity at the optimal cut-off of 1,200 ng/mL. It shows potential as a valuable screening tool in clinical practice, particularly for identifying patients requiring urgent neuroimaging. However, normal D-dimer levels do not exclude CVST, especially in cases of isolated cortical vein involvement. D-dimer should be interpreted within the appropriate clinical context and used as an adjunctive tool rather than as a standalone diagnostic test.
Attenuation of Hemodynamic Responses to Laryngoscopy and Intubation- Lignocaine versus Esmolol in 100 Cases
Background: Laryngoscopy and endotracheal intubation cause sympathetic stimulation producing tachycardia and hypertension which may be harmful in patients with cardiovascular disease. This randomized study compared intravenous lignocaine and esmolol for attenuation of this pressor response. Methods & Materials: 100 adult patients (ASA I–II) undergoing elective surgery under general anesthesia were randomized into two groups of 50 each. Group L received lignocaine 1.5 mg·kg⁻¹ IV 90 seconds before laryngoscopy; Group E received esmolol 1.0 mg·kg⁻¹ IV 90 seconds before laryngoscopy. Hemodynamic variables (heart rate [HR], mean arterial pressure [MAP]) were recorded at baseline (T0), after induction but before study drug (T1), immediately after intubation (T2), and at 1 (T3), 3 (T4) and 5 (T5) minutes after intubation. Primary endpoint: peak change in HR and MAP from baseline. Secondary endpoints: incidence of significant tachycardia (>20% increase), hypotension (MAP <65 mmHg), bradycardia (HR <50 bpm), and adverse events. Results: Both drugs attenuated the pressor response compared with historical untreated responses, but esmolol produced significantly less increase in HR and MAP at T2–T4. Mean peak HR change at T2: Group L +18.6 ± 9.4 bpm vs Group E +4.2 ± 7.8 bpm (p < 0.001). Mean peak MAP change at T2: Group L +16.8 ± 10.2 mmHg vs Group E +6.9 ± 8.5 mmHg (p < 0.001). Clinically significant tachycardia occurred in 28/50 (56%) of Group L and 6/50 (12%) of Group E (p < 0.001). Two patients in Group E had transient bradycardia responsive to atropine. No episode of sustained hypotension requiring vasopressor occurred. Conclusion: A single IV bolus of esmolol 1.0 mg·kg⁻¹ given shortly before laryngoscopy attenuates the hemodynamic response to intubation significantly better than lignocaine 1.5 mg·kg⁻¹ in ASA I–II adults. Esmolol may be preferred when a rapid, short-acting sympatholytic effect is desired.
Efficacy and Safety of Caudal Epidural Block in High-Risk Patients Undergoing Transurethral Resection of the Prostate in 70-Cases – A Prospective Study
Background: Transurethral resection of the prostate (TURP) remains the standard surgical treatment for symptomatic benign prostatic hyperplasia (BPH). Many candidates for TURP are elderly and burdened with comorbidities such as hypertension, diabetes, ischemic heart disease, and COPD, making anesthetic selection critical. Caudal epidural block (CEB) has resurfaced as a potential alternative for high-risk patients due to its hemodynamic stability and reduced neuraxial complications. Objectives: To evaluate the efficacy, safety, and hemodynamic profile of CEB in patients with comorbidities undergoing TURP. Methods & Materials: This prospective observational study included 70 high-risk patients (ASA II–III) scheduled for TURP. CEB was administered using a standardized technique with 1.5% lignocaine with adrenaline. Hemodynamic variables, block characteristics, intraoperative events, surgeon satisfaction, and postoperative outcomes were recorded. Exclusion criteria included coagulopathy, sepsis, prior spinal surgery, and inability to identify sacral hiatus. Results: CEB was successfully performed in 67 out of 70 patients (95.7%). Adequate surgical anesthesia was achieved in 61 patients (87.1%), whereas 6 required supplemental analgesia or conversion to general anesthesia. Hemodynamic parameters remained stable in the majority, with only 8.5% experiencing transient hypotension. Minor complications included urinary retention (7.1%), postoperative shivering (5.7%), and perineal discomfort at injection site (4.2%). No patient developed significant arrhythmias, TURP syndrome, or airway compromise. Surgeon satisfaction was high (85%), with optimal relaxation and minimal patient movement reported. Conclusion: CEB is a safe and effective anesthetic technique for TURP in patients with significant comorbidities, offering excellent hemodynamic stability and a favorable safety profile. It provides a valuable alternative to spinal anesthesia or general anesthesia in the elderly and medically fragile population.
Comparison between Epidural and Programmed Analgesia on Pain Relief during Labour in 70 Parturients
Background: Labour pain is one of the most severe forms of physiological pain, and effective analgesia significantly improves maternal satisfaction and obstetric outcomes. Epidural labour analgesia (ELA) is the gold standard; however, programmed labour analgesia (PLA) a multimodal regimen integrating pharmacological and non-pharmacological elements has gained popularity for its simplicity, accessibility, and reduced intervention rates. Objective: To compare the effectiveness, safety, and maternal satisfaction of Epidural Labour Analgesia (ELA) versus Programmed Labour Analgesia (PLA) in controlling labour pain among parturients. Methods & Materials: This comparative observational study included 70 term parturients divided into two groups: ELA (n=35) and PLA (n=35). Pain scores were measured using a Visual Analog Scale (VAS) at baseline, 30 min, 1 hour, and full dilation. Secondary outcomes included duration of labour, mode of delivery, maternal side effects, neonatal APGAR scores, and overall maternal satisfaction. Results: Both methods significantly reduced labour pain (p < 0.001). ELA achieved superior pain relief at all assessed intervals, with mean VAS at full dilation of 2.4 ± 1.1 compared to PLA’s 4.8 ± 1.5. The duration of the first and second stages of labour was slightly longer in the ELA group, though not statistically significant. Instrumental delivery was more frequent in ELA (14.3%) than PLA (5.7%). Maternal side effects such as hypotension and pruritus were higher in ELA. Neonatal outcomes were comparable. Maternal satisfaction was significantly higher in ELA (p < 0.05). Conclusion: Epidural labour analgesia provides superior pain control and greater maternal satisfaction, although it is associated with a slightly longer labour duration and higher rate of instrumental delivery. Programmed labour analgesia remains a safe, effective, and resource-friendly alternative in settings where epidural services are limited.
