The Planet is the official journal of Sher-E-Bangla Medical College, Barishal, Bangladesh and accepts articles for publication from home and abroad. This is a biannual, 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 in Bangladesh and serve as a media for dissemination of scientific information and recent knowledge among readers. ISSN (Print): 2617-0817 ISSN (Online): 2789-5912
Use of Methylene Blue Dye During Laparoscopic Cholecystectomy for Mapping of Extrahepatic Biliary Tree
Background: Laparoscopic cholecystectomy is the standard surgical treatment for symptomatic gallstone disease; however, bile duct injury remains one of the most serious complications. Accurate identification of extrahepatic biliary anatomy is essential for safe surgery. Intraoperative methylene blue dye injection has been proposed as a simple technique to improve visualization of biliary structures. Objective: This study aimed to evaluate the efficacy and safety of methylene blue dye use during laparoscopic cholecystectomy for delineation of extrahepatic biliary tree. Methods & Materials: This quasi-experimental study was conducted in the Department of Surgery, Chattogram Medical College Hospital, over a 12-month period from February 2022 to January 2023. A total of 111 patients with symptomatic gallstone disease undergoing laparoscopic cholecystectomy were included using convenient sampling. Diluted methylene blue dye was injected intraoperatively into the gallbladder lumen for visualization of biliary anatomy. Patients were followed postoperatively to assess complications. Statistical analysis was performed using SPSS version 25. Results: Mean age of patients was 42.8±12.3 years and 76.6% were female. Chronic cholecystitis was the most common clinical presentation (86.5%). Gallbladder visualization was achieved in 91.0% of cases, cystic duct in 73.0% and common bile duct in 27.0%. Mean operative time was 49.98±11.94 minutes. Postoperative urine discoloration occurred in 7.2% of patients. Mean hospital stay was 1.18±0.39 days. Conclusion: Intraoperative methylene blue dye injection is a feasible, safe and cost-effective method for delineation of extrahepatic biliary anatomy during laparoscopic cholecystectomy. The technique may reduce the risk of bile duct injury and can be useful in settings where advanced imaging modalities are not available.
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Maternal Serum Vitamin D Level and Its Association with Preeclampsia
Background: Preeclampsia is a pregnancy specific hypertensive disorder with multi-system involvement, usually occurs after 20 weeks of gestation. Vitamin D insufficiency is highly prevalent in children and adults including pregnant women. During pregnancy, maternal vitamin D insufficiency could increase risks of several pregnancy complications and adverse birth outcomes. Objectives: The aim of the study was to evaluate the vitamin D levels in preeclamptic and normotensive pregnant women and the role of vitamin D deficiency in the etiology of preeclampsia. Methods & Materials: In this case-control study, 50 preeclamptic women and 50 normotensive pregnant women were selected from Obstetrics & Gynecology department of Chittagong Medical College Hospital in Chattogram, Bangladesh by convenient sampling technique. Two ml of venous blood sample was collected from each pregnant woman and the serum 25-OH-D level was measured by Chemiluminescent Microparticle Immunoassay method and reported in nanograms per milliliter. levels of 25-OH-D less than 20 ng/mL, between 20 ng/mL and 29 ng/mL and more than 30 ng/mL, were considered as deficient, insufficient and sufficient 25-OH-D concentrations, respectively. Results were analyzed by independent t-test, Mann-Whitney U test, Chi-square test, Fisher’s exact test, and logistic regression. Results: Out of 50 preeclamptic cases, 28 (56.0%) had preeclampsia with severe features, and 22 (44.0%) had preeclampsia without severe features. The median serum vitamin D level of women with preeclampsia with severe features, preeclampsia without severe features and normotensive women were respectively 10.5 ng/ml, 11.9 ng/ml, and 17.5 ng/ml. This difference was highly significant statistically (p <0.001). Pairwise comparison between groups showed that preeclampsia with severe features and preeclampsia without severe features had significantly lower vitamin D levels than normotensive women, but the difference between the preeclampsia without severe features group and preeclampsia with severe features group was not statistically significant (p=0.420). The majority of the cases (92.0%) had a low vitamin D level compared to 58.0% of control group (p <0.001). Only one (2.0%) and 2 (4.0%) in cases and control groups respectively had adequate vitamin D levels in their serum (p=1.0). Participants with vitamin D deficiency had a statistically non-significant higher odd for preeclampsia (OR= 1.11, 95% CI = 0.05-24.51, p=0.946), compared to normotensive pregnant women. Conclusions: The prevalence of vitamin D deficiency was high in both normotensive pregnancies and pregnancies complicated by preeclampsia but amplified in preeclampsia. Additional studies are needed to explore the potential benefits and optimal dosing of vitamin D use in pregnancy.
