Systemic lupus erythematosus (SLE) in adolescents often presents more severely than in adults, with common complications including lupus nephritis (LN) and less frequently cardiac involvement such as pericarditis. Early recognition and treatment of these manifestations are critical, especially in resource limited settings where diagnostic and therapeutic delays can worsen the outcomes. We report the case of a 16 year old Bangladeshi girl with previously diagnosed SLE who presented with highgrade fever, fatigue, generalised edema, and pleuritic chest pain, and was diagnosed with SLE complicated by severe LN and a large lupus pericardial effusion. One year earlier, she had manifested with fever, rash, arthritis, oral ulcers, and renal involvement with serological confirmation of the diagnosis and responded well to corticosteroids and immunosuppressive therapy. On current presentation, examination revealed hypertension with bilateral pitting edema and signs of pericardial effusion (raised jugular venous pressure, distant heart sounds, and a pericardial friction rub), alongside anaemia but no active skin rash or arthritis. Echocardiography demonstrated a large pericardial effusion (~28 mm) with early features of cardiac tamponade. Due to financial constraints and urgent clinical need, invasive procedures were deferred. The patient was managed for a lupus flare with high dose corticosteroids, mycophenolate mofetil, and hydroxychloroquine, along with supportive care for cardiorenal syndrome resulting in marked clinical improvement and complete resolution of the effusion without invasive intervention. She was discharged on maintenance immunosuppression after showing marked improvement for a week. However, socioeconomic factors have impeded regular followup; at last telephone contact, she remains clinically stable on treatment.
Background: Stroke is the clinical syndrome of rapid onset of cerebral deficit (usually focal) lasting more than 24 hours or leading to death, with no apparent cause other than a vascular one1. Stroke is a common medical emergency with an annual incidence of between 180 and 300 per 100000. The incidence rises steeply with age, and in many developing countries, the incidence is rising because of the adoption of less healthy lifestyle. This observational prospective study was carried out to assess the relationship of hypertension among the ischemic stroke patients. The study also revealed the biochemical parameters, associated risk factors and socio-demographic scenario stroke victims. Different risk factors were recorded and analyzed for their association with Ischemic stroke. Among the non-modifiable risk factors age and sex distribution were studied. Methodology: The study was carried out on 171 patients of stroke in medicine unit of Holy Family Red Crescent Medical College with a view to assess the relationship between hypertension and ischemic stroke patients and it also provides simple health education on management of stroke victims and measures for its recurrence. Data collected in prescribed protocol were analyzed in simple statistical percentage, and cases were selected irrespective of age and sex. Results: Elderly people are the most vulnerable group for developing stroke. In the present study, 59.9 years was found to be the mean age of the Ischemic stroke patients and the maximum patients were between the age group of 61 to 70 years. Maximum (36.0%) of Ischemic stroke was between the age group of 61 to 70 years. The male female ratio was 3:1. Most of the patients were housewife (24.0%) and unemployed (42.0%). Hypertension was found in 66.0% cases and 10.0% cases had DM. More than half (60.0%) of the Ischemic patients had left sided abnormality, 40.0% had right sided, and 10.0% had both sided abnormality. Almost 44.0% of the study patients had family history of stroke and 40.0% were smoker, 34.0% had cardiac problems and 10.0% found as obese. Regarding the life style of the study patients, 68.0% lead moderate stressful life, 12.0% of the respondents had hyperlipildaemia, 10.0% had H/O alcohol intake. Among 50 Ischemic stroke patients, 76.0% were improved, 18.0% were static during discharge and 6.0% died. Conclusion: Stroke affects the people at the prime of their lives at the age of more than 60 years. This has a devastating effect on the individual, the family, the community and the nation as a whole. Perception of the problem is probably low in our country. This problem cannot be solved by the medical profession or the government alone. Community participation is essential for solving this huge problem.