Colposcopic Evaluation of VIA-Positive Cases in a Primary Healthcare Setting of Sreepur, Gazipur, Bangladesh
Introduction: Cervical cancer remains a leading cause of morbidity and mortality among women in developing countries. Visual Inspection with Acetic Acid (VIA) is an effective, low-cost screening tool for early detection of precancerous cervical lesions, especially in resource-limited settings like Bangladesh. Colposcopy serves as a confirmatory diagnostic procedure following VIA positivity. Methods and materials: A cross-sectional study was conducted at the Upazila Health Complex, Sreepur, Gazipur, from January 2022 to December 2023, including 300 VIA-positive women aged 20–60 years. Demographic and clinical data were recorded, and all participants underwent standardized colposcopic evaluation. Colposcopic findings were classified into normal, inflammatory, low-grade, high-grade, or suspicious for invasive carcinoma. Data analysis was performed using SPSS 25.0. Results: Among 300 VIA-positive women, 143 (47.7%) were confirmed colposcopically positive, while 157 (52.3%) showed no abnormal findings, indicating a false-positive rate of 52.3%. Among the colposcopically positive cases, CIN-I was detected in 27.69%, CIN-II in 18.46%, and CIN-III in 1.54% of women. Most participants were aged 30–49 years and of low socioeconomic status. The findings suggest that VIA is an effective primary screening tool, though confirmatory colposcopy remains essential for accurate diagnosis and lesion grading. Conclusion: Colposcopy is essential for confirming and grading cervical epithelial abnormalities in VIA-positive women. This study highlights the value of integrating VIA and colposcopy at primary and tertiary care levels to ensure early detection and timely management of precancerous cervical lesions. Enhancing awareness, provider training, and follow-up can help reduce cervical cancer incidence and improve women’s reproductive health outcomes in Bangladesh.
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Incidence of Early Postoperative Complications in Patients with Co-morbidities Undergoing Transurethral Resection of the Prostate
Introduction: BPH is a common condition among ageing men, often causing lower urinary tract symptoms for which TURP is usually indicated. Early post-operative complications are still a concern, especially in patients with co-morbidities. This study was therefore designed to evaluate the incidence and pattern of early postoperative complications in patients with co-morbidities undergoing TURP. Methods & Materials: The prospective observational study was carried out at the Department of Urology, BIRDEM General Hospital, Dhaka, Bangladesh, from November 2016 to May 2017. 50 patients undergoing TURP for benign prostatic enlargement were included. Data on demographic variables, comorbidities, operative details, and early postoperative complications were analysed using SPSS version 20. Results: The patients' mean age was 68.7 ± 8.1 years, and 84% had at least one comorbidity. Pre-existing conditions included diabetes mellitus in 66% and urinary tract infection in 54%. In the early postoperative period, 22% of the patients developed complications such as hematuria (16%), clot retention (8%), urinary incontinence (6%), and failure to void (6%). Conclusion: Early postoperative complications following TURP in patients with comorbidities are significantly higher. The number and type of comorbid conditions strongly influence morbidity.
Predictors of Functional Recovery after Posterior Decompression and Pedicle Screw-Rod Fixation in Unstable Thoracic Spine Pathology
Introduction: Unstable thoracic spine pathology carries a high neurological risk due to the narrow canal and rigid rib cage, often causing motor, sensory, and autonomic deficits. Posterior decompression with pedicle screw-rod fixation restores stability, but recovery varies. This study aims to identify predictors of functional recovery following this surgical approach. Methods and materials: This study was conducted from January 2021 to December 2023 at the Department of Orthopaedic, Bangladesh Medical University, including 57 consecutive patients with unstable thoracic spine pathology. Patients underwent posterior decompression with pedicle screw-rod fixation. Neurological, functional, and radiological outcomes were assessed pre- and post-operatively at 1, 3, 6, and 12 months using the modified Macnab criteria. Data were analysed using SPSS version 26, including descriptive statistics and logistic regression; p < 0.05 was considered significant. Results: Most patients were middle-aged (mean 39.6 years) and 56.1% female. Post-operatively, bowel-bladder dysfunction fell from 77.2% to 3.5%, full motor recovery occurred in 73.7%, and full sensory recovery in 71.9%. Functional mobility improved, with 56.1% walking with support and 43.9% independently. Excellent outcomes increased to 64.9%, and 78.9% achieved satisfactory recovery. Age >40, absent pre-operative motor or sensory function, bowel-bladder involvement, and post-operative complications were independent negative predictors. Conclusion: Posterior decompression with pedicle screw-rod fixation provides significant neurological and functional improvement in patients with unstable thoracic spine pathology.