Background: Neurometabolic disorders (NMD) encompass rare genetic errors affecting metabolism, often with neurological consequences. These disorders, characterized by genetic defects impacting enzyme function or vitamin deficiencies, can lead to severe neurological symptoms and lifelong disability. Whole exome sequencing (WES) is a vital diagnostic tool, offering a high yield in identifying genetic causes, especially in cases where traditional screenings fail to achieve diagnostic confirmation. Diagnostic confirmation is essential for providing precise treatment, genetic counseling, and prevention strategies for neurometabolic disorders. This study was conducted with the aim to observe the genetic profile of suspected neurometabolic diseases in children by whole exome sequencing. Method: The study was conducted at the department of pediatric neurology at the Institute of Pediatric Neurodisorder and Autism (IPNA) of Bangladesh Medical University (BMU) from April 2024 to March 2025, focused on infants and children suspected of neurometabolic diseases. Those aged over 1 month to less than 18 years with inconclusive initial metabolic screenings underwent whole exome sequencing for diagnosis. Real-world data were used, with subjects enrolled through convenience sampling with parental consent. The study adhered to the Ethical Committee's approval at Bangladesh Medical University. Detailed assessments included history taking, physical examinations, and investigations, with WES reports classified following ACMG guidelines. Results: In this study of 21 patients, with a gender distribution of 66.7% male and 33.3% female, consanguinity was present in 47.6% of cases. Common clinical features encompassed developmental delays, seizures, developmental regression. Basic metabolic screenings and neuroimaging unveiled specific abnormalities. Whole exome sequencing identified various gene mutations and neurometabolic diseases, including glycine encephalopathy, phenylketonuria and developmental and epileptic encephalopathies. Conclusion: This research demonstrated, whole exome sequencing (WES) provided valuable diagnostic information regarding different types of neurometabolic diseases in suspected children with neurometabolic diseases. Bangladesh J Medicine 2026; 37(2): 106-113
Prurigo pigmentosa is a rare inflammatory dermatosis, often linked to ketosis and dietary changes, and infrequently reported in South Asian populations. The majority of reported cases involve young adults, with a marked female predominance and peak incidence in the second to third decades of life. It presents diagnostic challenges due to its overlap with other papulosquamous and interface dermatoses. Doxycycline is effective for its anti-inflammatory properties and remains a mainstay in treatment. A 34-year-old Pakistani woman developed a pruritic, widespread red brownish scaly itchy rash all over the body for 4 days. There is h/o fever and sore throat 2 weeks ago, no join pain following intermittent fasting and an upper respiratory tract infection. On examination, pruritic erythematous maculopapular eruption with few lesions with scales, began as erythematous purpuric eruption, spreading and turning brownish present all over the body. Histopathology showed parakeratosis, interface dermatitis, and dermal lymphohistiocytic infiltrates with eosinophils features suggestive of prurigo pigmentosa. Differential diagnoses included pityriasis lichenoides et varioliformis acuta (PLEVA) and lichenoid drug reaction. Our plan is to administer symptomatic treatment with emollients, antihistamines, topical steroids and anti-inflammatory. Bilaxtin, Doxycycline for 15 days. The patient responded favourably to doxycycline and symptomatic treatment, with resolution of inflammation and residual hyperpigmentation.This case underscores the need for clinical suspicion of prurigo pigmentosa in patients with dietary or metabolic triggers. Early histopathological confirmation facilitates accurate diagnosis and management. Bangladesh J Medicine 2026; 37(2): 172-175
