Journal of the Medical College for Women & Hospital
Published by Medical College for Women & Hospital, Dhaka. Full-text articles available. Articles in the Journal of the Medical College for Women & Hospital are Open Access articles published under the Creative Commons CC BY-NC-ND License Attribution-NonCommercial-NoDerivatives 4.0 International License.This license permits Share— copy and redistribute the material in any medium or format.
Comparative Study of Epidural Analgesia and Programmed Labor Analgesia in Controlling Labor Pain
Objective: To compare the efficacy, safety, and outcomes of epidural analgesia versus programmed labor analgesia for pain management during labor at a tertiary care center in Bangladesh. Materials and Method: A prospective comparative study was conducted at Bangabandhu Sheikh Mujib Medical University from July 2019 to July 2020. One hundred parturients were randomly allocated into two groups: epidural analgesia (Group A, n=50) and programmed labor analgesia (Group B, n=50). Pain intensity was assessed using Visual Analog Scale (VAS). Primary outcomes included pain relief, duration of labor, mode of delivery, and maternal satisfaction. Secondary outcomes included fetal well-being and complications. Results: Epidural analgesia provided superior pain relief (mean VAS reduction: 5.1 vs 3.6, p<0.001) and higher maternal satisfaction scores (8.4 ± 1.2 vs 6.8 ± 1.5, p<0.001). First stage labor duration was longer in Group A (295 ± 42 vs 248 ± 38 minutes, p<0.001). Spontaneous vaginal delivery rates were comparable (76% vs 84%, p=0.317). Both groups showed similar fetal outcomes with comparable Appearance, Pulse, Grimace, Activity and Respiration (APGAR) scores. Group A experienced more hypotension (8% vs 2%), while Group B had higher instances of nausea (12% vs 4%). Cost analysis favored programmed labor analgesia (4,200 ± 450 BDT vs 12,500 ± 1,200 BDT, p<0.001). Conclusion: While epidural analgesia provides better pain relief and maternal satisfaction, programmed labor analgesia offers a cost-effective alternative with acceptable pain relief and potentially shorter labor duration. Both methods demonstrate comparable safety profiles, making programmed labor analgesia a viable option in resource-limited settings. J Med Coll Women Hosp.2025; 21 (2):16-26
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Factors Associated with Smoking Intensity in Adult Male Smokers
Background: Smoking is an epidemic and matter of public health concern. Often smokers as well as other members of the society are unaware of the harmful effects of smoking and very few have knowledge in regards to the factors that contribute to the behavior of smoking.Such knowledge if known can help the society and policymakers to develop support systems and strategies to help smokers to quit smoking and develop a healthy lifestyle.Aim: The aim of the study was to observe the factors prevalent and associated with intensity of smoking.Materials and Method: This cross-sectional study was carried out from July 2006 to June 2007 with 75 male smokers as participants (age 20-50 years) who were divided in to 3 groups of light smokers (2-9 cigarettes smoked/day),moderate smokers (10-19 cigarettes smoked /day) and heavy smokers (20 or more cigarettes smoked/day). The socio-demographic features like age of ,BMI, Occupation, education level, monthly family income and marital status and also the age of onset of smoking, number of years of smoking were analyzed to report the factors more prevalent among the smokers. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY; IBM Corp]. Data were expressed as frequency, percentage and mean±SD. p value was obtained from †One way ANOVA and Chi Square test. Results: Those smokers who were service holders were heavy smokers (84% of the participants), smoking 20 or more cigarettes per day (p 0.005). Those with monthly family income of less than Taka 15000 had a higher intensity of smoking (76%) compared to those whose monthly income was equal to or more than Taka 15000 (24%). The forest plot diagram revealed occupation to be moderate to heavy smoking. Conclusion: The findings of the study reveal certain factors that may influence intensity of smoking among smokers. Determining such factors may help develop policies to rehabilitate smokers and improve their quality of life. J Med Coll Women Hosp.2025; 21 (2):27-35
Histopathological spectrum of gallbladder lesions in cholecystectomy specimens-A Retrospective Study in a Medical College Hospital
