Background: Metabolic Syndrome (MetS) is a cluster of cardiovascular risk factors including central obesity, hypertension, dyslipidemia, and insulin resistance. It is strongly associated with increased risk and poorer outcomes in Myocardial Infarction (MI). Objective: To determine the prevalence of Metabolic Syndrome among patients admitted with Myocardial Infarction at a tertiary care hospital in Central India and to evaluate its association with MI severity and outcomes. Methods: A hospital-based, cross-sectional observational study was conducted over 18 months in the Department of Medicine at Amaltas Institute of Medical Sciences, Dewas. Seventy-five adult MI patients were enrolled using non-probability convenience sampling. Data on demographics, clinical history, anthropometry, blood pressure, fasting glucose, and lipid profile were collected. The diagnosis of MetS was based on standard criteria. Associations between MetS and MI severity, cardiac biomarkers, and clinical outcomes were analysed. Results: Metabolic Syndrome was present in 36% (27/75) of MI patients. Participants with MetS had significantly higher rates of severe MI (55.6% vs 31.3%; p=0.039) and adverse outcomes, including mortality (14.8% vs 0%; p=0.006) and severe morbidity (44.4% vs 10.4%; p=0.001). They also showed significantly elevated cardiac enzymes, including troponin (p=0.003), CK-MB (p<0.0001), and LDH (p=0.008). Conclusion: Metabolic Syndrome is common among MI patients and is associated with increased severity, higher cardiac enzyme levels, and worse clinical outcomes. Early identification and management of MetS components in MI patients may improve prognosis and reduce cardiovascular risk.
Posterior segment evaluation is essential in diagnosing sight-threatening ocular pathologies. However, media opacities such as dense cataracts, corneal opacities, and vitreous hemorrhage often preclude direct visualization. B-scan ultrasonography (Brightness-mode scan) is a valuable imaging tool in such cases, providing real-time, non-invasive cross-sectional images of intraocular structures.This study aimed to evaluate the role of B-scan ultrasonography in diagnosing posterior segment pathologies in patients with opaque ocular media and to correlate ultrasonographic findings with clinical diagnoses. Materials and Methods: A prospective observational study was conducted on 140 eyes from 100 patients with opaque media at Index Medical College Hospital & Research Centre, Indore, over 12 months. All patients underwent detailed clinical examination followed by B-scan ultrasonography using a 10 MHz probe. Findings were documented and analyzed to determine the prevalence and pattern of posterior segment pathologies. Results: Of the 140 eyes examined, 63 eyes (45%) showed posterior segment abnormalities. Vitreous disorders were most common (60%), followed by retinal detachment (14.2%) and combined retinal detachment with vitreous hemorrhage (11.6%). B-scan findings supplemented the clinical diagnosis in 70% of eyes and correlated in 27%. In 3% of eyes, B-scan failed to detect optic nerve pathologies due to dense hemorrhage. Lenticular opacity was the most frequent cause of media opacity (68%).
Major Depressive Disorder (MDD) is a mood disorder associated with significant alterations in lipid metabolism. Dyslipidemia may contribute to the pathogenesis of depression and is also a risk factor for cardiovascular disease. This study compares lipid profiles between MDD patients and age- and sex-matched healthy controls to explore their potential role as biomarkers. Methods: A cross-sectional study was conducted on patients attending the Psychiatry Outpatient Department (OPD) who were diagnosed with major endogenous depressive disorder, alongside age- and sex-matched healthy controls. Following ethical clearance and informed consent, lipid profiles were assessed using fasting blood samples. Hamilton Depression Rating Scale (HAM-D) was used to quantify depressive severity. Results: Patients with MDD had significantly higher levels of total cholesterol (198.37 ± 34.51 mg/dL vs. 162.13 ± 34.14 mg/dL; p = 0.0001), LDL (123.97 ± 27.87 mg/dL vs. 99.97 ± 32.52 mg/dL; p = 0.003), triglycerides (192.37 ± 122.84 mg/dL vs. 132.20 ± 39.41 mg/dL; p = 0.013), and VLDL (38.46 ± 24.56 mg/dL vs. 26.44 ± 7.88 mg/dL; p = 0.013). HDL levels were lower in the MDD group but not statistically significant (p = 0.159). Female patients exhibited significantly higher triglyceride and VLDL levels than males (p = 0.03). No significant correlation was found between lipid levels and HAM-D scores or depression severity.
Gestational Diabetes Mellitus (GDM) is a rising public health concern, particularly in South Asian populations with inherent insulin resistance. Early identification of high-risk pregnancies is critical to minimize maternal and fetal complications. Glycosylated hemoglobin (HbA1c), a marker of average blood glucose over 2–3 months, may offer a convenient early screening option when measured in the first trimester. Objective:This study aimed to evaluate the diagnostic accuracy of first-trimester HbA1c in predicting GDM and to determine an optimal HbA1c cutoff that could serve as a risk stratification tool in routine antenatal care. Methods:A prospective cohort study was conducted at a tertiary care hospital over six months. A total of 100 pregnant women with gestational age 8–13 weeks were enrolled. First-trimester HbA1c was measured using high-performance liquid chromatography. All participants underwent a 75 g OGTT at 24–28 weeks, and GDM was diagnosed as per IADPSG criteria. Data were analyzed using SPSS, and the diagnostic accuracy of HbA1c was assessed through sensitivity, specificity, and ROC analysis. Results:GDM was diagnosed in 15% of participants. All GDM cases had a first-trimester HbA1c ≥ 5.7%, showing 100% specificity but reduced sensitivity. A significant association was observed between GDM and obesity (p < 0.001), with all cases occurring in obese women. HbA1c ≥ 5.7% demonstrated strong predictive value but cannot replace OGTT due to limited negative predictive capacity. Conclusion:First-trimester HbA1c ≥5.7% is a useful high-specificity screening tool for GDM but lacks sufficient sensitivity to serve as a standalone diagnostic test. When combined with mid-pregnancy OGTT, it enhances early detection and facilitates targeted interventions.