Background: Ovarian yolk sac tumors are rare malignant germ cell tumors in young women. Fertility-sparing surgery plus bleomycin, etoposide, and cisplatin chemotherapy improves survival. Documented reports of term pregnancies after treatment are rare. Case Findings: A 29-yearold woman with a history of left ovarian yolk sac tumor underwent laparotomy with bilateral ovarian cystectomy. uterus and fallopian tubes were preserved. Tumor markers included CA 125 110.04 U/mL and total β hCG 84.57 mIU/mL on 4 March 2021, followed by CA 125 38.0 U/mL, β hCG 0.8 mIU/mL, LDH 244 U/L, and AFP 1150 ng/mL on 25 March 2021. Adjuvant BEP chemotherapy was administered as four 3 weekly cycles on 15 April 2021, 8 May 2021, 4 June 2021, and 24 June 2021, with completion of treatment on 1 July 2021. Whole body 18F-FDG PET/CT on 8 August 2021 showed no evidence of recurrence. She conceived in 2022. Antenatal ultrasonography demonstrated a single live intrauterine pregnancy with normal anatomy and Doppler findings. Outcome: At 38 plus weeks on 22 November 2022, she delivered by elective lower segment cesarean section a healthy female neonate weighing 3.2 kg, Apgar scores 8 and 9. Omental biopsy taken at cesarean was negative for metastasis. Conclusion: This case shows successful term pregnancy after fertilitysparing surgery and BEP chemotherapy for ovarian yolk sac tumor, with disease-free surveillance and negative intraoperative biopsy.
Urinary tract infection is one of the most common community-acquired and hospital-acquired infections in Bangladesh as well as around the world. Every year many men and women suffer from UTI and day by day treatment becomes difficult due to the development of antibiotic resistance. Our study aimed to investigate the antibiotic resistance of urinary pathogens isolated at Holy Family Red Crescent Medical College (HFRCMC) from January to December 2018. Out of 4258 urine samples,the total urine-positive samples were 1063. The most common pathogens isolated were Escherichia coli (51.4%), Klebsiella species (38.8%), Pseudomonas species (7.7%), and Acinetobacter species (2.2%%). E. coli and Klebsiella were found highly sensitive to Colistin, Imipenem, Meropenem, Nitrofurantoin, and Amikacin, but almost all were resistant to Cephalosporins and variably sensitive to Amoxiclav, Gentamicin, Ciprofloxacin, Cotrimoxazole, andPiperacillintazobactam. Pseudomonas species were found to havelow-level resistance to colistin, variableresistance to Imipenem and Meropenem, Gentamycin and Amikacin, Ciprofloxacin, and high resistance to Ceftazidime and Cefepime. Acinetobacter was found to be highly sensitive to Colistin and thento Co-trimoxazole. Imipenem, Meropenem, Ciprofloxacin, and Gentamycin showed variable resistance, and Cephalosporine, Amoxiclav, and Piperacillin tazobactam showed high resistance.
Introduction: Acute viral encephalitis (AVE) is a severe neurological condition associated with significant morbidity and mortality, often caused by neurotropic viruses such as herpes simplex virus (HSV) and Japanese encephalitis virus (JEV). Early recognition is challenging due to overlapping clinical features with other central nervous system disorders and variable laboratory and imaging findings. Objective: To describe the demographic characteristics, clinical presentations, neuroimaging findings, and cerebrospinal fluid (CSF) parameters of patients with clinically suspected AVE in a tertiary care hospital in Bangladesh. Methods: This observational study was carried out at the Department of Neurology during December-2024 to November-2025 in, Chittagong Medical College Hospital (CMCH), Chattogram, Bangladesh. A total of 93 patients irrespective of age and sex with clinically suspected acute viral encephalitis (AVE) were consecutively enrolled during the study period. Clinical evaluation, laboratory investigations, MRI, and CSF analysis were performed for all patients. Data were analyzed usingStatistical Package for Social Sciences(SPSS) version 23.0.Ethical approval for the study was obtained from the Institutional Review Board (IRB) of Chittagong Medical College, and confidentiality of all patients’ information was strictly maintained throughout the research process in accordance with the Declaration of Helsinki-1964. Results: The mean age of the study patients was 45.87 ± 20.13 years, with nearly equal gender distribution (52.7% male). Fever (100%) and altered consciousness (96.8%) were the most common clinical features, followed by confusion (80.7%), headache (54.8%), and vomiting (51.6%). MRI abnormalities were observed in 52.7% of patients, including restricted diffusion (50.5%), FLAIR T2 changes (50.5%), and hypodense areas of hypoxia (43%). Focal neurological deficits were present in 22.6% patients, and extensor plantar response predominated in (65.6%) patients. CSF analysis revealed a median glucose of 78 mg/dL, CSF/blood glucose ratio of 0.54, protein 53.7 mg/dL, RBC count 550 cells/μL, leukocyte count 8 cells/μL, neutrophils 10%, and lymphocytes 98%. Conclusion: Patients with suspected AVE in this setting presented with non-specific but severe neurological manifestations, with approximately half showing MRI abnormalities. CSF analysis provided supportive evidence of viral etiology, emphasizing the importance of integrating clinical, imaging, and laboratory data for early diagnosis and management.