Background: Gallbladder disease is a common health issue and a major reason for mortality and morbidity globally. It can range from cholelithiasis, cholecystitis to various neoplastic and non-neoplastic conditions. Cholelithiasis can result in diverse histopathological alterations in the mucosa of gallbladder like inflammation (acute, chronic, granulomatous), cholesterolosis, dysplasia and malignancy. Gallbladder carcinoma are often silent clinically in its initial phase and is diagnosed commonly as incidental histological findings following cholecystectomy. Therefore, it should be a regular practice for the surgeons to send all specimens of gallbladder for histopathological examination following surgical resection of gallbladder. To exclude the possibility of gallbladder carcinoma. Aim: This study aims to analyze the histopathological alterations in specimens of surgically removed gallbladder. Materials and Method: This retrospective, hospital-based study was performed in the department of pathology of the Medical College for Women and Hospital (MCWH), Dhaka, Bangladesh, over a time period of 1 year beginning from January 2023 to December 2023 .Histopathology reports of gall bladder specimens of 251 patients who have undergone resection of gall bladder during the mentioned time frame were included in the study. The specimens received included resected gall bladders of patients diagnosed with acute or chronic cholecystitis secondary to cholelithiasis (gall stone).The information were collected from the records of histopathology reports preserved in the laboratory of MCW&H. The analysis of the data was carried out using SPSS version 26.0software (Armonk, NY: IBM Corp.) . Incomplete information or non-diagnostic samples were excluded from the study. The information was recorded in a predesigned data collection sheet. Statistical analysis was done with frequency and percentage. Results:Of the 251 cases, 42 and 209 samples were received from male and female patients, respectively. The patients’ mean age in this study was 40.92±13.19 years.Out of the various histopathological findings, the most common was chronic cholecystitis, followed by cholelithiasis (25.9%), cholesterolosis (13.5%), and acute cholecystitis (6.8%). A single case of adenocarcinoma was found. Even though premalignant conditions like intestinal metaplasia and reactive atypia was not observed, one case of xanthoglanulomatous cholecystitis (XGC) ( a potential premalignant condition)was found .Conclusion: Gallbladder diseases often require surgical intervention. Out of these, chronic cholecystitis ( a known gallbladder carcinoma risk factor), is one of the most common such disease. It is imperative to perform histopathological examination in order to detect malignant and premalignant lesions,since these may escape macroscopic detection and progress in to adenocarcinoma. J Med Coll Women Hosp.2025; 21 (2):36-46
Perception and Practices Regarding Long-Acting Reversible Contraceptive Methods among Mothers of Urban Communities in Bangladesh
Background: Utilization of contraception is a crucial strategy for reducing fertility rates. It is necessary for the effectiveness of the national family program that woman of reproductive age who has at least one living child should use contraceptives which are long-acting and reversible. Aim: To assess the perception and practice of long acting contraceptive methods (LARC) among mothers of an urban communities. Materials and method: This community-based descriptive cross-sectional study purposively selected 180 mothers of reproductive age (18-49 years) with at least one living child under 2 years old, excluding women who had undergone bilateral tubal ligation. Data was collected between January and December 2022 using a pretested, face-to-face, semi-structured questionnaire.Results: The mean age of respondents was 33.3±8.4 years. Most respondents (44.4%) were not using any contraceptives, and 66.7% were not using LARC, while 33.3% were. LARC perception was significantly associated with both women's and husbands' education levels (p<0.05), and marginally with husband's age (p<0.05). Women with lower education levels and homemakers were more likely to use LARC (p<0.05). Those with fewer than two living children, no desire for more children, and NVD in their last delivery were also more likely to use LARC. Perception of LARC was strongly allied to its use (p<0.05).Conclusion: To develop a strategy for increasing LARC use among mothers in Bangladesh's urban community, further research with a larger, representative sample is needed to establish a baseline. J Med Coll Women Hosp.2025; 21 (2):47-61
Endocrine Referral Pattern: Experience From a Medical College Hospital
