Organ transplantation represents one of the most transformative milestones in modern medicine. While Bangladesh achieved early success in kidney and corneal transplants, national progress has stagnated due to fragmented policy, inadequate infrastructure, and dependence on foreign centers. The tragic case of Dr. Shaila Nazneen Tania, a gynecologic oncologist who succumbed to cancer due to lack of access to liver transplantation, underscores the urgency of national reform. This article argues for the establishment of a Bangladesh National Organ Transplant Center (BNOTC), based on the existing Super Specialized Hospital (SSPH) at Bangladesh Medical University (BMU), to coordinate kidney, liver, and bone marrow transplantation services. A structured, autonomous, and merit-driven model can not only reduce medical migration and costs but also restore confidence in the country’s tertiary healthcare capacity. J Bangladesh Coll Phys Surg 2026; 44: 140-142
Introduction: In Bangladesh, dengue fever is an endemic illness, with high rates of mortality during outbreaks. Acute diarrhoea is a common symptom of dengue fever. This study aimed to identify the frequency of acute diarrhoea in dengue virus infection, and its association with various factors and the in-hospital outcome. Methods: This cross-sectional study involved 203 dengue patients who were admitted to a tertiary-level teaching hospital in Dhaka, Bangladesh, between July and October 2023. The frequency of acute diarrhoea in dengue patients was calculated, and its associations with various demographic, clinical and haematological parameters, complications, categories of dengue virus infection, ICU/HDU transfer and length of hospital stay were assessed. Results: Diarrhoea developed in 17.7% of dengue patients. The study identified an association of platelet count less than 50,000/cumm with acute diarrhoea in dengue patients (p-value <0.001). Organ dysfunctions (p-value <0.001), particularly cholecystitis (p-value 0.03), acute kidney injury (p-value 0.04) and pancreatitis (p-value 0.02), as well as multiorgan dysfunctions (p-value 0.02), were significantly more frequent in dengue patients with acute diarrhoea. Dengue shock syndrome (p-value 0.047), expanded dengue syndrome (p-value 0.04) and severe dengue (p-value 0.01) were found in higher frequencies in dengue patients with acute diarrhoea, who also had longer hospital stays (p-value <0.001). Conclusion: This study demonstrates that acute diarrhoea is significantly associated with severe clinical outcomes in dengue, including organ dysfunction and prolonged hospitalization. Incorporating this symptom into early risk stratification may enhance clinical decision-making and patient care. J Bangladesh Coll Phys Surg 2026; 44: 94-102
Background: There has been a growing interest in childhood neuromuscular diseases due to the advancement of neurophysiological tests in Bangladesh recently. This diagnostic tool is very useful in identifying various neuromuscular disorders. This study aims to observe the electro-clinical profile of patients with suspected neuromuscular diseases referred to a neurophysiology laboratory. Methodology: This cross-sectional study was conducted in the Neurophysiology Laboratory of the Paediatric Neuroscience Department at Bangladesh Shishu Hospital and Institute from May 1st, 2024, to April 30th, 2025. During this period, children with suspected neuromuscular disease underwent nerve conduction studies and, when appropriate, needle electromyography (EMG). Demographic and clinical data were collected from the referral notes and from the parents. Results: Among 115 children with suspected neuromuscular disease, the most common presenting complaints were acute flaccid paralysis (40%), progressive limb weakness (28.7%), and traumatic injury (13%). Other symptoms included limb pain (10.4%), generalized floppiness (5.2%), periodic paralysis (1.7%), and isolated facial nerve palsy (0.9%). Nerve conduction studies (NCS) showed abnormalities in 67.8% in cases. EMG was performed in 26(22.6%). 15.65% participants showed abnormal EMG findings. Guillain-Barré Syndrome was the most common electro diagnosis (40%), followed by traumatic neuropathy (7%), non-inflammatory myopathy (6%), spinal muscular atrophy (5.2%), polyneuropathy (3.5%), inflammatory myopathy (2.6%), motor neuron disease (1.7%), plexopathy (1.7%), and facial nerve palsy (0.9%). Abnormal electrodiagnostic findings were significantly associated with suspected GBS, progressive disease course, and non-specific/symptom-based referral diagnosis, while age and sex showed no significant association. Conclusion: This study highlights the high diagnostic yield of electrodiagnostic testing in children with suspected neuromuscular disorders, with nearly two-thirds demonstrating abnormal NCS findings. Abnormal electrodiagnostic findings were significantly associated with suspected GBS, progressive disease course, and non-specific/symptom-based diagnosis, emphasizing the importance of appropriate clinical diagnosis. J Bangladesh Coll Phys Surg 2026; 44: 103-110
