The aging population is a worldwide issue. The global population is aging. Due to the swiftly aging populace, geriatric medicine is an essential and growing sector with significant potential in Bangladesh. The main perspectives emphasize major shortcomings of the existing healthcare system, along with increasing acknowledgment and legislative efforts to address the specific needs of older adults. Geriatricians can significantly influence the shift in elder care towards a unified, individual-centered approach that emphasizes age-friendly services, preventive strategies, and functional abilities. A reliable, competency-based definition of a geriatrician needs to be established to effectively evaluate the existing workforce with the essential geriatric expertise to facilitate the paradigm shift. Geriatric medicine in Bangladesh is an essential and swiftly expanding area with significant possibilities because of the nation's aging demographic. The main perspectives underscore major difficulties in the existing healthcare system, along with increased focus and government initiatives to address the specific requirements of the elderly. Geriatricians can significantly contribute to redirecting the care of older individuals toward a cohesive and person-focused approach that emphasizes functional ability, preventive measures, and services tailored to their age. The present circumstances require initiatives to establish a coherent competency-focused outline of a geriatrician to effectively evaluate the current workforce, where adequate geriatric training acts as essential resources to support the transformation. This review aims to address challenges in implementing geriatric care in Bangladesh. Bangladesh Medical Res Counc Bull 2026;52(1): 63-70
Background: Axial spondyloarthritis (axSpA) is often resistant to first-line non-steroidal anti-inflammatory drugs (NSAIDs), necessitating the use of advanced therapies. Janus kinase (JAK) inhibitors have become highly effective oral alternatives to biological agents. In resource-limited settings like Bangladesh, the availability of lower-cost tofacitinib provides a crucial therapeutic option, reducing financial and accessibility barriers associated with biologics. Effective patient management in these contexts requires tailored dosing strategies to carefully balance efficacy, safety, and affordability. Objective: To assess the therapeutic efficacy and safety of tofacitinib in patients with NSAID-refractory axSpA, with a particular focus on the outcomes of a dose-escalation strategy for patients showing an inadequate response to standard dosing. Methods: This prospective clinical trial (NCT03738956) enrolled 52 patients with NSAID-refractory axSpA. All participants initially received tofacitinib 5 mg twice daily (Phase A, months 0–3). At the end of month 3, treatment response was evaluated: patients achieving a clinically important improvement in ASDAS-CRP (“ASDAS-CRP e” 1.1) were maintained on 5 mg twice daily for the remainder of the study (Phase B, months 3–6). For those who failed to achieve this threshold, the tofacitinib dose was escalated to 10 mg twice daily. The primary efficacy endpoint was the ASAS20 response rate. Secondary assessments, conducted at baseline, 1, 3, and 6 months, included ASAS40/70, BASDAI, BASFI, ASDAS, MASES, CRP, ESR, spinal pain, and fatigue. Adverse events (AEs) and serious adverse events (SAEs) were actively monitored. Statistical significance was determined using two-sided tests, with p < 0.05 considered significant. Results: In this study, 52 patients (mean age 32.9 years, 78.8% male) were included. Tofacitinib demonstrated rapid and sustained efficacy; by month 3, overall ASAS20, ASAS40, and ASAS70 response rates were 73.1%, 65.4%, and 30.8%, respectively. Patients maintained on 5 mg twice daily (n=42) showed continued significant improvement at month 6 (ASAS20: 95.2%; ASAS40: 88.1%; ASAS70: 50.0%; all p<0.05). Ten patients (19.2%) with inadequate response at month 3 underwent dose escalation to 10 mg twice daily, achieving modest subsequent improvements by month 6 (ASAS20: 30%; ASAS40: 30%; ASAS70: 20%). All composite disease measures (including BASDAI, BASFI, and ASDAS-CRP) improved significantly from baseline (p<0.05). Adverse events occurred in 63.5% of patients, with serious adverse events, including herpes zoster and tuberculosis, reported in 13.5%. Conclusions: Standard dosing of tofacitinib showed rapid response, high efficacy, and sustained disease control in NSAID-refractory axial spondyloarthritis. Those with a poor response to the standard dose may benefit from dose escalation, but caution is required as serious adverse events are relatively common. Clinicians should prioritise vigilant safety monitoring and carefully weigh the risks and benefits before increasing the dose in non-responders. Bangladesh Medical Res Counc Bull 2026;52(1): 4-12
