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
Therapeutic evaluation of oral Spirulina platensis on glycemic control and pain modulation in streptozotocin-induced diabetic neuropathic Long-Evans rats
Background: Diabetic neuropathy, a major chronic complication of diabetes, results from hyperglycemia, oxidative stress, and neuroinflammation. Spirulina platensis, a nutrient-rich cyanobacterium, has antioxidant, anti-inflammatory, and potential blood sugar-lowering effects. This study evaluated Spirulina's effects on blood sugar and pain behavior in STZ-induced diabetic rats. Methods & Materials: Sixty Long Evans rats were allocated into six groups: control, Spirulina-treated, and sodium salicylate–treated for both non-diabetic and diabetic conditions. Diabetes was induced with STZ (60 mg/kg). Spirulina was given orally at 500 mg/kg/day for a month. Blood glucose and body weight were measured at baseline and week four. Nociceptive behavior was assessed using the formalin test, covering neurogenic (0–10 min) and inflammatory (15–60 min) phases. Results: Untreated diabetic rats developed marked hyperglycemia by week four (265.2 ± 28.13 mg/dL). Spirulina treatment significantly reduced fasting glucose (148.7 ± 25.47 mg/dL; P < 0.01), while non-diabetic groups remained normoglycemic. Body weight improved modestly in Spirulina-treated diabetic rats (200.8 ± 4.0 g to 212.9 ± 4.1 g), compared with minimal gains in diabetic controls. Formalin-induced nociceptive scores were highest in diabetic rats (1st phase: 2.18 ± 0.08; 2nd phase: 2.03 ± 0.07). Spirulina significantly attenuated nociception in both phases (1.67 ± 0.06 and 1.53 ± 0.05; P < 0.01), indicating both anti-neurogenic and anti-inflammatory effects. Sodium salicylate reduced pain predominantly in the late phase. Conclusion: Spirulina platensis exhibits strong antihyperglycemic, metabolic, and antinociceptive effects in STZ-induced diabetic rats. Its combined antioxidant, anti-inflammatory, and insulin-modulating activities suggest promising therapeutic potential for managing diabetic neuropathy and associated metabolic disturbances. Further mechanistic and clinical studies are warranted to validate its translational applicability.
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Clinical Progression and Determinants of Unfavorable Functional Outcomes in Guillain-Barré Syndrome – A Retrospective Analysis
Background: Guillain–Barré Syndrome (GBS) is an acute immune-mediated neuropathy causing motor, sensory, and autonomic dysfunction, often leading to long-term disability. Despite standard treatments, some patients experience rapid progression and unfavorable functional outcomes. Identifying predictors of poor recovery is crucial for early intervention and prognosis. Aim of the study: To evaluate the clinical progression of GBS and determine the factors associated with unfavorable short-term functional outcomes. Methods & Materials: A retrospective observational study was conducted at Dhaka Medical College Hospital from January 2017 to December 2018, including 50 adult patients with first-episode GBS admitted within seven days of symptom onset. Demographic, clinical, and laboratory data were collected. Functional outcomes at six weeks were assessed using the GBS Disability Scale. Univariate and multivariate analyses were performed to identify predictors of poor outcome. Result: Among 50 patients, 42 (84%) had favorable outcomes, and 8 (16%) experienced poor functional recovery. Advanced age (≥50 years), severe motor weakness (MRC score ≤10), pain at onset, hyponatremia (<135 mmol/L), and ICU admission were independent predictors of unfavorable outcomes. Significant correlations were observed between MRC sum score, CSF protein, serum sodium, and GBS disability scores. Conclusion: Advanced age, severe initial motor weakness, pain at onset, hyponatremia, and ICU admission are key determinants of poor short-term functional outcomes in GBS. Early identification of these high-risk patients may guide intensive monitoring, targeted therapy, and rehabilitation strategies to improve recovery.
Impact of Relationship Duration on Sexual Satisfaction – Evidence from Bangladeshi Couples Using the Bangla NSSS-S
Background: Sexual satisfaction is a vital component of marital well-being, yet its relationship with the duration of marriage remains complex and underexplored in conservative societies such as Bangladesh. The New Sexual Satisfaction Scale–Short Form (NSSS-S) has not been previously validated in Bangla. Aim of the study: To assess the association between relationship duration and sexual satisfaction among Bangladeshi married adults using the Bangla-adapted NSSS-S, and to validate its psychometric properties. Methods & Materials: A cross-sectional analytical study was conducted among 120 sexually active married adults at BSMMU, Dhaka. Data were collected using structured interviews, including sociodemographic variables, the Bangla NSSS-S, and the Arizona Sexual Experience Scale (ASEX). Reliability was assessed using Cronbach’s alpha. ANOVA, Pearson’s correlation, and effect size analyses were performed using SPSS 26. Result: The Bangla NSSS-S demonstrated excellent internal consistency (α = 0.97). Sexual satisfaction significantly declined with increasing relationship duration (mean NSSS-S scores: ≤5 years = 45.2 ± 6.4 vs. >15 years = 37.9 ± 8.3, p < 0.001). Relationship duration showed a moderate negative correlation with total sexual satisfaction (r = –0.468, p < 0.001). Higher marital satisfaction was strongly associated with greater sexual satisfaction (Cohen’s d = 0.8–1.19). Conclusion: Longer relationship duration is associated with decreased sexual satisfaction among Bangladeshi couples. The Bangla NSSS-S is a reliable tool for assessing sexual satisfaction in this population. Interventions focused on emotional intimacy and communication may help sustain sexual satisfaction in long-term relationships.