Background: Surgical site infection (SSI) remains one of the most common postoperative complications following gynecological oncology surgery, contributing to increased morbidity, prolonged hospitalization, and healthcare costs. This study aimed to describe the clinical, surgical, and microbiological characteristics of patients who developed SSI following gynecological oncology surgery. Methods: A descriptive observational study was conducted among patients who developed SSI following gynecologic oncology surgery at Bangladesh Medical University in 2024. A total of 29 patients with confirmed SSI were included. Data on socio-demographic characteristics, clinical factors, surgical variables, SSI type, and outcomes were collected. Microbiological culture and antimicrobial susceptibility testing were performed for bacterial isolates. Results: The mean age of patients was 47.0 ± 14.3 years. Most patients had normal BMI (58.6%), while 34.5% were overweight. Anaemia (75.9%), diabetes mellitus (58.6%), and hypertension (58.6%) were common comorbidities. Contaminated wounds accounted for 55.2% of cases, and 72.4% of patients received perioperative blood transfusion. Superficial incisional SSI was more common (75.9%) than deep incisional SSI (24.1%). No statistically significant association was observed between patient or surgical characteristics and SSI depth. Gram-negative organisms predominated, with Escherichia coli/Enterobacteriaceae being the most frequently isolated pathogen, followed by Klebsiella spp., Pseudomonas spp., and Acinetobacter spp., while Gram-positive organisms included Staphylococcus spp., Enterococcus spp., and Corynebacterium spp. High multidrug resistance (MDR) rates were observed among both gram-negative and gram-positive organisms. Conclusion: SSI following gynecological surgery is associated with significant comorbidities, contaminated wounds, and high antimicrobial resistance rates. Strengthening infection prevention practices and antimicrobial stewardship is essential to reduce SSI burden and improve postoperative outcomes.
Stroke remains a major cause of mortality and disability in low- and middle-income countries, where access to advanced diagnostic tools for early severity assessment is often limited. This hospital-based cross-sectional study aimed to examine the association between routinely measured blood biomarkers and stroke severity among newly diagnosed stroke patients in Bangladesh. The study was conducted at a tertiary care neurological center in Dhaka from January to December 2024 and included 200 adult patients with first-ever ischemic or hemorrhagic stroke confirmed by clinical evaluation and neuroimaging. Sociodemographic, clinical, and lifestyle-related information was collected using a pretested questionnaire. Stroke severity was assessed at admission using the National Institutes of Health Stroke Scale (NIHSS). Routine laboratory parameters, including complete blood count, fasting blood glucose, serum creatinine, fasting lipid profile, and serum electrolytes, were analyzed as part of standard clinical care. Ischemic stroke was the predominant subtype (75.5%), and most patients presented with mild stroke severity (75.0%). Hypertension and diabetes mellitus were the most common comorbidities. Abnormalities in routine biomarkers were frequent, including anemia, leukocytosis, dyslipidemia, and altered renal and electrolyte parameters. Increasing stroke severity was significantly associated with elevated white blood cell count, raised serum creatinine, adverse lipid profiles, abnormal potassium levels, and altered bicarbonate concentrations, while hemoglobin and serum sodium showed no significant association. Stroke severity also differed significantly by stroke subtype, with hemorrhagic stroke patients presenting with higher NIHSS scores. These findings indicate that routinely available blood biomarkers are significantly associated with stroke severity and may serve as practical adjuncts to clinical assessment for early risk stratification in resource-limited healthcare settings.