The practice of Clinical Medicine is a dynamically evolving paradigm. In its earliest era, medicine was intuitive – doctors relied on “experience” and heuristic assessment of signs and symptoms rather than scientific evidence.1 Since the late 20th century, this has rightly been replaced by evidence-based medicine (EBM), with clinical trials and meta-analyses considered the height of empirical evidence. EBM has undoubtedly transformed population-level patient outcomes by fostering “best medical practices” supported by systematic medical research. Nonetheless, this system has an inherent limitation evidence-based guidelines are formulated from mean results from a relatively homogeneous trial population, with the deliberate exclusion of heterogeneous characteristics.2 Consequently, at the individual level in real-world settings, this often leads to heterogeneous outcomes such as poor responses or adverse events. This is due to inter-individual variation in genetics, lifestyle, environmental exposures, comorbidities or drug interactions.3 It has become increasingly evident that treatment should be personalized, i.e.,it should target the patient with the disease, rather than the disease in the patient. Bangladesh Medical Res Counc Bull 2026;52(1): 1-3
Background: Solitary subungual neurofibroma is an exceptionally rare benign tumor of the nerve sheath that most commonly presents as a slow-growing, painless subungual nodule. Owing to its uncommon location and nonspecific presentation, it is frequently misdiagnosed as a fungal or inflammatory nail disorder. With fewer than ten cases have been documented globally, making awareness and ensuring accurate diagnosis are essential. Case presentation: We report a case of a 47-year-old Bangladeshi male with a three-year history of a painless, progressively enlarging nodule beneath the nail of his right great toe. Clinical evaluation revealed nail deformity (onychodystrophy), lifting of the nail plate, and a firm mass beneath the nail, with no evidence of neurofibromatosis or any underlying systemic illness. Imaging and ultrasonography revealed a hypoechoic mass, and surgical excision under local anesthesia was performed. Histopathological analysis revealed a benign, unencapsulated spindle cell neoplasm with a shredded carrot collagenous appearance containing mast cells. Postoperative recovery was uneventful, with no recurrence after one year. Conclusion: This case highlights the diagnostic challenges posed by solitary subungual neurofibromas because of their rarity and nonspecific presentation. Early recognition, histopathological confirmation, and complete surgical excision are key to favorable outcomes. Clinicians should keep neurofibroma in mind as a possible diagnosis for nail bed tumors, particularly when imaging results are unclear. Bangladesh Medical Res Counc Bull 2026;52(1): 71-75
Background: Acinetobacter species, particularly Acinetobacter baumannii, are among the most prevalent Gram negative pathogens responsible for hospital-acquired infections worldwide. These infections are widespread in Intensive Care Units (ICUs) and burn wards. Due to the organism’s ability to survive on surfaces for extended periods; its eradication from healthcare environments remains a significant challenge. In recent years, the alarming rise in antibiotic resistance among A. baumannii strains has become a major global health concern. Objectives: To explore the burden and antimicrobial resistance patterns of Multidrug-resistant (MDR) Acinetobacter baumannii isolates among burn patients admitted to a tertiary care burn hospital in Dhaka city. Method: This cross-sectional study was carried out on 200 samples over six months in the Department of Microbiology at the National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh. Wound swab specimens were obtained from burn patients from the Intensive Care Unit (ICU) and High Dependency Unit (HDU) and general burn wards. Acinetobacter baumannii isolates were identified by conventional culture and biochemical methods. Antimicrobial susceptibility was done using the conventional disc diffusion method as well as the VITEK® 2 automated system due to the high burden of MDR organisms. Antimicrobial susceptibility testing was conducted in accordance with the Clinical and Laboratory Standards Institute (CLSI) guidelines-2025. Tigecycline was used, as most of the isolates were MDR pathogens. Based on predefined criteria, the isolates were categorized as MDR organisms. Results: A total of 200 Acinetobacter spp. isolates were analyzed. The majority of patients were aged under 20 and the mean age was 23.3 ± 21.1 years, with a male-to-female ratio of 1.1:1. Overall, 98.5% of the isolates were classified as MDR, whereas only 1.5% were non-MDR. Resistance to cephalosporins and fluoroquinolones was markedly high. Carbapenem resistance to meropenem and imipenem was also high. Similarly, high resistance rates were observed for aminoglycosides, including gentamicin and amikacin. Relatively better susceptibility was noted for minocycline, tigecycline, colistin, and cefoperazone-sulbactam. The majority of susceptible isolates were MDR. Universal resistance to co-trimoxazole was observed. Overall, the findings demonstrate a high burden of multidrug resistance among Acinetobacter spp., with limited therapeutic options remaining effective. Conclusion: The study reveals a high burden of MDR Acinetobacter spp. in burn patients, with limited sensitivity to most antibiotics. The findings highlight the urgent need for antimicrobial stewardship and strict infection control in burn units. Bangladesh Medical Res Counc Bull 2026;52(1): 13-22
