Background: Pediatric musculoskeletal injuries represent a major component of childhood trauma burden globally, with distinct anatomical, biomechanical, and biological characteristics compared to adult injuries that necessitate age-specific management approaches. The presence of open physeal growth plates in skeletally immature bone renders children uniquely vulnerable to growth disturbance complications, while simultaneously conferring superior remodeling potential that enables favorable outcomes with appropriate management. Objectives: To evaluate the patterns of pediatric musculoskeletal injuries and their early clinical outcomes at a tertiary orthopedic center in Bangladesh. Methods: A cross-sectional observational study was conducted at the Department of Orthopedic, Gopalganj Medical College Hospital, Gopalganj, from January 2025 to December 2025, enrolling 110 pediatric patients aged below 16 years presenting with musculoskeletal injuries. Injury patterns, mechanisms, management modalities, and early clinical outcomes at six weeks were systematically recorded and analyzed using SPSS version 25. Results: Mean age was 8.6±3.4 years with male predominance (68.2%). Falls were the most common mechanism (52.7%). Forearm fractures were the most prevalent injury type (30.0%). Conservative management was employed in 63.6% of patients. Satisfactory early clinical outcomes were achieved in 82.7% of patients. Growth disturbance was documented in 4.5% of physeal injury cases. Conclusion: Pediatric musculoskeletal injuries in this Bangladeshi district hospital cohort predominantly affect school-age boys through fall mechanisms, with forearm fractures being the most common injury, and conservative management achieving satisfactory early outcomes in the majority of patients.
Background: Postoperative pain remains a major challenge after surgery and may delay mobilization, prolong hospital stay, and adversely affect patient satisfaction and recovery. Ketamine, an N-methyl-D-aspartate receptor antagonist, has been increasingly used as an adjunct to conventional analgesia because of its potential analgesic and opioid-sparing effects. This study compared perioperative ketamine with standard analgesia in terms of postoperative pain and recovery outcomes. Objective: To compare the effects of perioperative analgesic dose of ketamine and standard analgesia on postoperative pain, rescue analgesic requirement, early recovery, adverse effects, and patient satisfaction among patients undergoing surgery. Methods: This comparative clinical study was conducted at Sylhet Women’s Medical College & Hospital, Sylhet, Bangladesh, from June 2024 to May 2025. A total of 60 patients were included and divided into two groups of 30 each. Group A received perioperative ketamine in addition to standard analgesia, while Group B received standard analgesia alone. Postoperative pain was assessed at predefined time points. Rescue analgesic requirement, time to first ambulation, hospital stay, overall recovery score, adverse effects, and patient satisfaction were compared between the groups. Data were analyzed using SPSS version 23, with p<0.05 considered statistically significant. Results: The groups were comparable regarding baseline demographic and clinical characteristics. Postoperative pain scores were significantly lower in the ketamine group from immediate recovery through 24 hours (24-hour pain score: 1.6±0.6 vs. 2.3±0.7, p<0.001). Rescue analgesia was required by 40.0% of patients in Group A compared with 73.3% in Group B (p=0.011). The ketamine group had a longer time to first rescue analgesia (7.2±3.1 vs. 4.6±2.4 hours, p=0.001), earlier ambulation (11.8±4.2 vs. 15.6±5.1 hours, p=0.003), shorter hospital stay (3.8±1.1 vs. 4.7±1.4 days, p=0.008), and higher recovery scores (82.4±8.7 vs. 74.6±9.3, p=0.001). Overall adverse effects were comparable (46.7% vs. 50.0%, p=0.796). Patient satisfaction was higher in Group A (83.3% vs. 60.0%, p=0.048). Conclusion: Perioperative ketamine as an adjunct to standard analgesia was associated with improved postoperative pain control, reduced rescue analgesic requirement, earlier ambulation, shorter hospital stay, and better overall recovery, without a significant increase in adverse effects.