Analysis of Cesarean Section According to Robson Ten Group Classification in Chittagong Medical College Hospital
Background: The global rate of cesarean section (CS) has increased markedly over recent decades, raising concerns about unnecessary procedures and associated maternal and neonatal complications. The Robson Ten Group Classification System provides a standardized and widely accepted method to evaluate, compare, and monitor CS rates across healthcare facilities. Aim of the study: To analyze cesarean section cases according to the Robson Ten Group Classification System at Chittagong Medical College Hospital, Bangladesh, and identify the major contributing obstetric groups to the overall CS rate. Methods & Materials: This cross-sectional observational study was conducted in the Department of Obstetrics and Gynecology at Chittagong Medical College Hospital from November 2019 to April 2020. A total of 253 women who underwent cesarean delivery were included using convenient sampling. Participants were categorized according to the Robson Ten Group Classification System based on parity, gestational age, fetal presentation, number of fetuses, and onset of labor. Data were collected using structured forms from patient interviews, clinical examinations, and hospital records. Statistical analysis was performed using SPSS version 25.0. Categorical variables were expressed as frequency and percentage, while continuous variables were presented as mean ± standard deviation or median with interquartile range Result: The majority of patients were aged 21–25 years (34.39%), followed by 26–30 years (30.04%). Most participants were multiparous (57.71%), and 82.21% had term pregnancies. Cephalic presentation was observed in 86.96% of cases. Regular antenatal care was reported by only 18.58% of women. According to the Robson Ten Group Classification System, Group 5 (multiparous women with previous CS, singleton, cephalic, ≥37 weeks) contributed the largest proportion of cesarean deliveries (26.48%), followed by Group 2 (18.58%) and Group 1 (16.60%). Smaller contributions were observed from Groups 3 and 4 (9.49% each), while Groups 6–10 accounted for comparatively lower proportions. Conclusion: The study demonstrated that previous cesarean section (Robson Group 5) was the major contributor to the overall CS rate. Application of the Robson Ten Group Classification System provides a practical and standardized approach for monitoring cesarean deliveries and identifying target groups for reducing unnecessary CS. Strengthening antenatal care and promoting appropriate labor management strategies may help optimize cesarean section rates and improve maternal health outcomes.
Post-Tonsillectomy Chronic Throat Pain: A Radiological Evaluation for Elongated Styloid Process
Background: Chronic throat pain following tonsillectomy is an under-recognized clinical concern that may be associated with elongation of the styloid process, a condition related to Eagle syndrome. Radiological assessment plays a pivotal role in identifying elongated styloid processes in symptomatic patients, yet limited prospective data exist in the Bangladeshi population. Objective: To evaluate the prevalence of elongated styloid process among patients presenting with chronic neck pain after tonsillectomy using radiological imaging. Methods & Methods: This prospective cohort study was conducted at Bangladesh Medical College and Hospital, Dhaka, and SENTH of SAHIC from January 2023 to December 2025. A total of 73 patients with a history of tonsillectomy and persistent neck pain for more than three months were enrolled using purposive sampling. Clinical evaluation was followed by radiological assessment with digital X-ray and/or computed tomography to measure styloid process length. Data were analyzed using SPSS version 23.0. Results: Among the 73 participants, 46 (63.0%) were female, and 27 (37.0%) were male, with a mean age of 34.8 ± 9.6 years. Radiological evaluation revealed an elongated styloid process in 41 patients (56.2%). Bilateral elongation was observed in 24 (32.9%) cases, while unilateral elongation was found in 17 (23.3%). A significant association was observed between an elongated styloid process and the severity of neck/throat pain (p=0.01). Conclusion: Elongated styloid process is a common radiological finding in patients with post-tonsillectomy chronic throat pain. Routine radiological screening may facilitate early diagnosis and appropriate management, improving patient outcomes.