Background: Methotrexate (MTX) is the corner stone in management of rheumatoid arthritis (RA), but its limited use as oral formulation is frequently due to gastrointestinal intolerance, variable absorption and bioavailability. Subcutaneous (SC) MTX may offer better efficacy and tolerability. Objective: To compare the efficacy and safety of subcutaneous (SC) injection versus oral methotrexate (MTX) in patients suffering from active rheumatoid arthritis (RA). Methods: This open labeled randomized clinical trial was conducted on 84 patients at the department of rheumatology in Bangladesh medical university (BMU) during the period of January 2013 to October 2014. In phase 1, MTX was given 10 mg orally, weekly and the dose of MTX was increased to 15 mg/week after four weeks. All patients were followed up for 8 weeks from enrollment. In phase 2, patients were randomized in two groups. One group received 20 mg MTX subcutaneously weekly (n=40) and the other group received the same dose of MTX orally (n=44). After another 8 weeks the dose of MTX was increased to 25 mg/week. Final follow up was given at 16 weeks after randomization. ACR20, ACR50 and ACR70 response criteria was used to see the efficacy of MTX. Safety and adverse events were also recorded. Results: At the end of phase 1, ACR 20 response was observed in 20% patients and a significant improvement was noticed across multiple disease activity parameters (p < 0.05) after 8 weeks. After phase 2 follow up(16 weeks), ACR 20 & ACR 50 response were 100% & 45% , respectively in subcutaneous group and 95.5% and 29.5%, respectively, in oral group, difference was statistically significant (P value of 0.172 & 0.143). None of the patient achieved ACR70 response. The measures of disease activity (except swollen joint count) like tender joint counts, pain VAS, patient and physician global scores, HAQ, ESR, and DAS28 were significantly improved in the SC group (p < 0.05). Gastrointestinal upset were more in oral group like nausea occurred in 65% (SC) vs. 87% (oral), anorexia in 45% vs. 73%, and dizziness in 43% vs. 82% (p < 0.01). One patient discontinued oral MTX due to intolerance. Conclusion: Subcutaneous route was safe and effective than oral methotrexate. Subcutaneous MTX may be a preferable option in patients with inadequate response or intolerance to oral MTX in patient with active RA. Bangladesh Medical Res Counc Bull 2026;52(1): 40-49
Background: Urinary tract infection caused by Enterococcus species is of great concern both in community and hospital settings due to their increasing resistance to multiple antimicrobial agents. Nitrofurantoin is an important therapeutic option for urinary tract infection caused by Enterococcus species, whose mechanism of resistance remains to be explored. Objectives: The aim of the study was to evaluate nitrofurantoin resistance mechanism of Enterococcus species by detection of efflux pump genes (emeA, efrA, efrB) and nitroreductase genes (ef0404, ef0648) along with effect of efflux pump inhibitors (verapamil and chlorpromazine) in nitrofurantoin resistant isolates. Methods: Laboratory isolated Enterococcus species were identified from culture of urine specimen in Department of Microbiology and Immunology, BMU. These isolates were subjected to nitrofurantoin susceptibility tests by both broth microdilution technique and automated method (VITEK®2 Compact). Enterococcal efflux pump genes (emeA, efrA and efrB) and nitroreductase genes (ef0404, ef0648) were detected by conventional PCR. Finally, the minimum inhibitory concentrations (MICs) of nitrofurantoin with and without efflux pump inhibitors (verapamil and chlorpromazine) were determined in resistant isolates by broth microdilution method. Results: Among the 53 Enterococcus species isolated from urine, majority were E. faecalis (81.1%). Nitrofurantoin resistant isolates were 13.2% and mostly exhibited by the rarer species. All the nitrofurantoin susceptible enterococci isolates harbored at least one of the nitroreductase genes (ef0404, 80.4% and ef0648, 91.3%) and none of the nitroreductase genes were detected in the nitrofurantoin (NIT) resistant isolates. Among all nitrofurantoin susceptible enterococcal isolates, 65.2% and 34.8% isolates carried emeA and efrAB genes respectively. Less than half (40%) of the resistant isolates harbored efflux pump genes. Effective reduction of MIC of nitrofurantoin among nitrofurantoin resistant enterococci isolates were observed in the combination of nitrofurantoin and chlorpromazine in comparison to nitrofurantoin and verapamil combination. Conclusion: Deletions in the nitroreductases-encoding genes was the main reason for nitrofurantoin resistance in Enterococcus species. The finding of the present study would be helpful in formulating therapeutic options against Enterococcus. Bangladesh Medical Res Counc Bull 2026;52(1): 57-62