Background: Epilepsy is a common neurological disorder with the most demanding and challenging management, It ranges from narrowly focused medication-based management to holistic management. Martial and Methods: This cross-sectional study was conducted from Jan 2020 to June 2020 at the Institute of Pediatric Neurodisorder and Autism, Bangabandhu Shiekh Mujib Medical University (BSMMU). Previously diagnosed and purposively selected 70 epilepsy patients who are attending at the outpatient department during data collection period were included in the study. Data was collected through face-to-face interview using a pre tested questionnaire. Results: Mean age of the children was 4.28±3.65 (SD) years, majority were male (75.70%) having middle class group (54.73%) with rural inhabitant (51.40%). More than half (51.40%) parents had superstitious belief and 48.60% had history of taking consultation from traditional healer. History of post-natal complication and developmental delay prominent among patients and 47.1% had the onset of the disease within 06 months of age. One-fourth (24.3%) patients able to live independently without any supervisions. Nearly half of the patients (47.2%) had focal seizure and 37.1% had generalized seizure. Conclusion: In Bangladesh perspective, superstitious belief and seeking consultation to traditional healers are major drawbacks for availing modern treatment options. Mean age of the epileptic children was 4 years with clear male preponderance. Focal seizure was the commonest type among the study patients. It is also revealed that adequate treatment enabled a good number of patients to live independently. J Bangladesh Coll Phys Surg 2026; 44: 88-93
Primary biliary cholangitis (PBC) is a chronic autoimmune cholestatic liver disease characterized by progressive destruction of small intrahepatic bile ducts. It predominantly affects middle-aged women, and occurrence in males is uncommon. We report a case of a 53-year-old male presenting with long-standing pruritus, recent onset jaundice, and pedal edema. Laboratory evaluation revealed markedly elevated alkaline phosphatase, positive antinuclear antibody (ANA), and antimitochondrial antibody (AMA) with negative viral markers and no evidence of biliary obstruction on imaging. Fibroscan suggested advanced fibrosis, and endoscopy revealed esophageal varices. A diagnosis of PBC with cirrhotic changes was made. The patient was treated with ursodeoxycholic acid along with supportive therapy. This case highlights the importance of considering PBC in male patients with cholestatic liver disease for early diagnosis and management. J Bangladesh Coll Phys Surg 2026; 44: 138-139
Medical carelessness and misconduct are prevalent health concerns in Bangladesh. Individuals encounter diverse challenges within the healthcare industry in Bangladesh. Individuals receive services from both government hospitals and private hospitals and clinics, but the quality and adequacy of healthcare services and facilities still need improvement. The paper aims to examine the prevalence and nature of medical negligence and malpractice in Bangladesh, assess existing legal remedies, and identify policy measures to improve accountability and quality of care. This study employs a narrative review of existing literature, including academic publications, policy documents, legal frameworks, and relevant case reports on healthcare delivery and medical misconduct in Bangladesh. The review synthesizes evidence on systemic challenges, patterns of negligence, and the effectiveness of current legal and regulatory mechanisms. The review finds that patients in Bangladesh face significant deficiencies in both public and private healthcare systems, including inadequate service quality, limited accountability, and uneven access to care. Medical negligence and malpractice emerge as persistent issues, driven by weak regulatory enforcement, lack of professional oversight, and insufficient patient protection mechanisms. Existing legal remedies are often underutilized or ineffective due to procedural complexity, low public awareness, and barriers to access. These challenges affect individuals across socioeconomic groups, highlighting systemic weaknesses in healthcare governance. Strengthening regulatory oversight, improving professional accountability, and enhancing patient rights protections are critical to addressing medical negligence in Bangladesh. Reforms should include clearer legal pathways for redress, increased public awareness of patient rights, standardized clinical protocols, and stronger monitoring of healthcare providers. Policy interventions aimed at transparency, training, and institutional accountability are essential to ensure equitable and quality healthcare delivery. J Bangladesh Coll Phys Surg 2026; 44: 127-134