Assessment of Linguistic Equivalence and Internal Consistency of the Culturally Adapted Bangla Version of the Glasgow Antipsychotic Side-Effect Scale (GASS-B)
Background: Antipsychotic medications frequently cause a spectrum of adverse effects, which can reduce adherence and impact patient outcomes. The Glasgow Antipsychotic Side-Effect Scale (GASS) is a widely used self-administered tool to monitor these side effects, but no validated Bangla version exists. Aim of the study: To assess the linguistic equivalence, reliability, and validity of the culturally adapted Bangla version of the GASS (GASS-B) among adult patients receiving antipsychotics in Bangladesh. Methods & Materials: A cross-sectional study was conducted among 220 adult patients at the National Institute of Mental Health, Dhaka. Standardized translation, back-translation, expert review, and pilot testing procedures were employed. Data were analyzed using SPSS version 24. Descriptive statistics (frequencies, percentages, means, SDs) summarized variables. Reliability was assessed via Cronbach’s alpha, split-half reliability, and intraclass correlation coefficient (ICC). Validity was evaluated through face validity (expert review), content validity (Content Validity Index), and construct validity (confirmatory factor analysis and principal component analysis). Results were presented in tabular and graphical formats. Result: The GASS-B demonstrated acceptable internal consistency (α = 0.745), good test–retest reliability (ICC = 0.82), and strong content validity (I-CVI 0.83–1.00). Factor analyses supported a seven-factor structure explaining 58.9% of variance, confirming construct validity. Conclusion: The GASS-B is a linguistically and culturally valid, reliable, and practical tool for assessing antipsychotic side effects in Bangla-speaking patients, facilitating improved clinical monitoring and adherence.
Influence of Perioperative and Patient-Related Factors on Clinical Outcomes in Intertrochanteric Femoral Fractures Managed with Dynamic Hip Screw
Background: Intertrochanteric femoral fractures are common in the elderly and contribute to significant morbidity. Dynamic Hip Screw (DHS) fixation remains a widely used and cost-effective treatment, though outcomes depend on both patient factors and perioperative parameters. Aim: To assess how perioperative factors and patient characteristics influence clinical and functional outcomes after DHS fixation. Methods & Materials: This quasi-experimental observational study included 26 patients (aged 31–80 years) treated with DHS between September 2022 and September 2024. Demographics, comorbidities, injury mechanism, bone density (Singh Index), perioperative variables, and postoperative complications were analyzed. Pain was assessed using the Visual Analogue Scale (VAS), and functional recovery was evaluated by the Harris Hip Score (HHS) at nine months. Results: Mean age was 67.7 ± 10.3 years, with females comprising 61.5%. Falls from standing height caused most injuries (84.6%). The mean injury-to-surgery interval was 4.96 ± 1.76 days, operative time 66.8 ± 8.1 minutes, and blood loss 200 ± 50 mL. Mean union time was 16.6 ± 2.4 weeks. VAS improved significantly from 7.9 ± 0.95 to 1.0 ± 0.92. Independent ambulation was regained by 53.9% of patients. Complications were low (7.7% superficial infection; 7.7% screw cut-out). HHS was significantly associated with bone density (p = 0.04) and tip–apex distance (p = 0.003). Conclusion: DHS fixation provides predictable union, favorable functional outcomes, and low complication rates. Better bone quality and optimal screw positioning (TAD ≤25 mm) were key predictors of improved recovery.
Functional and Radiological Outcomes of Three-Dimensional versus Modified French Osteotomy in Pediatric Gunstock Deformity
Background: Cubitus varus (gunstock deformity) is a common complication of malunited supracondylar humerus fractures in children, causing functional impairment and cosmetic concerns. Traditional Modified French osteotomy corrects angular deformity but often fails to address rotational and sagittal components. Aim of the study: To compare the functional and radiological outcomes of Three-Dimensional (3D) Osteotomy versus Modified French Osteotomy in pediatric cubitus varus. Methods & Materials: A prospective comparative study was conducted on 40 patients (aged 8–20 years) at BSMMU, Dhaka. Participants were equally divided into 3D Osteotomy and Modified French Osteotomy groups (n=20 each). Perioperative outcomes, radiographic parameters, functional recovery (MEPS), patient satisfaction, and complications were evaluated. Statistical significance was set at p<0.05. Result: 3D Osteotomy demonstrated significantly shorter union time (10.25±1.29 vs 12.25±1.71 weeks), better correction of carrying angle (11.10°±2.13 vs 9.40°±2.62; p=0.035), reduced internal rotation deformity (2.25°±1.65 vs 5.60°±1.76; p=0.001), and improved humeral alignment (p=0.007). Functional scores were higher (MEPS 91.50±5.64 vs 86.00±7.18; p=0.015), with more excellent outcomes (75% vs 40%) and greater patient satisfaction (85% vs 55%). Complications such as nerve injury and loss of correction were more common in the Modified French group. Conclusion: Three-dimensional osteotomy offers superior functional restoration, radiological accuracy, and patient satisfaction compared to Modified French osteotomy, despite longer operative time and higher blood loss. It provides a more comprehensive correction for pediatric cubitus varus deformity.
Differential Patterns of Parenting – A Comparative Study of Mothers and Fathers of Young Adults with Borderline Personality Disorder
Background: Parenting practices significantly influence the emotional and behavioral development of offspring, with distinct maternal and paternal contributions potentially affecting the severity of Borderline Personality Disorder (BPD). Aim of the study: To compare differential parenting patterns between mothers and fathers of young adults diagnosed with BPD and to examine their association with symptom severity. Methods & Materials: A cross-sectional comparative study was conducted at BSMMU and NIMH, Dhaka, enrolling 50 young adults with BPD and their parents. Parenting dimensions, styles, expressed emotion, attachment, and empathy were assessed using validated instruments. Data were analyzed with t-tests, chi-square, Pearson correlations, and logistic regression. Results: Mothers exhibited higher care, authoritative parenting, and empathy, whereas fathers demonstrated greater overprotection, authoritarian style, and avoidant attachment. Maternal care negatively correlated with BPD severity (r=−0.43, p=0.001), while paternal overprotection showed a positive correlation (r=0.40, p=0.003). Multivariable analysis identified low maternal care and high paternal overprotection as independent predictors of dysfunctional parenting. Conclusion: Mothers and fathers of young adults with BPD display distinct but complementary parenting patterns that influence symptom severity. Targeted family-based interventions addressing maternal warmth and paternal engagement may improve psychosocial outcomes in BPD.