Background: Bisphenol A (BPA) is a ubiquitous environmental endocrine-disrupting chemical (EDC) widely found in plastics and food packaging. Growing epidemiological and experimental evidence suggests BPA exposure may contribute to metabolic dysfunction, particularly diabetes mellitus. This study investigated the association between serum BPA levels and diabetes mellitus, examining whether elevated BPA concentrations correlate with increased diabetic risk and altered glycemic parameters. Methods: A cross-sectional study was conducted involving 240 participants (120 individuals with type 2 diabetes mellitus (T2DM) and 120 age- and sex-matched controls). Serum BPA levels were measured using high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). Glycemic parameters, including fasting blood glucose, HbA1c, fasting insulin, and HOMA-IR, were assessed. Multiple logistic regression analysis was performed to evaluate the association between BPA exposure and diabetes prevalence, adjusting for potential confounders including age, sex, body mass index, physical activity, and dietary factors. Results: Median serum BPA levels were significantly higher in diabetic participants compared to controls (3.82 μg/L vs 1.64 μg/L, p<0.001). After adjusting for confounders, participants in the highest BPA quartile demonstrated 3.74-fold increased odds of diabetes (OR 3.74, 95% CI: 1.89-7.42) compared to the lowest quartile. Serum BPA concentrations showed positive correlations with fasting glucose (r=0.48, p<0.001), HbA1c (r=0.51, p<0.001), and HOMA-IR (r=0.44, p<0.001). Dose-response relationships were observed between BPA exposure and markers of insulin resistance. Conclusion: Elevated serum BPA levels are significantly associated with T2DM and impaired glycemic control. These findings support BPA's potential diabetogenic effects and highlight the need for public health interventions to reduce environmental BPA exposure. Further prospective studies are warranted to establish causality and elucidate underlying mechanisms. Bangladesh Medical Res Counc Bull 2026;52(1): 30-39
Background: Ovarian cancer is often diagnosed at an advanced stage, resulting in poor prognosis despite modern management strategies. Estrogen receptor (ER) and progesterone receptor (PR) expression in epithelial ovarian cancer (EOC) may serve as prognostic biomarkers and guide potential hormonal therapy. Objective: To determine the prevalence of ER and PR expression in EOC and to assess their association with clinical and histopathological characteristics. Methods: A cross-sectional observational study was conducted at the National Institute of Cancer Research & Hospital (NICRH), Dhaka, from July 2020 to June 2021. Forty women with histologically confirmed primary EOC were enrolled. Demographic, reproductive, and clinical data were collected. Histological grading and subtyping were performed, and ER/PR expression was assessed using immunohistochemistry. Associations of hormone receptor status with clinical and histopathological features were analyzed using Chi-squared and t-tests, with p < 0.05 considered significant. Results: Among the study population, 30% of tumors were ER positive and 22.5% PR positive. Histologically, 65% were serous, 30% mucinous, and 5% clear cell carcinomas, with 80% being Grade-III. ER overexpression was significantly associated with high-grade tumors (Grade-III, p = 0.038) and marginally associated with advanced stage (Stage III, p = 0.051). PR positivity was significantly associated with serous histology (p = 0.044) and higher clinical stage (Stage III, 55.6%). No significant associations were observed between ER status and reproductive characteristics, whereas PR-positive patients were significantly older than PR-negative counterparts (p = 0.039). Conclusion: ER overexpression in EOC is significantly associated with higher histological grade, while PR overexpression is associated with serous subtype and advanced stage. These findings suggest potential prognostic and therapeutic implications of hormone receptor status in EOC. Further studies with larger cohorts are recommended to confirm their role in guiding endocrine therapy. Bangladesh Medical Res Counc Bull 2026;52(1): 50-56
Background: Hyperlipidemia, a major modifiable risk factor for atherosclerosis and cardiovascular diseases, arises from abnormal lipid levels in the blood. Modern dietary habits, high saturated fats and refined sugars, contribute significantly to secondary hyperlipidemia. Evidence suggests that not only total cholesterol but also its distribution among lipoproteins influences disease risk. Aloe vera has been explored for its potential lipid lowering properties. Objectives: To evaluate the effects of aqueous extract of Aloe vera gel on serum lipid profile in high fatty diet induced hyperlipidemic rats. Methods: This experimental animal study was conducted at the Department of Pharmacology and Therapeutics, Sir Salimullah Medical College (SSMC), Dhaka in collaboration with the Institute of Nutrition and Food Science (INFS) Dhaka University, over a 12-month period following ethical approval. Thirty healthy adult male Long Evans rats were randomly divided into five groups (n=6 each). Group A (standard control) received a normal laboratory diet with distilled water and Group B (hyperlipidemic control) received a high-fat diet. Group C received a high-fat diet for the first two weeks followed by aqueous extract of Aloe vera gel (300 mg/kg body weight, orally) along with a high-fat diet for the another four weeks. Group D received a high-fat diet for two weeks followed by atorvastatin (10 mg/kg body weight, orally) with a high-fat diet for four weeks. Group E received a high-fat diet for two weeks followed by a combination of atorvastatin (10 mg/kg body weight) and Aloe vera gel extract (200 mg/kg body weight) along with a high-fat diet for the another four weeks. After 42 days of intervension, all rats were