Background: Referral is an integral part of comprehensive disease management, particularly when it involves multiple complications and comorbidities. Data regarding the referral pattern of endocrine diseases are scarce in the literature, especially from Bangladesh. Aim: To find out the referral patterns and spectrum of endocrine diseases among the referred patients. Materials and Method: This retrospective observational study included all consecutive patients who were referred to the endocrinologist from March 2022 to October 2024. Relevant clinical information of the referred patients was extracted from the referral registrar book. Results: A Total of 759 patients (Male 185, 24.4%; Female 574, 75.6%; median age 45 years were included in the study. The majority of the patients were referred from the inpatient department (IPD) (428, 56.4%). Medicine and allied departments were the main source (303, 39.9%) of referrals, followed by Surgery (240, 31.6%), Gynecology (204, 26.9%), and others (12, 1.6%). The majority of the patients suffered from multiple active non-endocrine diseases (≥two diseases, 651, 85.7%); however, most of the patients were referred for a single endocrine disease (640, 84.3%). Among the endocrine causes of referral, diabetes mellitus (DM) (612, 80.6%) was the most common cause of referral, followed by thyroid disorder (TDs) (152, 20%). Among referred patients with DM, multiple endocrine diseases were present in 97(15.8%) cases, and TDs were present in 60 (9.8%). Among other endocrine referrals, reproductive endocrine disease, adrenal disease, and electrolyte imbalance accounted for 32 (4.2%), 23 (3.0%), and 35 (4.6%), respectively. Conclusion: DM and TDs are the two most common forms of referral, followed by reproductive endocrine disease and adrenal disease, with more than half of the referred patients from IPD. J Med Coll Women Hosp.2025; 21 (2):62-70
Parameters of Lung function tests in healthy adult Bangladeshi population residing within Dhaka city
Background: Lung functions are affected by age, gender, body built, ethnicity, environmental, socioeconomical, technical and other unidentified factors. Availability of appropriate reference value is necessary for interpretation of lung function tests and in assessment of respiratory disease. The standard value of pulmonary function test which is obtained from western population may not agree with Bangladeshi population as the two entirely different populations vary in ethnicity, body built, socioeconomic condition and environmental factors. Thus, attempt needs to be made to obtain values of these parameters more specific for the population of this region. Objective: The present study was carried out to find out values for lung function parameters of FVC, FEV1 and FEV1/FVC ratio of healthy adult Bangladeshi population residing in different parts of Dhaka city to contribute data towards obtaining reference value for these parameters for healthy Bangladeshi population in the near future. Materials and Method: A cross sectional study was conducted in the department of Physiology, Dhaka Medical College, Dhaka from July 2017 to June 2018. A total number of 150 male subjects and 150 female subjects were selected with age ranging from 18 to 45 years. The subjects were selected from different areas of Dhaka city on the basis of exclusion and inclusion criteria. The study parameters were estimated in the Department of Physiology, Dhaka Medical College, Dhaka by computerized digital autospirometer. Data were collected in a predesigned structured questionnaire form by the researcher herself. For statistical analysis Unpaired Student’s ‘t’ test and Pearson’s correlation coefficient (r) test were performed by using SPSS windows, version 16. p value <0.05 was accepted as level of significance. Results: In this study, values for lung function parameters of healthy adult Bangladeshi population residing within Dhaka city were estimated. Mean value for FVC, FEV1 and FEV1/FVC ratio were found 3L, 2.82L and 93% in male subjects and 2.43L, 2.21L and 93% in female subjects respectively. Conclusion: In this study we observed the values for lung function parameters of FVC, FEV1 and FEV1/FVC ratio for adult healthy Bangladeshi population residing in Dhaka city and may be considered as a visionary contributing step towards determining the parameters’ value for reference in this country. More such studies in other parts of Bangladesh needs to be carried out. Data from such studies may be compiled to eventually develop a reference value for the above parameters which would be more specific for healthy adult population of Bangladesh. J Med Coll Women Hosp.2025; 21 (2):71-77
Driftodontics and Its Role in Orthodontics: A Clinical Study on 40 Patients at Military Dental Centre Dhaka: A Clinical Study on 40 Patients at Military Dental Centre Dhaka