Suicidal Ideation and Its Correlates Among Adult Patients with Obsessive-Compulsive Disorder (OCD)
Background: Obsessive-compulsive disorder (OCD) is a chronic psychiatric condition frequently associated with significant functional impairment and an elevated risk of suicidal ideation and behavior. Understanding its correlates is essential for early detection and prevention of suicide among vulnerable patients. Aim of the study: To assess the prevalence and correlates of suicidal ideation among adult patients with OCD attending a tertiary care hospital in Dhaka, Bangladesh. Methods & Materials: This cross-sectional study included 120 adult OCD patients diagnosed using DSM-5 criteria. Participants were divided into two groups: those with suicidal ideation (n=30) and those without (n=30). Standardized tools including Y-BOCS, HDRS, HAM-A, BABS, and WHOQOL-BREF were administered. Data were analyzed using chi-square tests, t-tests, Pearson’s correlations, and logistic regression. Result: Suicidal ideation was observed in 50% of participants. Independent predictors included comorbid depression (adjusted OR = 7.78, p < 0.001), higher Y-BOCS scores (adjusted OR = 1.13, p < 0.001), family psychiatric history (adjusted OR = 3.67, p = 0.012), longer duration of illness (adjusted OR = 1.20, p = 0.003), and unemployment (adjusted OR = 2.50, p = 0.025). Participants with suicidal ideation also demonstrated significantly lower quality of life (WHOQOL-BREF: 51.00 ± 9.40 vs. 64.80 ± 10.20, p < 0.001). Conclusion: Suicidal ideation is highly prevalent among Bangladeshi adults with OCD, strongly linked to depressive symptoms, illness severity, and psychosocial stressors. Early identification and comprehensive management, including suicide risk screening and psychosocial support, are essential to reduce suicide-related morbidity and mortality.
A study of Patterns, Toxic Agent and Contributing Factors in Death due to Poisoning
Background: Poisoning is a significant cause of morbidity and mortality worldwide, with young adults in developing countries disproportionately affected. In Bangladesh, pesticides and household chemicals are major contributors to poisoning-related deaths, yet region-specific data on patterns, toxic agents, and precipitating factors remain limited. Aim of the study: To evaluate the demographic patterns, toxic agents, and contributing psychosocial factors associated with poisoning-related deaths in Bangladesh to inform preventive strategies and improve clinical management. Methods & Materials: A retrospective study, conducted in 126 cases, data were collected from a predesigned format of autopsy reports, hospital notes and inquest reports all performed at Dhaka Medical College (DMC) Morgue during the year of January’2024 to June 2024. The data received were carefully recorded later, analyzed by computer and organized in tables. Result: Young adults (21–30 years) were the most affected group (30.16%), with a slight female predominance (53.97%). Housewives (27.78%) and farmers (23.81%) were the most vulnerable occupational groups. Organophosphorus compounds were the leading toxic agents (44.44%), followed by aluminum phosphide (20.63%) and zinc phosphide (14.29%). Familial disharmony/domestic conflict (31.75%), failure in personal affairs (15.87%), and examination failure (14.29%) were the primary precipitating factors. Conclusion: Poisoning-related deaths in Bangladesh predominantly affect young adults, with pesticides as the major toxic agents and psychosocial stressors as key triggers. Targeted public health interventions, regulation of hazardous chemicals, and mental health support are essential to reduce poisoning-related morbidity and mortality.
Outcome Evaluation of Intertrochanteric Fracture Fixation Using Dynamic Hip Screw
Background: Intertrochanteric femoral fractures are common in the elderly and often lead to significant morbidity. The Dynamic Hip Screw (DHS) is a widely used fixation method, though its outcomes continue to be evaluated in relation to fracture stability and patient factors. Aim: To assess the clinical, radiological, and functional outcomes of intertrochanteric fracture fixation using DHS and identify factors influencing postoperative recovery. Methods & Materials: This prospective study included 36 patients (mean age 75.2 ± 9.1 years) with AO/OTA 31-A1 to A3 fractures treated with DHS. Follow-up was ≥12 months. Radiological outcomes included time to union, neck–shaft angle, and fracture collapse. Functional outcomes were measured using Harris Hip Score (HHS) and SF-36 PCS. Statistical significance was set at p < 0.05. Results: Mean time to union was 13.6 ± 2.1 weeks, and mean neck–shaft angle was 129.8° ± 5.0°. Final HHS averaged 82.4 ± 10.2, and SF-36 PCS averaged 72.5 ± 11.3. Excellent or good outcomes were seen in 55.6% of patients. Younger age (<75 years), stable fracture pattern, early surgery (<3 days), and absence of complications were significantly associated with higher HHS. Complications occurred in 27.8%, including screw cut-out (5.6%), varus malunion (8.3%), and implant-related pain (11.1%). Conclusion: DHS fixation provides dependable union and satisfactory function, particularly in stable fractures and when surgery is performed early. Accurate reduction and careful postoperative care help minimize complications and improve outcomes in elderly patients.
Peroneus Longus Tendon Autograft in ACL Reconstruction – Clinical and Biomechanical Outcomes
Background: Anterior cruciate ligament (ACL) reconstruction aims to restore knee stability and function. While hamstring and patellar tendon autografts are standard, the peroneus longus tendon (PLT) has emerged as a strong alternative due to its biomechanical strength and easy harvest. Aim: To evaluate clinical, functional, and biomechanical outcomes of ACL reconstruction using ipsilateral PLT autograft at 24-month follow-up. Methods & Materials: This prospective study included 18 patients with isolated ACL rupture who underwent arthroscopic single-bundle ACL reconstruction using PLT autograft. Stability was assessed using Lachman and pivot shift tests, and anterior tibial translation was measured with a KT-1000 arthrometer. Functional outcomes were evaluated with IKDC, Lysholm, Tegner, and Cincinnati scores and the single-leg hop test. Biomechanical parameters were compared with the contralateral ACL. Donor site morbidity and complications were noted. Results: At 24 months, stability and function improved markedly. Lachman and pivot shift positivity decreased from 100% to 5.6%. Anterior tibial translation reduced from 9.4 ± 2.0 mm to 2.2 ± 0.9 mm (p < 0.001). Functional scores improved significantly (p < 0.001), and hop performance increased from 72 ± 10% to 94 ± 5%. PLT grafts showed good stiffness, high load to failure, minimal elongation, and acceptable rotational stability, comparable to native ACL. Donor site morbidity was low (11%), with no graft ruptures. Conclusion: PLT autograft offers strong clinical, functional, and biomechanical results with minimal morbidity, supporting its use as an effective alternative for ACL reconstruction.