anesthetized with chloroform on the morning of the 43rd day and following overnight fasting, blood samples were collected by cardiac puncture for estimation of the serum lipid profile. Data were analyzed using one-way ANOVA followed by Bonferroni test using SPSS version 26, with p<0.05 considered stastitically significant. Results: Rats in the high-fat diet group developed significant hyperlipidemia compared to normal control (p<0.001), with elevated serum TC, TG, and LDL-C levels and reduced HDL-C levels. Intervention with Aloe vera gel extract significantly improved the lipid profile (p<0.001), showing marked reductions in TC, TG, and LDL-C and an increase in HDL-C. Atorvastatin produced a similar degree of improvement (p<0.001). The combination of Aloe vera gel extract with Atorvastatin showed the greatest lipid lowering effect, although the difference compared to individual intervension was not statistically significant. Conclusion: Aloe vera gel extract significantly improved the lipid profile in high-fat-diet–induced hyperlipidemic rats. Its effects were comparable to atorvastatin for most parameters, except HDL. Combination therapy showed greater improvement than Aloe vera alone and produced effects comparable to atorvastatin, suggesting that Aloe vera may serve as a potential adjunct therapy for hyperlipidemia. Bangladesh Medical Res Counc Bull 2026;52(1): 23-29
Background: Solitary thyroid nodules are common in general population; most being asymptomatic and detected only through imaging. The main clinical concern is their potential risk of malignancy because thyroid cancer incidence had significantly increased over recent decades. Ultrasonography, the preferred imaging modality provides detailed structural information. In contrast, thyroid scintigraphy categorizes nodules based on functional status. The American College of Radiology has proposed the ultrasound Thyroid Imaging Reporting and Data System (TIRADS) that enhances ultrasound’s ability to stratify malignancy risk, offering a structured approach to management decisions in solitary thyroid nodules. Objective: To compare diagnostic performance of ultrasound TIRADS and thyroid scintigraphy for detection of malignancy in patients with solitary thyroid nodule. Methods: This cross-sectional study was carried out in the Department of Radiology and Imaging at Dhaka Medical College Hospital and the Institute of Nuclear Medicine and Allied Sciences, Dhaka, from March 2023 to February 2025. A total of 74 adult patients with solitary thyroid nodule were included in this study by non probability sampling. In all patients both ultrasound TIRADS and thyroid scintigraphy were done to evaluate the characteristics of the nodule. Patients were operated for nodule and postoperative biopsy was done for histopathology in each patient. Results of both ultrasound TIRADS and thyroid scintigraphic findings were compared with that of histopathology as gold standard to determine their (TIRADS & scintigraphy) diagnostic performance for malignancy detection with respect to sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy. Results: The mean age of the participants was 43.5 ± 11.0 years, with a higher frequency of females (64.9%). Ultrasound TIRADS classified, 36.5% of nodules as malignant (TIRADS 4-5). Thyroid scintigraphy showed 81.1% of nodules as cold (malignant). Histopathological analysis confirmed 20.3% of nodules as malignant. TIRADS demonstrated higher sensitivity (93.3%), specificity (77.97%), PPV (51.85%), NPV (97.87%) and accuracy (81.08%) in detecting malignancy compared to thyroid scintigraphy (sensitivity 66.67%, specificity 15.25%, PPV 16.67%, NPV 64.29% and accuracy 25.68%). Conclusion: This study demonstrates that ultrasound TIRADS is a more reliable imaging modality than thyroid scintigraphy for detection of malignancy in solitary thyroid nodules with significantly higher sensitivity, specificity, PPV, NPV and accuracy. While thyroid scintigraphy remains useful for functional assessment. Its limited specificity (15.25%) makes it ineffective for malignancy detection. Bangladesh Medical Res Counc Bull 2025;51(1):46-52
Background: Higher postoperative morbidity and longer hospital stay are linked to diabetes insipidus (DI) after surgery of sellar or suprasellar tumors. Objective: To find out the predictors of postoperative DI following sellar or suprasellar surgery. Methods: This case-control study was conducted at the National Institute of Neurosciences and Hospital, Dhaka, from January 2023 to June 2023. Patients with sellar or suprasellar tumors admitted to the neurosurgery department for surgery were included by non-probability consecutive sampling (n=109, age 39.4±13.7 years, 44.9% female). All patients were treated surgically by standard protocol. A standard institutional inpatient monitoring system was used in all postoperative patients regardless of symptoms, including hourly intake and output measurements. Participants were followed up regularly during their hospital stay and then after 6 weeks of surgery up to 6 months. Specific criteria were used to confirm the diagnosis of DI for each patient. All clinical and laboratory data were recorded in a data sheet. Finally patients developing DI were grouped as case and rest of them grouped as control. All clinical and laboratory parameters were compared