Prime Medical College

Background Breast cancer remains a major public health concern in low- and middle-income countries (LMIC's), including Bangladesh, where delayed healthcare-seeking contributes to late-stage diagnosis and poor outcomes. This study aimed to identify factors associated with delay in seeking medical care among breast cancer patients in Bangladesh. Methods A cross-sectional study was conducted at the Department of Radiotherapy, Rangpur Medical College Hospital, Bangladesh, from January to December 2024. A total of 206 newly diagnosed breast cancer patients aged ≥ 18 years were included. Data were collected using an interviewer-administered structured questionnaire covering socio-demographic characteristics, clinical features, presenting symptoms, healthcare-seeking behavior, and perceived causes of delay. Data were analyzed using IBM SPSS Statistics version 27. Descriptive statistics, Pearson's chi-square test, and binary logistic regression were performed. Crude odds ratios (CORs) and adjusted odds ratios (AORs) with 95% confidence intervals were reported. Results The mean age of participants was 46 ± 11.0 years, and most patients were female (202, 98.0%). A breast lump was the presenting symptom in all patients. A large proportion of patients presented with advanced-stage disease, particularly Stage III (42.2%) and Stage IV (18.0%). Delay in seeking medical care was observed in 123 patients. The most common reported cause of delay was the use of traditional treatment/homeopathy (77.2%), followed by misinterpretation of symptoms as non-serious (24.4%). Cancer stage was significantly associated with delay in seeking medical care (p < 0.001). In the adjusted analysis, Stage IV disease was significantly associated with higher odds of delay [AOR = 10.8, 95% confidence interval (CI): 1.28-119, p = 0.039]. The strongest predictor of delay was first consultation with a homeopathy practitioner (AOR = 51.7, 95% CI: 19.7-163, p < 0.001). Socio-demographic factors, including age, residence, education, income, occupation, and smokeless tobacco use, were not significantly associated with delay. Conclusion Delay in seeking medical care among breast cancer patients in Bangladesh was mainly associated with initial consultation with homeopathy practitioners and advanced cancer stage, rather than socio-demographic factors. Strengthening public awareness, promoting early symptom recognition, improving referral pathways, and discouraging reliance on non-formal care pathways may help reduce delays in breast cancer diagnosis and treatment.

Background: Conventional screening methods for cervical cancer, such as visual inspection with acetic acid (VIA), have limited specificity. The Swede score, a structured colposcopic scoring system, may improve detection and triage of cervical intraepithelial neoplasia (CIN) in VIA-positive women. Methods: This cross-sectional study was conducted in the Department of Obstetrics and Gynecology at a tertiary-level hospital in Bangladesh from October 2023 to July 2024. A total of 60 VIA-positive women meeting the selection criteria were consecutively enrolled after providing informed consent. Socio-demographic information and detailed medical history were recorded. All participants underwent colposcopic assessment using the Swede score, followed by colposcopy-guided biopsy. Data were analyzed using Stata (version 17). Results: The mean age was 41.7 ± 8.1 years, with 41.7% aged 40–49 and 48.3% having below-secondary education. Chronic cervicitis was found in 50%, while 30% had CIN1 and 18.3% had CIN2+. The mean Swede score was 5.3 ± 2.0. Notably, 96.6% of women with abnormal histopathology had Swede scores of 5–10, while 61.3% of those with normal histology scored 0–4. A Swede score cut-off of 6 demonstrated high sensitivity (82.8%) and specificity (96.8%) for CIN1+ (PPV 96.0%, NPV 85.7%). For CIN2+, a cut-off of 7 achieved perfect sensitivity (100%) and high specificity (85.7%), with an NPV of 100%. Multivariate analysis showed that each unit increase in Swede score increased the risk of CIN by 39-fold (AOR: 39.14, 95% CI: 2.33–658.33). Conclusion: The Swede score is a reliable tool for detecting CIN among VIA-positive women, supporting its use for targeted biopsies and “see-and-treat” strategies in low-resource settings.