Background: Dengue fever is a important mosquito-borne illness prevalent in tropical and subtropical regions, posing serious health risks, especially to children. While the common clinical features of dengue, such as high fever, rash, and joint pain, are well-documented, less is known about its neurological manifestations in pediatric patients. These can include a range of symptoms from headaches and seizures to more severe conditions like encephalitis and neuropathy. The complexity of these neurological symptoms often complicates the diagnosis and management of dengue in children.The aim of the study was to evaluate the neurological manifestations of childhood dengue fever and to enhance understanding of the frequency and types of these complications. Methodology: This observational cross sectional study was conducted in the Dengue unit of the Department of Paediatrics and the Department of Paediatric Neurology at BMU from June 2023 to May 2024. Children age 1 month to 15 years who diagnosed with dengue fever (Dengue NS1 positive) were included in this study, while children had large ascites were excluded. After admission to the dengue unit, each child was assessed clinically through a detailed history and thorough physical examination. All children were also evaluated neurologically Results: The data suggests that most children aged 5-10 years (61-120 months) 39(40.63%) with a mean age 96.38 ± 52.45 months, particularly males 56(58.3%), residing in urban areas 71(74.0%), and belonging to the middle social class 77(80.2%), may be at higher risk for dengue fever. Fever had 96(100.0%) of subjects, anorexia and vomiting 74(77.1%), and pain 60(62.5%) respectively. More than one fourth (28.1%) subjects had headache followed by encephalopathy 3(3.1%), febrile seizures 2(2.1%), and encephalitis-like features such as lethargy, confusion and coma 2(2.1%) respectively. Conclusion: Fever remains the most common presenting feature of dengue in children; however, a notable proportion develop neurological manifestations, including headache, encephalopathy, febrile seizures, and encephalitis-like features. Early recognition of these complications is essential for appropriate management and improved outcomes. J Bangladesh Coll Phys Surg 2026; 44: 111-116
Familial hypomagnesemia with secondary hypocalcemia (FHSH) is a rare genetic autosomal recessive disorder caused by mutations in the TRPM6 gene, which encodes for the receptor which serves as an active channel that transports Mg2+ and Ca2+ ions. It results in hypomagnesemia and secondary hypocalcemia. Typical symptoms begin in the neonatal period with seizures and tetany that are resistant to antiepileptic medications. This is a treatable condition, and the treatment involves magnesium and calcium supplementation. If left untreated, prolonged hypomagnesemia can lead to long-term disability. Here we report a case of a 50-day-old term female infant, born to non-consanguineous parents, who presented with recurrent generalized seizures starting at 40 days of age. Initial evaluation revealed severe hypocalcemia with persistent seizures despite calcium and antiepileptic therapy. Further workup showed marked hypomagnesemia with hyperphosphatemia. Seizures responded only after magnesium supplementation. Genetic testing confirmed a TRPM6 gene mutation, establishing the diagnosis of primary hypomagnesemia with secondary hypocalcemia. The patient achieved complete seizure control and normal milestones of development with appropriate magnesium replacement therapy. J Bangladesh Coll Phys Surg 2026; 44: 135-137
Background: For larger Renal Cell Carcinoma (RCC), partial nephrectomy (PN) is gaining its feasibility, which facilitates conservation of functional renal tissue but keeping oncological outcome unaltered. Our aim is to study the short term i.e. one year oncological and renal functional outcome of > 7 cm RCC cases treated with PN. Methodology: A descriptive, prospective, observational study was designed and cases of RCC with size >7 cm, favorable anatomy, treated with PN were included. Preoperative and post-operative renal function, tumor characteristics, oncological clearance, cancer recurrence and post-operative complication were studied by following up for 12 months. Result: Total 22 patients was enrolled, 86.4% were male, mean age 58.73 + 6.69 