Depression is characterized by decreased monoamine levels (dopamine, noradrenaline, serotonin), gamma-aminobutyric acid (GABA), elevated corticosterone, and dysregulation of the hypothalamic-pituitary-adrenal axis. This study aims to examine the effects of Artemisia pallens against behavioral depression in mice using the tail suspension test. Mice were divided into several groups and received different concentrations of ethyl acetate fractions of A. pallens. The duration of immobility of mice, brain levels of monoamines, GABA, and plasma corticosterone concentration were estimated. Extract (400 mg/kg) significantly (p<0.001) reduced immobility time and increased brain monoamines, GABA levels, and decreased plasma concentration of corticosterone compared to the control group. These findings suggest that A. pallens exhibits significant antidepressant-like activity, likely due to the restoration of the hypothalamic-pituitary-adrenal axis, enhanced brain monoamine and GABA levels, and reduced plasma corticosterone levels.
This study investigated the neuroprotective effects of 2-methoxy-6-acetyl-7-methyljuglone (MAM, a compound isolated from Polygonum cuspidatum) in 6-hydroxydopamine (6-OHDA)-injuried pheochromocytoma (PC12) cells. 6-OHDA treatment significantly induced cell death, apoptosis and mitochondrial membrane potential loss. MAM pretreatment significantly rescued PC12 cell viability, inhibited the 6-OHDA-induced apoptosis and depolarization in mitochondrial membrane potential. Results also demonstrated that 6-OHDA significantly induced ERK and NF-kappa B phosphorylation, while MAM pretreatment markedly reduced the 6-OHDA-elevated ERK and NF-kappa B phosphorylation levels. This suggested that MAM exerted neuroprotective effects likely by suppressing ERK-related oxidative stress and NF-kappa B-mediated neuroinflammation, thereby protecting neuronal cells from 6-OHDA-induced apoptosis. Collectively, these results suggested that MAM exerted a neuroprotective effect in 6-OHDA-induced Parkinson's disease cell model by suppressing ERK and NF-kappa B-mediated apoptotic mechanisms.
Tangeretin, a citrus-derived polymethoxylated flavone, exhibits potent and selective anti-cancer activity against HER2-positive breast cancer. It demonstrated cytotoxicity in SKBR3 cells (IC50 = 19.5 +/- 1.7 & micro;M) and MCF-7 cells (IC50 = 36.2 +/- 2.4 & micro;M), while sparing non-tumorigenic MCF-10A cells (>90% viability; IC50 = 327.5 +/- 18.2 & micro;M). Tangeretin markedly reduced clonogenic survival (51.4 +/- 3.1 colonies in SKBR3; 78.1 +/- 3.7 in MCF-7) and induced pronounced apoptosis, as evidenced by late apoptotic staining (50.6 +/- 2.3%), DNA laddering, and strong activation of caspase-3/7 (3.4 +/- 0.1-fold) and caspase-9 (2.9 +/- 0.1-fold). Flow cytometry revealed significant G(2)/M phase arrest in SKBR3 cells (38.9 +/- 2.0%). Mechanistically, tangeretin suppressed AKT kinase activity (0.4 +/- 0.04-fold), comparable to MK-2206 (0.3 +/- 0.0-fold), and reduced the expression of phosphorylated HER2 (p-HER2), p-PI3K, p-AKT, p-mTOR, p-p70S6K, and cyclin D1. These findings establish tangeretin as a selective HER2-targeted anti-cancer candidate that acts through dual inhibition of the PI3K/AKT/mTOR pathway and induction of mitochondrial apoptosis.
Alternanthera paronychioides is traditionally used for managing inflammatory disorders; however, its anti-arthritic efficacy and underlying mechanisms remain insufficiently characterized. The present study evaluated the anti-arthritic potential of A. paronychioides in acute and chronic animal models of arthritis. Previously, sequential extracts were assessed for inhibition of protein denaturation, proteinase activity, and erythrocyte membrane destabilization. The most active n-hexane extract was further investigated in carrageenan-induced inflammation and complete Freund's adjuvant-induced arthritis in rats. n-Hexane extract treatment significantly reduced paw edema, arthritic severity, hyperalgesia, and allodynia, while improving histopathological, and radiographic outcomes. Molecular analysis revealed marked suppression of pro-inflammatory mediators, including TNF-alpha, IL-1(3, IL-6, NF-kappa B, and COX-2, alongside up-regulation of IL-4. These findings demonstrate that A. paronychioides exerts potent anti-arthritic effects through multi-target immunomodulation.