It is necessary toassess the hypercoagulability and the risk of thromboembolism in women taking oral contraceptive pill (OCP) for prolonged period of time.So, we need to know the hemostatic changes that are occurring in Bangladeshi women taking OCP for prolonged period of time. This cross sectional study was done in the department of Physiology, Dhaka Medical College, Dhaka from Jan 2012 to Dec 2012. Ninety female subjects with the age range from 25-45 years, were taken as a study population. Among them, 60 women taking oral contraceptives for prolonged period of time ( >1 years) were included for the study group and age matched 30 women of OCP nonusers were taken as a control . Study subjects were divided into two group according to their duration of oral pill use: group B-1 ( 1 to 5 years users) were 30 women and group B-2 ( >5 to 10 years users) were 30 women.For assessment of hypercoagulable state total counts of platelet levels were estimated in all groups. Statistical analysis was done by unpaired Student’s 't' test and Pearson’s Correlation Coefficient test. In this studythe mean (+/-SD) total count of platelet level was higher in study group (who were taking OCP-s) than control group (OCP nonusers) which was statistically highly significant (P<0.001). Total count of platelet levels were positively correlated (r= +0.155) with the 1 to 5 years user group and negatively correlated (r= -0.019) with the >5 to 10 years user group. But all the relationships were statistically non-significant. My present study revealed that prolonged duration of OCP use ( at least 5 years) may increase the risk of thromboembolic effects.This study concludes that OCP users had more tendency of hypercoagulability and therefore this women are at higher risk of thromboembolic effects.
Background:The supraclavicular brachial plexus block is a widely used technique for upper limb anesthesia due to its rapid onset and reliable coverage. This study aims to assess the incidence of pneumothorax following supraclavicular brachial plexus block.The aim of the study was to determine the incidence of pneumothorax following supraclavicular brachial plexus block.Methodology:This prospective observational study was conducted from January 2022 to December 2024 at Holy Family Red Crescent Medical College and Kalatia Central Hospital Pvt. Ltd.,Keranigonj, Dhaka, Bangladesh in the Department of Anesthesia, Analgesia & Intensive Care Unit. 200 patients undergoing supraclavicular brachial plexus block were enrolled. Blocks were done via ultrasound or landmark technique; needle angle and attempts were recorded. Patients were monitored for pneumothorax, confirmed by chest X-ray if suspected. Incidence and risk factors were analyzed descriptively.Results:The study included 200 patients (mean age 38.2 ± 19.1 years), with 55% males and an average BMI of 23.5 ± 3.8 kg/m2. Most were ASA Grade I (63.5%), and 90% received ultrasound-guided blocks. Pneumothorax occurred in 4 cases (2.0%), with a higher incidence in the landmark group (15%) compared to the ultrasound group (0.6%). Among pneumothorax cases, 50% had preexisting pulmonary conditions, 25% were obese, and 75% had a needle angle ≥45°, suggesting these as contributing risk factors. Conclusion:Ultrasound-guided supraclavicular brachial plexus block is associated with a lower risk of pneumothorax, highlighting the importance of careful technique and patient risk assessment.
Acute appendicitis is a common surgical emergency; however, in adults it may rarely mask underlying colonic malignancy. We report the case of a 47-year-old woman who presented with history of right lower abdominal pain followed by a palpable appendiceal mass, initially managed as an appendicular lump. The absence of significant leukocytosis and persistence of the mass despite conservative management prompted further evaluation. Imaging and colonoscopy revealed a caecal mass, and biopsy confirmed adenocarcinoma. The patient underwent neoadjuvant chemotherapy followed by right hemicolectomy with primary anastomosis. This case highlights the need for suspicion of underlying malignancy in adults with atypical appendicitis and signifies the importance of multidisciplinary approaches.
Ovarian fibroma is a rare benign ovarian tumour about 4% of all ovarian tumour, which grows from connective tissue of the ovarian cortex. Among the sex cord stromal tumour, fibroma is the most commonly encountered subtype. Mean age of occurrence is 45 years to 55 years. Meig’s syndrome is characterized by a triad of ovarian fibroma, ascites and plural effusion which can manage surgically. Pleural effusion and ascites are usually transudative.