Background: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a major cause of morbidity and mortality worldwide. Identifying patients at risk for respiratory failure and ventilatory support is crucial for optimal management. N-terminal pro-brain natriuretic peptide (NTproBNP), a marker of cardiac wall stress, may have prognostic value in AECOPD. Objective: To evaluate the association between admission NT-proBNP levels and the need for ventilatory support and hospital outcomes in patients with AECOPD. Methods: This cross-sectional analytical study was conducted at the Department of Respiratory Medicine, National Institute of the Diseases of the Chest & Hospital (NIDCH), Dhaka, Bangladesh, from July 2018 to June 2019. A total of 70 patients with AECOPD were enrolled. Plasma NT-proBNP was measured within 24 hours of admission. Patients were categorized into normal (<150 pg/mL) and elevated (≥150 pg/mL) NT-proBNP groups. Need for ventilatory support (NIPPV/IPPV), ICU admission, length of hospital stay, and in-hospital mortality were recorded. Results: The mean age was 61.77±8.91 years, with male predominance (95.7%). Elevated NT-proBNP was significantly associated with lower SpO₂ (85.12 vs 88.0, p=0.002), lower PaO₂ (62.93 vs 73.28, p=0.002), higher PaCO₂ (55.71 vs 51.55, p<0.001), and higher PASP (49.02 vs 37.53, p=0.010). Patients with elevated NT-proBNP more frequently required ICU admission (55.8% vs 16.7%, p=0.004) and ventilatory support (NIPPV: 36.5% vs 11.1%; IPPV: 19.2% vs 5.6%; p=0.016). No significant differences were observed in mortality (11.5% vs 5.6%, p=0.466) or hospital stay duration (p=0.915). Conclusions: Elevated admission NT-proBNP is significantly associated with worse gas exchange, pulmonary hypertension, and increased need for ICU admission and ventilatory support in AECOPD patients. NT-proBNP may serve as a useful biomarker for early risk stratification.
Van Wyk-Grumbach Syndrome (VWGS) is presented as the usual triad of severe juvenile hypothyroidism (Hashimoto Thyroiditis is frequently the cause), isosexual precocious pseudopuberty and delayed bone age. With the treatment of the underlying thyroid hormone deficiency all of the features will be reversed dramatically. Here is the case described, with typical findings of hypothyroidism developed bilateral breast enlargement and menstruation. There was an intra-abdominal mass, in left lower abdomen about 7cm x 6 cm in diameter with soft consistency and irregular margin and surface. She had bilateral prominent calf muscle, generalized hypotonia & delayed relaxation of ankle jerk. Anthropometrically she was severely stunted and obese. Her height lies below MPH range. Pubertal developments in tanner stages were: thelarchae stage III, puberchae stage I (no adrenerchae). Serum TSH level was very high. Serum FSH and Estrogen level were also high for her age but, LH level was low. Her bone age was 3 years. Her pelvic sonogram showed enlarged uterus with bilateral multiple small adnexal cysts and a large multilocular cystic neoplasm in left adnexa. Treatment with Levothyroxine, her vaginal bleeding did not recur and ovarian cyst size decreased within 1 week and disappeared after 2 weeks. In conclusion, hypothyroidism should be evaluated who have precocious puberty with multicystic enlarged ovaries. It is important to keep in mind regarding complementary examinations and unnecessary surgical interventions to avoid parent as well as patient’s burden.
Background: Primary amenorrhoea is an uncommon but clinically important reproductive disorder that may result from anatomical, endocrine, ovarian, hypothalamic-pituitary or chromosomal abnormalities. Clinical examination, hormonal assessment, pelvic imaging and karyotyping are important for establishing the underlying diagnosis. Objective: To evaluate the association between clinical findings, hormonal profiles and karyotype abnormalities among patients presenting with primary amenorrhoea at a tertiary care hospital in Bangladesh. Methods: This prospective observational cross-sectional analytical study was conducted in the Gynaecology Outpatient Department of Bangladesh Medical University (BMU), Dhaka, Bangladesh, from December 2023 to January 2025. Forty-seven patients aged 13–35 years with primary amenorrhoea were included. Detailed clinical assessment included anthropometric measurements, evaluation of secondary sexual characteristics and external genital examination. Serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, prolactin and thyroid-stimulating hormone (TSH) were measured. Pelvic ultrasonography and peripheral blood karyotyping were performed. Associations between clinical characteristics, hormonal patterns and cytogenetic findings were analyzed using appropriate statistical tests. Results: The mean age was 19.9 ± 4.7 years with the 16–20-year age group predominating. Müllerian agenesis/MRKH syndrome and Turner syndrome/gonadal dysgenesis were the leading etiological categories. Hypergonadotropic hypogonadism was the most frequent hormonal pattern (38.3%). Abnormal karyotypes were identified in 31.9% of participants with 45,X Turner syndrome being the most frequent abnormality. Hypergonadotropic hypogonadism was significantly more common among participants with abnormal karyotypes than those with normal 46,XX karyotypes (86.7% vs. 28.1%, p<0.001). Short stature and poor breast development were also significantly associated with abnormal karyotype. Conclusion: Primary amenorrhoea has diverse anatomical, endocrine and chromosomal causes. Integrated clinical, hormonal, imaging and cytogenetic evaluation is important for accurate diagnosis and individualized management.