Chronic kidney disease (CKD) is one of the most common public health concerns around the world with numerous adverse outcomes such as cardiovascular disease (CVD), end stage renal disease (ESRD) and premature death. The progression of the CKD leads to an increase in the development of hematological alterations, such as low hemoglobin levels and iron deficiency. Diabetes mellitus is the most common cause of CKD, leading to ESRD and therefore, is also the most common cause of renal anemia. The aim of this study was to find out the influence of Iron Metabolism and Hemoglobin parameter among CKD patients with and without diabetes mellitus by determining iron profile and hemoglobin level. This cross-sectional analytical study was carried out in the department of Nephrology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) General Hospital, Dhaka over a period of one year July 2022 to June 2023. A total of 100 CKD patients were included in this study as respondents and divided them in to two halves; 50 CKD patients with DM were selected as group- I and other 50 CKD patients without DM as group II. After taking written informed consents, data were taken from patients by using a structured questionnaire. Data was analyzed by Statistical Package for Social Sciences (SPSS), version- 26. In this study serum iron was found significantly lower in group- I (Mean±SD: 6.16±2.36) than group- II (Mean±SD: 12.73±7.36), which was statistically significant. Group- I also represents 56% absolute iron deficiency, 18% functional iron deficiency and 26% normal iron status, Group- II represents 18% absolute iron deficiency, 38% functional iron deficiency and 44% normal iron status respectively. These differences between two groups were statistically significant (p value: <0.001.). Hb level as mean±SD was, 8.5±1.83 in group- I and 12.89±2.54 in group- II respectively and statistically differences were significant. Among the study subjects, frequency of anemia was higher in group- I. In correlation analysis, variables of all study subjects with eGFR showed significant positive correlation with serum iron and Hb level. This study showed that serum iron and Hb level were significantly lower in diabetic chronic kidney disease patients than non-diabetic CKD patients. The findings also revealed that absolute iron deficiency was more common in diabetic CKD patients. Bangladesh Med J. 2024 Jan; 53(1): 7-11
In surgical practice, it is common and important to deal with intra-abdominal abscesses. Incision and drainage through laparotomy has traditionally been used to manage abdominal abscesses. Percutaneous catheter drainage is favorable due to avoiding of laparotomy, general anesthesia, easier postoperative care, less patients’ complaints, shortened hospital stay and less cost. However, the advance technology of ultrasonography helps for precise localization of abscesses to place the catheter percutaneous for effective, adequate and definitive drainage. This hospital based prospective observational study was carried out among the patients of intra-abdominal abscess and the aim was to measure the short-term outcomes of drainage of intra-abdominal abscesses with an image-guided percutaneous pigtail catheter. Study subjects were selected from patients with intra-abdominal abscess and were enrolled as per selection criteria. Data connected to intra-abdominal abscess derived from the pan-procedure was collected on or after the follow-up sheet and also from post-procedure investigation reports. The questionnaire was finalized following pretesting. Collected data were checked daily and edited (if needed). Data were processed and analyzed using computer software SPSS (Statistical Package for Social Sciences) version 20. Quantitative data were expressed as mean and standard deviation. Qualitative data were expressed as frequency and percentage; and comparison was done by fisher exact test. A probability value (p) of less than 0.05 was considered as statistical significance. This study finds that maximum patients (30%) were in the age group of 41-50 years and males were predominant (65%). Most of the (85%) pig-tail catheters were used for intra-abdominal abscess were 14Fr size. All most all (95%) of the intra-abdominal abscess were single abscess and a few of those (5%) were multiple abscess. More than half (55%) of the abscess were appendicular, 10% were liver abscess, one-fourth (25%) of those were sub-hepatic and 10% were sub phrenic abscess. It was observed that 95% required single drainage and 5% required multiple drainage. All most all of the patients (95%) were given local anesthesia and only 1 patient (5%) needed conversion (open surgery). Nearly two-third (65%) patients were needed hospital stay for 6 to 10 days. Most of them (90%) were success and failures were minimum (10%). The average (Mean ± SD) catheter removal was 6.90±1.87 days and most of the patients (90%) had no complications. It was observed that 60% organism were escherchia coli, 25% were staph. aureus, 5% were pseudomonas and 10% were streptococcus spp. Using an image-guided percutaneous pigtail catheter for drainage of intra-abdominal abscesses is easily applicable, well-tolerated procedure that doesn't require general anesthesia with high success rates and low complications. The practice of this method can reform the treatment policy for drainage of intra-abdominal abscesses. Bangladesh Med J. 2024 Jan; 53(1): 1-6