Meniere’s disease is a chronic disorder of the inner ear characterized by episodic vertigo, fluctuating sensorineural hearing loss, tinnitus, and aural fullness. The condition predominantly affects middle-aged adults; early-onset presentations are rare and often misdiagnosed, particularly when sinonasal pathology coexists. We report the case of an 18-year-old male presenting with persistent bilateral tinnitus, progressive hearing loss, recurrent vertigo attacks, nausea, imbalance, headache, facial pain, and ear discomfort for more than one year. Despite prolonged medical therapy including betahistine, cinnarizine, prochlorperazine, clonazepam, analgesics, and multivitamin supplementation, symptoms persisted and significantly impaired quality of life. Computed tomography of the paranasal sinuses revealed mucosal thickening and partial opacification of the maxillary and ethmoid sinuses, suggestive of chronic sinusitis with possible Eustachian tube dysfunction. Clinical findings were consistent with early-onset Meniere’s disease. Given poor response to pharmacological therapy, the patient was advised bilateral myringotomy with ventilation tube placement, followed by intratympanic steroid administration to reduce inner ear inflammation and stabilize vestibular symptoms. This case highlights the diagnostic complexity of early-onset Meniere’s disease when associated with chronic sinonasal inflammation. Early multidisciplinary evaluation and targeted intratympanic therapy may improve symptom control and prevent long-term auditory-vestibular disability. Bangladesh J Medicine 2026; 37(2): 156-160
Background: Thalidomide has been shown as a promising treatment option for reducing transfusion volume in adults with β-thalassemia. It induces γ-globin expression in erythroid progenitor cells, but its efficacy on children with transfusion-dependent β-thalassemia (TDT) remains unclear. This study aimed to determine the safety and efficacy of thalidomide in TDT children. Methods: In this phase 2, single-center, quasi-randomized, single-blind clinical trial, 60 patients of 3-18 years were randomly assigned to receive placebo or thalidomide for 12 weeks. The primary endpoint was the change of hemoglobin (Hb) level in the patients. The secondary endpoints included the red blood cell (RBC) units transfused and adverse effects. Results: In the placebo-controlled period, Hb concentrations in patients treated with thalidomide achieved a median elevation of 14.5 (range, 5.0 to 34.0) g/L, whereas Hb in patients treated with placebo did not significantly change. Within the 12 weeks, the mean RBC transfusion frequency for patients treated with thalidomide and placebo was 0.73 ± 0.9 times and 2.9 ± 0.6 times, respectively (P < 0.001). Significant increase in Hb concentration and reduction in RBC transfusions were associated in children with E-β Thalassemia in comparision with β-thalassemia major (P < 0.001). No unfavorable efects were observed on kidney and liver functions. Mild adverse events including drowsiness, dizziness, pyrexia, pruritus, abdominal pain, nausea, constipation, facial edema were more frequently found in (60%) patients treated with thalidomide. Conclusion: This study concludes that thalidomide is an efective and well-tolerated drug that can significantly increase Hb levels and reduce transfusion burden in children with TDT patients. Bangladesh J Medicine 2026; 37(2): 100-105
Background: Carbapenem-resistant Enterobacteriaceae (CRE) poses a public-health threat due to limited treatment options thus leading to substantial morbidity and mortality. We aimed to systematically review the prevalence of CRE in Bangladesh from previously published literatures with organism distribution and associated resistance genes. Methods: Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, we searched PubMed, Google Scholar, and the Directory of Open Access Journals (DOAJ) to identify cross-sectional studies from Bangladesh. After screening and eligibility assessment, we identified seven studies that met the inclusion criteria. Results: The crude prevalence of CRE was 11.79% (95% CI, 10.64–13.05). The pooled prevalence was 15.46% (95% CI, 6.85–31.27; I² = 93.1%), indicating high between-study heterogeneity. Predominant species were Escherichia coli (40.57%), Klebsiella pneumoniae (25.47%), and Enterobacter cloacae (3.77%); Enterobacter spp. (15.99%) and Klebsiella spp. (4.72%) were also frequent. Among resistance genes, the NDM family predominated: blaNDM-5 was detected in 30 isolates and blaNDM-1 in 29. Other reported genes included blaOXA-1 (n = 17) and blaCTX-M-1 (n = 10). Conclusion: It’s urgent to strengthen the national antimicrobial resistance surveillance and establishment of antimicrobial-stewardship programs. Further research should investigate the transmission dynamics and genetic contexts of resistance determinants within these bacterial lineages. Bangladesh J Medicine 2026; 37(2): 92-99