Background: Driftodontics has emerged as a promising approach that leverages the natural physiological movement of teeth to achieve alignment. This concept involves creating optimal conditions—such as through selective extractions, interproximal reduction, or occlusal adjustments—to guide teeth into their ideal positions without the need for extensive mechanical appliances. Objective: To evaluate the clinical efficacy of Driftodontics—a minimally invasive orthodontic approach leveraging natural tooth drifting—compared to traditional orthodontics in patients with mild-to-moderate malocclusions.Materials and Method: A 24-months prospective observational study was conducted at the Military Dental Centre Dhaka on 40 patients (aged 18–35 years). Participants were divided into two groups: Driftodontics (selective extractions, interproximal reduction; n=20) and Traditional Orthodontics (fixed appliances; n=20). Outcomes included alignment success, treatment duration, patient satisfaction, and occlusal stability. Results: Driftodontics achieved 85% alignment success versus 95% with traditional methods (p=0.16), with significantly shorter treatment duration (8.2 vs. 14.6 months; p<0.001). Patient satisfaction was higher in the Driftodontics group (90% vs. 65%; p=0.04). Both groups showed comparable occlusal stability (PAR score reduction: 82% vs. 88%; p=0.32). Conclusion: Driftodontics offers a time-efficient, patient-friendly alternative for mild-to-moderate malocclusions, particularly in time-constrained populations, without compromising clinical outcomes. J Med Coll Women Hosp.2025; 21 (2):78-82
Effect of Cigarette Smoking on Serum Homocysteine and Folic Acid Levels in Apparently Healthy Male Smokers
Background: Globally, smoking cigarette is one of the most common reason for demise which is preventable. In those who smoke ,altered levels of serum homocysteine and that of folic acid have been noted to aggravate the development of atherosclerosis and cardiovascular complications. Therefore. the level of these two sensitive biomarkers may aid in detecting early the changes leading up to such complications in those who smoke.Aim: The aim of the study was to observe the serum levels of homocysteine and folic acid in smokers and compare these parameters with that of non smokers .Materials and Method: This research work (cross sectional in nature) was conducted on 90 apparently healthy male recruits (age between 20-60 years) in Sir Salimullah Medical College (SSMC),Dhaka.The department in which the study took place was the Physiology department. The duration of the research was one year (July 2019 – June 2020) .Sixty out of the ninety recruits were considered as group A and those included in this group were smokers. This group A was further split in to 2 groups (Group A1 and A2) in accordance to the pack-years of smoking. The A1 group consisted of those having history of 5-10 pack years of smoking and the A2 group included those having >10 pack-years history of smoking. Thirty non smokers with matching age and body mass index (BMI) were included as the group for making comparison with the study group and was termed as group B. The parameters assessed were levels of homocysteine and folic acid in the serum.Results:The study observed the level of homocysteine in serum was significantly greater in recruits who smoke than those recruits who do not smoke with p value <0.001.The levels of folic acid in serum noted to be lower significantly (p<0.001) in smoking recruits when compared to non smoking recruits.Such alterations were more profound in the smokers with >10 pack-year of smoking history. Besides this, positive correlation between pack year history of smoking and level of homocysteine in serum (r = 0.948) and the relationship was highly significant statistically (p<0.001) .Levels of folic acid in serum were negatively correlated (r = - 0.844 and r = - 0.863) with pack-year of smoking history which were significant statistically (p<0.001 and p<0.001). Conclusion: The present study reveals that serum homocysteine level is significantly higher whereas levels of folic acid in serum are significantly lower among smokers and these changes are more marked in the smokers with >10 pack-years of smoking history. J Med Coll Women Hosp.2025; 21 (2):83-90
Community Knowledge and Practices for Malaria Prevention: A Cross-sectional Study on Tribal Adults in Bangladesh.
Background: Malaria is a major public health concern in Bangladesh, with ethnic minorities in the Chittagong Hill Tracts (CHTs) being highly vulnerable due to forest-based occupations and poor housing. Aim: This study aims to find out the current state of knowledge and practices on the prevention of malaria among tribal adults in Bangladesh. Materials and Method: A community-based cross-sectional study was carried out from January to December 2022 in the Rangamati district, Bangladesh. Data were collected from 234 conveniently selected tribal adults through face-to-face interviews using a semi-structured questionnaire. Results: Knowledge of malaria transmission and prevention was generally high, with 96.6% identifying mosquito bites as the cause and 99.1% recognizing it as preventable. Most (97.9%) knew preventive measures, and long lasting insecticide treated Net (LLINs) were widely known (96.6%), though none were owned or used. Misconceptions persisted, with 30.8% attributing malaria to poor cleanliness. Symptom recognition was inconsistent, with fever and shivering (60.7%) most common, while awareness of intermittent fever, sweating, and convulsions were low. Vulnerable groups such as pregnant women (67.1%) and children (44.4%) were better