between two groups. Result: Transient DI (resolved within 6 weeks of surgery) was present in 53 (49%) and prolonged DI (persisted >6 weeks of surgery) in 22 (20%) participants. Transient DI were more frequent in participants with 1st postoperative serum sodium level >145 mmol/L (p<0.001). Participants with younger age (p=0.044), non pituitary sellar tumor (p=0.044), preoperative hypothyroidism (p=0.048), gross total removal of tumor (p=0.027) and 1st postoperative serum sodium level >145 mmol/L (p<0.001) had higher frequency of prolonged DI. However, in logistic regression, preoperative hypothyroidism (OR 3.4; 95% CI 1.0-11.6; p=0.048) and 1st post operative serum sodium >145 mmol/l (OR 11.4; 95% CI 2.8-46.4; p<0.001) showed a significant association with prolonged DI when adjusted for age, tumor type, route and extent of resection. Conclusion: First post-operative serum sodium >145 mmol/L is a significant predictor of transient DI; whereas first post-operative serum sodium >145 mmol/L and preoperative hypothyroidism are found to be significant predictor of prolonged DI. Bangladesh Medical Res Counc Bull 2025; 51(1):4-10
Background: Prolonged screen time (time spent on digital devices) among children has become a global concern due to its detrimental effects on their development and behavior. Objective: This study investigated the adverse effects of prolonged screen time in children. Methods: A cross-sectional survey was conducted among 153 parents from Defence Services Command and Staff College, Mirpur Cantonment, Dhaka, Bangladesh; who had at least one child aged 1 to 12 years. Data were collected during August to October 2022 from the parents about their children’s screen time, developmental and behavioral issues by using a self-administered questionnaire. Statistical analysis included descriptive methods and the Chi-square test, with a significance threshold of p-value ≤0.05. Results: The mean age of the participants (parents) was 32.99 ± 3.49 years, majority being women (66%). Female parents and parents who were homemaker or had higher educational background, more likely reported their children to be on excessive screen time. In 56% of cases, no adverse developmental or behavioral issues were observed. Parents identified speech delay (17%), aggressive behavior (13%), poor communication (9%), hyperactivity (7%), screen addiction for feeding (7%), vision problems (4%), inattention to study (4%) and sleep disturbances (3%) as common adverse effects of excess screen time exposure in their children. Aggressive behavior, poor communication, addiction on screens during feeding were found strongly associated with prolonged screen time (≥2 hour per day) use in children. Children of most participants (87%) had access to smartphones, with 52% usage reported for recreational purpose. Conclusion: The growing prevalence of excessive screen use among children in Bangladesh is associated with various developmental problem (speech delay and poor communication) and behavioral changes (aggressive behavior, hyperactivity, screen addiction for feeding, visual & sleep disturbance, inattention to study). Parents should play the pivotal role in managing screen time to mitigate these negative outcomes. Bangladesh Medical Res Counc Bull 2025;51(1):11-17
Background: Endometrial carcinoma is influenced by estrogen and progesterone, with their receptors playing pivotal roles in tumor pathogenesis and therapeutic response. Objective: Hormonal receptor expression is linked to tumor differentiation and response to hormone therapy. This study aimed to evaluate the expression of estrogen receptors (ER), progesterone receptors (PR), and HER2/neu in endometrial carcinoma and their correlations with histological type, grade, and FIGO stage, identifying patients potentially benefiting from hormone therapy. Methods: This cross-sectional study included 31 histologically confirmed cases of endometrial carcinoma. Clinicopathological data were collected, and immunohistochemistry was performed to assess ER, PR, and HER2/neu expression. Statistical tests were used to evaluate associations with tumor characteristics and disease staging. Results: The mean age of patients was 57.87 ± 8.91 years, with 45.2% aged ≥60 years. Postmenopausal bleeding (80.6%) was the most common symptom, and diabetes mellitus (83.9%) and hypertension (48.4%) were frequent comorbidities. Endometrioid adenocarcinoma (58.06%) was the most common subtype, and deep myometrial invasion was observed in 54.8%. ER and PR positivity rates were 51.6% and 48.4%, respectively, with significant co-expression (p < 0.001). Both markers were strongly associated with type I and grade 2 tumors but showed no significant correlation with FIGO stage. HER2/neu expression was rare (3.2%). Conclusion: ER and PR expression were significantly associated with favorable histological types and grades, suggesting their potential as biomarkers for hormone therapy in endometrial carcinoma. Further studies with larger cohorts are recommended to validate these findings. Bangladesh Medical Res Counc Bull 2025;51(1):39-45