Ocular syphilis is a rare manifestation of Treponema pallidum infection that can occur at any stage of disease and may lead to irreversible vision loss if not recognized and treated promptly. Because it can mimic a wide range of ocular inflammatory conditions and may occur without classic systemic features of syphilis, diagnosis is often delayed. Recent epidemiologic data demonstrate a marked rise in syphilitic uveitis cases globally. We report a 44-year-old woman with bipolar disorder, seizure disorder, hepatitis C, and polysubstance use who presented with acute right eye swelling, irritation, and bilateral visual disturbances. Her visual symptoms were repeatedly attributed to allergic irritation, delaying diagnosis.Ophthalmologic evaluation demonstrated mild ocular inflammation, and serologic testing confirmed syphilis with positive treponemal and nontreponemal results. Despite multiple interruptions in therapy, she ultimately completed treatment with intravenous penicillin G in accordance with current guidelines. This case highlights the importance of maintaining a high index of suspicion for ocular syphilis, obtaining timely serologic testing, and addressing barriers to treatment adherence through coordinated multidisciplinary care. Bangladesh J Medicine 2026; 37(2): 161-164
Chronic obstructive pulmonary disease (COPD) remains a leading cause of morbidity and mortality globally and is driven mainly by smoking, indoor biomass exposure, and air pollution. Despite advances in inhaled therapy, many patients continue to experience exacerbations and poor quality of life. This narrative review summarizes recent updates in pharmacologic and nonpharmacologic management drawn from major randomized trials, meta-analyses, and guidelines published between 2010 and 2025. The evidence supports early combination and triple-inhaler therapy to reduce exacerbations, improve lung function, and lower mortality, particularly in eosinophilic COPD patients. Novel biologics, such as mepolizumab and dupilumab, result in meaningful reductions in moderate or severe exacerbations, whereas new agents, such as roflumilast and ensifentrine, benefit frequent exacerbators with chronic bronchitis. Nontarmacologic measures, including smoking cessation, pulmonary rehabilitation, vaccination and high-intensity noninvasive ventilation, remain essential components of comprehensive care. In resource-limited settings such as Bangladesh, barriers to diagnosis, cost, and access to inhalers highlight the need for affordable generics, local rehabilitation programs, and the integration of COPD services into primary care. The evolving therapeutic landscape now enables more personalized, phenotype-driven management. Continued research and the adaptation of global evidence to local contexts are critical for reducing the COPD burden and improving long-term outcomes. Bangladesh J Medicine 2026; 37(2): 86-91
Leptospirosis is a common zoonotic infection in tropical countries due to contact with water contaminated by the spirochaete Leptospira. Here, we present four different and unrelated cases of patients presenting with leptospirosis. A23-year-old pregnant woman hailing from Savar presented with aseptic meningitis due to leptospirosis after bathing in contaminated water.She did not respond to Ceftriaxone initially and was treated with adjunct Dexamethasone according to the treatment protocol for bacterial meningitis. We also present cases of three middle-aged gentlemen presenting with Weil’s disease. Out of these three patients, two of them presented with fever and jaundice, and one presented with fever, jaundice, and acute kidney injury. Clinical vigilance is required to ensure appropriate recognition of patients with leptospirosis, as the presentation is variable. Bangladesh J Medicine 2026; 37(2): 165-171
Background: Vitamin D (Vit D) is a fat-soluble steroid hormone crucial for skeletal health, immune function, and chronic disease prevention. Despite ample sunlight, a high prevalence of hypovitaminosis D has been reported in Bangladesh. This study aimed to determine the prevalence and correlates of Vit D deficiency(VDD) among adults attending a tertiary care facility in Dhaka. Methods: A crosssectional study was conducted at the Bangladesh Institute of Health Sciences (BIHS) General Hospital, Dhaka, from 1st January 2021 to 31st December 2023. A total of 300 adult patients (N=300) meeting inclusion criteria were enrolled. Data on socio-demographics, lifestyle, and clinical presentation were collected via a structured questionnaire. Serum 25-hydroxyvitamin D [25(OH)D] was measured by Chemiluminescent Microparticle Immunoassay (CMIA). Results: The mean age of participants was 38.7±12.4 years, with 54.0% Female and 46.0% male. Hypovitaminosis D (25(OH)D<30 ng/mL) was present in 276 (92.0%) patients, comprising 179 (59.7%) deficient (<20 ng/mL) and 97 (32.3%) insufficient (20-29.9 ng/mL). Only 24 (8.0%) had sufficient levels. Deficiency was significantly higher in females (66.7%) compared to males (53.7%) (p=0.015), in those with indoor occupation (65.8%) (p=0.001), inadequate sun exposure (67.2%) (p=<0.001), and low fish intake (<2 times/week) (69.0%) (p=<0.001). The predominant presenting complaints were generalized fatigue (67.7%), bone/joint pain (59.3%), and muscle weakness (52.0%). Conclusion: An alarmingly high prevalence of Vit D deficiency was found among adult patients in this urban tertiary care setting. Female gender, indoor lifestyle, inadequate sun exposure, and poor dietary habits were significant risk factors. Public health strategies, including awareness campaigns, dietary fortification, and targeted supplementation, are urgently needed to address this silent epidemic. Bangladesh J Medicine 2026; 37(2): 143-148