years, mean BMI 24.34 + 2.7 kg/m2 and 02 (9.1%) patient had Chronic Kidney Disease (CKD). Mean maximum tumor diameter was 7.58 + 0.52 cm, and RENAL score was 9.86 + 1.12. Among them 21 (95.5%) patient were T2aN0M0 (Stage-ii) and 01 (4.5%) T2aN1M0 (Stage-iii). Pre-operative mean serum creatinine was 1.05 + 0.31 mg/dl and eGFR was 86.3+ 21.4 ml/min. After following up for one year the mean serum creatinine and eGFR was 1.0 + 0.24 mg/dl and 88.9 + 19.2 ml/min respectively. No significant alteration observed in concurrent variables like Hb%, ESR, alkaline phosphatase and LDH level. Seventeen cases (77.3%) was found to have clear cell variety of RCC, whereas 02 (9.1%) papillary RCC and 3 (13.6%) chromophobe RCC. While plotted on Clavien-Dindo Classification of post-operative complication, 05 (22.7%) patient developed Grade-1 complication. None of our cases had any recurrence of cancer within the 01 year of follow up. Conclusion: Our study supports expanding the role of partial nephrectomy beyond traditional size limits, demonstrating that even tumors >7 cm can be managed effectively with nephron-sparing surgery in selected patients. When performed in specialized centers, PN offers favorable short-term oncological outcomes while preserving renal function, underscoring its growing importance in modern RCC management. J Bangladesh Coll Phys Surg 2026; 44: 117-126
Background: Knee joints play an important role in gait and weight bearing. So reliable knee joint coverage is essential for recovery of the most function of lower limb. Among a variety of reconstructive options for the knee the Lateral Genicular artery Perforator Flap is reliable method in soft-tissue cover around the knee with an excellent outcome and minimal morbidity of the donor site. The vascular basis of this flap has consistent and reliable anatomy. So the present study observes the outcome of superior lateral genicular artery flap for soft tissue defect around the knee. Material & Methods: This study was done at the department of Plastic and Reconstructive Surgery, Chittagong Medical College Hospitals, from January 2020 to July 2023. It included 18 patients Result: Among 18 patients male were predominant with their age ranged from 15 to 60 years. The knee defects were due to different etiologies maximum patients (12) were patients with road traffic accidents. The defects were covered by the superior lateral genicular artery perforator flap all flaps survived except in 3 cases. 2 cases managed conservatively and healed well and in the third case the necrotic part was debrided and skin grafted. The donor site was closed primarily in 12 cases and skin grafted in 6 cases. Conclusion: Superior Lateral genicular artery perforator flap is a good option for cover of soft tissue defects around the knee . The anatomy of the flap perforators is consistent and reliable. Donor site morbidity is minimal with no functional loss. J Bangladesh Coll Phys Surg 2026; 44: 83-87
Abstract not available J Bangladesh Coll Phys Surg 2026; 44: 72-74
Dengue is a common but potentially deadly illness, which can be complicated by hemophagocytic lymphohistiocytosis (HLH). This report describes two cases of dengue fever in otherwise healthy individuals who faced challenges due to HLH. The diagnosis was established by meeting the clinical and laboratory criteria for HLH. Both patients were successfully treated with a pulse regimen of methylprednisolone and other supportive measures. This case report highlights the importance of early diagnosis and appropriate treatment for HLH patients to reduce morbidity and mortality associated with this condition. J Bangladesh Coll Phys Surg 2026; 44: 68-71
Hemoglobin Lepore is one of the rare structural variations of hemoglobin (Hb) that arises from unequal crossing over between the δ and β globin genes. Hb Lepore heterozygous is clinically similar to people with mild thalassemia. Here we reported a 32-years-old male febrile patient diagnosed incidentally as a rare haemoglobin Lepore trait. J Bangladesh Coll Phys Surg 2026; 44: 60-63
Effective communication is fundamental for efficient healthcare delivery. It enhances and ensures standards of patient care, patient safety and satisfaction. It fosters a positive and collaborative environment enabling and safeguarding standards of patient care and also teaching and training in medicine. In practice different methods of communication are used in complex combinations for meaningful exchange of information. Each component skill carries its significance for transfer of intended information, ideas and spirits. Dearth in any of these skills may alter the theme of the massage. Hence a high level of competence in each of them is essential for complete and undistorted communication. Behavioral communication has significant impact for health care personals in all capacities. This paper is a brief review of different skills considered essential for physicians in their professional practice. J Bangladesh Coll Phys Surg 2026; 44: 47-59