recognized than the elderly (30.8%) or people with chronic disease (1.3%). Prevention practices relied mainly on environmental control: cleaning surroundings (98.7%), vegetation clearance (73.1%), and land levelling (54.7%); while personal protective measures (21.8%) were less used. The absence of LLIN access, despite high awareness, highlights the need for improved distribution and targeted health education. Conclusion: The study highlights strong general awareness of malaria transmission and prevention among the respondents, with widespread knowledge of LLINs despite none owning them. Environmental management practices are well adopted, but personal protective measures and recognition of less common symptoms and vulnerable groups remain limited. J Med Coll Women Hosp.2025; 21 (2):91-101
Effectiveness of dexmedetomidine in reducing blood loss during middle ear surgery under general anaesthesia
Background: Controlled hypotension is crucial for optimal surgical conditions during the operation in the middle ear. This study evaluated dexmedetomidine's effectiveness in decreasing loss of blood during the surgery of the middle ear under general anesthesia. Materials and Method: A prospective, randomized, double-blinded study of 100 female patients (ASA I-II) undergoing middle ear surgery was carried out to observe the effectiveness of dexmedetomidine in reducing blood loss during middle ear surgery under general anaesthesia. Group D (n=50) received dexmedetomidine (1 μg/kg loading, 0.4-0.7 μg/kg/hr maintenance); Group C (n=50) received normal saline. Primary outcomes included loss of blood , quality of field of surgery, and hemodynamic parameters.Results: Group D showed significantly lower loss of blood (145.6 ± 32.4 vs 198.3 ± 41.7 mL, p<0.001), better scores of visibility of field of surgery (1.8 ± 0.6 vs 2.9 ± 0.8, p<0.001), and improved hemodynamic stability. Time of emergence was slightly prolonged in Group D (8.4 ± 2.1 vs 6.8 ± 1.9 min, p=0.02), but postoperative pain scores were lower (VAS 3.2 ± 1.1 vs 4.8 ± 1.4, p<0.001). Adverse events were comparable between groups. Conclusion: Dexmedetomidine effectively decreases loss of blood during surgery and improves visibility of the field of surgery during the surgery of the middle ear, with minimal adverse effects. J Med Coll Women Hosp.2025; 21 (2):102-109
Noise induced hearing loss among drivers of compressed natural gas (CNG) run three-wheeler auto rickshaws in Dhaka Metropolitan City, Bangladesh
Background: Noise is an occupational hazard that affects worker health and safety. Prolonged exposure to noisy environment results in hearing loss of the affected individuals. Compressed Natural Gas (CNG) run three-wheeler auto rickshaw drivers in Dhaka Metropolitan City are frequently exposed to heavy traffic and are prone to develop more vulnerable They have to work in excessive sound levels and this repeated exposure to noise on daily basis could result in noise induced hearing loss (NIHL). However, the hearing status in CNG run three-wheeler auto rickshaw drivers is unknown as they are not addressed in previous studies. Aim: The aim of the study was to assess the hearing threshold status of the auto rickshaw drivers of Compressed Natural Gas (CNG) run three-wheeler in Dhaka Metropolitan City of Bangladesh and comparing it with the control group. Materials and Method: The study was a cross sectional study and conducted in the Department of Physiology, Dhaka Medical College, Dhaka, from January 2020 to December 2020. After fulfilling the ethical aspect, a total number of 305 drivers of CNG run 4-stroke three-wheeler auto rickshaws were selected purposively from different vehicles stands of Dhaka Metropolitan City on the basis of inclusion and exclusion criteria. In addition, 100 apparently healthy office workers were taken as control group for A comparison. Informed written consent was taken from all the participants. Pure tone air and bone conduction, parameters were tested and data was collected in pre-designed structured questionnaire form. Results: A total of 31.47% of auto rickshaw drivers suffered from NIHL (95% CI 11.8%-22.5%) Audiometric results showed moderate degree of hearing loss have higher rate (62.50%) than mild or severe degree of hearing loss. The mean hearing thresholds showed a typical dip at 4000 to 6000 Hz. Conclusion: The occupational hazards of auto rickshaw driving significantly increased the hearing threshold values. It is found that the mean hearing threshold values for autorickshaw drivers increase at higher frequencies at higher frequencies with increase in driving experience. Therefore, drivers must be educated about the hearing conservation during driving and should be periodically evaluated to detect audiological damage. J Med Coll Women Hosp.2025; 21 (2): 110-122
Abul Fazal Shah Muhammad Shazedur Rahman
Assessment of Rickshaw Pullers' Knowledge, Attitude, and Safety Practices Regarding COVID-19 Infection