Gall bladder carcinoma is the most prevalent biliary tract malignancy worldwide. It has no specific symptoms. Symptoms begin with the advancement of disease, and it terminates the life rapidly. Therefore, early diagnosis and intervention lead to positive results, and better outcomes could be assured following surgery. This cross sectional descriptive study was conducted among admitted patients, in the Department of Hepato-Biliary-Pancreatic Surgery and Liver Transplant (HBPS & LT) of BIRDEM General Hospital, Ibn Sina Specialized hospital and Crescent Gastro Liver and General Hospital in Dhaka City from January 2022 to June 2024, over a period of 2 years and 6 months. Most of the data (90%) were obtained from BIRDEM and rest 10% from above mentioned hospitals. The initial estimated sample size was 86; however, after applying the inclusion and exclusion criteria, only 40 cases were included due to data limitations. The study included all histopathologically verified early gallbladder carcinoma cases, but excluded those with signs of advanced malignancy. Cases were selected irrespective of age or sex, anatomical distribution, clinical features, risk factors, histological type, and surgical outcomes. After receiving ethical approval from the Ethical Committee and verbal consent from the patients, data were collected through face-to-face interviews and observations using a pre-testing questionnaire check list specifically designed for the study by the researcher. A total 40 cases were included in the study. The peak incidence of gallbladder carcinoma was observed in 5th and 6th decades of life with the mean age of the cases being 58.12±7.75 years and their age range was 35 to 80 years. Female was predominance; where, male female ratio was 1:2.34. Gall stone (80%) was the most common associated factor and mostly diagnosed incidentally (92.5%). Mostly done procedure was laparoscopic cholecystectomy and it was about 90% .Tumor involve fundus of the gallbladder in 55% cases and most of these were adenocarcinoma (90%). After surgery, wound infection rate was 7.5% and port site hernia was 5%, however there was no recurrence and survivability was 97.5% within the duration of study periods. Early surgical intervention brings good result in the management of early gallbladder carcinoma. Bangladesh Med J. 2024 Jan; 53(1): 33-38
Sub-fertility is an upsetting situation for childless couples who are experiencing a lot of physical, mental, social, and economic trauma. Many women go to an infertility clinic or gynecologist without their husbands because it is still considered a female issue, but male factors play a significant role in its etiology. Semen analysis is the most fundamental, useful and inexpensive means of assessing male factor infertility. This descriptive cross-sectional study was directed among sub-fertile males of infertile couples visiting the CARE (Centre for Assisted Reproduction) in Department of Obstetrics and Gynaecology of BIRDEM, Dhaka. The study was conducted among 126 males who were sub-fertile and aimed to evaluate the patterns of sperm parameters using semen analysis. After receiving informed consent and meeting eligibility criteria, participants were interviewed and semen analysis reports were obtained. Semen from the male partners were analyzed in the laboratory using the World Health Organization (WHO) 2021 criteria for human semen characteristics. Data were analyzed by using SPSS- 22. A total of 126 participants’ semen analysis and background characteristics were evaluated by using WHO standard for semen normality criteria, 2021. The WHO standard for semen normality criteria, 2021 was used to evaluate the semen analysis and background characteristics of 126 participants. The mean age (Mean±SD) of the study subjects was 34.92±6 years with their age range 21 – 52 years; among these respondents most of them (84.10%) were in the most productive fertile age group 21-40 years. In this study primary sub-fertility was observed in 68.3% of men and maximum of them (43.7%) were demanding to conceive over 3-5 years.Study found the following normal parameters of semen analysis; those are, 4.76% of the men had <1.4 ml semen volume per ejaculation, nearly one-fourth (22.22%) of men had sperm concentration <16 million/ml, more than half (55.56%) of the men’s total sperm motility was <42% and 17.46% of them were found abnormal morphology of sperm (teratospermia). The mean (Mean±SD) of semen volume was 2.59±0.99 ml, pH was 7.27±0.69, sperm concentration was 59.38±52.34 million/ml and the mean of total motility of the sperm was 36.70±24.71%; however mean of immotile sperm was 