Evaluation of Serum Zinc as a Potential Biomarker of Dyslipidemia among Obese Adults
Background: Dyslipidemia is a common metabolic disorder among obese adults, and emerging evidence suggests that micronutrient imbalance, particularly serum zinc deficiency, may be linked to altered lipid metabolism. This study aimed to evaluate serum zinc as a potential biomarker of dyslipidemia among obese adults. Methods & Materials: This comparative cross-sectional study was conducted in the Department of Physiology at Sylhet MAG Osmani Medical College, Sylhet, Bangladesh, from July 2022 to June 2023. A total of 60 individuals attending various Outpatient Departments of Sylhet MAG Osmani Medical College Hospital were enrolled. Participants were divided into two groups: Group A (Obese individuals with BMI ≥ 25 kg/m²), and Group B (Healthy individuals with normal BMI). Results: The demographic characteristics were comparable between the groups (p > 0.05). Obese participants exhibited significantly higher TC, TG, and LDL-C levels and lower HDL-C levels compared to healthy controls (p < 0.01). Serum zinc was significantly reduced in Group A (10.15 ± 1.03 µmol/L) compared to Group B (13.13 ± 1.34 µmol/L; p < 0.001). Regression analyses revealed moderate linear correlations between serum zinc and TC (r = –0.503), TG (r = –0.591), HDL-C (r = 0.616), and LDL-C (r = –0.546), all of which were statistically significant (p < 0.001). Each lipid parameter significantly predicted serum zinc levels, with HDL-C showing the strongest predictive association. Conclusion: Serum zinc levels are significantly associated with lipid abnormalities in obese adults and may serve as a potential biomarker for dyslipidemia. Further longitudinal studies are recommended to validate its predictive utility.
Fertility outcome following laparoscopic cystectomy in patients with chocolate cyst
Background: Ovarian endometrioma (chocolate cyst) is a common manifestation of endometriosis and a significant cause of infertility in reproductive-age women. Laparoscopic cystectomy is widely employed to improve fertility outcomes, yet the extent of its effectiveness and influencing factors remain subjects of ongoing investigation. Objective: To evaluate 12-month fertility outcomes following laparoscopic excision of chocolate cysts in women presenting with infertility and to identify factors associated with successful conception. Methods & Materials: This prospective observational study was conducted at the Department of Obstetrics and Gynecology, Anowar Khan Modern Medical College, Chattogram, Bangladesh, from January to December 2024. A total of 138 infertile women aged 20–40 years with diagnosed ovarian endometrioma underwent laparoscopic cystectomy. Clinical pregnancy within 12 months post-surgery was the primary outcome, with follow-ups conducted every 3 months. Data were analyzed using SPSS, with p<0.05 considered statistically significant. Results: The overall pregnancy rate within 12 months was 65.2%, including 52.2% spontaneous conception and 13.0% through assisted reproductive techniques. Most conceptions occurred within the first 6 months (48.9%). Significant predictors of successful pregnancy included age <35 years (72.3% vs 49.1%, p=0.02), unilateral cysts (69.8% vs 52.4%, p=0.03), and Stage III endometriosis (70.7% vs 57.1%, p=0.04). Cyst size did not significantly affect pregnancy outcomes. Among pregnancies, 86.7% resulted in live births, while 13.3% ended in miscarriage. Conclusion: Laparoscopic cystectomy offers favorable fertility outcomes in women with ovarian endometrioma, particularly those who are younger, have unilateral cysts, and less advanced disease. Careful patient selection and fertility counseling are crucial to optimize outcomes while preserving ovarian reserve.
The incidence and risk factors of low back pain in rural communities of Bangladesh
Background: Low back pain (LBP) has become a major public health concern. It is a leading cause of activity limitation. The risk variables were not fully examined. Aim of the study: The study aimed to assess the prevalence of low back pain (LBP) among middle-aged and elderly rural community participants in Bangladesh, as well as the associated risk factors. Methods & Materials: This cross-sectional study was conducted in the Department of Orthopedics & Traumatology, TMSS Medical College, Bogura and Natore Trauma Centre & Hospital, Natore, Bangladesh from January 1, 2023 to January 1, 2025. The study involved 5181 participants. The study measured the prevalence and severity of LBP across time. All data was collected, documented in a Microsoft Excel work sheet, and analyzed using descriptive statistics in SPSS 17.0. Results: The average age of the study participants was 57.7 years, with 55.7% being women. women had a greater lifetime prevalence of LBP (73.1%), compared to men. Women had greater prevalence rates at both the point and 6-month levels. LBP was significantly linked with age, female sex, obesity (point only), and osteoporosis (lifetime alone). LBP was found to be negatively linked with both lifetime and point exercise, as well as point-only manual activity. Conclusion: Our findings suggest that the prevalence of LBP in Bangladesh's rural communities is comparable to that of other populations. LBP risk factors include advanced age, female sex, and osteophytes.