Background: The COVID-19 pandemic has prompted a comprehensive reevaluation of knowledge, attitudes and safety practices (KAsP) across diverse populations including rickshaw pullers. Aim: To assess the knowledge, attitude and safety practices regarding COVID-19 among rickshaw pullers.Materials and Method: A cross-sectional study was conducted among 187 rickshaw pullers in selected areas of Dhaka City from January to December 2020. Participants aged ≥18 years were conveniently sampled. Data were collected via face-to-face interviews using a pre-tested semi-structured questionnaire covering socio-demographics, COVID-19 knowledge, attitudes, and safety practices. Results: Most respondents revealed average levels of knowledge (45.5%) and safety practices (87.7%), but majority (94.1%) unveiled negative attitude. The level of knowledge was found to be statistically significantly associated with marital status, type of family, job loss due to the pandemic, and ownership of a homestead, with p≤0.05. Similarly, the level of practice showed significant associations with marital status, education, and monthly family income, with p≤0.05. The level of attitude was found to be statistically significantly associated with monthly family income, with p≤0.05. The correlations between knowledge, safety practices, and attitude regarding COVID-19 among rickshaw pullers findings indicate that a positive correlation exists between the level of knowledge and attitude (p≤0.05). Also a positive correlation was evident between attitude and knowledge levels (p≤0.05).Conclusion: The study revealed that majority of respondents had negative attitudes, while a significant number showed average levels of knowledge and safety practices. This study provided important insights for targeted interventions focused on improving rickshaw pullers' comprehension of COVID-19 safety measures. J Med Coll Women Hosp.2025; 21 (2):123-135
Exploring hand washing behavior among the students of Canadian Maple International School: Understanding knowledge attitude and practices.
Introduction: Hand washing is the act of cleaning one’s hand with any liquid or with soap for the purpose of removing microorganism. Hand washing is a learned behavior, so it is required to learn proper hand washing as a child to lay down the fundamentals of lifelong responsibility of maintaining personal hygiene in childhood. Lack of knowledge and practice of proper hygiene increases the incidence of communicable diseases especially among school children in developing countries. Aim:This study is done to identify gaps in knowledge, poor attitudes and substandard practices in hand washing and to enhance the development of appropriate strategies to promote hand hygiene for primary and secondary school students in the future. Hand washing is key to reducing the occurrence of infectious diseases among school students . Materials and Method: The survey was cross-sectional which was conducted among the children of Canadian Maple International School during the period of August to October 2022 to assess the level of knowledge about hand washing among the school students. Sampling was done by purposive method and data was collected through face-to-face interview by using semi-structured questionnaire. After completion of data collection, statistical analysis was done using the Statistical Package for the Social Science. Study was conducted among 51 students of (8-14) years old. Result: Among 51 respondents, 49.02% were within 8-10 years of age, 35.29% were within (10-12) years of age and the rest 15.69% belonged to (12-14) age group. All of them were Muslims. About 49.01% respondents have more than 4 family members. 98% of the respondents had the habit of daily hand washing. 74.50% were aware of hands washing after handling money. 84.30% respondents washed their hands with soap water. In the midst of 51 respondent there is a significant difference in the habit of hand washing at 5% level of significance. The study reveals that more than 80% students have the knowledge about hand washing. Conclusion: Although the results of this study indicated that respondents had high levels of knowledge, attitude and practices of hand hygiene, the information provided in this study regarding current hand hygiene knowledge, attitudes and practices among students will help identify the gaps in knowledge, poor attitudes and substandard practices. This will also be valuable to the design and implementation of the hand hygiene intervention. Hand hygiene is essential to the health of the school community. This study assessed the levels of knowledge, attitude and practices of hand hygiene among Canadian Maple International School, Dhaka. J Med Coll Women Hosp.2025; 21 (2):136-143
Antimicrobial Resistance, Infection Prevention and Control, and Patient Safety
Abstract not available J Med Coll Women Hosp.2025; 21 (2):14-15
An Unusual Prolonged Duration of Illness of Dengue in a Child- A Case Report