Background: The prevalence of coronary artery anomalies (CAAs) varies from 0.2% to 5.6%. Besides conventional invasive coronary angiography (CAG), Computerised Tomography Coronary Angiography (CT-CAG) provides better anatomy of coronary arteries. Early detection and evaluation of coronary artery anomalies is essential because of their potential association with myocardial ischemia and sudden death. We aimed to find the clinical and demographic profile of patients with CAAs and describe pattern of CAAs as detected by CT-CAG at our center. Methods: This cross-sectional study was carried out in the Department of Cardiology, Shahid Gangalal National Heart Centre, Kathmandu, Nepal, from April 2025 to March 2026. The data was collected by analysing the coronary angiographic reports of the patients that underwent CT-CAG. Clinical and demographic profiles of the patients were recorded and CAAs were described using Angelini’s classification. Results: CAAs were found in 84 (40 males and 44 females) of 4081 patients giving a frequency of 2.05%. The mean age was 54.02+11.76 (range 25 - 79). The chest pain was the most common indication for undergoing CT-CAG. Among these, anomalies of origin and course were the most common seen in 69(82.14%) cases. RCA arising from left sinus of Valsalva with interarterial course was the most common anomaly present in 47 (55.9%). LCx arising from RSV was found in 8(9.52%) cases. High take-off of RCAfrom ascending aorta, single ostial origin of both coronary arteries and anomalous origin of left main coronary artery (LMCA) each were seen in 4 (4.76%) cases. Coronary artery aneurysm was seen in 9 (10.71%) cases, while dual LAD was seen in 2 (2.38%) patients, and five (5.95%) cases of coronary cameral fistula were seen. one (1.19%) case each of LCx arising from RCA and LAD arising from RSV were found. Conclusion: We found that the frequency of CAAs was slight female predominance and chest pain being commonest indication for CT-CAG. Though generally asymptomatic some CAAs may produce angina symptoms, myocardial infarction and sudden death. Bangladesh J Medicine 2026; 37(2): 149-155
Background: Thiopurine S-methyltransferase (TPMT) is the rate-limiting enzyme in the metabolism of azathioprine (AZA). Genetic polymorphisms in TPMT can increase the risk of adverse effects from AZA. AZA is commonly used as an immunosuppressant to maintain remission in patients with Systemic Lupus Erythematosus (SLE). This study aims to investigate the frequency of TPMT polymorphisms in SLE patients . Methods: This post hoc case–control study was conducted at Bangladesh Medical University and the University of Dhaka from July 2022 to January 2023. Adults (18–65 years) fulfilling American College of Rheumatology criteria for SLE were enrolled. TPMT genotyping was performed using polymerase chain reaction–restriction fragment length polymorphism (PCR–RFLP). Patients were assigned to AZA (n = 120) or non-AZA (n = 217) groups. Exclusion criteria included recent blood transfusion, use of drugs causing myelosuppression or interfering with AZA/6-MP metabolism, concomitant cyclosporine or mycophenolate mofetil therapy, and pregnancy. AZA was initiated for clinical indications at 1 mg/kg/day, escalated to 2 mg/kg/day after two weeks, and continued with four-weekly assessments for 12 week. Results: The mean age of the AZA group was 28.4 ± 9.5 years; 96.65% were female. TPMT polymorphisms were detected in 12 patients (3.56%), all carrying the TPMT*3C allele. Ten patients developed myelosuppression; among AZA-treated patients with TPMT polymorphisms, six of seven (85.7%) developed myelosuppression. Overall, 16 patients (14.4%) develop AZA-related adverse effects.Conclusion: TPMT polymorphisms were uncommon in this study but strongly associated with AZA-induced myelosuppression. Pre-treatment genotyping may improve the safety of AZA therapy in SLE patients. Bangladesh J Medicine 2026; 37(2): 128-136