The most prevalent type of cancer in males is prostate adenocarcinoma. Based only on histologic features, it can occasionally be challenging to distinguish prostatic adenocarcinoma from prostatic mimickers. Using immunohistochemistry (IHC) and a negative immunological response to p63, along with positive staining for Alpha Methyl Acyl CoA Racemase (AMACR), cancer is diagnosed. The prostatic tumour suppressor gene NKX3.1 is found on chromosome 8p. While most primary prostatic adenocarcinomas stain positive for the NKX3.1 protein, most high-grade prostate cancers have it downregulated, and most metastatic prostate cancers have it completely lost (e.g., in 65% to 78% of lesions), according to most studies. Therefore, the study aimed to evaluate the diagnostic accuracy of Nkx3.1 in combination with AMACR & P63 in prostatic adenocarcinoma. This was an observational, prospective & retrospective study involving 56 samples of biopsies and specimens, conducted over a period of 12 months after the fulfillment of the criteria. After following the standard protocol for specimen staining, the IHC was carried out. The correlated histopathological features in all the cases were selected, and the diagnostic utility was determined statistically. The data was collected and analysed using the Chi-square test, all the results showed 5% level of significance & 95% confidence interval with a p-value of <0.05. The maximum age group of the patients was within 70-80 years, with the maximum cases of prostatic adenocarcinoma diagnosed in 42 (75%) patients, with 15 (26.8%) in grade 4. A high statistical significance was seen between the association of diagnosis with IHC expression. To distinguish between adenocarcinoma and its mimics of prostatic lesions, NKX3.1 as a diagnostic performance in a combination with p63 and AMACR proves to be significant. In suspected situations, IHC is advised to minimise diagnostic error.
Background: Antimicrobial resistance (AMR) poses a critical global health threat, with irrational antibiotic prescribing practices being a key driver—especially in low- and middle-income countries (LMICs) like Bangladesh. Despite the existence of national and international prescribing guidelines, adherence among physicians remains inconsistent, particularly in tertiary care settings. Objective: This study aimed to evaluate adherence to national (BSMMU) and international (WHO AWaRe) antibiotic prescribing guidelines and to assess patterns and influencing factors of antibiotic use among physicians in tertiary care institutions in Bangladesh. Methods: A descriptive cross-sectional study was conducted among 232 physicians across three tertiary care hospitals in Dhaka. A total of 266 prescriptions were reviewed, of which 192 (72%) contained at least one antibiotic. Data were collected using structured questionnaires and WHO prescribing indicator checklists. Statistical analysis was performed using SPSS (version 26). Results: The average number of drugs per prescription was 5.4, with antibiotics prescribed in 72% of encounters—significantly exceeding WHO recommendations. Generic prescribing was low (6.4%), while 96% of antibiotics were broad-spectrum. Watch or Reserve group antibiotics accounted for 48% of prescriptions, surpassing the WHO threshold (≤40%). Only 59% of prescriptions adhered to BSMMU’s preferred guidelines. Physicians frequently considered clinical and pharmacologic factors but reported limited formal training in antibiotic prescribing (25%). Conclusion: The findings reveal substantial deviations from recommended antibiotic prescribing standards, underscoring the need for improved stewardship interventions, continuous medical education, and enhanced regulatory oversight to promote rational antibiotic use in Bangladeshi tertiary care settings.
Background: Laparoscopic cholecystectomy (LC) is a commonly performed surgical procedure for gallbladder diseases. Despite being minimally invasive, LC carries a risk of complications, primarily due to anatomical and physiological variations in the hepatobiliary system, especially the cystic artery. An understanding of these variations is crucial to reduce intraoperative bleeding, bile duct injury, and conversion to open surgery. Objective: To assess the prevalence and types of anatomical and physiological variations in the cystic artery and their impact on surgical risk during laparoscopic cholecystectomy. Methodology: This cross-sectional study was conducted over a period of 12 months from January to December 2024 at a tertiary care teaching Hospital Lahore. A total of 150 patients undergoing elective laparoscopic cholecystectomy were included. Intraoperative findings regarding the anatomy of the cystic artery such as origin, course, number, and relation to the cystic duct were documented. Data on intraoperative complications, conversion rates, and operative time were also recorded. Descriptive statistics and chi-square tests were used for analysis. A p-value of <0.05 was considered statistically significant. Results: Anatomical variations of the cystic artery were observed in 38% of cases. The most common variation was a double cystic artery (16%), followed by low-lying artery (12%), and artery arising from the right hepatic artery with a tortuous course (10%). Intraoperative complications occurred in 22% of cases with variant anatomy, compared to 6% in those with typical anatomy (p = 0.01). Mean operative time was significantly longer in patients with anatomical variations (78 ± 15 min vs. 56 ± 10 min, p < 0.001). Conversion to open surgery was required in 4 cases (2.6%), all of which had complex arterial variations. Conclusion: Anatomical and physiological variations in the cystic artery are common and significantly increase the risk of intraoperative complications during laparoscopic cholecystectomy. Preoperative planning and meticulous dissection techniques are essential to minimize surgical risks. Awareness and anticipation of such variations can improve surgical outcomes and reduce the rate of complications and conversion to open procedures.