51.99±28.04% and normal morphology of sperm was 35.52±24.49%. An abnormal patterns of semen parameters were seen in majority (58.73%) of men; among them more than one-third (34.9%) of them were asthenozoospermia, 11.1% was azoospermia, Oligoasthenoteratozoospermia was 7.1%, Oligospermia 8% and Oligoasthenozoospermia 4.8%. According to age-wise distribution maximum cases of asthenospermia (20.6%) were observed between the age group of 31-40 years. Single-factor abnormalities was observed in 47.6% cases and 11.11% had combined factor abnormalities. This study found that asthenozoospermia was the main single factor abnormality or sub-fertile state, followed by azoospermia. Male partners of sub-fertile couples attending infertility clinics consistently have abnormal semen parameters, which are prevalent with primary sub-fertility. This study similarly found that asthenozoospermia and azoospermia were common abnormalities in male partners. Bangladesh Med J. 2024 Jan; 53(1): 18-25
Shock wave lithotripsy (SWL) is a noninvasive, safe, and effective method of treating renal stones. The overall stone-free rate (SFR) varies greatly depending on stone location and size. Failure to disintegrate the stone results in unnecessary exposure to shock waves and radiation, as well as the need for alternative treatment procedures, which raises medical costs. Prior to treatment, it is critical to identify predictors of treatment success or failure in patients who are potential candidates for SWL. The purpose of this study is to determine if stone attenuation and skin-to-stone distance in computed tomography have the ability to predict the success of shock wave lithotripsy in renal stone disease. This prospective observational study was carried out in the Department of Urology at BSMMU's in collaboration with the Department of Radiology and Imaging from January to December 2023. Patients with renal stones who were scheduled for shock wave lithotripsy (SWL) were enrolled in this study after obtaining their consent. The history of these patients, including their drug and dietary histories, was recorded in detail. Each patient was given computed tomography to evaluate stone attenuation and skin-to-stone distance. After SWL Stone clearance rate was compared with stone attenuation and skin-to-stone distance. The statistical package for social sciences (SPSS) version 20.0 was used to analyze the data. Males were more prevalent than females, but the stone-free rate was higher in females, though this difference was not statistically significant. Younger patients experienced a higher stone-free rate, and patients with low BMI had better outcomes than those with high BMI. Stones were most abundant in the lower pole, followed by the pelvis, central, and upper pole. The stone-free rate was highest in the pelvis, followed by the central, lower pole, and upper pole. Stone-free status was more common among patients with smaller stones and lower stone attenuation, though these differences were not statistically significant. Patients with a shorter skin-to-stone distance had a significantly higher rate of stone extraction. Skin-to-stone distance more effectively predicts the success of SWL in renal stone disease than stone attenuation. Bangladesh Med J. 2024 Jan; 53(1): 12-17
Worldwide, the incidence of diabetes mellitus (DM) is rising alarmingly. In 2019, according to International Diabetic Federation (IDF) atlas, Bangladesh was in the 10th position with an estimated 8.4 million diabetic subjects and 56% of them were undiagnosed. If the prevailing situation persists, the number will be increased to 11.4 million in 2030 (and 15.0 million in 2045, occupying the 9th position among countries with high diabetic populations). Early and correct diagnosis with proper management can save people from immense sufferings of DM and its complications. Glycated Hemoglobin (Hemoglobin A1c or HbA1c) level, is a well-recognized marker in the diagnosis and treatment of diabetes. In this study, the cut-off level for HbA1c level was determined in relation to their fasting venous plasma glucose levels of individuals with diabetes and pre-diabetes. This cross-sectional observational study was conducted among 139 newly diagnosed, untreated type 2 diabetic and pre-diabetic individuals who attended Outpatient Departments (OPDs) of Bangabandhu Sheik Mujib Medical University (BSMMU) and Sir Salimullah Medical College Mitford Hospital (SSMC & MH). Type 1 diabetic, patients receiving or received any treatment for diabetes, taking steroids, pregnant, having anemia were excluded from this study. Sensitivity, specificity and the area under the Receiver Operating Characteristic (ROC) curve for HbA1c, using different cut-off values, were calculated considering venous plasma glucose the gold standard test for diagnosis of Diabetes Mellitus. According to the findings of this study, the optimal diagnostic cut-off level of HbA1c was 6.8% with sensitivity 69.81%, specificity 72.73%, positive predictive value 89.02%, negative predictive value 43.21% and accuracy 70.51%. Based on the findings of this study, a larger study involving normoglycemic, newly diagnosed prediabetic and diabetic population, will hopefully determine the cut-off level of HbA1c more accurately to diagnose diabetes and decide the targeted HbA1c in treating diabetes in this population group. This will definitely help diabetic subject, their families and will have a positive impact on society and the country. Bangladesh Med J. 2024 Jan; 53(1): 26-32