Introduction: Medical expulsive therapy (MET) is one of the treatment modality for ureteric calculi. Recent studies have reported excellent results with MET for lower ureteral calculi. The aim of study to evaluate the effect of tamsulosin on treatment of lower ureteric calculi. Materials and Methods: A prospective study was conducted at outpatient department of Urology, Prime Medical College Hospital, Rangpur, Bangladesh during February 2018 to February 2019. A total of 100 patients with lower ureteric calculi included in this study. Cases were selected by inclusion and exclusion criteria and randomly allocated in two groups. Tamsulosin group (50 patients) were given capsule tamsulosin 0.4 mg, at bed time while observation group (50 patients) were given standard therapy without tamsulosin. The patients were prescribed diclofenac (50 mg) on demand for pain relief and were followed-up by X ray and ultrasonography of kidney, ureter and urinary bladder region for 28 days. The stone expulsion rate, expulsion time, and analgesic requirements were also recorded. Data were analyzed and compared by statistical tests. Results: Tamsulosin group showed a statistically significant advantage in terms of the stone expulsion rate. A stone expulsion rate of 78% (39 out of 50 patients) in tamsulosin group and 54% (27 out of 50 patients) was observed for observation group (p=0.011). In tamsulosin group, mean expulsion time was 7.26 ±3.35 days whereas in observation group mean expulsion time of 8.93 ±3.56 days (p=0.017). Tamsulosin group stone expulsion time was lower as compared to observation group. Overall the number of doses of analgesic (diclofenac) required in tamsulosin group, it was 3.78 ± 2.82 whereas in observation group was observed to be 5.93± 1.76. The variation between number of doses of analgesic required by patients in both groups was found to statistically significant (p=0.001). Conclusions: The effectiveness of tamsulosin as a medical expulsive therapy in patients with lower ureteric calculi was higher as compared to observation group. Tamsulosin has been found to increase stone expulsion rates, reduces mean days to stone expulsion and decreases number of doses of analgesic requirement. Bangladesh Journal of Urology, Vol. 22, No. 2, July 2019 p.155-159

Objectives: To compare the outcomes of Percutaneous Nephrolithotomy (PCNL) with or without nephrostomy tube. Materials & Methods: This prospective comparative study intended to compare the outcomes between PCNL without nephrostomy tube and PCNL with nephrostomy tube. A total of 50 cases of renal stone disease planned for PCNL in Dhaka Medical College Hospital from July 2015 to June 2017, were included in this study according to the statistical calculation. Cases were randomly allocated to group A (PCNL without nephrostomy tube) and group B (PCNL with nephrostomy tube). Each group consisted of 25 patients. The outcome variables were post operative pain, requirement of analgesic, leakage of urine and post operative hospital stay. Data were analyzed and compared by statistical tests. Results: No significant differences were found regarding age (p = 0.95), sex (p = 0.55) and operation time (p = 0.36) between two groups. Post operative pain (p p p p < 0.0001). Conclusions: Percutaneous nephrolithotomy without nephrostomy tube is better than percutaneous nephrolithotomy with nephrostomy tube in selective cases. It significantly reduces post operativepain, analgesic requirement and postoperative hospital stay. So percutaneous nephrolithotomy without nephrostomy tube is safe and effective.

Ovarian luteinized follicular cyst is a relatively uncommon benign condition characterized by bilateral or solitary ovarian enlargement during pregnancy. A large luteinized follicular cyst can rupture or twist during pregnancy. Few cases of this clinical condition have been reported in literature. A large (12.5 × 9 cm) cyst and a live fetus of 8 weeks were detected on ultrasound scan of a 28 year old lady who had lower abdominal pain was the subject of this case report. The cyst was growing rapidly. Laparotomic excision of the cyst, and dilation and curettage was performed. Macroscopically the cyst was 15 cm in length with smooth regular outer and inner wall. Microscopic examination revealed a large luteinized follicular cyst of pregnancy. A rapidly enlarging ovarian mass in pregnancy poses significant diagnostic problems. Large luteinized cysts of pregnancy are thought to involve stimulation by human chorionic gonadotropin (hCG), or increased tissue sensitivity to hCG. A literature search identified eight previous cases that had been detected prenatally. In summary, large luteinized cysts of pregnancy are an uncommon type of cystic mass particular to pregnancy, characterized by the combination of a benign appearance and a tendency to enlarge rapidly, eventually becoming symptomatic and most often necessitating surgery.Mediscope Vol. 5, No. 1: Jan 2018, Page 38-41