Background: Hepatitis B Virus (HBV) infection constitutes a significant occupational hazard for healthcare workers (HCWs), particularly intern doctors who are at the frontline of patient care and perform high-risk procedures. Vaccination is the most effective preventive measure, and postvaccination serological testing for anti-HBs antibodies is crucial to confirm seroprotection .This study aimed to assess the HBV vaccination status and determine the seroprotection rate among intern doctors in a Medical College of Bangladesh. Methods: A cross-sectional study was conducted from January to March 2023 among 200 intern doctorsin the Department of Gastroenterology, Rangpur Medical College Hospital ofBangladesh. Participants were interviewed using a structured questionnaire to ascertain their HBV vaccination history. Those with a complete vaccination record (three or more doses) were included for serological testing. Individuals with known immunodeficiency disorders, chronic illnesses, or on immunosuppressive therapy were excluded. A total of 159 interns were confirmed as vaccinated. Among them, 150 consented to provide a blood sample for quantitative anti- HBs titer measurement via Chemiluminescent Microparticle Immunoassay (CMIA). Results: The vaccination coverage among the intern doctors was 79.5% (159/200). Among the 150 interns whose anti-HBs titers were analyzed, 132 (88.0%) had protective antibody levels (anti-HBs e”10 mIU/mL). The mean anti-HBs titer was 287.6 mIU/mL (Range: 2.1 to >1000 mIU/mL). However, 18 (12.0%) interns were identified as non-responders (anti-HBs <10 mIU/mL) despite completing the primary vaccination series. No significant correlation was found between the time since last vaccination and antibody titer within this short follow-up duration. Conclusion: Although a high rate of vaccination coverage was observed, a concerning 12% of vaccinated intern doctors lacked adequate seroprotection against HBV, leaving them vulnerable to a life-threatening occupational infection. This underscores the critical necessity of mandatory post-vaccination serological testing (anti-HBs titer) for all healthcare workers following primary immunization. Non-responders must be identified and managed with additional vaccine doses or strict adherence to universal precautions to prevent this preventable professional hazard. Bangladesh J Medicine 2026; 37(2): 137-142
Background: Non-alcoholic fatty liver disease (NAFLD), a growing global epidemic, encompasses a broad spectrum of stages of disease severity, including simple steatosis, steatohepatitis (NASH), and cirrhosis. Accurate staging is necessary for the treatment and follow-up of the patients. Several non-invasive methods for the objective assessment of disease severity in NAFLD have been tested; serum ferritin is relatively new. Therefore, the objective of the study was to evaluate the correlation between the variation of serum ferritin levels and different histological stages of NAFLD. Methods: The study was a hospital-based cross-sectional observational study conducted at the Department of Medicine and Hepatology, DMCH, from July 2017 to December 2017. All adult patients of NAFLD admitted or attended outdoors in the aforementioned department were approached for inclusion in the study. Assessment of the patients was done by the NAFLD Activity Score (NAS), and fibrosis staging and estimation of serum ferritin were also performed for each patient. Written informed consent was taken from the subject, and ethical issues were addressed. Following data collection, it was analyzed by the SPSS 17. Results: Out of a total of 50 patients, 60% were males and 40% were females (M: F=3:2). Mean age was 49.22±9.30 SD (years), ranging from 33 to 65 years. About 46% had class I obesity, 26% were overweight, and 8% had class II obesity. The majority of patients (62%) had NASH, 34% had borderline NASH, and 4% had no signature of NASH in the histopathology. The mean NAFLD activity score (NAS) was 4.98±1.47. Of all, 46%, 40%, and 10% of patients were in fibrosis stages 2, 1, and 3, respectively. Mean serum ferritin was 226.47±155.70 SD (ng/ml) [range: 13.60-722.00 ng/ml with a median value of 186.00 ng/ml]. Serum ferritin level was slightly higher in patients with NASH stage on histopathology than in those with borderline NASH stage and non-NASH stage. Similarly, the mean serum ferritin level was found to increase slightly with increasing fibrosis score. However, in both cases, the relationship is not statistically significant (p-value>0.05). Conclusion: Serum ferritin level is not associated with different histological stages of Non-alcoholic fatty liver disease. Bangladesh J Medicine 2026; 37(2): 114-120