Public health concerns about sexually transmitted infections (STIs) are becoming more widespread, particularly in developing countries with dense populations and high rates of population mobility. Their prevalence rises with widespread exposure to risk factors. Promoting knowledge and comprehension of STI prevention is essential to shielding women of reproductive age groups (15-45 years) from its harmful effects. This household-based cross-sectional study was directed to assess the level of perception of sexually transmitted infections among 273 purposively selected urban women residing in Moghbazar, Malibagh, and Shantibagh areas of Dhaka South City Corporation, Bangladesh. Data were collected using a pre-tested semi-structured questionnaire based on participants' convenience. The participants had a mean age of 32.8±4.2 years, ranging from 18 to 45 years, with the maximum (40.3%) of them were in age group 31-40 years. In terms of education, over half (54.6%) had completed secondary education, mostly similar to their partners (52.7%) and their average monthly household income was 18765.2±3262.8 BDT. The mean age at marriage was 19.8±2.1 years, with 10.3% marrying before 18. The average duration of marriage was 9.2±6.3 years. The most commonly used contraceptive methods were oral pills (60.4%) and condoms (41.0%). Majority of the women (51.3%) had a poor perception of STIs, while more than one-third (36.1%) had an average perception, and 12.6% had a good perception. The level of STIs perception among women was significantly associated with age, education, spouse's education, and marital duration (p<0.05). The survey uncovered that most women in the selected urban regions had a poor to average perception of STIs, with only one in ten having a good perception. Implementing comprehensive sexual and reproductive health education can reduce the current and future burden of STIs. Bangladesh Med J. 2024 Jan; 53(1): 39-46
Brachio-basilic arteriovenous fistulas (BBAVFs) are a preferred vascular access option for hemodialysis in patients with end-stage renal disease (ESRD) when the cephalic vein is unsuitable. Both the one-stage and two-stage BBAVF techniques offer distinct advantages and are widely practiced, but their comparative outcomes remain under debate. This study aims to compare the clinical outcomes of one-stage versus two-stage BBAVF creation in patients with ESRD. This prospective, randomized interventional study was conducted at the Vascular Surgery Department of Ibrahim Cardiac Hospital & Research Institute, Dhaka, from January 2021 and June 2024. A total of 64 ESRD patients who met the inclusion criteria were randomly assigned into two equal groups (n = 32 each) to undergo either one-stage or two-stage BBAVF creation. Preoperative evaluations included clinical assessment, laboratory tests, and duplex ultrasonography. The outcomes assessed included primary and secondary patency, complication rates, early postoperative discomfort, and vascular parameters, with consideration of baseline characteristics. Baseline characteristics were comparable between the two groups. The two-stage group demonstrated significantly higher primary patency (96.9% vs. 81.3%; p = 0.045), while secondary patency rates were identical (90.6%) in both groups. However, the two-stage technique was associated with significantly higher rates of venous hypertension (p = 0.020) and steal syndrome (p = 0.039). Early postoperative pain was significantly lower in the one-stage group (p = 0.001). No significant differences were found between the groups regarding postoperative vein diameter, depth, or volume flow. Although the two-stage BBAVF technique offers superior primary patency, it carries a higher risk of complications. In contrast, the one-stage approach provides comparable long-term outcomes with less early postoperative pain. These findings highlight the need to individualize the choice of technique based on patient anatomy, comorbidities, and surgical expertise. Bangladesh Med J. 2024 May; 53(2): 1-7