Dengue is the most important human virus transmitted by arthropod. It is the leading cause of viral disease that is transmitted by arthropod globally. The virus enters into host through the skin following an infected mosquito bite. The illness progresses as it involves all immune responses including innate, cellular and humoral immunity. When the virus is cleared rapidly from the host, there occurs severe clinical signs of the illness.The term break bone fever has been used to describe the symptom suffered by dengue patients as there is severe joint pain and muscle spasm. There exists a wide range of manifestations clinically for dengue patients including severe dengue (SD) that is dengue shock syndrome (DSS), dengue hemorrhagic fever (DHS) but some patients may show no symptoms that is they remain asymptomatic to dengue fever (DF). Even though most of the cases remain without any symptoms, some patients develop severe form of dengue and may even die. Since specific treatment like antiviral agent or preventive measure such as vaccines for dengue remain undiscovered, the only option is to manage the patients as per symptoms. The infection manifests with broad clinical spectrum, sometimes with unusual manifestation. Here a case is being reported about a boy of 4 years age with unusually prolonged duration of illness, who presented with features of dengue shock (hypotension, narrow pulse pressure and prolonged Capillary Refill Time). J Med Coll Women Hosp.2025; 21 (2):144-149
Intracholecystic Papillary Neoplasm- A Case Report
Intracholecystic Papillary Neoplasm (ICPN) is a rare entity and is a premalignant lesion of the gallbladder. It is usually an incidental finding on imaging and can only be diagnosed on histomorphological evaluation. Here we report a case of ICPN in a 40 year old woman who had a short history of abdominal pain. Ultrasound examination of the abdomen revealed multiple polyps in the gallbladder. Laparoscopic cholecystectomy was done and diagnosed as ICPN on histopathological examination. J Med Coll Women Hosp.2025; 21 (2):150-156
A 1 year 2 months old child with Kawasaki Disease- A Case Report
Kawasaki disease (KD) is a self-limiting and acute median vessels vasculitis of causes that are unknown and takes place predominantly in infants and children. The disease in its acute phase is self-limited and the diagnosis may be missed; if untreated, KD can result in aneurysm of the coronary artery in 25% of patients. Principal criteria for diagnosing the disease is fever of more than 5 days and presence of a minimum of following 4 principal features: erythema and cracking of lips, strawberry tongue, bilateral non-purulent conjunctival injection, rash, erythema and edema of the hands or feet, cervical lymphadenopathy >1.5cm, usually unilateral. Our patient presented with all the above features. Additional features like irritability, arthritis, desquamation, vomiting, diarrhea, abdominal pain, Bacillus Calmette-Guérin (BCG) induration. Diagnosis of KD is mainly clinical, but anemia, neutrophilic leukocytosis, thrombocytosis, raised Erythrocyte Sedimentation Rate (ESR) , raised aminotransferase, raised C-Reactive Protein (CRP), reduced serum albumin, pyuria may be present. The investigation findings of this patient indicated towards the diagnosis of KD. Echocardiogram was done and coronary artery dilatation was noted. The patient was managed using a single dose of intravenous immunoglobulin(IVIG) 2g/kg administered over a period of over 10 hours which was followed by aspirin 75mg/kg until the patient became afebrile. This dose of aspirin was continued for another 3 days then 5mg/kg of aspirin was given for 8 weeks. During follow-up the patient’s condition was uneventful. J Med Coll Women Hosp.2025; 21 (2):157-162
Spurious T3 Toxicosis in Multiple Myeloma: A Case Report
Alteration of thyroid function tests (TFT) may be seen in apparently healthy individuals in the presence of many drugs, chemicals, and vitamins in abnormal concentration in blood. Presence of plasma protein in high concentration (e.g., paraprotein) may affect the TFT by altering the binding capacity, giving rise to high concentration of total triiodothyronine (TT3) and total thyroxine (TT4) with normal concentration of free hormones (FT3, FT4). Here is a case report of a 25-year-old clinically euthyroid man without previous personal or family history of thyroid disease.He was referred to the endocrinologist for evaluation of inappropriately high TT3 >8.0 ng/ml (Reference range: 0.6-1.81) in the presence of normal TSH, TT4 concentration. He was diagnosed as a case of multiple myeloma (MM) five months back, receiving chemotherapy (Bortezomib and cyclophosphamide). The patient was clinically euthyroid, and his free T3 (FT3) was checked and was found to be within the normal reference range (FT3=3.03pg/ml; reference range 2.3-4.2). He was not taking any drugs (e.g., Tamoxifen, Biotin, Estrogen, Clofibrate, 5-Fluorouracil, Methadone) concomitantly that may interfere with the thyroid function test reports. He had normal liver function test reports with mild impairment of renal function (Serum Creatinine level: 1.48mg/dl, eGFR:58 ml/min/1.73m2). The patient was on follow-up without specific treatment for abnormal TFT, ensuring that the abnormal TFT report was due to paraproteinemia, which must be interpreted cautiously in such a situation. J Med Coll Women Hosp.2025; 21 (2):163-165