A Study on Clinical Presentation, Predisposing Factors and Outcome of Retained Placenta
Background: Retained placenta is a significant obstetric complication associated with increased maternal morbidity and mortality. Objective: This study aimed to assess the clinical presentation, predisposing factors, and outcomes of retained placenta among women delivering in a tertiary care setting. Methods & Materials: This case control study was conducted in the Department of Obstetrics & Gynaecology, Dhaka Medical College and Hospital, Dhaka, Bangladesh, from January 2012 to June 2012. A total of 100 patients were enrolled, comprising 50 patients with retained placenta were taken as cases and 50 patients without retained placenta were taken as controls. Results: This study shows that age and parity differed significantly between groups, with higher parity more common among cases. Retained placenta was strongly associated with mismanagement of the third stage of labor (30% vs. 4%), previous uterine surgery (20% vs. 4%), preterm labor (22% vs. 8%), and grand multiparity (16% vs. 2%). Clinically, cases had higher rates of primary postpartum hemorrhage (50%), anemia (80%), and shock (30%). Although adverse maternal outcomes were more frequent among cases, differences were not statistically significant. Multivariate analysis identified mismanagement of the third stage of labor (AOR 2.80), previous uterine surgery (AOR 9.20), preterm labor (AOR 3.79), and grand multiparity (AOR 4.67) as independent predictors. Conclusion: Retained placenta is strongly associated with preventable obstetric factors and presents with significant clinical complications. Early identification of high-risk women and improved management of the third stage of labor are essential for reducing adverse outcomes.
Clinical Outcome & Side Effect of Methotrexate in the Treatment of Unruptured Tubal Ectopic Pregnancy in a Tertiary Care Hospital
Background: Ectopic pregnancy is a major cause of maternal morbidity & mortality during early gestation. Methotrexate therapy offers a conservative, fertility-preserving alternative for unruptured tubal ectopic pregnancies; however, outcomes vary across populations. Objectives: This study aimed to evaluate the clinical outcomes and side effects of methotrexate in treating unruptured tubal ectopic pregnancy at a tertiary care hospital in Bangladesh. Methods & Materials: This prospective observational study was conducted at the Department of Obstetrics and Gynecology, Shaheed Suhrawardy Medical College and Hospital, Dhaka, Bangladesh, from July 2024 to June 2025. A total of 100 hemodynamically stable women diagnosed with unruptured tubal ectopic pregnancy were treated with intramuscular methotrexate (50 mg/m²). Serum β-hCG was monitored on days 4 and 7; success was defined as a ≥15% decline between these intervals and complete resolution without surgery. Data were analyzed using SPSS version 25.0. Results: The overall treatment success rate was 82%, with 72% of patients achieving resolution after a single dose and 10% requiring a second dose. Mean β-hCG resolution time was 31.6 ± 8.7 days. Significant predictors of success included baseline β-hCG levels <5000 mIU/mL (p = 0.02) and ectopic mass size <4.0 cm (p = 0.03). Adverse effects were mild, with abdominal pain (28%) and nausea/vomiting (22%) being the most common. Conclusion: Methotrexate is a highly effective, safe, and well-tolerated non-surgical option for appropriately selected patients with unruptured tubal ectopic pregnancy in tertiary care settings.
Comparative Study of Locking Compression Plate versus Intramedullary Nail in Distal Femur Fracture
Introduction: Distal femur fractures are complex injuries that can occur from high-energy trauma in young adults or low-energy falls in the elderly. Surgical fixation is the standard approach to restoring alignment, allowing early mobilisation, and achieving good functional outcomes. The two most common methods are Locking Compression Plate (LCP) and Intramedullary Nailing (IMN). This study aimed to compare the clinical, radiological, and functional outcomes of Locking Compression Plate versus Intramedullary Nailing in patients with distal femur fractures. Methods & Materials: This comparative observational study was conducted in the Department of Orthopedics, Satkhira Sadar Hospital, Satkhira, Bangladesh from January 2024 to January 2025. A total of 68 patients diagnosed with distal femur fractures (AO/OTA type 33) were enrolled based on predefined inclusion and exclusion criteria. Data were analysed using SPSS software version 25.0. Result: In our study of 68 distal femur fracture patients (34 treated with Locking Compression Plate (LCP) and 34 with Intramedullary Nailing (IMN)), IMN resulted in significantly shorter operative time, less intraoperative blood loss, and faster radiological union (mean 15.9 vs. 18.7 weeks, p = 0.004). Functional outcomes (knee motion, pain, walking ability) at 6 months were slightly better in the IMN group, though not statistically significant. Complication rates— including infection, implant failure, non-union, and knee stiffness — were roughly similar between groups. Conclusion: IMN was associated with shorter operative time, less blood loss, and faster union, while LCP offered better stability for comminuted or intra-articular fractures with slightly superior early functional outcomes.
Knowledge and Utilization of Community Clinic Services among the Catchment Area of Nandigram, Bogura, Bangladesh
Introduction: Bangladesh has made signiﬁcant progress in recent times in many of its social development indicators, particularly in rural health services. Clinic (CC) is also based on principles of Primary Health Care to serve the greatest interest to the largest population. Methods & Materials: This Cross-sectional type of descriptive study was conducted at Department of Community Medicine, Rajshahi Medical College Hospital from January 2020 to December 2020. People who were residing in ward no 6, 7, 9, vatra union, Nandigram Upazila, Bogura were the study population. Results: Majority of the respondents (94.0%) knew about overall the services given by community clinic. The relationship between age and knowledge about supplied contraceptives for women from community clinic was statistically significant. Relationship between Monthly income and knowledge about contraceptives supplied for women from community clinic was statistatically significant. Conclusion: In spite of some limitations in the provision of healthcare services, community clinics have emerged as a flagship program of the Government of Bangladesh. By providing adequate and appropriate logistics supports, PHC services can establish from Ccs.
Distribution of Fingerprint Patterns among Bengali Postgraduate Medical Residents in Bangladesh
Background: Fingerprints serve as unique, permanent, and reliable biometric identifiers that remain unchanged throughout life. Dermatoglyphic studies have gained increasing interest for their potential applications in forensic and anthropological sciences. However, such data are limited among Bangladeshi populations, especially in medical professionals. Objective: To determine the distribution of fingerprint patterns among Bangladeshi postgraduate medical residents and to assess the association with sex. Methods & Materials: This cross-sectional study was conducted at the Department of Forensic Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), from February 2024 to January 2025. A total of 115 postgraduate medical residents (1150) were included through convenient sampling. Fingerprints were collected using the rolling ink method and classified into arches, loops, and whorls. Data were analyzed using SPSS version 26. The Chi-square (χ²) test was applied to assess the association between fingerprint patterns and sex, with a significance level set at p < 0.05. Results: Loops were the most prevalent fingerprint pattern (62.5%), followed by whorls (29.1%) and arches (8.4%). Female participants exhibited a higher proportion of loop patterns than males, though the difference was not statistically significant (χ² = 1.409, p = 0.494). Finger-wise analysis showed loops were most frequent on middle and little fingers, while whorls predominated on ring digit. Conclusion: Loop patterns predominated among Bangladeshi postgraduate medical residents, with no significant sex-based differences. These findings provide baseline dermatoglyphic data for Bangladeshi adults and highlight the need for broader population-based research to explore potential genetic and biological influences.
