Army Medical College

The objective of this audit is to evaluate adherence to AAO-HNS guidelines in management of age-related hearing loss (ARHL) by ENT doctors in a tertiary care hospital. Moreover, this audit aims to implement an educational intervention to address identified gap, if any and reassess adherence post-intervention to evaluate improvement. A pre- and post-intervention audit was conducted over a span of one and a half months at a tertiary care facility to assess the management of ARHL by ENT specialists. Phase 1 involved 51 participants, followed by Phase 2 with 53 participants after the implementation of an educational intervention, which focused on the AAO-HNS Clinical Practice Guidelines for ARHL 2024. The study included patients aged ≥ 50 years presenting with ENT-related presenting complaints, excluding individuals with mental health disorders or those currently undergoing auditory rehabilitation. Data collection was done through REDCap server database, which included patient demographics, presenting complaints, and physicians’ adherence to a checklist of Key Action Statements (KAS) 1–11 outlined in AAO-HNS guidelines. Statistical analysis was performed using IBM SPSS v26. The percentage distributions and frequency counts indicated that pre-intervention practices of physicians didn’t consistently adhere to the guidelines established in the audit standards. Significant improvement in the overall adherence to the clinical practice guidelines after the intervention was found (p value < 0.001). Moreover, the physicians’ clinical adherence in relation to patients’ presenting complaints displayed variability in both the pre- and post-intervention assessments. Patients aged ≥ 50 years should be routinely screened for ARHL and enrolled in structured care pathways for early detection and management. Adherence to standardized clinical practice guidelines ensures patient safety, optimizes hearing outcomes, and reduces the burden of untreated hearing loss. Future audits should assess the long-term sustainability of guideline adherence and the impact of educational interventions on clinical practice.

Background: Psoriasis is a chronic immune-mediated inflammatory skin disease increasingly recognized as a systemic disorder associated with metabolic and cardiovascular comorbidities. Dyslipidemia may contribute to the increased cardiovascular risk observed among patients with psoriasis. This study aimed to evaluate the lipid profile among patients with psoriasis and compare lipid parameters with healthy individuals. Methods: This cross-sectional analytical study was conducted among 30 patients with psoriasis and 30 age- and sex-matched healthy individuals in a tertiary care hospital in Bangladesh. Demographic and clinical characteristics were recorded, and psoriasis severity was assessed clinically. Serum total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were measured and compared between the two groups. Associations between lipid parameters and psoriasis severity were also evaluated. Results: The mean age was 36.7±15.3 years among psoriasis patients and 39.53±15.62 years among healthy participants (p=0.737). Mean BMI was also comparable between the groups (22.8±2.11 vs. 22.0±2.0 kg/m²; p=0.126). Psoriasis patients had significantly higher TC mean rank (39.18 vs. 21.82; p<0.01) and LDL-C mean rank (40.37 vs. 20.63; p<0.01) than healthy participants. Mean TG was significantly higher among psoriasis patients than healthy participants (160.88±79.03 vs. 111.0±41.64 mg/dL; p<0.01), whereas HDL-C was significantly lower (30.86±9.52 vs. 43.53±8.08 mg/dL; p<0.01). An altered lipid profile was observed in 100% of psoriasis patients compared with 56.7% of healthy participants (p<0.01). Among psoriasis patients, 70% had mild-to-moderate and 30% had severe disease. Elevated TG was significantly associated with severe psoriasis (88.9% vs. 42.9%; p=0.02). Conclusion: Patients with psoriasis demonstrated significant adverse lipid-profile changes despite having normal BMI. Hypertriglyceridemia was significantly associated with greater disease severity. Routine lipid-profile assessment may therefore be valuable for cardiovascular risk evaluation in patients with psoriasis.