Introduction: Base tongue carcinoma is commonly diagnosed an advanced stage in low-resource settings. Concurrent chemoradiotherapy (CCRT) and sequential chemoradiotherapy (SCRT) after induction chemotherapy are both used, but their comparative effectiveness remains unclear in such contexts. Aim of the study: The study aimed to compare the treatment response and acute toxicities between concurrent chemoradiotherapy and sequential chemoradiotherapy in patients with locally advanced base of tongue carcinoma in a limited-resource setting. Methods: The study was conducted using a purposive sampling technique at the National Institute of Cancer Research and Hospital (NICRH), Dhaka, over 12 months (June 2016–May 2017). A total of 60 patients with histopathologically confirmed squamous cell carcinoma of the base of tongue at stage III or IVA were enrolled and randomized into two equal groups. Arm A received concurrent chemoradiotherapy (CCRT) with external beam radiotherapy (66 Gy in 33 fractions over 6½ weeks) using the 3D Conformal Radiotherapy (3DCRT) technique, along with weekly cisplatin (40 mg/m²). Arm B received three cycles of induction chemotherapy (cisplatin 75 mg/m² on Day 1 and 5-FU 750 mg/m²/day for 3 days, every 3 weeks), followed by the same CCRT as Arm A. Data were analyzed using SPSS v22.0, employing descriptive statistics and Chi-square/Fisher’s exact tests, with p<0.05 considered statistically significant. Results: In this study involving 60 patients with unresectable locally advanced esophageal cancer, baseline characteristics such as tumor location (p=0.564), stage (p=0.558), and histological grade (p=0.739) were comparable between the concurrent and sequential CRT groups. The complete response rate was higher in the sequential CRT arm (56.7%) compared to the concurrent arm (46.7%), though this difference was not statistically significant (p=0.578). There were no significant differences in hematologic toxicity (e.g., anemia: p=0.793; leukopenia: p=0.630; neutropenia: p=0.278; thrombocytopenia: p=0.682) or non-hematologic toxicity (e.g., nausea/vomiting: p=0.907; mucositis: p=0.517; dysphagia: p=0.794; esophagitis: p=0.541; fatigue: p=0.898; anorexia: p=0.759) between the two treatment groups across follow-ups. These findings suggest that both concurrent and sequential CRT offer similar efficacy and safety profiles in the management of locally advanced esophageal cancer. Conclusion: Both concurrent and sequential chemoradiotherapy demonstrated comparable efficacy and tolerable toxicity profiles in treating locally advanced base of tongue carcinoma in a limited resource setting. Either approach can be considered a viable treatment option depending on patient factors and resource availability. J Bangladesh Coll Phys Surg 2026; 44: 26-32
Background: Adequate closure of the appendiceal stump is vital to minimize intraabdominal complications and surgical site infections in laparoscopic appendectomy. There are various techniques for the closure of base of the appendix while performing a laparoscopic appendectomy like endoloop, extracorporeal (Roeder’s knot) or intracorporeal knotting, clips and endo stapler. Objective: To assess the safety and efficacy of nonabsorbable hem-o-lock polymer clips for laparoscopic appendiceal stump closure in acute appendicitis. Methodology: This is a descriptive observational study carried out at Brahmanbaria Medical College Hospital from January 2017 to August 2023. Patients, who underwent laparoscopic appendectomy with nonabsorbable hem-o-lok polymer clips appendiceal stump closure, were included in the study. Data on patients’ demography, intraoperative and postoperative complications, operative time and hospital stay were collected for statistical analysis. Result: A total of 42 patients who underwent laparoscopic appendectomy with nonabsorbable hem-o-lok polymer clips stump closure, were included in this study. Among them 62% were female and 38% male. Mean age was 23±4.042 years. The mean operative time was 38.40±8.709 minutes. Mean hospital stay was 2.5±0.707 days. No major intraoperative and postoperative complications observed. Conclusion: The use of nonabsorbable hem-o-lock polymer clips for the closure of appendiceal stump in laparoscopic appendectomy is feasible, safe, fast and effective technique. Due to simplicity of the technique it may be a useful alternative to the other methods of laparoscopic appendiceal stump closure. J Bangladesh Coll Phys Surg 2026; 44: 33-39