Measuring Variation of IVC Diameter in Bangladeshi Population in BIRDEM – A Prospective Observational Study
ABSTRACT Background: Echocardiographic assessment of inferior vena cava (IVC) diameter and its respiratory variation helps to measure right atrial pressure (RAP). While IVC distends RAP rises. Phases of respiratory cycle has significant variation of inferior vena cava diameter in normal individual. There may be other factors that also influence IVC diameter. Aim: The present study aimed to see the size and dynamics of IVC, its respiratory variation and other factors influencing IVC diameter.. Methods & Materials: This prospective observational study was conducted at BIRDEM over six months in 2024, involving 1200 adult patients. Demographic data were recorded. BMI was calculated and categorized for analysis. Echocardiographic assessments of IVC maximum (IVC Max) and minimum (IVC Min) diameters, collapsibility index (CI), left ventricular ejection fraction (EF), and diastolic dysfunction (DD) were measured. Variation of IVC diameter with age, sex, BMI, EF, DD, and DM were assessed, with p < 0.05 considered significant. Results: The mean age of participants was 53.04 ± 10.95 years, and mean BMI was 26.00 ± 4.46 kg/m². Mean IVC Max and Min diameters were 18.44 ± 1.84 mm and 13.28 ± 2.00 mm, with a mean CI of 0.292 ± 0.115. IVC size correlated positively with age, male sex, and BMI (p < 0.01) but not with diabetes (p > 0.05). Larger IVC diameters and lower CI were observed in participants with reduced EF and advanced diastolic dysfunction (p < 0.001). Conclusion: IVC diameter and collapsibility index are significantly related to cardiac function and demographic factors, serving as useful non-invasive indicators of right atrial pressure and cardiac filling status.
Comparative Clinical Outcomes of Patients with Low and Preserved Left Ventricular Ejection Fraction Undergoing Off-Pump Coronary Artery Bypass Surgery – A Single-Center Study
Background: Left ventricular dysfunction is a major risk factor influencing outcomes after coronary artery bypass grafting (CABG). Off-pump CABG (OPCABG) has been proposed as a safer alternative for patients with reduced ejection fraction by avoiding cardiopulmonary bypass-related complications. This study aimed to compare intraoperative and early postoperative outcomes between patients with reduced and preserved left ventricular ejection fraction (LVEF). Methods & Materials: This comparative observational study was conducted in the Department of Cardiac surgery, United Hospital, Dhaka, Bangladesh, from July 2024 to December 2024. A total of 100 patients undergoing OPCABG were included: Group A (LVEF ≤35%, n=50) and Group B (LVEF >35%, n=50). Results: Patients with reduced LVEF were slightly older (61.8 ± 8.2 vs. 58.4 ± 7.9 years; p=0.041) and had more prior myocardial infarctions (64% vs. 44%; p=0.047). Group A received fewer grafts (2.7 ± 0.8 vs. 3.1 ± 0.7; p=0.008) and required longer operative time (220 ± 35 vs. 205 ± 30 min; p=0.03). The need for intra-aortic balloon pump (16% vs. 4%; p=0.046), prolonged inotropic support (42% vs. 20%; p=0.018), ICU stay (3.8 ± 1.6 vs. 2.9 ± 1.1 days; p=0.004), and hospital stay (9.2 ± 2.5 vs. 7.8 ± 2.0 days; p=0.006) were higher in Group A. LVEF improved significantly in both groups, with greater recovery in Group A (Δ% +8.4 ± 4.1 vs. +4.8 ± 3.9; p=0.002). Conclusion: OPCABG is safe and effective even in patients with severe left ventricular dysfunction, resulting in significant improvement in ventricular function and acceptable early morbidity and mortality rates.
Off-pump coronary artery bypass grafting
Relationship of Microalbuminuria with HbA1c and Other Renal Function Parameters in Type 2 Diabetic Post Menopausal Women
Background: Type 2 diabetes mellitus (T2DM) is a growing global health concern, with Bangladesh projected to rank 8th in adult diabetes prevalence by 2030 [1–4]. Microalbuminuria, an early marker of diabetic nephropathy linked to poor glycemic control, predicts renal and cardiovascular complications [5,6]. This study aims to assess the correlation between microalbuminuria, glycemic control, and renal function parameters in postmenopausal women with T2DM. Aim of the study: The aim of the study was to evaluate the association between microalbuminuria, HbA1c levels, and renal function parameters in postmenopausal women with type 2 diabetes at DMCH. Methods & Materials: This cross-sectional study at the Department of Biochemistry, Dhaka Medical College, Dhaka, Bangladesh (July 2014–June 2015) included 100 postmenopausal women with type 2 diabetes from the endocrine outpatient department. Blood and urine samples were analyzed for glucose, HbA1c, albumin, creatinine, microalbuminuria, and ACR. Data were processed using SPSS v21; p<0.05 was considered significant. Results: Among 100 postmenopausal women with T2DM, 78% had microalbuminuria. All patients with diabetes >5 years and 94.4% with hypoalbuminemia were microalbuminuria positive. Significant correlations were found with ACR (r=0.997), HbA1c (r=0.75), FBS (r=0.717), S. creatinine (r=0.694), S. albumin (r=–0.750), and U. creatinine (r=–0.762) (p=0.001). Conclusion: Microalbuminuria is common in diabetic postmenopausal women in Bangladesh, and early screening can help prevent diabetic complications and chronic kidney disease.