Background: Hypothyroidism is the most common thyroid problem in Bangladesh and worldwide. Autoimmune thyroid disease is the most common cause of hypothyroidism. Levothyroxine (LT4) dose requirements vary among patients and may be influenced by thyroid autoantibody status and metabolic comorbidities such as type 2 diabetes mellitus (T2DM) to achieve euthyroidism. Objective: To assess the relationship between thyroid autoantibody status and levothyroxine dose requirements in hypothyroid patients with or without T2DM. Methods: This cross-sectional study was conducted at the Department of Biochemistry, BIRDEM General Hospital, from July 2024 to June 2025 on 100 patients with hypothyroidism recruited from outpatient department of endocrinology, BIRDEM, Dhaka, and divided into two groups: Group 1 (Hypothyroid patients with T2DM, n=50) and Group 2 (Hypothyroid patients without T2DM, n=50). Data on demographic, physical, biochemical variables and dose of levothyroxine were collected. Thyroid peroxidase (TPO) antibody, thyroglobulin (Tg) antibody, TSH and HbA1c were measured. Statistical analysis was performed using SPSS version 29.0. Results: Among 100 patients with hypothyroidism, mean age was 49.66±11.19 years in Group 1 and 45.84±14.4 years in Group 2. TPO antibody positivity was significantly lower in hypothyroid patients with T2DM (36%) compared to those without T2DM (66%) (p=0.003).The mean levothyroxine dose was substantially higher among anti-TPO positive patients than anti-TPO negative patients (67.6±28.0 μg vs. 40.6±17.8 μg, p<0.001), with a similar pattern observed for anti-Tg positivity (74.1±32.3 μg vs. 46.7±20.3 μg, p<0.001). Conclusion: Thyroid autoantibody positivity is strongly associated with higher levothyroxine dose requirements in hypothyroid patients, irrespective of diabetes status. Recognition of thyroid autoimmunity is essential for individualized dose optimization. J Rang Med Col.2026 Mar;11(1):177-182

Background: Thermal injuries to the skin cause intense inflammation and delayed healing, leading to considerable challenges in the field of advanced wound healing. Stem cell-derived extracellular vesicles (EVs) have strong paracrine capacities to guide cell behaviour throughout wound healing in the cutis. Hypothesis: Exosomes enriched-hydrogels can repair tissue, reduce systemic inflammation and promote re-epithelialization in partial thickness thermal burn wounds when compared to the use of standard hydrogel therapy. Methods: This double blind, parallel group randomized controlled trial involved 60 patients suffering from acute partial thickness thermal burn in 6 months study in central Punjab. The participants were randomly assigned (1:1) to either the exosome-enriched hydrogel dressing (n=30) or the identical hydrogel dressing (n=30) applied at intervals of 48 hours for 4 weeks. The percent of total epithelialization at week 4 was a primary outcome. Secondary outcomes were: Visual Analog Scale (VAS) pain score, serum C-reactive protein (CRP) level, and Vancouver Scar Scale score. A total of 55 subjects were included in the final analysis (28 intervention, 27 control). Results: At 4 weeks, the intervention group demonstrated a significantly higher mean complete epithelialization rate compared to controls (91.2\% \pm 5.8\% vs. 71.8\% \pm 7.3\%; mean difference: 19.4\%, 95\% CI: 14.2\% to 24.6\%; p < 0.001). There was a significant time \times group interaction for wound closure as indicated by repeated-measures ANOVA (F(1, 53) = 112.45, p < 0.001). Patients treated with exosome hydrogels experienced significantly greater reductions in VAS pain scores (1.8 \pm 0.7 vs. 3.9 \pm 0.9; p < 0.001), lower serum CRP levels (6.2 \pm 1.8\text{ mg/L} vs. 14.5 \pm 3.1\text{ mg/L}; p < 0.001), and lower scar scale ratings (2.4 \pm 0.8 vs. 4.8 \pm 1.1; p < 0.001). In conclusion, exosome-enriched hydrogel dressings can efficiently promote re-epithelialization and minimize early inflammation and tissue scarring in PTBI, and this cell-free regenerative strategy is very promising