Background: Renal stones commonly occur in the lower pole calyx, making treatment challenging due to anatomical factors. The main treatment options for lower calyceal stones are extracorporeal shock wave lithotripsy (ESWL), retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL). ESWL is preferred for stone <1cm, while PCNL is preferred for stone >2cm. However, for 1-2 cm stone with favorable lower pole calyceal anatomy, both treatments are practiced. ESWL is non-invasive with fewer complications but has lower stone clearance requiring multiple sessions. Objective: To evaluate efficacy and safety of PCNL compared to ESWL in treating lower calyceal renal stone of 1-2 cm in favorable lower pole calyceal anatomy. Methods: This was a single center quasi-experimental study on 44 patients, divided into two groups: group A (experimental group) and group B (control group), from January 2023 to August 2024 in the Department of Urology, Bangladesh Medical University (BMU), Shahbag, Dhaka. The unilateral, single, radiopaque, 1-2 cm sized lower calyceal renal stone in favorable lower pole calyx anatomy was included in the study. The computed tomography urogram (CTU) was carried out to assess the favorable infundibular characteristics, stone size, Hounsfield unit and skin to stone distance. Experimental group underwent PCNL and control group, ESWL. Operation duration, post operative complications determined by modified Clavien Dindo, duration of hospital stay and stone clearance were evaluated between the groups. Continuous variables were analyzed by t-test and categorical variables by chi-square test and fisher’s exact test. P-value <0.05 was considered statistically significant. Results: Experimental group (65±13.54 minutes) had shorter operation time compared to control group (70.23±23.73 minutes); but the difference was not statistically significant (p=0.374). Grade-1 complication was more in control group than experimental group. While grade-2 complication was more in experimental group than control group but overall complication rate was identical (p=0.763) between two groups. Duration of hospital stay was significantly shorter (p<0.01) in control group (11.09±3.89 hours) than experimental group (77.45±22.13 hours). Stone clearance was significantly (p=0.012) higher in experimental group (81.1%) than control group (45%). Conclusion: PCNL offers better stone clearance but require longer hospital stay than ESWL with identical operation time and complication rates between them. Bangladesh Medical Res Counc Bull 2025;51(1):18-24
Background: Diabetes mellitus (DM) and its associated complication is getting a big concern day by day around the whole world including Bangladesh. Fasting plasma glucose (FPG),2hour post load plasma glucose (2hPG) and glycated hemoglobin (HbA1C) are commonly used diagnostic tools to diagnose diabetes mellitus (DM) but there is disparity and discordance among these three diagnostic tools in detection of DM. Objective: The aim was to address the issue of concordance and discordance among the three diagnostic tools (FPG, 2hPG,HbA1C) in detection of diabetes mellitus. Method :This cross sectional analytical study was conducted among the individuals attending for screening of diabetes mellitus to outpatient department of endocrinology, Bangladesh Medical University (BMU), Dhaka during the period of March 2019 to February 2020.A total 1165 subjects were recruited by non-probability sampling technique. Individuals were identified as diabetic by positivity of any of the three tools (FPG,2hPG and HbA1C) and individuals were regarded as nondiabetic by negativity of all three tools simultaneously. Frequency of diabetes mellitus detected by these three tools were compared among them to determine their concordance(agreement) or discordance(disagreement) by Kappa test. Data were analyzed using SPSS. Results: This study shows that; out of 1165 study subjects, 339(29%) were diabetic by any tool positivity and 826(71%) were non diabetic by all three tools negativity. The frequency of diabetes was found 15.9% detected by FPG, 21.2% detected by 2hPG and 23.2% detected by HbA1C. Here, 2hPG and HbA1C detected almost similar number of diabetic population but FPG underestimates the diagnosis of DM significantly. In agreement test, all three diagnostic tools showed merely good agreement with the lowest kappa value, which was not satisfactory from clinical point of view. In case of missed diagnosis; FPG alone missed 45.5%, 2hPG 27.0% and HbA1c 20.0% of diabetic patients. The rate of missed diagnosis by HbA1c found to be lowest. Conclusions: DM detection rate was found highest by use of HbA1C and lowest by FPG; on the other hand, FPG showed highest missed diagnosis and HbA1C showed the lowest. No clinically satisfactory agreement (concordance) was found among the three diagnostic tools (FPG,2hPG and HbA1C) for diagnosis of DM. Bangladesh Medical Res Counc Bull 2025;51(1):33-38