Efficacy of Core Decompression alone in Early-Stage Avascular Necrosis of the Femoral Head
Background: Avascular necrosis of the femoral head (AVNFH) is a progressive musculoskeletal disorder that can cause substantial disability due to collapse of the articular surface, primarily affecting young, active adults and posing significant socioeconomic challenges. The purpose of the study was to evaluate the efficacy of core decompression alone in patients with early-stage avascular necrosis of the femoral head. Methods & Materials: This prospective observational study at the Department of Orthopedics, Rangpur Medical College Hospital, Rangpur, and Sadar Hospital, Lalmonirhat, Bangladesh (July 2021–June 2025), included 30 patients with early-stage AVN (Ficat–Arlet I–II) undergoing core decompression. Demographics, HHS, radiological outcomes, and complications were recorded; data were analyzed using SPSS 26.0, with mean ± SD, frequencies (%), and paired t-tests for HHS changes (p < 0.05). Results: Among 30 patients (mean age 24.8 ± 4.0 years; 23 males), 14 had bilateral hip involvement. Etiology included steroid-induced AVN in 14, idiopathic in 10, and alcohol-related in 6 cases. Mean Harris Hip Score improved significantly from 58.4 preoperatively to 84.6 at 12 months (p < 0.001), with 22 patients achieving good-to-excellent outcomes. Radiologically, 24 hips remained stable or improved, while 6 progressed. Postoperative complications were minimal: mild pain in 8 patients, early femoral head collapse in 2, and no femoral neck fractures. Conclusion: Core decompression alone is a safe and effective treatment for early-stage avascular necrosis of the femoral head, providing significant functional improvement and radiological stability.
Artificial Intelligence in Medical Science: Navigating Promise and Peril – an editorial
The accelerating integration of artificial intelligence (AI) into medical science marks a pivotal moment for global health systems. Once considered a speculative tool, AI is rapidly becoming an essential component of diagnostics, therapeutics, and health-care delivery. Yet its future role will be defined not by technological capability alone, but by our collective willingness to govern it responsibly, equitably, and transparently. In diagnosis, AI has demonstrated clear value. Deep-learning models can detect abnormalities in radiology and digital pathology with a consistency that often narrows inter-observer variation. Early evidence from prospective studies suggests that AI-assisted reporting can reduce time to diagnosis and support overburdened clinical services without compromising safety...
Temporal Onset and Duration of Pulmonary Haemorrhage – Impact on Survival Outcomes in Neonates
Introduction: Pulmonary haemorrhage is a catastrophic neonatal condition associated with extremely high mortality. The timing of onset and duration of bleeding play crucial roles in determining outcomes. The present study aimed to evaluate the impact of temporal onset and duration of pulmonary haemorrhage on survival outcomes in neonates. Methods & Materials: This prospective cohort study was conducted at Bangladesh Shishu Hospital & Institute, Dhaka, from July 2019 to June 2021. Seventy neonates (gestational age 28–42 weeks) who developed pulmonary haemorrhage during hospitalisation were enrolled. Demographic, clinical, and temporal data were recorded. Survival outcomes were compared between survivors (n=8) and non-survivors (n=62) using the unpaired Student’s t-test and Fisher’s Exact test. Statistical analysis was performed using SPSS version 22.0. Results: Mortality was 88.5%. Survivors had significantly earlier onset of haemorrhage (3.00 ± 1.69 days) compared with non-survivors (8.12 ± 7.07 days; p=0.046). Similarly, onset during hospitalisation was earlier (3.37 ± 1.18 days vs. 6.64 ± 3.44 days; p=0.007), and duration was markedly shorter in survivors (4.50 ± 0.53 h vs. 9.48 ± 0.56 h; p=0.001). Clinical appearance differed significantly (p=0.044), with dyspneic presentations dominating among survivors, whereas lethargy predominated in deaths. Conclusion: Temporal variables—particularly early onset and shorter duration—are strong survival predictors in neonatal pulmonary haemorrhage. Prompt recognition and early hemostatic intervention within the first few hours are crucial for improving prognosis and guiding clinical management.
Prevalence and Patterns of Migraine among Adults Attending Tertiary Hospitals in Bangladesh
Introduction: Migraine is a disabling, recurrent primary headache disorder characterized by moderate-to-severe recurrent head pain associated with nausea, photophobia, and phonophobia. The research aims to quantify the prevalence and pattern of migraine among adults presenting at Bangladeshi tertiary hospitals. Methods & Materials: This was a cross-sectional observational study conducted among 58 adult patients who were seen in the Neurology Outpatient Departments of Neurology, Gopalganj Medical College, Gopalganj, Bangladesh between January 2024 and December 2024. Adults aged 18 years or more who met the ICHD-3 criteria for migraine and were willing to participate were included. Data were analyzed using SPSS version 26.0. Result: The female sex (74.1%) and age 26–35 years (41.3%) were predominant among the 58 patients. Migraine without aura was most frequent (72.4%), with 4–9 attacks per month and 4–12 hours' duration being most common. The most frequent precipitating factors were stress (69.0%), disturbance of sleep (65.5%), and exposure to noise (50.0%). Most frequent associated symptoms were nausea/vomiting (72.4%), photophobia (69.0%), and phonophobia (65.5%). Conclusion: This study establishes migraine as a prevalent neurological disorder in adults who are presenting to tertiary centres in Bangladesh, with extreme female predominance and highest prevalence in the age group of 26–35 years. Migraine without aura was present in most cases, and precipitating factors were stress, inadequate sleep, and sound exposure. In most patients, attacks lasted 4–12 hours, and were accompanied by nausea, photophobia, and phonophobia.