Ureteroscopy (URS) is a precise, minimally invasive surgical procedure that have emerged as the standard approach for treating large ureteral stones in many medical facilities, owing to their comparatively low complication rates and high success in achieving stone-free outcomes. In the context of ureteroscopic lithotripsy, various types of lithotripters are available, including electrohydraulic, ultrasonic, pneumatic, and laser options. Among these, laser lithotripsy (LL) and pneumatic lithotripsy (PL) are the most commonly utilized methods. The aim of this cross-sectional analytical study was carried out to compare the outcome of LL and PL in the management of ureteric calculi. Over the course of a year (from November 2022 to October 2023), this study was conducted among 96 patients with ureteral calculi in the Department of Urology at Bangabandhu Ssheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Following the acquisition of both verbal and written consent from every patient, participants were enrolled in this study. The patients were categorized into two groups: Group A and Group B. Those who underwent procedure LL were placed in Group A, whereas those who received PL were assigned to Group B. A questionnaire was developed to gather data. Each patient was interviewed regarding their medical history and clinical characteristics, which included outcome variables such as the size of the stone, its location, the stone clearance rate, the duration of the procedure, the necessity for the Double J (DJ) method, the length of hospital stay, complications, the frequency of stone retrieval instrument usage, the rate of proximal fragment migration, and the requirement for Extracorporeal Shock Wave Lithotripsy (ESWL). The outcomes of the two procedures were compared in terms of stone clearance rate, duration of the procedure, requirement for DJ, length of hospital stay, complications, frequency of stone retrieval instrument usage, rate of proximal fragment migration, and necessity for ESWL. The data were analyzed using the statistical package for social sciences (SPSS) version 23.0. The mean age of participants in the LL group was 38.94 ± 9.47 years (range: 21-55), while in the PL group it was 36.46 ± 8.72 years (range: 23-50), with no significant difference (p>0.05). There was a predominance of males in both groups (p>0.05). The LL group had more right-sided stones while the PL group had more bilateral instances (p>0.05). Laser lithotripsy demonstrated less stone migration and DJ stenting, a higher stone-free rate, and shorter operative times compared to pneumatic lithotripsy. Both modalities were effective and safe for proximal ureteric calculus management. The mean size of stones was almost similar in both the LL and PL groups, with no significant difference observed. The stone size measured 10.37 ± 2.45 (ranging from 7.25 to 19.0) mm in the LL group, while it was 9.98 ± 2.26 (ranging from 7 to 17) mm in the PL group. The operative time was significantly short in the LL group compared to the PL group, recorded at 43.35 ± 3.86 minutes versus 55.08 ± 3.79 minutes; p<0.05. The immediate stone-free rate was significantly greater in the LL group (95.8%) compared to the PL group (79.2%). Additionally, stone migration was significantly less in the LL group than in the PL group. The rate of DJ stenting was also significantly lower in the LL group (33.3%) compared to the pneumatic group (54.2%). Although the complication rate was lower in the LL group (2.1%) than in the PL group (12.5%), this difference was not statistically significant. LL exhibited reduced stone migration and DJ stenting, a higher stone-free rate, and shorter operative times when compared to PL. Both procedures proved to be effective and safe for the management of proximal ureteric calculi. Bangladesh Med J. 2024 May; 53(2): 13-18
Thyroid dysfunction in thalassemia leads to the production of insufficient thyroid hormone which is responsible for various complications. Therefore, this study aimed to investigate the thalassemia related variables and thyroid status in the thalassemic patients. Data were collected from 138 thalassemia patients by using the questionnaire formulated after a detailed review of formerly published relevant literature. Statistical analysis was performed by using SPSS (v20, Inc., Chicago). An alpha level of 0.05 or less was considered as significant at 95% confidence interval. Around 76.1% of the patients were Hb E β-thalassemia patients including β-thalassemia major patient, β-thalassemia trait and Hb E trait and others (12.3%, 5.8%, and 2.9% respectively). History of blood transfusion had in 92% of patients. About 88% of these transfused respondents got frequent blood transfusion for the last 6 months. Iron chelator was prescribed in 58% patients either deferasirox (28.3%) or deferiprone (29.7%). Patients had the mean serum ferritin and hemoglobin level of 1682.43 (±1752.61) ng/dl and 7.81(±1.52) g/dl respectively. We found a strong correlation of transfusion dependency, interval between blood transfusions, iron chelator using and serum ferritin control with the thyroid status. The study also revealed that non-transfusion dependent and iron chelator independent respondents were less likely to develop hypothyroidism (ꭓ² = 9.81; p = 0.002 and ꭓ² = 8.424; p = 0.004, respectively). Hypothyroidism was more common in respondents with frequent blood transfusion compared with that of others (ꭓ² = 11.276; p = 0.003) and in respondent with bad control of serum ferritin than the respondents with good control (ꭓ² = 13.929; p < 0.001). The present study explored various thalassemia related factors including transfusion dependency, interval between blood transfusions, iron chelator using and serum ferritin control with the thyroid status. Further study is required to support our findings. Bangladesh Med J. 2024 May; 53(2): 19-25