Application of Titanium Elastic Nails for Treating Pediatric Tibial Shaft Fractures
Background: Pediatric tibial shaft fractures are among the most common long bone injuries, particularly in developing countries, often requiring effective surgical management for optimal outcomes. Aim of the study to evaluate the effectiveness and clinical outcomes of Titanium Elastic Nailing in pediatric tibial shaft fractures. Methods & Materials: This prospective observational study was conducted over one year at the Department of Orthopedic & Spine Surgery, Ad-Din women's Medical College Hospital and Barak PRP Medical Centre & General Hospital, Dhaka, Bangladesh, Dhaka, Bangladesh. A total of 15 pediatric patients aged 5–15 years with tibial shaft fractures were treated using Titanium Elastic Nails. Demographic data, fracture characteristics, operative details, and postoperative outcomes were recorded. Functional outcomes were assessed using Flynn criteria, and radiological parameters were evaluated for alignment and limb length discrepancy. Statistical analysis was performed using SPSS version 26 with descriptive statistics. Result: The mean age was 10.4±2.9 years, with male predominance (73.33%). Road traffic accidents (40%) were the most common cause. The mean time to union was 9.8±2.1 weeks, with most cases (86.67%) achieving union within 12 weeks. Complications were minimal, with 73.33% having no complications. Functional outcomes were excellent in 66.67% and good in 26.67% of patients. Radiologically, 86.67% had <5° angular deformity, and 93.33% had <1 cm limb length discrepancy. Conclusion: Titanium Elastic Nailing is an effective and reliable treatment for pediatric tibial shaft fractures, providing excellent functional and radiological outcomes with minimal complications.
Association between Hypertension and Dementia in Elderly Patients
Background: Dementia poses a significant and growing health challenge among the aging population globally. While vascular risk factors are implicated in cognitive decline, the specific association between hypertension and dementia in the context of Bangladesh requires further elucidation. Objective: To determine the association between hypertension and dementia in elderly patients attending a tertiary care hospital in Bangladesh. Methods & Materials: This prospective cohort study was conducted at the Department of Medicine, Mymensingh Medical College Hospital, Mymensingh, Bangladesh, from January 2023 to December 2024. A total of 87 elderly patients (aged ≥60 years) were enrolled using purposive sampling. Of 87 elderly patients, 45 with hypertension and 42 without were followed for 24 months. Dementia was diagnosed using DSM-5 criteria. Data analysis employed SPSS version 23.0 to determine the association between exposure and outcome. Results: The mean age of participants was 68.4±6.2 years. At the end of the follow-up period, the incidence of dementia was significantly higher in the hypertensive group (15/45, 33.3%) compared to the normotensive group (6/42, 14.3%). The relative risk for developing dementia among hypertensive elderly patients was 2.33 (95% CI: 1.01–5.41, p=0.037), indicating a statistically significant positive association between hypertension and incident dementia. Conclusion: This study demonstrates a significant positive association between hypertension and the subsequent development of dementia in the elderly Bangladeshi population. These findings underscore the importance of rigorous blood pressure control as a potential strategy for reducing the burden of dementia in this setting.
Outcome of Circumcision Using Bipolar Diathermy: An Observational Study
Background: Circumcision is a common surgical procedure, and achieving optimal outcomes with minimal complications remains a priority. Bipolar diathermy is increasingly used for its precision and reduced bleeding risk, but limited prospective data exist on its efficacy in resource-constrained settings like Bangladesh. Objective: This study aimed to evaluate the postoperative outcomes of circumcision using bipolar diathermy. Methods & Materials: This retrospective observational study was conducted at the Department of Surgery, Delta Medical College & Hospital, Dhaka, Bangladesh. (Jan 2022- Dec 2023) Included 86 patients undergoing bipolar diathermy circumcision. We used purposive sampling to assess operative time, blood loss, postoperative pain (VAS), healing time, and complications at 24h, 7d, and 14d follow-ups. Data were analyzed using descriptive statistics in MS Excel. Ethical approval was obtained, with informed consent from all participants. Results: The study of 86 patients revealed a mean operative time of 18.7 minutes with minimal blood loss (5.2 mL). Postoperative pain scores decreased from 4.2 (Day 1) to 1.3 (Day 7) on VAS, with 88.4% achieving wound healing within 10 days. Complication rates were low (13.9%), primarily mild edema and infections. Patient satisfaction was high (93% good/excellent outcomes), supporting bipolar diathermy as an effective circumcision method. Conclusion: Bipolar diathermy circumcision demonstrated excellent safety and efficacy, with minimal blood loss, rapid healing, and high patient satisfaction. The technique appears particularly suitable for resource-limited settings. Further comparative studies are recommended to establish its advantages over conventional methods.