Burden of Chronic Suppurative Otitis Media and Hearing Loss among Primary and Secondary School Children – A Cross-Sectional Study
Introduction: Chronic suppurative otitis media (CSOM) is a chronic inflammation of the middle ear with perforation of the tympanic membrane and frequent or continuous discharge from the ear, typically resulting in hearing loss. The aim of this study is to ascertain the burden of hearing loss and chronic suppurative otitis media in children in primary and secondary schools. Methods & Materials: It was a cross-sectional survey conducted between January 2024 to December 2024 in 76 children who were 6-16 years of age, studying in primary and secondary schools, in North Bengal Medical College & Hospital to assess the burden of chronic suppurative otitis media (CSOM) and hearing loss following it. Data analysis was performed using SPSS version 26.0. Result: In the current study of 76 school children with a mean age of 10.8 ± 2.9 years, 35.5% of them had chronic suppurative otitis media (CSOM) with a majority being unilateral (81.5%) and tubotympanic type (77.8%). Duration of discharge from the ear was 2.4 ± 1.1 years. In 92.6% of the infected children, impaired hearing was described primarily as mild to moderate conductive impairment (85.2%), averaging 38.4 ± 9.2 dB in hearing threshold, indicating heavy disease burden and accompanying auditory deficit in this subgroup. Conclusion: This study sets a colossal burden of chronic suppurative otitis media (CSOM) and associated hearing loss in primary and secondary school children with a prevalence rate of 35.5% and hearing impairment observed in 92.6% of the cases.
Pleural Fluid Cytology and Biochemical Profiles in Pediatric Pleural Effusion
Introduction: Pleural effusion, the accumulation of excess fluid in the pleural cavity, is a common cause of respiratory morbidity in children and can result from a variety of infectious and non-infectious conditions. In the pediatric population, parapneumonic effusion and tuberculous pleural effusion are among the most frequently encountered causes, each with distinct cytological and biochemical profiles. This study aims to evaluate the pleural fluid cytology and biochemical parameters in children with pleural effusion. Methods & Materials: This cross-sectional study was conducted at the Department of Pediatric Respiratory Medicine, Bangladesh Shishu Hospital and Institute, Dhaka, from July 2019 to January 2022. A total of 58 children from 1 to 18 years of age admitted with pleural effusion were selected as study subjects. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 26.0. Result: Among the 47 study patients, parapneumonic effusion (63.8%) was the most common cause of pleural effusion, followed by tuberculous pleural effusion (36.2%). Pleural fluid analysis showed that TPE cases had significantly lower total cell counts and polymorph percentages, but higher lymphocyte percentages compared to non-TPE cases (P <0.001). Glucose levels were also significantly lower in TPE (P <0.001), while protein and LDH levels did not differ significantly between the groups. Conclusion: Analysis of pleural fluid cytology and biochemical profiles in pediatric pleural effusion revealed that tuberculous pleural effusion is characterized by significantly higher lymphocyte percentages and lower polymorphonuclear cell counts, along with reduced glucose levels and lower total cell counts, compared to non-tuberculous effusions.
Distinguishing Suicidal Hanging from Homicidal Ligature Strangulation – A Diagnostic Accuracy Study of Autopsy and Scene Findings
Introduction: Differentiating suicidal hanging from homicidal strangulation remains a critical challenge in forensic pathology due to overlapping scene findings, ligature patterns, and internal neck injuries. Accurate classification is essential for justice, mortality reporting, and public health surveillance. This study aimed to evaluate the diagnostic accuracy of autopsy, internal neck injury, and scene findings in distinguishing suicidal hanging from homicidal strangulation. Methods & Materials: This observational, cross-sectional autopsy-based forensic study analyzed 120 cases (95 suicidal and 25 homicidal) after excluding incomplete or decomposed cases. The study was conducted at the Department of Forensic Medicine at Dhaka Medical College from January 2022 to July 2022. The manner of death was determined through combined scene evidence, police inquest, and autopsy consensus. Data were collected using a structured pro forma, and statistical analysis was performed using SPSS (version 26.0). Results: Suicidal hangings were marked by oblique, non-continuous ligature marks above the thyroid cartilage, parchmentization, and no defense injuries, while homicidal cases showed horizontal marks, fractures, and signs of struggle. Sedatives were found only in homicides. The predictive model accurately distinguished suicides from homicides (AUC = 0.97, sensitivity = 97%, specificity = 92%). Conclusion: Careful assessment of the scene and autopsy findings can effectively differentiate suicidal hangings from homicidal strangulations. Oblique, non-continuous ligature marks above the thyroid cartilage and absence of defense injuries indicate suicide, while horizontal marks, internal trauma, and struggle signs suggest homicide.
Pregnancy Outcome in Women with and without Diabetes Mellitus – A Comparative Study
Background: Diabetes during pregnancy, both gestational and pre-existing, is an increasing concern in South Asia, linked to higher risks of preeclampsia, cesarean delivery, macrosomia, and neonatal hypoglycemia. This study compared maternal and neonatal outcomes between diabetic and non-diabetic pregnancies in a tertiary hospital. Methods & Materials: This comparative cross-sectional study was carried out in the Department of Gynecology and Obstetrics, Gazi Medical College Hospital, Khulna, Bangladesh, from January to December 2024. A total of 320 pregnant women (160 with diabetes and 160 without) were enrolled to compare maternal and neonatal outcomes. Participants were ≥28 weeks gestation with singleton pregnancies. Data on demographics, antenatal complications, delivery, and neonatal outcomes were collected using a structured questionnaire. Gestational diabetes was diagnosed per IADPSG/WHO 2013 criteria, and analyses were performed using SPSS v26.0. Results: Among 320 pregnant women, most diabetics had gestational diabetes diagnosed at 26 weeks, with 70% achieving good glycemic control. Diabetic mothers showed higher rates of polyhydramnios, caesarean delivery, macrosomia, and shoulder dystocia. Their infants had greater birthweight, more hypoglycaemia, NICU admissions, and longer hospital stays. Adverse maternal (21.3% vs. 11.3%) and neonatal (36.3% vs. 21.3%) outcomes were significantly higher in diabetics. Diabetes, maternal age ≥35 years, and hypertension independently predicted poor outcomes. Conclusion: This study found that diabetes during pregnancy, whether gestational or pre-existing, significantly increases the risk of adverse maternal and neonatal outcomes, including hypertension, cesarean delivery, macrosomia, and neonatal hypoglycemia. Even with reasonable glycemic control, complications remained more common among diabetic mothers than non-diabetic ones.