A thorough medical history, physical examination, and clinical presentation are crucial diagnostic processes for leukemia diagnosis. As a result, fatigue, irritability, and anorexia are common non-specific leukemia symptoms. Fever, pallor, lassitude, purpuric lesions, and bleeding are often the most common clinical observations and symptoms, which are usually indicators of the underlying thrombocytopenia, neutropenia, and anemia. This study aimed to evaluate the clinical presentation of leukemia in pediatric patients. This cross sectional study was conducted in the Department of Hemato-Oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, for a period of 6 months from 1st September 2010 to 31st March 2011. A total of 80 diagnosed cases of leukemia among children aged 0 to 15 years who attended the study site were included in the study. The data were analyzed using the Statistical Package for the Social Sciences (SPSS), version 15. The most prevalent (58.8%) age group among the 80 patients was ≤5 years, followed by 30.0% and 11.2% in age group of 5-10 and >10 years respectively. Regarding sex, the male to female ratio was 1.67:1, consisting of 62.5% males. The most frequent clinical symptom observed was fever, occurring in 95.0% of cases, followed by progressive pallor at 43.8%. Other notable clinical presentations included bone pain, lymph node enlargement, and haemorrhagic symptoms, with frequencies of 31.3%, 38.8%, and 25.0%, respectively. Additionally, headache (3.8%), vomiting (3.8%), abdominal distention (16.3%), a history of sore throat (1.3%), weight loss (2.5%), anorexia (3.8%), weakness (2.5%), and proptosis (1.3%) were also reported as presenting complaints. The presence of fever, which is then succeeded by increasing pallor, could be essential in the diagnostic procedures for leukemia. Bangladesh Med J. 2024 May; 53(2): 26-30
There is no consensus on which imaging method is more appropriate for people with suspected nephrolithiasis, computed tomography (CT) or ultrasound. In regular clinical practice, ultrasonography can be a useful alternative of CT for evaluating suspected nephrolithiasis, as suggested by the new study. Despite not being as sensitive as CT, USG provides equivalent accuracy while exposing patients to less cumulative radiation and reducing the number of high-risk diagnoses with consequences. This cross-sectional analytical study was carried out from May 2022 to May 2023 in the Department of Urology in collaboration with Department of Radiology and Imaging at Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh to compare the USG and CT scan methods in the diagnosis of renal stone. In this study a total of 206 suspected cases of nephrolithiasis were enrolled initially from outpatient department (OPD), among them 160 cases were primarily diagnosed with renal stones and 46 without renal stones by physical examinations and x-ray. Then 206 suspected cases were scheduled for USG and CT scans to confirm the stone after obtaining consent. A data collection questionnaire was used to record the detailed history of these patients, including USG and CT scan reports. The statistical package for social sciences (SPSS) version 21.0 were used to analyze the data. Study found that male-female ratio was 1.61:1; where male was 61.7%. More than half (54.4%) patients were young/ early adults (21–40 years) and 45.6% of them was in middle age group (41–60 years). Calcium oxalate was the most prevalent type of stone, followed by calcium phosphate (38.1%), cysteine (5.6%), and uric acid (3.8%). Out of 206 suspected cases, 160 patients were accurately diagnosed with renal stones and 46 diagnosed without renal stone. Among the diagnosed renal stone patients 138 were positive and 22 were negative in the USG, with 138 being true positive and 22 being false negative. In 46 patients who were diagnosed without renal stone, 36 were found to be negative and 10 were found to be positive in USG, with these cases being true negative and false positive respectively. Out of the 160 patients diagnosed with renal stones, 148 were diagnosed positive and 12 were negative on CT scan, these were true positive and false negative cases. In 46 patients who were diagnosed without renal stone, 37 were labeled as negative and 9 were labeled as positive on CT scan, these were true negative and false positive cases respectively. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of USG in diagnosis of renal stone were 86.3%, 78.3%, 93.2%, 62.1% and 84.5% respectively. Whereas sensitivity, specificity, PPV, NPV and accuracy of CT scan in diagnosis renal stone were 92.5%, 80.4%, 94.3%, 75.5% and 89.8% respectively. The study found that both imaging modalities USG and CT scan were effective in diagnosing renal stones. However, CT scan results were better, so USG should be considered if CT is not available. Bangladesh Med J. 2024 May; 53(2): 8-12