Background: Epicardial adipose tissue is the main determinant of interatrial septum thickness (IST) and it is also a true marker of cardiac adiposity. The relationship of interatrial septal thickness as a marker cardiac adiposity with severity of coronary artery disease (CAD) is not thoroughly investigated in our population. Objectives: This study was conducted to evaluate the association of interatrial septal thickness (IST) with severity of coronary artery disease. Methods: This cross-sectional study was conducted in the National Institute of Cardiovascular Disease (NICVD), Dhaka from April 2016 to March 2017. A total of 100 patients with coronary artery disease (CAD) who agreed to undergo coronary angiography were selected by non probability sampling. Interatrial septal thickness (IST) was measured using bidimensional echocardiography. On the basis of IST, study subjects were divided into two groups: 50 patients of CAD with IST ≥14.2 mm were designated as Group I (Thick) and 50 patients of CAD with IST<14.2 mm were designated as Group II (Thin). During angiogram coronary artery disease severity was assessed by Gensini score. Then the collected data were analysed. Categorical variables were analyzed by chi-square test. Quantitative variables were analyzed by unpaired t-test. Correlation between IST and angiographic severity (gensini score) was measured by Spearman’s rank correlation coefficient test. Odds ratio (OR) and logistic regression test were done to identify the factors associate with CAD severity. P<0.05 was considered as significant. Statistical analyses were performed with SPSS, version 16.0 (SPSS Inc). Results: Severe CAD patients were found significantly more in Group I (thick) than in Group II (thin) [78% vs 14%, p<0.001]. IST showed a moderate positive correlation with Gensini score (r=0.58). Univariate and multivariate analysis revealed that dyslipidemia, diabetes mellitus, high waist circumference and increased IST were independently significant predictors of severe CAD. Out of them increased IST was found be the strongest independent predictor of the severity of CAD with odd ratio 9.8 (95% CI 2.17 - 44.4). Conclusion: The study concludes that increased interatrial septal thickness (IST) is associated with severe coronary artery disease (CAD). So, severe CAD may be predicted by measuring the interatrial septal thickness. Bangladesh Medical Res Counc Bull 2025;51(1):25-32
Background: Acute Coronary Syndrome (ACS) is a significant manifestation of coronary artery disease (CAD). Severity of CAD is determined by SYNTAX score based on coronary angiogram which is an invasive procedure. A noninvasive evaluation of CAD severity by Triglyceride-Glucose (TyG) index before coronary angiogram might help with risk assessment and selection of treatment strategy. Objective: To evaluate the association of Triglyceride-Glucose (TyG) index with severity of CAD determined by SYNTAX score in patients with ACS. Methods: This cross-sectional study was done in the department of Biochemistry of Sir Salimullah Medical College from March 2024 to February 2025. A total 224 patients with ACS undergoing coronary angiography were enrolled as study subjects by purposive sampling. TyG index was calculated from fasting plasma glucose and fasting serum triglycerides level. Subjects were grouped according to the tertile of TyG index into tertile 1 (T1), tertile 2 (T2) & tertile 3 (T3). A SYNTAX score of ≤22 was considered as not severe and a SYNTAX score of > 22 was considered as severe CAD. Severity of CAD was compared among different tertile groups by chi square test. Association of high TyG Index with severity of CAD was determined by odds ratio (OR). The correlation of TyG Index with severity of CAD was determined by Pearson’s correlation coefficient test. The cut off point of TyG index was determined by Youden’s Index. The diagnostic role of TyG index for detection of severe CAD was determined by Receiver operator characteristic (ROC) curve, the area under (AUC) curve, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy. P-value ≤0.05 was considered statistically significant. Results: Among 224 subjects divided into TyG index tertiles, the highest tertile (T3) was strongly associated with a high SYNTAX score (>22), and subjects with high TyG index (>8.47) found to have 37.83 times more risk to have severe CAD (OR= 37.83, CI:17.06-84.0). The TyG index showed a significant positive correlation with the SYNTAX score (r=0.880, p< 0.001). Receiver operating characteristics (ROC) curve analysis of TyG index (cut-off point 8.47) for predicting severe CAD showed the area under curve (AUC) to be 0.99, sensitivity 76.5%, specificity 92.0%, PPV 88.0%, NPV 83.5% and accuracy 85.0%. Conclusion: High TyG index was associated with increased severity of coronary artery disease in ACS patients. High TyG index was a good predictor of severe CAD with high sensitivity , specificity, diagnostic accuracy and AUC. Bangladesh Medical Res Counc Bull 2025;51(3): 145-150
Heart failure (HF) affects millions globally, and family caregivers play a vital role in supporting HF patients through cardiac rehabilitation (CR). These caregivers help with medication management, physical activity, and emotional support, contributing significantly to patient outcomes. However, the impact of caregiving on family members’ health and well-being is understudied. This review aims to evaluate the effects of family caregiver involvement on cardiovascular outcomes, quality of life, and mental well-being for HF patients. A narrative review was conducted by analyzing studies on family caregivers in CR for HF patients, using databases such as PubMed, Google Scholar, and Embase. Family caregivers’ involvement is to improved cardiovascular outcomes, exercise capacity, and mental well-being in HF patients, but also face emotional and physical burdens. Supporting caregivers is essential for optimizing CR programs. Bangladesh Medical Res Counc Bull 2025;51(3): 151-157