Mycobacterial seeding of the urogenital tract by hematogenous dissemination causes tuberculosis affecting the kidney and urologic system; this can happen after a lung infection, reactivation, or military disease. Kidney parenchymal lesions, such as glomerulonephritis and interstitial nephritis, are less frequent. Tuberculous bacteria have the ability to penetrate the medullary interstitium and result in development of granuloma. In the absence of obvious kidney disease, they may heal with accompanying fibrosis. Alternatively, years after the initial infection, they may burst and break down into the tubular lumen, releasing tuberculous bacilli into the urinary system and causing the infection to spread continuously. When an infection descends to the bladder and ureter, it results in hydronephrosis, ureteral stricture and blockage, and impaired kidney function. When individuals exhibit pertinent clinical symptoms and pertinent epidemiologic characteristics, urogenital tuberculosis should be suspected. Urinary frequency, hematuria, acidic urine, sterile pyuria, and/or dysuria are important clinical indicators for renal or urologic tuberculosis. Infertility, pelvic or abdominal discomfort, and/or menstrual abnormalities in women; nodular lesions of the scrotum, prostate, and/or testis in males; and nonhealing ulcers of the external genitalia in women are all signs of genital TB. Relatively seldom are systemic signs like fever and weight loss. The presence of tubercle bacilli in the urine can confirm the diagnosis of urogenital TB. Additionally, radiographic imaging is necessary for individuals who may have urologic or renal tuberculosis. When possible, contrast-enhanced computerized tomography is the preferable method; intravenous pyelography and high-resolution ultrasonography are other radiography methods. Antituberculous treatment is recommended for patients with urogenital TB; the main strategy is the same as for pulmonary TB. Surgical interventions are justified to a certain extent. J Med Coll Women Hosp.2025; 21 (2):166-174
Industrial Toxicants in Bangladesh: Sources, Exposure and Public Health Impacts – A Systematic Review: Sources, Exposure and Public Health Impacts – A Systematic Review
Background: Bangladesh’s rapid industrialization has significantly contributed to economic growth but has also resulted in widespread environmental contamination. Industries such as tanneries, textile dyeing, battery recycling, and metal processing discharge effluents containing hazardous toxicants, particularly heavy metals like lead (Pb), cadmium (Cd), arsenic (As), chromium (Cr), and mercury (Hg). These substances have been found across environmental media -including air, water, soil, and food- posing serious health risks, especially for children, pregnant women, and industrial workers. Materials and Method: This systematic review was conducted following PRISMA guidelines. A total of 35 peer-reviewed studies published between 2009 and 2024 were selected from electronic databases. Studies were included if they assessed heavy metal concentrations, exposure pathways, health effects, or ecological impacts in industrial areas of Bangladesh. Data extraction included study location, sample type, toxicant concentration, health endpoints, and risk metrics such as Hazard Index (HI) and Target Carcinogenic Risk (TCR). Geographic coverage spanned major industrial hubs including Dhaka, Gazipur, Narayanganj, Savar, Hazaribagh, Kushtia, Tangail, and Sylhet. Results: The review revealed heavy metal contamination in street dust, vegetables, rice, water, and biological samples. Blood lead levels among battery workers averaged 65.25 µg/dL, far exceeding safe limits. Arsenic in drinking water reached up to 0.146 mg/L, over 14 times the World Health Organization (WHO) guideline. Children near industrial zones had elevated urinary metal levels associated with neurodevelopmental issues. Environmental impacts included degraded soil fertility, disrupted aquatic ecosystems, contaminated groundwater, and food chain bioaccumulation. Conclusion: Industrial toxicants pose a critical and often underestimated public health and ecological threat in Bangladesh. Urgent, coordinated policy action is needed to strengthen pollution control, enforce effluent treatment, enhance occupational safety, and expand environmental surveillance and public health education. J Med Coll Women Hosp.2025; 21 (2):175-191