In recent years, Bangladesh has made considerable progress in digitizing its healthcare system through the introduction of e-Health services. ese services leverage information and communication technology (ICT) to improve healthcare delivery, particularly in rural and underserved regions where access to medical professionals is limited. e Government of Bangladesh, in partnership with non-governmental organizations (NGOs) and private stakeholders, has initiated several programs including telemedicine services, mobile health (mHealth), electronic health records (EHRs), and digital health portals. Notable government-led initiatives include the deployment of telemedicine centers at Upazila Health Complexes, SMS-based health advisories, and the “Health Call Center” (16263), which o€ers 24/7 medical consultation. Additionally, private sector platforms like Doctorola, Maya, and Tonic have gained popularity for providing remote consultations, mental health support, and digital prescriptions. However, despite these promising developments, e-Health in Bangladesh is still in a transitional phase. Challenges such as low digital literacy, inadequate internet connectivity in rural areas, shortage of trained personnel, and lack of interoperability among systems have limited its full potential. Bangladesh Med J. 2024 May; 53(2): 31-33
Households in rural Bangladesh face severe financial hardship due to rising healthcare costs, particularly for chronic and non-communicable diseases. This study examined the patterns of illness, treatment practices, and catastrophic health expenditure among residents of Masjidia village, Mirsharai, Chittagong. A community-based cross-sectional survey was conducted in 2016 among 152 households to retrospectively assess healthcare utilization and expenditure patterns for 2015-2016. Convenience sampling was used due to geographical constraints. Catastrophic health expenditure was defined as spending exceeding 10% of total household income. Data were collected using structured questionnaires and analyzed descriptively. Illness prevalence was 84.2% among respondents. The average annual household income was BDT 35,352, while total healthcare expenditure accounted for 52.5% of this income, exceeding the catastrophic threshold by fivefold. Medication costs were the major expense, comprising 49–82% of total healthcare spending, followed by consultation, investigation, and transport costs. Most treatments were sought from private clinics and specialists, indicating high out-of-pocket dependency. The reliance on allopathic medicine remained dominant (above 94%), reflecting both accessibility and perceived efficacy. Health spending in rural Bangladesh imposes a catastrophic financial burden on households, driven primarily by medication costs and private-sector dependence. Targeted interventions—including subsidized essential medicines, expansion of community-based insurance, and improved public primary healthcare—are essential to reduce financial vulnerability and promote equitable access. Bangladesh Med J. 2024 Sept; 53(3): 7-15
Rising antimicrobial resistance (AMR) substantially undermines infection management worldwide. In Bangladesh, regional variations in resistance hinder empirical therapy. This study characterizes local AMR patterns among clinical isolates in a private tertiary level hospital in Sylhet, Bangladesh. We retrospectively reviewed culture and sensitivity records from July 2023 to February 2024 at Mount Adora Hospital. Specimens included urine, sputum, blood, and wound swabs. Identification and antibiotic sensitivity testing followed Clinical and Laboratory Standards Institute guidelines. Descriptive statistics summarized pathogen distribution and resistance rates. Of 1,360 culture-positive specimens, urine dominated (57.6%), followed by sputum (24.1%), blood (15.9%), and wound swabs (2.4%). Escherichia coli (54.5%) and Klebsiella spp. (20.4%) led urinary isolates; Staphylococcus aureus predominated blood cultures (70.8%); Streptococcus spp. (36.6%) and Klebsiella spp. (32.9%) were common in sputum; wound swabs chiefly yielded S. aureus (42.4%). High resistance in urine isolates was noted for azithromycin (80.9%), cefixime (78.3%), and nalidixic acid (79.1%); carbapenems retained >80% activity. Bloodstream isolates showed >75% resistance to cefixime and ceftazidime but remained >80% sensitive to imipenem and amikacin. Sputum and wound pathogens exhibited similar resistance trends to first-line agents, with tigecycline and carbapenems preserving efficacy. Common antibiotics demonstrate alarming resistance rates, whereas reserve antibiotic particularly carbapenems and tigecycline remain reliable. Updated, region-specific antibiotic guidelines and stewardship interventions are immediately needed. Bangladesh Med J. 2024 Sept; 53(3): 23-30