Association of Serum Uric Acid with Disease Severity in Hospitalized Patients with Acute Exacerbation of COPD in Bangladesh
Background: Acute Exacerbation of COPD (AECOPD) is a major cause of morbidity and mortality. Serum uric acid (SUA) has emerged as a potential biomarker for oxidative stress and disease severity. Aim of the study: To characterize the clinical and epidemiological profile of hospitalized AECOPD patients. Methods & Materials: This observational study was conducted at a tertiary care chest hospital in Bangladesh from July 2019 to June 2020. Ninety-six patients admitted with AECOPD were enrolled via purposive sampling and stratified into two groups based on admission SUA levels: Group A (Low SUA, <6.9 mg/dL; n=48) and Group B (High SUA, ≥6.9 mg/dL; n=48). Data on socio-demographics, clinical history, and GOLD stage were collected. Statistical analysis was performed using SPSS version 20. Results: The mean age of participants was 55.18 (±8.52) years, with a majority being male, from rural areas, and of lower-middle socioeconomic status. Most were current or ex-smokers (69.79%). No significant differences were found in these baseline characteristics between the two SUA groups. However, a significantly higher proportion of patients in the high SUA group had severe/very severe COPD (83.33% vs. 22.92%, p<0.001) and experienced acute respiratory failure (64.58% vs. 22.92%, p=0.001). Median SUA levels showed a strong positive correlation with worsening GOLD stage (P < 0.001). Conclusion: Elevated serum uric acid on admission is significantly associated with more severe airflow limitation and a higher incidence of acute respiratory failure in hospitalized AECOPD patients, suggesting its utility as a prognostic biomarker in this population.
Relationship between Platelet Distribution Width (PDW) and GRACE Risk Score to Assess the In-Hospital Outcome in Patients with Acute Coronary Syndrome
Background: Acute coronary syndrome (ACS) is a leading cause of morbidity and in-hospital mortality worldwide, highlighting the need for simple, cost-effective biomarkers for early risk stratification. This study aimed to determine the relationship between platelet distribution width (PDW) and GRACE Risk Score with adverse in-hospital outcomes in patients with ACS. Methods & Materials: This cross-sectional observational study was carried out in the Department of Cardiology at Mymensingh Medical College Hospital, Mymensingh, Bangladesh, from January 2024 to December 2024. A purposive sample of 80 patients who were admitted with ACS (STEMI, NSTEMI, and unstable angina) was used. PDW was measured from a routine complete blood count at admission, and GRACE risk scores were calculated. In-hospital adverse events were recorded. Data were entered and analyzed using SPSS version 26. Results: The mean age of the participants was 61.8±10.9 years, with the majority being males (72.5%). The most prevalent type of ACS was STEMI (42.5%). Mean PDW was 16.82±2.5 fL, and mean GRACE score was 135.72±24.8 fL. In 35% of the patients, elevated PDW (>17.0 fL) was detected. Adverse events occurred in 30% of patients. High PDW (p=0.004) and elevated GRACE risk (p=0.002) were significantly associated with outcomes. Logistic regression showed PDW (adjusted OR 3.92; p=0.017) and GRACE score (adjusted OR 1.31; p=0.022) independently predicted in-hospital events. Conclusion: Platelet distribution width (PDW), an easily obtainable parameter, is associated with adverse in-hospital outcomes in ACS and improves GRACE score–based risk stratification, especially in resource-limited settings.
Respiratory Distress in the Neonatal Intensive Care Unit: Prevalence and Key Etiological Factors
Background: Respiratory distress in newborns, marked by tachypnoea, grunting, retractions, or cyanosis, is a common cause of urgent NICU admission, especially in South Asia. This study aimed to determine the prevalence of respiratory distress among NICU-admitted patients and to identify key etiological factors and associated other conditions. Methods & Materials: This hospital-based observational descriptive analytic study was conducted in the NICU of Uttara Crescent Hospital, Dhaka, Bangladesh, from February 2023 to January 2024, including 169 consecutive neonatal admissions over one year. Respiratory distress was defined by clinician diagnosis, standard signs, or need for respiratory support at admission or during stay. Data were extracted via a structured form; outcomes analyzed in SPSS v26 using unadjusted odds ratios, 95% CIs, p<0.05. Results: Among 169 NICU admissions, respiratory distress (RD) was present in 96 neonates, with a prevalence 56.80%. RD cases had a mean age of 6.79±3.81 days, were predominantly male (63.54%), mostly preterm (60.42%), and commonly admitted within ≤3 days of life (83.33%). Common causes included CHD (40.6%), neonatal sepsis (35.4%), TTN (32.3%), and RDS (18.8%). Supportive care was frequent; mean NICU stay was 5.6±4.1 days.On unadjusted analysis, TTN (OR 5.88, p = 0.002), RDS (OR 5.65, p = 0.03), and CHD (OR 2.57, p = 0.033) were significantly associated with RD. Conclusion: Respiratory distress affected over half of NICU admissions, mostly within three days, with CHD, EONS/LONS, and TTN as leadin cause. Early evaluation and standardized protocols can optimize oxygen therapy, echocardiography, and antibiotic stewardship.