Background: Worldwide, 350 million people are chronically infected with HBV, and >50% of HCCs are attributable to HBV infection. Among them, a significant portion presents with a space-occupying lesion (SOL) in the liver and is detected incidentally. Alpha-fetoprotein (AFP) has long been considered the ideal serological marker for detecting hepatocellular carcinoma (HCC). However, limited studies were conducted to reveal the correlation between serum alpha-fetoprotein level & FNAC findings of liver SOL in patients with chronic HBV infection. Therefore, this study aimed to assess the relation between serum alpha-fetoprotein level & ultrasound-guided FNAC findings of liver SOL in patients with chronic HBV infection. Methods: The study was a cross-sectional observational study conducted at the Department of Hepatology & Medicine in Dhaka Medical College Hospital. The study duration was six months. Formal ethical approval was taken before the commencement of the study. Adult patients of chronic HBV infection with newly diagnosed liver SOL through USG admitted to the DMCH were approached and selected according to the selection criteria. Following the description of the study's purpose, methods, benefits, and hazards, informed written consent was taken from each subject. All patients were subjected to a detailed history, clinical examination, and relevant investigations. Data were collected using qualitative and quantitative methods, using a questionnaire designed for the researcher's study. After collection, the data were edited manually and prepared for data entry. The final analysis was done by using SPSS 23. Results: Out of 70 SOL in the liver with chronic HBV patients, the mean age was 49.11±12.78 SD (years) [age range 25-72 years] with 80% male and 20% female representation. The majority of the patients (48.6%) had AFP levels were 1 – 10 ng/ml, and 39% had above 400 ng/ml, followed by 7.1% between 11 – 100 ng/ml and 5.7% between 101 – 400 ng/ml. The mean serum AFP level was 5611.94±14861.24 SD (ng/ml). FNAC showed that 42% had well-differentiated carcinoma, 20% had moderately differentiated carcinoma, and 38% had poorly differentiated carcinoma. Rising of alpha-fetoprotein is significantly correlated with cytopathologic grading (p<.05). Conclusion: Serum alpha-fetoprotein level is significantly correlated with the findings of histological grading of liver SOL in patients with chronic HBV infection. Bangladesh J Medicine 2026; 37(2): 121-127
Takayasu arteritis (TA), a rare granulomatous vasculitis primarily affecting large vessels, presents with a myriad of complex clinical features. This case report discusses a 24-year-old female presenting with fever, breathlessness, and heart failure, ultimately diagnosed with Takayasu arteritis (TA) complicated by autoimmune hemolyticanemia (AIHA). Despite treatment with antibiotics, steroids, and methotrexate, alongside interventions for pneumonia and tuberculosis, the patient’s condition deteriorated, resulting in mortality. The case underscores TA’s diverse and challenging clinical manifestations, including cardiac involvement and AIHA, emphasizing the need for multidisciplinary management and heightened clinical awareness. Despite efforts to address complications, the patient’s outcome highlights the complexity and severity of TA, warranting further research and awareness in clinical practice. Bangladesh J Medicine 2026; 37(1): 72-76
Subclavian artery thrombosis is a rare but clinically significant condition that can present with upper limb ischemia and neurological symptoms. While atherosclerosis remains the most common cause, hypercoagulable states such as hyperhomocysteinemia are increasingly being recognized as potential contributors.We report the case of a 40-year-old chronic smoker who presented with progressive pain, numbness, and weakness in the left upper limb. Clinical examination revealed absent pulses and a significant blood pressure discrepancy between the arms. CT angiography demonstrated thrombotic occlusion in the proximal segment of the left subclavian artery. Laboratory workup showed a markedly elevated serum homocysteine level (43 μmol/L), reduced protein C (65%) and protein S (51%) levels, and a positive Factor V Leiden test. Antithrombin III was within normal range (111%). Interestingly, fasting serum vitamin B12 and folate levels were elevated (980 pg/mL and 120 ng/mL, respectively). The patient was managed with anticoagulation, antiplatelets, and vitamin supplementation, and showed clinical improvement.This case underscores the importance of evaluating metabolic and thrombophilic risk factors, including hyperhomocysteinemia and inherited thrombophilia, in patients with arterial thrombosis at uncommon sites or in the absence of conventional risk factors. Early identification and correction can guide targeted therapy and potentially prevent recurrence. Bangladesh J Medicine 2026; 37(1): 62-67