Introduction: Labor pain is one of the deepest and most challenging sensations a person can endure, shapingboth the physical and emotional perspective of childbirth, often requiring effective management to ensure apositive childbirth experience. The goal of labor analgesia is to provide sufficient pain relief while minimizingadverse effects on the mother and fetus. Methods: This prospective observational comparative study wasconducted at Holy Family Red Crescent Medical College Hospital, Dhaka, and Popular Medical CollegeHospital, Dhaka, Bangladesh; the study spanned 2.5 years from December 2022 to July 2024. Result: Theaverage pain score, measured on a scale from 0 to 10, indicates that patients in the walking epidural groupexperienced significantly less pain (2.5 ± 1.2) than those in the traditional epidural group (3.8 ± 1.5). Womenwho received the Walking Epidural (n=40) had a statistically significantly shorter average labor duration (8.5hours ± 2.0) compared to those who received the Traditional Epidural (9.8 hours ± 2.5), with a p-value of 0.03.90% of patients in the Walking Epidural group reported high satisfaction compared to 70% in the TraditionalEpidural group (p = 0.02). The NICU admission rate was 5% (2 out of 40) in the Walking Epidural group and10% (8 out of 40) in the Traditional Epidural group. The difference in the study was not statistically significant(p = 0.45). Conclusion: Our study demonstrates that walking epidurals provide superior pain relief, enhancedmobility, shorter labor durations, higher maternal satisfaction, and favorable delivery outcomes compared totraditional epidurals.
Solid Pseudopapillary Tumors are rare pancreaticneoplasms first identified as Hammoudi or Franztumors, later classified by the WHO as SPTs in 1996.These tumors primarily affect young non-Caucasianwomen, with a male-to-female ratio of 1:11. Surgicalexcision remains the standard treatment. SolidPseudopapillary Tumors (SPTs) within the pancreasare rare, accounting for less than 3% of pancreaticneoplasms. They predominantly occur in youngwomen and are characterized by low malignantpotential with high surgical cure rates. This reportdetails the case of a 14-year-old girl in Bangladeshundergoing a successful Whipple’s procedure for anSPT.
Astrocytomas are the most common intrinsic tumors of the central nervous system and derive from astrocytes.Ki-67 and p53 are two cellular proteins that have roles in pathogenesis and evolution of astrocytomas. Ki-67 is a nuclear non-histone protein produced by cells in the proliferative phases, and the Ki-67 proliferativeindex quantitatively reflects the growth potential of tumors, making it a significant biological marker. p53is a nuclear protein that controls cell cycle, apoptosis, and genomic stability. Assessment of Ki-67 and p53in various grades of astrocytoma can aid as an ancillary tool in understanding tumor behavior. This cross-sectional type of descriptive study was carried out at the Department of Pathology, RMC, Rajshahi, andBSMMU, Dhaka, over two years, between January 2021 and December 2022. In this study, a total of 30astrocytoma cases that were histologically diagnosed were included. Ki-67 and p53 immunostaining was doneon formalin-fixed paraffin-embedded tissue blocks of all cases and compared with WHO histological gradingof astrocytomas. Both biomarkers were directly associated with each other and the grade of astrocytoma.Statistically significant differences in Ki-67 LI and p53 LI were seen between grade I and grade IV andbetween grade II and IV. However, there was no statistically significant difference between grades I and II,grades I and III, or grades II and III. These markers can aid as an ancillary tool in understanding tumorbehavior and progression.
Background: Gastrointestinal endoscopy is essential for diagnosing and treating gastrointestinal conditions.Procedural efficiency, patient safety, and satisfaction all depend on the choice of sedation. Although propofol-based sedation has been popular due to its rapid onset and fast recovery, this study compares the safetyand efficacy of propofol-based sedation versus conventional anesthesia during gastrointestinal endoscopeprocedures. Methods: This retrospective observational study occurred in the Department of Anesthesia-Analgesia & Intensive Care Unit, Holy Family Red Crescent Medical College Hospital, from August 2022 to July2024. A total of 120 patients were equally divided into two groups based on sedation type. Data on proceduralparameters, recovery time, hemodynamic stability, patient satisfaction, and adverse events were analyzed.Results: Sedation with propofol significantly reduced procedure duration (38.5±10.2 vs. 43.6±11.5 minutes;p=0.01) and recovery time (15.5±5.4 vs. 35±15.5 minutes; p<0.001). Supplemental oxygen requirementswere significantly lower (11.7% vs. 28.3%; p=0.02), along with higher patient satisfaction scores (4.6±0.5 vs.4.2±0.6; p<0.001) for patients receiving propofol. In addition to fewer adverse events, the propofol group hadfewer prolonged recovery times (0% vs. 10%; p=0.01). Conclusion: Gastrointestinal endoscopic procedureswere well suited for propofol-based sedation, as propofol performed better on all measures associated withefficiency, patient recovery, patient satisfaction, and adverse events. Continuous monitoring is required tomitigate respiratory risks.
